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Falls and fall prevention in community-dwelling older adults
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience.ORCID iD: 0000-0003-0527-0627
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Falls are the primary cause of injuries among older adults, and accidents that result from falls can lead to personal suffering and extensive societal burdens. The overall aims of this thesis were to explore and describe falls and fall prevention strategies in community-dwelling older adults and to evaluate a fall prevention home exercise program, the Otago Exercise Program (OEP), with or without motivational interviewing (MI).

Methods: Qualitative and quantitative research methods were uses. The designs were as follows: a cross-sectional, descriptive and comparative study (study I); a descriptive feasibility investigation (study II) and a randomized controlled trial (RCT) with two interventions, the OEP and OEP+MI, as well as a control group, with a 12-month follow-up (study III); and a prospective and descriptive study (study IV). The four studies comprised community-dwelling individuals aged 75 years or older. Study I included 262 individuals and studies II-IV had 175 participants who needed walking aids or home support. Study II also included 12 physical therapists.  Data collection was performed via self-reported questionnaires, fall calendars, exercise diaries, physical performance tests and a semi-structured questionnaire. 

Results and conclusions: Suggested actions to prevent falls significantly differed between high and low active older adults (study I). Support for self-directed behavioral strategies could be important for preventing falls in older adults who have low physical activity levels. The study protocol for the RCT had acceptable feasibility (study II), and only minor changes of the protocol were needed. There were no benefits for OEP or OEP+MI with personal support implemented nine times over the 12-month period. However, all groups maintained physical functioning and activity (study III). To increase physical functioning and reduce falls in this sub-group of older adults, more frequent personal support and/or an alternative delivery format may be required for efficient intensity and challenge in home exercises. Over 12 months, falls and fall-related injuries in the RCT sample were the most common when moving around within the home and transitioning from sitting to standing (study IV). Special attention to these activities might be important for preventing falls in community-dwelling older adults who need walking aids or home support.

 

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2018. , p. 64
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1396
Keyword [en]
older adults, falls, fall prevention, exercise, ICF, motivational interviewing
National Category
Medical and Health Sciences
Research subject
Physiotherapy
Identifiers
URN: urn:nbn:se:uu:diva-333507ISBN: 978-91-513-0156-3 (print)OAI: oai:DiVA.org:uu-333507DiVA, id: diva2:1158640
Public defence
2018-01-11, A1:107a, Biomedicinskt centrum, Husargatan 3, Uppsala, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2017-12-19 Created: 2017-11-20 Last updated: 2018-03-08
List of papers
1. Older adults' opinions on fall prevention in relation to physical activity level
Open this publication in new window or tab >>Older adults' opinions on fall prevention in relation to physical activity level
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2018 (English)In: Journal of Applied Gerontology, ISSN 0733-4648, E-ISSN 1552-4523, Vol. 37, no 1, p. 58-78Article in journal (Refereed) Published
Abstract [en]

The purpose of this study was to explore and describe older adults' opinions regarding actions to prevent falls and to analyze differences in the opinions of highly versus less physically active older adults. An open-ended question was answered by 262 individuals aged 75 to 98 years living in the community. The answers were analyzed using qualitative content analysis, and differences in the categories were compared between highly and less physically active persons. Physical activity was measured according to a five-level scale. The content analysis resulted in eight categories: assistive devices, avoiding hazards, behavioral adaptive strategies, being physically active, healthy lifestyle, indoor modifications, outdoor modifications, and seeking assistance. Behavioral adaptive strategies were mentioned to a greater extent by highly active people, and indoor modifications were more often mentioned by less active older adults. Support for active self-directed behavioral strategies might be important for fall prevention among less physically active older adults.

National Category
Other Medical Sciences
Identifiers
urn:nbn:se:uu:diva-278203 (URN)10.1177/0733464815624776 (DOI)000417697100005 ()26769824 (PubMedID)
Available from: 2016-02-24 Created: 2016-02-24 Last updated: 2018-02-07Bibliographically approved
2. A feasibility study of a randomised controlled trial comparing fall prevention using exercise with or without the support of motivational interviewing
Open this publication in new window or tab >>A feasibility study of a randomised controlled trial comparing fall prevention using exercise with or without the support of motivational interviewing
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2015 (English)In: Preventive Medicine Reports, ISSN 0350-1159, E-ISSN 2211-3355, Vol. 2, p. 134-140Article in journal (Refereed) Published
National Category
Health Sciences
Identifiers
urn:nbn:se:uu:diva-278198 (URN)10.1016/j.pmedr.2015.01.007 (DOI)
Available from: 2016-02-24 Created: 2016-02-24 Last updated: 2018-02-21Bibliographically approved
3. The Otago Exercise Program with or without Motivational Interviewing for community-dwelling older adults: A 12-month follow-up of a randomized, controlled trial
Open this publication in new window or tab >>The Otago Exercise Program with or without Motivational Interviewing for community-dwelling older adults: A 12-month follow-up of a randomized, controlled trial
(English)In: Article in journal (Refereed) Submitted
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-333500 (URN)
Available from: 2017-11-14 Created: 2017-11-14 Last updated: 2017-11-20
4. Circumstances and consequences of falls in community-dwelling older adults who need walking aids or home support - with a focus on activities connected to falls and fall injuries
Open this publication in new window or tab >>Circumstances and consequences of falls in community-dwelling older adults who need walking aids or home support - with a focus on activities connected to falls and fall injuries
(English)In: Article in journal (Refereed) Submitted
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-333503 (URN)
Available from: 2017-11-14 Created: 2017-11-14 Last updated: 2017-11-27

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