Formål: Formålet var at beskrive variationen i ældres opfattelse af at falde, hvordan ældre håndterede fald, samt hvad der påvirkede ældres motivation til at deltage i faldforebyggende tiltag med henblik på at kunne målrette fremtidige indsatser. Metode: Der blev foretaget en kvalitativ interviewundersøgelse med 14 ældre mennesker over 65 år som efter et fald henvendte sig på en skadestue på et universitetshospital i Danmark. Fænomenografi blev anvendt som analysemetode. Resultater: Der blev dannet fem beskrivende kategorier med tilsammen 15 underkategorier. De fem kategorier var: Følelsesmæssig opfattelse af at falde; at falde har konsekvenser; tager hånd om situationen; støtte fra omgivelserne; og motivation og demotivation.Undersøgelsen viste variation i ældres opfattelse af at falde. De ældre accepterede at falde fordi de var blevet ældre. Opfattelsen var, at fald både var flovt og pinligt og havde en forklaring. Nogle ældre oplevede frygten for at falde som dominerende. De ældre opfattede ikke fald som en risikofaktor, der skulle tages hånd om, men håndterede situationen ved at begrænse deres bevægemuligheder eller ved at fravælge aktiviteter. Hvis kravene oversteg de ældres ressourcer, søgte de hjælp fra de pårørende eller den praktiserende læge. De ældre fik støtte, anerkendelse og accept til at foretage valgene af omgivelserne. De ældre blev motiveret af forhold, som autonomi, kompetence og sociale relationer og foretrak aktiviteter, der spredte glæde og nydelse og helst i sociale sammenhænge. De ældre værnede om deres identitet med at ville være medbestemmende om, hvad de deltog i, men mødte forhold i omgivelserne, som var hæmmende for deres motivation. Konklusion: Fremtidige faldforebyggende tiltag skal målrettes ældres behov og tage højde for, at der ikke er én måde men mange måder at opfatte fald på, og at ældre i høj grad selv klarer at håndtere fald, men at de valgte strategier, ikke nødvendigvis er de mest hensigtsmæssige. De ældres netværk og den praktiserende læge kan med fordel spille en aktiv rolle i forbindelse med faldforebyggelse. Ved planlægningen af faldforebyggende interventioner skal der tages hensyn til, at ældres motivation påvirkes af, i hvilken omfang programmerne understøtter de ældres behov for autonomi, kompetence og sociale relationer. / Aim: This study aimed to describe variations in elderly people’s perceptions of falling, and how they coped with falls. To target future initiatives to needs of the elderly, we also sought to determine what motivated them to participate in fall-prevention initiatives. Method: We collected data using semi-structured interviews with 14 elderly individuals (65 years +) who had contacted the emergency ward at a university hospital in Denmark. We analyzed the data using a phenomenographic approach that focused on describing varying perceptions by the elderly on the phenomenon of “falling.” Results: Five categories and 15 subcategories emerged from the interviews. The five main categories included emotional perceptions of falling; falling has consequences; handling the situation; support from the social network; motivation and demotivation. The study showed that older people’s perceptions of falling vary. Individuals accepted falling because they had become older. Falls were embarrassing and could be explained. The fear of falling was the foremost concern of some individuals. The elderly did consider falls a meaningful risk factor, but coped by restricting movements or dropping activities to prevent falls in the future. If demands exceeded resources, they asked their relatives or the GP for help. The elderly gained support, approval, and acceptance from their social network when deciding which coping strategies to use. The elderly were motivated by autonomy, competence, and relatedness and they preferred activities that increased happiness and enjoyment, preferably in a social atmosphere. The elderly protected their identity self-determining their activities, but they often encountered factors in their surroundings that restricted motivation. Conclusion: Future fall-prevention initiatives must target the needs of the elderly and consider that there are not one but many ways of perceiving falling. Further, the coping strategies that elderly individuals develop are not necessarily convenient. Social networks and the GP can play active roles in encouraging the elderly to participate in fall-prevention initiatives. When planning fall-prevention interventions, one should consider the extent to which such programs support the elderly individual’s need for autonomy, competence, and relatedness, because these factors affect motivation. / <p>ISBN 978-91-85721-70-2</p>

Benskörhet (osteoporos) och frakturer orsakade av osteoporos är ett stort globalt problem. Syftet med det tioåriga projektet ”Vadstena en benhård kommun” var att utvärdera om man med en befolkningsinriktad interventionsstrategi kunde minska osteoporos och osteoporosrelaterade frakturer i en kommun. Ett representativt urval av befolkningen i åldern 20-79 år, 15% av en population på 7800 personer, blev tillfrågade om att delta vid fyra undersökningstillfällen som innebar att fylla i en enkät och att bentäthetsmätas. Vid första tillfället deltog 70%, första uppföljningen 69%, andra uppföljningen 79% och vid den tredje uppföljningen 65%.Syftet med denna MPH-uppsats är att beskriva det praktiska interventionsarbetet utifrån dagboksanteckningar och att presentera befolkningens upplevelser av interventionsarbetet.Vi nådde uppskattningsvis 5000 personer (65%) av befolkningen med direkt information.De personer som fick individuella riskprofiler baserade på angivna svar i frågeformulär och bentäthetsvärden var de som gav mest positiv respons och kan tillskrivas en lyckad individuell intervention.Den grupp som varit med en eller flera gånger tidigare (interventionsgruppen) var de som vid sista undersökningen 1999, hade fått ökad kunskap om osteoporos (P&lt;0,001). Den gruppen kände även bäst till projektet (P&lt;0, 001), men även den nya gruppen (befolkningsgruppen) kände i hög grad till projektet (75 %). På frågan om deltagarna ville förändra sina vanor var båda grupperna lika villiga (65 % respektive 64 %), vilken kan tillskrivas en lyckad generell intervention.Sjukdomen osteoporos och dess följder tar lång tid att utveckla. Det tar därför även lång tid att mäta effekt av att projekt som detta, som dessutom innefattar en hel befolkning. Nu, 18 år efter projektets start görs en uppföljning av projektet där delar av de mål som sattes upp i början av projektet mäts, bland annat frakturincidens och kunskap om osteoporos hos befolkningen.Nyckelord / Osteoporosis and fractures due to osteoporosis are an increasing global health problem. The aim ofthe ten-years Vadstena Osteoporosis Prevention Project (VOPP) was to evaluate if it was possible toreduce osteoporosis and osteoporotic-related fractures with a community-based prevention programA representative sample aged 20-79 years (Vadstena population of 7800) was invited to participatein the study comprising four measurements including questionnaire and bone mineral densitymeasurement. At baseline 70% participated, at first follow-up 69%, second follow-up 70% and at thethird follow-up 65 %.The aim with this MPH- essay is to describe the intervention from a diary and to present thepopulations experience of the VOPP.We met approximately 5000 persons (65%) of the citizens directly with our intervention. Theparticipators who received individual feedback letters on their answers in the questionnaire and theresults from the bone measurement gave us the best response.The group that participated once or more had the best knowledge about osteoporosis (p&lt; 0.001)and were to an high extent familiar with the project (p&lt;0.001). Even the single participating grouphad god knowledge about the project (75 %). Both groups stated that they wanted to change lifestyle(65 % vs. 64 %) showing a successful general intervention.Osteoporosis is a disease that is present for a long period without signs, before resulting in theclinical sign, fractures. Therefore results of a preventive program towards a whole population isexpected to be found not until after several years. Now eighteen years later a follow up is planned inorder to measure the incidence of osteoporotic fractures and the knowledge about osteoporosis in thepopulation. / <p>ISBN 978-91-85721-45-0</p>

Falls are the primary cause of injuries among older adults, and accidents that result from falls can lead to personal suffering and extensive societal burdens. The overall aims of this thesis were to explore and describe falls and fall prevention strategies in community-dwelling older adults and to evaluate a fall prevention home exercise program, the Otago Exercise Program (OEP), with or without motivational interviewing (MI). Methods: Qualitative and quantitative research methods were uses. The designs were as follows: a cross-sectional, descriptive and comparative study (study I); a descriptive feasibility investigation (study II) and a randomized controlled trial (RCT) with two interventions, the OEP and OEP+MI, as well as a control group, with a 12-month follow-up (study III); and a prospective and descriptive study (study IV). The four studies comprised community-dwelling individuals aged 75 years or older. Study I included 262 individuals and studies II-IV had 175 participants who needed walking aids or home support. Study II also included 12 physical therapists.  Data collection was performed via self-reported questionnaires, fall calendars, exercise diaries, physical performance tests and a semi-structured questionnaire.  Results and conclusions: Suggested actions to prevent falls significantly differed between high and low active older adults (study I). Support for self-directed behavioral strategies could be important for preventing falls in older adults who have low physical activity levels. The study protocol for the RCT had acceptable feasibility (study II), and only minor changes of the protocol were needed. There were no benefits for OEP or OEP+MI with personal support implemented nine times over the 12-month period. However, all groups maintained physical functioning and activity (study III). To increase physical functioning and reduce falls in this sub-group of older adults, more frequent personal support and/or an alternative delivery format may be required for efficient intensity and challenge in home exercises. Over 12 months, falls and fall-related injuries in the RCT sample were the most common when moving around within the home and transitioning from sitting to standing (study IV). Special attention to these activities might be important for preventing falls in community-dwelling older adults who need walking aids or home support.

abstract: This dissertation aimed to evaluate the effectiveness and drawbacks of promising fall prevention strategies in individuals with stroke by rigorously analyzing the biomechanics of laboratory falls and compensatory movements required to prevent a fall. Ankle-foot-orthoses (AFOs) and functional electrical stimulators (FESs) are commonly prescribed to treat foot drop. Despite well-established positive impacts of AFOs and FES devices on balance and gait, AFO and FES users fall at a high rate. In chapter 2 (as a preliminary study), solely mechanical impacts of a semi-rigid AFO on the compensatory stepping response of young healthy individuals following trip-like treadmill perturbations were evaluated. It was found that a semi-rigid AFO on the stepping leg diminished the propulsive impulse of the compensatory step which led to decreased trunk movement control, shorter step length, and reduced center of mass (COM) stability. These results highlight the critical role of plantarflexors in generating an effective compensatory stepping response. In chapter 3, the underlying biomechanical mechanisms leading to high fall risk in long-term AFO and FES users with chronic stroke were studied. It was found that AFO and FES users fall more than Non-users because they have a more impaired lower limb that is not fully addressed by AFO/FES, therefore leading to a more impaired compensatory stepping response characterized by increased inability to generate a compensatory step with paretic leg and decreased trunk movement control. An ideal future AFO that provides dorsiflexion assistance during the swing phase and plantarflexion assistance during the push-off phase of gait is suggested to enhance the compensatory stepping response and reduce more falls. In chapter 4, the effects of a single-session trip-specific training on the compensatory stepping response of individuals with stroke were evaluated. Trunk movement control was improved after a single session of training suggesting that this type of training is a viable option to enhance compensatory stepping response and reduce falls in individuals with stroke. Finally, a future powered AFO with plantarflexion assistance complemented by a trip-specific training program is suggested to enhance the compensatory stepping response and decrease falls in individuals with stroke. / Dissertation/Thesis / Doctoral Dissertation Mechanical Engineering 2019

Bakgrund: Distriktssköterskan möter i sitt arbete ofta en åldrande befolkning i deras hem, och ska arbeta för att främja deras trygghet och välbefinnande. Fall hos äldre personer är ett stort folkhälsoproblem då skadorna ofta blir stora och rehabiliteringen omfattande. Distriktssköterskan är en nyckelperson i fallpreventionsarbetet och ska arbeta med en helhetssyn kring den äldre personen, när omvårdnadsåtgärder sätts in för att förebygga fall. Syfte: Syftet med denna studie var att beskriva distriktssköterskans fallpreventiva omvårdnadsåtgärder i äldre personers hem. Metod: En litteraturöversikt med induktiv ansats utfördes, baserad på 14 vetenskapliga artiklar med både kvantitativt- och kvalitativt innehåll. Artiklarna söktes i databaserna Cinahl, Psykinfo och Pubmed, och kvalitetsgranskades med hjälp av granskningsmall från Statens beredning för medicinsk och social utvärdering (SBU). Resultat: Tre kategorier framkom; fallrelaterade skador kan minskas med fallpreventionsprogram, fallriskutredning och samverkan, samt utbildning leder till välbefinnande. Diskussion: I resultatet framkom att distriktssköterskan bör samverka med andra yrkesprofessioner inom vårdteamet för att informera och utbilda äldre personer om fallrisker. Riskbedömningsinstrument var ett bra screeningverkyg. Resultatet diskuterades med stöd av Katie Erikssons omvårdnadsteori om vårdandets idé. Slutsats: Denna litteraturöversikt visade att distriktssköterskans olika fallpreventiva omvårdnadsåtgärder framgångsrikt förebygger fall hos äldre personer och det viktigaste är att förebygga det första fallet. / Background: In her work, the district nurse often meets an aging population in their homes where she should work for the improvement of their safety and well-being. Fall accidents of elderly people form a major public health problem as injuries often are complicated and rehabilitation is extensive. The district nurse is a key person in fall-prevention and should work with a holistic view of the older person, in situations where care measures are taken to prevent falls. The purpose of this study is to describe the district nurse's fall preventative care measures in the homes of older people. Method: A literature review based on an inductive approach was conducted, comprising 14 scientific articles with both quantitative and qualitative content. The articles were found in the databases Cinahl, Psykinfo and Pubmed, and were quality assured using a review template from the Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU). Results: Three categories emerged: Fall-related injuries can be reduced with fall prevention programs, fall risk assessment and cooperation, and how education leads to well-being. Discussion: The result indicates that the district nurse should work with other occupational professionals within the health care team to inform and educate older people about fall risks. Risk assessment methods proved to be a good tool for screening. The result was discussed with the support of “Katie Eriksson's nursing theory” on the idea of care. Conclusion: This literature review showed that the district nurse's various fall preventative care measures successfully prevent fall accidents of elderly people, and that preventing the first fall is most important. / <p>Godkännandedatum: 2019-12-11</p>

Bakgrund: Fallolyckor bland äldre är vanligt. År 2019 var drygt 5% av vårdskadorna på sjukhus fallolyckor. Fallolyckor får konsekvenser för samhället i form av stora kostnader, men även för den äldre i form av bland annat social isolation. Idag finns många fallpreventiva åtgärder och riskbedömningsinstrument och det är sjuksköterskans ansvar att bedriva säker vård och förhindra fallolyckor som skapar ett vårdlidande hos patienterna. Syfte: Att undersöka faktorer som orsakar fallolyckor bland äldre patienter på sjukhus. Metod: Metoden som användes var en allmän litteraturöversikt av vetenskapliga artiklar med både kvalitativ och kvantitativ ansats som tagits fram genom systematisk artikelsökning i flera databaser.Resultat: Tre huvudkategorier identifierades: inre faktorer, yttre faktorer och mänskliga faktorer. Inre faktorer som orsakar fall är sjukdomar och läkemedel. Yttre faktorer är miljöfaktorer, eller tid, rum och aktivitet där de flesta fall sker nattetid vid förflyttning till badrummet eller i samband vid toalettbesök. Mänskliga faktorer är faktorer orsakat av patient och anhörig, eller på grund av brister i sjuksköterskans omvårdnad i form av brister i riskbedömning, åtgärder och information. Konklusion: Orsaken till fall hos äldre patienter är ofta multifaktoriella men det vanligaste är fall nattetid på väg till toaletten. Den mänskliga faktorn är en stor bidragande faktor till fall. / Background: Fall accidents among older persons are common. In 2019, just over 5% of health care injuries in hospitals were fall accidents. Fall accidents have consequences for the society such as large costs, but also for the older patients who become socially isolated. Today, there are many fall prevention interventions and risk assessment instruments. It is the nurse’s responsibility to provide safe care and to prevent falls that cause patients to suffer. Aim: To investigate factors that cause fall accidents among elderly inpatients.Method: The method used was a general literature review of articles with both a qualitative and quantitative approach, which was found through a systematic article search in several databases.Findings: Three main categories were identified: internal factors, external factors and human factors. Internal factors that cause falls are diagnoses and drug treatments. External factors are environmental factors, or time, space and activity where most falls occur at night when transferring to the bathroom or in near connection to toilet visits. Human factors are factors caused by the patients and relatives, or due to lacks in the nurse's care such as risk assessment, measures and information.Conclusion: Cause of falls in older patients is often multifactorial, but the most common fall is falling at night on the way to the toilet. The human factor is a major contributing factor to falls.

Bakgrund: Fall hos äldre personer är vanligt förekommande och får ofta allvarliga konsekvenser för individen såsom svårigheter att bo kvar sin bostad, sjukdom och död. Fall hos äldre innebär också stor belastning på sjukvården och stora samhällskostnader. I den kommunala hemsjukvården arbetar fysioterapeuter med att förebygga fall genom olika åtgärder i hemmet.  Syfte: Att beskriva hur fysioterapeuter upplever att de arbetar vid fallförebyggande hembesök för äldre i hemsjukvården. Metod: Studien genomfördes med en kvalitativ design och induktiv ansats. Sex fysioterapeuter rekryterades till individuella intervjuer genom ett ändamålsenligt bekvämlighetsurval från en kommun i mellersta Sverige. Materialet från intervjuerna analyserades genom en kvalitativ innehållsanalys. Resultat: Resultatet delades upp i fem kategorier med tillhörande underkategorier, två respektive fem. Informanterna belyste hur de identifierade individens egna behov och resurser, skapade ett förtroende, identifierade individens omgivningsfaktorer, informerade om fallförebyggande och identifierade svårigheter och hinder vid hembesök. Slutsats: Fysioterapeuterna beskrev att genom att ta hänsyn till fysiska, psykologiska faktorer och omgivningsfaktorer hos individen möjliggörs genomförandet av fallförebyggande åtgärder.

Despite the availability of many fall prevention measures, many patients fall in U.S. hospitals each year. Experts view patient fall rates as the measure that can be most affected by a nurse-led, evidence-based intervention. The purpose of this quality improvement project was to implement and evaluate the impact of patient engagement strategies on patient compliance to fall prevention education and the reduction of falls. The quality improvement framework used for this project was the Iowa Model. Interventions for this project included patient engagement strategies including the teach-back (TB) method and video-based fall prevention education paired with the project site's existing fall prevention program. A prospective quantitative design was used to answer the practice-focused question of whether the implementation of a falls protocol incorporating patient engagement strategies improves patient compliance with the fall prevention plan of care and reduces patient falls. A total of 58 patients were included in this project, conducted from July to October 2017. The results showed a 75% reduction in the fall rate compared to the same three month period in 2016. This finding suggests that reinforcement of oral and written instruction through video education follow-up and the use of the TB method to assess patient understanding are effective measures to reduce patient falls and increase patient compliance to the fall prevention plan of care. These patient engagement strategies can be replicated by nurses in similar acute care settings. Adoption of such evidence-based changes in nursing practice may improve patient safety and decrease harm in hospital settings as implications for positive social change.

Falls among the elderly is a health concern affecting multiple patients annually. Hospice patients and those with multiple comorbidities are at the greatest risk of falling and sustaining injuries from falls. Aromatherapy has been used for reducing multiple symptoms as well as for decreasing falls. The practice-focused question explored whether an education program on using aromatherapy for fall prevention would increase knowledge of this intervention for an interdisciplinary group of hospice staff. The design was developed using Knowles's theory of andragogy and Bloom's taxonomy. Thirteen staff members from the same facility participated in the education program. The program was targeted to educate staff who worked with hospice patients about implementing the intervention in their practice. The program was also offered facility-wide to allow all staff the opportunity to increase their knowledge in using the intervention in their fall- reduction programs. Assessment tools including pretest, posttest, and evaluations were completed by all program participants. Using a Likert scale to calculate participant responses, results revealed an increase in knowledge gained from 15% to 60%. The participants rated the program favorably with a mean score of 4.4 to 4.6 out of 5. This program would be beneficial to hospice caregivers and a broader range of staff members including nonhospice nurses, therapists, and providers who are interested in decreasing falls in their patient population. The program would also be of interest to accrediting bodies, hospice, palliative care, oncologic, and geriatric organizations for alternative fall-reduction interventions. Reducing falls will result in a positive social change by decreasing fall-related injuries costs and improving quality at end-of-life.

Falls are the leading cause of injuries among older adults (>65) and frequently result in reduced mobility, loss of independence, decreased quality of life, injury, and death.  Extensive research has been conducted regarding postural coordination and control, and other mechanisms/processes involved in maintaining postural stability.  However, there is relatively limited knowledge regarding the patterns of joint coordination, the underlying postural controller, and efficient methods to assess passive and active musculoskeletal properties relevant to balance.  In the current work, three new methods were developed to address these limitations and also to better understand the effects of localized ankle muscle fatigue, gender, and aging on postural coordination and control. First, two methods were used to evaluate postural coordination.  A wavelet coherence approach was developed and applied to assess the level and pattern of coordination between pairs of joints (i.e., ankle-knee, ankle-trunk, and ankle-head).  In addition, the uncontrolled manifold method was implemented for evaluation of potential whole-body coordination control goals.  Clear patterns of intermittent wavelet coherence were evident, indicating that joint coordination is intermittently executed.  Both in-phase and anti-phase coherence were detected over frequencies of 2.5 -- 4.0 Hz.  Shoulder and head kinematics appeared more likely than the whole-body center of mass as control goals for whole body coordination.  Both aging and ankle muscle fatigue led to a reduction of joint coordination. Second, an intermittent sliding mode controller was developed to model quiet upright stance.  In contrast to most previous postural controllers, which assume continuous control, an intermittent controller was considered more consistent with recent evidence on muscle activity and the results of the first study on postural coordination.  The sliding mode controller was able to accurately track kinematics and kinetics, and generated passive and active ankle torques comparable with previous results.  Ankle fatigue led to an increase in active ankle torque especially among young adults and males. Third, a new method was developed to estimate passive and active mechanical properties at the ankle (e.g., stiffness and damping).  This method was inspired from intermittent control theory, and the earlier results noted.  As opposed to conventional methods, this new method is computationally efficient and does not require external mechanical or sensory perturbations.  The method yielded a ratio of passive to active ankle torques consistent with earlier evidence, and larger passive and active ankle torques among males and older adults.  A post-fatigue increase of active ankle torque was estimated, especially among males and young adults. In addition to providing new analytical methods, the noted studies suggest that older adults have decreased joint coordination and increased ankle stiffness.  As a practical implication of this, fall prevention training programs may benefit from seeking to develop appropriate joint coordination strategies and ankle stiffness magnitudes.  To expand on the current work, future research should consider measuring muscle contraction characteristics at multiple joints and in different postures or activities. / Ph. D.