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| 2. |
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| 3. |
- Gregersen, Nils. P., et al.
(författare)
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Accident involvement among learner drivers : an analysis of the consequences of supervised practice
- 2003
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Ingår i: Accident Analysis and Prevention. - 0001-4575. ; 35:5, s. 725-730
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Tidskriftsartikel (refereegranskat)abstract
- It is a well-known fact that experience is important for safe driving. Previously, this presented a problem since experience was mostly gained during the most dangerous period of driving—the first years with a licence. In many countries, this “experience paradox” has been addressed by providing increased opportunities to gain experience through supervised practice. One question, however, which still needs to be answered is what has been lost and what has been gained through supervised practice. Does this method lead to fewer accidents after licensing and/or has the number of accidents in driving practice increased? There were three aims in the study. The first was to calculate the size of the accident problem in terms of the number of accidents, health risk and accident risk during practising. The second aim was to evaluate the solution of the “experience paradox” that supervised practice suggests by calculating the costs in terms of accidents during driving practice and the benefits in terms of reduced accident involvement after obtaining a licence. The third aim was to analyse conflict types that occur during driving practice. National register data on licence holders and police-reported injury accidents and self-reported exposure were used. The results show that during the period 1994–2000, 444 driving practice injury accidents were registered, compared to 13,657 accidents during the first 2 years with a licence. The health risk during the period after licensing was 33 times higher and the accident risk 10 times higher than the corresponding risk during practice. The cost-benefit analysis showed that the benefits in terms of accident reduction after licensing were 30 times higher than the costs in terms of driving practice accidents. It is recommended that measures to reduce such accidents should focus on better education of the lay instructor, but not on introducing measures to reduce the amount of lay-instructed practice.
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| 4. |
- Gregersen, Nils. P., et al.
(författare)
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Sixteen years age limit for learner drivers in Sweden : an evaluation of safety effects
- 2000
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Ingår i: Accident Analysis and Prevention. - 0001-4575. ; 32:1, s. 25-35
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Tidskriftsartikel (refereegranskat)abstract
- Through a reform implemented in Sweden, September 1993, the age limit for practising car driving was lowered from 17½ to 16 years while the licensing age remained 18. The purpose of lowering the age limit was to give the learner drivers an opportunity to acquire more experience as drivers before being allowed to drive on their own. The primary aim of this study was to evaluate the effect of the reform in terms of accident involvement and data were therefore obtained from the national register of police reported accidents. The results show that after the reform there was a general reduction in the accident risk (accidents per 10 million km) of novice drivers with approximately 15%. Additional analyses show that the reduction of accident risk in the group who utilised the new age limit was approximately 40%, whereas those who did not utilise the prolonged training period did not benefit at all. Between 45 and 50% of the age population were found to utilise the reform. The accident reduction does not seem to be just an initial first year effect since the results were similar over 3 years of novice drivers during their first 2 years with a licence. These results suggest that the reform has been beneficial for the safety of novice drivers in Sweden. The results also suggest a potential for additional safety improvements if more young learner drivers can be brought to utilise the low age limit.
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| 5. |
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| 6. |
- Gregersen, Nils Petter, et al.
(författare)
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Sixteen years age limit for learner drivers in Sweden - an evaluation of safety effects
- 2000
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Ingår i: ACCIDENT ANALYSIS AND PREVENTION. - : PERGAMON-ELSEVIER SCIENCE LTD. - 0001-4575. ; 32:1, s. 25-35
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Through a reform implemented in Sweden, September 1993, the age limit for practising car driving was lowered from 17 1/2 to 16 years while the licensing age remained 18. The purpose of lowering the age limit was to give the learner drivers an opportunity
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| 7. |
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| 9. |
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| 10. |
- 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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| 11. |
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| 12. |
- 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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| 13. |
- 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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| 14. |
- 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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| 15. |
- 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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| 16. |
- 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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| 17. |
- Lindelöf, Nina, et al.
(författare)
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Perceptions of participating in high-intensity functional exercise among older people dependent in activities of daily living (ADL)
- 2013
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Ingår i: Archives of gerontology and geriatrics (Print). - : Elsevier. - 0167-4943 .- 1872-6976. ; 57:3, s. 369-376
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Tidskriftsartikel (refereegranskat)abstract
- The purpose of the study was to evaluate how older people, dependent in ADL perceive their participation in a high-intensity, functional exercise program compared to the perceptions of those participating in a control activity. Forty-eight older people living in residential care facilities answered a questionnaire about their perceptions of participating in an activity for three months. They were aged 65-98, had a mean score of 24 on Mini Mental State Examination (MMSE) and 14 on Barthel ADL Index. The participants had been randomized to exercise (n=20) or control activity (n=28). Differences in responses between exercise and control activity were evaluated using logistic and ordinal regression analyses. The results show that a majority of the exercise group perceived positive changes in lower limb strength, balance, and in the ability to move more safely and securely compared to a minority of the control group (p<0.001). Significantly more respondents in the exercise activity answered that they felt less tired due to the activity (p=0.027) and that they prioritized this activity above other activities (p=0.010). More exercise participants reported that meeting for three months was too short, and fewer that it was too long compared to the control group (p=0.038). This study shows that older people living in residential care facilities, dependent in ADL, and with mild or no cognitive impairment had positive perceptions about participating in high-intensity functional exercise. The findings support the use of a high-intensity exercise program in this population of older people.
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| 18. |
- 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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| 19. |
- 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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| 20. |
- 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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| 21. |
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| 22. |
- Lundin-Olsson, Lillemor, et al.
(författare)
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The Mobility Interaction Fall chart
- 2000
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Ingår i: Physiotherapy Research International. - : Wiley. - 1358-2267 .- 1471-2865. ; 5:3, s. 190-201
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND PURPOSE: The aim of this study was to develop and evaluate a screening tool for the identification of older people living in residential care facilities who are prone to falling. METHOD: Two tests focusing on attentional demands while walking were performed: 'Stops walking when talking' and the 'diffTUG'. Medical assessment, rating for cognition, depression and activities of daily living were also carried out. Falls indoors were followed up prospectively over a period of six months. A flowchart, the Mobility Interaction Fall (MIF) chart, for the identification of older people who are prone to falling was developed. The MIF chart includes an observation of mobility level and 'Stops walking when talking', the diffTUG, a test of vision and a rating of concentration. Study subjects were 78 residents, aged over 65 years, in one residential care facility (22 M; 56 F; median age 82 years, range 66-99 years) in Umea, Sweden. RESULTS: Thirty-three (42%) subjects suffered at least one fall indoors during the follow-up period. The rate of falls differed significantly between those subjects classified as being at risk of falls and those not so classified (log rank test 39.1; p < 0.001; hazard ratio 12.1; 95% CI 4.6-31.8). The positive predictive value for the classification was 78% (95% CI 67-87%) and the negative predictive value was 88% (95% CI 79-95%). CONCLUSION: The initial findings for the MIF chart indicate a promising way of classifying older people at residential care facilities as being at high or low risk of falling. The classification is quick and easy and requires no expensive equipment
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| 23. |
- Lundström, Maria, et al.
(författare)
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Postoperative delirium in old patients with femoral neck fracture : a randomized intervention study.
- 2007
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Ingår i: Aging Clinical and Experimental Research. - 1594-0667 .- 1720-8319. ; 19:3, s. 178-186
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND AIMS: Delirium is a common postoperative complication in elderly patients which has a serious impact on outcome in terms of morbidity and costs. We examined whether a postoperative multi-factorial intervention program can reduce delirium and improve outcome in patients with femoral neck fractures.METHODS: One hundred and ninety-nine patients, aged 70 years and over (mean age+/-SD, 82+/-6, 74% women), were randomly assigned to postoperative care in a specialized geriatric ward or a conventional orthopedic ward. The intervention consisted of staff education focusing on the assessment, prevention and treatment of delirium and associated complications. The staff worked as a team, applying comprehensive geriatric assessment, management and rehabilitation. Patients were assessed using the Mini Mental State Examination and the Organic Brain Syndrome Scale, and delirium was diagnosed according to DSM-IV criteria.RESULTS: The number of days of postoperative delirium among intervention patients was fewer (5.0+/-7.1 days vs 10.2+/-13.3 days, p=0.009) compared with controls. A lower proportion of intervention patients were delirious postoperatively than controls (56/102, 54.9% vs 73/97, 75.3%, p=0.003). Eighteen percent in the intervention ward and 52% of controls were delirious after the seventh postoperative day (p<0.001). Intervention patients suffered from fewer complications, such as decubitus ulcers, urinary tract infections, nutritional complications, sleeping problems and falls, than controls. Total postoperative hospitalization was shorter in the intervention ward (28.0+/-17.9 days vs 38.0+/-40.6 days, p=0.028).CONCLUSIONS: Patients with postoperative delirium can be successfully treated, resulting in fewer days of delirium, fewer other complications, and shorter length of hospitalization.
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| 24. |
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| 25. |
- Löfgren, Britta, et al.
(författare)
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Cross-validation of a model predicting discharge home after stroke rehabilitation : validating stroke discharge predictors
- 2000
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Ingår i: Cerebrovascular Diseases. - : S. Karger AG. - 1015-9770 .- 1421-9786. ; 10:2, s. 118-125
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Tidskriftsartikel (refereegranskat)abstract
- A new sample of 116 stroke patients was collected in order to validate a logistic regression model, predicting the chances of severely affected stroke patients being discharged home to independent living. The model was found to be accurate in the new sample, especially for those patients who had a high estimated probability of being discharged home. When the dividing line for the predicted probability for discharge home was set at a value of >/=0.5, the positive and negative predictive values were 74 and 73%, respectively. Further modelling resulted in a new extended model including the variables postural stability on admission, cohabiting, age and perceptual impairment on admission that formed the basis for an index predicting discharge home. This index was then validated in the sample of 93 patients that the first developed model was derived from and showed positive and negative predictive values of 85 and 77%, respectively
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| 26. |
- Löfgren, Britta, et al.
(författare)
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In-patient rehabilitation after stroke : outcome and factors associated with improvement
- 1998
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Ingår i: Disability and Rehabilitation. - : Informa UK Limited. - 0963-8288 .- 1464-5165. ; 20:2, s. 55-61
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Tidskriftsartikel (refereegranskat)abstract
- A study aimed at examining the outcome of activities of daily living (ADL) of patients undergoing geriatric stroke rehabilitation was performed. Background and admission data of 99 patients surviving the acute phase and needing further hospital rehabilitation were registered. Forty per cent of the patients improved their ADL ability. The logistic regression modelling with the dichotomous dependent variable improvement versus no improvement showed the following factors associated with improvement: a diagnosis of intracerebral haemorrhage, male sex, high postural stability score at the admission and cohabitation. In conclusion, the most severely affected stroke patients, especially patients with intracerebral haemorrhage, have a great potential for improving their ADL. The results of the logistic regression model can serve as a useful guide when it comes to identifying patients that stand a fair chance of improving during their rehabilitation stay. Equally important, patients with a poor rehabilitation prognosis who may need intensified rehabilitation efforts to achieve optimum improvement can now be identified.
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| 27. |
- Löfgren, Britta, et al.
(författare)
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Psychological well-being 3 years after severe stroke
- 1999
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Ingår i: Stroke. - 0039-2499 .- 1524-4628. ; 30:3, s. 567-572
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND PURPOSE: Stroke often has a very negative influence on the victims' perception of their life situation. The aim of this study was therefore to assess the subjects' long-term psychological well-being and to explore associations between subject characteristics, impairments, disabilities, and psychological well-being. METHODS: Of 100 subjects rehabilitated at a specialized geriatric stroke ward after the acute phase, 47 survivors were assessed in their homes 3 years after discharge and interviewed regarding their psychological well-being with the Philadelphia Geriatric Center Morale Scale (PGCMS). RESULTS: Sixty-four percent of the subjects were classified as having high scores for psychological well-being or fell within the middle range. In a cluster analysis, depression was shown to have the strongest association with the subjects' PGCMS scores. Variables including the subjects' social situation and functions as well as age, gender, ability to communicate, and need for help showed a much weaker association with the PGCMS. CONCLUSIONS: More than half of the stroke subjects were classified as having levels of psychological well-being that were good or fairly good. The strong association between PGCMS scores and depression indicates the importance of detecting and treating depression and of following up initiated therapy after stroke.
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| 28. |
- Löfgren, Britta, et al.
(författare)
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Rehabilitation of stroke patients who are older and severely affected: short- and long-term perspectives
- 2000
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Ingår i: Topics in Stroke Rehabilitation. - 1074-9357 .- 1945-5119. ; 6:4, s. 20-29
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Tidskriftsartikel (refereegranskat)abstract
- This review has focused on older and severely affected patients. The following aspects have been studied: the suffering of a stroke, experiences of stroke units, rehabilitation, long-term perspective, and psychological well-being. The conclusion is that older and severely affected patients can make substantial progress during rehabilitation. Most patients can maintain or even improve this progress in the long-term perspective. The review shows that many can stay in independent living with support from home help services and relatives, home adjustments, and assistive devices. In long-term follow-ups, some indications show that stroke patients assess their psychological well-being as good, or fairly good, but detection and treatment of depression are essential
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| 29. |
- Löfgren, Britta, et al.
(författare)
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Three years after in-patient stroke rehabilitation : A follow-up study
- 1999
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Ingår i: Cerebrovascular Diseases. - : S. Karger AG. - 1015-9770 .- 1421-9786. ; 9:3, s. 163-170
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Tidskriftsartikel (refereegranskat)abstract
- A 3-year follow-up study was performed aimed at describing the outcome for severely affected stroke survivors who had undergone geriatric in-patient rehabilitation. Living conditions, psychological well-being, and changes in functions were assessed in 55 survivors. Twenty-five people were living in the community, 15 in apartment hotels or homes for the aged and 15 in nursing homes. From discharge to follow-up 11 people had had to move to an accommodation offering more support. Living alone, recurrent strokes and functional decline were associated with moving. Many of those living in the community were supported by relatives or home help services. Home adjustments and assistive devices were common and in most cases were aimed at facilitating transfers and bathroom activities. Motor function had deteriorated from discharge to follow-up, otherwise no statistically significant changes were seen in the survivors' abilities and functions. Most survivors had in fact been able to maintain their functions or to make further improvements. Also, their psychological well-being seemed quite good. These results should encourage rehabilitation efforts for elderly people severely affected by stroke
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| 30. |
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| 31. |
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| 32. |
- Nyberg, Jonna, 1967-
(författare)
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Förändringar i transportrelaterad välfärd och myndighetsförtroende : en studie om personer som fått sitt körkort återkallat på grund av synfältsbortfall
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Access to transport, and thus accessibility to desired and needed activities, is of importance for the individual's welfare and subjective well-being. In many western contexts, land use and infrastructure are configured for the benefit of cars. A withdrawn driving license (WDL) might thereby affect welfare and subjective well-being. Further, if the WDL is perceived as unfair, trust for authorities involved in the WDL process can be affected. The overall aim is to explore changes of having a WDL due to visual field loss (VFL), concerning transport-related welfare and trust in authorities. Four studies were conducted, and both qualitative and quantitative methods have been used. The results showed that the WDL had led to negative welfare consequences for the respondents, such as ended careers, limited or ceased opportunities for leisure activities, and difficulties managing daily errands. These consequences can be explained by lacking or unsatisfactory alternative transport arrangements (study I). Also, the WDL had led to worsen overall subjective wellbeing. This can, for example, be explained by the respondents' perception of unsatisfactory access to transport means, to live a life to be satisfied with (study II). The respondents perceived the vision tests on which the WDL isbased as unfair, as they do not measure individual driving ability related to traffic safety. Perceptions of outcomes and processes were fueled by experiences of deficiencies regarding, for example, performance and information, leading to a decrease in trust in the authorities involved in the process of WDL due to VFL: the Health Care (the physician being obligated to report the VFL to the Swedish Transport Agency), the Swedish Transport Agency (decisions on WDL), and the Judicial system (decisions in cases of appeals) (study III). Gender had no effect on trust for none of these authorities. Though, diagnosis (reasons for VFL) had effect, and differences in degree oftrust for each of the three authorities were seen, related to type of diagnosis. The results also showed that low trust related to WDL process can generate lower trust in authorities in general (53%) (study IV). Finally, the thesis contributes to insights of goal conflicts that driving license withdrawals can entail, dealing with issues of safety, accessibility, and justice.
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| 33. |
- Nyberg, Jonna, 1967-, et al.
(författare)
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How does driving license withdrawal affect subjective well-being? A Swedish comparative survey study of visual field loss
- 2021
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Ingår i: European Transport Research Review. - : Springer. - 1867-0717 .- 1866-8887. ; 13:1
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Tidskriftsartikel (refereegranskat)abstract
- Research has found strong relationships between access to transport, accessibility of activities, and subjective well-being (SWB), and society is said to be car dependent. Accordingly, this study investigates, in a Swedish context, whether and how withdrawal of a driving license for a private car due to visual field loss (VFL) affects SWB. A web survey was used for statistical comparisons of three respondent groups (n = 436): people with a driving license, people with a driving license and VFL, and people whose driving license was withdrawn due to VFL. The inclusion criterion for all participants was that they should have a diagnosis that could cause VFL. The no-license group had lower overall SWB than did respondents with driving licenses. The no-license group also perceived less access to transport means in order to live a life to be satisfied with than did the other groups. The most used transport means in the no-license group was getting a lift in a car, though this group had a strong desire to drive a car. Few respondents in the license groups wanted to use specific transport means to a greater extent, car driving being the most used transport means. Some inter-group differences were seen regarding how access to activities (measured by frequency of actual trips) affected SWB. This study found a significant negative effect of driving license withdrawal on SWB. However, the results imply that qualitative aspects other than the relationship between the frequencies of trips and activities might also affect SWB, and more research on this subject is needed.
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| 34. |
- Nyberg, Jonna, 1967-, et al.
(författare)
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Welfare consequences for individuals whose driving licenses are withdrawn due to visual field loss : A Swedish example
- 2019
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Ingår i: Journal of Transport & Health. - : Elsevier Ltd. - 2214-1405 .- 2214-1413. ; 14
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Tidskriftsartikel (refereegranskat)abstract
- HighlightsNegative consequences in many welfare dimensions due to driving license withdrawal.Car-oriented land use affect the ability to use alternative transport.Strong links between transport access, participation in activities, and welfare.Perceptions of unfairness concerning the license withdrawal due to visual field loss.Reduced citizen trust in government regulations/decisions warrants further research.
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| 35. |
- Nyberg, Lars, et al.
(författare)
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Fall prediction index for patients in stroke
- 1997
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Ingår i: Stroke. - 0039-2499 .- 1524-4628. ; 28:4, s. 716-721
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND PURPOSE: The identification of stroke patients who are prone to falls is essential to the development of prevention strategies. This study aimed at developing an easily administered fall risk index for patients in stroke rehabilitation. METHODS: A consecutive series of 135 patients in geriatric stroke rehabilitation was studied. Patient characteristics viewed as potential fall predictor variables were assessed at admission. Univariate and multiple Cox regression analyses of these variables were used in the development of a fall prediction index. RESULTS: The final index included the following items: male sex, poor performance of activities of daily living, urinary incontinence, impaired postural stability, bilateral motor impairment, presence of bilateral cortical or white matter lesions, visuospatial hemineglect, and use of diuretics, antidepressants, or sedatives. The index score correlated significantly with the fall risk (odds ratio, 1.46; 95% confidence interval, 1.26 to 1.69). The score was also used to classify individuals into low-, intermediate-, and high-risk groups, among which the fall rates differed significantly (log rank statistics, 29.86; P < .001). CONCLUSIONS: An easily administered fall risk index is suggested, which might serve as a basis for prevention strategies among patients in stroke rehabilitation.
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| 36. |
- Nyberg, Lars, et al.
(författare)
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Falls leading to femoral neck fractures in lucid older people
- 1996
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Ingår i: Journal of The American Geriatrics Society. - : Wiley. - 0002-8614 .- 1532-5415. ; 44:2, s. 156-160
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To analyze the mechanisms of falls that result in femoral neck fractures among lucid older people. DESIGN: A cross-sectional study. SETTING: An orthopedic university hospital department. PARTICIPANTS: A consecutive series of 123 lucid patients, 65 years of age or more, who were admitted for femoral neck fractures. MEASUREMENTS: On admission, the subjects were interviewed about fracture accident characteristics, and falling mechanisms were classified. An arterial blood gas sample was taken from each patient soon after admission. Based on data regarding drug consumption and social and medical characteristics, a fall-risk index was calculated for each subject. RESULTS: It was ascertained that 95% of the fractures were caused by falls and < 2% were spontaneous. Most accidents (68%) took place indoors, 47% of the falls were classified as extrinsic, 24% as intrinsic, 7% as nonbipedal, and 22% remained unclassified. Almost all outdoor falls were extrinsic; however, intrinsic falls were as common as extrinsic falls indoors (P < .001). Extrinsic fallers presented a significantly lower fall-risk index score than subjects with fractures caused by intrinsic, nonbipedal, and unclassifiable falls. A large proportion of subjects (24%) wre hypoxemic (pO2 < 8 kPa) on admission, and patients who sustained fractures at night had lower oxygen tension than that of daytime fallers (P = .006). CONCLUSIONS: Accidental falls are the primary cause of femoral neck fractures. Preventive actions should be directed toward intrinsic, as well as extrinsic, risk factors for falls. Hypoxemia might be a risk factor for falls, especially those falls that occur at night.
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| 37. |
- Nyberg, Lars, et al.
(författare)
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Incidence of falls in three different types of geriatric care : A Swedish prospective study
- 1997
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Ingår i: Scandinavian Journal of Social Medicine. - : SAGE Publications. - 0300-8037. ; 25:1, s. 8-13
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Tidskriftsartikel (refereegranskat)abstract
- The incidence and consequences of falls were investigated in three different types of Swedish geriatric care clinics: a geriatric rehabilitation clinic, a psychogeriatric clinic and a nursing home. Falls were prospectively registered by the nursing staff. The incidence rate (and 95% confidence interval) of falls per 10,000 patient days of the psychogeriatric clinic was 171 (146-196), compared with 92 (72-112) at the geriatric rehabilitation clinic, and 31 (22-41) at the nursing home. Most falls (62%) did not result in injury, while major injuries occurred in 5%. We conclude that accidental falls are a major problem in geriatric care in Sweden, but there is a considerable difference in incidence rates between different types of institutions
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| 38. |
- Nyberg, Lars, et al.
(författare)
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Patient falls in stroke rehabilitation : A challenge to rehabilitation strategies
- 1995
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Ingår i: Stroke. - 0039-2499 .- 1524-4628. ; 26:5, s. 838-842
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND PURPOSE: The risk of falls is very high among stroke patients, and falling is a major complication in stroke rehabilitation. This study aimed to investigate the incidence, characteristics, and consequences of falls in an inpatient stroke rehabilitation setting. METHODS: One hundred sixty-one patients consecutively admitted to a geriatric stroke rehabilitation unit were studied. Falls that occurred during their rehabilitation stay were prospectively registered and analyzed. RESULTS: Sixty-two of the patients (39%) suffered falls. The total number of falls was 153, which corresponds to an incidence rate of 159 falls per 10,000 patient-days. Most falls occurred during transfers or from sitting in a wheelchair or on some other kind of furniture. Seventeen falls (11%) were classified as the result of extrinsic mechanisms, 49 (32%) were intrinsic falls, 39 (25%) occurred in a nonbipedal position (while sitting or lying), and 48 falls (31%) remained unclassified. No injury was observed in 109 of 153 incidents (71%), whereas 6 falls (4%) involved fractures or other serious injury. CONCLUSIONS: Since falls are so frequent, they must be considered a significant problem in stroke rehabilitation. Fall prevention strategies should therefore be developed and included in rehabilitation programs.
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| 39. |
- Nyberg, Lars, et al.
(författare)
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Using the Downton index to predict those prone to falls in stroke rehabilitation
- 1996
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Ingår i: Stroke. - 0039-2499 .- 1524-4628. ; 27:10, s. 1821-1824
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND PURPOSE: Falls are a major complication in inpatient stroke rehabilitation. An important issue in preventive strategies is the early identification of those at risk. This study aimed at assessing the fall-prediction accuracy of an easily administered fall risk index in stroke rehabilitation. METHODS: A consecutive series of 135 patients admitted to a geriatric stroke rehabilitation unit was studied. A score on the Downton fall risk index was obtained from the admission assessment data and used as a predictive indicator of the risk of falls. The patients' falls were prospectively recorded during their rehabilitation stay. The correlation between falls and the predicted risk was assessed by means of survival analysis and a multiple regression analysis, adjusting for the time of observation. RESULTS: The risk of falls as a function of the time observed was significantly greater among those predicted to be at high risk (index score > or = 3) than among the others (P = .009, log-rank test; odds ratio, 2.9). Furthermore, the number of falls during rehabilitation stay was moderately correlated (R = .57) with the fall risk index sum when adjusted as for the time of observation. The sensitivity of the fall prediction as to outcome was 91%, whereas the specificity was limited to 27%. CONCLUSIONS: A moderately high correlation was found between the predicted and the observed risk of falls in stroke rehabilitation when the Downton fall risk index was used. However, a low specificity rate limits the accuracy of the prediction
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| 40. |
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| 41. |
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| 42. |
- Ramnemark, Anna, et al.
(författare)
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Fractures after stroke
- 1998
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Ingår i: Osteoporosis International. - : Springer Science and Business Media LLC. - 0937-941X .- 1433-2965. ; 8:1, s. 92-95
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Tidskriftsartikel (refereegranskat)abstract
- Fractures are a serious complication after stroke. Among patients with femoral neck fractures, a large subgroup have had a previous stroke. This study aimed to investigate the incidence of fractures after stroke. Included in the study were 1139 patients consecutively admitted for acute stroke. Fractures occurring from stroke onset until the end of the study or death were registered retrospectively. Hip fracture incidence was compared with corresponding rates from the general population. Patients were followed up for a total of 4132 patient-years (median 2.9 years). There were 154 fractures in 120 patients and median time between the onset of stroke and the first fracture was 24 months. Women had significantly more fractures than men (chi 2 = 15.6; p < 0.001). In patients with paresis most of the fractures affected the paretic side (chi 2 = 22.5; p < 0.001) and 84% of the fractures were caused by falls. Hip fracture was the most frequent fracture and the incidence was 2-4 times higher in stroke patients compared with the reference population. Fractures are thus a common complication after stroke. They are usually caused by falls and affect the paretic side. It is necessary to focus on the prevention of post-stroke fractures, including the prevention of both falls and osteoporosis.
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| 43. |
- Ramnemark, Anna, et al.
(författare)
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Hemiosteoporosis after severe stroke, independent of changes in body composition and weight
- 1999
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Ingår i: Stroke. - 0039-2499 .- 1524-4628. ; 30:4, s. 755-760
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND PURPOSE: Fractures are a serious complication after stroke, and the risk of hip fractures among stroke patients is increased 2 to 4 times versus a reference population. Fractures after stroke are probably caused by the development of hemiosteoporosis and the high incidence of accidental falls. The aim of this study was to investigate the development of hemiosteoporosis in relation to other changes in body composition during the first year after severe stroke. METHODS: The study included 24 patients with extensive paresis after stroke. Bone mineral content (BMC) and fat and lean mass were assessed 1, 4, 7, and 12 months after stroke onset by a dual-energy x-ray absorptiometer. RESULTS: The loss of total body BMC was significant during the first year after stroke (-1.6%; P<0.05), but there were no significant changes in total lean or fat mass. At inclusion, there were no significant differences between sides in lean or fat mass or BMC, but during follow-up, BMC of the affected side decreased significantly compared with the same side at inclusion (-7.5%; P<0.01). Side differences in fat mass became significant between legs (9.3%; P<0.001) and whole sides (4. 8%; P<0.01). There were only minor side changes in lean mass. Loss of BMC was independent of weight changes. CONCLUSIONS: During the first year after severe stroke, patients developed pronounced hemiosteoporosis. This was not associated with general changes in lean or fat mass. The development of hemiosteoporosis was independent of weight changes after stroke.
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| 44. |
- Ramnemark, Anna, et al.
(författare)
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Progressive hemiosteoporosis on the paretic side and increased bone mineral density in the nonparetic arm the first year after severe stroke
- 1999
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Ingår i: Osteoporosis International. - : Springer Science and Business Media LLC. - 0937-941X .- 1433-2965. ; 9:3, s. 269-275
-
Tidskriftsartikel (refereegranskat)abstract
- Fractures are a common and serious complication after stroke and the risk of hip fractures among stroke patients is 2 to 4 times greater than among other elderly people. The aim of this study was to investigate prospectively the change in bone mineral density (BMD) after severe stroke and to study the association between motor impairment, disability and the development of hemiosteoporosis. The study comprised 24 stroke patients, with no persistent paresis from previous strokes or previous osteoporotic fractures, included 1 month after stroke onset. BMD, motor function, ambulation and activities of daily living (ADL) were assessed at 1, 4, 7 and 12 months after stroke onset. At inclusion, the patients' BMD was normal for their age. During the study, there was a significant loss of BMD in the total body (-2.0%; p < 0.05), but not in the head or spine. BMD differed significantly between the paretic and the non-paretic arm at inclusion (-4.8%; p < 0.001). Decrease in BMD was most pronounced in the affected humerus (-17.4%; p < 0.001) and proximal femur (-12.2%; p < 0.01). BMD decreased significantly in both lower extremities during follow-up, but the losses were more pronounced on the paretic side (p < 0.01). In the nonaffected ultradistal radius there was a significant increase in BMD from inclusion to the end of the study (+5.8%; p < 0.01). There was no pattern in the bone losses correlating with presumptive risk factors for hemiosteoporosis such as motor function, ability to perform ADL or ambulation. Two patients had fractures at follow-up, both on the paretic side. Loss of bone mineral density in the paretic extremities is thus pronounced and progressive during the first year after stroke, indicating that loss of BMD is probably an important risk factor for post-stroke fractures. Surprisingly, BMD in the nonaffected arm increased significantly during the first year after stroke, most likely due to increased physical activity, and perhaps a redistribution of bone minerals from the paretic extremities.
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| 45. |
- Rosendahl, Erik, et al.
(författare)
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A high-intensity functional exercise program is applicable for older people with cognitive impairment
- 2007
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Ingår i: Research and practice in Alzheimer's disease. - Paris : Serdi publisher. - 2914377991 ; , s. 212-215
-
Bokkapitel (övrigt vetenskapligt/konstnärligt)abstract
- Maintaining or improving physical functions among older people with cognitive impairment in effective ways is of great importance, since cognitive decline is associated with a decline in physical performance. Training at high intensity has a greater effect than at a lower intensity, but there are few studies evaluating high-intensity training among older people with severe cognitive impairment. However, results from a recent study (the FOPANU Study) among older people dependent in activities of daily living and living in residential care facilities showed that a high-intensity functional weigh-bearing program had positive long-term effects on balance, gait ability and lower-limb strength. The mean score for the Mini-Mental State Examination was 18 (range 10-29) and 52% of the participants had a dementia disease. Regarding the applicability of the exercise program, no statistically significant differences in attendance, intensity or adverse events were observed when participants with dementia were compared with participants without dementia. A main clinical implication of the FOPANU Study is that people with severe cognitive impairment can be offered high-intensity functional exercise programs.
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| 46. |
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| 47. |
- Rosendahl, Erik, et al.
(författare)
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A randomised controlled trial of fall prevention by a high-intensity functional exercise program for older people in residential care facilities
- 2008
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Ingår i: Aging Clinical and Experimental Research. - Milan : Editrice Kurtis SRL. - 1594-0667 .- 1720-8319. ; 20:1, s. 67-75
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND AIMS: Falls are particularly common among older people living in residential care facilities. The aim of this randomized controlled trial was to evaluate the effectiveness of a high-intensity functional exercise program in reducing falls in residential care facilities.METHODS: Participants comprised 191 older people, 139 women and 52 men, who were dependent in activities of daily living. Their mean+/-SD score on the Mini-Mental State Examination was 17.8+/-5.1 (range 10-30). Participants were randomized to a high-intensity functional exercise program or a control activity, consisting of 29 sessions over 3 months. The fall rate and proportion of participants sustaining a fall were the outcome measures, subsequently analysed using negative binominal analysis and logistic regression analysis, respectively.RESULTS: During the 6-month follow-up period, when all participants were compared, no statistically significant differences between groups were found for fall rate (exercise group 3.6 falls per person years [PY], control group 4.6 falls per PY), incidence rate ratio (95% CI) 0.82 (0.49-1.39), p=0.46, or the proportion of participants sustaining a fall (exercise 53%, control 51%), odds ratio (95% CI) 0.95 (0.52-1.74), p=0.86. A subgroup interaction analysis revealed that, among participants who improved their balance during the intervention period, the exercise group had a lower fall rate than the control group (exercise 2.7 falls per PY, control 5.9 falls per PY), incidence rate ratio (95% CI) 0.44 (0.21-0.91), p=0.03.CONCLUSIONS: In older people living in residential care facilities, a high-intensity functional exercise program may prevent falls among those who improve their balance.
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| 48. |
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| 49. |
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| 50. |
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