The purposes of this study were to identify and analyze characteristics of patients who fall, the types and circumstances of their falls, and analyze risk factors for fall-related injuries. In this retrospective study of 137 patients who fell between July 1, 2002 and December 31, 2005 at the neurological unit of a medical center located in the south of Taiwan. Data on patient characteristics, fall circumstances, and injuries were collected by reviewing of adverse event reports. Analyses were performed by use of SPSS statistical software. The result of this study found that the average age of patient who fell was 59.6 years. The majority of sex of the patient falls is male (61.3%). Many patients who fell had caregivers taking constant care (84%), and occurred in the patient room (68.6%). The most frequent diseases related to falls were cerebrovascular disease (47.5%). They usually falls happened during 12AM to 8AM (50.4%). Most falls (81%) did not result in severe injury, or disturbances of gait (78.8%). The most common activity performed at time of fall was during ambulation (39.4%), and getting out of bed (29.9%).The study found that significant risk factors for dizziness were correlated with fall injury (P<0.05); location and activity at time of fall were related to fall injury (P<0.05). The logistic regression model revealed that the significant risk factors for fall-related injuries were activity at time of fall sit and trying to pick up something (OR=18.15 with 95% CI of 1.15 to 285.92). The identified factors associated with injury may provide the information on reducing falling injuries for neurological patients, and development of fall intervention programs. The preventive strategies can ensure patient safety, improve health care quality and reduce resource utilization.

Thesis (Ph. D.)--University of Missouri-Columbia, 1999. / Typescript. Vita. Includes bibliographical references (leaves 237-246). Also available on the Internet.

Revision of AZ1267 / 2 pp. / Alfalfa varieties differ in fall dormancy, defined as growth during the fall. Nondormant alfalfa varieties are usually planted in mild winter areas for their ability to grow in the late fall, winter, and early spring. Select alfalfa varieties that have resistance to potential pest problems. Alfalfa varieties are available that have salt tolerance or are Roundup Ready. Ratings are provided in this publication. Many of the varieties listed in this publication have been tested for yield and final stand by the University of Arizona in small plot trials.

In this thesis, new computer vision based techniques are proposed to detect falls of an elderly person living alone. This is an important problem in assisted living. Different types of information extracted from video recordings are exploited for fall detection using both analytical and machine learning techniques. Initially, a particle filter is used to extract a 2D cue, head velocity, to determine a likely fall event. The human body region is then extracted with a modern background subtraction algorithm. Ellipse fitting is used to represent this shape and its orientation angle is employed for fall detection. An analytical method is used by setting proper thresholds against which the head velocity and orientation angle are compared for fall discrimination. Movement amplitude is then integrated into the fall detector to reduce false alarms. Since 2D features can generate false alarms and are not invariant to different directions, more robust 3D features are next extracted from a 3D person representation formed from video measurements from multiple calibrated cameras. Instead of using thresholds, different data fitting methods are applied to construct models corresponding to fall activities. These are then used to distinguish falls and non-falls. In the final works, two practical fall detection schemes which use only one un-calibrated camera are tested in a real home environment. These approaches are based on 2D features which describe human body posture. These extracted features are then applied to construct either a supervised method for posture classification or an unsupervised method for abnormal posture detection. Certain rules which are set according to the characteristics of fall activities are lastly used to build robust fall detection methods. Extensive evaluation studies are included to confirm the efficiency of the schemes.

Injurious falls are a common problem among older institutionalized adults, having serious physical, psychological and/or financial consequences for the fallers, their families, and personal care home (PCH) staff (Tideiksaar, 2002). North Eastman Health Association (NEHA) introduced a Fall Management Program into its five PCHs in 2005 in an effort to keep residents active and mobile, while minimizing injuries if they fell. The purpose of this research was to evaluate the Fall Management Program to determine if its goals of increased resident mobility and injury minimization were being met. A quasi-experimental, pre-post, comparison group design triangulating different data sources was used to evaluate the effectiveness of the program. Fall Occurrence Report data were collected from all five NEHA PCHs, and from seven similar PCHs in the Interlake Regional Health Authority (IRHA) that did not have a fall program in place. Administrative data from the Manitoba Centre for Health Policy (MCHP) were also used to provide information about some explanatory variables. Comparisons were made between regional health authorities (RHAs) and over time, from the pre- to post- period. Results indicate that NEHA’s Fall Management Program had some benefits for residents – there was a trend towards an increase in mobility (i.e., a non-significant upward trend in falls) while overall injuries remained stable, and falls resulting in hospitalization decreased significantly. NEHA residents appear to have been protected from an increase in injuries despite an upward trend in falls. Moreover, NEHA’s residents had significantly better outcomes compared to similar residents in the non-program PCHs in IRHA. By the post-period, both RHAs had the same rate of falls, but NEHA had significantly fewer injurious falls and falls resulting in hospitalization than IRHA. This suggests that the non-program PCHs had more difficulty preventing resident injuries than the program PCHs in NEHA.

Injurious falls are a common problem among older institutionalized adults, having serious physical, psychological and/or financial consequences for the fallers, their families, and personal care home (PCH) staff (Tideiksaar, 2002). North Eastman Health Association (NEHA) introduced a Fall Management Program into its five PCHs in 2005 in an effort to keep residents active and mobile, while minimizing injuries if they fell. The purpose of this research was to evaluate the Fall Management Program to determine if its goals of increased resident mobility and injury minimization were being met. A quasi-experimental, pre-post, comparison group design triangulating different data sources was used to evaluate the effectiveness of the program. Fall Occurrence Report data were collected from all five NEHA PCHs, and from seven similar PCHs in the Interlake Regional Health Authority (IRHA) that did not have a fall program in place. Administrative data from the Manitoba Centre for Health Policy (MCHP) were also used to provide information about some explanatory variables. Comparisons were made between regional health authorities (RHAs) and over time, from the pre- to post- period. Results indicate that NEHA’s Fall Management Program had some benefits for residents – there was a trend towards an increase in mobility (i.e., a non-significant upward trend in falls) while overall injuries remained stable, and falls resulting in hospitalization decreased significantly. NEHA residents appear to have been protected from an increase in injuries despite an upward trend in falls. Moreover, NEHA’s residents had significantly better outcomes compared to similar residents in the non-program PCHs in IRHA. By the post-period, both RHAs had the same rate of falls, but NEHA had significantly fewer injurious falls and falls resulting in hospitalization than IRHA. This suggests that the non-program PCHs had more difficulty preventing resident injuries than the program PCHs in NEHA.

This thesis is a palaeoenviromnental investigation into possible non-climatic effects on the environment from volcanic ash fall and toxic emissions outside the blast zone of a volcanic eruption. These effects are determined from palynological and geochemical changes following tephra fall at a range of sites across the North Island of New Zealand which were located at increasing distances from the main volcanic source, the Taupo Volcanic Zone. These sites collectively covered a wide variety of habitats existing under different climatic regimes. The first site is a peat bog at a warm temperate, comparatively unstable coastal location, Matakana Island. The peat profile extends to 1000 yrs BP and contains the Kaharoa Tephra layer, erupted around the time of early human settlement in New Zealand. The second study site is Kaipo peat bog which, in contrast to Matakana Island, is an upland sub-alpine site existing under a harsher climatic regime with cool temperatures, strong winds and heavy rainfall. The Kaipo record covers the Holocene period up to recent times. Lake Rotoroa is the third site which is located inland, sheltered within the Waikato valley, an area of rich fertile soils and mild temperate climate. The Lake Rotoroa record extends to approximately 15,000 yrs BP including the end of the last glacial period and the Holocene. The final site investigated, Kohuora bog, is situated in an extinct late Quaternary volcanic crater within Auckland urban area, a region of warm temperate climate. This record extends from the last glacial period to the present. Fine resolution sampling methods were employed above tephra layers preserved at each of these sites to examine the immediate short-term palaeoenvironmental impacts from volcanic tephra deposition. The methods used included pollen analysis, and the relatively new technique of Energy Dispersive X-ray Micro Analysis (EDMA) which investigated changes in sediment geochemistry to provide further information on local environmental change following tephra impact. The use of pollen analysis together with EDMA proved beneficial in assessing overall short term environmental impacts from tephra fell. Results revealed that thicker tephra layers did not always cause extensive environmental damage, as impacts seen above the 0.5 cm thick Egmont 15 Tephra at Lake Rotoroa were among the most significant recorded at this site. Instead, the contributing factors of prevailing climate and local site factors (e.g. drainage, soils, vegetation cover and shelter) at the time of an eruption, together with local forest diversity and species sensitivity to tephra deposition, proved more important in determining the degree of tephra impact. Taxa found to be particularly sensitive to tephra deposition included Halocarpus, with inconsistent impacts from tephra fell on Dacrydium and Metrosideros. Duration of tephra impacts varied between sites, but broad estimates from the results showed the time taken for recovery of forest vegetation following an eruption was &gt;100 years, with environmental stability returning after a minimum period of 50 years. The results from Matakana Island revealed that any possible tephra impacts from deposition of the Kaharoa Tephra were obscured owing to large-scale deforestation following Polynesian settlement on the island around the time of the Kaharoa eruption. This study indicates the importance of investigating distal volcanic impacts prior to human settlement to eliminate ambiguity in interpretation of palaeoenvironmental data.

Introduction: A review of the literature shows that standard clinical balance measures do not adequately predict fall risk in community-dwelling older individuals. There is significant evidence demonstrating the interactions of fear, anxiety, and confidence with the control of standing posture. Little is known however about the nature of this relationship under more challenging balance conditions, particularly in the elderly. The primary purpose of this work was to evaluate the relationship between fear of falling, clinical balance measures and fall-risk. Methods: Three studies were conducted evaluating the effects of postural threat (manipulated by support surface elevation) and/or cognitive loading (working memory secondary task) on clinical balance performance and task-specific psychological measures. Predictive and construct validity as well as test-retest reliability was evaluated for measures used to assess fear of falling and related psychological constructs . Results: Postural threat resulted in reduced balance confidence and perceived stability as well as increased state anxiety and fear of falling. These changes were significantly correlated to decrements in performance of clinical balance tasks. Neither standard clinical scales of balance and mobility nor generalized psychological measures, alone or in combination, could predict falls in community-dwelling elderly. However, combined scores on selected challenging clinical balance tasks could significantly predict falls. Furthermore, improved predictive precision resulted from having these tasks performed under combined postural threat and cognitive loading. Finally, the inclusion of task-specific psychological measures resulted in further improvements to predictive precision. Psychological measures demonstrated fair to excellent test-retest reliability in both healthy young and independent-living older individuals. Conclusions: Clinical balance tasks performed under more challenging conditions likely better reflect everyday experiences in which a fall is likely to occur. Incorporating easy-to-administer task-specific psychological evaluations and self-reported health estimates with clinical balance assessments might improve the likelihood of correctly identifying community-dwelling individuals at risk for falls. Improved estimates of fall-risk may lead to a reduction in the number of falls experienced in this population, thereby reducing the significant burden of fall-related hospitalizations, treatments and rehabilitation on the individual, families and health care system.

Background: The incidence of falls and severity of fall related injuries steadily increase with age. As well as physical injury, falls can lead to adverse psychological and social consequences, which can further reduce older adults’ quality of life. The most commonly reported cause of falls in older persons is tripping over an obstacle, which may reflect the difficulty many older adults have in making an appropriate stepping response. In order to reduce the number of falls experienced by older adults, individuals at high risk of falling need to be identified so that targeted interventions can be implemented. Aims: This series of studies aimed to develop a new Multiple-Lunge test to distinguish between Fallers and Non-fallers in independent older adults, aged 65 years and over. The studies sought to determine the test-retest reliability of the Multiple-Lunge test; as well its validity to predict faller status in a sample of community-dwelling older adults. Methods: One hundred and thirty community-dwelling older adults, aged 65 – 93 years (mean age 77 ± 7 years) with (n = 40) and without (n = 90) a history of falls were administered the Multiple-Lunge test. For the purpose of this study, a Faller was classified as an older adult with a history of one fall, or a Multiple-faller if there was a history of two or more falls in the previous 12 months. The Multiple-Lunge test required the individual to lunge forward to a step length determined as 60% of their leg length, and return to start position, for a total of five repetitions. Two trials were performed after a familiarisation trial. The number of correct steps and the total time for the five steps were recorded for each trial. The highest number of correct steps and the lowest total time of the two trials were used for data analysis. Test-retest reliability of the Multiple-Lunge test was established across two testing occasions from a sub-sample of the validity study (n = 14, mean age 79 ± 6 years). A cross-sectional design was used to establish the sensitivity and specificity of the Multiple-Lunge test to predict faller status based on retrospective self-reported fall history. Initial analysis using the number of correct steps and total time, was followed by a linear regression analysis to determine the validity of the test to predict falls. Results: The Multiple-Lunge test was found to be reliable across trials (ICC = 0.79 for number of correct steps; ICC = 0.86 for total time). The change in the mean for steps was small and similar across four trials (-0.43 steps, -0.36 steps, -0.50 steps). The change in the mean for time showed a gradual decrease in time scores across trials (-0.69 seconds, -0.73 seconds, -0.93 seconds). Sensitivity and specificity values were calculated as 73% and 63% for predicting Multiple-fallers using the measure of all five steps done correctly. Linear regression analysis did not indicate that the Multiple-Lunge test could be used to predict faller status for either of the step predictor variables (0/5 steps or 5/5 steps). However, a very high sensitivity value (98%) was observed for the variable of both steps and time in predicting Fallers. Also a very high specificity value (99%) was recorded for the variable of time to predict Multiple-fallers. Conclusions: The Multiple-Lunge test is an easily administered test for independent older adults. Due to the challenging nature of the test it may be well suited to detect subtle differences in abilities of higher functioning older adults. The test mimics the movements needed in response to a trip, the most common cause of falls in older adults. This test is a reliable and reasonably valid measure of falls risk. A practitioner can be confident in 7 out of 10 cases that an older adult who cannot complete all five steps of the Multiple-Lunge test is at high risk of falls. The results of this thesis suggest that there is potential for the Multiple-Lunge test to be used in clinical practice and fall prevention research. However, additional research on how to further increase its validity and/or to determine the most appropriate populations with which to administer this test appears warranted.

Background: The incidence of falls and severity of fall related injuries steadily increase with age. As well as physical injury, falls can lead to adverse psychological and social consequences, which can further reduce older adults’ quality of life. The most commonly reported cause of falls in older persons is tripping over an obstacle, which may reflect the difficulty many older adults have in making an appropriate stepping response. In order to reduce the number of falls experienced by older adults, individuals at high risk of falling need to be identified so that targeted interventions can be implemented. Aims: This series of studies aimed to develop a new Multiple-Lunge test to distinguish between Fallers and Non-fallers in independent older adults, aged 65 years and over. The studies sought to determine the test-retest reliability of the Multiple-Lunge test; as well its validity to predict faller status in a sample of community-dwelling older adults. Methods: One hundred and thirty community-dwelling older adults, aged 65 – 93 years (mean age 77 ± 7 years) with (n = 40) and without (n = 90) a history of falls were administered the Multiple-Lunge test. For the purpose of this study, a Faller was classified as an older adult with a history of one fall, or a Multiple-faller if there was a history of two or more falls in the previous 12 months. The Multiple-Lunge test required the individual to lunge forward to a step length determined as 60% of their leg length, and return to start position, for a total of five repetitions. Two trials were performed after a familiarisation trial. The number of correct steps and the total time for the five steps were recorded for each trial. The highest number of correct steps and the lowest total time of the two trials were used for data analysis. Test-retest reliability of the Multiple-Lunge test was established across two testing occasions from a sub-sample of the validity study (n = 14, mean age 79 ± 6 years). A cross-sectional design was used to establish the sensitivity and specificity of the Multiple-Lunge test to predict faller status based on retrospective self-reported fall history. Initial analysis using the number of correct steps and total time, was followed by a linear regression analysis to determine the validity of the test to predict falls. Results: The Multiple-Lunge test was found to be reliable across trials (ICC = 0.79 for number of correct steps; ICC = 0.86 for total time). The change in the mean for steps was small and similar across four trials (-0.43 steps, -0.36 steps, -0.50 steps). The change in the mean for time showed a gradual decrease in time scores across trials (-0.69 seconds, -0.73 seconds, -0.93 seconds). Sensitivity and specificity values were calculated as 73% and 63% for predicting Multiple-fallers using the measure of all five steps done correctly. Linear regression analysis did not indicate that the Multiple-Lunge test could be used to predict faller status for either of the step predictor variables (0/5 steps or 5/5 steps). However, a very high sensitivity value (98%) was observed for the variable of both steps and time in predicting Fallers. Also a very high specificity value (99%) was recorded for the variable of time to predict Multiple-fallers. Conclusions: The Multiple-Lunge test is an easily administered test for independent older adults. Due to the challenging nature of the test it may be well suited to detect subtle differences in abilities of higher functioning older adults. The test mimics the movements needed in response to a trip, the most common cause of falls in older adults. This test is a reliable and reasonably valid measure of falls risk. A practitioner can be confident in 7 out of 10 cases that an older adult who cannot complete all five steps of the Multiple-Lunge test is at high risk of falls. The results of this thesis suggest that there is potential for the Multiple-Lunge test to be used in clinical practice and fall prevention research. However, additional research on how to further increase its validity and/or to determine the most appropriate populations with which to administer this test appears warranted.