Dissertations / Theses: 'Fall risk assessment'

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Zhang, Xiaoyue. "Fall Risk Assessment By Measuring Determinants Of Gait." Diss., Virginia Tech, 2013. http://hdl.handle.net/10919/24535.

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Fall accidents are one of the most serious problems leading to unintentional injuries and fatalities among older adults. However, it is difficult to assess individuals' fall risk and to determine who are at risk of falls and in need of fall interventions. Therefore, this study was motivated by a need to provide a cogent fall risk assessment strategy that may be conducive to various wireless platforms. It aimed at developing a fall risk assessment method for evaluating individuals' fall risk by providing diagnostic modalities associated with gait. In this study, a "determinants of gait" model was adopted to analyze gait characteristics and associate them with fall risk. As a proof of concept, this study concentrated on slip-induced falls and the slip initiation risks. Two important parameters of determinants of gait, i.e. the pelvic rotation and the knee flexion, were found to be associated with slip initiation severity. This relationship appeared to be capable of differentiating fallers and non-fallers within older adults, as well as differentiating normal walking conditions and constrained walking conditions. Furthermore, this study also leveraged portable wireless sensor techniques and investigated if miniature inertial measurement units could effectively measure the important parameters of determinants of gait, and therefore assess slip and fall risk. Results in this study suggested that pelvic rotation and knee flexion measured by the inertial measurement units can be used as a substitution of the traditional motion capture system and can assess slip and fall risk with fairly good accuracy. As a summary, findings of this study filled the knowledge gap about how critical gait characteristics can influence slip and fall risk, and demonstrated a new solution to assess slip and fall risk with low cost and high efficiency.
Ph. D.

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Vonderhaar-Picard, Vanessa. "Identification of High Fall Risk Patients in Acute Rehab." Mount St. Joseph University Dept. of Nursing / OhioLINK, 2019. http://rave.ohiolink.edu/etdc/view?acc_num=msjdn1557840767904783.

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Grönlund, Mattias, and Sebastian Olsson. "Bedömning av fallrisk hos patienter som vårdas inneliggande på sjukhus och inom kommunal vård : Med hjälp av Downton Fall Risk Index." Thesis, Högskolan Kristianstad, Sektionen för Hälsa och Samhälle, 2010. http://urn.kb.se/resolve?urn=urn:nbn:se:hkr:diva-7566.

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Background: Fall injuries are a costly problem for society, with costs ranging up to 14 billion a year. In addition to economic loss accidental falls also creates human value losses and reduced quality of life for its victims. In order to prevent the occurrence of injury related to accidental falls healthcare providers utilize various scientifically developed risk assessment tools, one of them being Downton Fall Risk Index. Method: Empirical, quantitative cross-sectional study. Objective: The purpose of the extended essay was to describe the categories in Downton Fall Risk Index that have a bearing on patients' risk of falling while in hospital and in municipal care, and to illustrate how nurses can use the fall risk assessment tool. Results: Of the 708 participants a total of 73% had a high risk of falling according to Downton Fall Risk Index, of the patients being treated at a hospital 66% had high risk of falling and of the patients being treated in municipal care 87% had high risk of falling. Downton Fall Risk Index indicates that the medication was by far the largest category and included 576 patients (81%), followed by sensory impairment in 474 patients (67%). 335 patients (47%) had fallen previously. Discussion: Previous studies show that among patients being treated in hospitals, between 1.3 to 2.1% will fall. Downton Fall Risk Index indicates that 66% of the group of patients are at high risk of falling. This may be due to the fact that Downton Fall Risk Index focuses too much on medication. It is the nurse’s responsibility to coordinate work around the patient in order to minimize the risk of falling. For example, contact an occupational therapist or an ophthalmologist who can undertake specific actions to reduce patients' risk of falling. Nurses should also use appropriate risk assessment tools to identify risk factors in the patient and then use these to formulate a nursing diagnosis. Conclusion: Downton Fall Risk Index is too sensitive to be used on hospitalized patients, the instrument works better in patients being treated in municipal care. It is important that the nurse can use scientifically designed tool for ensuring good health care for the patient, tools such as the fall risk assessment tool.
Bakgrund: Fallskador är ett dyrt problem för samhället med kostnader som sträcker sig upp mot 14 miljarder kronor om året i Sverige. Förutom ekonomiska förluster skapar fall även humanvärdesförluster och försämrad livskvalitet för den drabbade. För att förhindra uppkomsten av fallskador används inom sjukvården olika vetenskapligt framtagna fallriskbedömningsinstrument, ett av dessa är Downton Fall Risk Index. Metod: Empirisk, kvantitativ tvärsnittsstudie. Syfte: Syftet med fördjupningsarbetet är att beskriva vilka kategorier i Downton Fall Risk Index som har betydelse för patienters fallrisk vid vistelse på sjukhus och vid kommunal vård, samt att belysa hur sjuksköterskan kan använda Fallriskbedömningsinstrument. Resultat: Av de 708 medverkande hade totalt 73% hög risk att falla enligt Downton Fall Risk Index, på sjukhus hade 66% av patienterna hög risk att falla och i kommunal vård hade 87% av patienterna hög risk att falla. Downton Fall Risk Index anger att medicinering var den klart största kategorin och inkluderade 576 av patienterna (81%), därefter kom sensorisk funktionsnedsättning med 474 patienter (67%). 335 patienter (47%) hade fallit tidigare. Diskussion: Tidigare studier visar att på sjukhus faller mellan 1,3-2,1% av patienterna. Downton Fall Risk Index anger att 66% av samma patientgrupp har hög risk för fall. Detta kan bero på att Downton Fall Risk Index fokuserar för mycket på medicinering. Det är sjuksköterskans uppgift att samordna arbetet runt patienten så att fallrisken minimeras. Till exempel ska sjuksköterskan kontakta arbetsterapeuter eller ögonläkare som kan utföra punktinsatser för att minska patientens fallrisk. Sjuksköterskan ska även använda fallriskbedömningsinstrument för att identifiera riskfaktorer hos patienten och sedan använda dessa för att utforma en omvårdnadsdiagnos. Slutsats: Downton Fall Risk Index är alldeles för känsligt för att kunna användas på patienter inneliggande på sjukhus, instrumentet fungerar bättre på patienter inneliggande i kommunal vård. Det är viktigt att sjuksköterskan kan använda vetenskapligt utformade verktyg för att säkerställa en god omvårdnad för patienten, verktyg såsom Fallriskbedömningsinstrument.

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Aliu, Omokhele Rosemary. "Frequent Fall Risk Assessment Reduces Fall Rates in Elderly Patients in Long-Term Care." Thesis, Walden University, 2017. http://pqdtopen.proquest.com/#viewpdf?dispub=10256725.

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Falls are a serious issue for the elderly living in long-term care facilities, as falls contribute to significant health problems such as increased dependence, loss of autonomy, confusion, immobilization, depression, restriction in daily activities, and, in some cases, death. An estimated 424,000 fatal falls in elderly patients residing in long-term facilities occur annually in the United States costing $34 billion in direct medical costs. One way to reduce falls among elderly patients in long-term care is to assess for fall risk frequently and implement evidence-based strategies to prevent falls. Patients in this project site facility had been assessed for fall risk via the Briggs Fall Risk Assessment Tool with implementation of fall risk iinterventions only upon admission or when there was a fall. The purpose of this project was to assess whether changing to weekly use of the Briggs Fall Risk Assessment Tool with implementation of fall risk interventions by nursing staff could decrease fall rates in the elderly in long-term care in Harris County, Texas. The model of prevention served as the conceptual framework for this project. Thirty participants (20 females and 10 males) between the ages of 65-115 participated in the program. Pre-implementation data were collected for 1 month and post-implementation data were collected for 1 month. The total number of falls reported weekly was counted before and after the weekly implementation of the Briggs Fall Risk Assessment Tool. The number of falls decreased from 12(70.6%) before the implementation of the assessment tool to 5(29.4%) falls afterwards. A fall prevention program in long-term care may affect social change positively by reducing fall risk in long term care by reinforcing the importance of increased awareness of risk of falls to implement fall prevention strategies

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Myers, Helen. "Fall risk assessment : A prospective investigation of nurses' clinical judgement and risk assessment tools in predicting patient falls in an acute care setting." Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 2003. https://ro.ecu.edu.au/theses/1494.

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Falls are a significant problem in acute care, hospital settings, and can have serious consequences, especially for older patients. Fall prevention has therefore been recognised as an important area for research and intervention. In order to target interventions and use resources effectively, a major strategy of many fall prevention programmes has been the development and/or use of risk assessment tools to identify patients who are at high risk of falling. Although many tools have been developed, few have been rigorously tested, and there is currently no evidence to support the clinical utility of fall risk assessment tools. There is a need to conduct further research to establish the efficacy of fall risk assessment tools for inpatient populations. Additionally, nurses clinical judgement in assessing fall risk may aid the development of fall risk assessment protocols and further research is needed to build on limited knowledge in this area. A prospective cohort study was used to evaluate two fall risk assessment tools and nurses' clinical judgement in predicting patient falls. Each patient was assessed for fall risk by the clinical judgement of the nurse caring for the patient and by the researcher using a data collection form containing the two fall risk assessment tools. The study wards comprised two aged care and rehabilitation wards, within a 570 bed acute care tertiary teaching hospital facility in Western Australia. Test-retest reliability of the two fall risk assessment tools and nurses' clinical judgement was established over a twenty four hour period. The ability of the fall risk assessment tools, and nurses' clinical judgements to discriminate between patients with a high probability of falling and , patients with a low probability of falling; was determined by calculating the sensitivity, specificity, positive predictive value and negative-predictive value for each method. The reference criterion used for these calculations was whether or not the patient fell within the hospitalisation period in which they were admitted to the study. In addition, the accuracy of each method was determined by calculating the number of times the risk assessment tool or clinical judgement classified the patient into the correct, fall risk category, expressed as a percentage. The same reference criterion was used for this calculation. Both the fall risk assessment tools and nurses' clinical judgement had good test-retest reliability. When assessing validity, all three methods of determining fall risk showed good sensitivity, ranging from 88% to 91 %,but poor specificity, ranging from 25% to 26%. This meant that the risk assessment methods classified too many patients who did not fall as at high risk for falling. All methods also had limited accuracy, ranging from 35% to 36%, and overall exhibited an inability to adequately discriminate between patient populations at risk of falling and those not at risk of falling. Consequently, neither nurses' clinical judgement nor the fall risk assessment tools could be recommended for assessing fall risk in the clinical setting. In addition, results indicated that there was a large difference between the accuracy of first year enrolled and registered nurses in assessing patient fall risk. First year enrolled nurses accurately predicted fall risk 44.4% of the time while first year registered nurses achieved an accuracy level of only 8.6%. These results are potentially biased, as measuring differences in accuracy between types of nurses was not a main focus of this study and in many cases the same nurse gave multiple judgements about patients' fall risk. The results however, provide an indication that further study is warranted using a specifically methodology to explore this issue. There are a number of specific recommendations arising from the results of this study. It is recommended that further studies be undertaken to assess the reliability and validity of current fall risk assessment tools in inpatient populations. If no valid and reliable fall risk assessment tool can be identified, research should be undertaken to develop such a tool. It is also recommended that studies be conducted to assess changes in fall risk profiles over time to determine if the sensitivity and specificity of instruments changes depending on the timing of the risk assessment. Differentiating between stable and transient risk factors should be an integral component of these types of studies. Further research is also required to determine if there are differences in fall risk factors between different specialties or if a generic risk assessment tool can be used for all inpatient populations. Additionally, further investigation into the clinical judgement of registered and enrolled nurses in .their first year of clinical practice should be undertaken and results reported to appropriate educational institutions. Changes in accuracy of clinical judgement in the first five years of clinical practice should also be measured.

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Bagalà, Fabio <1983&gt. "From fall-risk assessment to fall detection: inertial sensors in the clinical routine and daily life." Doctoral thesis, Alma Mater Studiorum - Università di Bologna, 2012. http://amsdottorato.unibo.it/4842/.

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Falls are caused by complex interaction between multiple risk factors which may be modified by age, disease and environment. A variety of methods and tools for fall risk assessment have been proposed, but none of which is universally accepted. Existing tools are generally not capable of providing a quantitative predictive assessment of fall risk. The need for objective, cost-effective and clinically applicable methods would enable quantitative assessment of fall risk on a subject-specific basis. Tracking objectively falls risk could provide timely feedback about the effectiveness of administered interventions enabling intervention strategies to be modified or changed if found to be ineffective. Moreover, some of the fundamental factors leading to falls and what actually happens during a fall remain unclear. Objectively documented and measured falls are needed to improve knowledge of fall in order to develop more effective prevention strategies and prolong independent living. In the last decade, several research groups have developed sensor-based automatic or semi-automatic fall risk assessment tools using wearable inertial sensors. This approach may also serve to detect falls. At the moment, i) several fall-risk assessment studies based on inertial sensors, even if promising, lack of a biomechanical model-based approach which could provide accurate and more detailed measurements of interests (e.g., joint moments, forces) and ii) the number of published real-world fall data of older people in a real-world environment is minimal since most authors have used simulations with healthy volunteers as a surrogate for real-world falls. With these limitations in mind, this thesis aims i) to suggest a novel method for the kinematics and dynamics evaluation of functional motor tasks, often used in clinics for the fall-risk evaluation, through a body sensor network and a biomechanical approach and ii) to define the guidelines for a fall detection algorithm based on a real-world fall database availability.

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Belcher, Janet Maxine. "Quality Initiative to Reduce Falls in an Acute Care Setting." ScholarWorks, 2020. https://scholarworks.waldenu.edu/dissertations/7599.

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Falls are the most frequently reported incidents among hospitalized patients in the United States with at least 4 falls per 1,000 patient days occurring annually. Falls are related to high rates of mortality and morbidity and high hospital costs. The purpose of this project was to evaluate a fall prevention quality initiative to reduce falls in an acute care facility by educating staff on an evidence-based fall prevention protocol. The project sought to explore whether implementation of an evidence-based fall prevention initiative in educating nurses would affect the nurses’ professional knowledge and the number of patient fall incidences in the cardiac care unit. The theoretical framework supporting this project was Neuman’s systems theory. The Iowa model was used to guide this evidence-based project. An educational session was implemented to increase nurses’ awareness of fall prevention practices. Two sets of data were collected: the pretest and posttest results, and the number of falls on the unit. A total of 21 unit nurses participated in the pretest; 18 (86.0%) completed the posttest. The mean score on the pretest was 81.62%; the mean score was 85.89% for the posttest with a mean difference of 4.27%. A paired sample t-test revealed no statistically significant differences in scores after education. This project has implications for social change by supporting patient safety, decreased hospital stays, and reduced health care expenses to patients and health care organizations.

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Liu, Hok-kan Vino. "Systematic risk management approach to deal with boulder and rock fall hazard for road slope works." Click to view the E-thesis via HKUTO, 2004. http://sunzi.lib.hku.hk/hkuto/record/B42577615.

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Nordin, Ellinor. "Assessment of balance control in relation to fall risk among older people." Doctoral thesis, Umeå universitet, Samhällsmedicin och rehabilitering, 2008. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-1933.

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Falls and their consequences among older people are a serious medical and public health problem. Identifying individuals at risk of falling is therefore a major concern. The purpose of this thesis was to evaluate measurement tools of balance control and their predictive value when screening for fall risk in physically dependent individuals ≥65 years old living in residential care facilities, and physically independent individuals ≥75 years old living in the community. Following baseline assessments falls were monitored during six months in physically dependent individuals based on staff reports, and during one year in physically independent individuals based on self reports. In physically dependent individuals test-retest reliability of the Timed Up&Go test (TUG) was established in relation to cognitive impairment. Absolute reliability measures exposed substantial day-to-day variability in mobility performance at an individual level despite excellent relative reliability (ICC 1.1 >0.90) regardless of cognitive function (MMSE ≥10). Fifty-three percent of the participants fell at least once during follow-up. Staff judgement of their residents’ fall risk had the best prognostic value for ruling in a fall risk in individuals judged with ‘high risk’ (positive Likelihood ratio, LR+ 2.8). Timed, and subjective rating of fall risk (modified Get Up&Go test, GUG-m) were useful for ruling out a high fall risk in individuals with TUG scores <15 seconds (negative LR, LR- 0.1) and GUG-m scores of ‘no fall risk’ (LR- 0.4), however few participants achieved such scores. In physically independent individuals balance control was challenged by dual-task performances. Subsequent dual-task costs in gait (DTC), i.e. the difference between single walking and walking with a simultaneous second task, were registered using an electronic mat. Forty-eight percent of the participants fell at least once during follow-up. A small prognostic guidance for ruling in a high fall risk was found for DTC in mean step width of ≤3.7 mm with a manual task (LR+ 2.3), and a small guidance for ruling out a high fall risk with DTC in mean step width of ≤3.6 mm with a cognitive task (LR- 0.5). In cross-sectional evaluations DTC related to an increased fall risk were associated with: sub-maximal physical performance stance scores (Odds Ratio, OR, 3.2 to 3.8), lower self-reported balance confidence (OR 2.6), higher activity avoidance (OR 2.1), mobility disability (OR 4.0), and cautious walking out-door (OR 3.0). However, these other measures of physical function failed to provide any guidance to fall risk in this population of seemingly able older persons. In conclusion – Fall risk assessments may guide clinicians in two directions, either in ruling in or in ruling out a high fall risk. A single cut-off score, however, does not necessarily give guidance in both directions. Staff experienced knowledge is superior to a single assessment of mobility performance for ruling in a high fall risk. Clinicians need to consider the day-to-day variability in mobility when interpreting the TUG score of a physically dependent individual. DTC of gait can, depending on the type of secondary task, indicate a functional limitation related to an increased fall risk or a flexible capacity related to a decreased fall risk. DTC in mean step width seems to be a valid measure of balance control in physically independent older people and may be a valuable part of the physical examination of balance and gait when screening for fall risk as other measures of balance control may fail to provide any guidance of fall risk in this population.

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Doire, Terry L. "Evaluating the Knowledge and Attitudes of Orthopedic Nurses Regarding the Use of SPHM Algorithms as a Standard of Care." NSUWorks, 2019. https://nsuworks.nova.edu/hpd_con_stuetd/63.

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Background: Healthcare workers are ranked among one of the top occupations for musculoskeletal disorder (MSD) injuries that affect the muscles, the bones, the nervous system and due to repetitive motion tasks (Centers for Disease Control and Prevention, 2017). Numerous high-risk patient handling tasks such as lifting, transferring, ambulating and repositioning of patients cause injuries that can be prevented when evidence-based solutions are used for safe patient handling and mobility (SPHM) tasks. Purpose: The purpose of this quality improvement project was to evaluate the knowledge and attitudes of orthopedic nurses regarding the use of SPHM algorithms as the standard of care when transferring patients. Theoretical Framework. Lewin’s Theory of Change Methods. A quasi-experimental pretest-post-test design was utilized in this evidenced-based practice project. Results. Descriptive statistics that evaluated pre and post questionnaires of the orthopedic nurses noted nurses displayed behavioral and attitudinal intent to use the SPHM algorithms as the standard of care to improve patient outcomes by decreasing falls. Although the behavioral beliefs and attitudes reflected acknowledgement of SPHM skills and knowledge, nursing did not improve in their documentation of SPH fall risk as two separate tools were required on each patient. Conclusions: SPHM evidenced-based standards do guide staff to critically examine how to safely transfer and mobilize a patient. Patient fall rates did decrease during educational sessions, prompting the need for on-going education of all staff on the unit that transfers patients. The findings from this quality project may encourage future practice approaches to use of the safe patient handling (SPH) fall risk assessment tool for all patients to prevent patient falls.

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Saunders, Nathan. "Reliability and Validity of an Accelerometer-based Balance Assessment for Fall Risk Screening." The Ohio State University, 2013. http://rave.ohiolink.edu/etdc/view?acc_num=osu1372337896.

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Riva, Federico <1984&gt. "Methods for the Quantification of Motor Stability for the Assessment of Fall Risk." Doctoral thesis, Alma Mater Studiorum - Università di Bologna, 2013. http://amsdottorato.unibo.it/5636/.

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The research field of the Thesis is the evaluation of motor variability and the analysis of motor stability for the assessment of fall risk. Since many falls occur during walking, a better understanding of motor stability could lead to the definition of a reliable fall risk index aiming at measuring and assessing the risk of fall in the elderly, in the attempt to prevent traumatic events. Several motor variability and stability measures are proposed in the literature, but still a proper methodological characterization is lacking. Moreover, the relationship between many of these measures and fall history or fall risk is still unknown, or not completely clear. The aim of this thesis is hence to: i) analyze the influence of experimental implementation parameters on variability/stability measures and understand how variations in these parameters affect the outputs; ii) assess the relationship between variability/stability measures and long- short-term fall history. Several implementation issues have been addressed. Following the need for a methodological standardization of gait variability/stability measures, highlighted in particular for orbital stability analysis through a systematic review, general indications about implementation of orbital stability analysis have been showed, together with an analysis of the number of strides and the test-retest reliability of several variability/stability numbers. Indications about the influence of directional changes on measures have been provided. The association between measures and long/short-term fall history has also been assessed. Of all the analyzed variability/stability measures, Multiscale entropy and Recurrence quantification analysis demonstrated particularly good results in terms of reliability, applicability and association with fall history. Therefore, these measures should be taken in consideration for the definition of a fall risk index.
L’ambito di ricerca della tesi è la valutazione della variabilità motoria e l'analisi della stabilità motoria per la stima del rischio di caduta. Dal momento che molte cadute avvengono durante il cammino, una migliore comprensione della stabilità motoria potrebbe portare alla definizione di un indice affidabile del rischio caduta con lo scopo di misurare e valutare il rischio di caduta negli anziani, nel tentativo di evitare l’insorgere di eventi traumatici. Diverse misure di variabilità e stabilità motoria sono proposte in letteratura, ma manca ancora una scrupolosa caratterizzazione metodologica. Inoltre, il rapporto tra molte di queste misure e la storia di cadute o il rischio caduta è ancora sconosciuto, o non del tutto chiaro. Lo scopo di questa tesi è quindi di: i) analizzare l'influenza dei parametri implementativi sperimentali sulle misure di variabilità/stabilità e analizzare come le variazioni di questi parametri influenzano le uscite; ii) valutare la relazione tra le misure di variabilità/stabilità e la storia di cadute a lungo e breve termine. Diversi aspetti implementativi sono state affrontati. A seguito della necessità di una standardizzazione metodologica delle misure di variabilità/stabilità, evidenziata, in particolare, da una revisione sistematica della letteratura sull’analisi di stabilità orbitale, indicazioni generali riguardanti l’implementazione della suddetta analisi sono stati presentate, assieme ad un'analisi del numero di passi richiesti e affidabilità test-retest di diverse misure di variabilità/stabilità. Indicazioni circa l'influenza dei cambi direzionali sulle sono state inoltre fornite. L’associazione tra le misure e la storia di cadute a lungo e breve termine è stata valutata. Di tutte le misure di variabilità/stabilità analizzate, la Multiscale entropy e la Recurrence quantification analysis hanno dimostrato risultati particolarmente buoni in termini di affidabilità, applicabilità e associazione con la storia di cadute. Pertanto, tali misure dovrebbero essere prese in considerazione per la definizione di un indice di rischio di caduta.

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Blanchard, Erin H. "A qualitative assessment of the stay well at home fall risk reduction program." Thesis, California State University, Fullerton, 2015. http://pqdtopen.proquest.com/#viewpdf?dispub=1605565.

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The population of older adults in the United States is rapidly increasing. Falls are a major health concern among the older adult population, and there is an increasing need for more theory-driven fall risk reduction programs that are multifactorial, effective, and inexpensive. The Stay Well At Home (SWAH) program was a 16-week, in-home multifactorial fall risk reduction program that was implemented by trained lay facilitators. The development of this intervention was guided by the Health Action Process Approach (HAPA). The purpose of this study was to qualitatively examine the efficacy of SWAH program as a multifactorial program, to determine its effectiveness as a HAPA-guided intervention, and also to inform further program development of the SWAH program. Semi-structured interviews were conducted with a sample of SWAH recipients (N=15) at the conclusion of the 8-week in-home phase of the program. The purpose of the interviews was to learn about participant experiences with the program and changes they may have observed in themselves. All interviews were recorded, transcribed verbatim, and then thematically analyzed. Themes were also related back to HAPA constructs. The major themes reported by SWAH recipients included an overall increase in fall protective behaviors (100%) as well as improvement in gait (80%), balance (73%), and physical performance (53%). Recipients also responded positively to the SWAH program content and structure. Common barriers for SWAH recipients were health and motivation barriers (73%) and taking the time to exercise (67%). Analysis of the main themes in this study suggest that SWAH was effective at implementing the HAPA model with the exception of successfully implementing action planning activities. The SWAH program was perceived by the interviewed participants as effective in reducing overall fall risk and was fairly successful as a HAPA-guided intervention. Further, it was well received and viewed as beneficial by many SWAH recipients.

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Covert, Kelly L., and Courtney D. Hall. "Pills and Spills: An Assessment of Medications and Fall Risk in Older Patients." Digital Commons @ East Tennessee State University, 2020. https://dc.etsu.edu/etsu-works/7785.

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Dekenah, Ghabrielle Anne. "The development of a fall risk assessment and exercise intervention programme for geriatric subjects." Thesis, Stellenbosch : Stellenbosch University, 2012. http://hdl.handle.net/10019.1/71783.

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Thesis (M Sport Sc)--Stellenbosch University, 2012.
ENGLISH ABSTRACT: Falling is a common occurrence and one of the most serious problems in the elderly population (65 years and older). Falls account for 70% of accidental deaths in persons aged 75 years and older. Falls can be markers/indicators of poor health and declining function, and are often associated with significant morbidity. More than 90% of hip fractures occur as a result of falls, with most of these fractures occurring in persons over 70 years of age (Fuller, 2000). About one third of people aged 65 years and older fall each year, resulting in a substantial decrease in quality of life in addition to placing a huge burden on current health care systems. The purpose of this study was to determine whether a 12-week exercise intervention programme, consisting of two 30 minute exercise sessions a week, could lower the risk of falling in a group of elderly women. Female subjects (n=22) with an average age of 79.5 years were selected from three retirement homes situated in Stellenbosch, Western Cape, South Africa, according to specific inclusion and exclusion criteria. The subjects included presented no major cardiovascular and pulmonary disease signs and symptoms as recognised by the American College of Sports Medicine (2011); had no serious illnesses or co-morbidities; were mobile with no significant musculoskeletal disorders; had no uncorrected visual or vestibular problems as well as no significant cognitive impairments or major psychological disturbances; were not taking any psychotropic medications or Benzodiazepines that could affect their progress. Subjects also had to be willing to follow the 12-week exercise intervention programme and sign an informed consent document. The selected subjects then underwent a pre- and post-intervention assessment consisting of a subjective rating of their fear of falling, the Fall Risk Assessment: Biodex Balance system, Balance Evaluations Systems Test (BESTest) and the 30-Second Chair Stand Test. Statistica 10 was used to analyse the data. Data was analysed to assess any significant improvements that the exercise intervention had on each fall risk variable tested. The main fall risk variables consisted of: fear of falling, muscular strength, balance, gait and getting up strategies. Statistically significant improvements (p<0.001) were seen in: Fear of falling, muscular strength, balance, gait and getting up strategies after the 12-week exercise intervention programme. This study suggests that exercise intervention has the potential to decrease the risk of falling among elderly women and should play an extremely important role in the prevention of falling amongst this population group.
AFRIKAANSE OPSOMMING: Om te val is ‘n alledaagse gebeurtenis en een van die mees ernstige probleme vir ons bejaarde bevolking (65 jaar en ouer). Insidente van val verklaar tot 70% van toevallige sterftes met betrekking tot persone van 75 jarige ouderdom en ouer. Om te val kan ‘n teken van swak gesondheid en/of ‘n afname in funksionele kapasiteit wees, en is gewoonlik met morbiditeitspatrone gekoppel. Meer as 90% van heupfrakture kom as gevolg van valle voor, waar die meeste van die frakture in persone bo 70 jarige ouderdom voorkom (Fuller, 2000). Minstens een derde van persone bo 65 jaar en ouer val elke jaar, so ‘n val het ‘n noemenswaardige afname in lewenskwaliteit tot gevolg asook ‘n enorme druk wat op huidige gesondheidsorg sisteme geplaas word. Die doel van die studie was om te bepaal of ‘n 12 week oefenintervensieprogram, wat uit twee oefen sessies van 30 minute elk bestaan, die risiko van val vir n groep bejaarde vroue kan verlaag. Vroulike individue (n=22) met ‘n gemiddelde ouderdom van 79.5 jaar uit drie ouetehuise/aftree oorde in Stellenbosch, Wes-Kaap, Suid-Afrika geleë; is volgens bepaalde insluitings- en uitsluitingskriteria geselekteer. Individue wie ingesluit is het geen tekens of simptome van grootskaalse kardiovaskulêre of pulmonêre siekte getoon nie, soos herken deur die “American College of Sports Medicine (2011) ; het aan geen ernstige siektes of ko-morbiditeite gely nie; kon stap met geen merkwaardige muskulo-skeletale afwykings nie; het geen nie-gekorrigeerde visie of vestibulêre probleme asook geen beduidende kognitiewe gestremdhede of ernstige sielkundige steurnisse gehad nie; het nie enige psigotropiese medikasie of Benzodiazepines geneem wat hul kon beinvloed nie. Individue moes bereid gewees het om die 12 week oefenintervensieprogram te volg en moes ook ‘n ingeligte toestemmingsvorm onderteken. Die geselekteerde individue het ‘n pre- en post-intervensie assessering ondergaan wat uit ‘n subjektiewe bepaling van hul vrees vir val bestaan het, die Val Risiko Assessering asook “Biodex Balans System Test, Balance Evaluations Systems Test (BESTest)” asook die 30 Sekonde Stoel-staan Toets. Statistica 10 is gebruik om die data te analiseer. Data was geanaliseer om enige merkwaardige verandering wat die oefenintervensie op elke val risiko veranderlike wat getoets was gehad het, te bepaal. Die belangrikste val risiko veranderlikes het uit: die vrees vir val, spier sterkte, balans, stappatroon en opstaan tegnieke bestaan. Betekenisvolle statistiese veranderinge (p<0.001) is gerapporteer in: die vrees vir val, spiersterkte, balans, stappatroon en opstaan tegnieke na die 12 week oefenintervensieprogram. Die studie bevind dat die intervensieprogram die potensiaal het om die risiko van val onder bejaarde vroue te verminder en behoort ‘n uiters belangrike rol in die voorkoming van val onder die bevolkingsgroep te speel.

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Paliwal, Monica. "Development of a novel balance assessment tool to study postural instability and fall risk." Diss., University of Iowa, 2015. https://ir.uiowa.edu/etd/6826.

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Balance disorders and falls are prevalent among multiple pathologies that affect the musculoskeletal or sensorineural systems. Annually, fall-related injuries put excessive economic burden on society and yet, current clinical balance assessment tools based on functional tests are inaccurate and have limited association with fall risk. Therefore, there is a growing need of an accurate balance and fall risk assessment tool for clinical use. The primary purpose of this research was to develop an accurate Center of Pressure (COP) based balance assessment tool to study postural instability and fall risk. Chapter 1 aimed at development of the COP based tool using cost effective equipment- a Wii Balance Board (WBB) and testing its accuracy and errors. The result of this study indicated that the WBB tool is reliable in assessing balance and the linearity and hysteresis errors in WBB tool are higher than force plates but it compares well in terms of cost, portability and availability. Chapter 2 aimed at assessing the relation between the radiographic parameters of balance, COP metrics, and health related quality of life in adults with spinal deformities. The results of this investigation revealed that just like radiographic parameters, COP metrics could help explain some variability in symptoms in patients with comparable extent of deformity. Chapter 3 attempted to establish a threshold value of COP metrics for binary classification of fall risk in patients with multiple sclerosis (MS). The findings of this study highlighted path length as an excellent predictor of future falls with high test accuracy, sensitivity and specificity. This dissertation concludes that the WBB tool has the potential to revolutionize balance and fall risk assessment in clinical fields such as geriatrics, rehabilitation, neurology, and orthopedics.

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Nasiri, Sarvi Masoud. "Assessment of hip fracture risk by a two-level subject-specific biomechanical model." Elsevier, 2013. http://hdl.handle.net/1993/31139.

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Sideways fall-induced hip fracture is a major worldwide health problem among the elderly population. Biomechanical modeling is a practical way to study hip fracture risk. However, all existing biomechanical models for assessing hip fracture risk mainly consider the femur-related parameters. Their accuracy is limited as hip fracture is significantly affected by loading conditions as well. The objective of this study is to introduce a two-level subject-specific model to improve the assessment of hip fracture risk. The proposed biomechanical model consists of a whole-body dynamics model and a proximal femur finite element model, which are constructed from the subject’s whole-body and hip DXA (dual energy X-ray absorptiometry) scan. The whole-body dynamics model is used to determine the impact force onto the hip during a sideways fall. Obtained load/constraint conditions are applied to the finite element model in order to determine the stress/strain distribution in the proximal femur. Fracture risk index is then defined over the critical locations of the femur using the finite element solutions. It is found that hip fracture risk is significantly affected by the subject’s body configuration during the fall, body anthropometric parameters, trochanteric soft tissue thickness, load/constraint conditions, and bone mineral density, which are not effectively taken into account by currently available hip fracture discriminatory tools. Predicted hip fracture risk of 130 clinical cases, including 80 females and 50 males, by the proposed model reveals that biomechanical determinants of hip fracture differ widely from individual to individual. This study presents the first in-depth subject-specific model that provides a comprehensive, fast, accurate, and non-expensive method for assessing the hip fracture risk. The proposed model can be easily adopted in clinical centers to identify patients at high risk of hip fracture who may benefit from the in-time treatment to reduce the fracture risk.
May 2016

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Ancrum-Lee, Shanetta Monique. "Implementation of a Standardized Multifactorial Fall Prevention Program in a Rehabilitation Facility." ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/3382.

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One and a half million people are currently living in residential care facilities; as the baby boomer generation ages, this number will increase to 3 million. Approximately 3 out of 4 residents of these facilities fall each year, and 10% to 20% of those falls result in serious injuries such as fractures, disability, and a decreased quality of living. The BOUNCE Back fall initiative is a multifactorial program that uses a systematic approach starting on admission and to re-evaluate a resident following a fall. Nursing and therapy uses the Morse Fall Scale and the Elderly Mobility Scale to assess and categorize the resident's risk for falls. Guided by Lewin's theory of change, this project was designed to assess the effectiveness of the fall initiative as a quality improvement 60-day (August 2016- September 2016) pilot study in a skilled nursing and rehabilitation facility as a potential means to reduce the number of resident falls. Sixty residents (aged 64 to 98, mean age 81) were assessed at a minimum 2 time points to determine their level of fall risk and needed intervention, within 60 minutes of admission to the facility and 7 days postadmission. De-identified pre- and post-implementation data were provided from the corporate quality measure database, entered into a spreadsheet, and numbers were compared. As a result of the fall prevention pilot, for August 2016, 5 falls occurred with no repeat fallers; September 2016, 3 falls with 1 repeat faller which is a significant decrease from 14-22 falls occurring per month for 2 consecutive years. Following implementation, the facility scored 3%-5% for the number of falls, which is below the 7% threshold set forth by the pilot facility's corporate office. Prior to the implementation of the initiative, the facility had not met the 7% fall threshold in 2 years

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Bishop, Keith Allan. "Predictor Variables Related To Falls In A Long-Term Care Environment." Thesis, Virginia Tech, 2002. http://hdl.handle.net/10919/9717.

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Although a great deal is known about the etiology of falls in elderly individuals, fall accidents continue to represent a significant burden to elders residing in long-term care facilities. It has been stated that 75% of deaths due to falls in the United States occur in the 13% of the population age 65 and over. The first objective of the study was to identify which fall-predictor variables acknowledged in the research literature are associated with increased fall frequency with the older population. Identifying specific predictor variables related to a high occurrence of falls in long-term care setting can assist in the redesign of tools and programs aimed to recognize fall risk, and prevent fall-related accidents and fatalities in the geriatric population. The second objective of the study was to identify which combination of predictor variables could better predict the frequency of falls. A history of falls variable was the only predictive variable that differed significantly between groups of residents who had sustained subsequent falls and those who had not. Other variables including age, mental status, day number of stay, elimination, visual impairment, confinement, blood pressure drop, gait and balance, and medication were found to not be statistically significant between groups of fallers and non-fallers. In this setting, the current design of the tool had limited accuracy and exhibited an inability to effectively discriminate between resident populations at risk of falling and those not at risk of falling. Consequently, the current fall risk assessment tool is not adequate for assessing fall risk in this clinical setting.
Master of Science

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Bigelow, Kimberly Edginton. "Identification of Key Traditional and Fractal Postural Sway Parameters to Develop a Clinical Protocol for Fall Risk Assessment in Older Adults." The Ohio State University, 2008. http://rave.ohiolink.edu/etdc/view?acc_num=osu1227561171.

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21

Lundkvist, Markus. "Accident Risk and Environmental Assessment : Development of an Assessment Guideline with Examination in Northern Scandinavia." Doctoral thesis, Uppsala : Department of Social and Economic Geography, Uppsala University, 2005. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-5849.

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22

Ashari, Asmidawati. "Fall Risk Assessment and Effectiveness of Home Based Exercise on Balance and Functional Mobility among Malaysian Adult Aged 50 years and above." Thesis, Curtin University, 2017. http://hdl.handle.net/20.500.11937/53061.

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Falls prevention research and practice are in there infancy in developing countries such as Malaysia. This research evaluated falls and falls-risk factors among community-dwelling Malaysians aged >50 years. An important risk factor identified, with little previous research, was turning impairment. A randomized trial found improved balance/mobility outcomes for Malaysians aged >50 who had turning impairment. These outcomes provide useful local data to inform future falls prevention activity in Malaysia and other developing countries in Asia.

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Farias, Juliano Ricardo. "Resistance risk assessment of Spodoptera frugiperda (J.E. Smith) (Lepidoptera: Noctuidae) to Cry1F protein from Bacillus thuringiensis Berliner in Brazil." Universidade de São Paulo, 2014. http://www.teses.usp.br/teses/disponiveis/11/11146/tde-04022014-150013/.

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The event TC1507 maize with cry1F gene from the bacterium Bacillus thuringiensis Berliner (Bt) was approved for commercial release in Brazil in 2008. The evolution of pest resistance to Bt plants has been a great concern to preserve the lifetime of this technology. Therefore, in this study we assess the risk of evolution of resistance to Cry1F protein in Spodoptera frugiperda (J.E. Smith) (Lepidoptera: Noctuidae) populations from major maize-growing regions in Brazil. The baseline susceptibility to Cry1F was detemined with diet overlay bioassay for susceptible reference population and four field populations of S. frugiperda. Then, we monitored 43 populations of S. frugiperda sampled in nine different States of Brazil during 2010/2011, 2011/2012 and 2012/2013 crop seasons. Only 4-fold variation in susceptibility to Cry1F was detected among S. frugiperda from field populations in the baseline susceptibility study. Diagnostic concentration of 2,000 ng cm-2 was defined for monitoring the susceptibility to Cry1F in S. frugiperda populations. Survival at 2,000 ng cm-2 of Cry1F protein increased significantly throughout crop seasons in populations from São Paulo, Santa Catarina, Rio Grande do Sul, Bahia, Mato Grosso, Goiás, Mato Grosso do Sul, and Paraná, but not in Minas Gerais. We also sampled a population of S. frugiperda in TC1507 field failures in Bahia in October, 2011. This population was selected in laboratory with Cry1F protein up to 20,000 ng cm-2 and the resistance ratio of the selected resistant population (BA25R) was > 5,000-fold. This resistant population was able to survive in Cry1F maize from neonate till pupa and produce normal adult. The inheritance of S. frugiperda resistance to Cry1F protein was autosomal. To test the functional dominance, neonate larvae obtained from the cross of resistant and susceptible populations were tested in leaf bioassay, and around 8% of heterozygotes were able to survive and complete the larval development and produce normal adults on TC1507 leaves while susceptible larvae could not survive for up to five days after infestation. Dominance was estimated to be 0.15 ± 0.09, suggesting that resistance to Cry1F in TC1507 maize was incompletely recessive. We also conducted resistance selection studies in other seven S. frugiperda populations from six different Brazilian states to test whether the resistance alleles were at same locus or not. The F1 larvae obtained from the cross between resistant population (BA25R) and each of the seven selected resistant populations were able to survive at 2,000 ng cm-2 of Cry1F protein in diet bioassay, and therefore they shared the same locus of resistance to Cry1F protein. We estimated the frequency of resistance allele to Cry1F protein in populations of S. frugiperda of main crop season 2011/2012 from five states. We stablished 517 isofemale lines using F2 screen method. The total frequency of Cry1F resistance allele in Brazil was 0.088 with 95% confidence interval between 0.077 and 0.100. Based on results obtained in this study, the risk of resistance evolution to Cry1F protein by S. frugiperda is high in Brazil.
O evento de milho TC1507 com gene cry1F da bactéria Bacillus thuringiensis Berliner foi aprovado comercialmente no Brasil em 2008. A evolução da resistência de pragas a plantas Bt tem sido uma grande preocupação na preservação desta tecnologia. Portanto, neste estudo foi avaliado o risco de evolução da resistência à proteína Cry1F em populações de Spodoptera frugiperda (J.E. Smith) (Lepidoptera: Noctuidae) das principais regiões de cultivo de milho no Brasil. A linha-básica de suscetibilidade à proteina Cry1F foi determinada em bioensaio de aplicação superfícial na dieta para a população suscetível de referência e quatro populações de campo de S. frugiperda. Posteriormente, a suscetibilidade a Cry1F foi monitorada em 43 populações de S. frugiperda coletadas em nove Estados do Brasil nas safras agrícolas de 2010/2011, 2011/2012 e 2012/2013. A variação na suscetibilidade foi de apenas quatro vezes para Cry1F entre as populações de campo na linha-básica de suscetibilidade. A concentração diagnóstica de 2.000 ng cm-2 de proteína Cry1F foi definida para o monitoramento da suscetibilidade. A sobrevivência em 2.000 ng cm-2 de proteína Cry1F aumentou significativamente no decorrer das safras em populações de São Paulo, Santa Catarina, Rio Grande do Sul, Bahia, Mato Grosso, Goiás, Mato Grosso do Sul e Paraná, mas não em Minas Gerais. Além disso, uma população de S. frugiperda foi coletada em milho TC1507 com falha de controle na Bahia em outubro de 2011. Esta população foi selecionada no laboratório com a proteína Cry1F até 20.000 ng cm-2, obtendo-se uma população resistente (BA25R) com razão de resistência >5000 vezes. Esta população resistente foi capaz de sobreviver no milho TC1507 desde larva neonata até a fase de pupa e com emergência de adultos normais. O padrão de herança da resistência de S. frugiperda a Cry1F foi autossômica. Para testar a dominância funcional, as larvas neonatas do cruzamento entre a população resistente e suscetível foram testadas em folhas do evento TC1507 e cerca de 8% dos heterozigotos foram capazes de sobreviver, completar o desenvolvimento e produzir adultos normais, enquanto as larvas da linhagem suscetível não sobreviveram por mais de cinco dias após a infestação. A dominância foi estimada em 0,15 ± 0,09; portanto, a resistência à proteína Cry1F no milho TC1507 foi incompletamente recessiva. A resistência foi selecionada para outras sete populações de seis Estados brasileiros para testar se os alelos de resistência estavam no mesmo locus. As larvas F1 obtidas do cruzamento entre a população resistente (BA25R) e cada uma das sete populações selecionadas sobreviveram na concentração de 2,000 ng cm-2 de proteína Cry1F e, portanto, essas populações compartilharam o mesmo locus de resistência à proteína Cry1F. A freqüência do alelo resistente à proteína Cry1F foi estimada em populações de S. frugiperda coletadas em cinco Estados na safra 2011/2012. Foram estabelecidas 517 isolinhas utilizando o método de \"F2 screen\". A freqüência total do alelo de resistência à proteína Cry1F no Brasil foi de 0,088, com intervalo de confiança de 95% entre 0,077 e 0,100. Com base nos resultados, o risco de evolução da resistência à proteína Cry1F por S. frugiperda é elevada no Brasil.

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Bell, Regan, Nomathamsanqa Mgutshini, Nitin Joshi, and Peter Panus. "Comparing EMR Fall Risk Calculation to Performance-based Assessments." Digital Commons @ East Tennessee State University, 2021. https://dc.etsu.edu/asrf/2021/presentations/61.

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Falls are the second leading cause of accidental or unintentional injury deaths worldwide. Many factors contribute to an increased risk of falling, such as age, disease state, and medication use. The purpose of the current investigation was to compare an electronic medical record (EMR) fall risk calculator, the theoretical Timed Up and Go (T-TUG), which utilizes gender, age, BMI, and prescription and OTC drug counts as variables, to other established performance- and paper-based assessments of fall risk. The National Social Life, Health, and Aging Project (NSHAP) Database was used to develop the T-TUG. Data was analyzed from participants in Wave 1 of the Irish Longitudinal Study on Ageing (TILDA) to validate the T-TUG. Performance-based assessments included mean grip force for both dominant and nondominant hands, Timed Up and Go (TUG), and a paper-based assessment titled the Steadiness Index. The latter is a series of 3 questions assessing steadiness when walking, standing, or getting up from a chair. Those participants of the TILDA cohort passing the inclusion criteria were divided into those who reported a fall in the previous year (N=1159) and those reporting no falls (N=4746). Two group comparisons were analyzed by Mann-Whitney U Test (p<0.05) and a Receiver Operator Characteristics (ROC) curve analysis was used to detect separation of fall and non-fall groups. For the Mann-Whitney U test the fall and no fall groups were statistically different for the T-TUG (p<0.001), TUG (p<0.001), dominant and nondominant grip forces (p<0.001), and the steadiness index (p< 0.001). In the fall group, the grip forces were weaker, T-TUG and TUG time longer, and the steadiness index scores lower. For the grip force assessments and steadiness index, lower scores are more likely to be associated with a higher fall risk. In the T-TUG and TUG, longer times are more likely to be associated with a higher fall risk. In the ROC curve analyses, the T-TUG (0.567, p<0.001) demonstrated similar outcomes compared to dominant (AUC=547, p<0.09) and non-dominant (AUC=0.550, p<0.01) grip forces, and the TUG (AUC=0.558, p<0.001). The steadiness index ROC analysis was slightly better than the T-TUG (AUC=0.579, p<0.001). Sensitivity (52-58%) and specificity (50-57%) ranges were equivalent for all performance-based assessments, whereas for the Steadiness Index, the sensitivity (40%) was lower than the specificity (75%). The EMR fall-risk calculator (T-TUG) is a valid triage tool to estimate fall risk in older community dwellers. The EMR calculator has the potential for real-time assessment of patients using current data compared to other performance- and paper-based assessments, which would allow the healthcare team to spend more time with higher fall risk patients.

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Tiedemann, Anne Public Health &amp Community Medicine Faculty of Medicine UNSW. "The development of a validated falls risk assessment for use in clinical practice." Awarded by:University of New South Wales. School of Public Health and Community Medicine, 2006. http://handle.unsw.edu.au/1959.4/27255.

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Falls risk factor assessment is the first step in the development of appropriate intervention strategies for the prevention of falls. However, few multifactorial, validated falls risk assessments exist which are suitable for use in busy clinical settings. This project aimed to develop a reliable and valid falls risk assessment that was feasible for use in various clinical settings. The QuickScreen Clinical Falls Risk Assessment was developed and evaluated via four methods; a) the test-retest reliability of the measures was assessed with 30 community-dwelling older people, b) the concurrent validity of the measures was assessed by comparison with performance in the Physiological Profile Assessment, c) the predictive validity of the measures was assessed by comparison of performance with prospective falls in two studies involving large samples of community dwelling older people and d) the feasibility of the assessment was evaluated with 40 clinicians who trialled the assessment with their patients. The QuickScreen clinical falls risk assessment consists of eight measures, including previous falls, total medications, psychoactive medications, visual acuity, touch sensation, the sit to stand test, the near tandem stand test and the alternate step test. The test-retest reliability of the assessment measures was acceptable (intraclass correlation coefficients ranged from 0.56 to 0.89) and the assessment measures discriminated between multiple fallers and non-multiple fallers with relative risk values ranging from 1.4 to 2.5. The clinicians that trialled the assessment reported that it was quick and easy to administer and that it assisted in the management of their elderly patients. These results show that the QuickScreen Clinical Falls Risk Assessment has proven validity, test-retest reliability and is practical for use in a variety of clinical settings.

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26

Huang, Hui-Chi. "Risk assessment and interventions to prevent falls in older people in Taiwan." Thesis, University of Ulster, 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.393489.

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Roeles, Sanne. "The development of a reactive gait assessment : toward identifying risk for falls in older adults." Thesis, University of Strathclyde, 2017. http://digitool.lib.strath.ac.uk:80/R/?func=dbin-jump-full&object_id=30235.

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Falls are the leading cause of injuries in older adults. To prevent falls, early identification of individuals at risk is therefore needed. Although gait impairments are among the main risk factors, currently available clinical balance and gait assessments lack sensitivity in identifying risk for falls. Since most falls occur following trips or slips reduced ability to adequately recover from gait perturbations may be indicative of fall risk. The main aim of my industrial doctorate programme was to investigate whether reactive gait assessment can be used to identify risk for falls in older adults I used innovative technology from the company Motek and developed a mixed-perturbation protocol to challenge the individual's gait pattern and measure the recovery responses in a safe, standardized and objective manner. The initial protocol and outcome measures were based on a literature review. Three subsequent phases of development and evaluation were used to deliver a standardized reactive gait assessment. Using this assessment I was able to reveal that older adults with a history of falls were more affected by contralateral sway and deceleration perturbation in terms of continuous trunk motion than those without a history of falls, while no differences between fallers and non-fallers were found in clinical and steady state gait measures. This suggests that reactive gait assessment has added value in fall risk identification in older adults. Therefore, I recommend using the contralateral sway and deceleration perturbations of our developed perturbation protocol and assessing responses by means of continuous trunk motion to further evaluate the use of reactive gait assessment for fall risk identification in older adults. Motek as an industrial company can facilitate this by providing customers with the developed reactive gait assessment and encourage clinically driven research to examine the reproducibility and validity of reactive gait assessment using evidence-based, affordable and easy-to-use technologies.

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Zahiri, Hani. "A predictive GIS methodology for mapping potential mining induced rock falls." Access electronically, 2006. http://www.library.uow.edu.au/adt-NWU/public/adt-NWU20060725.120628/index.html.

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Bell, Rebecca A. "Aerobic fitness, physical function and falls among older people : a prospective study." Thesis, Queensland University of Technology, 2008. https://eprints.qut.edu.au/16616/1/Rebecca_Bell_Thesis.pdf.

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Falls in people aged over 65 years account for the largest proportion of all injury-related deaths and hospitalisations within Australia. Falls contributed to 1,000 deaths and 50,000 hospitalisations in older people during 1998 (Commonwealth Department of Health and Aged Care 2001). It has been predicted that by 2016, 16% of the Australian population will be aged over 65 years (Australian Bureau of Statistics 1999) placing considerable pressure on the health care system. Furthermore, prospective studies have shown that 30-50% of people aged 65 years and over, will experience a fall (Tinetti et al. 1988b; Campbell et al. 1989; Lord et al. 1994b; Hill 1999; Brauer et al. 2000; Stalenhoef et al. 2002) and this figure increases exponentially with age (Lord et al. 1994b). Many physiological falls risk factors have been established including reduced leg strength, poor balance, impaired vision, slowed reaction time and proprioception deficits. However, little research has been conducted to determine whether performance on aerobic fitness tasks is also a physiological falls risk factor. Aerobic fitness has previously been related to an individual's ability to perform activities of daily living, which in turn has been linked to falls. It was therefore proposed that aerobic fitness might also be a risk factor for falls among community dwelling older people. This research aimed to provide clinical evidence to inform public health practice. This thesis comprised of four objectives: the first to find suitable measures of aerobic fitness for older people; the second investigated relationships between existing clinical tests and future falls; the third explored relationships between aerobic fitness tests and future falls; the final objective was to examine the independent relationships between falls and clinical and physiological characteristics. The participants were recruited through a random sample from the local electoral roll, with an average age of 73 ±6 years. Of the 87 participants who completed the prospective component of the study, 37% were male and 63% were female. Sixty-three participants (65%) reported no previous falls, 19 (20%) reported a single fall, and 16 (15%) reported two or more falls in the previous 12 months. The first objective required participants recruited from the community to take part in submaximal and maximal fitness tests in order to find suitable measures of aerobic fitness. A further objective was to determine whether older people were able to fulfil the 'standard' criteria for completion of a maximum oxygen consumption test. The measures used in this research included: maximum oxygen consumption, peak oxygen consumption, ventilatory threshold, oxygen uptake kinetics, oxygen deficit, efficiencies, oxygen consumption at zero, 30 and 50 watts, predicted max and Six-Minute Walk Test distance. Only weak relationships were observed between submaximal aerobic measures and peak oxygen consumption. Furthermore, only 54% of participants were able to fulfil the criteria to complete a test of maximum oxygen consumption, indicating it was not a suitable measure for use among a sample of community dwelling older people. Therefore submaximal aerobic variables were used in the following chapters. The second objective investigated the relationship between clinical measures and falls among older people and was carried out to enable comparisons between the population in this study and those described in the literature. This research found that the Timed Up and Go (TUG) test was the most sensitive of all clinical tests (including the Berg Balance Scale, Function Reach, Performance Oriented Mobility Assessment and Physiological Profile Assessment) for the assessment of future falls. The TUG requires participants to stand up, walk 3m, turn, walk back, and sit down. Time taken to complete the test is the recorded value. For this study, a cut-off value of 7-seconds was established, above which individuals were at increased risk of falls. Previous research suggested cut-off times of over 10s were appropriate for older people. However, this is the first study to assess falls prospectively and definitively find that the TUG can discriminate between future fallers and non-fallers. This research also investigated the differences in falls risk factors for functionally different subsamples, as defined by their ability to undertake and complete the cycle test. The participants who could complete the test had significantly better balance ability and strength than those unable to undertake or complete the cycle test. However, this inability to undertake or complete the cycle test was not itself a predictor of future falls. These two groups also differed in the relationships between clinical test results and falls risk. Participants in the no-cycle group had very similar results to that of the entire cohort. Even after adjustment for age, the TUG, foot and hand reaction times and knee flexion strength were all performed better by non-fallers than fallers. However, none of these differed between fallers and non-fallers for participants in the cycle group. This group had better balance ability and strength than the no-cycle group. These results indicated that the cycle group differed from the no-cycle group and the entire sample, further indicating that factors other than the physiological variables measured in this research influence falls risk in strong participants with good balance ability. Similar results were reported when aerobic tests and falls were investigated in the third objective. In the whole sample, the fallers walked significantly less distance than non-fallers for the 6-MWT. Similar results were found for participants in the no-cycle group but not the cycle group. All participants were able to complete the Six-Minute Walk Test (6-MWT) although only 74% were able to undertake and complete the cycle test. The fourth objective was to consider all measures from the previous chapters as potential predictors of falls. The variables most predictive of future falls were the TUG and having experienced one or more falls in the previous 12 months. As a result they could be used as screening tools for the identification of high-risk fallers who require referral for further assessment. This could be completed by a General Practitioner or Practice Nurse, which would ensure that screening is being undertaken in the wider population. If the patient is at high risk they should be referred for falls risk factor assessment to determine an optimal tailored intervention to reduce future falls. Low risk patients should be referred for preventive evidence-based activities. These steps can potentially improve quality of life for individuals, and if effective in preventing future falls, will result in reduced costs to the individual and the Australian public. The results of this work demonstrate that the best screening tests are simple tasks like the TUG and asking an individual if they have experienced a fall in the last 12 months. This research also found that strong, mobile older people who could undertake and complete a submaximal cycle ergometer test, still experienced falls in the following 12 months, although the causes of this are currently unknown. This research showed that physiological falls risk factors are less relevant as these highly functional older people do not have physiological deficits. However, this research found that the 6-MWT showed promise as a predictor of falls in a group who could not complete a submaximal cycle ergometer test, who had lower strength, balance and functional fitness scores than a group who could complete this cycle test. The results showed that physiological falls risk factors are still very important for older people with lower physical abilities, and this is where aerobic fitness may still be related to falls. While the association between aerobic fitness and falls remains unclear, these are novel and provocative findings highlighting the need for future falls risk investigations to consider aerobic fitness as a contributing factor.

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30

Bell, Rebecca A. "Aerobic fitness, physical function and falls among older people : a prospective study." Queensland University of Technology, 2008. http://eprints.qut.edu.au/16616/.

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Falls in people aged over 65 years account for the largest proportion of all injury-related deaths and hospitalisations within Australia. Falls contributed to 1,000 deaths and 50,000 hospitalisations in older people during 1998 (Commonwealth Department of Health and Aged Care 2001). It has been predicted that by 2016, 16% of the Australian population will be aged over 65 years (Australian Bureau of Statistics 1999) placing considerable pressure on the health care system. Furthermore, prospective studies have shown that 30-50% of people aged 65 years and over, will experience a fall (Tinetti et al. 1988b; Campbell et al. 1989; Lord et al. 1994b; Hill 1999; Brauer et al. 2000; Stalenhoef et al. 2002) and this figure increases exponentially with age (Lord et al. 1994b). Many physiological falls risk factors have been established including reduced leg strength, poor balance, impaired vision, slowed reaction time and proprioception deficits. However, little research has been conducted to determine whether performance on aerobic fitness tasks is also a physiological falls risk factor. Aerobic fitness has previously been related to an individual's ability to perform activities of daily living, which in turn has been linked to falls. It was therefore proposed that aerobic fitness might also be a risk factor for falls among community dwelling older people. This research aimed to provide clinical evidence to inform public health practice. This thesis comprised of four objectives: the first to find suitable measures of aerobic fitness for older people; the second investigated relationships between existing clinical tests and future falls; the third explored relationships between aerobic fitness tests and future falls; the final objective was to examine the independent relationships between falls and clinical and physiological characteristics. The participants were recruited through a random sample from the local electoral roll, with an average age of 73 ±6 years. Of the 87 participants who completed the prospective component of the study, 37% were male and 63% were female. Sixty-three participants (65%) reported no previous falls, 19 (20%) reported a single fall, and 16 (15%) reported two or more falls in the previous 12 months. The first objective required participants recruited from the community to take part in submaximal and maximal fitness tests in order to find suitable measures of aerobic fitness. A further objective was to determine whether older people were able to fulfil the 'standard' criteria for completion of a maximum oxygen consumption test. The measures used in this research included: maximum oxygen consumption, peak oxygen consumption, ventilatory threshold, oxygen uptake kinetics, oxygen deficit, efficiencies, oxygen consumption at zero, 30 and 50 watts, predicted max and Six-Minute Walk Test distance. Only weak relationships were observed between submaximal aerobic measures and peak oxygen consumption. Furthermore, only 54% of participants were able to fulfil the criteria to complete a test of maximum oxygen consumption, indicating it was not a suitable measure for use among a sample of community dwelling older people. Therefore submaximal aerobic variables were used in the following chapters. The second objective investigated the relationship between clinical measures and falls among older people and was carried out to enable comparisons between the population in this study and those described in the literature. This research found that the Timed Up and Go (TUG) test was the most sensitive of all clinical tests (including the Berg Balance Scale, Function Reach, Performance Oriented Mobility Assessment and Physiological Profile Assessment) for the assessment of future falls. The TUG requires participants to stand up, walk 3m, turn, walk back, and sit down. Time taken to complete the test is the recorded value. For this study, a cut-off value of 7-seconds was established, above which individuals were at increased risk of falls. Previous research suggested cut-off times of over 10s were appropriate for older people. However, this is the first study to assess falls prospectively and definitively find that the TUG can discriminate between future fallers and non-fallers. This research also investigated the differences in falls risk factors for functionally different subsamples, as defined by their ability to undertake and complete the cycle test. The participants who could complete the test had significantly better balance ability and strength than those unable to undertake or complete the cycle test. However, this inability to undertake or complete the cycle test was not itself a predictor of future falls. These two groups also differed in the relationships between clinical test results and falls risk. Participants in the no-cycle group had very similar results to that of the entire cohort. Even after adjustment for age, the TUG, foot and hand reaction times and knee flexion strength were all performed better by non-fallers than fallers. However, none of these differed between fallers and non-fallers for participants in the cycle group. This group had better balance ability and strength than the no-cycle group. These results indicated that the cycle group differed from the no-cycle group and the entire sample, further indicating that factors other than the physiological variables measured in this research influence falls risk in strong participants with good balance ability. Similar results were reported when aerobic tests and falls were investigated in the third objective. In the whole sample, the fallers walked significantly less distance than non-fallers for the 6-MWT. Similar results were found for participants in the no-cycle group but not the cycle group. All participants were able to complete the Six-Minute Walk Test (6-MWT) although only 74% were able to undertake and complete the cycle test. The fourth objective was to consider all measures from the previous chapters as potential predictors of falls. The variables most predictive of future falls were the TUG and having experienced one or more falls in the previous 12 months. As a result they could be used as screening tools for the identification of high-risk fallers who require referral for further assessment. This could be completed by a General Practitioner or Practice Nurse, which would ensure that screening is being undertaken in the wider population. If the patient is at high risk they should be referred for falls risk factor assessment to determine an optimal tailored intervention to reduce future falls. Low risk patients should be referred for preventive evidence-based activities. These steps can potentially improve quality of life for individuals, and if effective in preventing future falls, will result in reduced costs to the individual and the Australian public. The results of this work demonstrate that the best screening tests are simple tasks like the TUG and asking an individual if they have experienced a fall in the last 12 months. This research also found that strong, mobile older people who could undertake and complete a submaximal cycle ergometer test, still experienced falls in the following 12 months, although the causes of this are currently unknown. This research showed that physiological falls risk factors are less relevant as these highly functional older people do not have physiological deficits. However, this research found that the 6-MWT showed promise as a predictor of falls in a group who could not complete a submaximal cycle ergometer test, who had lower strength, balance and functional fitness scores than a group who could complete this cycle test. The results showed that physiological falls risk factors are still very important for older people with lower physical abilities, and this is where aerobic fitness may still be related to falls. While the association between aerobic fitness and falls remains unclear, these are novel and provocative findings highlighting the need for future falls risk investigations to consider aerobic fitness as a contributing factor.

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31

Li, Lee, and 李利. "Do the elderly need to think when they walk?" Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2005. http://hub.hku.hk/bib/B45013895.

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32

Honaker, Julie Ann. "A Team Approach Risk of Falling Assessment and Remediation Program for Community Dwelling Older Adults with a Fear of Falling and Balance Disorders." University of Cincinnati / OhioLINK, 2006. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1163703882.

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33

Conradie, Magda. "A comparative study of the determinants of bone strength and the propensity to falls in black and white South African women." Thesis, Stellenbosch : Stellenbosch University, 2008. http://hdl.handle.net/10019.1/1151.

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Thesis (DMed)--Stellenbosch University, 2008.
The comparative study presented in this dissertation specifically aimed to assess fracture risk in black (Xhosa) and white South African women by evaluating known determinants of bone strength as well as the propensity to falls. We thus compared the prevalence of clinical (historic) risk factors for osteoporosis, measured and compared vertebral and femoral bone mineral density (BMD) employing dual energy X-ray absorptiometry (DEXA), ultrasound variables using the Sahara sonometer, serum parathyroid hormone (PTH) and 25-OH Vitamin D, mineral homeostasis and modern biochemical markers of bone turnover, bone geometry and the propensity to falls. Finally, we determined the prevalence of vertebral fractures in these black and white South African females. 1. Significant ethnic differences were noted in the presence and frequency of historical clinical and lifestyle risk factors for osteoporosis. Blacks were heavier and shorter, they consumed less calcium, were more inactive, preferred depot-medroxyprogesterone acetate as contraceptive agent and were of higher parity. Whites smoked more, preferred oral oestrogen containing contraceptive tablets and were more likely to have a positive family history of osteoporosis. Hormone therapy was used almost exclusively by postmenopausal whites. Inter-ethnic differences in weight, physical activity and high parity was most marked in the older subjects. 2. We found that peak spinal BMD was lower, but peak femoral BMD similar or higher (depending on the specific proximal femoral site measured) in black South-African females compared with whites. The lower peak spinal BMD was mainly attributed to lower BMD’s in the subgroup of black females with normal to low body weight, indicating that obesity either protected black females against a low spinal BMD or enhanced optimal attainment of bone mineral. An apparent slower rate of decline in both spinal- and femoral BMD with ageing was noted in the black females compared with whites in this cross-sectional study – an observation which will require confirmation in longitudinal, follow-up studies. This resulted in similar spinal BMD values in postmenopausal blacks and whites, but significantly higher femoral BMD measurements in blacks. The volumetric calculation of bone mineral apparent density (BMAD) at the lumbar spine and femoral neck yielded similar results to that of BMD. Spinal BMAD was similar in blacks and whites and femoral neck BMAD was consistently higher in all the menopausal subgroups studied. Weight significantly correlated with peak- and postmenopausal BMD at all sites in the black and white female cohorts. Greater and better maintained body weight may be partially responsible for slower rates of bone loss observed in black postmenopausal females. Most of the observed ethnic difference in BMD was, in fact, explained by differences in body weight between the two cohorts and not by ethnicity per se. 3. A low body weight and advanced age was identified as by far the most informative individual clinical risk factors for osteopenia in our black and white females, whereas physical inactivity was also identified as an important individual risk factor in blacks only. Risk assessment tools, developed and validated in Asian and European populations, demonstrated poor sensitivity for identification of South African women at increased risk of osteopenia. The osteoporosis risk assessment instrument (ORAI) showed the best results, with sensitivities to identify osteopenic whites at most skeletal sites approaching 80% (78% - 81%). The risk assessment tool scores appear to be inappropriate for our larger sized study cohort, especially our black subjects, thus resulting in incorrect risk stratification and poor test sensitivity. General discriminant analysis identified certain risk factor subsets for combined prediction of osteopenia in blacks and whites. These risk factor subsets were more sensitive to identify osteopenia in blacks at all skeletal sites, compared with the risk assessment tools described in the literature. 4. Higher ultrasonographically measured broadband ultrasound attenuation (BUA) and speed of sound (SOS) values were documented in our elderly blacks compared with whites, even after correction for differences in DEXA determined BMD at the spine and proximal femoral sites. BUA and SOS showed no decline with ageing in blacks, in contrast to an apparent significant deterioration in both parameters in ageing whites. If these quantitative ultrasound (QUS) parameters do measure qualitative properties of bone in our black population, independent of BMD as has been suggested in previous work in Caucasian populations, the higher values documented in elderly blacks imply better preservation of bone quality in ageing blacks compared with whites. The correlation between QUS calcaneal BMD and DEXA measured BMD at the hip and spine was modest at best. QUS calcaneal BMD was therefore unable to predict DEXA measured BMD at clinically important fracture sites in our study population. 5. Bone turnover, as assessed biochemically, was similar in the total pre- and postmenopausal black and white cohorts, but bone turnover rates appeared to differ with ageing between the two racial groups. A lower bone turnover rate was noted in blacks at the time of the menopausal transition and is consistent with the finding of a lower percentage bone loss at femoral sites at this time in blacks compared with whites. Bone turnover only increased in ageing postmenopausal blacks, and this could be ascribed, at least in part, to the observed negative calcium balance and the more pronounced secondary hyperparathyroidism noted in blacks. Deleterious effects of secondary hyperparathyroidism on bone mineral density at the proximal femoral sites were demonstrated in our postmenopausal blacks and contest the idea of an absolute skeletal resistance to the action of PTH in blacks. The increase in bone turnover and the presence of secondary hyperparathyroidism due to a negative calcium balance may thus potentially aggravate bone loss in ageing blacks, especially at proximal femoral sites. 6. Shorter, adult black women have a significantly shorter hip axis length (HAL) than whites. This geometric feature has been documented to protect against hip fracture. The approximately one standard deviation (SD) difference in HAL between our blacks and whites may therefore significantly contribute to the lower hip fracture rate previously reported in South African black females compared with whites. Average vertebral size was, however, smaller in black females and fail to explain the apparent lower vertebral fracture risk previously reported in this population. Racial differences in vertebral dimensions (height, width) and/or other qualitative bone properties as suggested by our QUS data may, however, account for different vertebral fracture rates in white and black women – that is, if such a difference in fact exists. 7. The number of women with a history of falls was similar in our black and white cohorts, and in both ethnic groups the risk of falling increased with age. There is a suggestion that the nature of falls in our black and white postmenopausal females may differ, but this will have to be confirmed in a larger study. Fallers in our postmenopausal study population were more likely to have osteoporosis than non-fallers. Postmenopausal blacks in our study demonstrated poorer outcomes regarding neuromuscular function, Vitamin D status and visual contrast testing and were shown to be more inactive with ageing compared with whites. An increased fall tendency amongst the black females could not however be documented in this small study. Quadriceps weakness and slower reaction time indicated an increased fall risk amongst whites, but were unable to distinguish black female fallers from non-fallers. 8. Vertebral fractures occurred in a similar percentage of postmenopausal blacks (11.5%) and whites (8.1%) in our study. Proximal femoral BMD best identified black and white vertebral fracture cases in this study. Quite a number of other risk factors i.e. physical inactivity, alcohol-intake, poorer physical performance test results and a longer HAL were more frequent in the white fracture cases and could therefore serve as markers of increased fracture risk, although not necessarily implicated in the pathophysiology of OP or falls. However, in blacks, only femoral BMD served as risk factor. Similar risk factors for blacks and whites cannot therefore be assumed and is deserving of further study. White fracture cases did not fall more despite lower 25-OH-Vitamin D, poorer physical performance and lower activity levels than non-fracture cases. Calcaneal ultrasonography and biochemical parameters of bone turnover were similar in fracture and non-fracture cases in both ethnic groups. Our study data on vertebral fractures in this cohort of urbanized blacks thus cautions against the belief that blacks are not at risk of sustaining vertebral compression fractures and emphasize the need for further studies to better define fracture prevalence in the different ethnic populations of South Africa. 9. In our study, hormone therapy in postmenopausal white women improved bone strength parameters and reduced fall risk. In hormone treated whites compared with non-hormone users, a higher BMD at the spine and proximal femur as determined by DEXA were documented and all QUS measurements were also significantly higher. The biochemically determined bone turnover rate, as reflected by serum osteocalcin levels, was lower in hormone users. Fall frequency was lower in the older hormone treated women (≥ 60yrs) and greater quadriceps strength and reduced lateral sway was noted. Only one patient amongst the hormone users (2%) had radiological evidence of vertebral fractures compared with four patients (6%) amongst the never-users. As hormone therapy was used almost exclusively by whites in this study population, the impact of hormone therapy on postmenopausal black study subjects could not be assessed.

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Couto, Fernanda Bueno D'Elboux. "Perfil de idosos ativos participantes de um grupo de terceira idade do municipio de Itu que sofreram quedas." [s.n.], 2006. http://repositorio.unicamp.br/jspui/handle/REPOSIP/252940.

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Orientador: Monica Rodrigues Perracini
Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Educação
Made available in DSpace on 2018-08-07T16:08:14Z (GMT). No. of bitstreams: 1 Couto_FernandaBuenoD'Elboux_M.pdf: 663108 bytes, checksum: 0f27420af62b7a0a088cc1f56a53fa01 (MD5) Previous issue date: 2006
Resumo: Queda é um evento freqüente na população idosa e está associada à incapacidade, institucionalização, declínio da saúde e mortalidade. OBJETIVO: Analisar o comportamento de variáveis sócio-demográficas, clínicas, funcionais e psico-cognitivas em idosos ativos residentes na comunidade, identificando o perfil destes idosos quanto a quedas e quedas recorrentes. MÉTODO: Estudo exploratório com 150 idosos com 65 anos e mais, com idade média de 71,9 ± 5,6 anos, participantes de um grupo de terceira idade. Utilizou-se uma entrevista semi-estruturada e os instrumentos BOMFAQ, GDS, MEEM e Timed up and go test. Procedeu-se a análise de cluster e de regressão logística multivariada com nível de significância de p<0.05. RESULTADOS: A prevalência de quedas foi de 38,7%, sendo que 62,1% caíram uma única vez e 37,9% caíram duas ou mais vezes. As fraturas ocorreram em 6,4% da amostra de idosos que caíram, sendo que o hematoma, o edema e o corte, associados, foram as lesões mais freqüentes. Verificou-se que não houve diferença significativa entre os perfis para nenhum dos blocos de variáveis tanto nas análises de regressão logística uni e multivariada para quedas, mas a análise univariada para quedas recorrentes mostrou que os indivíduos sem depressão mas com alteração cognitiva tem 2,7 vezes mais chance de cair, mas quando na presença dos demais perfis, essa diferença torna-se uma tendência levemente significativa (p=0.082)
Abstract: Falling is a regular event in the elderly population, being related to impairment, institutionalization, health decreasement and mortality. OBJECTIVE: To analyse the social-demographic, clinical, psychological-cognitive and functional variables behaviour in the community living elderly, identifying their profile as for falling and recurrent falling. METHOD: Exploratory study of 150 elderly with 65 years or over, with an average age of 71,9 ± 5,6 years, who participate in a third age group. A semi-structured interview was used, plus the BOMFAQ, GDS, MEEM and Timed up and go test instruments. Cluster and multivariated logistic regression analysis were applied, with a 95% confidence intervals. RESULTS: Fall prevalency equaled 38,7%, with 62,1% falling only once and 37,9% falling twice or more. Fractures occurred in 6,4% of the falling elderly sample, and associated bruise, swelling and cuts were the most frequent injuries. There was no meaningful difference between the profiles verified for none of the variable blocks both in the univariated and multivariated logistical regression analysis for falling, but the univariated analysis for recurrent falling has shown that subjects with no depression but displaying cognitive disorders have 2.7 times greater chance of falling, but in the presence of the remaining profiles, this difference becomes a slightly significant tendency (p=0.082)
Mestrado
Mestre em Gerontologia

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Sylvestre, Marie-Pierre. "Flexible modelling for the cumulative effects of time-varying exposure, weighted by recency, on the hazard." Thesis, McGill University, 2008. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=111917.

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Many epidemiological studies assess the effects of time-dependent exposures, where both the exposure status and its intensity vary over time. The analysis of such studies poses the challenge of modelling the association between complex time-dependent drug exposure and the risk, especially given the uncertainty about the etiological relevance of doses taken in different time periods.
To address this challenge, I developed a flexible method for modelling cumulative effects of time-varying exposures, weighted by recency, represented by time-dependent covariates in the Cox proportional hazards model. The function that assigns weights to doses taken in the past is estimated using cubic regression splines. Models with different number of knots and constraints are estimated. Bootstrap techniques are used to obtain pointwise confidence bands around the weight functions, accounting for both the sampling variation of the regression coefficients, and the uncertainty at the model selection stage, i.e. the additional variance due to a posteriori selection of the number of knots.
To assess the method in simulations, I had to develop and validate a novel algorithm to generate event times conditional on time-dependent covariates and compared it with the algorithms available in the literature. The proposed algorithm extends a previously proposed permutational algorithm to include a rejection sampler. While all the algorithms generated data sets that, once analyzed, provided virtually unbiased estimates with comparable variances, the algorithm that I proposed reduced the computational time by more than 50 per cent relative to alternative methods. I used simulations to systematically investigate the properties of the weighted cumulative dose method. Six different weight functions were considered. Simulations showed that in most situations, the proposed method was able to capture the shape of the true weight functions and to produce estimates of the magnitude of the exposure effect on the risk that were close to those used to generate the data. I finally illustrated the use of the weighted cumulative dose modelling by reassessing the association between the use of selected benzodiazepines and fall-related injuries, using administrative data on a cohort of elderly who initiated their use of benzodiazepines between 1990 and 2004.

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Santos, Angela Cristina Silva dos. "Valor dos instrumentos de avaliação de risco de quedas em idosos com fibrilação atrial." Universidade de São Paulo, 2007. http://www.teses.usp.br/teses/disponiveis/5/5131/tde-12022008-132620/.

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INTRODUÇÃO: A queda é um fenômeno complexo, altamente prevalente e de alto custo, podendo causar sérias conseqüências inclusive a morte. O idoso com fibrilação atrial se beneficia do uso de anticoagulante. No entanto, a ocorrência de quedas pode restringe o seu uso. Este trabalho objetivou analisar a associação entre a ocorrência de queda e as variáveis obtidas na avaliação clínica e multifatorial em idosos com fibrilação atrial; verificar a freqüência, características e conseqüências das quedas. MÉTODOS: Neste estudo transversal, foram avaliados 107 idosos com 60 anos ou mais com fibrilação atrial crônica do ambulatório de cardiogeriatria do InCor-HCFMUSP. Os participantes foram divididos em dois grupos: (1) sem história de queda no último ano e (2) com história de um ou mais episódios de queda no último ano. Foram submetidos à avaliação que incluiu: dados sóciodemográficos; história da quedas; suas características e conseqüências; questionários de qualidade de vida (BOMFAQ); de nível funcional (HAQ); de risco nutricional (Guigoz); da função psico-cognitiva (Prime MD, Mini-Mental); avaliação do equilíbrio e da mobilidade (escala de Berg, POMA, Timed up & go); avaliação neurológica e de força muscular; avaliação da acuidade visual (tabela de Snellen e teste de Donders) e avaliação auditiva. Todos os dados foram submetidos à análise estatística com teste qui-quadrado ou teste de verossimilhança ou teste exato de Fisher. As médias das variáveis quantitativas foram comparadas com teste t-Student ou teste da soma de postos de Wilcoxon. Os valores de p<0,05 foram considerados estatisticamente significantes. As variáveis significantes na análise univariada foram utilizadas no ajuste do modelo de regressão logística, determinando sensibilidade, especificidade e probabilidade estimada de queda. Resultados: 1) 51,4% (55 idosos) caíram ao menos uma vez no último ano, sendo que as quedas resultaram em lesões corporais em 90% dos casos, 2) não houve diferenças entre os grupos com respeito à idade, sexo, índice de massa corporal, hábitos, riscos nutricionais e atividade física, 2) houve relação significante entre a ocorrência de queda com: a presença de sintomas, como cansaço; o uso de amiodarona; diagnóstico de insuficiência cardíaca CF III e de diabete melito; força muscular; o BOMFAQ (dificuldade de manter o equilíbrio); deficiência auditiva e visual e a escala equilíbrio da POMA A regressão logística das variáveis significantes positivas mostrou as seguintes variáveis independentes: uso de amiodarona, diagnóstico de diabete melito e a queixa de dificuldade de manter equilíbrio no BOMFAQ. O conjunto apresentou sensibilidade de 92,9% e especificidade 44,9%, a razão de chance foi de 5,95 e razão de verossimilhança positivo foi de 5.0. Conclusão:Em um grupo de idosos com FAC capaz de freqüentar ambulatório e relativamente independente, muitos fatores de risco de quedas foram identificados, sendo preditores independentes deste risco, a simples referência de dificuldade em manter o equilíbrio, o diagnóstico de diabete melito e o uso de amiodarona; A ocorrência de quedas com recorrências e conseqüências foi elevada. Nesses pacientes, o questionamento sobre a ocorrência de quedas no último ano e a avaliação do risco de quedas é fundamental diante da decisão em indicar a anticoagulação.
Introduction: Falling is a complex phenomenon, highly prevalent and costly. It may cause serious consequences, including death. Anticoagulation is beneficial for elderly patients with atrial fibrillation. However, falls may limit its use, especially when recurrent. The goals of this study were to evaluate the association between the occurrence of falls and variables derived from clinical and multidisciplinary evaluation of elderly patients with atrial fibrillation, to analyze the prevalence, characteristics and consequences of falls. Methods: This cross-sectional study involved 107 elderly patients older than 60 years of age with chronic atrial fibrillation who were followed in the Geriatric Cardiology Outpatient Clinic of InCor-HCFMUSP. Subjects were divided in two groups: (1) those with no history of falls in the past year, and (2) patients with at least one fall within the previous year. All patients underwent clinical and multifactorial evaluation, which included socio-demographic data, history of falls, their characteristics and consequences, questionnaires on quality of life (BOMFAQ), functional activity (HAQ), nutritional risk (Guigoz), psycho-cognitive function (PRIME MD, Mini-Mental), and the following evaluations: balance and mobility (Berg scale, POMA, Timed up & go), neurologic, muscular strength, and hearing status, and visual acuity (Snellen table and Donders test). Statistical tests employed included chi-square, analysis of likelihood methods, and Fisher exact test, as appropriate. Quantitative variables were compared by t-test or Wilcoxon. A p-value <0.05 was considered statistically significant. Variables statistically significant by univariate analysis were employed in a model of logistic regression to determine sensitivity, specificity, and estimated probability of falls. Results: 1) 51.4% of the patients (55) fell at least once in the preceding year, with 90% of the falls resulting in corporal lesions. 2) There were no difference between the two groups in regard to age, gender, body mass index, habits, nutritional risks, and level of physical activity. 3) There was a significant relationship between the occurrence of fall and the following univariate variables: symptom of fatigue, use of amiodarone, class III heart failure , diabetes, muscular strength, difficulty to maintain balance detected by the BOMFAQ questionnaire, hearing and visual impairment, and POMA balance scale. 4) The risk factors most frequent were hypertension, visual and hearing impairments, and muscular weakness. Logistic regression yielded the following independent variables: use of amiodarone, diabetes, and difficulty to maintain balance by BOMFAQ. These variables together had 92,9% sensitivity and 44,9% specificificity for predicting the occurrence of falls, with a hazard ratio of 5.95 and likelihood methods of 5.0. Conclusion: in a group of relatively independent, elderly patients with chronic atrial fibrillation which were able to visit an out-patient clinic, many risk factors for falls were identified. The multivariate analysis identified as independent risk factors, the use of amiodarone, the diagnosis of diabetes and difficulty in maintaining balance detected by the BOMFAQ questionnaire. The frequency of falls with recurrences and consequences was high. In these patients, it is very important to ask about the occurrence of falls in the last year and to evaluate the risk of falls, considering the decision to prescribe anti-coagulation.

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Sunčica, Ivanović. "Фактори ризика за пад и функционална способност старих особа." Phd thesis, Univerzitet u Novom Sadu, Medicinski fakultet u Novom Sadu, 2017. https://www.cris.uns.ac.rs/record.jsf?recordId=104912&source=NDLTD&language=en.

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Увод. Годишње најмање 30% особа старијих од 65 година доживи један или више падова. Са повећањем година повећава се и озбиљност компликација услед пада, степен функционалног оштећења и ниво инвалидитета. Одговорност за пад приписује се многим факторима ризика. Због сложености њихове природе, од кључног је значаја да се ревидирају концептуални и методолошки оквири за разумевање и предвиђање пада у популацији старих особа. Циљеви истраживања. Утврдити учесталост падова код особа старијих од 65 година; утврдити најзначајније факторе ризика од пада и проценити њихову интеракцију са функционалним способностима и забринутост због пада. Материјал и методологија. Истраживање је спроведено у од фебруара до јуна 2014. године у виду студије пресека и обухватило је 400 испитаника старијих од 65 година. Испитаници су тестирани у кућним условима приликом посете патронажне службе. Коришћени су следећи инструменти: општи упитник, Elderly Fall Screening Test – ЕFST, Multi-factor Falls Questionnaire – MFQ, Tinetti Balance Assessment, Lawton Instrumental Activities of Daily Living Scale − IADL, Falls Efficacy Scale International FES-I. Стaтистички прорaчуни су вршени прогрaмом SPSS верзијa 20. Резултати истраживања. Резултати студије показују да је пад доживело 55% испитаника. Регресиони модел EFST са варијаблама био је статистички значајан, а као независни предиктори показали су се женски пол (OR = 2,751; < 0,001), године старости (OR = 1,138; p < 0,001), и степен образовања (OR = 0,554; p = 0,027). Слични резултати су добијении и за регресиони модел са Тинетијевим скором где су се као независни предиктори показали пол (Beta = -0,107; p = 0,029) старост (Beta = -0,260; p < 0,001) и степен образовања (Beta = 0,191; p < 0,001). Све корелације између ЕFST, FESI, IADL и скором Тинетијевог теста биле су статистички значајне (p < 0,05). Вредности скора FESI биле су у јакој позитивној корелацији са скором ЕFST и изузетно негативној корелацији са IADL и скором Тинетијевог теста. Скор ЕFST показао је умерену негативну корелацију са скором IADL и јаку негативну са скором Тинетијевог теста, док су скор IADL и скор Тинетијевог теста показали умерену позитивну корелацију. Модел EFST био је статистички значајан и у целини тачно класификује 83,3% случајева. Варијабле које су се показале као независни предиктори били су: Тинети скор (OR = 0,783; p < 0,001), скор (OR = 1,041; p = 0,019) и ортостатска хипотензија (OR = 2,291; p = 0,035). Закључак. У испитиваној популацији падови су веома учестала појава и више од половине особа доживела је пад у последњих годину дана. У повећаном ризику од пада су жене. Такође ризик од пада повећава се са годинама старости. Нижи степен образовања показао се као независни предиктор пада. Предикција ризика од пада утврђеног на основу скрининг тест за пад код старих особа у општој популацији могућа је уз висок степен детерминације на основу скора Тинетијевог теста и, скора FESI и ортостатске хипотензије.
Uvod. Godišnje najmanje 30% osoba starijih od 65 godina doživi jedan ili više padova. Sa povećanjem godina povećava se i ozbiljnost komplikacija usled pada, stepen funkcionalnog oštećenja i nivo invaliditeta. Odgovornost za pad pripisuje se mnogim faktorima rizika. Zbog složenosti njihove prirode, od ključnog je značaja da se revidiraju konceptualni i metodološki okviri za razumevanje i predviđanje pada u populaciji starih osoba. Ciljevi istraživanja. Utvrditi učestalost padova kod osoba starijih od 65 godina; utvrditi najznačajnije faktore rizika od pada i proceniti njihovu interakciju sa funkcionalnim sposobnostima i zabrinutost zbog pada. Materijal i metodologija. Istraživanje je sprovedeno u od februara do juna 2014. godine u vidu studije preseka i obuhvatilo je 400 ispitanika starijih od 65 godina. Ispitanici su testirani u kućnim uslovima prilikom posete patronažne službe. Korišćeni su sledeći instrumenti: opšti upitnik, Elderly Fall Screening Test – EFST, Multi-factor Falls Questionnaire – MFQ, Tinetti Balance Assessment, Lawton Instrumental Activities of Daily Living Scale − IADL, Falls Efficacy Scale International FES-I. Statistički proračuni su vršeni programom SPSS verzija 20. Rezultati istraživanja. Rezultati studije pokazuju da je pad doživelo 55% ispitanika. Regresioni model EFST sa varijablama bio je statistički značajan, a kao nezavisni prediktori pokazali su se ženski pol (OR = 2,751; < 0,001), godine starosti (OR = 1,138; p < 0,001), i stepen obrazovanja (OR = 0,554; p = 0,027). Slični rezultati su dobijenii i za regresioni model sa Tinetijevim skorom gde su se kao nezavisni prediktori pokazali pol (Beta = -0,107; p = 0,029) starost (Beta = -0,260; p < 0,001) i stepen obrazovanja (Beta = 0,191; p < 0,001). Sve korelacije između EFST, FESI, IADL i skorom Tinetijevog testa bile su statistički značajne (p < 0,05). Vrednosti skora FESI bile su u jakoj pozitivnoj korelaciji sa skorom EFST i izuzetno negativnoj korelaciji sa IADL i skorom Tinetijevog testa. Skor EFST pokazao je umerenu negativnu korelaciju sa skorom IADL i jaku negativnu sa skorom Tinetijevog testa, dok su skor IADL i skor Tinetijevog testa pokazali umerenu pozitivnu korelaciju. Model EFST bio je statistički značajan i u celini tačno klasifikuje 83,3% slučajeva. Varijable koje su se pokazale kao nezavisni prediktori bili su: Tineti skor (OR = 0,783; p < 0,001), skor (OR = 1,041; p = 0,019) i ortostatska hipotenzija (OR = 2,291; p = 0,035). Zaključak. U ispitivanoj populaciji padovi su veoma učestala pojava i više od polovine osoba doživela je pad u poslednjih godinu dana. U povećanom riziku od pada su žene. Takođe rizik od pada povećava se sa godinama starosti. Niži stepen obrazovanja pokazao se kao nezavisni prediktor pada. Predikcija rizika od pada utvrđenog na osnovu skrining test za pad kod starih osoba u opštoj populaciji moguća je uz visok stepen determinacije na osnovu skora Tinetijevog testa i, skora FESI i ortostatske hipotenzije.
Introduction. Annually at least 30% of people over 65 experience one or more falls. With the increase in years, the severity of complications due to falls, degree of functional impairment and level of disability also increase. The responsibility for the fall is attributed to many risk factors. Due to the complexity of their nature, it is crucial that the conceptual and methodological frameworks for understanding and predicting the decline in the elderly population are revised. Research goals. Determine the incidence of falls in people over 65 years of age; identify the most important risk factors of the fall and evaluate their interaction with functional abilities and fear for falling. Material and methodology. The survey was conducted from February to June 2014 in the form of a cross sectional study and included 400 respondents over 65 years of age. Respondents were tested at home during a visit of the patronage service. The following instruments were used: general questionnaire, Elderly Fall Screening Test - EFST, Multi-factor Falls Questionnaire - MFQ, Tinetti Balance Assessment, Lawton Instrumental Activities of Daily Living Scale - IADL, Falls Efficacy Scale International FES-I. Statistical calculations were performed by the SPSS version 20 program. Research results. The results of the study show that the fall was experienced by 55% of respondents. The regression model EFST with variables was statistically significant, and as independent predictors the female sex (OR = 2,751; <0,001), age (OR = 1,138; p <0,001), and the level of education (OR = 0,554; p = 0.027) were shown. Similar results were obtained for the regression model with the Tinetti's score, where the gender (Beta = -0.107; p = 0.029) age (Beta = -0.260; p <0.001) and education (Beta = 0.191; p < 0.001) were shown as independent predictors. All correlations between EFST, FESI, IADL and the Tinetti's test score were statistically significant (p <0.05). The FESI score values were in a strong positive correlation with the EFST score and extremely negative correlation with IADL and the Tinetti’s test score. The EFST score showed a moderate negative correlation with the IADL score and a strong negative with the Tinetti’s test score, while the IADL score and the Tinetti test score showed moderate positive correlation. The EFST model was statistically significant and in its entirety accurately classified 83.3% of cases. Variables that proved to be independent predictors were: Tinetti score (OR = 0.783; p <0.001), score (OR = 1.041; p = 0.019) and orthostatic hypotension (OR = 2.291; p = 0.035). Conclusion. In the studied population, falls are a very common occurrence and more than half of the people experienced a fall in the past year. Women are at increased risk of falling. Also, the risk of falling increases with age. A lower level of education has proven to be an independent fall predictor. Prediction of the risk of a fall that has been established on the basis of a screening test for elderly people in the general population is possible with a high degree of determination based on the Tinetti test score and, recent FESI and orthostatic hypotension.

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Lopes, Joana Rita Ferreira. "Accidental Fall in Hemiparetic Patients: Functional Risk Assessment and Prevention." Master's thesis, 2017. http://hdl.handle.net/10316/81960.

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Trabalho de Projeto do Mestrado Integrado em Medicina apresentado à Faculdade de Medicina
Introdução: A queda acidental é um fenómeno comum na população acometida por acidente vascular cerebral, sendo causa frequente de medo de queda, hospitalização e agravamento do prognóstico. A avaliação do medo de queda é um método já comprovado de prevenção de futura morbilidade, contudo, os estudos realizados em populações hemiplégicas funcionais são ainda escassos, nomeadamente em Portugal.Objetivos: Avaliar a utilização da Fall Efficacy Scale (FES), na versão portuguesa, como preditor do risco de queda numa população hemiplégica funcional. Pretende-se ainda comparar o risco de queda nesta população com outra sem défices motores e funcionais.Materiais e Métodos: Este estudo explorativo não randomizado foi realizado no Serviço de Medicina Física do Centro Hospitalar Universitário de Coimbra (PRM-CHUC), com uma amostra experimental de 33 doentes hemiplégicos de 45-80 anos, com evento vascular cerebral ocorrido há mais de 12 meses, capazes de efectuar marcha autónoma e com Medida de Independência Funcional (FIM) superior a 110. Foram submetidos a um questionário que incluía parâmetros sociodemográficos, antropométricos, caracterização das quedas, execução de uma marcha de 10 metros cronometrada e a FES. Recorreu-se também a um grupo de controlo de 33 adultos, de 65-75 anos, com FIMs equivalentes e sem défices motores. Foram utilizados os testes t-student para amostras independentes, coeficiente de correlação e qui-quadrado de Pearson, na versão 22 do SPSS Statistics®. Resultados: Do grupo experimental com 7 mulheres e 26 homens, com idade média de 61.09±7.34 anos, 51.5% (17 pacientes) tiveram pelo menos uma ocorrência de queda, com uma média de 2.59±1.58. Os 17 que caíram obtiveram um score médio na FES de 72.41±22.62 enquanto os 16 que não caíram obtiveram 85.75±6.55. A FES revelou uma relação significativa com a ocorrência de queda (p=0.031) e correlação significativa com o número de quedas (p=0.032 e coeficiente correlativo de Pearson= -0.520). Do grupo controlo de 33 adultos, 9 homens e 24 mulheres, com uma idade média de 68.61±2.78, 57.6% (19 pacientes) tiveram pelo menos uma ocorrência de queda, com uma média de 2.42±2.27. Não se demonstrou diferença significativa entre o número de quedas do grupo experimental e do grupo controlo (p=0.579 e qui-quadrado de Pearson= 0.308). Conclusão: A FES pode ser utilizada como um instrumento preditor da ocorrência de quedas em populações hemiplégicas funcionais. Este tipo de população, após um programa de reabilitação, é equiparável, em termos de morbilidade relativa a quedas acidentais, a uma população de adultos saudáveis. Este facto acentua a importância da reabilitação para a manutenção da funcionalidade individual.
Introduction: Accidental fall is a common event in stroke patients, leading to fear of falling, frequent hospitalization and worsening prognosis. The fear of falling assessment is an important and proven method for preventing future disability but is yet to be fully tested in functional hemiparetic populations, particularly in Portugal.Objectives: To evaluate the use of the Fall Efficacy Scale (FES), in its Portuguese validated version, as a predictor of fall risk in a functional hemiparetic population. This population’s falls were also compared to a control population, with no motor or functional deficits. Materials and Methods: This exploratory non-randomized study was conducted in the Physical and Rehabilitation Medicine department in the Coimbra Hospital and University Center (PRM-CHUC) with an experimental group of 33 hemiparetic patients aged between 45 and 80 years, with a minimum of 12 months since stroke and hemiparesis. Autonomous mobility was also required, with or without mobility aids, and a Functional Independence Measure (FIM) superior to 110. They were submitted to a questionnaire which included sociodemographic and anthropometric parameters, fall history and characterization, a timed 10 meter walk test and the FES. A control group of 33 patients ranging from 65 to 75 years was also used, with identical FIMs and no motor deficits. The t-Test for independent samples, Pearson Correlation Coefficient and Pearson Chi-Squared test were used for the statistical analysis, in the SPSS Statistics® version 22.Results: In the experimental group, with 7 women and 26 men, mean age of 61.09±7.34 years, 51.5% (17 patients) experienced at least one fall, with an average of 2.59±1.58 falls. The fallers scored a mean of 72.41±22.62 on the FES while the 16 non-fallers scored 85.75±6.55. The FES revealed a significant relation with fall occurrence (p-value=0.031) and a significant correlation with number of falls (p-value=0.032 and Pearson correlation coefficient= -0.520). In the control group, with 9 men and 24 women, mean age of 68.61±2.78 years, 57.6% (19 patients) experienced at least one fall, with a mean of 2.42±2.27 falls. No significant relation was found between the number of falls of the experimental group and the control group (p-value=0.579 and Pearson Chi-Squared Test=0.308).Conclusions: The FES can be used to predict fall occurrence in functional hemiparetic populations. After a rehabilitation program, a functional hemiparetic population’s fall related mobility is similar to that of a healthy population. This fact enhances the importance of rehabilitation in the maintenance of individual function.

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Vaz, Sílvia Leontina Rosa. "Screening and assessment of risk of falling: basis for exercise prescription." Master's thesis, 2017. http://hdl.handle.net/10400.26/23432.

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Introduction: Falls are currently considered one of the most common and serious public health problems (Gschwind et al 2013). Faced with this problem, it becomes necessary to explore which factors can better predict the risk of falls in individuals living in the community, so that, preventive measures can be considered. Objectives: To identify fall risk indicators and to relate them to exercise prescription levels; to relate the history of fall, the functional capacity (measured through the Timed Up & Go, 10-meter walking speed test, Step test) and the fall risk factors and propose a guide based on those relations to address exercise prescription. Material and Methods: Descriptive and exploratory study. Two hundred community dwelling adults aged 55 or older were assessed, integrating two sub-samples, a Portuguese and a Polish. Study participants were assessed for socio-demographic data, history of falls, fear of falling, exercise, sedentary lifestyle, hearing problems and/or dizziness, visual problems, alcohol consumption, exercise self-efficacy and confidence in activities of the daily life (FES-Portuguese version). They were also subjected to three functional tests, golden measures in the assessment of fall risk, Timed Up and Go (TUG), 10-meter walking speed test and Step Test (15s).The statistical design included descriptive analyses, inferential analyses (bivariate: t-test for independent samples, One-Way ANOVA and Pearson’s correlation coefficient. Results: The percentage of fall in the population was 39.5% and 45.3% in total and Portuguese samples, respectively. TUG, 10-meter walking speed test and step test could distinguish those with history of fall and those without, with statistically significant differences (p≤0.05). Taking more than 4 different medications per day, fear of falling, hearing problems and/or dizziness and the need for help getting up from a chair were related to the history of falls, TUG, walking speed and step test (p≤0.05).The sedentary lifestyle and the use of assistive devices were associated to worst results of the functional tests(p <0.05) in the Portuguese population. TUG, 10-meter walking speed test, step test were correlated with self-efficacy for the exercise. Conclusions: The incidence of falls are higher than literature have reported and it is inversely associated with the functional capacity of the community dwelling adults aged over 55 years old. Data from this study is a valuable basis for exercise prescription, taking into account the levels of risk and the levels of exercise prescription.

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Kuo, Nai-Wei, and 郭乃瑋. "Development of Fall Risk Assessment and Fall Detection System Based on Hidden Markov Model and Gait Parameters." Thesis, 2018. http://ndltd.ncl.edu.tw/handle/dnce3k.

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碩士
國立臺北科技大學
電機工程系
106
This research develops a fall risk assessment and fall detection system based on the hidden Markov model (HMM) and gait parameters. The gait parameters are employed to train the HMM-based gait model. While the user is walking, the smartphone held by the user will extract the gait parameters by using a tri-axial accelerometer and a gyro. The extracted data are then transmitted to the server to calculate the fall risk parameters by employing the gait sequence observed in the HMM. If a fall event was detected, the system will send an alert to the caregiver. The porpsoed system is built based on the client-server framework; the client is constructed by using the Web App to get the user’s gait parameters and the server is established by employing the Node.js to greatly reduce the signal processing time. Experimental results exhibit that the error of the fall risk parameters is less than 6.5% and the sensitivity, specificity, and accuracy for fall detection are 81.2%, 98.7%, and 98.3%, respectively; indicating the preliminary application potential of the proposed system.

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Huang, Chian-rong, and 黃千容. "Application of Bayesian Network in Establishing Fall Type Accident Risk Assessment Model." Thesis, 2009. http://ndltd.ncl.edu.tw/handle/43941932858536001484.

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碩士
國立臺灣科技大學
營建工程系
97
Construction accident not only will result in casualties, but also will cause delay for construction progress, increase project cost and harm in working environment. Apart from being probably addressed on possible criminal responsibility, construction company will also suffer damage regarding to its business image. In order to reduce the accident occurrence, highly important attention not only paid to safety management during construction method, but also to pre-construction safety planning and design assessment. Many advanced countries had included pre-construction safety planning and design rules in their national construction code in order to effectively avoid accident risk during pre-construction stage. Based on above fact, thus this research establish a assessment model and further carry out pre-construction safety risk assessment using qualitative analysis based on the information acquired during pre-construction stage. On the other hand, due to the diversified construction assignment, complexity in construction technique and working environment, it will be extremely difficult to involve all accident types in the assessment model. In addition, as “fall” type accident recent rate is the highest in the construction industry, therefore this research will only consider “fall” type accident risk and finally using Bayesian Network Theory in establishing Pre-Construction Fall Risk Assessment Model.

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42

Wang, Wan-chieh, and 王婉ㄗ. "Validating the Precision of a Fall Risk Assessment Scale for Psychiatric Hospitalization Patients." Thesis, 2011. http://ndltd.ncl.edu.tw/handle/08786415208544316922.

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碩士
大仁科技大學
休閒健康管理研究所
99
The number and percentage of falls was the top of the Taiwan Patient-Safety Reporting System (TPR) with 3,656 counts and 28.8% of the entire reports in 2011. Specific to the psychiatric hospitals, its environmental risk factors were higher than those general hospitals at 15.8% against 15.1%. The focus hospital had reported 108 falls per quarter in 2010 with an extreme high rate of 79.44%. This had made the falls a critical problem to address. The current study attempted to (1) analyze the association of demographic factors of psychiatric hospitalization patients and fall risk factors; (2) explore the accuracy of the fall risk scales in terms of sensitivity, specificity, and likelihood in the context of psychiatric hospitalization patients; (3) examine the influences of risk factors of the scale on the falls of the hospitalized patients. This study was a prospective study which is using a purposive sampling method. Objects were approached between the January 1st, 2011 to the June 30th, 2011 from 661 patients in acute, chronic health insurance, and long-term care units. Some inappropriate cases were excluded with 552 valid cases left for analyses. A new scale was then developed specific for the patients of impatient units in the psychiatric hospital, named as Yulih Psychiatric Impatient Fall Scale (YPIFS). In addition, this study gathered 88 out of 125 reports to the TPR in the period of March to June, 2011 to validate the new scale. The test results indicated that the new scale returned with a sensitivity of 81.82%, specificity of 57.26%, positive predictive value of 32.00%, negative predictive value of 92.76%, and likelihood ratio of 1.96. A logistic regression result shown that the STRATIFY, the Poly-pharmacy, and the Lower Limb Muscle Strength were all statistical significant with the odds ratios of 3.750, 2.877, and1.896 times respectively. These had shown that the new scale had good predictive capability. The average time required for one test was 130.9 ± 43.21 seconds (2.18 minutes). For the time being, the new scale was initially confirmed as an easy, fast, and effective tool in identifying a high risk prospective of fall in a psychiatric hospital. This instrument could be also adopted to develop an active fall-prevention program. Study results and the new scale could be generalized into other hospitals with similar characteristics in screening patients who have high risk of fall.

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Chien-ChingLin and 林建慶. "Fall Risk Assessment in the Elderly Based on Force Plate and Inertial Sensor." Thesis, 2017. http://ndltd.ncl.edu.tw/handle/6r445e.

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44

Chen, Ya ling, and 陳雅伶. "Development and validation of the fall risk assessment tool in Long-term Care Facilities." Thesis, 2010. http://ndltd.ncl.edu.tw/handle/67082330838339076836.

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碩士
長庚大學
護理學系
98
For the elderly residents in a long-term care facility, fall is a common, dangerous problem which influences physical health state. A good effective assessment tool of fall can sift the high-risk group effectively and then it can provide needed preventable measure to prevent them from falling. Therefore, the purpose of the study is to develop on using the risk factor assessment tool in the elderly residents in a long-term care facility, to test its reliability, validity and truly examine the effect in a long-term care facility. The study was designed in a descriptive, correlative and predictive way. The targets were the elderly residents in one nursing home of a medical center in northern Taiwan. First, the study used a retrospective way to understand the dangerous factors of fall from the 66 residents who had the experience of fall in one year. Through this, the assessment tool of risk factor for the residents was developed. It was included 6 essential items: fall experience in one year (RR=275.56), vertigo and dizziness (RR=5.00), walking aids (RR=3.40 and 8.14), medical treatment (RR=8.10), rise and balance test (RR=2.49 and 4.13), and mental status (RR=2.46). Then the first-stage developed from compared with other 3 tools (Morse Fall Scale, STRATIFY, and Hendrich II Fall Risk Assessment Tool) , which were used in foreign long-term care facilitys and nursing homes, focusing on 235 elderly residents in nursing homes who had the reliable and validity test after the assessment and made sure that when the risk factor assessment tool which the researcher developed the long-term care facility had set the scale which was greater than or equal to 7, its sensitivity ( .94), specificity ( .95), ROC curve area ( .94), test-retest reliability (p < .001), and inter-rater reliability (p < .001) were the best. The most effective way is to sift the high, risk group of fall correctly among the residents in the nursing homes. Finally, the study used the developed tool on the residents for 6 months and kept monitoring them once a month. During the evaluation, there were 30 residents in total who fell, and there were 28 ones sifted as ones in the high, dangerous group before they fell. The predicting rate of fall was 93%. In conclusion, it was found that the high, risk assessment tool which the research developed in a long-term care facility had high sensitivity, specificity, test-retest reliability and inter-rater reliability. Moreover, the sifting way is easy, quick, correct, low in cost and suitable for the elderly residents in nursing homes and it can predict steadily if the elder in the high, risk group are going to fall. The study suggest that the tool apply on other nursing homes in other facilities or long-term care facilities and evaluate once a month and have a longitudinal study for one year or more. Then we can evaluate its prediction and population and see the items on the tool to understand the risk factors which make the elderly fall. Focusing on the risk factors, we can deal with them by carrying out fall prevention for individuals with personal needs. At last, we can see the effects of the prevention.

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Kuo, Hsiao-I., and 郭曉意. "The Reliability, Validity, and Responsiveness ofThe Fall Risk Assessment Tool for Subjects with Stroke." Thesis, 2010. http://ndltd.ncl.edu.tw/handle/07669413783708271669.

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碩士
臺灣大學
物理治療學研究所
98
Background and Purpose: Previous studies have found the physical impairments of intrinsic factors were important risk factors for falls in subjects with stroke. One approach for assessing intrinsic fall risk was Physiological profile Assessment (PPA), which was developed in 1991 by Dr. Lord. To be practical in clinical setting, present study chose the short form of PPA which contained five components, i.e., vision, peripheral sensation, muscle force, reaction time, and balance. The aim of this study was to assess the reliability, acuuracy, and responsiveness of PPA-short form for subjects with stroke. Methods: Sixty subjects with stroke aged 52-81 years were recruited in the study (Mean STREAM= 65.4). We chose PPA-short form to assess the population. The short form contained 5 items: a test of vision (edge contrast sensitivity), proprioception, knee extension force, hand choice reaction time and body sway (sway when standing on the medium-density foam rubber mat). The method included three major parts. The first part was to examine the test-retest reliability of PPA among subjects with stroke on two occasions with one week apart by intraclass correlation coefficient (ICC) analysis. The second part was to calculate the association validity of the PPA to the other measures for fall risk (i.e., Berg balance scale) in subjects with stroke by the Pearson correlation coefficient. The PPA was also be analyzed between fallers and non-fallers for subjects with stroke, and the accuracy was analyzed with receiver operating characteristics curve (ROC-curve). The third part was to assess the responsiveness of PPA by investigating the changes after four weeks balance training in subjects with stroke. The results would help the fall risk assessment in clinics. Results: A strong correlation was observed between PPA overall fall risk score and Berg balance scale (r=-0.605). All PPA tests showed good test-retest reliability (ICC= 0.83-0.96). Twenty-two participants were classified as fallers. Significant differences were found between fallers and non-fallers on all physiological domains (p<0.05). The PPA classified 91% subjects into faller and non-faller group. All PPA variables showed moderate to large responsiveness (ES=0.5-4.8; SRM=3-41) except vision (ES=0.1; SRM=0.3). Conclusions: The PPA which demonstrated good reliability, accuracy and responsiveness was recommended as a good fall risk assessment tool for mild to moderate stroke.

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Sun, Jui-Chuan, and 孫睿銓. "The application of force plates on fall-risk assessment and prediction in older adults." Thesis, 2018. http://ndltd.ncl.edu.tw/handle/7s69rs.

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碩士
國立陽明大學
物理治療暨輔助科技學系
107
Background: The global population is rapidly aging, and the population in Taiwan also become an aged society in 2018. The second leading cause of death in Taiwan from over 65 years old is accidental fall. There are 51% of older adults have experience of falling, and 39% of them will fall again. Additional-ly, the chance of falls increases with age. Falls will not only cause physical damage to the individuals, but also affect their psychological, family and even socio-economic aspects. Therefore, screening for high-risk individuals and preventing fall of elderly people have become an important issue of concern for the elderly. However, it is difficult to screen out high-risk individuals at present because the subjective clinical tests require well-trained people to execute assessments, and the objective analysis methods, such as instrument analysis, are limited for specific space and high cost of the equipment. Purpose: The purpose of this study is to design a cheaper and easy-portable force plate, and use this force plate to develop an easy-to-execute movement test as a fall-risk screening test. Then establishing a quantifiable fall-risk index according to the result of the movement tests. Method: 59 subjects participated in the study, including 43 elderly adults and 16 young adults. It is a cross-sectional exploration study that uses the Physiological Profile Assess-ment, PPA, to stratify elderly subjects into three group according to the score of PPA. Comparisons of basic characteristics and fall-related performance among those groups were conducted using one-way ANOVA and Pearson’s Correlation Analysis. The predictive and discriminative abilities of the movement tests to different fall-risk groups were examined by Pearson correlation coefficient. Result: In sit-to-stand test (STS), reaction time (RT), maximum reaction force divided by the body weight (MF/BW), power, and stabilization time (EndP), those parameters were significantly different between the young and the elderly adults (p < .05). However, according to the PPA score, the senior group (43 people) is stratified into three groups, of which 29 people (67.4%) have a low fall-risk, 6 people (15.0%) have a medium fall-risk, and 8 people (18.6%) have a high fall-risk. There were no significant differences in gender, body weight (BW), history of fall (FH), timed-up and Go test (TUG), reaction time (RT), maximum reaction force (MF), MF/BW, power, and stabilization time between those groups. However, the results showed the trend that the movement performance got badly as the fall-risk increased. There is significant deference in age and Fall_risk index between the groups(p<.05). The age of people in low fall-risk group averaged 67.8±7.4 years old, in the medium fall-risk group averaged 69.1±6.2 years old, and in the high fall-risk group aver-aged 76.6±6.6 years old. The Fall_risk index of people in low fall-risk group averaged 2.68±0.63, in the medium fall-risk group averaged 3.52±1.98 years old, and in the high fall-risk group averaged 3.81±1.54 years old. Discussion: The muscle strength of the elderly is gradually declining, and the reaction time of the elderly is longer than that of the adults below 65 years old, which may result in weaker power of lower extremities when performing functional activities. And prevention of falls requires individuals to respond to accidents effectively in a short time. In other words, to prevent falls requires sufficient power of lower extremities to face the accidents, so it is very important to distinguish muscle strength between the elderly and adults below 65 years old. The EndP reflects the coordination which maintain body posture; therefore, we believe that MF and EndP can be regarded as the parameters of the risk of falling, which is the ele-ments of the Fall_risk index (Fall_risk). The definition of Fall_risk is: "stability time / maximum reaction force * 100". Although the fall risk index did not show a significant correlation with the fall history, it was significantly positively correlated with the PPA value (r=.476, p<.01). Conclusion: As individual aging, many physiological system functions gradually degradation, also include the balance performance, which will be affected and gradually getting bad. This study uses the developed force plate to distinguish the difference between the elderly and adults. In the future, the parameters can be reference indicators for pre-dicting aging and performance degradation. The parameters, including RT, MF, power, EndP, and the Fall_risk index, can be tested by using the developed force plate with sit-to-stand test (STS). And the Fall_risk index can be used as an indicator for screening of falling risk of elderly. The larger value of Fall_risk index indicates the higher risk of falling.

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47

Beauchamp, Marla Kim. "Balance Assessment and Treatment in Individuals with Chronic Obstructive Pulmonary Disease." Thesis, 2012. http://hdl.handle.net/1807/33929.

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Preliminary evidence suggests that balance deficits constitute an important secondary impairment in individuals with chronic obstructive pulmonary disease (COPD). The main objective of this thesis was to describe balance impairment and fall risk in individuals with COPD and to examine interventions for improving balance and reducing fall risk in the context of pulmonary rehabilitation. The first study of this thesis showed that falls are common in patients with COPD and that fallers are characterized by impairments in standard clinical balance measures, such as the Berg Balance Scale and Timed Up and Go. In the second study, we found that the exercise component of conventional pulmonary rehabilitation has only modest effects on balance and fall risk in COPD, highlighting the need to examine the role of balance-specific training for these patients. The third study of this thesis identified the postural control subsystems most responsible for the observed balance deficits in COPD. Compared with age-matched controls, individuals with COPD demonstrated reductions in all balance control subsystems and slower reaction times in response to external perturbations. In this study, we also showed that deficits in balance in patients with COPD were associated with peripheral muscle weakness and reduced physical activity levels. These results informed the design of the final study of this thesis, a randomized controlled trial evaluating the addition of specific balance training to pulmonary rehabilitation for improving balance in patients with COPD. Preliminary results from this study suggest that the addition of thrice weekly balance exercises to a conventional pulmonary rehabilitation program is effective for optimizing gains in measures of functional balance and fall risk. The findings from the four studies included in this thesis support the need for incorporating balance assessment and treatment for at-risk patients with COPD, as part of their comprehensive management.

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Shen, Chia-Chen, and 沈家禎. "Combined Effect of Physical Activity and Mini Nutrition Assessment (MNA) on Predicting the Risk of Fall in Elderly Taiwanese." Thesis, 2014. http://ndltd.ncl.edu.tw/handle/78854782548848367180.

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碩士
亞洲大學
健康產業管理學系健康管理組碩士在職專班
102
Background: Research shows that one-third of the elderly will fall, which is a leading cause of accidental death for the elderly. Not only does fall causes harm and suffering for the elderly, it also increases burden on caregivers. Numerous fall prevention methods exist nowadays, but how to reduce the risk of falls is worth exploring. Study objectives: This study investigates the combined effect of daily exercise and nutritional status on reducing the risk of falling. Study methods: The resource “Taiwan Longitudinal Survey on Aging (TLSA)” of this study comes from the Health Promotion Administration, Ministry of Health and Welfare. It was based on the information taken from 1999 to 2003. Logistical regression analysis was conducted to determine the effect of daily physical activity and nutritional status on the risk of falls. Results: Studies have shown by daily exercise and well nutrition status (MNA score≧ 24) as a control group. Poor daily exercise and nutritional status (MNA < 24) will increase 85% the risk of fall (p<.001) than those who have well daily exercise and nourished (MNA≧ 24). Conclusion: The study found that combined effect of well daily physical activity and nutritional status will reduce the risk of falls. Research also showed nourished (MNA score≧ 24) has lower the risk of falls than their risk for malnutrition (MNA score < 24). The well daily physical activity has the lower risk of falls than the poor daily physical activity and malnutrition. The results are consistent with the findings of other scholars. The importance of physical activity and a balanced diet displayed, and through simple nutritional assessment scales may be used as the elderly fall risk assessment, in order to prevent the occurrence of falls for the elderly.

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49

Schick, Carol Maureen. "Identifying elderly patients at risk to fall utilizing nurses' assessments and the Morse Fall Scale." 1991. http://hdl.handle.net/1993/17402.

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50

Clark, Sean. "Task and support surface constraints on the coordination and control of posture in older adults." Thesis, 1998. http://hdl.handle.net/1957/33801.

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Although research evidence clearly indicates support surface properties are a major factor contributing to fall risk among the elderly, investigations examining the influence of variations in surface conditions on the postural control of older adults during task performance have been limited. Thus, the primary purpose of the present studies was to determine whether the coordination and control of body kinematics exhibited by older adults during upright leaning (i.e., leaning forward through the region of stability) and gait would be different across variations in support surface properties. Secondary objectives of these studies included, examining if coordination and control measures of body kinematics differed as a function of the participants' level of postural stability and/or repeated exposure to the support surface properties. Three support surface conditions were selected for inclusion based on resistance properties to applied forces (i.e., normal and shear): rigid, high friction; compliant; and rigid, low friction. For both tasks performed, body kinematics for trials 1-3 (T1) and 10-12 (T2) from 12 completed trials on each support surface were analyzed using three-dimensional (3-D) video analyses. Results of separate univariate repeated measures analyses of variance yielded significant surface condition main effects for lower extremity coordination patterns and postural control strategies in the gait and leaning task, respectively. Additionally, a significant surface condition main effect and an interaction effect of surface condition by trial block were identified for the measure of head stability in the gait and leaning tasks, respectively. Differences in head stability and the control of lower extremity joint motions as a function of level of postural stability (i.e., group differences) were observed only during the walking task. Present findings indicate that during goal-directed behavior, the coordinated movements of the body and its segments emerge from constraints imposed by the interaction of the support surface, the task and the individual. The observed adaptations in the coordination and control of posture in response to support surface constraints evidenced in the present studies provide support for the theory of perception and the control of bodily orientation (Riccio & Stoffregen, 1988).
Graduation date: 1998

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