No / Background: Falls are the most common safety incident reported by acute hospitals. NICE recommends multifactorial falls risk assessment and tailored interventions, but implementation is variable. Aim: Determine how and in what contexts multifactorial falls risk assessment and tailored interventions are used in acute NHS hospitals in England. Design: Realist review and multi-site case study. (1) Systematic searches to identify stakeholders’ theories, tested using empirical data from primary studies. Review of falls prevention policies of acute Trusts. (2) Theory testing and refinement through observation, staff interviews (N=50), patient and carer interviews (N=31), and record review (N=60). Setting: Three Trusts, one orthopaedic and one older person ward in each. Results: Seventy-eight studies were used for theory construction and 50 for theory testing. Four theories were explored: (1) Leadership: Wards had falls link practitioners but authority to allocate resources for falls prevention resided with senior nurses. (2) Shared Responsibility: A key falls prevention strategy was patient supervision. This fell to nursing staff, constraining the extent to which responsibility for falls prevention could be shared. (3) Facilitation: Assessments were consistently documented but workload pressures could reduce this to a tick-box exercise. Assessment items varied. While individual patient risk factors were identified, patients were categorised as high or low risk to determine who should receive supervision. (4) Patient Participation: Nursing staff lacked time to explain to patients their falls risks or how to prevent themselves from falling, although other staff could do so. Sensitive communication could prevent patients taking actions that increase their risk of falling. Limitations: Within the realist review, we completed synthesis for only two theories. We could not access patient records before observations, preventing assessment of whether care plans were enacted. Conclusions: (1) Leadership: There should be a clear distinction between senior nurses’ roles and falls link practitioners in relation to falls prevention; (2) Shared Responsibility: Trusts should consider how processes and systems, including the electronic health record, can be revised to better support a multidisciplinary approach, and alternatives to patient supervision should be considered; (3) Facilitation: Trusts should consider how to reduce documentation burden and avoid tick-box responses, and ensure items included in the falls risk assessment tools align with guidance. Falls risk assessment tools and falls care plans should be presented as tools to support practice, rather than something to be audited; (4) Patient Participation: Trusts should consider how they can ensure patients receive individualised information about risks and preventing falls and provide staff with guidance on brief but sensitive ways to talk with patients to reduce the likelihood of actions that increase their risk of falling. Future work: (1) Development and evaluation of interventions to support multidisciplinary teams to undertake, and involve patients in, multifactorial falls risk assessment and selection and delivery of tailored interventions; (2) Mixed method and economic evaluations of patient supervision; (3) Evaluation of engagement support workers, volunteers, and/or carers to support falls prevention. Research should include those with cognitive impairment and patients who do not speak English. / This project was funded by the National Institute for Health Research (NIHR) Health and Social Care Delivery Research programme and will be published in the Health and Social Care Delivery Research Journal.

Yeung, Pui Yee. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2009. / Includes bibliographical references (leaves 131-145). / Abstract and some appendixes also in Chinese. / ABSTRACT --- p.i / ABSTRACT (in Chinese) --- p.iii / DECLARATION OF ORIGINALITY --- p.iv / ACKNOWLEDGEMENTS --- p.v / RESEARCH-RELATED PRESENTATIONS AND AWARD --- p.vi / TABLE OF CONTENTS --- p.vii / LIST OF ABBREVIATIONS --- p.xi / LIST OF FIGURES --- p.xii / LIST OF TABLES --- p.xiii / Chapter CHAPTER 1 --- INTRODUCTION --- p.1 / Chapter CHAPTER 2 --- LITERATURE REVIEW --- p.3 / Chapter 2.1 --- Incidence and prevalence of falls in older people --- p.4 / Chapter 2.1.1 --- Incidence and prevalence in western countries --- p.4 / Chapter 2.1.2 --- Incidence and prevalence in Hong Kong --- p.4 / Chapter 2.2 --- Causes and risk factors for falls --- p.5 / Chapter 2.2.1 --- Causes for falls --- p.5 / Chapter 2.2.2 --- Risk factors for falls --- p.6 / Chapter 2.3 --- Consequences of falls --- p.7 / Chapter 2.3.1 --- Individual perspective --- p.7 / Chapter 2.3.2 --- Impact on health service and society --- p.9 / Chapter 2.4 --- Intervention and prevention strategies --- p.10 / Chapter 2.4.1 --- Effective interventions and preventive approaches --- p.10 / Chapter 2.4.2 --- Areas of uncertainty for interventions and prevention approaches --- p.19 / Chapter 2.5 --- Existing efforts in intervention and prevention --- p.20 / Chapter 2.5.1 --- Worldwide levels and collaborations among various countries --- p.20 / Chapter 2.5.2 --- Current services for falls prevention in Hong Kong --- p.23 / Chapter 2.6 --- Criteria contributing to successful intervention and risks modification --- p.27 / Chapter 2.6.1 --- Identification of elderly fallers at Accident & Emergency Department --- p.28 / Chapter 2.6.2 --- Selection of the proved effective programme to those likely to benefit --- p.29 / Chapter 2.6.3 --- Uptake and adherence of the target fallers to the selected programmes --- p.30 / Chapter 2.7 --- Current gaps in study of services for elderly fallers in Hong Kong --- p.31 / Chapter CHAPTER 3 --- METHODOLOGY --- p.32 / Chapter 3.1 --- Research objectives --- p.33 / Chapter 3.2 --- Operational definition of falls --- p.33 / Chapter 3.3 --- Study design --- p.34 / Chapter 3.3.1 --- Diagrammatic illustration of the study design --- p.35 / Chapter 3.3.2 --- "Subjects, assessors and setting" --- p.37 / Chapter 3.3.3 --- Sources of data collection --- p.38 / Chapter 3.3.4 --- Questionnaire and assessment instruments --- p.39 / Chapter 3.3.5 --- Referrals and interventions --- p.49 / Chapter 3.4 --- Plan of data analysis --- p.52 / Chapter CHAPTER 4 --- RESULT --- p.55 / Chapter 4.1 --- Progression of elderly fallers --- p.56 / Chapter 4.2 --- Characteristics of all elderly fallers presented to A&E --- p.58 / Chapter 4.2.1 --- Demographics --- p.58 / Chapter 4.2.2 --- Rate of hip fracture --- p.58 / Chapter 4.2.3 --- Seasonal variation for occurrence of falls --- p.58 / Chapter 4.2.4 --- Subsequent one-year mortality --- p.59 / Chapter 4.2.5 --- Subsequent one-year occurrence of falls with presentation to A&E --- p.59 / Chapter 4.2.6 --- Subsequent one-year hospitalization and length of stay --- p.59 / Chapter 4.3 --- Profile of elderly fallers who received comprehensive falls assessment --- p.63 / Chapter 4.3.1 --- Demographics --- p.63 / Chapter 4.3.2 --- "Circumstances, consequences and past history of falls" --- p.67 / Chapter 4.3.3 --- Health and functional profile --- p.75 / Chapter 4.4 --- Uptake of interventions or referrals by elderly fallers --- p.89 / Chapter 4.4.1 --- Uptake rate of various interventions or referrals --- p.89 / Chapter 4.4.2 --- Reasons for refusing interventions or referrals --- p.89 / Chapter 4.5 --- Comparison between recurrent fallers and non-recurrent fallers --- p.91 / Chapter 4.5.1 --- Co-morbidity between recurrent fallers and non-recurrent fallers --- p.91 / Chapter 4.5.2 --- Functional profile between recurrent fallers and non-recurrent fallers --- p.91 / Chapter 4.6 --- Comparison between injurious falls and non-injurious falls --- p.93 / Chapter 4.6.1 --- Co-morbidity between fallers with resultant injury and fallers without injury --- p.93 / Chapter 4.6.2 --- Functional profile between fallers with resultant injury and fallers without injury --- p.93 / Chapter 4.7 --- Comparison of the profiles between the elderly fallers and the general older population in Hong Kong --- p.95 / Chapter 4.7.1 --- Comparison in demographics --- p.95 / Chapter 4.7.2 --- Comparison in self-perceived health --- p.95 / Chapter 4.7.3 --- Comparison in lifestyle factors --- p.95 / Chapter 4.7.4 --- Comparison in BMI --- p.96 / Chapter 4.7.5 --- Comparison in morbidity --- p.96 / Chapter 4.7.6 --- Comparison in number of disease --- p.97 / Chapter 4.7.7 --- Comparison in medication use --- p.97 / Chapter 4.8 --- Comparison between fallers attended and those who did not attend the falls assessment clinic in terms of the subsequent one-year results --- p.102 / Chapter 4.8.1 --- Comparison in subsequent one-year mortality --- p.102 / Chapter 4.8.2 --- Comparison in subsequent one-year recurrent falls with presentation to A&E --- p.102 / Chapter 4.8.3 --- Comparison in subsequent one-year hospitalization and LOS --- p.103 / Chapter 4.9 --- Validation of a simple screening tool adopted from the Mr. Os (Hong Kong) study by the result of this study --- p.106 / Chapter CHAPTER --- 5 DISCUSSION --- p.108 / Chapter 5.1 --- Profile of elderly fallers presenting to A&E and its implications to health care planning for the elderly --- p.110 / Chapter 5.1.1 --- Profile of fallers in terms of subsequent one-year results --- p.110 / Chapter 5.1.2 --- Profile of fallers compared with general older population --- p.111 / Chapter 5.1.3 --- Implications on health care planning for the elderly --- p.113 / Chapter 5.2 --- Acceptability of various interventions and referrals by fallers and its implications to health care planning for the elderly --- p.116 / Chapter 5.2.1 --- Uptake rates for various interventions and referrals --- p.116 / Chapter 5.2.2 --- Views towards various interventions and referrals by fallers --- p.117 / Chapter 5.2.3 --- Implications on health care planning for the elderly --- p.117 / Chapter 5.3 --- Discussion of other findings --- p.120 / Chapter 5.3.1 --- Seasonal variation in occurrence of falls --- p.120 / Chapter 5.3.2 --- "Circumstances, consequences and past history of falls" --- p.122 / Chapter 5.3.3 --- Comparison between recurrent fallers and non-recurrent fallers in terms of co-morbidity and functional profile --- p.123 / Chapter 5.3.4 --- Comparison between fallers with resultant injury and fallers without injury in terms of co-morbidity and functional profile --- p.123 / Chapter 5.3.5 --- Comparison between fallers attended and those who did not attend the falls assessment clinicin terms of subsequent one-year results --- p.124 / Chapter 5.3.6 --- Usefulness of the risk profile of recurrent falling adopted from Mr. Os (Hong Kong) Studyin screening the fallers with high risk of falling --- p.125 / Chapter 5.4 --- Limitations --- p.126 / Chapter 5.5 --- Recommendations for further research --- p.128 / Chapter CHAPTER 6 --- CONCLUSION --- p.129 / REFERENCES --- p.131 / APPENDICES / Appendix 1 Assessment Form used in Falls Assessment Clinic --- p.146 / Appendix 2a Scale for Subjective Socioeconomic Status -English version --- p.151 / Appendix 2b Scale for Subjective Socioeconomic Status -Chinese version --- p.152 / Appendix 3a Simple Physical Activity Questionnaire -English version --- p.153 / Appendix 3b Simple Physical Activity Questionnaire -Chinese version --- p.155 / Appendix 4 Modified Barthel Index --- p.157 / Appendix 5 Rating Form for Impairment in IADL --- p.159 / Appendix 6 Mini-Mental State Examination -Cantonese version (CMMSE) --- p.160 / Appendix 7 Geriatric Depression Scale - Four-item short form (GDS-4) --- p.162 / Appendix 8 Berg Balance Scale - short form (BBS short form) --- p.163

The Centers for Medicare and Medicaid Services (CMS) report thousands of falls in hospitals each year. The CMS does not reimburse hospitals for fall related injuries, costing the hospital system organization for which this DNP project was designed millions of dollars each year. Framed within the Iowa model of evidence-based practice and using a team approach, the purpose of this project was to develop an evidence-based (EB) fall safety bundle for use by nursing staff and a curriculum to educate staff on prevention strategies. The components of the EB fall bundle kit were approved by the stakeholder committee. Evaluation of the curriculum and the pretest/posttest items was completed by three content experts. The curriculum was evaluated related to the objectives using a 'met' (2) and a 'not met' (1) response. All responses were 'met' for an average score of 2 showing the content met the objectives. Validation of the pretest/post items was conducted using a 10-item, Likert scale, ranging from 1- 'is not relevant' to 4- 'is highly relevant'. The content validation index was 1.0, showing that the test items met the objectives and content of the course. Recommendations included providing a consistent methodology to disseminate the fall safety bundle and educational curriculum across the entire healthcare system as well as adding the fall safety bundle tool kit to the hospital's intranet page for ease of access for all staff. Social change will be achieved by facilitating prevention of fall related injuries and avoiding the financial impact on the facility.

The diploma thesis is structured into a theoretical part and an empirical part. The theoretical part consists of four chapters. The empirical part of the diploma thesis is based on qualitative research. The data were collected via semi-structured interviews with the senior citizens and the nurses. The replies were processed into clearly arranged charts and categories with brief descriptions. Another research method applied was observation. The interviews were followed by a detailed analysis of the documentation, which involved the analysis of the medical records of the senior citizens with a focus on medical diagnosis, chronic medication, and processing of the fall risk and its evaluation. The diploma thesis pursued three objectives by means of four related research questions. The first objective was to ascertain the extent of the clients' awareness of fall risks. The second objective was to assess the discomfort associated with usage of the special device preventing hip joint injuries resulting from falls during common everyday activities of the senior citizens. Finally, the third objective was to obtain the opinions of the healthcare staff on working with clients wearing special devices preventing the hip joint injuries. Four research questions were formulated in connection with these three objectives. Research question No. 1: What is the quality of information provided by the healthcare staff as part of the preventive intervention regarding the falls? Research question No. 2: How willing are the clients to accept changes contributing to fall prevention? Research question No. 3: To what extent is the comfort of the client affected by using special devices preventing fall-related hip joint injuries? Research question No. 4: To what extent is the work of the healthcare staff affected if their clients use devices preventing fall-related hip joint injuries? The results of the qualitative research suggest that the extent of information provided by the healthcare staff as part of the preventive intervention regarding the falls is insufficient in terms of awareness of the risky places. In particular, the research revealed that the nurses fail to sufficiently monitor the effects of chronic medication which may contribute to psycho-motor inhibition of the senior clients. As far as mobility aids are concerned, the nurses offer these devices sufficiently. The nurses demonstrated very good knowledge of all the mobility aids which may facilitate self-reliance of the senior clients. Another problematic issue is the safety of the rooms, particularly in terms of various protrusions and unevenness in the bathrooms. The results of the research do not show any unwillingness of the clients to accept changes contributing to fall prevention. Nevertheless, two of the respondents failed to engage in the activities and maintain physical fitness by regular exercise in the Retirement House. Furthermore, the results do not show any limitation of the clients' comfort resulting from using special devices preventing fall-related hip joint injuries. Finally, according to the research the healthcare staff does not feel restricted in any way when working with senior clients using such device. The results of the research will be used for repeated meetings with the senior clients and particularly with the nurses. The management of the Retirement House, together with the healthcare staff, are working on a new educational material which would indicate risky places with increased probability of falls. These results could be beneficial also for other facilities where healthcare staff takes care of senior citizens. Last but not least, the results are of interest also to the health insurance companies which could provide this special device with at least partial subsidy as part of the primary prevention programme.

Falls, with and without injury, in acute care hospitals are quite common but can be prevented if appropriate interventions are in place to address this issue. It is imperative that nurses assess fall risks of all patients admitted to the hospital and advocate for appropriate interventions to prevent falls in those who are found to be at risk. The purpose of this project was to recommend changes to the current fall prevention protocol in the project facility, an acute care hospital, based on best practices identified in a systematic review of the literature. At the time of the project, the hospital had a high rate of falls. The clinical practice question addressed by this project focused on the evidence-based fall prevention interventions that have resulted in a decreased fall rate among patients on medical-surgical units in an acute inpatient hospital setting. This doctoral project was informed by Kolcaba's theory of caring, and the major source of evidence was a systematic review of the literature focusing on fall prevention. Findings indicated that identification of fall risk factors and implementation of multifactorial fall prevention interventions, such as fall prevention teams, unit fall team champions and use of a fall risk scale, can reduce falls on medical surgical units in acute care hospitals. It was recommended that a multidisciplinary fall prevention team be developed in conjunction with unit fall team champions and that a fall risk scale be used to bridge the practice gap. If implemented, these changes may benefit patients, nurses, and the organization as a whole through decreased falls, lengths of stay, and health care costs.

跌倒和肌肉減少症是威脅老年人身體健康和生命安全的兩個重要問題。肌肉減少症所致的肌肉力量減弱和平衡能力下降是導致老年人跌倒的最主要原因。老年人跌倒最普遍和最嚴重的後果是脆性骨折。跌倒所致的脆性骨折是常見老年病，同時也是導致老年人生活品質下降和死亡的最主要原因之一。高頻低幅振動(LMHFV)是一種非侵入性生物物理干預手段，通過給予全身物理震動刺激，可有效提高肌肉功能和改善骨質。由此推測高頻低幅振動治療有望應用於預防跌倒/骨折及延緩肌肉減少。 / 本研究的目的在於，採用臨床隨機對照研究方法，通過對社區老年人進行高頻低幅振動治療，探索高頻低幅振動治療在預防跌倒/骨折、降低骨折發生率以及延緩肌肉量下降的作用。本研究假設高頻低幅振動治療可有效提高肌肉力量和改善骨質，從而降低骨折風險、跌倒率以及骨折發生率。本研究將分成兩部分進行以驗證此假說。 / 第一部分研究中，710名60歲或以上的社區老年人按社區中心為單位隨機分成振動治療組和對照組。振動治療組給予35Hz，0.3g的振動治療，並以每天20分鐘，每週5 天，持續18 個月；對照組則如常生活而不予振動治療。18個月治療過程中，振動治療組的跌倒率低於對照組46% (p=0.001)。同時，治療組的在平衡力測試中的反應時間、移動速度，和最遠移動距離也都有明顯改善 (所有指標 p<0.001）。在高頻低幅振動治療停止一年後，振動治療組的主導腿和非主導腿肌肉力量仍高於接受振動治療前 (p=0.029, p=0.002)。在平衡力測試中，治療組的反應時間、移動速度以及最遠移動距離也明顯優於對照組 (p=0.001，p=0.014，p=0.007)。在停止治療的一年期間，兩組受試者的肌肉力量，平衡能力以及生活品質均有下降的趨勢，但兩組的下降率並無明顯的差異。 / 第二部分的設計是基於第一部分的研究成果，目的在於更深入研究高頻低幅振動治療對肌肉功能、肌肉量以及肌肉質素的影響。60名社區老人隨機分成對照組和振動治療組。振動治療組給予35Hz，0.3g的高頻低幅振動治療，並以每天20分鐘，每週5天，持續9個月; 對照組則如常生活而不予振動治療。9個月後，治療組的主導腿和非主導腿的肌肉力量明顯高於對照組 (p<0.001，p=0.003)。在用以評估肌肉力量以及平衡力的計時起立坐下測試中，振動治療組用以完成連串起立及坐下動作的時間明顯低於對照組 (p=0.009)。振動治療組的下肢功能尺度問卷評估結果也明顯優於對照組 (p=0.002)。雖然兩組間的身體成份及肌電圖測試結果並無明顯差異，但治療組的肌肉量和肌電圖平均頻率均有上升的趨勢。而且，在兩部分實驗中，受試者對高頻低幅振動治療均有良好的耐受性，目前並沒有發現對受試者身體產生不利影響。因此，高頻低幅振動治療可安全地應用於社區老年人。 / 總括而言研究結果證明高頻低幅振動治療可明顯降低老年人跌倒發生率。9至18個月的振動治療可明顯改善老年人下肢功能和平衡力。在完成為期18個月高頻低幅振動治療後的1年，肌肉功能仍高於對照組，表明高頻低幅振動治療具有長期療效。因此，高頻低幅振動治療應在社區推廣作為老年人跌倒的預防方案之一。 / Fall and sarcopenia are two major problems among elderly. Poor muscle strength and balancing ability resulted from sarcopenia are the major causes of fall incidences. Fragility fracture is one of the most common and serious consequences of falls, which accounts for most of the deaths, as well as morbidity and poor quality of life. Low magnitude high frequency vibration (LMHFV) treatment is a non-invasive biophysical modality to provide a whole-body mechanical stimulation, which was previously shown to improve muscle performance and bone quality implying the potential application for fall/fracture prevention and reducing muscle loss. / The objectives of this study were to conduct prospective randomized controlled clinical trials to investigate the effect of LMHFV treatment on fall/fracture prevention, fracture risks and muscle loss among community elderly. It was hypothesized that LMHFV treatment could enhance muscle performance and bone quality, thus reducing the fracture risks, fall incidence and fracture rate. Two parts of studies were designed to testify the hypotheses. / In the Part I study, a total of 710 community elderly who were aged 60 years or above were recruited and randomized into vibration or control group on center-basis. The subjects in vibration group received LMHFV treatment (35Hz, 0.3g) 20min/day and 5days/week for 18 months, while control group remained sedentary. During the 18-month study period, the vibration group had reported 46% lower fall incidence rate when compared with control group (p=0.001). Significant improvements were found in reaction time, movement velocity and maximum excursion of balancing ability assessment, and also the quadriceps muscle strength (p<0.001 to all). After ceasing the LMHFV for 1 year, the muscle strength of dominant and non-dominant legs in vibration group were still significantly better than the baseline assessed before intervention (p=0.029 and 0.002 respectively), as compared with the control. In balancing ability test, the reaction time, movement velocity and maximum excursion of vibration group also remained significantly improved, as compared with the control group (p=0.001, 0.014 and 0.007 respectively). During the 1 year post-intervention period, both groups had shown a decreasing trend of muscle strength, balancing ability and quality of life but the rate of changes were not significantly different between two groups. / With reference to the results of Part I study, the Part II study was designed to investigate further the effects of LMHFV on muscle performance, mass and quality. 60 community elderly were recruited and randomized into either vibration or control group. Vibration group subjects received LMHFV treatment (35Hz, 0.3g) 20min/day, 5days/week for 9 months, while control group remained sedentary. Significant enhancement of dominant and non-dominant leg muscle strength was observed in the vibration group after 9 months LMHFV (p<0.001 and =0.003 respectively). In the chair rising test assessing muscle power and balancing ability, vibration group showed significantly shorter time needed for sit-to-stand cycles than the control (p=0.009). Significant increase of the lower extremity functional scale was also observed in the vibration group (p=0.002). No significant findings were found in the body composition and vibromyography (VMG) assessment, however, a trend of increasing lean mass and VMG mean frequency were observed. Also, minimal adverse effects were documented in both parts of study; all subjects were well-tolerated for LMHFV treatment. LMHFV is therefore safe and applicable to elderly in the community setting. / LMHFV was demonstrated to reduce fall incidences significantly. Significant effects on improving lower limbs function and balancing ability were observed as early as 9 months after treatment. Enhancement of muscle performance still remained significant 1 year after completion of 18-month LMHFV treatment, indicating strong residual effects of LMHFV. Use of LMHFV in the community as an effective fall prevention program is recommended. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Li, Chi Yu. / Thesis (Ph.D.) Chinese University of Hong Kong, 2014. / Includes bibliographical references (leaves 154-167). / Abstracts also in Chinese.

Chan Cheung Shing. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2007. / Includes bibliographical references (leaves 88-90). / Abstracts in English and Chinese. / Abstract --- p.ii / Acknowledgements --- p.iv / Table of Contents --- p.v / List of Figures --- p.viii / List of Tables --- p.xii / Abbreviations and Notations --- p.xiii / Chapter Chapter 1 --- Introduction --- p.1 / Chapter 1.1 --- Background and Objective --- p.1 / Chapter 1.2 --- Contribution --- p.4 / Chapter 1.3 --- Thesis Outline --- p.5 / Chapter Chapter 2 --- System Architecture --- p.6 / Chapter 2.1 --- Conceptual Design --- p.6 / Chapter 2.2 --- Sensing Device and Fall-Detection Algorithm --- p.7 / Chapter 2.3 --- Mechanical Part --- p.10 / Chapter Chapter 3 --- Mechanical Design --- p.11 / Chapter 3.1 --- Similar Products --- p.11 / Chapter 3.1.1 --- Airbag Restraining Systems in Automobiles --- p.11 / Chapter 3.1.2 --- Airbag Jackets for Motorcycle and House Riders --- p.12 / Chapter 3.2 --- Mechanism adopted --- p.12 / Chapter 3.2.1 --- Time Requirement of Inflator --- p.12 / Chapter 3.2.2 --- Mechanism and Design --- p.13 / Chapter 3.2.3 --- Actuator --- p.14 / Chapter 3.2.4 --- Punch --- p.15 / Chapter 3.2.5 --- Airbags --- p.18 / Chapter 3.2.6 --- Other Mechanisms Tried --- p.19 / Chapter 3.3 --- Prototype --- p.21 / Chapter 3.3.1 --- Implementation --- p.21 / Chapter 3.3.2 --- Demonstration --- p.23 / Chapter Chapter 4 --- Inflation Estimation --- p.25 / Chapter 4.1 --- Theory and Model --- p.25 / Chapter 4.2 --- Validation of Model --- p.28 / Chapter 4.2.1 --- Testing Equipment --- p.28 / Chapter 4.2.2 --- Preprocessing of Pressure Sensor Outputs --- p.28 / Chapter 4.2.3 --- Validation for Basic Equations --- p.29 / Chapter 4.2.4 --- Adjustment of Discharge Coefficients --- p.36 / Chapter 4.2.5 --- Validation for Discharging to a Fixed Volume --- p.40 / Chapter 4.2.6 --- Estimation of the Size of Airbag's Leakage Hole --- p.45 / Chapter 4.2.7 --- Validation for Discharging to an Airbag --- p.47 / Chapter 4.2.8 --- Time Delay due to Addition of a Pipe --- p.52 / Chapter 4.3 --- Summary of Experiments --- p.53 / Chapter 4.4 --- Limitation of Model --- p.54 / Chapter 4.5 --- Prediction of Inflation Time and Airbag Pressure --- p.55 / Chapter 4.5.1 --- Effects of Orifice Size and Vent Size on Airbag Pressure and Volume --- p.55 / Chapter Chapter 5 --- Force Attenuation Estimation --- p.58 / Chapter 5.1 --- Theory and Model --- p.58 / Chapter 5.1.1 --- Kelvin-Voigt Model --- p.59 / Chapter 5.1.2 --- Standard Linear Solid Support Model --- p.59 / Chapter 5.2 --- Simple Testing for Validation --- p.61 / Chapter 5.3 --- Summary of Experiment --- p.64 / Chapter 5.4 --- Estimation --- p.64 / Chapter 5.4.1 --- Force Attenuation Ability of Prototype --- p.64 / Chapter 5.4.2 --- Minimum Airbag Volume and Pressure Required to Reduce the Force --- p.65 / Chapter Chapter 6 --- Future Work --- p.66 / Chapter 6.1 --- Impact Test for Airbag System --- p.66 / Chapter 6.2 --- The Effective Mass of the Target User --- p.67 / Chapter 6.3 --- The Motion Data Collection --- p.68 / Chapter 6.4 --- Modification in the Inflator --- p.69 / Chapter Chapter 7 --- Conclusion --- p.70 / Appendix A Review of Basic Thermodynamics and Fluid Dynamics --- p.72 / Chapter A.1 --- Thermodynamics --- p.72 / Chapter A.2 --- Fluid Mechanics: Incompressible and Compressible Flow --- p.75 / Appendix B Derivation of Equations --- p.77 / Chapter B.1 --- Mass Flow Rate Equations --- p.77 / Chapter B.2 --- Relationship between Rate of Changes of Airbag Pressure and Volume --- p.80 / Chapter B.3 --- Pressure Change of Compressed Gas Cylinder --- p.82 / Chapter B.4 --- Dominating Factors in the Mass Flow Rate Equation --- p.83 / Appendix C Dimensions of Inflator --- p.85 / Appendix D Experimental Data --- p.86

Impairments in balance, mobility, and lower-limb strength are common in the growing population of older people and can lead to dramatic consequences for the individual, such as dependency in activities of daily living, admission to nursing home, falls, and fractures. The main purposes of this thesis were, among older people in residential care facilities, to validate a fall-risk assessment tool and to evaluate a high-intensity functional weight-bearing exercise pro-gramme regarding its applicability as well as its effect on physical functions and falls. The prediction accuracy of the Downton fall risk index within 3, 6 and 12 months was evaluated among 78 residents, aged 65 years or more, at one residential care facility. The participants were assessed as having either a low or high fall risk according to the index and were followed-up for falls using two different fall definitions related to the cause of the fall. With all falls included, a significant prognostic separation was found between the low- and the high-risk group at 3, 6 and 12 months. A definition in which falls precipitated by acute illness, acute disease, or drug side-effects were excluded did not improve the accuracy of the fall prediction. The effect on physical functions of a high-intensity functional exercise programme was evaluated in a randomised controlled trial among 191 older people, dependent in activities of daily living, with a Mini-Mental State Examination score of ten or more, and living in nine residential care facilities. Participants were randomised to an exercise programme or a control activity, including 29 supervised sessions over 3 months, as well as to an intake of a milk-based 200 ml protein-enriched energy supplement (7.4 g protein per 100 g) or a placebo drink immediately after each session. The Berg Balance Scale, usual and maximum gait speed, and one-repetition maximum in lower-limb strength in a leg press machine were followed up at 3 and 6 months by blinded assessors and analysed using the intention-to-treat principle. Significant long-term effects of the high-intensity functional exercise programme were seen in balance, gait ability and lower-limb strength in comparison with the control activity. The intake of the protein-enriched energy supplement did not increase the effect of the training. The evaluation of the applicability of the exercise programme showed that there was a high rate of attendance, a relatively high achieved intensity in the exercises, and only two serious adverse events, neither of which led to manifest injury or disease, despite that most of the participants had severe cognitive or physical impairments. The applicability of the programme was not associated with the participants’ cognitive function. The evaluation of the fall-prevention effect of the exercise programme, during the 6 months following the intervention, showed that neither fall rate nor proportion of participants who sustained a fall differed between the exercise programme and the control activity, when all participants were compared. However, among participants who improved their balance during the intervention period, a significant reduction in fall rate was seen in favour of the exercise group. In conclusion, among older people living in residential care facilities, the Downton fall risk index appears to be a useful tool for predicting residents sustaining a fall, irrespective of the cause of the fall, even with a perspective of only a few months. A high-intensity functional exercise programme is applicable for use, regardless of cognitive function, and has positive long-term effects on balance, gait ability, and lower-limb strength. An intake of a protein-enriched energy supplement immediately after the exercise does not appear to increase the effect of the training. Participants who improve their balance function due to the exercise programme may reduce their risk of falling.

Among elderly people, falls lead to a considerable amount of immobility, morbidity, and mortality. The purpose of this study was to develop and evaluate methods for predicting falls, and to evaluate a fall prevention program among elderly people living in residential care facilities. A fall was defined as any event in which the resident unintentionally came to rest on the floor or the ground regardless of whether or not an injury was sustained. In developing the prediction methods, it was hypothesised that older persons showing difficulties in performing a familiar second task while walking were more likely to fall within six months. For residents who stopped walking when talking, the relative risk of falling was 3.5 (95% CL2.0-6.2) compared to those who continued walking. For residents with a time difference (diffTUG) of at least 4.5 seconds between two performances of the Timed Up&amp;Go test, with and without carrying a glass, the hazard ratio for falls was 4.7 (95% Cl: 1.5-14.2) compared to those with a shorter diffTUG. A screening tool, the Mobility Interaction Fall (MIF) chart, was developed and evaluated, then validated in a new sample. This tool included a mobility rating, ‘Stops walking when talking’, ‘diffTUG’, a test of vision, and a concentration rating. In the first sample, the hazard ratio was 12.1 (95% 0:4.6-31.8) for residents classified as ‘high-risk’ compared to ‘low-risk’. The positive predictive value was 78%, and the negative predictive value, the sensitivity, and the specificity were above 80% for falling in six months. In the second sample the prediction accuracy of the MIF chart was lower (hazard ratio 1.7, 95% Cl: 1.1-2.5) and a 6-month fall history or a global rating of fall risk by staff were at least equally valuable. A combination of any two of the methods - the MIF chart, staff judgement, fall history - was more accurate at identifying high risk residents than any method alone. Half of the residents classified by two methods as ‘high risk’ sustained a fall within 6 months. In a randomised study a prevention program directed to residents, staff, and environment resulted in a significant reduction in the number of residents falling (44% vs. 56%; odds ratio 0.62, 95% CF0.41-0.92), the incidence of falls (incidence rate ratio IRR 0.80, 95% CF0.69-0.94) and of femoral fractures (IRR 0.25, 95% 0:0.08-0.82) in the intervention compared to the control group. In conclusion, a combination of any two of the staff judgement, fall history or MIF chart has the potential to identify a large proportion of residents at particular high fall risk. A multidisciplinary and multifactorial fall prevention program directed to residents, staff, and the environment can reduce the numbnumber of residents falling, of falls and of femoral fractures. / <p>Diss. (sammanfattning) Umeå : Umeå universitet, 2000,, härtill 5 uppsatser</p> / digitalisering@umu

Made available in DSpace on 2015-07-22T20:50:54Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-10-28. Added 1 bitstream(s) on 2015-08-11T03:26:00Z : No. of bitstreams: 1 Publico-11922.pdf: 2026305 bytes, checksum: 6748d516ad453759f76cc254710a50b1 (MD5) / OBJETIVO: avaliar o efeito de um programa de treinamento de força muscular progressiva e propriocepção, na força muscular do quadríceps, no equilíbrio, na qualidade de vida e na redução do risco de quedas em mulheres com osteoporose pós-menopausa. MÉTODOS: Foram selecionadas cem mulheres sedentárias com idade entre 55 e 75 anos com osteoporose pós-menopausa, randomizadas em dois grupos: grupo intervenção composto por 50 pacientes submetidas a 18 semanas de treinamento de força muscular progressiva do quadríceps (a 50%, 60%, 70% até 80% de 1-RM – uma repetição máxima), e de propriocepção, associados ao tratamento clínico medicamentoso para osteoporose; e grupo controle também composto por 50 pacientes que receberam apenas o tratamento clínico medicamentoso. Força muscular, equilíbrio, mobilidade funcional e qualidade de vida foram avaliados no início e ao final da pesquisa através do Teste de Uma Repetição Máxima (1-RM), Berg Balance Scale (BBS), Timed Up & Go Test (TUG) e SF-36. Número de quedas foi avaliado 6 meses que antecederam à pesquisa e nos 6 meses seguintes. RESULTADOS: 85 pacientes concluíram a pesquisa. Os valores para SF-36 melhoraram em todas as oito sub-escalas no grupo intervenção (p ≤ 0.0018), Timed Up & Go Test (p < 0,0001), do teste de 1-RM (p < 0,0001), da Berg Balance Scale (p < 0,0001), e, ainda, uma redução do risco de quedas no grupo intervenção comparada ao grupo controle (IRR 0.263, 95% IC 0.10, 0.68). CONCLUSÃO: A associação do treinamento de força muscular progressiva para quadríceps e o treinamento proprioceptivo é efetivo na redução do risco de quedas, no aumento da força muscular do quadríceps, na melhora do equilíbrio estático e dinâmico, na melhora da capacidade funcional e da qualidade de vida em mulheres com osteoporose pós-menopausa. / OBJECTIVE: To evaluate the effect of a progressive muscular strength and proprioception training program on the muscle strength of the quadriceps, balance, quality of life and reduction in the risk of falls in postmenopausal women with osteoporosis. METHODS: One hundred sedentary postmenopausal women with osteoporosis, ages ranging from 55 to 75, were selected and randomized into two groups: the intervention group comprised of 50 patients who underwent a 18-week of progressive load training for the quadriceps muscle (50%, 60%, 70% up to 80% of 1- RM – one maximum repetition) and proprioception training associated to a drug treatment of osteoporosis and the control group that included 50 patients who only underwent a drug treatment of osteoporosis. The muscular strength, balance, functional mobility and quality of life were evaluated in the beginning and end of the research through the One Maximum Repetition Test (1-RM), Berg Balance Scale (BBS), Timed Up & Go Test (TU & GT) and SF-36. The number of falls was evaluated 6 months preceding the research and in the following six months. Results: Eighty-five patients concluded the research. The program promoted a significant difference among the groups for SF-36 in the eight sub-scales (p ≤ 0.0018), Timed Up & Go Test (p < 0.0001), 1-RM test (p < 0.0001), Berg Balance Scale (p < 0.0001) and also a decrease in the number of falls in the intervention group compared to control (IRR 0.263, 95% CI 0.10, 0.68). Conclusion: The association of progressive strength training for the quadriceps and the proprioceptive training is effective for the prevention of falls, increasing the muscle power, the static and dynamic balance and increasing the speed of the motor responses, therefore improving the performance of daily activities. / TEDE / BV UNIFESP: Teses e dissertações