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Background and Aims Personality traits, such as neuroticism and extraversion, are emerging as important predictors of falls. Despite their significance, existing fall prevention programs often overlook these traits, creating a notable research gap. This study aims to conduct a comprehensive scoping review to explore the existing literature on the relationships among personality traits, falls, and fall-related psychological concerns (FrPCs). Methods This scoping review will adhere to the framework established by Arksey and O'Malley, incorporating extensions recommended by the Joanna Briggs Institute and using the PRISMA-ScR checklist. A thorough search strategy will be employed, aligning with the population, concept, and context (PCC) selection criteria. Electronic databases, including MEDLINE, APA PsycINFO, Web of Science, CINAHL, and SPORTDiscus, will be searched from their inception to the present. Additionally, a manual search of the reference lists of identified and relevant full-text articles will be conducted. Two independent reviewers will screen titles and abstracts, perform full-text reviews, and extract data from pertinent articles. Discussion Personality traits are increasingly recognized as influential predictors of falls and related psychological concerns. This review aims to make a substantial contribution to the existing literature by being the first to comprehensively explore and provide a descriptive synthesis of the relationship between personality traits and falls, as well as FrPCs in adults. It is hoped that the outcomes of this review will enhance our comprehension of the role of personality traits in falls, potentially informing future research and strategies for this critical area of study.

The fear of falling is a pressing public health issue, yet current interventions often fall short in addressing it effectively. As a result, there is a need for innovative interventions that go beyond symptom relief to address the underlying causes. From this standpoint, we propose that limited exposure to floors and a lack of post-fall contingencies may contribute to the uncertainty that amplifies the fear of falling, particularly in fall prone populations. We explore the theoretical underpinnings of this hypothesis and propose a framework based on the Uncertainty and Anticipation model to elucidate potential connections. Building upon this, we introduce the Floor-hugging intervention—a two-part strategy designed to confront these challenges. Firstly, we propose gradual exposure to different floor scenarios through guided imagery to diminish fear by familiarizing individuals with such situations. Secondly, we advocate for the adoption of evidence-based ways to get up from the floor for developing after fall contingencies. We delve into the theoretical framework supporting our approach and its potential to reduce the fear of falling while improving physical, social, and psychological well-being. Additionally, we outline prospective outcome measures to comprehensively assess the impact of the intervention across biopsychosocial domains. This perspective aims to stimulate discussion on the potential role of floor exposure and post-fall strategies in reducing the fear of falling, while also advocating for innovative interventions to empower and protect fall-prone populations.

Falls remain the second leading cause of injury-related deaths worldwide; therefore, longstanding practical fall-prevention efforts are needed. Falls can also lead to a reduction in independence and quality of life among older adults. Fall-prevention research has found that early prevention promotes a prolonged independence. However, it remains unknown which intervention is most beneficial for early prevention and how these interventions should be implemented for long-term effects. In addition, the present and future burden on social and healthcare services contributes to a gap in needs and requires an evidence-based fall prevention. Research suggests that strength, balance, and functional training are effective in reducing falls and fall-related injuries. Such training could greatly impacting independence. Fear of falling and strategies for managing falls are the suggested components to be included when evaluating fall-prevention programs. Thus, the preservation of physical functions is highly relevant for both independence and quality of life. It also contributes to psychological and social well-being, which are important factors for enabling individuals to stay at home for as long as possible. To meet future challenges associated with the expected increase in the older population, older adults should be viewed as a golden resource. With assistance from professionals and researchers, they can learn and gain the ability to institute fall-prevention programs in their own environments. These environments are primarily beyond the responsibilities of the healthcare sector. Therefore, programs comprising current knowledge about fall prevention should be developed, evaluated, and implemented with older adults by using a “train-The-trainer” approach, where a natural collaboration is established between civil society and/or volunteers, healthcare professionals, and researchers. For sustainable and effective fall-prevention programs, a co-design and early collaborative appr

Problems with balance, postural control and fear of falling are highly prevalent in lower limb prosthesis users, with much research conducted to understand these issues. The variety of tools used to assess these concepts presents a challenge when interpreting research outcomes. This systematic review aimed to provide a synthesis of quantifiable methods used in the evaluation of balance, postural control and fear of falling in lower limb prosthesis users with an amputation level at or proximal to the ankle joint. A systematic search was conducted in CINAHL, Medline, AMED, Cochrane, Ageline, Scopus, Web of Science, Proquest, PsychINFO, PsycArticles and PubPsych databases followed by additional manual searching via reference lists in the reviewed articles databases. Included articles utilized quantitative measure of balance or postural control as one of the dependent variables, lower limb prosthesis users as a sample group, were published in a peer-reviewed journal in English. Relevant assessment questions were created by the investigators to rate the assessment methods used in the individual studies. Descriptive and summary statistics are utilized to synthesize the results. The search yielded (n=187) articles assessing balance or postural control (n=5487 persons in total) and (n=66) articles assessing fear of falling or balance confidence (n=7325 persons in total). A large number of studies did not present if the chosen methods were valid and reliable for the lower limb prosthesis users. Among study limitations, small sample size was common.

Background: Family carers are important in preventing community-dwelling older people from falling. Family carers’ concerns about older people's risk of falling could affect their own physical and psychological health, lifestyle, and burden of care. While there are many studies exploring factors associated with fear of falling among older people, there is no research on family carers’ fall concern of older people (care recipients) who are hospitalised. Aim: This paper describes a prospective study protocol exploring the relationship of fall concern, psychological distress, and quality of life of family carers when their care recipient is hospitalised and after discharge. Methods: The study will recruit 180 family carers and older people. Family carers providing support for an older person without cognitive impairment who has been admitted to a private metropolitan hospital in Western Australia and assessed to have a risk of falling will be included. Data will be collected using an interviewer-administered survey. All participants will complete the survey within 48 h before the patient's discharge, follow-up one week later (only for family carers), and again 30 days after the patient is discharged. Data related to falls, fall concern, psychological distress, and quality of life will be obtained from family carers and care recipients. Discussion: This study will provide deeper understanding about the factors affecting fall concern among family carers of older people during hospitalisation and after discharge. This will help healthcare professionals better support family carers to implement fall prevention strategies for older people whilst in hospital and in the community.

Many older adults have fear of falling or are concerned to fall. However, little is known about factors that contribute to effective interventions for this problem. The first part of this thesis identified several characteristics of interventions and intervention participants that potentially influence the effects of interventions. These can be used as inspiration for the optimization of interventions for fear of falling. The second part of this thesis evaluated a measurement instrument for avoidance behavior due to concerns about falling. The Falls Efficacy Scale – International Avoidance Behavior (FES-IAB) was a good instrument to assess avoidance behavior due to concerns about falling in the population under study. Overall, the findings in this thesis contribute towards improved management of fear of falling in older adults.

Purpose: To explore the longitudinal impact of central vision loss on concern about falling (CF), over a 12-month period, in people with age-related macular degeneration (AMD). Methods: Participants included 60 community-dwelling older people (age, 79.7 ± 6.4 years) with central vision impairment due to AMD. Binocular high-contrast visual acuity, contrast sensitivity, and visual fields were assessed at baseline and at 12 months. CF was assessed at both time points using the Falls Efficacy Scale–International (FES-I). Senso-rimotor function (sit to stand, knee extension, postural sway, and walking speed) and neuropsychological function (reaction time, symptoms of anxiety and depression) were also assessed at both time points using validated instruments. Falls data were collected using monthly diaries during the 12 months. Results: CF increased by a small but significant amount over the 12-month follow-up (2.1 units; P = 0.01), with increasing prevalence of high levels of CF (FES-I score ≥ 23), from 48% at baseline to 65% at 12 months. Linear mixed models showed that reduced contrast sensitivity was significantly associated with increased concern about falling (P = 0.004), whereas declines in both visual acuity and contrast sensitivity during the follow-up period were associated with increases in CF over the 12-month follow-up (P = 0.041 and P = 0.054, respectively), independent of age, gender, falls history, or number of comorbidities. Conclusions: Higher levels of CF are common in older people with AMD, and levels increase over time; this increase is associated with declines in both visual acuity and contrast sensitivity. These findings highlight the need for regular assessment of both visual acuity and contrast sensitivity to identify those at greatest risk of developing higher CF. Translational Relevance: Routine assessment of visual acuity and contrast sensitivity in older people with AMD will assist in identifying those at risk of developing high CF.

Background: To study gait is of great importance for the health of the aging population. Higher-level gait disorders (HLGD) are characterized by a slow, symmetrical, unsteady gait. Its cause is most often unknown. HLGD in combination with ventriculomegaly (i.e., large brain ventricles) is obligatory for the diagnosis of Idiopathic Normal pressure hydrocephalus (INPH), a syndrome that is sometimes treatable with insertion of a CSF shunt. It is therefore important to investigate the prevalence of HLGD in the population and brain morphometry in individuals with HLGD. Further, self-perceived confidence in gait and balance among patients with HLGD and INPH is unknown and important to study as slow gait velocity is associated with falls, injuries, and death. CSF shunts in INPH are associated with adverse events and little is known about epilepsy after surgery or minor and moderate adverse events such as headache and abdominal pain. Objective: In the older population investigate the prevalence of HLGD, and its association to ventriculomegaly. To investigate quality of life (QoL), depressive symptoms, and balance confidence in an HLGD population. In patients shunted for INPH, assess falls, fear of falling, balance confidence and prevalence of the possible adverse events headache, epilepsy, and abdominal pain after shunt surgery. Methods: Two population-based case-controlled cohorts were studied. In the first study, the "Ventriculomegaly and gait disturbance in the senior population in the region of Västerbotten" (VESPR) study, individuals (65-84 years) were recruited through a questionnaire (n=6467 dispatched). The final population consisted of 798 cases with gait disorders and 249 controls without gait disorders, age- and sex-matched to individuals with HLGD. All had been examined by a physician and were categorized: 1. "HLGD"; 2. "neurological gait disorder"; 3. "non-neurological gait disorder" or; 4. "no gait disorder". Participants were assessed with: the Swedish modif

Background: Fear of falling and environmental barriers in the home are two major factors that cause the incidence of falling. Poor visibility at night is one of the key environmental barriers that contribute to falls among older adult residents. Ensuring their visual perception of the surroundings, therefore, becomes vital to prevent falling injuries. However, there are limited works in the literature investigating the impact of the visibility of the target on older adults’ walking destinations and how that impact differs across them with different levels of fear of falling. Objective: The purpose of the study was to examine the effects of target salience on older adults’ walking performance and investigate whether older adults with varying levels of fear of falling behave differently. Methods: The salient target was constructed with LED strips around the destination of walking. Fifteen older adults (aged 75 years old and above), seven with low fear of falling and eight with high fear of falling, volunteered for the study. Participants walked from the designated origin (i.e., near their beds) to the destination (i.e., near the bathroom entrance), with the target turned on or off around the destination of the walking trials. Spatiotemporal gait variables and lower-body kinematics were recorded by inertial sensors and compared by using analysis of variance methods. Results: Data from inertial sensors showed that a more salient target at the destination increased older adults’ gait speed and improved their walking stability. These changes were accompanied by less hip flexion at heel strikes and toe offs during walking. In addition, older adults with low fear of falling showed more substantial lower-body posture adjustments with the salient target presented in the environment. Conclusions: Older adults with a low fear of falling can potentially benefit from a more salient target at their walking destination, whereas those with a high fear of falling were advised to impl

Safely remaining active can be a challenge in older adults when age-related decline of physiological capacity sets in. In the introduction, it is argued that an accurate perception of physical ability is likely necessary to balance the health benefits of physical activity against the exposure to balance threatening situations that inherently comes with being physically active. We also noted that self-perceived ability may not only relate to fall risk through an association with physical activity but that it may also have an effect on people’s performance in situations that may be perceived as balance threatening. The overall aim of the thesis is to explore if the relation between physical ability and falls was modulated by self-perceived ability, potentially mediated through physical activity, in community dwelling older adults. In the thesis results are presented based on the FARAO cohort and the VIBE cohort. The latter was designed specifically to the aim to this thesis. The results of this cohort study are presented and are placed into a larger context.

Sarcopenia and obesity are common conditions in older adults that may have differing effects on falls and fracture risk. This systematic review and meta-analysis aimed to determine whether older adults with sarcopenic obesity have increased risk of falls and fractures or lower bone mass compared with older adults with sarcopenia, obesity, or neither condition. Twenty-six studies (n = 37,124) were included in the systematic review and 17 (n = 31,540) were included in the meta-analysis. Older adults with sarcopenic obesity had lower femoral neck areal bone mineral density (aBMD) compared with those with obesity alone but had higher femoral neck aBMD compared with counterparts with sarcopenia alone (both P < 0.05). Older adults with sarcopenic obesity had higher nonvertebral fracture rates (incidence rate ratio: 1.88; 95% confidence intervals: 1.09, 3.23; based on two studies), compared with those with sarcopenia alone, and also had higher falls risk compared with controls (risk ratio: 1.30; 95% confidence intervals: 1.10, 1.54) and obesity alone (risk ratio: 1.17; 95% confidence intervals: 1.01, 1.36). In conclusion, this systematic review and meta-analysis has demonstrated that older adults with sarcopenic obesity are at increased risk of adverse musculoskeletal outcomes compared with individuals with obesity, sarcopenia, or neither condition. These data support the need for developing interventions to improve bone health and physical function in this population.Copyright © 2020 World Obesity Federation

Purpose: To investigate the prevalence and level of concern about falling (CF) among older people with vision impairment due to age-related macular degeneration (AMD) compared to a visually normal control group, and to identify determinants of CF for the AMD group. Methods: Participants included 133 older people: 77 with AMD (mean age = 80.5 ± 6.2 years), and 56 controls (mean age = 75.4 ± 5.3 years). Binocular visual acuity, contrast sensitivity and visual fields were measured, and CF was assessed using the Falls Efficacy Scale – International (FES-I). Data were also collected for sensorimotor function (postural sway, sit-to-stand, knee extensions, walking speed, proprioception), and neuropsychological function (reaction time, symptoms of anxiety and depression) using validated tests and scales. Results: Concern about falling scores were higher for AMD participants compared to control participants (mean ± S.D. 24.6 ± 8.0 vs 21.6 ± 5.7, p = 0.02, respectively), although these findings failed to reach significance when adjusted for age (p = 0.16). Among AMD participants, multivariable models showed that greater CF was associated with reduced contrast sensitivity (p = 0.02), slower sit-to-stand times (p < 0.001) and higher anxiety scores (p < 0.001); these factors explained 40% of the variance in CF (p < 0.01). Conclusion: Levels of CF in older people with AMD were not found to be elevated by their disease status alone, but rather by the extent of vision loss. Levels of CF in those with AMD were associated with various visual, sensorimotor and neuropsychological factors. These findings will assist clinicians in identifying those at greatest risk of developing high CF and inform the design of future intervention programmes for this population.

Falls are common among persons with late effects of polio (LEoP), which may lead to fear of falling and activity avoidance in everyday life. Here, we assessed the occurrence of fall-related activity avoidance among persons with LEoP and explored how these experiences influenced daily life. Fourteen ambulatory persons (seven women; mean age 70 years) with LEoP participated. They responded to the modified Survey of Activities and Fear of Falling in the Elderly (mSAFFE) and participated in individual interviews, which were analysed by systematic text condensation. Each quotation was deductively analysed from its representation with regard to mSAFFE. We found that many persons often avoided activities related to standing and walking, for example, taking a bath, performing household chores, walking outdoors, attending social events if there were stairs in the building and travelling by public transport, due to fear of falling, increased pain and fatigability. To facilitate the performance of daily activities participants expressed that strategic thinking and aids were important to use. In conclusion, fall-related activity avoidance is common in persons with LEoP, which negatively influence daily life and social participation. To increase daily functioning in this population, fall-related activity avoidance should be included in a multifaceted fall management program., Funding: The study was supported by grants from the Stiftelsen för bistånd åt rörelsehindrade i Skåne, Sweden, Gyllenstiernska Krapperupsstiftelsen (The Gyllenstierna Krapperup Foundation), Sweden and the Faculty of Medicine at Lund University, Lund, Sweden. The funding agencies were not involved in any aspects of the study design, data collection, data interpretation or manuscript preparation.

With the world population shifting its proportions towards higher ages, it is imperative to increase healthspan rather than lifespan, both for the sakes of community sustainability as well as individual quality of life. One of the main means to obtain healthy ageing, is a concept called active ageing, as activity has shown to slow down the natural ageing process. Active ageing is threatened by a decline in balance performance and an increase of fall-related concerns, as activity curtailment is a major consequence. Fall-related concerns are prevalent in a large portion of the older population. Current understanding of its mechanisms is largely hypothesised, based on few observational studies in which single factors – mostly psychological – are researched. Postural control is the system that helps us maintain balance and control while moving or being still. Yet, the interactions between fall-related concerns and postural control are not very well described. Sensory input and processing have been identified as possibly an important part, but more in-depth investigations are needed. To investigate the prevalence and factors that may play a part in fall-related concerns, 153 older adults (70 years and over) were visited in their home. During these visits questionnaires and clinical tests were administered (among them FES-I, PGCM, SPPB, MMSE). To investigate the relationship between fall-related concerns and postural control more thoroughly, 45 of the original sample were also tested in the movement laboratory. Several modalities of sensory function were recorded, as well as lower limb strength and quiet stance centre of pressure. The home visits showed that 70% of people 70 years and older, living in the community experience at least one of the constructs of fall-related concerns and that associated factors are of both psychological and physical nature (fear, morale, and physical performance). Large and significant differences between men and women were discovered not, BAHRT

Introduktion Fallolyckor är den vanligaste typen av olycka hos äldre personer och det finns behov av nya fallpreventiva åtgärder där fysisk träning med mobilapplikation är en möjlighet. Syftet med studien var att undersöka om träningsmängden påverkar effekten av ett års fallpreventiv träning med mobilapplikation för äldre personer i ordinärt boende mätt i funktionell benstyrka, upplevd balans och benstyrka samt fallrädsla och hälsorelaterad livskvalité hos äldre personer. Metod Deltagarna medverkade i ett större projekt där de under ett år erbjudits fallpreventiv träning med en mobilapplikation. Innan studiens start samt efter 12 månader besvarades en enkät som behandlade bland annat ett 30 sekunders uppresningstest för funktionell benstyrka, upplevd balans, upplevd benstyrka, fallrädsla och hälsorelaterad livskvalité. Vid 12 månader skattade deltagarna även sin genomsnittliga träningsmängd under de senaste tre månaderna. Deltagarna delades in i grupper efter träningsmängd; ingen träning (n=13), <30 minuter (n=31), 30-59 minuter (n=13), ≥60 minuter (n=25). Effekten av träningen jämfördes mellan grupperna med hjälp av Kruskal–Wallis one-way analysis of variance. Resultat 82 deltagare inkluderades i denna studie, de hade en medelålder på 76 år, varav 72% var kvinnor. Gruppen som tränat ≥60 minuter hade signifikant förbättrad funktionell benstyrka samt upplevd benstyrka i dagsläget i jämförelse med hur den var för ett år sedan vid jämförelse med gruppen som tränat <30 minuter. De som tränat ≥60 minuter visade även en signifikant förbättring i upplevd balans i dagsläget i jämförelse med ett år sedan gentemot gruppen som inte tränat alls samt gruppen som tränat <30. Inga signifikanta gruppskillnader sågs i fallrädsla eller hälsorelaterad livskvalité. Konklusion Fallpreventiv träning som utförs ≥60 minuter i veckan ger signifikanta förbättringar i jämförelse med mindre träningsmängd gällande funktionell benstyrka samt upplevd balans och benstyrka i jämförelse

Med bakgrund av fallolyckor som ett betydande folkhälsoproblem, med personligt lidande och omfattande samhällskostnader som följd, undersökte studien produktdesigners möjligheter att skapa en tillgänglig och användbar produkt värd att använda, för personer över 65år, som känner rädsla för att falla (FHM, 2021). I en generell kommentar till FN:s mål för hållbar utveckling, uttrycks vikten av tillämpning av Universell Design (UD) i design av alla nya produkter (UN, 2013). Genom den globalt växande och breda målgruppen, blev det därför centralt att parallellt undersöka hur man kan skapa en bredare tillämpning av UD i designbranschen (WHO, 2018). Designprocessen tog stöd av principerna för UD (Story, Mueller & Mace, 1998) i kombination med Emotionell design och Normans (2004) tre nivåer av emotion. Studien tog även stöd i gerontologisk forskning om fenomenet Fear of falling (FoF), som pekar på att högst nivå av FoF uppmätts hos personer då man ställer rädslan i relation till en aktivitet (Lachman et al., 1998). Studiens empiri genererades huvudsakligen ur metoderna enkätundersökning och dagboksstudie, vilka visade en utbredd strategi bland användarna, att hantera rädsla för att falla genom aktivitetsbegränsning. Aktiviteten att nå högt placerade föremål i hemmet, blev central efter upptäckten att deltagarna i stor utsträckning använder annan utrustning och inredning än en avsedd stegpall. Studiens designbidrag resulterade i en stegpall, vars utformning inte ska motivera att använda en köksstol för aktiviteten. Studiens kunskapsbidrag till designbranschen är ett visuellt greppbart analysresultat, vars styrka är att kommunicera både konkret mätbara och känslomässiga värden i en produkt., With the background in fall accidents as a significant public health issue, causing both individual suffering and a large social cost, the study examined product designers’ opportunities to create accessible, useful products worth using, for people over 65, who suffers from fear of falling (FHM, 2021). In a general comment to the UN’s sustainable development goal’s, the importance of practising Universal Design (UD) in design of all new products is clearly expressed (UN, 2013). With a globally ageing population and within a broad target group, it became central to explore how to reach a more common practice of UD in the industry of product design (WHO, 2018). The design process was supported by the principles of UD (Story, Mueller & Mace, 1998) combined with Emotional Design and Norman’s (2004) three levels of emotion. The study also included theories from gerontological research on the phenomenon of Fear of falling (FoF), which indicates that a higher level of FoF is expressed by people when it is put in relation to an activity (Lachman et al., 1998). The study’s empirics were mainly generated from the methods Questionnaire and Diary study, which showed a widespread strategy among users, to handle FoF through activity restriction. The activity to reach highly placed objects at home became central after the discovering that the participants often use other equipment and furnishing than a designated step stool. The study’s design proposal resulted in a step stool, which should not justify using a kitchen chair for the activity. The study contributes closing a knowledge gap, which can benefit the design industry with a visually tangible analysis result of both measurable and emotional value in a product.

[Resumen]: Las dificultades didácticas asociadas al contacto en las prácticas motrices son una realidad muchas veces olvidada total o parcialmente en los procesos de enseñanza-aprendizaje de ese tipo de prácticas. Esta situación viene determinada por el carácter multidimensional del concepto y, en parte, por su origen empírico, lo que implica una gran diversidad terminológica. El presente trabajo pretende aportar una propuesta justificada para la conceptualización de los problemas afectivos derivados del contacto., [Abstract]: The didactic difficulties associated to contact in motor tasks are often partially or fully forgotten in teachinglearning processes of this type of practice. This situation is determined by the multidimensional nature of the concept and, in part, by its empirical origin, which has led to a great terminological diversity. This paper provides a justified proposal for the conceptualization of emotional problems related to contact.

To examine if knee-extension strength (KES) measures indicating probable sarcopenia are associated with health-related outcomes and if KES and hand grip strength (HGS) measures are associated with 1-year mortality after hip fracture. Two groups of older patients with hip fracture had either HGS (n = 32) or KES (n = 150) assessed during their acute hospital stay. Cut-points for HGS (<27 kg for men and <16 kg for women), and cut-points for maximal isometric KES (non-fractured limb), being the lowest sex-specific quintile (<23.64 kg for men and <15.24 kg for women), were used to examine association with health-related outcomes and 1-year mortality. Overall, 1-year mortality was 12.6% in the two strength groups, of which 47% (HGS) and 46% (KES) respectively, were classified as probable sarcopenia. Probable sarcopenia patients (KES) had lower prefracture function, performed poorly in mobility measures and expressed a greater concern of falling compared to their stronger counterparts. Hazard ratio for 1-year mortality was 2.7 (95%CI = 0.49-14.7, p = 0.3) for HGS and 9.8 (95%CI = 2.2-43.0, p = 0.002) for KES for probable sarcopenia patients compared to those not. Sex-specific KES measures indicating sarcopenia is associated with health-related outcomes and a strong predictor of 1-year mortality after hip fracture.

[Resumen]: Partiendo de la conceptualización de los problemas afectivos derivados del contacto (PADC) estudiamos su influencia en el aprendizaje de Rugby, Balonmano y Voleibol. El trabajo, desarrollado en el contexto universitario (n=16), se aborda dentro del paradigma cualitativo, mediante el análisis de contenido y con el apoyo de estrategias cuantitativas, siguiendo los Métodos Mixtos. El estudio prospectivo de los datos permitió describir la realidad a estudiar y el refinamiento de la metodología, centrada en el método de análisis de diarios con entrevista sobre los diarios, con el apoyo de herramientas informáticas de análisis cualitativo (Nvivo). Los resultados muestran la existencia de PADC y su influencia negativa en el aprendizaje de tareas motrices de los deportes estudiados. Las emociones que suscitan la aparición de estos problemas están fundamentalmente relacionadas con el miedo, aunque también con la ansiedad y/o la vergüenza. Además, se describen cuáles son los tipos de contactos que generan esos problemas. Igualmente, se concretan 29 factores que podrían ser valorados para disminuir la aparición de los PADC en procesos de enseñanza-aprendizaje de tareas motrices que impliquen contacto. La importancia de cada uno de estos factores varía en función del tipo de contacto que requiera la tarea motriz., [Abstract]: From the conceptualization of emotional problems related to contact (EPRC), we study its influence in the learning of Rugby, Handball and Volleyball. This research, developed at the university sphere (n=16), is framed within qualitative framework through the analysis of content assisted with quantitative strategies (Mixed Methods). The prospective study of the data allowed the description of the reality in study and the refinement in methodology. So, the method focused on the analysis of diaries with interviews about them with the support of computer tools of qualitative analysis (NVivo). The results show the existence of EPRC and its negative influence in the learning of motor tasks of the aforementioned sports. The emotions that facilitate the appearance of these problems are fundamentally related to fear, but also to anxiety or shame. In addition, the types of contacts that generate these problems are described. Furthermore, there were specified 29 factors that could be considerated to decrease the appearance of EPRCs in contact motor tasks teaching-learning processes. The importance of each of these factors varies depending on the type of contact that the motor task requires., [Resumo]: Partindo da conceituação de problemas afetivos derivados do contacto (PADC), estudamos sua influência na aprendizagem de Rugby, Handebol e Voleibol. O trabalho, desenvolvido no contexto universitário (n=16), é abordado dentro do paradigma qualitativo, através do método de análise de conteúdo e com o apoio de estratégias quantitativas, seguindo os Métodos Mistos. O estudo prospetivo dos dados permitiu descrever a realidade a ser estudada e o aprimoramento da metodologia, centrada no método de análise de diários com entrevista sobre os diários, com o apoio duma ferramenta computacional de análise qualitativa (Nvivo). Os resultados mostram a existência do PADC e sua influência negativa na aprendizagem de tarefas motoras dos desportos observados. As emoções produtoras desses problemas estão fundamentalmente relacionadas ao medo, mas também à ansiedade ou vergonha. Além disso, são descritos os tipos de contactos que geram esses problemas. Da mesma forma, foram especificados 29 fatores que poderiam ser avaliados para diminuir a aparência dos PADCs nos processos de ensino-aprendizagem de tarefas motoras que envolvem contacto. A importância de cada um desses fatores varia de acordo com o tipo de contacto que a tarefa motora exige

Background: Reduced kidney function has become a major public health concern, especially among older people, as Chronic Kidney Disease (CKD) is associated with increased risk of end stage renal disease and mortality. Falls are a serious negative health outcome in older persons with one third of people aged 65 years experiencing a fall per year and increasing fall rates with increasing age. The impact of CKD on falls in older community-dwelling persons is not well investigated. Additionally, lower urinary tract symptoms (LUTS) may also increase the risk of falls. Therefore, our aim was to investigate the impact of CKD and LUTS on falls as well as on injurious falls. Methods: The SCOPE study is an observational, multinational, multicenter, prospective cohort study involving communitydwelling older persons aged 75 years and more recruited from August 2016 to March 2018 in seven European countries. The main outcomes of the present study were any falls and any injurious falls during the 12 months before enrolment The cross-sectional association of estimated glomerular filtration rate (eGFR) and LUIS with study outcomes was investigated by logistic regression analysis adjusted for baseline characteristics of enrolled subjects. Results: Our series consisted of 2256 SCOPE participants (median age = 795 years, 55.7% female). Of them, 746 participants experienced a fall and 484 reported an injurious fall in the 12 months prior to baseline assessment CKD was not significantly associated with falls (OR = 0.95, 95%CI = 0.79-1.14 for eGFR< 60; OR = 1.02, 95%CI = 0.81-128 for eGFR< 45; OR = 1.08, 95%CI = 0.74-1.57 for eGFR< 30) or injurious falls (OR = 0.91, 95%CI = 0.67-124 for eGFR< 60; OR = 0.93, 95%CI = 0.63-137 for eGFR< 45; OR = 1.19, 95%CI = 0.62-2.29 for eGFR< 30). LUTS were found significantly associated with both falls (OR = 156, 95960 =129-1.89) and injurious falls (OR = 158, 95%0 =1.14-2.19), and such associations were confirmed in all multivariable m

Little is known of the factors that transform fear of falling (FOF) from a normal adaptive to a maladaptive response that could alter its impact on fall risk. Focusing on judgment capacity, we investigated whether it is associated with FOF and FOF-related activity restriction (AR), and whether it modifies the influence of FOF on fall risk. Data came from 2625 community-dwelling older adults enrolled in the Progetto Veneto Anziani. Baseline FOF and AR were assessed through personal interviews, and judgment capacity-high, moderate, or poor-through situational tests. At follow-up after 4.4 years, self-reported falls during the previous year were recorded. The associations between judgment and FOF/AR, and between FOF and the risk of at least one fall or recurrent falls (two or more falls), stratified by judgment capacity, were evaluated using multinomial logistic regressions. Compared with high-judgment participants, lower judgment participants were 20% more likely to report FOF; moderate judgment participants were 54% more likely and poor judgment participants twice as likely to report AR. After adjusting for potential confounders, including physical activity and physical performance, FOF increased the reporting of at least one fall only in the poor judgment group. The association between FOF and recurrent falls was stronger in individuals with poor (odds ratio [OR] = 3.66, 95% confidence interval [CI]: 2.10-6.36) than with moderate (OR = 2.81, 95% CI: 2.22-3.55) or high (OR = 1.65, 95% CI: 1.48-1.83) judgment. Poor judgment capacity increases the probability of FOF and AR in older adults, and may exacerbate the effect of FOF in increasing fall risk.

Aims: This study aimed to investigate the psychometric properties of the Carers’ Fall Concern Instrument (CFC-I) for measuring carers’ concern for older people (care recipients) at risk of falling. Background: Family carers are crucial in preventing older people from falling at home. Their concerns for older people at risk of falling have severe implications on carers’ psychological well-being and ability to prevent falls. However, there is no validated instrument measuring this concern. Methods: A cross-sectional study was used to examine the validity and reliability of the CFC-I. Carers looking after older people living at home completed the 17-item CFC-I and provided information about their care arrangements and the older people's fall history. Construct validity was tested using exploratory factor analysis and hypothesis testing. Internal consistency was determined by calculating Cronbach's alpha coefficient. Results: 143 carers completed the survey either by face-to-face or by online. After deleting one item with an item-total correlation of below 0.3, the remaining 16-item CFC-I reported a Cronbach alpha of 0.93. Construct validity was supported by strong item-total correlations (0.51–0.76), mean inter-item correlations (0.47) and factor loadings (0.557–0.809). Factor analysis revealed three factors that include concerns about care recipients’ health and function, living environment and carers’ perception of fall and fall risk. The 16-item CFC-I can discriminate between carers of older people with and without recurrent (fallen 3/ more times) falls. Conclusion: The 16-item CFC-I is a valid and reliable scale for measuring carers’ concern for the older people's risk of falling. Future analysis of test–retest and inter-rater reliability of the instrument will further support its clinical use for carers. Implications for practice: The newly developed multi-item CFC-I can be used to quantify the carers’ level of fall concern and inform targeted interventions for ca

Purpose: Huntington's disease (HD) is an neurodegenerative genetic disorder with characteristic gait changes. HD also results in a range of cognitive impairments, such as difficulties to divide attention, or simultaneously monitoring two tasks. Aim: The impact of cognitive and/or motor tasks on HD gait has not been fully elucidated. The aim was to examine gait in HD patients while performing motor and/or cognitive dual-task walking. Methods: Gait was measured with and without performing concurrent cognitive and/or motor tasks. Sixteen HD patients and 24 healthy control (HC) subjects performed a self-paced basic walking task, a dual motor, a dual mental and a combined motor and mental task while walking. Results: Base walk gait parameters are significantly different between HD and HC groups. Same is true for motor, mental and combined tasks comparisons of HD and HC subjects. Gait velocity is also significantly reduced in HD compared to HC for all experimental conditions. Comparison of base walk and mental task performance showing differences in cycle time, stride length, double support time and CV of stride length, while base walk to motor task comparison is different only in stride length. No differences were found when motor and combined tasks were compared to mental task in HD patients. Conclusion: Gait pattern in HD patients while performing motor and/or cognitive dual tasks walking is remarkably preserved. Gait parameters are changed in order to reduce possible falls, and lack of differences of dual tasks gait parameters variability is attributed that patients minimizing risk of falling and preserving stability.

Concern about falling (CF) is a significant health issue among older people, leading to activity restriction, physical decline, and increased falls risk. Age-related macular degeneration (AMD) is the leading cause of irreversible vision loss among older people, yet little is known about CF in this population. High levels of CF were demonstrated among those with AMD, predicted by reduced visual function, and other physical and psychological factors. Over a 12-month period, CF increased, more so than in general older populations. These results provide an important basis for developing interventions to manage excessive CF, promote activity participation and reduce falls risk.

Health-related quality of life (HRQoL) and physical function deteriorate with age and may adversely impact bone health in older adults. We determined associations of objective measures of physical function and HRQoL with bone health in postmenopausal women with low areal bone mineral density (aBMD). Fifty postmenopausal women (64.4 +/- 7.7 years old, mean +/- standard deviation) with low spine, hip or femoral neck aBMD (T-or Z-score < -1.0) on dual-energy X-ray absorptiometry (DXA) participated. Femoral surface BMD, trabecular, integral and cortical volumetric BMD (vBMD) measurements were obtained using 3D-SHAPER software on DXA. Distal tibial vBMD and microarchitecture were assessed using high-resolution peripheral quantitative computed tomography (HRpQCT). Participants completed self-administered EuroQol-5D (EQ-5D) and modified falls efficacy scale (MFES) questionnaires, and physical function assessments. Stair climb power was positively associated with bone parameters at the hip, femoral neck, and distal tibia (all p < 0.05) in multivariable linear regression. EQ-5D demonstrated no significant associations with bone parameters and MFES was positively associated only with distal tibial cortical vBMD and cortical von Mises stress (both p < 0.05). Objective measures of physical function, particularly muscle power, are more consistently associated with bone parameters compared with self-administered HRQoL questionnaires.Copyright © 2019 by the authors. Licensee MDPI, Basel, Switzerland.

Background: An understanding of capacity for physical activity in obese populations should help guide interventions to promote physical activity. Fear of falling is a phenomenon reported in the elderly, which is associated with reduced mobility and lower physical activity levels. However, although falls are reportedly common in obese adults, fear of falling and its relationship with activity has not been investigated in younger obese populations. Methods: In a cross-sectional study, fear of falling was measured in 63 women aged 18 to 49 years, with mean BMI 42.1 kg/m2 (SD 10.3) using the Modified Falls Efficacy (MFES), the Consequences of Falling (COF) and the Modified Survey of Activities and Fear of Falling in the Elderly (MSAFFE) scales. The choice of scales was informed by prior qualitative interviews with obese younger women. Physical activity levels were measured at the same time using the International Physical Activity Questionnaire. The mean score for fear of falling scales, with 95% confidence intervals, were estimated. Chi-square tests and t-tests were used to explore differences in age, body mass index and fear of falling scores between fallers and non-fallers. For each fear of falling scale, binomial logistic regression was used to explore its relationship with physical activity. Results: Mean scores suggested high levels of fear of falling: MFES [mean 7.7 (SD 2.7); median 8.5]; COF [mean 31.3 (SD 9.4)]; MSAFFE [mean 25.9 (SD 8.7); median 23]. Scores were significantly worse in fallers (n=42) compared to non-fallers (n=21). MFES and MSAFFE were independently associated with lower levels of physical activity [odds ratio = 0.65, 95% Cl 0.44 to 0.96 and odds ratio = 1.14, 95% CI 1.01 to 1.28 respectively], when adjusted for age, BMI and depression. Conclusions: This study confirms that fear of falling is present in obese women under 50 years of age. It suggests that it is associated with low levels of physical activity. These novel findings warrant further

OBJECTIVES:To evaluate the safety and acceptability of a novel 8-week intervention integrating exercise, exposure therapy, cognitive restructuring, and a home safety evaluation, conducted by a physical therapist, in reducing fear of falling and activity avoidance. To collect preliminary evidence of efficacy. DESIGN:Randomized pilot study comparing the intervention to time- and attention-equivalent fall prevention education. SETTING:Participants' homes. PARTICIPANTS:42 older adults with disproportionate fear of falling (high fear, low to moderate objective fall risk). MEASUREMENTS:Falls Efficacy Scale-International, modified Activity Card Sort, satisfaction, falls. RESULTS:Relative to education, the intervention reduced fear of falling (d = 1.23) and activity avoidance (d = 1.02) at 8 weeks, but effects eroded over a 6-month follow-up period. The intervention did not increase falls, and participants rated the exercise, exposure therapy, and non-specific elements as most helpful. CONCLUSIONS:An integration of exercise and exposure therapy may help older adults with disproportionate fear of falling, but modifications to the intervention or its duration may be needed to maintain participants' gains.

Fear of falling (FoF) increases fall risk and is associated with functional problems. Identifying factors that predict or maintain FoF could improve fall prevention and functional ability for older adults. The relationship between FoF and attitudes toward aging, a potential predictor of FoF, is not known. Additionally, despite the well-documented relationship between falls and cognition, the neuropsychological correlates of FoF are not well-characterized. The current study aimed to evaluate the relationships among FoF, attitudes toward aging, and balance (Study 1), and characterize the neuropsychological correlates of FoF (Study 2).Both studies were cross-sectional and included participants from a larger study. The short Falls Efficacy Scale International (FES-I) was used to measure FoF. Study 1 included 69 adults aged 65-83. Attitudes toward aging were assessed with the Age Implicit Association Test and the Attitudes to Ageing Questionnaire (AAQ). Balance was operationalized as postural sway and assessed with a force platform. The relationships among attitudes toward aging, FoF, and balance were examined with linear regression analyses. Study 2 was a secondary analysis of 136 adults aged 62-85. Processing speed, memory, executive function, working memory, anxiety, and depression were assessed with the NIH Toolbox Cognition Battery and PROMIS scales. The neuropsychological profile of FoF was examined using hierarchical linear regression analyses.Study 1 did not find support for a significant relationship between postural sway and FoF or attitudes toward aging, nor between FoF and attitudes toward aging. Post hoc analyses revealed higher scores on the AAQ Psychological Growth subscale were associated with increased risk of FoF. Contrary to hypotheses, Study 2 found higher FoF was associated with better working memory and poorer episodic memory. Fear of falling was not significantly associated with executive function, processing speed, anxiety, or depression.Findings

Background: Parkinson's disease (PD) is a chronic progressive neurodegenerative disease that results in functional loss and disability. People with PD have an increased risk of falling, and most of their falls occur while walking. As yet, there is limited knowledge concerning activity avoidance due to perceived risk of falling in people with PD. In order to quantitatively assess perceived walking difficulties, a psychometrically-sound instrument is necessary. Although the generic Walk-12 scale (the Walk-12G) seems promising, only one prior study has investigated its psychometric properties in people with PD. Moreover, little is known about factors that independently contribute to perceived walking difficulties in people with PD. No study has yet investigated the use and perceived needs of mobility devices (MDs) over a period of time in people with PD. Aim: The overarching aim of this PhD thesis was to gain increased knowledge regarding activity avoidance due to perceived risk of falling, perceived walking difficulties, and the use and perceived needs of MDs in people with PD. Methods: The thesis was based on a longitudinal cohort survey of participants with PD with a baseline data collection (n = 255), using self-administered and structured questions/questionnaires, observations and clinical assessments, and an equivalent 3-year follow-up (n = 165). Statistical analyses included bivariate analyses (Study I), psychometric evaluation (Study II), multivariate analyses (Study III), and descriptive- and follow-up analyses (Study IV). Main results: Study I: Activity avoidance due to perceived risk of falling was reported by 30% of the non-fallers whereas the corresponding rate was 57% in recurrent fallers (i.e. ≥ 2 falls). Twenty-four percent of participants with an early/mild PD stage reported activity avoidance due to the perceived risk of falling which rose to 74% among those in the most severe stages. Moreover, it was reported by 51% of participants with near falls (b

Fallolyckor är vanligt förekommande bland äldre personer i Sverige. Trots detta saknas studier på de drabbades upplevelse efter ett fall. Syfte: Examensarbetets syfte var därför att beskriva hur äldre upplever sina dagliga aktiviteter efter fall. Metod: Metoden för examensarbetet var kvalitativ med semistrukturerade intervjuer. Nio personer i södra Sverige mellan 71–94 år har deltagit. Materialet har analyserats genom en kvalitativ innehållsanalys. Resultat: Resultatet mynnade ut i tre kategorier, känslor som påverkar utförandet av aktiviteter, fysiska upplevelser som leder till begränsningar samt strategier för att hantera vardagen. Efter fall upplevde många trötthet, rädsla och oro. Även smärta och försämrad rörelseförmåga förekom bland deltagarna. Konsekvenserna efter fall upplevdes påverka och begränsa vardagliga aktiviteter. Slutsats: I resultatet framkom att de personliga erfarenheterna, känslorna och upplevelsen av fall hade minst lika stor påverkan på vardagen som den tillhörande fysiska skadan., Fall accidents are common among older people in Sweden. Despite that there is lack of studies about the affected person's experience after a fall. Purpose: The purpose of the study is therefore to describe how older people’s experience their daily activities after falling. Method: The study was a qualitative interview study with semi-structured interviews. Nine people 71-94 years old from south Sweden have been participating in the interview study. The collected data was analyzed with a qualitative content analysis. Result: The result was divided into three categories: Feelings that affect the performance of activities, physical experiences that lead to limitations and strategies for managing everyday life. Many experienced tiredness, fear and anxiety after a fall. Even pain and impaired mobility occurred among the participants. The consequences after a fall were found to affect and limit the everyday life. Conclusion: Based on the results of this study the personal experiences, feelings and the experience of the fall had at least as much influence on the daily life as the physical injury.

Background There has been a lack of research examining the relationship among self-perceptions, behaviour, cognitions and functioning in older adults. This study, therefore, examined the relationship between global and physical self-perceptions, physical activity behaviour, and fear of falling taking into considerations objective measures of physical functioning in community dwelling older adults. Methods/design Sixty-six participants between 60 and 90 years old (71.9 ± 6.6 years; 47 females; 19 males) completed questionnaires assessing physical and global self-description (PSDQ), planned and incidental physical activity behaviour (IPEQ), and falls efficacy (Short FES-I) as well as tests measuring physical functioning. Backwards multiple linear regression modelling was used to assess possible relationships among variables. Results Findings showed that physical self-perceptions (activity, coordination, endurance, flexibility) were associated with self-reported planned and incidental PA whereas sit-to-stand was the only objectively measured physical functioning variable associated with planned PA. Similarly, more falls, global self-esteem, general physical and domain specific physical self-perceptions (flexibility and strength) as well as knee strength were associated with fear of falling. There were also associations between some of the objectively measured physical functioning variables and self-perceptions of the physical self, providing some predictive validity for the PDSQ. Conclusions The findings of this study come to corroborate that the belief system of older adults ideally need to be taken into consideration when designing interventions that aim to enhance PA behaviour or reduce fear of falling. Coupling that with goal-setting, life coaching and behaviour change strategies would also be beneficial to address engagement and adherence to such interventions. Trial registration This trial was retrospectively registered with the Australian New Zealand Clinical Tr

Background: Chronic musculoskeletal pain is a major health problem among older adults, particularly those who live alone and/or those who are dependent on formal care. Chronic pain is associated with mobility problems, falls, fear of falling, catastrophizing thoughts, and a lower quality of life. Research shows that physical therapy interventions based on behavioral medicine approaches are beneficial for middle-aged adults with chronic pain. However, there appears to be no previous randomized controlled trials (RCTs) based on this theoretical framework that have examined the effect on older adults with chronic musculoskeletal pain who live alone at home and are dependent on formal care to manage their everyday lives. The aim of the planned study is to evaluate the effect of an individually tailored integrated physical therapy intervention based on a behavioral medicine approach compared with the effect of standard care. Methods/design: The planned study is an RCT that will include one intervention and one control group involving a total of 150 adults aged ≥75 years with chronic musculoskeletal pain who live alone at home and are dependent on formal care to manage their everyday lives. The intervention will involve a 12-week home-based individually tailored intervention that will be designed to enhance the participants’ ability to perform everyday activities by improving physical function and reducing pain-related disability and beliefs. The control group will be given standard care, including general advice about physical activity. The participants will be assessed at baseline and at 3 and 6 months after baseline. The primary outcome will be pain-related disability and physical performance. Discussion: The intervention, if effective, will have the potential to be the basis of the first evidence-based guidelines for physical therapists who work with older adults with chronic musculoskeletal pain.

Background. Falling is a major clinical problem in elderly people, demanding effective solutions. At present, the only effective intervention is motor training of balance and strength. Executive function-based training (EFt) might be effective at preventing falls according to evidence showing a relationship between executive functions and gait abnormalities. The aim was to assess the effectiveness of a motor and a cognitive treatment developed within the EU co-funded project I-DONT-FALL. Methods. In a sample of 481 elderly people at risk of falls recruited in this multicenter randomised controlled trial, the effectiveness of a motor treatment (pure motor or mixed with EFt) of 24 one-hour sessions delivered through an i-Walker with a non-motor treatment (pure EFt or control condition) was evaluated. Similarly, a 24 one-hour session cognitive treatment (pure EFt or mixed with motor training), delivered through a touch-screen computer was compared with a non-cognitive treatment (pure motor or control condition). Results. Motor treatment, particularly when mixed with EFt, reduced significantly fear of falling (F(1,478) = 6.786, p = 0.009) although to a limited extent (ES -0.25) restricted to the period after intervention. Conclusions. This study suggests the effectiveness of motor treatment empowered by EFt in reducing fear of falling., Peer Reviewed, Postprint (published version)

Background Dizziness is highly prevalent among older people and associated with many health factors. The aim of the study was to determine the prevalence of and factors related to dizziness among community-dwelling older adults in Sweden. In contrast to previous studies, the subjects with dizziness were divided into two groups, mild and substantial dizziness, according to the frequency and intensity of dizziness. Methods A sample of 305 older persons between 75 and 90 years of age (mean age 81 years) were interviewed and examined. Subjects with dizziness answered the University of California Los Angeles Dizziness Questionnaire and questions about provoking movements. The groups with substantial, mild, or no dizziness were compared with regard to age, sex, diseases, drugs, blood pressure, physical activity, exercises, falls, fear of falling, quality of life, general health, mobility aids, and physical performance. Results In this sample, 79 subjects experienced substantial and 46 mild dizziness. Subjects with substantial dizziness were less physically active, reported more fear of falling, falls, depression/anxiety, diabetes, stroke/TIA, heart disease, a higher total number of drugs and antihypertensive drugs, lower quality of life and general health, and performed worse physically. Conclusions There are many and complex associations between dizziness and factors like falls, diseases, drugs, physical performance, and activity. For most of these factors, the associations are stronger in subjects with substantial dizziness compared with subjects with mild or no dizziness; therefore, it is relevant to differ between mild and substantial dizziness symptoms in research and clinical practice in the future.

ObjectiveFear of falling is an important problem among older adults, even those with relatively low rates of objective fall risk, who are often overlooked as targets for intervention.MethodWe developed and pilot tested a new intervention, Activity, Balance, Learning, and Exposure (ABLE), in a sample of 10 older adults with excessive fear of falling. The ABLE intervention integrates exposure therapy and cognitive restructuring with a home safety evaluation and an exercise program and is conducted in the home. In this pilot project, ABLE was jointly conducted by a physical therapist and a psychologist with expertise in geriatric anxiety disorders.ResultsThe intervention was feasible and acceptable and resulted in decreases in fear and activity avoidance for most participants. One participant experienced an injurious fall.DiscussionWe learned a number of important lessons resulting in modifications to the inclusion criteria, assessments, and intervention over the course of this pilot study. Results suggest that ABLE has promise for treating excessive fear of falling in the elderly and support testing the intervention in a larger randomized trial. Copyright © 2016 John Wiley & Sons, Ltd.

Falls pose an important problem for older adults. Balance training is one of the main prevention strategies, but there is a lack of objective measurement methods that would allow the effectiveness of the treatments employed to be assessed. This study aimed to analyse the relationship between posturographic parameters and risk factors associated with falling, including the fear of falling (FoF). Forty-one healthy community-dwelling older adults were surveyed on their perception of problems considered to be fall risk factors. Balance measurement with posturography was performed. The relationships between risk factors and falls and risk factors and posturography were analysed by means of cross-tabulation and logistic regression, respectively. Experimental results showed a significant relationship between some of the posturographic parameters and various fall risk factors. Stability limits were related to FoF, and results from the Romberg test with eyes closed with and without foam correlated with problems in kneeling/crouching. The results from the Romberg test with eyes closed and foam correlated with osteoarthritis. Equations were developed to estimate the probability of having such problems. In conclusion, posturography is useful for the estimation of fall risk conditions in relation to three important fall risk factors (FoF, osteoarthritis and problems in kneeling/crouching), and it could be used for targeting, training and studying progress after the use of different treatments. Relevance to industry: Posturography can be used as an assessment tool to analyse the effects of those treatments aimed at preventing falls. Furthermore, the equations derived from our results can be used along with posturographic variables to assess patient progress. (C) 2016 Elsevier B.V. All rights reserved.

El objetivo del presente trabajo de innovación es presentar un modelo adaptado y utilitario del Judo como instrumento educativo para disminuir el miedo a caer en Adultos-Mayores. Su pertinencia se encuentra en una necesidad formativa del alumnado de Grado en Ciencias de la Actividad Física y del Deporte y del Máster en Actividad Física y Calidad de Vida de Personas Adultas y Mayores, formación que le permita dar una respuesta utilitaria y saludable a esta población especial, para lo cual se lleva a cabo un trabajo específico sobre los fundamentos del Judo (las caídas). Para su valoración se ha utilizado el cuestionario internacional FES-I., obteniendo resultados entre los que podemos destacar la existencia de actividades ante las cuales, los sujetos analizados perciben temor a caerse, siendo mayoritario dicho temor en actividades desarrolladas fueras del entorno doméstico, no existiendo diferencias significativas en función de la edad., The aim of this paper is to present an innovation model that adapts utility of Judo as an educational tool to reduce the fear of falling in adult-elderly population. Its relevance is in training needs of students in Bachelor CCAFyD and Master AFCV, training that will enable a utilitarian and healthy response to this special population. It performs a specific job on the basics of Judo (falls). For evaluation it has been used in international FES-I questionnaire. As important results can be noted that there are activities to which the subjects analyzed perceived fear of falling, fear being developed major activities that they do beyond their normal domestic environment, with no significant differences by age.

Background: Concerns about falls are common among older people. These concerns, also referred to as fear of falling, can have serious physical and psychosocial consequences, such as functional decline, increased risk of falls, activity restriction, and lower social participation. Although cognitive behavioral group programs to reduce concerns about falls are available, no home-based approaches for older people with health problems, who may not be able to attend such group programs are available yet. The aim of this study was to assess the effectiveness of a home-based cognitive behavioral program on concerns about falls, in frail, older people living in the community.Methods: In a randomized controlled trial in the Netherlands, 389 people aged 70 years and older, in fair or poor perceived health, who reported at least some concerns about falls and related activity avoidance were allocated to a control (n = 195) or intervention group (n = 194). The intervention was a home-based, cognitive behavioral program consisting of seven sessions including three home visits and four telephone contacts. The program aims to instill adaptive and realistic views about fall risks via cognitive restructuring and to increase activity and safe behavior using goal setting and action planning and was facilitated by community nurses. Control group participants received usual care. Outcomes at 5 and 12 months follow-up were concerns about falls, activity avoidance due to concerns about falls, disability and falls.Results: At 12 months, the intervention group showed significant lower levels of concerns about falls compared to the control group. Furthermore, significant reductions in activity avoidance, disability and indoor falls were identified in the intervention group compared with the control group. Effect sizes were small to medium. No significant difference in total number of falls was noted between the groups.Conclusions: The home-based, cognitive behavioral p

ObjectivesThe effect of fear of falling (FoF) on recovery 1 year after hip fracture is not well known. Furthermore, the potential influence of premorbid function has not been explored. We aimed to describe rates of FoF after hip fracture, to assess the association of FoF with functional recovery 1 year post-fracture, and to evaluate the potential moderating effect of premorbid function on the relationship between FoF and functional recovery.DesignSecondary analysis of data from a prospective, longitudinal observational study to assess genetic factors influencing functional and psychological outcomes after hip fracture over 52 weeks.SettingEight area hospitals in St. Louis, MO.Participants241 cognitively intact individuals 60 years of age or older requiring surgical repair for hip fracture.MeasurementsFear of falling was measured by the short Falls Efficacy Scale-International 4 and 12 weeks post-fracture. The primary outcome was probability of full recovery 52 weeks post-fracture assessed with the Functional Recovery Score.ResultsHigh rates of FoF were seen at 4 (60.5%) and 12 weeks (47.0%) post-fracture. Week 12 FoF was associated with lower odds of recovery for those with high function pre-fracture (odds ratio [OR]: 0.82, 95% confidence interval [CI]: 0.72, 0.93), but not for those with impaired activities of daily living performance (OR: 1.04, 95% CI: 0.91, 1.19).ConclusionsFear of falling is common after hip fracture and is associated with poorer functional recovery 1 year after fracture, particularly in patients with high premorbid function. Fear of falling is a modifiable problem that represents a potential target for interventions to improve functional outcomes after hip fracture.

Background Falls are the leading cause for non-fatal injuries in older community-dwelling people. Compared to men, women fall more often, experience more fall-related injuries, and report fear of falling (FoF) more often. Falls may be prevented with specific exercises, but adherence is often low in long-term. One aim of the thesis was to gain a deeper understanding of the risk factors previous falls, FoF, and gender. Another aim was to explore safety strategies in older community-dwelling people in terms of fall risk awareness and actions taken to protect from falls, and to identify motives for exercising and preferred exercise properties. A gender perspective was used throughout the thesis. Methods To determine the impact of the risk factors on future falls and injurious falls, a cross-sectional design was used combined with longitudinal data. Baseline data from 230 community-dwelling people over 75 years were collected with questionnaires and performance-based tests. FoF was measured with the single item question “Are you afraid of falling?”. Monthly fall calendars were collected for one year (monitoring year). Based on status on falls, participants were classified as those with i) no falls (n=119), ii) 1 non-injurious fall (n=51), iii) ≥2 non-injurious falls (n=40), and iv) ≥1 injurious fall (n=20). These data were linked to data from an injury database (IDB) with respect to registered injurious falls for a period of about 5 years (long term follow-up). Andersen-Gill method of Cox regression for multiple events was used to estimate the risk of future injurious fall events. To find relationships between FoF, gender, and falls (defined as two or more falls), a general log-linear analysis was performed. Associations between FoF and the components of the International Classification of Functioning (ICF) were explored with a structural equation model. To explore fall risk awareness and safety strategies, and to identify motives and preferred exercise properties, quali

Vi åldras på flera sätt, biologiskt, psykologiskt och socialt. Rädsla för att ramla, en pågående oro för att ramla och som leder till undvikande av aktiviteter man fortfarande kan göra, finns hos många äldre och påverkar dem på flera sätt. Rädslan kan leda till inaktivitet som i sin tur leder till ensamhet och nedstämdhet. Syftet med studien är att beskriva äldre personers egen erfarenhet av att uppleva rädsla för fall och dess konsekvenser. En kvalitativ studie har gjorts där fem personer har intervjuats. Intervjuerna och analysen av dem är gjorda utifrån en fenomenologisk metod. Vid analysen framkom tre huvudkategorier: Oro för konsekvenserna av ett fall, Strategier för att undvika fall samt Saknad. Äldre personer som upplever en rädsla för fall undviker vissa aktiviteter. De upplever också en saknad efter aktiviteter de tidigare utfört men nu slutat med. De har strategier för att hantera sina rädslor. Det är viktigt att inte se äldre som en homogen grupp och att vid rehabilitering ta hänsyn till olika faktorer som person, miljön personen vistas i, aktiviteter de utför eller önskar utföra och känslan av delaktighet., We age in different ways, biologically, psychologically and socially. Fear of falling which means a lasting concern about falling which leads to an avoiding of activities that the person still has a capability to do. This can cause inactivity that eventually leads to loneliness and depression. The aim of this study is to describe older peoples own experiences to live with fear of falling and its consequences. A qualitative study was done where five older people were interviewed. The interviews and analyses were done using a phenomenological method. At the analysis three main categories were found: Concern about the consequences of a fall, Strategies to avoid a fall and A feeling of missing. Older people with fear of falling avoid some activities. There is a feeling that they miss some activities they have previously done but don't do any longer. They have strategies to handle their fears. In rehabilitation it is important not to see the elderly as an homogeneous group. It is also important to consider different factors such as the person, the environment in which the person lives, activity and feeling of involvement.

BACKGROUND: This study aimed to comprehensibly investigate potential contributing factors to fear of falling (FOF) among people with idiopathic Parkinson's disease (PD). METHODS: The study included 104 people with PD. Mean (SD) age and PD-duration were 68 (9.4) and 5 (4.2) years, respectively, and the participants' PD-symptoms were relatively mild. FOF (the dependent variable) was investigated with the Swedish version of the Falls Efficacy Scale, i.e. FES(S). The first multiple linear regression model replicated a previous study and independent variables targeted: walking difficulties in daily life; freezing of gait; dyskinesia; fatigue; need of help in daily activities; age; PD-duration; history of falls/near falls and pain. Model II included also the following clinically assessed variables: motor symptoms, cognitive functions, gait speed, dual-task difficulties and functional balance performance as well as reactive postural responses. RESULTS: Both regression models showed that the strongest contributing factor to FOF was walking difficulties, i.e. explaining 60% and 64% of the variance in FOF-scores, respectively. Other significant independent variables in both models were needing help from others in daily activities and fatigue. Functional balance was the only clinical variable contributing additional significant information to model I, increasing the explained variance from 66% to 73%. CONCLUSIONS: The results imply that one should primarily target walking difficulties in daily life in order to reduce FOF in people mildly affected by PD. This finding applies even when considering a broad variety of aspects not previously considered in PD-studies targeting FOF. Functional balance performance, dependence in daily activities, and fatigue were also independently associated with FOF, but to a lesser extent. Longitudinal studies are warranted to gain an increased understanding of predictors of FOF in PD and who is at risk of developing a FOF.

Background: In line with a rapidly ageing global population, the rise in the frequency of falls will lead to increased healthcare and social care costs. This study will be one of the few randomized controlled trials evaluating a multifaceted falls intervention in a low-middle income, culturally-diverse older Asian community. The primary objective of our paper is to evaluate whether individually tailored multifactorial interventions will successfully reduce the number of falls among older adults. Methods: Three hundred community-dwelling older Malaysian adults with a history of (i) two or more falls, or (ii) one injurious fall in the past 12 months will be recruited. Baseline assessment will include cardiovascular, frailty, fracture risk, psychological factors, gait and balance, activities of daily living and visual assessments. Fallers will be randomized into 2 groups: to receive tailored multifactorial interventions (intervention group); or given lifestyle advice with continued conventional care (control group). Multifactorial interventions will target 6 specific risk factors. All participants will be re-assessed after 12 months. The primary outcome measure will be fall recurrence, measured with monthly falls diaries. Secondary outcomes include falls risk factors; and psychological measures including fear of falling, and quality of life.Previous studies evaluating multifactorial interventions in falls have reported variable outcomes. Given likely cultural, personal, lifestyle and health service differences in Asian countries, it is vital that individually-tailored multifaceted interventions are evaluated in an Asian population to determine applicability of these interventions in our setting. If successful, these approaches have the potential for widespread application in geriatric healthcare services, will reduce the projected escalation of falls and fall-related injuries, and improve the quality of life of our older community.

Aim: This paper reviews international scientific studies aimed at determining the benefits of practicing Tai Chi Chuan (TCC) on knee osteoarthritis (OR), balance, fear of falling, and quality of life. Method: A bibliographic search of eight international databases was undertaken (Medline-Pubmed, Scirus, Pascal, ScienceDirect, SportDiscus, Science Citation Index, BIOSIS y PsycINFO) until April 2012. Results: A total of 74 studies were analyzed, 13 of them corresponding to systematic reviews and 61 to specific studies (42 randomized controlled studies (EAC) and 19 non-controlled studies (ENC)). In particular, 11 studies were analyzed regarding knee osteoarthritis (7 EAC and 4 ENC), 32 regarding balance-fear of falling (26 EAC and 6 ENC), and 30 regarding quality of life (18 EAC and 12 ENC). Conclusion: The effects of TCC on knee osteoarthritis are contradictory although a positive tendency was observed regarding control of pain and the improvement of physical functionality. Regarding the effects on balance-fear of falling, a significant improvement in static and dynamic balance was observed as well as confidence in terms of fear of falling. Regarding quality of life, TCC practice improves emotional well-being, self-perception and physical well-being. The obtained results should be treated with some caution since many of the studies examined show methodological weaknesses in the design (small samples, lack of inclusion and exclusion criteria for the participants, deficiencies in the statistical analyses, lack of standardization in the measurement of results, etc.), and the specific information about the conditions of the TCC program applied (style practised, dose, experience of the instructors, posture height, time spent carrying out each form)., Objetivo: Este trabajo hace una revisión de los estudios científicos realizados a nivel internacional con el fin de actualizar el conocimiento sobre cuáles son los beneficios que aporta la práctica del Tai Chi Chuan (TCC) sobre la osteoartritis de rodilla (OR), el equilibrio, el miedo a las caídas y la calidad de vida. Método: Se realizó una búsqueda bibliográfica sobre ocho bases de datos internacionales (Medline-Pubmed, Scirus, Pascal, ScienceDirect, SportDiscus, Science Citation Index, BIOSIS y PsycINFO) hasta abril del año 2012. Resultados: El número total de estudios analizados fue de 74, de los cuales 13 corresponden a revisiones sistemáticas y 61 a estudios específicos (42 ensayos aleatorios controlados (EAC) y 19 ensayos no controlados (ENC). En particular se analizaron 11 estudios con relación a la osteoartritis de rodilla (7 EAC y 4 ENC), 32 sobre el equilibrio-miedo a las caídas (26 EAC y 6 ENC), y 30 sobre calidad de vida (18 EAC y 12 ENC) Conclusión: Los efectos de TCC sobre la OA son contradictorios, aunque se observa una tendencia positiva respecto al control de dolor y la mejora en la funcionalidad física. Respecto a los efectos sobre el equilibrio-miedo a la caída se ha registrado una mejora significativa en el equilibrio estático y dinámico, y en la confianza respecto al miedo a la caída. Con relación a la calidad de vida la práctica del TCC aporta mejoras en las dimensiones de bienestar emocional, percepción de sí mismo, bienestar corporal. Estos resultados obtenidos deben ser tomados con cierta precaución dado que gran número de los estudios examinados muestran carencias metodológicas en cuanto al diseño de investigación (muestras reducidas, carencias en los criterios de inclusión y de exclusión de los participantes, deficiencias en los análisis estadísticos, carencias en la estandarización de la medición de resultados, etc.) y la información específica respecto a las condiciones del programa de TCC utilizado (el estilo practicado, la dosificació