| 1. |
- Dahlgren, Gunilla, et al.
(författare)
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Reliabilitetstestning av den svenska versionen av Shoulder Rating Questionnaire, SRQ-S
- 2002
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Ingår i: Nordisk fysioterapi. - 1402-3024. ; 6, s. 134-143
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to evaluatethe test-retest reliability of theSwedish version of the ShoulderRating Questionnaire - SRQ-S.This self-rating scale comprises21 questions, divided into sevenweighted domains concerninghealth, pain, daily activities, recreationaland athletic activities, work,satisfaction and areas for improvement.The Shoulder Rating Questionnairewas fi rst translated intoSwedish and slightly adapted. Itwas then sent twice to 38 patientswith clinically stable shoulder disordersat an Orthopaedic Clinicin Sweden. The majority of theanswers were identical or almostidentical on both occasions. Theagreement of the total score wasexcellent (both rs and ICC=0.97).All domains, except ‘recreationaland athletic activities’, also showedan excellent agreement (rs 0.90-0.97, ICC 0.88-0.97). Individualquestions resulted in a very highweighted Kappa value for sevenof the questions (0.81-1.0), elevenquestions with a substantial value(0.61-0.80) and three moderatevalues (0.41-0.60). We concludethat the questions posed wereeasily understood and answeredand that the SRQ–S is test-retestreliable. These qualities wouldmake it a useful instrument for theassessment of the outcome of treatmentof shoulder disorders.
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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. |
- Lundin-Olsson, Lillemor, et al.
(författare)
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Predicting falls in residential care by a risk assessment tool, staff judgement, and history of falls
- 2003
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Ingår i: Aging Clinical and Experimental Research. - 1594-0667 .- 1720-8319. ; 15:1, s. 51-59
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND AIMS: It is of great importance to consider whether a tool's predictive value is generalizable to similar samples in other locations. Numerous fall prediction systems have been developed, but very few are evaluated over a different time period in a different location. The purpose of this study was to validate the predictive accuracy of the Mobility Interaction Fall (MIF) chart, and to compare it to staff judgement of fall risk and history of falls. METHODS: The MIF chart, staff judgement, and fall history were used to classify the risk of falling in 208 residents (mean age 83.2 +/- 6.8 years) living in four residential care facilities in northern Sweden. The MIF chart includes an observation of the ability to walk and simultaneously interact with a person or an object, a vision test, and a concentration rating. Staff rated each resident's risk as high or low and reported the resident's history of falls during the past 6 months. Falls were followed up for 6 months. RESULTS: During the follow-up period, 104 residents (50%) fell at least once indoors. Many of the factors commonly associated with falls did not differ significantly between residents who fell at least once and residents who did not fall. In this validating sample the predictive accuracy of the MIF chart was notably lower than in the developmental sample. A combination of any two of the MIF chart, staff judgement, and history of falls was more accurate than any approach alone; more than half of the residents classified as 'high risk' by two approaches sustained a fall within 3 months. CONCLUSIONS: Residents classified as 'high risk' by any two of the MIF chart, staff judgement, and history of falls should be regarded as particularly prone to falling and in urgent need of preventive measures.
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| 10. |
- Lundin-Olsson, Lillemor, 1950-
(författare)
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Prediction and prevention of falls among elderly people in residential care
- 2000
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Among elderly people, falls lead to a considerable amount of immobility, morbidity, and mortality. The purpose of this study was to develop and evaluate methods for predicting falls, and to evaluate a fall prevention program among elderly people living in residential care facilities. A fall was defined as any event in which the resident unintentionally came to rest on the floor or the ground regardless of whether or not an injury was sustained.In developing the prediction methods, it was hypothesised that older persons showing difficulties in performing a familiar second task while walking were more likely to fall within six months. For residents who stopped walking when talking, the relative risk of falling was 3.5 (95% CL2.0-6.2) compared to those who continued walking. For residents with a time difference (diffTUG) of at least 4.5 seconds between two performances of the Timed Up&Go test, with and without carrying a glass, the hazard ratio for falls was 4.7 (95% Cl: 1.5-14.2) compared to those with a shorter diffTUG.A screening tool, the Mobility Interaction Fall (MIF) chart, was developed and evaluated, then validated in a new sample. This tool included a mobility rating, ‘Stops walking when talking’, ‘diffTUG’, a test of vision, and a concentration rating. In the first sample, the hazard ratio was 12.1 (95% 0:4.6-31.8) for residents classified as ‘high-risk’ compared to ‘low-risk’. The positive predictive value was 78%, and the negative predictive value, the sensitivity, and the specificity were above 80% for falling in six months. In the second sample the prediction accuracy of the MIF chart was lower (hazard ratio 1.7, 95% Cl: 1.1-2.5) and a 6-month fall history or a global rating of fall risk by staff were at least equally valuable. A combination of any two of the methods - the MIF chart, staff judgement, fall history - was more accurate at identifying high risk residents than any method alone. Half of the residents classified by two methods as ‘high risk’ sustained a fall within 6 months.In a randomised study a prevention program directed to residents, staff, and environment resulted in a significant reduction in the number of residents falling (44% vs. 56%; odds ratio 0.62, 95% CF0.41-0.92), the incidence of falls (incidence rate ratio IRR 0.80, 95% CF0.69-0.94) and of femoral fractures (IRR 0.25, 95% 0:0.08-0.82) in the intervention compared to the control group.In conclusion, a combination of any two of the staff judgement, fall history or MIF chart has the potential to identify a large proportion of residents at particular high fall risk. A multidisciplinary and multifactorial fall prevention program directed to residents, staff, and the environment can reduce the numbnumber of residents falling, of falls and of femoral fractures.
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