| 1. |
- Hasselgren, Lotta, et al.
(författare)
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Is leg muscle strength correlated with functional balance and mobility among inpatients in geriatric rehabilitation?
- 2011
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Ingår i: Archives of gerontology and geriatrics (Print). - : Elsevier BV. - 0167-4943 .- 1872-6976. ; 52:3, s. E220-E225
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Tidskriftsartikel (refereegranskat)abstract
- Determinants of previous termfunctional balance and mobilitynext term have rarely been investigated in geriatric wards. This study examined if leg muscle previous termstrengthnext term correlates to previous termfunctional balance and mobilitynext term among geriatric inpatients. Fifty inpatients, 29 women and 21 men (mean age 79.6 years) were included. previous termFunctional balancenext term was assessed with the Berg previous termBalancenext term Scale (BBS) and previous termmobilitynext term was assessed with the Physiotherapy Clinical Outcome Variable Scale (COVS). previous termStrengthnext term in the leg extension muscles was measured as 1 Repetition Maximum (1RM) in a leg press and previous termstrengthnext term in the ankle muscles was measured with Medical Research Council grades (MRC, 0–5). The sum scores, and most of the single items, of the BBS and the COVS significantly previous termcorrelatednext term to 1RM/body weight, ankle dorsiflexion, and plantar flexion. In a stepwise multiple regression, ankle dorsiflexion and 1RM/body weight together accounted for 39% of the variance of the BBS and 41% of the variance of the COVS. Estimated values of the BBS and the COVS can be calculated from the equation. In clinical work, the knowledge about how leg muscle previous termstrengthnext term associates with previous termbalance and mobilitynext term may be useful in analyzing underlying causes of reduced previous termbalance and mobilitynext term function, and in planning rehabilitation programs.
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| 2. |
- Jensen, Jane, et al.
(författare)
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Effects of a fall prevention program including exercise on mobility and falls in frail older people living in residential care facilities
- 2004
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Ingår i: Aging Clinical and Experimental Research. - 1594-0667 .- 1720-8319. ; 16:4, s. 283-92
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND AIMS: Impaired mobility is one of the strongest predictors for falls in older people. We hypothesized that exercise as part of a fall prevention program would have positive effects, both short- and long-term, on gait, balance and strength in older people at high risk of falling and with varying levels of cognition, residing in residential care facilities. A secondary hypothesis was that these effects would be associated with a reduced risk of falling. METHODS: 187 out of all residents living in 9 facilities, > or =65 years of age were at high risk of falling. The facilities were cluster-randomized to fall intervention or usual care. The intervention program comprised: education, environment, individually designed exercise, drug review, post-fall assessments, aids, and hip protectors. Data were adjusted for baseline performance and clustering. RESULTS: At 11 weeks, positive intervention effects were found on independent ambulation (FAC, p=0.026), maximum gait speed (p=0.002), and step height (> or =10 cm, p<0.001), but not significantly on the Berg Balance Scale. At 9 months (long-term outcome), 3 intervention and 15 control residents had lost the ability to walk (p=0.001). Independent ambulation and maximum gait speed were maintained in the intervention group but deteriorated in the control group (p=0.001). Residents with both higher and lower cognition benefited in most outcome measures. Noassociation was found between improved mobility and reduced risk of falling.CONCLUSIONS: Exercise, as part of a fall prevention program, appears to preserve the ability to walk, maintain gait speed, ambulate independently, and improve step height. Benefits were found in residents with both lower and higher cognitive impairment, but were not found to be associated with a reduced risk of falling
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| 3. |
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| 4. |
- Jensen, Jane, et al.
(författare)
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Fall and injury prevention in older people living in residential care facilities : A cluster randomized trial
- 2002
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Ingår i: Annals of Internal Medicine. - : American College of Physicians. - 0003-4819 .- 1539-3704. ; 136:10, s. 733-41
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Falls and resulting injuries are particularly common in older people living in residential care facilities, but knowledge about the prevention of falls is limited. OBJECTIVE: To investigate whether a multifactorial intervention program would reduce falls and fall-related injuries. DESIGN: A cluster randomized, controlled, nonblinded trial. SETTING: 9 residential care facilities located in a northern Swedish city. PATIENTS: 439 residents 65 years of age or older. INTERVENTION: An 11-week multidisciplinary program that included both general and resident-specific, tailored strategies. The strategies comprised educating staff, modifying the environment, implementing exercise programs, supplying and repairing aids, reviewing drug regimens, providing free hip protectors, having post-fall problem-solving conferences, and guiding staff. MEASUREMENTS: The primary outcomes were the number of residents sustaining a fall, the number of falls, and the time to occurrence of the first fall. A secondary outcome was the number of injuries resulting from falls. RESULTS: During the 34-week follow-up period, 82 residents (44%) in the intervention program sustained a fall compared with 109 residents (56%) in the control group (risk ratio, 0.78 [95% CI, 0.64 to 0.96]). The adjusted odds ratio was 0.49 (CI, 0.37 to 0.65), and the adjusted incidence rate ratio of falls was 0.60 (CI, 0.50 to 0.73). Each of 3 residents in the intervention group and 12 in the control group had 1 femoral fracture (adjusted odds ratio, 0.23 [CI, 0.06 to 0.94]). Clustering was considered in all regression models. CONCLUSION: An interdisciplinary and multifactorial prevention program targeting residents, staff, and the environment may reduce falls and femoral fractures.
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| 5. |
- Jensen, Jane, et al.
(författare)
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Fall and injury prevention in residential care : effects in residents with higher and lower levels of cognition
- 2003
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Ingår i: Journal of The American Geriatrics Society. - : Wiley. - 0002-8614 .- 1532-5415. ; 51:5, s. 627-35
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To evaluate the effectiveness of a multifactorial fall and injury prevention program in older people with higher and lower levels of cognition. DESIGN: A preplanned subgroup comparison of the effectiveness of a cluster-randomized, nonblinded, usual-care, controlled trial.SETTING: Nine residential facilities in Umea, Sweden. PARTICIPANTS: All consenting residents living in the facilities, aged 65 and older, who could be assessed using the Mini-Mental State Examination (MMSE; n = 378).An MMSE score of 19 was used to divide the sample into one group with lower and one with higher level of cognition. The lower MMSE group was older (mean +/- standard deviation = 83.9 +/- 5.8 vs 82.2 +/- 7.5) and more functionally impaired (Barthel Index, median (interquartile range) 11 (6-15) vs 17 (13-18)) and had a higher risk of falling (64% vs 36%) than the higher MMSE group. INTERVENTION: A multifactorial fall prevention program comprising staff education, environmental adjustment, exercise, drug review, aids, hip protectors, and postfall problem-solving conferences. MEASUREMENTS: The number of falls, time to first fall, and number of injuries were evaluated and compared by study group (intervention vs control) and by MMSE group. RESULTS: A significant intervention effect on falls appeared in the higher MMSE group but not in the lower MMSE group (adjusted incidence rates ratio of falls P =.016 and P =.121 and adjusted hazard ratio P <.001 and P =.420, respectively). In the lower MMSE group, 10 femoral fractures were found, all of which occurred in the control group (P =.006). CONCLUSION: The higher MMSE group experienced fewer falls after this multifactorial intervention program, whereas the lower MMSE group did not respond as well to the intervention, but femoral fractures were reduced in the lower MMSE group
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| 6. |
- Jensen, Jane, et al.
(författare)
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Falls among frail older people in residential care
- 2002
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Ingår i: Scandinavian Journal of Public Health. - : SAGE Publications. - 1403-4948 .- 1651-1905. ; 30:1, s. 54-61
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Tidskriftsartikel (refereegranskat)abstract
- Aims: A prospective study was carried out to investigate the incidence, circumstances, and injuries from falls among frail older people living in three different types of Swedish residential care settings. Methods: The settings were senior citizens' apartments, an old people's home, and a group dwelling for people with dementia. The falls were registered during the three-year study period on a semi-structured fall report, and injurious falls were categorized according to severity. Results: In total 428 falls occurred among 121 residents. The incidence rate of falls at the group dwelling was twice the rates of the old people's home and senior citizens' apartments (4282 compared with 1709 and 2114 falls per 1000 person-years respectively). Some 27% of the falls occurred during the night (2100 h to 0600 h) and 28% were related to a visit to the lavatory. The presence of acute disease at the time of a fall was diagnosed in 23% of the falls. Some type of injury occurred in 118 falls (28%) and 36 of these (8%) led to moderate or serious injuries. In total 48 fractures were diagnosed. Conclusions: In a preventive programme for falls and injuries in residential care settings, areas of particular interest should include falls after mealtimes and falls at night, conditions of acute diseases, rising up from sitting, walking, and activities in progress, especially visits to the lavatory.
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| 7. |
- Kallin, Kristina, et al.
(författare)
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Predisposing and precipitating factors for falls among older people in residential care
- 2002
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Ingår i: Public Health. - 0033-3506 .- 1476-5616. ; 116:5, s. 263-271
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Tidskriftsartikel (refereegranskat)abstract
- Falls and their consequences are serious health problems among older populations. To study predisposing and precipitating factors for falls among older people in residential care we used a cross-sectional study design with a prospective follow up for falls. Fifty-eight women and 25 men, with a mean age of 79.6 y, were included and prospectively followed up regarding falls for a period of 1 y after baseline assessments. All those who fell were assessed regarding factors that might have precipitated the fall. The incidence rate was 2.29 falls/person years. Antidepressants (selective serotonin reuptake inhibitors, SSRIs), impaired vision and being unable to use stairs without assistance were independently associated with being a 'faller'. Twenty-eight (53.8%) of the fallers suffered injuries as a result of their falls, including 21 fractures. Twenty-seven percent of the falls were judged to be precipitated by an acute illness or disease and 8.6% by a side effect of a drug. Acute symptoms of diseases or drug side effects were associated with 58% of the falls which resulted in fractures. We conclude that SSRIs seem to constitute one important factor that predisposes older people to fall, once or repeatedly. Since acute illnesses and drug side-effects were important precipitating factors, falls should be regarded as a possible symptom of disease or a side-effect of a drug until it is proven otherwise.
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| 8. |
- Kallin, Kristina, et al.
(författare)
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Why the elderly fall in residential care facilities, and suggested remedies.
- 2004
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Ingår i: The Journal of family practice. - 0094-3509 .- 1533-7294. ; 53:1, s. 41-52
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To study precipitating factors for falls among older people living in residential care facilities. DESIGN: Prospective cohort study. SETTING: Five residential care facilities. PARTICIPANTS: 140 women and 59 men, mean age +/- SD 82.4 +/- 6.8 (range, 65-97). MEASUREMENTS: After baseline assessments, falls in the population were tracked for 1 year. A physician, a nurse, and a physiotherapist investigated each event, and reached a consensus concerning the most probable precipitating factors for the fall. RESULTS: Previous falls and treatment with antidepressants were found to be the most important predisposing factors for falls. Probable precipitating factors could be determined in 331 (68.7%) of the 482 registered falls. Acute disease or symptoms of disease were judged to be precipitating, alone or in combination in 186 (38.6%) of all falls; delirium was a factor in 48 falls (10.0%), and infection, most often urinary tract infection, was a factor in 38 falls (7.9%). Benzodiazepines or neuroleptics were involved in the majority of the 37 falls (7.7%) precipitated by drugs. External factors, such as material defects and obstacles, precipitated 38 (7.9%) of the falls. Other conditions both related to the individual and the environment, such as misinterpretation (eg, overestimation of capacity or forgetfulness), misuse of a roller walker, or mistakes made by the staff were precipitating factors in 83 (17.2%) of falls. CONCLUSION: Among older people in residential care facilities, acute diseases and side effects of drugs are important precipitating factors for falls. Falls should therefore be regarded as a possible symptom of disease or a drug side effect until proven otherwise. Timely correction of precipitating and predisposing factors will help prevent further falls.
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| 9. |
- Littbrand, Håkan, 1966-, et al.
(författare)
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A high-intensity functional weight-bearing exercise program for older people dependent in activities of daily living and living in residential care facilities : evaluation of the applicability with focus on cognitive function
- 2006
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Ingår i: Physical Therapy. - : Oxford University Press (OUP). - 0031-9023 .- 1538-6724. ; 86:4, s. 489-498
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND PURPOSE: Knowledge concerning the applicability and the effect of high-intensity exercise programs is very limited for older people with severe cognitive and physical impairments. The primary aim of this study was to evaluate the applicability of a high-intensity functional weight-bearing exercise program among older people who are dependent in activities of daily living and living in residential care facilities. A second aim was to analyze whether cognitive function was associated with the applicability of the program. SUBJECTS: The subjects were 91 older people (mean age=85.3 years, SD=6.1, range=68-100) who were dependent in personal activities of daily living and randomly assigned to participate in an exercise intervention. Their mean score for the Mini-Mental State Examination (MMSE) was 17.5 (SD=5.0, range=10-29). METHODS: A high-intensity functional weight-bearing exercise program was performed in groups of 3 to 7 participants who were supervised by physical therapists. There were 29 exercise sessions over 13 weeks. Attendance, intensity of lower-limb strength and balance exercises, and occurrence and seriousness of adverse events were the outcome variables in evaluating the applicability of the program. RESULTS: The median attendance rate was 76%. Lower-limb strength exercises with high intensity were performed in a median of 53% of the attended exercise sessions, and balance exercises with high intensity were performed in a median of 73% of the attended exercise sessions. The median rate of sessions with adverse events was 5%. All except 2 adverse events were assessed as minor and temporary, and none led to manifest injury or disease. No significant differences were observed in applicability when comparing participants with dementia and participants without dementia. In addition, there was no significant correlation between applicability and the MMSE score. DISCUSSION AND CONCLUSION: The results suggest that a high-intensity functional weight-bearing exercise program is applicable for use, regardless of cognitive function, among older people who are dependent in activities of daily living, living in residential care facilities, and have an MMSE score of 10 or higher.
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| 10. |
- Lundin-Olsson, Lillemor, et al.
(författare)
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Attention, frailty, and falls : the effect of a manual task on basic mobility
- 1998
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Ingår i: Journal of The American Geriatrics Society. - : Wiley. - 0002-8614 .- 1532-5415. ; 46:6, s. 758-761
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To investigate the effect of a second task on balance and gait maneuvers used in everyday life. Our hypothesis was that those who were more distracted by a familiar manual task performed concurrently with functional maneuvers were more frail and more prone to falls. DESIGN: A cross-sectional design with prospective follow-up for falls. SETTING: Sheltered accommodation in Umea, Sweden. PARTICIPANTS: Forty-two residents (30 women, 12 men; mean age +/- SD = 79.7 +/- 6.1 years), ambulant with or without a walking aid, able to follow simple instructions and able to carry a tumbler. MEASUREMENTS: Timed Up & Go (TUG), i.e., the time taken to rise from an armchair, walk 3 meters, turn round, and sit down again. TUG was repeated with an added manual task (TUGmanual), which was to carry a glass of water while walking. The Montgomery-Asberg Depression Rating Scale, Barthel Index, Functional Reach, Mini-Mental State Examination, and Line Bisection test were used to assess for frailty. The subjects were followed-up prospectively regarding falls indoors for a period of 6-months. RESULTS: Subjects with a time difference (diffTUG) between TUGmanual and TUG of > or = 4.5 seconds were considered to be distracted by the second task. Ten subjects had a difference in time of > or = 4.5 seconds. These subjects were more frail, and seven of them fell indoors during the follow-up period (odds ratio 4.7, 95%Confidence Interval (CI) 1.5-14.2). CONCLUSION: The time difference between the TUGmanual and the TUG appears to be a valid marker of frailty and a useful tool for identifying older persons prone to falling.
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