Search

Purpose We report the findings of a knowledge synthesis research project on the topic of dementia-friendly acute care (D-FAC) design. This exploratory project systematically mapped what is known about D-FAC physical design in hospitals. We discuss our challenges in locating reportable evidence and the implications of such design for maximizing independent function while ensuring safety and harm reduction in older people living with dementia. Design and methods Exploratory iterative design utilizing scoping literature review methodology. Results A total of 28 primary studies plus expert reviewers' narratives on the impact of design and architectural features on independent function of hospitalized older people with dementia were included and evaluated. Items were mapped to key design elements to describe a D-FAC environment. This scoping review project confirms the limited nature of available acute care design evidence on maximizing function. Implications Physical design influences the usability and activity undertaken in a health care space and ultimately affects patient outcomes. Achieving safe quality hospital care for older people living with dementia is particularly challenging. Evidence of design principle effectiveness is needed that can be applied to general medical and surgical units where the bulk of older persons with and without dementia are treated.

Essa dissertação apresenta uma interpretação do poema "Fábula de Anfion", de João Cabral de Melo Neto, identificando o substrato trágico presente em seu enredo. Num primeiro momento, delimito as implicações filosóficas referentes ao conceito de trágico, a partir de uma leitura crítica de temas trabalhados na filosofia idealista e pós-idealista. Em seguida, procuro analisar como, em grande medida, o poema de Cabral representa uma concepção de mundo dotada de natureza trágica, e como tal fato se associa a aspectos fundamentais da poética cabralina como um todo. This dissertation presents an interpretation of the poem Fábula de Anfion, written by João Cabral de Melo Neto, identifying the tragic substrate depicted from its plot. In a first moment, I delimit the philosophical implications of the concept of tragic, according to a critical examination of certain themes worked on idealist and post-idealist philosophy. Afterwards, I try to analyze how, in a way, Cabrals poem represents a tragic view of the word and how this fact can be associated to fundamental aspects of the poetics developed by the writer.

Background. Fall-related injuries result in significant physical and psychological suffering to the affected individuals. The physical environment is considered to have an important role in falls.Purpose. To conduct extensive review of and synthesize related literature, and to develop a conceptual framework to explain the relationship among falls, the physical environment, and older adults.Method. Review of the literature was conducted to examine: (a) link between environmental hazards and falls, (b) efficacy of home-modification interventions, and (c) role of the physical environment in falls of people with cognitive impairment.Results. A strong link between environmental hazards and the risk of falls has yet to be established. A conceptual framework is presented that proposes that an individual's risk for falls can be determined by the interaction of three main factors: mobility, risk-taking behaviour, and physical environment.Implications. Environmental interventions should be combined with other interventions such as exercise programs and education.

Liu-Ambrose T, Ahamed Y, Graf P, Feldman F, Robinovitch SN. Older fallers with poor working memory overestimate their postural limits. Objective To compare the accuracy of perceived postural limits between older fallers with good working memory and those with poor working memory. Design Cross-sectional study. Setting Research laboratory. Participants Thirty-three community-dwelling older adults with a history of falls. Interventions Not applicable. Main Outcome Measures We measured the accuracy of perceived postural limits by using the perceived reach test in 33 fallers. The difference between the verbal digits forward test score and the verbal digits backward test score was used to provide an index of the central executive component of working memory. Participants were then allocated into 2 groups: (1) good working memory or (2) poor working memory. Comparisons of group characteristics and scores were undertaken by using Student independent-sample t tests for differences in means between those with good working memory and those with poor memory. One hierarchical linear regression model was constructed to determine the independent association of the central executive component of working memory with the accuracy of older fallers' perceived reach capacity. Results There was a significant difference in the mean percentage error in perceived reach between older fallers with good working memory and those with poor working memory ( P =.01). The verbal digit span difference score was independently associated with the percentage error in perceived reach. The verbal digit span difference score resulted in an R 2 change of 18.2% and significantly improved the regression model (F 1,26 change, 7.45; P =.01). Conclusions Our novel results suggest that impaired executive functioning may increase falls risk by impairing older adults' judgment in motor planning for daily activities. However, future studies with larger sample sizes are needed to confirm our current results.

Preliminary clinical findings suggest that compliant flooring may reduce the incidence and severity of fall- related injuries in long-term care (Knoefel et al., 2013) and acute-care settings (Drahota et al., 2013). However, there is concern that manoeuvring wheeled equipment on compliant flooring could expose care staff to potentially harmful pushing forces (Drahota et al., 2013; Wynn et al., 2011). We measured the external resultant hand forces (initial and sustained) required for female direct care staff to push two floor - based lifts (conventional manual and motor-driven) (n=14) or a wheelchair (n=14), loaded with passengers of average (67 kg) and ninetieth percentile (90 kg) resident weights, over four flooring systems: concrete + vinyl, compliant (1” SmartCells) + vinyl, concrete + carpet, and compliant + carpet. We observed an interaction between lift type and floor system for initial (p < 0.001) and sustained (p < 0.001) forces. Independent of resident weight, mean forces were lower for the motor-driven lift than the conventional lift on all flooring conditions (by 34.8 – 74.4 N for initial forces and by 14.1 – 64.5 N for sustained forces). With the vinyl overlay, initial forces were higher on compliant than concrete subflooring when using the conventional lift (mean difference = 44.7 N, 47.7% increase, p < 0.001) and motor-driven lift (29.8 N, 45.8% increase, p < 0.001). Similarly, with the vinyl overlay, sustained resultant forces were higher on compliant subflooring than concrete subflooring when using the conventional lift (39.0 N, 88.2% increase, p < 0.001) and motor-driven lift (9.7 N, 29.0% increase, p < 0.001). With the carpet overlay, the differences between compliant and concrete subfloors were less pronounced than with the vinyl overlay for the conventional lift (Finitial: 23.0 N higher, 14.9% increase, p < 0.001; Fsustained: 15.6 N higher, 18.7% increase, p < 0.001) and absent when using the motor-driven lift (Finitial: p = 0.975; Fsustained: p = 0.999). We also observed an interaction between resident weight and lift type for initial (p = 0.004) and sustained forces (p < 0.001). Independent of flooring system, Finitial was 18.6 N higher (13.5% increase, p < 0.001) and Fsustained was 11.7 N higher (14.3% increase, p < 0.001) for the ninetieth percentile weight than the average weight for the conventional lift. In contrast, there were no differences in Finitial (p = 0.200) and Fsustained (p = 0.100) between the average and ninetieth percentile weight conditions for the motor-driven lift. Similar trends were observed when participants pushed the wheelchair. In summary, this study found that compliant subflooring increased the external hand forces required for female direct care staff to push floor -based lifts and wheelchairs compared to concrete subflooring, and these increases in force were greater when pushing over vinyl than carpet overlay. This study also demonstrated that a motor-driven lift substantially reduced push forces compared to a conventional manual lift. Thus, motor-driven lifts may help to prevent work- related musculoskeletal injuries in long-term care facilities, especially in facilities with compliant flooring.

In response to high rates of work-related musculoskeletal injury (MSI) in long-term care (LTC), decision makers have implemented minimal-lift policies to reduce strain arising from resident transferring, often advocating the use of lifting devices. Floor-based lifts, in particular, are widely used in LTC, even though users are known to experience potentially injurious forces when pushing overweight or obese residents on carpet (Marras, Knapik & Ferguson, 2009). Motivated by this, a European manufacturer has developed a motor-driven, floor-based lift to assist users with resident transferring (esense Rise, Active4Care, Enschede, NL). Despite the motor-driven lift’s promise as a strategy for improved workplace safety, no research has been published examining its ability to reduce external hand forces, or perceptions of ease among users, during pushing. Therefore, we compared external hand forces and subjective ratings of perceived ease when straight-line pushing a motor-driven versus conventional (manual wheeled) floor-based lift, under conditions of low (vinyl) and high (carpet) rolling resistance, and while transporting passengers of average (67 kg) and ninetieth percentile (90 kg) resident weight. We recruited fourteen female direct care staff from a partner LTC site in British Columbia, Canada. We collected external hand force data using a piezoelectric, triaxial load cell (model 9074C, Kistler, Winterthur, Switzerland), custom mounted between existing lift handholds and a cylindrical handlebar. We also collected information on exposure (frequency, distance) to pushing in LTC by questionnaire, and calculated participant-specific tolerance limits for initial and sustained forces using Snook and Ciriello’s (1991) Hazard Analysis Tool. We observed a significant interaction between lift type and floor surface on initial (p < 0.001) and sustained (p < 0.001) forces. On vinyl, the motor-driven lift required, on average, 35 N (34%) less initial force (p < 0.001) and 14 N (27%) less sustained force (p < 0.001) than the conventional lift, regardless of resident weight. On carpet, we observed larger differences in forces between lifts, with the motor-driven lift requiring, on average, 64 N (36%) less initial force (p < 0.001) and 51 N (52%) less sustained force (p < 0.001) than the conventional lift, regardless of resident weight. Furthermore, there was an interaction between lift type and floor surface on subjective ratings of perceived ease of pushing (p < 0.001). On vinyl, subjective ratings did not differ between lifts (p = 0.32), with the majority of participants rating their ease of pushing as ‘very easy’ when pushing 90 kg passengers in both the conventional lift (n = 8, 57.1%) and the motor- driven lift (n = 12, 85.7%). On carpet, however, ratings were, on average, 1.8-points lower with the motor- driven lift (mean = 1.7; ‘somewhat easy’) than the conventional lift (mean = 3.5; ‘somewhat difficult’), independent of resident weight (p < 0.001). No conditions involving the motor-driven lift imposed forces above tolerable limits, while three of fourteen (21.4%) direct care staff exerted forces above tolerable limits when using the conventional lift on carpet only. Our results did not demonstrate a clear need for a motor-driven lift to mitigate the biomechanical demands of linear pushing on vinyl, as no participants’ force values approached tolerable limits for either lift on vinyl. Subjective ratings were also no different between lifts on vinyl. We did, however, demonstrate that motor-driven lifts reduce the biomechanical demands associated with pushing floor-based lifts on carpet. This insight can be used to inform evidence-based practices to improve worker safety during resident transferring, which could lead to reductions in both the incidence and severity of work-related MSI in LTC.

Hip fracture is rare in young adults, despite evidence that the energy available in a fall is sufficient to fracture the young proximal femur. This might be explained by protective responses that allow young individuals to avoid hip impact during sideways falls. To test this hypothesis, we conducted experiments with 44 individuals (31 women and 13 men) aged 19-26 years, who were instructed to try to maintain balance after a sudden unpredictable sideways translation was applied to the platform they stood upon. While the surface adjacent to the platform was formed of gymnasium mats, we provided no information on surface compliance, or the direction and speed of the perturbation. Ninety percent of participants fell and impacted the pelvis, and 98% of those cases involved direct impact to the hip region. Impact occurred to the hand in 98% of falls, and preceded impact to the pelvis by 50 ms on average (SD=40, range=-12-175 ms). The impact velocity of the pelvis decreased 3.6% for every 10 ms increase in the interval between hand and pelvis impact, and was reduced by 22% on average by stepping prior to impact. Our results suggest that the lack of hip fractures in young adults cannot be explained by avoidance of hip impact during sideways falls. Rather, it probably relates to use of the hands and stepping, and by simply possessing sufficient bone strength to withstand the direct blow to the greater trochanter that tends to accompany sideways falls.

Falls are a major cause of injury in the elderly, and risk for falls depends on frequency of imbalance episodes. Improved techniques are required for determining how risk for imbalance during daily activities depends on behavioural (e.g., risk taking) versus neuromuscular factors. We developed a novel technique to determine whether differences exist between young and elderly women in tendency to approach imbalance during a forward reaching task. Eighteen young women (18‐35 years) and 18 elderly community-dwelling women (70‐87 years) participated in trials that required them to stand and reach forward to grasp as quickly as possible a targetthat moved back and forth, in and out of reach. We conducted 21 trials with each subject, varying the targetdistance at the time of thego cue, to measure how closely subjects would approach their maximum reach distance, beyond which imbalance would occur. On average, elderly women approached 65 13% (S.D.) of their maximum reach on the first trial, while young women approached 84 11%. Subjects became more confident over multiple trials, with the 75th percentile in voluntary reach averaging 79 8% of maximum reach in elderly, and 89 4% in young. Tendency to approach maximumreach did notassociatewithActivitiesBalance Confidence(ABC) scores, orwithmaximum reach itself.These resultsindicate that, even in the absence of fear of falling, elderly women are less likely than young to approach imbalance during forward reaching. Furthermore, physical capacity and cautiousness contribute independently to reaching behaviour in these individuals. # 2004 Elsevier B.V. All rights reserved.

Background Falls are a leading cause of morbidity and mortality in older adults. Although numerous trials of falls prevention interventions have been completed, there is extensive variation in their intervention components and clinical context, such that the key elements of an effective falls prevention program remain unclear to patients, clinicians, and policy-makers. Our objective is to identify the most effective interventions and combinations of interventions that prevent falls though a systematic review and meta-analysis, including a network meta-analysis. Methods/Design We will search for published (e.g., MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Ageline) and unpublished (e.g., trial registries, dissertations) randomised clinical trials (RCTs) in all languages examining interventions to prevent falls compared to usual care or other falls prevention interventions among adults aged ≥65 years from all settings (e.g., community, acute care, long-term care, and rehabilitation). The primary outcomes are number of injurious falls and number of hospitalizations due to falls. Secondary outcomes include falls rate, number of fallers, number of emergency room visits due to falls, number of physician visits due to falls, number of fractures, costs, and number of intervention-related harms (e.g., muscle soreness related to exercise). We will calibrate our eligibility criteria amongst the team and two independent team members will screen the literature search results in duplicate. Conflicts will be resolved through team discussion. A similar process will be used for data abstraction and quality appraisal with the Cochrane risk of bias tool. Our results will be synthesized descriptively and a random effects meta-analysis will be conducted if the studies are deemed methodologically, clinically, and statistically (e.g., I2 Discussion We will identify the most effective interventions and combinations of interventions that prevent falls in older people. Our results will be used to optimize falls prevention strategies, and our goal is to ultimately improve the health of seniors internationally. Systematic review registration PROSPERO registry number: CRD42013004151

Background Hip protectors (HP) represent an attractive strategy for reducing hip fractures in high-risk elderly individuals. However, clinical studies have yielded conflicting results regarding their clinical effectiveness. This is mainly due to poor compliance (acceptance and adherence) among users. As a result, there is an urgent need to identify potential barriers and facilitators to initial acceptance and continued adherence with HP use. Aims/Objectives/Purpose The objective of this Systematic Review is to (1) synthesize available research evidence to identify factors that influence HP compliance among older adults in long-term care facilities; (2) interpret the findings to identify the best strategies to overcome perceived barriers and improve acceptance and adherence with HP use; and (3) package and disseminate the findings in a form that is relevant, practical and easily interpreted by the knowledge users and decision makers. Methods A key word search was conducted for studies published in English between 2000 and 2011 that employed quantitative, qualitative, or mixed-methods research designs. Each study was independently reviewed by two reviewers against the inclusion criteria with discrepancies determined by a third. Results/Outcomes 24 articles met the criteria and 63 barrier and facilitator factors were separated into 4 levels: organizational, staff, resident, and product. Significance/Contribution to the field The outcomes provide decision makers, health professionals, and caregivers with a greater awareness of strategies to improve compliance with the use of hip protectors. Furthermore, researchers will be able to use the information to design better clinical trials that will yield high acceptance and adherence.

Background Older adults living in long term care (LTC) settings are vulnerable to fall-related injuries. There is a need to develop and implement evidence-based approaches to address fall injury prevention in LTC. Knowledge translation (KT) interventions to support the uptake of evidence-based approaches to fall injury prevention in LTC need to be responsive to the learning needs of LTC staff and use mediums, such as videos, that are accessible and easy-to-use. This article describes the development of two unique educational videos to promote fall injury prevention in long-term care (LTC) settings. These videos are unique from other fall prevention videos in that they include video footage of real life falls captured in the LTC setting. Methods Two educational videos were developed (2012–2013) to support the uptake of findings from a study exploring the causes of falls based on video footage captured in LTC facilities. The videos were developed by: (1) conducting learning needs assessment in LTC settings via six focus groups (2) liaising with LTC settings to identify learning priorities through unstructured conversations; and (3) aligning the content with principles of adult learning theory. Results The videos included footage of falls, interviews with older adults and fall injury prevention experts. The videos present evidence-based fall injury prevention recommendations aligned to the needs of LTC staff and: (1) highlight recommendations deemed by LTC staff as most urgent (learner-centered learning); (2) highlight negative impacts of falls on older adults (encourage meaning-making); and, (3) prompt LTC staff to reflect on fall injury prevention practices (encourage critical reflection). Conclusions Educational videos are an important tool available to researchers seeking to translate evidence-based recommendations into LTC settings. Additional research is needed to determine their impact on practice.

Background: Falls are the number one cause of injuries in older adults, and are particularly common in long-term care (LTC). Lack of objective evidence on the mechanisms of falls in this setting is a major barrier to prevention. Video capture of real-life falls can help to address this barrier, if valid tools are available for data analysis. To address this need, we developed a 24-item fall video analysis questionnaire (FVAQ) to probe key biomechanical, behavioural, situational, and environmental aspects of the initiation, descent, and impact stages of falls. We then tested the reliability of this tool using video footage of falls collected in LTC. Methods: Over three years, we video-captured 221 falls experienced by 130 individuals in common areas (e.g., dining rooms, hallways, and lounges) of two LTC facilities. The FVAQ was developed through literature review and an iterative process to ensure our responses captured the most common behaviours observed in preliminary review of fall videos. Inter-rater reliability was assessed by comparing responses from two teams, each having three members, who reviewed 15 randomly-selected videos. Intra-rater reliability was measured by comparing responses from one team at baseline and 12 months later. Results: In 17 of the 24 questions, the percentage of inter- and intra-rater agreement was over 80% and the Cohen's Kappa was greater than 0.60, reflecting good reliability. These included questions on the cause of imbalance, activity at the time of the fall, fall direction, stepping responses, and impact to specific body sites. Poorer agreement was observed for footwear, contribution of clutter, reach-to-grasp responses, and perceived site of injury risk. Conclusions: Our results provide strong evidence of the reliability of the FVAQ for classifying biomechanical, behavioural, situational, and environmental aspects of falls captured on video in common areas in LTC. Application of this tool should reveal new and important strategies for the prevention and treatment of falls and fall-related injuries in this setting.