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11.
  • Pettersson, Beatrice, et al. (författare)
  • "Managing pieces of a personal puzzle' Older people's experiences of self-management falls prevention exercise guided by a digital program or a booklet
  • 2019
  • Ingår i: BMC Geriatrics. - BioMed Central. - 1471-2318 .- 1471-2318. ; 19
  • Tidskriftsartikel (refereegranskat)abstract
    • <p>Background: Exercise is effective in order to prevent falls in community-dwelling older people. Self-management programs have the potential to increase access and reduce costs related to exercise-based fall prevention. However, information regarding older people's views of participating in such programs is needed to support implementation. The aim of this study was to explore older people's experiences of a self-management fall prevention exercise routine guided either by a digital program (web-based or mobile) or a paper booklet.</p><p>Methods: This qualitative study was part of a feasibility study exploring two completely self-managed exercise interventions in which the participants tailored their own program, guided either by a digital program or a paper booklet. Individual face-to-face semi-structured interviews were conducted with a purposeful sample of 28 participants (18 women), mean age 76yrs. Qualitative content analysis was used to analyse the data.</p><p>Results: Self-managing and self-tailoring these exercise programs was experienced as Managing pieces of a personal puzzle'. To independently being able to create a program and manage exercise was described in the categories Finding my own level' and Programming it into my life'. The participants experienced the flexibility and independence provided by completely self-managed exercise as positive and constructive although it required discipline. Furthermore, different needs and preferences when managing their exercise were described, as well as varying sources of motivation for doing the exercise, as highlighted in the category Defining my source of motivation'. The category Evolving my acquired knowledge' captures the participants' views of building their competence and strategies for maintenance of the exercise. It describes a combined process of learning the program and developing reflection, which was more clearly articulated by participants using the digital program.</p><p>Conclusions: This study provides new knowledge regarding experiences, preferences and motivations of older people to engage in home-based self-managed fall prevention exercise. They expressed both a capability and willingness to independently manage their exercise. A digital program seems to have strengthened the feeling of support while creating their own exercise program and tailoring it to their preferences and circumstances, which might therefore create better opportunities for adoption and adherence in the long term.</p>
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12.
  • Pohl, Petra, et al. (författare)
  • Fall risk awareness and safety precautions taken by older community-dwelling women and men a qualitative study using focus group discussions
  • 2015
  • Ingår i: PLoS ONE. - 1932-6203 .- 1932-6203. ; 10:3
  • Tidskriftsartikel (refereegranskat)abstract
    • <p>Introduction Daily life requires frequent estimations of the risk of falling and the ability to avoid a fall. The objective of this study was to explore older women's and men's understanding of fall risk and their experiences with safety precautions taken to prevent falls.</p><p>Methods A qualitative study with focus group discussions was conducted. Eighteen community-dwelling people [10 women and 8 men] with and without a history of falls were purposively recruited. Participants were divided into two groups, and each group met four times. A participatory and appreciative action and reflection approach was used to guide the discussions. All discussions were audio recorded and transcribed verbatim. Data were analysed by qualitative content analysis, and categories were determined inductively.</p><p>Findings Three categories describing the process of becoming aware of fall risks in everyday life were identified: 1] Facing various feelings, 2] Recognizing one's fall risk, and 3] Taking precautions. Each category comprised several subcategories. The comprehensive theme derived from the categories was "Safety precautions through fall risk awareness". Three strategies of ignoring [continuing a risky activity], gaining insight [realizing the danger in a certain situation], and anticipating [thinking ahead and acting in advance] were related to all choices of actions and could fluctuate in the same person in different contexts.</p><p>Conclusions The fall risk awareness process might be initiated for various reasons and can involve different feelings and precautions as well as different strategies. This finding highlights that there are many possible channels to reach older people with information about fall risk and fall prevention, including the media and their peers. The findings offer a deeper understanding of older peoples' conceptualizations about fall risk awareness and make an important contribution to the development and implementation of fall prevention programmes.</p>
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13.
  • Pohl, Petra, et al. (författare)
  • Fall risk awareness and safety precautions taken by older community-dwelling women and men : A qualitative study using focus group discussions
  • 2015
  • Ingår i: Early signs of mobility limitations and fall events in old age: long-term consequences and tailored preventive interventions through interactive media.
  • Tidskriftsartikel (refereegranskat)abstract
    • <p>INTRODUCTION: Daily life requires frequent estimations of the risk of falling and the ability to avoid a fall. The objective of this study was to explore older women's and men's understanding of fall risk and their experiences with safety precautions taken to prevent falls.METHODS: A qualitative study with focus group discussions was conducted. Eighteen community-dwelling people [10 women and 8 men] with and without a history of falls were purposively recruited. Participants were divided into two groups, and each group met four times. A participatory and appreciative action and reflection approach was used to guide the discussions. All discussions were audio recorded and transcribed verbatim. Data were analysed by qualitative content analysis, and categories were determined inductively.FINDINGS: Three categories describing the process of becoming aware of fall risks in everyday life were identified: 1] Facing various feelings, 2] Recognizing one's fall risk, and 3] Taking precautions. Each category comprised several subcategories. The comprehensive theme derived from the categories was "Safety precautions through fall risk awareness". Three strategies of ignoring [continuing a risky activity], gaining insight [realizing the danger in a certain situation], and anticipating [thinking ahead and acting in advance] were related to all choices of actions and could fluctuate in the same person in different contexts.CONCLUSIONS: The fall risk awareness process might be initiated for various reasons and can involve different feelings and precautions as well as different strategies. This finding highlights that there are many possible channels to reach older people with information about fall risk and fall prevention, including the media and their peers. The findings offer a deeper understanding of older peoples' conceptualizations about fall risk awareness and make an important contribution to the development and implementation of fall prevention programmes.</p>
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14.
  • Pohl, Petra, 1965- (författare)
  • Falls in older community-dwelling women and men risk factors and safety strategies. Fall risk awareness, fear of falling, and preferred exercise properties from a gender perspective.
  • 2015
  • Doktorsavhandling (övrigt vetenskapligt)abstract
    • <p><strong>Background</strong> Falls are the leading cause for non-fatal injuries in older community-dwelling people. Compared to men, women fall more often, experience more fall-related injuries, and report fear of falling (FoF) more often. Falls may be prevented with specific exercises, but adherence is often low in long-term. One aim of the thesis was to gain a deeper understanding of the risk factors previous falls, FoF, and gender. Another aim was to explore safety strategies in older community-dwelling people in terms of fall risk awareness and actions taken to protect from falls, and to identify motives for exercising and preferred exercise properties. A gender perspective was used throughout the thesis.</p><p><strong>Methods</strong> To determine the impact of the risk factors on future falls and injurious falls, a cross-sectional design was used combined with longitudinal data. Baseline data from 230 community-dwelling people over 75 years were collected with questionnaires and performance-based tests. FoF was measured with the single item question “Are you afraid of falling?”. Monthly fall calendars were collected for one year (monitoring year). Based on status on falls, participants were classified as those with i) no falls (n=119), ii) 1 non-injurious fall (n=51), iii) ≥2 non-injurious falls (n=40), and iv) ≥1 injurious fall (n=20). These data were linked to data from an injury database (IDB) with respect to registered injurious falls for a period of about 5 years (long term follow-up). Andersen-Gill method of Cox regression for multiple events was used to estimate the risk of future injurious fall events. To find relationships between FoF, gender, and falls (defined as two or more falls), a general log-linear analysis was performed. Associations between FoF and the components of the International Classification of Functioning (ICF) were explored with a structural equation model. To explore fall risk awareness and safety strategies, and to identify motives and preferred exercise properties, qualitative study design was used. Multistage focus groups were held with 18 community-dwelling people (10 women and 8 men) between 70 and 80 years. Transcriptions were analysed with qualitative content analysis.</p><p><strong>Results</strong> Fourty-eight per cent of the 230 participants fell at least once during the monitoring year, and 23% experienced recurrent falls. Compared to men, women reported FoF more often, but did not experience more recurrent falls, and no more injurious falls. FoF was significantly associated with the ICF components <em>Activity/Participation</em> and <em>Personal Factors</em> in women and men both; but in opposite directions for women and men on <em>Personal Factors</em>. During the long-term follow-up, 91 injurious falls were registered in 70 participants (30%). Those with injurious falls during the monitoring year were at significant risk of experiencing new injurious falls in long-term (HR 2.78; 95% CI 1.40-5.50), compared to those with no falls. Women experienced a higher rate of fractures than did men. Analyses from the multistage focus groups resulted in three categories: Facing various feelings; Recognizing one’s fall risk; and Taking precautions. A comprehensive theme tied them together:<em> Safety precautions through fall risk awareness</em>. Analyses also resulted in six categories identifying preferred exercise properties in the context of falls prevention: Motives to start exercise; Barriers to start exercise; Exercise characteristics; Confirmation; Spirit lifters; and Maintenance tricks. All categories included sub-categories. Both studies revealed greater variations among women and among men than between women and men.</p><p><strong>Conclusion</strong> Community-dwelling people over 75 years who have experienced an injurious fall are at high risk of sustaining new injurious falls the forthcoming five years, and should be offered multifactorial fall risk assessments with targeted interventions to optimize the prevention of future falls. The single item question “Are you afraid of falling?” has no predictive value for future falls, and the answer may be strongly gendered. The questions should therefore be avoided in clinical practice and research in community settings. The participants of the qualitative studies implicity and explicitly described how they had become aware of fall risks in everyday life, and both women and men took precautionary actions. Raised fall risk awareness was achieved by several channels including the media, and by meeting with peers and professionals with expertise in falls prevention. A wide variety of preferred exercise properties in the context of falls prevention were identified among the older community-dwelling people. The variations of the requests were greater among women and among men than between women and men. The results should be taken into consideration when offering exercise-based falls prevention interventions to older people. The results from this thesis indicated that measures can be taken on a broad front in order to reduce the damage from injurious falls in older community-dwelling people. A gender perspective is warranted for in clinical practice and future research. Adopting a gender perspective may broaden the understanding of gender differences and similarities when implementing falls prevention activities.</p><p></p>
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15.
  • Pohl, Petra, et al. (författare)
  • Gender perspective on fear of falling using the classification of functioning as the model
  • 2015
  • Ingår i: Disability and Rehabilitation. - Informa Healthcare. - 0963-8288 .- 1464-5165. ; 37:3, s. 214-222
  • Tidskriftsartikel (refereegranskat)abstract
    • <p>Abstract Purpose: To investigate associations between fear of falling (FOF) and recurrent falls among women and men, and gender differences in FOF with respect to International Classification of Functioning (ICF). Methods: Community-dwelling people (n = 230, 75-93 years, 72% women) were included and followed 1 year regarding falls. Data collection included self-reported demographics, questionnaires, and physical performance-based tests. FOF was assessed with the question "Are you afraid of falling?". Results were discussed with a gender relational approach. Results: At baseline 55% women (n = 92) and 22% men (n = 14) reported FOF. During the follow-up 21% women (n = 35) and 30% men (n = 19) experienced recurrent falls. There was an association between gender and FOF (p = 0.001), but not between FOF and recurrent falls (p = 0.79), or between gender and recurrent falls (p = 0.32). FOF was related to Personal factors and Activity and Participation. The relationship between FOF and Personal factors was in opposite directions for women and men. Conclusions: Results did not support the prevailing paradigm that FOF increases rate of recurrent falls in community-dwelling people, and indicated that the answer to "Are you afraid of falling?" might be highly influenced by gendered patterns.</p><p>Implications for Rehabilitation</p><p>The question "Are you afraid of falling?" has no predictive value when screening for the risk of falling in independent community-dwelling women or men over 75 years of age.</p><p>Gendered patterns might influence the answer to the question "Are you afraid of falling?" Healthcare personnel are recommended to be aware of this when asking older women and men about fear of falling.</p>
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16.
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17.
  • Sandlund, Marlene, et al. (författare)
  • Gender Perspective on Older People's Exercise Preferences and Motivators in the Context of Falls Prevention : A Qualitative Study.
  • 2018
  • Ingår i: BioMed Research International. - Hindawi Publishing Corporation. - 2314-6133 .- 2314-6141. ; 2018
  • Tidskriftsartikel (refereegranskat)abstract
    • <p><strong>Background:</strong> Several factors have previously been identified to positively influence the uptake and adherence for fall prevention exercise programmes. There is, however, a lack of studies investigating if men and women differ in their views and preferences for fall prevention exercises.</p><p><strong>Aim:</strong> To explore exercise preferences and motivators of older community-dwelling women and men in the context of falls prevention from a gender perspective.</p><p><strong>Methods:</strong> Workshops including multistage focus group discussions were conducted with 18 older community-dwelling people with and without history of falls. Participants were purposively selected and divided into two groups. Each group met on six occasions over a period of five months. Participatory and Appreciative Action and Reflection methodology was used to guide the discussions. A qualitative content analysis approach was used in the analysis.</p><p><strong>Results:</strong> Older participants had many diverse preferences and confirmed that individually tailored exercise, in terms of mode, intensity, challenge, and social context, is important. Moreover, important factors for exercise adherence and maintenance included the experience of individual confirmation; different spirit lifters to increase enjoyment; and personal tricks to maintain exercise routines. The individual differences within genders were more diverse than the differences between women and men.</p><p><strong>Conclusion:</strong> Exercise interventions to prevent falls should be individually tailored, based on the specific needs and preferences of the older participant, and do not appear to require gender specific approaches. To increase adherence, intrinsic motivation for exercise may be encouraged by competence enhancing confirmations, energizing spirit lifters, and practical tips for exercise maintenance. The study provides an awareness about women's and men's preferences for fall prevention exercises, and this information could be used as guidance in designing inclusive exercise interventions.</p>
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18.
  • Sandlund, Marlene, et al. (författare)
  • Gender perspective on older people’s exercise preferences and motivators in the context of falls prevention : a qualitative Study
  • 2018
  • Ingår i: BioMed Research International. - Hindawi Publishing Corporation. - 2314-6133 .- 2314-6141.
  • Tidskriftsartikel (refereegranskat)abstract
    • <p>Background. Several factors have previously been identified to positively influence the uptake and adherence for fall prevention exercise programmes. There is, however, a lack of studies investigating if men and women differ in their views and preferences for fall prevention exercises. Aim. To explore exercise preferences and motivators of older community-dwelling women and men in the context of falls prevention from a gender perspective. Methods. Workshops including multistage focus group discussions were conducted with 18 older community-dwelling people with and without history of falls. Participants were purposively selected and divided into two groups. Each group met on six occasions over a period of five months. Participatory and Appreciative Action and Reflection methodology was used to guide the discussions. A qualitative content analysis approach was used in the analysis. Results. Older participants had many diverse preferences and confirmed that individually tailored exercise, in terms of mode, intensity, challenge, and social context, is important. Moreover, important factors for exercise adherence and maintenance included the experience of individual confirmation; different spirit lifters to increase enjoyment; and personal tricks to maintain exercise routines. The individual differences within genders were more diverse than the differences between women and men. Conclusion. Exercise interventions to prevent falls should be individually tailored, based on the specific needs and preferences of the older participant, and do not appear to require gender specific approaches. To increase adherence, intrinsic motivation for exercise may be encouraged by competence enhancing confirmations, energizing spirit lifters, and practical tips for exercise maintenance. The study provides an awareness about women’s and men’s preferences for fall prevention exercises, and this information could be used as guidance in designing inclusive exercise interventions.</p>
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19.
  • Sandlund, Marlene, 1972-, et al. (författare)
  • Gender Perspective on Older People's Exercise Preferences and Motivators in the Context of Falls Prevention A Qualitative Study
  • 2018
  • Ingår i: BioMed Research International. - Hindawi Publishing Corporation. - 2314-6133 .- 2314-6141.
  • Tidskriftsartikel (refereegranskat)abstract
    • <p>Background: Several factors have previously been identified to positively influence the uptake and adherence for fall prevention exercise programmes. There is, however, a lack of studies investigating if men and women differ in their views and preferences for fall prevention exercises.</p><p>Aim: To explore exercise preferences and motivators of older community-dwelling women and men in the context of falls prevention from a gender perspective.</p><p>Methods: Workshops including multistage focus group discussions were conducted with 18 older community-dwelling people with and without history of falls. Participants were purposively selected and divided into two groups. Each group met on six occasions over a period of five months. Participatory and Appreciative Action and Reflection methodology was used to guide the discussions. A qualitative content analysis approach was used in the analysis.</p><p>Results: Older participants had many diverse preferences and confirmed that individually tailored exercise, in terms of mode, intensity, challenge, and social context, is important. Moreover, important factors for exercise adherence and maintenance included the experience of individual confirmation; different spirit lifters to increase enjoyment; and personal tricks to maintain exercise routines. The individual differences within genders were more diverse than the differences between women and men.</p><p>Conclusion: Exercise interventions to prevent falls should be individually tailored, based on the specific needs and preferences of the older participant, and do not appear to require gender specific approaches. To increase adherence, intrinsic motivation for exercise may be encouraged by competence enhancing confirmations, energizing spirit lifters, and practical tips for exercise maintenance. The study provides an awareness about women's and men's preferences for fall prevention exercises, and this information could be used as guidance in designing inclusive exercise interventions.</p>
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20.
  • Sandlund, Marlene, et al. (författare)
  • Gender perspectives on views and preferences of older people on exercise to prevent falls : mixed studies review
  • 2017
  • Ingår i: Säkra steg. - BioMed Central.
  • Tidskriftsartikel (refereegranskat)abstract
    • <p>BACKGROUNDTo offer fall prevention exercise programs that attract older people of both sexes there is a need to understand both women's and men's views and preferences regarding these programs. This paper aims to systematically review the literature to explore any underlying gender perspectives or gender interpretations on older people's views or preferences regarding uptake and adherence to exercise to prevent falls.METHODSA review of the literature was carried out using a convergent qualitative design based on systematic searches of seven electronic databases (PubMed, CINAHL, Amed, PsycINFO, Scopus, PEDro, and OTseeker). Two investigators identified eligible studies. Each included article was read by at least two authors independently to extract data into tables. Views and preferences reported were coded and summarized in themes of facilitators and barriers using a thematic analysis approach.RESULTSNine hundred and nine unique studies were identified. Twenty five studies met the criteria for inclusion. Only five of these contained a gender analysis of men's and women's views on fall prevention exercises. The results suggests that both women and men see women as more receptive to and in more need of fall prevention messages. The synthesis from all 25 studies identified six themes illustrating facilitators and six themes describing barriers for older people either starting or adhering to fall prevention exercise. The facilitators were: support from professionals or family; social interaction; perceived benefits; a supportive exercise context; feelings of commitment; and having fun. Barriers were: practical issues; concerns about exercise; unawareness; reduced health status; lack of support; and lack of interest. Considerably more women than men were included in the studies.CONCLUSIONAlthough there is plenty of information on the facilitators and barriers to falls prevention exercise in older people, there is a distinct lack of studies investigating differences or similarities in older women's and men's views regarding fall prevention exercise. In order to ensure that fall prevention exercise is appealing to both sexes and that the inclusion of both men and women are encouraged, more research is needed to find out whether gender differences exists and whether practitioners need to offer a range of opportunities and support strategies to attract both women and men to falls prevention exercise.</p>
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