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  • 1.
    Jensen, Jane
    et al.
    Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå university.
    Nyberg, Lars
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Rosendahl, Erik
    Gustafson, Yngve
    Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå university.
    Lundin-Olsson, Lillemor
    Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå university.
    Effects of a fall prevention program including exercise on mobility and falls in frail older people living in residential care facilities2004In: Aging Clinical and Experimental Research, ISSN 1594-0667, E-ISSN 1720-8319, Vol. 16, no 4, p. 283-92Article in journal (Refereed)
    Abstract [en]

    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

  • 2.
    Lundin-Olsson, Lillemor
    et al.
    Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå university.
    Jensen, Jane
    Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå university.
    Nyberg, Lars
    Gustafson, Yngve
    Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå university.
    Predicting falls in residential care by a risk assessment tool, staff judgement, and history of falls2003In: Aging Clinical and Experimental Research, ISSN 1594-0667, E-ISSN 1720-8319, Vol. 15, no 1, p. 51-59Article in journal (Refereed)
    Abstract [en]

    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.

  • 3.
    Lundström, Maria
    et al.
    Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå university.
    Olofsson, Birgitta
    Department of Orthopaedics, Surgical and Perioperative Sciences, Umeå University.
    Stenvall, Michael
    Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå university.
    Karlsson, Stig
    Umeå University, Department of Community Medicine and Rehabilitation.
    Nyberg, Lars
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Englund, Undis
    Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå university.
    Borssén, Bengt
    Department of Orthopaedics, Surgical and Perioperative Sciences, Umeå University.
    Svensson, Olle
    Department of Surgical and Perioperative Science, Umeå University.
    Gustafson, Yngve
    Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå university.
    Postoperative delirium in old patients with femoral neck fracture: a randomized intervention study2007In: Aging Clinical and Experimental Research, ISSN 1594-0667, E-ISSN 1720-8319, Vol. 19, no 3, p. 178-86Article in journal (Refereed)
    Abstract [en]

    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

  • 4.
    Pauelsen, Mascha
    et al.
    Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation.
    Nyberg, Lars
    Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation.
    Röijezon, Ulrik
    Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation.
    Vikman, Irene
    Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation.
    Both psychological factors and physical performance are associated with fall-related concerns2018In: Aging Clinical and Experimental Research, ISSN 1594-0667, E-ISSN 1720-8319, Vol. 30, no 9, p. 1079-1085Article in journal (Refereed)
    Abstract [en]

    Background Fall-related concern strongly correlates to activity avoidance in older people.  In this complex phenomenon, different terminology and instruments are often used interchangeably. Three main concepts make up fall-related concerns: fear-of-falling, consequence concern, and falls self-efficacy. It is suggested that fall-related concerns are mediated by psychological and physical factors.

    Aims Our aims were to describe the prevalence of fall-related concerns and find explanatory factors for its most studied concept – falls self-efficacy – in an older population.

    Methods We executed a cross sectional study on a random sample of 153 community dwelling older people (70 years or older). We used validated and reliable instruments as well as structured interviews to gather data on the three concepts of fall-related concerns and possible mediating factors. We then calculated descriptive statistics on prevalence and regression models for the total group, and men and women separately.

    Results 70% of the total sample (80% of women and 53% of men) reported at least one of the three concepts of fall-related concern. For the total sample, fear-of-falling, morale and physical performance were associated factors with falls self-efficacy. For women, number of prescription medications was added. For men, physical performance and concerns for injury were associated.

    Conclusion Fall-related concern is prevalent in large proportions with higher prevalence for women than for men. Important factors are fear of falling, morale, and physical performance. Gender differences in the emergence and variance of fall-related concern and the relation between physical performance and fall-related concern should be targeted in future research endeavors. 

  • 5.
    Rosendahl, Erik
    et al.
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Gustafson, Yngve
    Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå university.
    Nordin, Ellinor
    Umeå University, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Lundin-Olsson, Lillemor
    Umeå University, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Nyberg, Lars
    A randomized controlled trial of fall prevention by a high-intensity functional exercise program for older people living in residential care facilities2008In: Aging Clinical and Experimental Research, ISSN 1594-0667, E-ISSN 1720-8319, Vol. 20, no 1, p. 67-75Article in journal (Refereed)
    Abstract [en]

    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.

  • 6.
    Rosendahl, Erik
    et al.
    Luleå University of Technology, Department of Health Sciences, Health and Rehab.
    Lundin-Olsson, Lillemor
    Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå university.
    Kallin, Kristina
    Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå university.
    Jensen, Jane
    Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå university.
    Gustafson, Yngve
    Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå university.
    Nyberg, Lars
    Prediction of falls among older people in residential care facilities by the Downton index2003In: Aging Clinical and Experimental Research, ISSN 1594-0667, E-ISSN 1720-8319, Vol. 15, no 2, p. 142-7Article in journal (Refereed)
    Abstract [en]

    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

1 - 6 of 6
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