| 1. |
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| 2. |
- Gregersen, Nils. P., et al.
(author)
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Accident involvement among learner drivers : an analysis of the consequences of supervised practice
- 2003
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In: Accident Analysis and Prevention. - 0001-4575. ; 35:5, s. 725-730
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Journal article (peer-reviewed)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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| 3. |
- Gregersen, Nils. P., et al.
(author)
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Sixteen years age limit for learner drivers in Sweden : an evaluation of safety effects
- 2000
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In: Accident Analysis and Prevention. - 0001-4575. ; 32:1, s. 25-35
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Journal article (peer-reviewed)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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| 4. |
- Gregersen, Nils Petter, et al.
(author)
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Sixteen years age limit for learner drivers in Sweden - an evaluation of safety effects
- 2000
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In: ACCIDENT ANALYSIS AND PREVENTION. - : PERGAMON-ELSEVIER SCIENCE LTD. - 0001-4575. ; 32:1, s. 25-35
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Journal article (other academic/artistic)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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| 5. |
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| 6. |
- Jensen, Jane, et al.
(author)
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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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In: Aging Clinical and Experimental Research. - 1594-0667 .- 1720-8319. ; 16:4, s. 283-92
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Journal article (peer-reviewed)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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| 7. |
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| 8. |
- Jensen, Jane, et al.
(author)
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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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In: Annals of Internal Medicine. - : American College of Physicians. - 0003-4819 .- 1539-3704. ; 136:10, s. 733-41
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Journal article (peer-reviewed)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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| 9. |
- Jensen, Jane, et al.
(author)
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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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In: Journal of The American Geriatrics Society. - : Wiley. - 0002-8614 .- 1532-5415. ; 51:5, s. 627-35
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Journal article (peer-reviewed)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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| 10. |
- Jensen, Jane, et al.
(author)
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Falls among frail older people in residential care
- 2002
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In: Scandinavian Journal of Public Health. - : SAGE Publications. - 1403-4948 .- 1651-1905. ; 30:1, s. 54-61
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Journal article (peer-reviewed)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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| 11. |
- Kallin, Kristina, et al.
(author)
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Predisposing and precipitating factors for falls among older people in residential care
- 2002
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In: Public Health. - 0033-3506 .- 1476-5616. ; 116:5, s. 263-271
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Journal article (peer-reviewed)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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| 12. |
- Kallin, Kristina, et al.
(author)
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Why the elderly fall in residential care facilities, and suggested remedies.
- 2004
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In: The Journal of family practice. - 0094-3509 .- 1533-7294. ; 53:1, s. 41-52
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Journal article (peer-reviewed)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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| 13. |
- Lindelöf, Nina, et al.
(author)
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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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In: Archives of gerontology and geriatrics (Print). - : Elsevier. - 0167-4943 .- 1872-6976. ; 57:3, s. 369-376
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Journal article (peer-reviewed)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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| 14. |
- Littbrand, Håkan, 1966-, et al.
(author)
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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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In: Physical Therapy. - : Oxford University Press (OUP). - 0031-9023 .- 1538-6724. ; 86:4, s. 489-498
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Journal article (peer-reviewed)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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| 15. |
- Lundin-Olsson, Lillemor, et al.
(author)
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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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In: Aging Clinical and Experimental Research. - 1594-0667 .- 1720-8319. ; 15:1, s. 51-59
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Journal article (peer-reviewed)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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| 16. |
- Lundin-Olsson, Lillemor, et al.
(author)
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The Mobility Interaction Fall chart
- 2000
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In: Physiotherapy Research International. - : Wiley. - 1358-2267 .- 1471-2865. ; 5:3, s. 190-201
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Journal article (peer-reviewed)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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| 17. |
- Lundström, Maria, et al.
(author)
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Postoperative delirium in old patients with femoral neck fracture : a randomized intervention study.
- 2007
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In: Aging Clinical and Experimental Research. - 1594-0667 .- 1720-8319. ; 19:3, s. 178-186
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Journal article (peer-reviewed)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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| 18. |
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| 19. |
- Löfgren, Britta, et al.
(author)
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Cross-validation of a model predicting discharge home after stroke rehabilitation : validating stroke discharge predictors
- 2000
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In: Cerebrovascular Diseases. - : S. Karger AG. - 1015-9770 .- 1421-9786. ; 10:2, s. 118-125
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Journal article (peer-reviewed)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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| 20. |
- Löfgren, Britta, et al.
(author)
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Rehabilitation of stroke patients who are older and severely affected: short- and long-term perspectives
- 2000
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In: Topics in Stroke Rehabilitation. - 1074-9357 .- 1945-5119. ; 6:4, s. 20-29
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Journal article (peer-reviewed)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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| 21. |
- Nyberg, Jonna, 1967-, et al.
(author)
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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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In: Journal of Transport & Health. - : Elsevier Ltd. - 2214-1405 .- 2214-1413. ; 14
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Journal article (peer-reviewed)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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| 22. |
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| 23. |
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| 24. |
- Rosendahl, Erik, et al.
(author)
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A high-intensity functional exercise program is applicable for older people with cognitive impairment
- 2007
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In: Research and practice in Alzheimer's disease. - Paris : Serdi publisher. - 2914377991 ; , s. 212-215
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Book chapter (other academic/artistic)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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| 25. |
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| 26. |
- Rosendahl, Erik, et al.
(author)
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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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In: Aging Clinical and Experimental Research. - Milan : Editrice Kurtis SRL. - 1594-0667 .- 1720-8319. ; 20:1, s. 67-75
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Journal article (peer-reviewed)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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| 27. |
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| 28. |
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| 29. |
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| 30. |
- Rosendahl, Erik
(author)
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Fall prediction and a high-intensity functional exercise programme to improve physical functions and to prevent falls among older people living in residential care facilities
- 2006
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Doctoral thesis (other academic/artistic)abstract
- Impairments in balance, mobility, and lower-limb strength are common in the growing population of older people and can lead to dramatic consequences for the individual, such as dependency in activities of daily living, admission to nursing home, falls, and fractures. The main purposes of this thesis were, among older people in residential care facilities, to validate a fall-risk assessment tool and to evaluate a high-intensity functional weight-bearing exercise pro-gramme regarding its applicability as well as its effect on physical functions and falls. The prediction accuracy of the Downton fall risk index within 3, 6 and 12 months was evaluated among 78 residents, aged 65 years or more, at one residential care facility. The participants were assessed as having either a low or high fall risk according to the index and were followed-up for falls using two different fall definitions related to the cause of the fall. With all falls included, a significant prognostic separation was found between the low- and the high-risk group at 3, 6 and 12 months. A definition in which falls precipitated by acute illness, acute disease, or drug side-effects were excluded did not improve the accuracy of the fall prediction. The effect on physical functions of a high-intensity functional exercise programme was evaluated in a randomised controlled trial among 191 older people, dependent in activities of daily living, with a Mini-Mental State Examination score of ten or more, and living in nine residential care facilities. Participants were randomised to an exercise programme or a control activity, including 29 supervised sessions over 3 months, as well as to an intake of a milk-based 200 ml protein-enriched energy supplement (7.4 g protein per 100 g) or a placebo drink immediately after each session. The Berg Balance Scale, usual and maximum gait speed, and one-repetition maximum in lower-limb strength in a leg press machine were followed up at 3 and 6 months by blinded assessors and analysed using the intention-to-treat principle. Significant long-term effects of the high-intensity functional exercise programme were seen in balance, gait ability and lower-limb strength in comparison with the control activity. The intake of the protein-enriched energy supplement did not increase the effect of the training. The evaluation of the applicability of the exercise programme showed that there was a high rate of attendance, a relatively high achieved intensity in the exercises, and only two serious adverse events, neither of which led to manifest injury or disease, despite that most of the participants had severe cognitive or physical impairments. The applicability of the programme was not associated with the participants’ cognitive function. The evaluation of the fall-prevention effect of the exercise programme, during the 6 months following the intervention, showed that neither fall rate nor proportion of participants who sustained a fall differed between the exercise programme and the control activity, when all participants were compared. However, among participants who improved their balance during the intervention period, a significant reduction in fall rate was seen in favour of the exercise group. In conclusion, among older people living in residential care facilities, the Downton fall risk index appears to be a useful tool for predicting residents sustaining a fall, irrespective of the cause of the fall, even with a perspective of only a few months. A high-intensity functional exercise programme is applicable for use, regardless of cognitive function, and has positive long-term effects on balance, gait ability, and lower-limb strength. An intake of a protein-enriched energy supplement immediately after the exercise does not appear to increase the effect of the training. Participants who improve their balance function due to the exercise programme may reduce their risk of falling.
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| 31. |
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| 32. |
- Rosendahl, Erik, et al.
(author)
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High-intensity functional exercise program and protein-enriched energy supplement for older persons dependent in activities of daily living : a randomised controlled trial
- 2006
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In: Australian Journal of Physiotherapy. - 0004-9514. ; 52:2, s. 105-113
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Journal article (peer-reviewed)abstract
- The aims of this randomised controlled trial were to determine if a high-intensity functional exercise program improves balance, gait ability, and lower-limb strength in older persons dependent in activities of daily living and if an intake of protein-enriched energy supplement immediately after the exercises increases the effects of the training. One hundred and ninety-one older persons dependent in activities of daily living, living in residential care facilities, and with a Mini-Mental State Examination (MMSE) score of ? 10 participated. They were randomised to a high-intensity functional exercise program or a control activity, which included 29 sessions over 3 months, as well as to protein-enriched energy supplement or placebo. Berg Balance Scale, self-paced and maximum gait speed, and one-repetition maximum in lower-limb strength were followed-up at three and six months and analysed by 2 x 2 factorial ANCOVA, using the intention-to-treat principle. At three months, the exercise group had improved significantly in self-paced gait speed compared with the control group (mean difference 0.04 m/s, p = 0.02). At six months, there were significant improvements favouring the exercise group for Berg Balance Scale (1.9 points, p = 0.05), self-paced gait speed (0.05 m/s, p = 0.009), and lower-limb strength (10.8 kg, p = 0.03). No interaction effects were seen between the exercise and nutrition interventions. In conclusion, a high-intensity functional exercise program has positive long-term effects in balance, gait ability, and lower-limb strength for older persons dependent in activities of daily living. An intake of protein-enriched energy supplement immediately after the exercises does not appear to increase the effects of the training.
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| 33. |
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| 34. |
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| 35. |
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| 36. |
- Rosendahl, Erik, et al.
(author)
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High-intensity functional exercise program for older people dependent in ADL : a randomized controlled trial evaluating the effects on falls
- 2008
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Conference paper (other academic/artistic)abstract
- PURPOSE: To determine if a high-intensity functional exercise program improves balance, gait ability, and lower-limb strength in older people dependent in activities of daily living (ADL), if an intake of protein-enriched energy supplement immediately after the exercises increases these effects of the training, and if the exercise program reduces falls. RELEVANCE: Impairments in physical functions among older people can lead to dramatic consequences for the individual such as admission to nursing home, falls and fractures. High-intensity exercise programs are effective to improve physical functions among older people but knowledge is limited concerning the effects for older people with severe cognitive or physical impairments. PARTICIPANTS: 191 older people dependent in ADL, living in residential care facilities, and with a Mini-Mental State Examination (MMSE) score of ≥ 10 participated in this study (the FOPANU Study). METHODS: The participants were randomized to a high-intensity functional weight-bearing exercise program (the HIFE Program) or a control activity, including 29 sessions over 3 months, as well as to protein-enriched energy supplement or placebo. Berg Balance Scale, usual and maximum gait speed, and one-repetition maximum in lower-limb strength were followed-up at 3 and 6 months by assessors blinded to group allocation. Fall rate and the proportion of participants sustaining a fall during the six months following the intervention were the outcome measures of the fall preventive effect of the exercise program. ANALYSIS: The intention-to-treat principle was used. Balance, gait ability, and lower-limb strength: 2 x 2 factorial ANCOVA. Falls: Negative binominal analysis and logistic regression analysis. RESULTS: At 3 months, the exercise group had improved significantly in usual gait speed compared with the control group (mean difference 0.04 m/s, P = 0.02). At 6 months, there were significant improvements favoring the exercise group for Berg Balance Scale (1.9 points, P = 0.05), usual gait speed (0.05 m/s, P = 0.009), and lower-limb strength (10.8 kg, P = 0.03). No interaction effects were seen between the exercise and nutrition interventions. When all participants were compared, no statistically significant differences between groups were found for fall rate (exercise group 3.6 falls per person years and control group 4.6 fall per person years) or the proportion of participants sustaining a fall (exercise 53% and control 51%). 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 person years and control 5.9 falls per person years, incidence rate ratio 0.44, P = 0.03). CONCLUSIONS: A high-intensity functional exercise program has positive long-term effects in balance, gait ability, and lower-limb strength for older people who are dependent in ADL. An intake of protein-enriched energy supplement immediately after the exercises does not appear to increase these effects of the training. In addition, the high-intensity functional exercise program may have an effect in preventing falls among those who respond to the intervention. IMPLICATIONS: High-intensity functional exercise can be offered to improve physical functions among older people who are living in residential care facilities and have severe cognitive or physical impairments.
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| 37. |
- Rosendahl, Erik, et al.
(author)
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Prediction of falls among older people in residential care facilities by the Downton index
- 2003
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In: Aging Clinical and Experimental Research. - 1594-0667 .- 1720-8319. ; 15:2, s. 142-7
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Journal article (peer-reviewed)abstract
- BACKGROUND AND AIMS: Falls are frequent among older people living in residential care facilities. The aim of this study was to investigate the prediction accuracy of the Downton fall risk index among older people living in residential care facilities at 3, 6 and 12 months, and with two different definitions of falls. METHODS: Seventy-eight residents in one residential care facility, 56 women and 22 men, mean +/- SD age 81 +/- 6 years, participated in this study. Forty-seven percent of participants had dementia, 45% depression, and 32% previous stroke. Forty-one percent of participants used a walking device indoors, and the median score of the Barthel ADL Index was 16. At baseline, the Downton fall risk index was scored for each individual. A score of 3 or more was taken to indicate high risk of falls. Participants were followed up prospectively for 12 months, with regard to falls indoors. RESULTS: At 3, 6 and 12 months, and using a fall definition including all indoor falls, sensitivity ranged from 81 to 95% with the highest value at 3 months, and specificity ranged from 35 to 40%. The prognostic separation values ranged from 0.26 to 0.37. Within 3 months, the risk of falling was 36% in the high-risk group (index score > or = 3) and 5% in the low-risk group. The accuracy of predictions did not improve when applying a fall definition in which falls precipitated by acute illness, acute disease, or drug side-effects were excluded. CONCLUSIONS: Already after 3 months, the Downton fall risk index appears to be a useful tool for predicting falls, irrespective of their cause, among older people in residential care facilities
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| 38. |
- Rosendahl, Erik, et al.
(author)
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Prediction of falls among older people in residential care facilities by the Downton index
- 2002
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In: Aging Clinical and Experimental Research. - 1594-0667 .- 1720-8319. ; 15:2, s. 142-147
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Journal article (peer-reviewed)abstract
- BACKGROUND AND AIMS: Falls are frequent among older people living in residential care facilities. The aim of this study was to investigate the prediction accuracy of the Downton fall risk index among older people living in residential care facilities at 3, 6 and 12 months, and with two different definitions of falls. METHODS: Seventy-eight residents in one residential care facility, 56 women and 22 men, mean +/- SD age 81 +/- 6 years, participated in this study. Forty-seven percent of participants had dementia, 45% depression, and 32% previous stroke. Forty-one percent of participants used a walking device indoors, and the median score of the Barthel ADL Index was 16. At baseline, the Downton fall risk index was scored for each individual. A score of 3 or more was taken to indicate high risk of falls. Participants were followed up prospectively for 12 months, with regard to falls indoors. RESULTS: At 3, 6 and 12 months, and using a fall definition including all indoor falls, sensitivity ranged from 81 to 95% with the highest value at 3 months, and specificity ranged from 35 to 40%. The prognostic separation values ranged from 0.26 to 0.37. Within 3 months, the risk of falling was 36% in the high-risk group (index score > or = 3) and 5% in the low-risk group. The accuracy of predictions did not improve when applying a fall definition in which falls precipitated by acute illness, acute disease, or drug side-effects were excluded. CONCLUSIONS: Already after 3 months, the Downton fall risk index appears to be a useful tool for predicting falls, irrespective of their cause, among older people in residential care facilities.
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| 39. |
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| 40. |
- Stenvall, Michael, et al.
(author)
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A multidisciplinary, multifactorial intervention program reduces postoperative falls and injuries after femoral neck fracture.
- 2007
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In: Osteoporosis International. - : Springer Science and Business Media LLC. - 0937-941X .- 1433-2965. ; 18:2, s. 167-175
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Journal article (peer-reviewed)abstract
- INTRODUCTION: This study evaluates whether a postoperative multidisciplinary, intervention program, including systematic assessment and treatment of fall risk factors, active prevention, detection, and treatment of postoperative complications, could reduce inpatient falls and fall-related injuries after a femoral neck fracture.METHODS: A randomized, controlled trial at the orthopedic and geriatric departments at Umeå University Hospital, Sweden, included 199 patients with femoral neck fracture, aged >or=70 years.RESULTS: Twelve patients fell 18 times in the intervention group compared with 26 patients suffering 60 falls in the control group. Only one patient with dementia fell in the intervention group compared with 11 in the control group. The crude postoperative fall incidence rate was 6.29/1,000 days in the intervention group vs 16.28/1,000 days in the control group. The incidence rate ratio was 0.38 [95% confidence interval (CI): 0.20 - 0.76, p=0.006] for the total sample and 0.07 (95% CI: 0.01-0.57, p=0.013) among patients with dementia. There were no new fractures in the intervention group but four in the control group.CONCLUSION: A team applying comprehensive geriatric assessment and rehabilitation, including prevention, detection, and treatment of fall risk factors, can successfully prevent inpatient falls and injuries, even in patients with dementia.
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| 41. |
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| 42. |
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| 43. |
- Stenvall, Michael, 1966-
(author)
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Hip fractures among old people : their prevalence, consequences and complications, and the evaluation of a multi-factorial intervention program designed to prevent falls and injuries and enhance performance of activities of daily living
- 2006
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Doctoral thesis (other academic/artistic)abstract
- The number of old people is growing and will increase future demands on healthcare services for old people. Hip fracture is one of the diagnoses that increases with age and it has become a major problem, both for those suffering a fracture and for society due to the large numbers involved, the morbidity with complications such as falls, functional decline, and the high mortality rate among those affected. The main purposes of this thesis were, to study the impact of previous hip fractures on their life among the very old, to study in-patient falls, fall-related injuries and fall-risk factors, and to evaluate a multidisciplinary, multi-factorial intervention program designed to reduce in-patient falls and to enhance functional performance among old people who have sustained a femoral neck fracture. The impact of a hip fracture was examined in a cross-sectional population-based study, among the very old (Umeå 85+). After adjustment for potential covariates, participants with a history of hip fracture were found to be more dependent in the performance of Personal/Primary Activities of Daily Living (P-ADL) (p=0.024), walked less independently (p=0.040) and used a wheelchair more frequently (p=0.017). Most of the participants with earlier hip fractures who had moved to institutional care or begun using mobility aids, as compared to before the fracture, had started to do so permanently in connection with the fracture incident. In-patient falls, fall-related injuries and fall-risk factors were studied in 97 participants, aged 70 or more, treated for a femoral neck fracture. There were 60 postoperative falls occurring among 26/97 participants (27%). Thirty-two percent of the falls resulted in injuries, 25 % were minor, and 7 % were serious. Delirium after day seven, (Hazard Rate Ratio (HRR) with a 95% Confidence Interval (CI)), 4.62 (1.30-16.37), male sex 3.92 (1.58-9.73), and sleeping disturbances 3.49 (1.24-9.86), were associated with in-patient falls. Forty-five percent of the participants were delirious on the day they fell. The effects of a multidisciplinary, multi-factorial intervention program on in-hospital falls and injuries as well as the short- and long-term effects on living conditions, walking ability and performance of activities of daily living were evaluated in a randomised controlled trial among 199 participants with femoral neck fracture, aged ≥70 years. Participants were randomised to care in a geriatric ward (intervention, n=102) or to conventional postoperative routines (control, n=97). The intervention consisted of staff education, individualized care planning and rehabilitation, systematic assessment and treatment of fall-risk factors, active prevention, and detection and treatment of postoperative complications and an intervention follow up at four-months. The staff worked in teams to apply comprehensive geriatric assessment, management and rehabilitation. Twelve participants fell a total 18 times in the intervention group compared to 26 participants suffering a total 60 falls in the control group. Only one participant with dementia fell in the intervention group compared to 11 participants with dementia in the control group. The fall incidence rate was 6.29/1000 days vs. 16.28/1000 for the intervention and control groups respectively. The Incidence Rate Ratio (IRR) was 0.38 (95% CI: 0.20-0.76, p=0.006) for the total sample and 0.07 (95% CI: 0.01-0.57, p=0.013) among participants with dementia. No new fractures were incurred in the intervention group but there were four in the control group. In addition, despite shorter hospitalization, significantly more people from the intervention group had regained independence in P-ADL performance at the four- and twelve-month follow ups, Odds Ratios (OR), with 95% CI, were 2.51 (1.00-6.30) and 3.49 (1.31-9.23) respectively. More participants in the intervention group had also regained the ability to walk independently without walking aids indoors, at the end of the study period, 3.01 (1.18-7.61). In conclusion, hip fracture among the very old seems to be associated with poorer P-ADL performance and poorer mobility. Falls and injuries are common during in-patient rehabilitation after a femoral neck fracture, delirium and sleep disturbances and male gender are factors associated with in-patient falls. Having a team apply comprehensive geriatric assessments and rehabilitation, including the prevention, detection and treatment of fall-risk factors, can successfully prevent in-patient falls and fall-related injuries, even among participants with dementia, and can also enhance the performance of Activities of Daily Living (ADL) and mobility after a hip fracture, in both short- and long-term perspectives.
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| 44. |
- Stenvall, Michael, et al.
(author)
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Improved performance in activities of daily living and mobility after a multidisciplinary postoperative rehabilitation in older people with femoral neck fracture : a randomized controlled trial with 1-year follow-up.
- 2007
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In: Journal of Rehabilitation Medicine. - : Medical Journals Sweden AB. - 1650-1977 .- 1651-2081 .- 0001-5555. ; 39:3, s. 232-238
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Journal article (peer-reviewed)abstract
- OBJECTIVE: To investigate the short- and long-term effects of a multidisciplinary postoperative rehabilitation programme in patients with femoral neck fracture.DESIGN AND SUBJECTS: A randomized controlled trial in patients (n = 199) with femoral neck fracture, aged >or= 70 years.METHODS: The primary outcomes were: living conditions, walking ability and activities of daily living performance on discharge, 4 and 12 months postoperatively. The intervention consisted of staff education, individualized care planning and rehabilitation, active prevention, detection and treatment of postoperative complications. The staff worked in teams to apply comprehensive geriatric assessment, management and rehabilitation. A geriatric team assessed those in the intervention group 4 months postoperatively, in order to detect and treat any complications. The control group followed conventional postoperative routines.RESULTS: Despite shorter hospitalization, significantly more people from the intervention group had regained independence in personal activities of daily living performance at the 4- and 12-month follow-ups; odds ratios (95% confidence interval (CI) ) 2.51 (1.00-6.30) and 3.49 (1.31-9.23), respectively. More patients in the intervention group had also regained the ability to walk independently indoors without walking aids by the end of the study period, odds ratio (95% confidence interval) 3.01 (1.18-7.61).CONCLUSION: A multidisciplinary postoperative intervention programme enhances activities of daily living performance and mobility after hip fracture, from both a short-term and long-term perspective.
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| 45. |
- Stenvall, Michael, et al.
(author)
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Inpatient falls and injuries in older patients treated for femoral neck fracture.
- 2006
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In: Archives of gerontology and geriatrics (Print). - : Elsevier BV. - 0167-4943 .- 1872-6976. ; 43:3, s. 389-399
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Journal article (peer-reviewed)abstract
- A prospective inpatient study was performed at the Orthopedic and Geriatric Departments at the Umeå University Hospital, Sweden, to study inpatient falls, fall-related injuries, and risk factors for falls following femoral neck fracture surgery. Ninety-seven patients with femoral neck fracture aged 70 years or older were included, background characteristics, falls, injuries, and other postoperative complications were assessed and registered during the hospitalization. There were 60 postoperative falls among 26/97 patients (27%). The postoperative fall event rate was 16.3/1000 Days (95% CI 12.2-20.4). Thirty two percent of the falls resulted in injuries, 25% minor, and 7% serious ones. In multiple regression analyses, delirium after Day 7, HRR 4.62 (95% CI 1.24-16.37), male sex 3.92 (1.58-9.73), and sleeping disturbances 3.49 (1.24-9.86), were associated with inpatient falls. Forty-five percent of the patients were delirious the day they fell. Intervention programs, including prevention and treatment of delirium and sleeping disturbances, as well as better supervision of male patients, could be possible fall prevention strategies. Improvement of the quality of care and rehabilitation, with the focus on fall prevention based on these results, should be implemented in postoperative care of older people.
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