Reach the person behind the dementia: physical therapists' reflections and strategies when composing physical training

Dementia is a disease characterized by cognitive impairment and physical decline that worsens over time. Exercise is one lifestyle factor that has been identified as a potential means of reducing or delaying progression of the symptoms of dementia, maximizing function and independence. The purpose of this study was to explore physical therapists' (PTs) experiences and reflections on facilitating high-intensity functional exercise with older people living with dementia, in residential care home settings. The study used a qualitative design based on interviews, individually or in small groups, with seven PTs engaged as leaders in the training of older people with dementia. The interviews were analyzed with a modified Grounded Theory method with focus on constant comparisons. To increase trustworthiness the study used triangulation within investigators and member checking. The core category "Discover and act in the moment-learn over time" reflects how the PTs continuously developed their own learning in an iterative process. They built on previous knowledge to communicate with residents and staff and to tailor the high intensity training in relation to each individual at that time point. The category "Be on your toes" highlights how the PTs searched for sufficient information about each individual, before and during training, by eliciting the person's current status from staff and by interpreting the person's body language. The category "Build a bond with a palette of strategies" describes the importance of confirmation to build up trust and the use of group members and the room to create an interplay between exercise and social interaction. These findings highlight the continuous iterative process of building on existing knowledge, sharing and reflecting, being alert to any alterations needed for individuals that day, communication skills (both with residents and staff) and building a relationship and trust with residents in the effective delivery of high intensity functional exercise to older people living with dementia in care settings

Assessment of balance control in relation to fall risk among older people

Falls and their consequences among older people are a serious medical and public health problem. Identifying individuals at risk of falling is therefore a major concern. The purpose of this thesis was to evaluate measurement tools of balance control and their predictive value when screening for fall risk in physically dependent individuals ≥65 years old living in residential care facilities, and physically independent individuals ≥75 years old living in the community. Following baseline assessments falls were monitored during six months in physically dependent individuals based on staff reports, and during one year in physically independent individuals based on self reports. In physically dependent individuals test-retest reliability of the Timed Up&Go test (TUG) was established in relation to cognitive impairment. Absolute reliability measures exposed substantial day-to-day variability in mobility performance at an individual level despite excellent relative reliability (ICC 1.1 >0.90) regardless of cognitive function (MMSE ≥10). Fifty-three percent of the participants fell at least once during follow-up. Staff judgement of their residents’ fall risk had the best prognostic value for ruling in a fall risk in individuals judged with ‘high risk’ (positive Likelihood ratio, LR+ 2.8). Timed, and subjective rating of fall risk (modified Get Up&Go test, GUG-m) were useful for ruling out a high fall risk in individuals with TUG scores <15 seconds (negative LR, LR- 0.1) and GUG-m scores of ‘no fall risk’ (LR- 0.4), however few participants achieved such scores. In physically independent individuals balance control was challenged by dual-task performances. Subsequent dual-task costs in gait (DTC), i.e. the difference between single walking and walking with a simultaneous second task, were registered using an electronic mat. Forty-eight percent of the participants fell at least once during follow-up. A small prognostic guidance for ruling in a high fall risk was found for DTC in mean step width of ≤3.7 mm with a manual task (LR+ 2.3), and a small guidance for ruling out a high fall risk with DTC in mean step width of ≤3.6 mm with a cognitive task (LR- 0.5). In cross-sectional evaluations DTC related to an increased fall risk were associated with: sub-maximal physical performance stance scores (Odds Ratio, OR, 3.2 to 3.8), lower self-reported balance confidence (OR 2.6), higher activity avoidance (OR 2.1), mobility disability (OR 4.0), and cautious walking out-door (OR 3.0). However, these other measures of physical function failed to provide any guidance to fall risk in this population of seemingly able older persons. In conclusion – Fall risk assessments may guide clinicians in two directions, either in ruling in or in ruling out a high fall risk. A single cut-off score, however, does not necessarily give guidance in both directions. Staff experienced knowledge is superior to a single assessment of mobility performance for ruling in a high fall risk. Clinicians need to consider the day-to-day variability in mobility when interpreting the TUG score of a physically dependent individual. DTC of gait can, depending on the type of secondary task, indicate a functional limitation related to an increased fall risk or a flexible capacity related to a decreased fall risk. DTC in mean step width seems to be a valid measure of balance control in physically independent older people and may be a valuable part of the physical examination of balance and gait when screening for fall risk as other measures of balance control may fail to provide any guidance of fall risk in this population

Neither Timed Up and Go test nor Short Physical Performance Battery predict future falls among independent adults aged ≥75 years living in the community

Objectives: Previous research has shown that balance and gait difficulties are predictors of falls. The aim of this study was to evaluate the predictive validity of two tools reporting on balance and gait among older community living adults independent in personal activities of daily living (p-ADL). Methods: Prospective study design. Baseline assessment included the Timed Up and Go test (TUG) and the Short Physical Performance Battery (SPPB). Following baseline, falls were recorded monthly for one year by 202 participants (70.1% women) who were independent in p-ADL, and at least 75 years old (79.2±3.5). ROC-curves were made and AUC were calculated. Results: Fortyseven percent of the participants reported falls. AUCs calculated for TUG were 0.5 (95% CI: 0.5-0.6) for those with at least one fall, and 0.5 (95% CI: 0.5-0.6) for recurrent fallers. Corresponding figures for SPPB were 0.5 (95% CI: 0.5-0.6) and 0.5 (95% CI: 0.5-0.6). Conclusion: This study does not support a recommendation to use the Timed Up and Go test or the Short Physical Performance Battery as tools for the identification of fall-prone persons among older adults living in the community. These results reinforce the need for further research into appropriate tools for identifying independent but fall-prone older adults

Proposals for continued research to determine older adults’ falls risk

Early detection of older adults with an increased risk of falling could enable early onset of preventative measures. Currently used fall risk assessment tools have not proven sufficiently effective in differentiating between high and low fall risk in community-living older adults. There are a number of tests and measures available, but many timed and observation-based tools are performed on a flat floor without interaction with the surrounding. To improve falls prediction, measurements in other areas that challenge mobility in dynamic conditions and that take a persons’ own perception of steadiness into account should be further developed and evaluated as single or combined measures. The tools should be easy to apply in clinical practice or used as a self-assessment by the older adults themselves

A randomized controlled trial of fall prevention by a high-intensity functional exercise program for older people living in residential care facilities

BACKGROUND AND AIMS: Falls are particularly common among older people living in residential care facilities. The aim of this randomized controlled trial was to evaluate the effectiveness of a high-intensity functional exercise program in reducing falls in residential care facilities. METHODS: Participants comprised 191 older people, 139 women and 52 men, who were dependent in activities of daily living. Their mean±SD score on the Mini-Mental State Examination was 17.8±5.1 (range 10-30). Participants were randomized to a high-intensity functional exercise program or a control activity, consisting of 29 sessions over 3 months. The fall rate and proportion of participants sustaining a fall were the outcome measures, subsequently analysed using negative binominal analysis and logistic regression analysis, respectively. RESULTS: During the 6- month follow-up period, when all participants were compared, no statistically significant differences between groups were found for fall rate (exercise group 3.6 falls per person years [PY], control group 4.6 falls per PY), incidence rate ratio (95% CI) 0.82 (0.49-1.39), p=0.46, or the proportion of participants sustaining a fall (exercise 53%, control 51%), odds ratio (95% CI) 0.95 (0.52-1.74), p=0.86. A subgroup interaction analysis revealed that, among participants who improved their balance during the intervention period, the exercise group had a lower fall rate than the control group (exercise 2.7 falls per PY, control 5.9 falls per PY), incidence rate ratio (95% CI) 0.44 (0.21-0.91), p=0.03. CONCLUSIONS: In older people living in residential care facilities, a high-intensity functional exercise program may prevent falls among those who improve their balance.Validerad; 2008; 20080626 (eriros)</p

Оптимизация выбора технологии изготовления литейных моделей методом 3D-печати

Диссертация на соискание академической степени магистра технических наук по специальности 1-42 80 01 "Металлургия". Научный руководитель : к.т.н., доцент Одарченко И. Б

Community-dwelling older people with an injurious fall are likely to sustain new injurious falls within 5 years : a prospective long-term follow-up study

BACKGROUND: Fall-related injuries in older people are a leading cause of morbidity and mortality. Self-reported fall events in the last year is often used to estimate fall risk in older people. However, it remains to be investigated if the fall frequency and the consequences of the falls have an impact on the risk for subsequent injurious falls in the long term. The objective of this study was to investigate if a history of one single non-injurious fall, at least two non-injurious falls, or at least one injurious fall within 12 months increases the risk of sustaining future injurious falls. METHODS: Community-dwelling individuals 75-93 years of age (n = 230) were initially followed prospectively with monthly calendars reporting falls over a period of 12 months. The participants were classified into four groups based on the number and type of falls (0, 1, ≥2 non-injurious falls, and ≥1 injurious fall severe enough to cause a visit to a hospital emergency department). The participants were then followed for several years (mean time 5.0 years ±1.1) regarding injurious falls requiring a visit to the emergency department. The Andersen-Gill method of Cox regression for multiple events was used to estimate the risk of injurious falls. RESULTS: During the long-term follow-up period, thirty per cent of the participants suffered from at least one injurious fall. Those with a self-reported history of at least one injurious fall during the initial 12 months follow-up period showed a significantly higher risk for sustaining subsequent injurious falls in the long term (hazard ratio 2.78; 95% CI, 1.40-5.50) compared to those with no falls. No other group showed an increased risk. CONCLUSIONS: In community-dwelling people over 75 years of age, a history of at least one self-reported injurious fall severe enough to cause a visit to the emergency department within a period of 12 months implies an increased risk of sustaining future injurious falls. Our results support the recommendations to offer a multifactorial fall-risk assessment coupled with adequate interventions to community-dwelling people over 75 years who present to the ED due to an injurious fall

Vätgasproduktion för ellagring efter elnätsnytta och affärsmodeller

Detta projekt genomfördes av RISE – Research Institutes of Sweden, i samarbete med Mariestads kommun (ElectriVillage) och VänerEnergi. Studien utgår från vätgastankstationen i Mariestad i ett framtidsscenario med ett ökat transportbehov och större dimensioner på komponenter i systemet. Genom att kombinera vätgas och batterier för att lagra energi har det studerats möjliga affärsmodeller för elhandel, syrgasproduktion och spillvärme. Även legala och tekniska aspekter med lagring har utvärderats. Studien har kommit fram till att nuvarande regelverk inte är anpassade för till exempel energilagring, samt att hantering av syrgas utgör den största säkerhetsrisken. Dessutom är värdet på intäktskällorna mycket svåra att uppskatta, då de till stor del påverkas av elpriser. Både syrgas och lågtempererad spillvärme är lätta att framställa på flera sätt och deras ekonomiska värde är därför förhållandevis lågt. Att använda syrgas från elektrolys till reningsverk har potential att minska reningsverkets energianvändning samtidigt som det också underlättar vid eventuell introduktion av rening av läkemedelsrester. För tankstationen hade det varit möjligt att få viss intäkt från detta som inte är försumbar. Studien kom även fram till att spillvärmen från elektrolysen har potential att bidra som uppvärmning för bostäder och växthus. En simuleringsmodell upprättades av vätgastankstationen i MATLAB/Simulink©. Där analyserades möjligheter att minska överuttag på Mariestads regionnät för åren 2020 och 2021. Med överuttag menas de effekter som överstiger abonnerad effekt (idag 26 MW) vilket leder till extra kostnader för det lokala elnätsbolaget VänerEnergi. Resultaten visade att tankstationen har möjlighet att sänka överuttag och i vissa fall även sänka abonnerad effekt, vilket leder till besparingar. Storleken på bränslecellen, elektrolys och vätgaslager är avgörande för hur stor effekt som systemet kan hjälpa elnätet med och under hur lång tid. Nätnyttan frekvensreglering är också möjlig med hjälp av tankstationen. Intäkten från frekvensregleringen är mycket osäker då den bygger på en marknad med budgivningssystem. I detta arbete är det uppskattat att frekvensreglering är den mest signifikanta intäktskällan för tankstationen efter drivmedelsförsäljning.Projektledare och projektägare: RISE – Research Institutes of Sweden.    Projektpartner: Mariestads kommun / ElectriVillage VänerEnergi.    Finansiärer: Energimyndigheten,  Mariestads kommun (in-kind), VänerEnergi (in-kind).</p

Vätgasproduktion för ellagring efter elnätsnytta och affärsmodeller

Detta projekt genomfördes av RISE – Research Institutes of Sweden, i samarbete med Mariestads kommun (ElectriVillage) och VänerEnergi. Studien utgår från vätgastankstationen i Mariestad i ett framtidsscenario med ett ökat transportbehov och större dimensioner på komponenter i systemet. Genom att kombinera vätgas och batterier för att lagra energi har det studerats möjliga affärsmodeller för elhandel, syrgasproduktion och spillvärme. Även legala och tekniska aspekter med lagring har utvärderats. Studien har kommit fram till att nuvarande regelverk inte är anpassade för till exempel energilagring, samt att hantering av syrgas utgör den största säkerhetsrisken. Dessutom är värdet på intäktskällorna mycket svåra att uppskatta, då de till stor del påverkas av elpriser. Både syrgas och lågtempererad spillvärme är lätta att framställa på flera sätt och deras ekonomiska värde är därför förhållandevis lågt. Att använda syrgas från elektrolys till reningsverk har potential att minska reningsverkets energianvändning samtidigt som det också underlättar vid eventuell introduktion av rening av läkemedelsrester. För tankstationen hade det varit möjligt att få viss intäkt från detta som inte är försumbar. Studien kom även fram till att spillvärmen från elektrolysen har potential att bidra som uppvärmning för bostäder och växthus. En simuleringsmodell upprättades av vätgastankstationen i MATLAB/Simulink©. Där analyserades möjligheter att minska överuttag på Mariestads regionnät för åren 2020 och 2021. Med överuttag menas de effekter som överstiger abonnerad effekt (idag 26 MW) vilket leder till extra kostnader för det lokala elnätsbolaget VänerEnergi. Resultaten visade att tankstationen har möjlighet att sänka överuttag och i vissa fall även sänka abonnerad effekt, vilket leder till besparingar. Storleken på bränslecellen, elektrolys och vätgaslager är avgörande för hur stor effekt som systemet kan hjälpa elnätet med och under hur lång tid. Nätnyttan frekvensreglering är också möjlig med hjälp av tankstationen. Intäkten från frekvensregleringen är mycket osäker då den bygger på en marknad med budgivningssystem. I detta arbete är det uppskattat att frekvensreglering är den mest signifikanta intäktskällan för tankstationen efter drivmedelsförsäljning.Projektledare och projektägare: RISE – Research Institutes of Sweden.    Projektpartner: Mariestads kommun / ElectriVillage VänerEnergi.    Finansiärer: Energimyndigheten,  Mariestads kommun (in-kind), VänerEnergi (in-kind).</p