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Background and Purpose: Falls are the leading cause of accidental death among older adults. Reducing falls risk is one of the major safety concerns for older persons. More than one-third of people 65 years and older will experience one or more falls per year and nearly half of the people over 80 years of age will fall at least once each year. A key initial step in reducing falls is identifying those persons at highest risk so that they can be assessed and prescribed appropriate interventions. Therefore, the purpose of this study was to examine the capacity of a number of field and laboratory tests to identify fallers in a sample of older independently-living, community-dwelling persons. Participants: 66 healthy, independently living older persons, ages 60 and older. Method: During three visits to the laboratory, participants performed various field and laboratory balance tests. Field tests included the Timed Up and Go Test (TUG), the One-Leg Stand Test (OLS), the Functional Reach Test (FR), and the Tinetti Performance Oriented Mobility Assessment (POMA). The laboratory tests included a center of pressure (COP) test with time-to-boundary (TTB) measurements on a force platform, and dynamic posturography using the Proprio 5000. Each participant was classified as a “faller” or “non-faller” based on whether he or she recalled experiencing a fall within the past year. Results: Receiver-operated characteristics (ROC) curve analyses (specificity and sensitivity throughout the measurement ranges) revealed the OLS and TUG field tests and selected Proprio 5000 and TTB variables had the best capacity to distinguish fallers from non-fallers. For both field and laboratory tests one-way ANOVA revealed between-group differences similar to those indicated by the ROC results. Discussion and Conclusion: Both selected field and laboratory tests could identify fallers (16 out of 66). In addition, the laboratory tests revealed balance decrements in specific planes of motion that provide information concerning directional falls risk and a offer a framework for the prescription of interventions to reduce that risk.

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Bakgrund: Fall är vanligt och kan leda till höftfrakturer och ett tidigare behov av särskiltboende. Ett hälsofrämjande och sjukdomsförebyggande perspektiv ska vara en självklar deli all vård och behandling. Syfte: Syftet med studien var att beskriva hur sjuksköterskor kanförebygga och minska risken för fallskador hos äldre på särskilt boende. Metod: Arbetetvar en litteraturstudie på tidigare forskningsmaterial. Resultat: Den viktigaste åtgärden äratt få fram vilka äldre som tillhör riskgruppen. Detta innebär att det är viktigt attuppmärksamma äldre med kognitiva försämringar, tidigare fall, urininkontinens,nedstämdhet, lågt BMI och äldre med behov av hjälp i sin ADL. Andra åtgärder är blandannat att ha regelbundna läkemedelsgenomgångar, att skapa förutsättningar för äldrepersoner att bära höftskydd, att informera och handleda omvårdnadspersonalen, attinformera de äldre och deras anhöriga om risker och åtgärder. Slutsats: Ytterligareforskning behövs vad det gäller sjuksköterskans omvårdnadsåtgärder för att förebygga ochminska fallskador på särskilt boende för att nå ett tillförlitligt resultat inom dettaämnesområde. Förbättrade bedömningar och åtgärder, mer stöd och förståelse från cheferskulle kunna ge tydligare rutiner, minskade kostnader för samhället och inte minst minskadet lidande som det kan innebära för äldre med fallskador. / Background: Falls are common and can lead to hip fractures and earlier need ofinstitutionalization. A health promoting and preventive perspective is an important concernin public health. Aim: The aim of the study was to examine how the nurse can prevent andreduce the risk of fall injures at older people living in residential care. Method: This workwas a literature study on earlier research materials. Results: The most important measureis to identify older people with risk factors for falls. This means that it is important toattentive older people with cognitive impairment, history of falls, urinary incontinence,depressed mood, low BMI and older persons with needs of help in daily physical activities.Other measures are for example to have regular medicine reviews, to create conditions forthe older to carry hip protections, to inform and teach the care employers, to inform theolder and his relative about risks and measures. Conclusion: Further research is neededregarding nurses care measures to prevent and decrease fall injuries in residential care inorder to reach a good result within the subject. Improved assessment and measures, moresupport and understanding of the managers would give more clear routines, the costs forsociety would decrease and most important it would decrease the suffering that fall injuriescauses elderly residents.

Background and Rationale: Falls are among the most common problems faced by elderly persons. While the physical risk factors for falls are well established, the psychosocial aspects have been largely neglected. Moreover, studies exploring the responses to falls from the individuals’ perspectives in an immigrant population are virtually non-existent. The older Chinese immigrant population is substantial and growing in the Greater Toronto Area. The cultural and immigrant-related factors that influence their responses to and recovery after a fall are important considerations as health and social care professionals develop falls prevention strategies, and provide services and care. This dissertation explored the nature of immediate and subsequent responses of community-dwelling older Chinese immigrants after falling. Method: Focussed Ethnography, as guided by elements from Critical Social Theory, was used as the research methodology. Eighteen informants over 70 years of age, living in the community who had experienced a recent fall were interviewed using a semi-structured guide developed after a detailed literature review. Thematic analysis of transcribed interviews was conducted. Results: Four major themes related to responses to falling were drawn forth from the interview data: 1) Help-seeking decisions immediately after the fall, 2) Psychological impact of the fall, 3) Care and support networks, and 4) Learning from the fall. Discussion: The psychosocial responses supported a “blended” explanatory model of illness. Respondents appeared to adhere to both Western medical models and traditional Chinese explanatory model depending on the severity of the fall injuries. Also, the roots of Chinese culture in the blended traditions and philosophies of Confucianism, Taoism, and Buddhism appear to be the foundation for many of the beliefs and attitudes expressed in this study, and these beliefs and attitudes in turn influence how Chinese fallers experience falling. The wide range of psychosocial responses also illustrated the complexity of the Andersen’s Behavioural model for health services use and its potential to explain the different types of services an older Chinese immigrant may need post-fall. Conclusions: Findings from this study provided key, previously unexplored insights into the cultural and immigrant-related factors that influence the psychosocial experience, vulnerability and care-seeking behaviours of older Chinese immigrants following a fall.

FACILITATORS AND BARRIERS OF PHYSICAL ACTIVITY IN OLDER PERSONS WHO HAVE EXPERIENCED A FALL Edwin Yoshiyuki Hanada, Master's of Science Degree, Institute of Medical Science, University of Toronto, 2008 ABSTRACT A systematic review and four focus groups were conducted to determine the facilitators and barriers of physical activity in older adults who have experienced a fall. Results from the systematic review demonstrated facilitators and barriers of purposeful and non-purposeful physical activity for older adults, but not specifically fallers. Facilitators identified in the systematic review and elaborated upon in the focus groups involving older fallers included: deriving benefits from physical activity in the physical, psychological, or functional realms; and social support providing encouragement for participation in physical activity, or acting as a distraction from negative physical symptoms during participation in group physical activity. Conversely, barriers to purposeful and non-purposeful physical activity included: symptoms of chronic illnesses, such as cardiac chest pain, arthritic pain, poor balance or poor eyesight; a fear of falling; and adverse physical environmental conditions, such as cold or warm, humid weather. The focus groups identified disinclination to activity as an important barrier to purposeful physical activity. When placed in a theoretical context such as Bandura’s Social Cognitive Theory and Marcus and Owen’s Readiness for Change model, the results of this study can help inform the design of physical activity interventions to prevent falls in older adults with a history of falls.

No description available.

FACILITATORS AND BARRIERS OF PHYSICAL ACTIVITY IN OLDER PERSONS WHO HAVE EXPERIENCED A FALL Edwin Yoshiyuki Hanada, Master's of Science Degree, Institute of Medical Science, University of Toronto, 2008 ABSTRACT A systematic review and four focus groups were conducted to determine the facilitators and barriers of physical activity in older adults who have experienced a fall. Results from the systematic review demonstrated facilitators and barriers of purposeful and non-purposeful physical activity for older adults, but not specifically fallers. Facilitators identified in the systematic review and elaborated upon in the focus groups involving older fallers included: deriving benefits from physical activity in the physical, psychological, or functional realms; and social support providing encouragement for participation in physical activity, or acting as a distraction from negative physical symptoms during participation in group physical activity. Conversely, barriers to purposeful and non-purposeful physical activity included: symptoms of chronic illnesses, such as cardiac chest pain, arthritic pain, poor balance or poor eyesight; a fear of falling; and adverse physical environmental conditions, such as cold or warm, humid weather. The focus groups identified disinclination to activity as an important barrier to purposeful physical activity. When placed in a theoretical context such as Bandura’s Social Cognitive Theory and Marcus and Owen’s Readiness for Change model, the results of this study can help inform the design of physical activity interventions to prevent falls in older adults with a history of falls.

Background and Rationale: Falls are among the most common problems faced by elderly persons. While the physical risk factors for falls are well established, the psychosocial aspects have been largely neglected. Moreover, studies exploring the responses to falls from the individuals’ perspectives in an immigrant population are virtually non-existent. The older Chinese immigrant population is substantial and growing in the Greater Toronto Area. The cultural and immigrant-related factors that influence their responses to and recovery after a fall are important considerations as health and social care professionals develop falls prevention strategies, and provide services and care. This dissertation explored the nature of immediate and subsequent responses of community-dwelling older Chinese immigrants after falling. Method: Focussed Ethnography, as guided by elements from Critical Social Theory, was used as the research methodology. Eighteen informants over 70 years of age, living in the community who had experienced a recent fall were interviewed using a semi-structured guide developed after a detailed literature review. Thematic analysis of transcribed interviews was conducted. Results: Four major themes related to responses to falling were drawn forth from the interview data: 1) Help-seeking decisions immediately after the fall, 2) Psychological impact of the fall, 3) Care and support networks, and 4) Learning from the fall. Discussion: The psychosocial responses supported a “blended” explanatory model of illness. Respondents appeared to adhere to both Western medical models and traditional Chinese explanatory model depending on the severity of the fall injuries. Also, the roots of Chinese culture in the blended traditions and philosophies of Confucianism, Taoism, and Buddhism appear to be the foundation for many of the beliefs and attitudes expressed in this study, and these beliefs and attitudes in turn influence how Chinese fallers experience falling. The wide range of psychosocial responses also illustrated the complexity of the Andersen’s Behavioural model for health services use and its potential to explain the different types of services an older Chinese immigrant may need post-fall. Conclusions: Findings from this study provided key, previously unexplored insights into the cultural and immigrant-related factors that influence the psychosocial experience, vulnerability and care-seeking behaviours of older Chinese immigrants following a fall.