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- Eriksson, Staffan, 1969-
(författare)
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Falls in people with dementia
- 2007
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Falls and concomitant injuries are common problems among large groups of the elderly population, leading to immobility and mortality. These problems are even more pronounced among people suffering from dementia. This thesis targets fall risk factors for people with dementia in institutions. The overall aim of this thesis was to investigate risk factors for falls, predisposing as well as related to circumstances surrounding falls, and to do this as efficiently as possible. In a prospective cohort study including residents of residential care facilities with and without dementia, the fall rate was higher for those with dementia, the crude incidence rate ratio (IRR) was 2.55 (95% CI 1.60–4.08) and the adjusted IRR was 3.79 (95% CI 1.95–7.36). In the group of people suffering from dementia, including 103 residents, a total of 197 falls resulted in 11 fractures during the 6-months follow-up period. From the same baseline measurements 26% and 55%, respectively, of the variation in falls could be explained in the group of residents with and without dementia. Fall predictors significantly and independently associated with an increased risk of falls in the group of people suffering from dementia were the category “man walking with an aid” and the use of more than four drugs. In a prospective cohort study, including 204 patients in a psychogeriatric ward, a total of 244 falls resulted in 14 fractures. Fall predictors significantly and independently associated with an increased risk of falls were male sex, failure to copy a design, use of clomethiazole, and walking difficulties. Treatment with statins was associated with a reduced risk of falls. With these fall predictors in the negative binomial regression (Nbreg) model, 48% of the variation in falls was explained. The data from the psychogeriatric ward were also analysed with the use of partial least squares regression (PLS) and regression tree to be compared with the results of the Nbreg analysis. PLS and regression tree are techniques based on combinations of variables. They both showed similar patterns, that a combination of a more severe level of dementia, behavioral complications and medication related to these complications is associated with an increased fall rate. Thirty-two percent and 38%, respectively, of the variation in fall rate were explained in the PLS and regression tree analysis. The circumstances surrounding the falls in the psychogeriatric ward were analysed. It was found that the fall rate was equally high during the night and the day. A large proportion of the falls was sustained in the patients’ own room and a small proportion of the falls was witnessed by the staff. This pattern was even more pronounced during the night. The proportion of diurnal rhythm disturbances and activity disturbances was higher for falls at night than for falls during the day. Circumstances associated with an increased risk of falls, as shown by a short time to first fall, were anxiety, darkness, not wearing any shoes and, for women, urinary tract infection. The proportion of urinary tract infection was also higher in connection to falls sustained by women than to falls sustained by men. This thesis confirms that people suffering from dementia are prone to fall. Walking difficulties, male sex and impaired visual perception are factors that should be considered in the work of reducing falls among people suffering from dementia. Furthermore, falls at night, behavioral complications and medication related to these complications should also be considered in this work, especially as the dementia disease progresses. A larger portion of the variation of the outcome variable was explained by the Nbreg model than the regression tree and PLS. However, these statistical methods, based on combinations of variables, gave a complementary perspective on how the fall predictors were related to falls.
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| 2. |
- von Heideken Wågert, Petra, 1977-
(författare)
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Health, physical ability, falls and morale in very old people: the Umeå 85+ Study
- 2006
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The very old, aged 80 years and over, is the fastest growing age group today, and the demands for healthcare and services will be even higher in the future. It is, therefore, of great importance to advance our knowledge about this group. The main purpose of this thesis was to describe living conditions and health, with a special focus on physical ability, falls and morale, in women and men in three different age groups of very old people in northern Sweden. Half the population aged 85, and the total population aged 90 and ≥95 (-103) in the municipality of Umeå were selected for participation (n=348) in this population-based cross-sectional study, entitled the Umeå 85+ Study. Structured interviews and assessments were performed with the participants in their homes, and data were also collected from next-of-kins, caregivers and medical charts. Cognition was screened for using the Mini-Mental State Examination (MMSE), depressive symptoms using the Geriatric Depression Scale-15 (GDS-15), and nutritional status using the Mini Nutritional Assessment (MNA). Activities of Daily Living (ADL) were assessed using the Staircase of ADL (including the Katz Index of ADL) and morale using the Philadelphia Geriatric Center Morale Scale (PGCMS). Participants also rated their own health and answered a questionnaire about symptoms. Physical ability was assessed using a gait speed test over 2.4 meters (8 feet), three consecutive chair stands, and the Berg Balance Scale (BBS). A follow-up study for falls was performed during a period of six months with fall calendars and telephone calls. The very old people in this northern population have more depression, hypertension and hip fractures, as well as a higher consumption of drugs than comparable, more southern populations. In general, younger participants had lower rates of diagnoses and prescribed drugs, were less dependent in ADL and other functional variables than older participants, and men had lower rates of diagnoses and reported symptoms than women. However, there were no age or sex differences in self-rated health or morale, which were both rated as good by the majority of the participants. There was a wide range of physical ability among these very old people, especially in women, where an age-related decline was seen. The results also demonstrate that men had greater physical ability than women. The BBS had no floor or ceiling effects in the present sample. In contrast, a large proportion was unable to perform the gait speed and chair stands test, resulting in a floor effect for the timed performances, especially in women. Falling is a major public health problem in very old people. From the results of the present study, it could be predicted that every seventh participant and every third of the people who did fall would suffer a fracture over a period of one year. The independent explanatory risk factors for time to first fall in this sample of very old people were dependency in personal (P-) ADL but not bedridden, thyroid disorders, treatment with Selective Serotonin Reuptake Inhibitors (SSRIs) and occurrence of fall/s in the preceding year. These factors should all be considered in fall prevention programmes. The morale of very old people was found in this study to be rather high, with similar scores among age groups and sexes. The most important factors for high morale were the absence of depressive symptoms, living in ordinary housing, having previously had a stroke and yet still living in ordinary housing, not feeling lonely and having few symptoms. The PGCMS seems applicable in the evaluation of morale in very old people. In conclusion, there were wide variations in health status and physical ability in this northern population of very old people. Women had poorer health and physical ability than men. Falls and fractures were common and serious health problems. Morale seemed to be high, despite the fact that a large proportion of the participants suffered from many diseases and functional decline.
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