Frailty, falls and poor functional mobility predict new onset of activity restriction due to concerns about falling in older adults: a prospective 12-month cohort study

Purpose Concerns about falling are common in older adults and often cause activity restriction. This can lead to physical deconditioning, falls and social isolation. However, not every concerned older adult will restrict their activities. This 12-month longitudinal study investigated the physical and psychosocial factors that predict the new onset of activity restriction due to concerns about falling in older people. Methods Participants were 543 older adults (Mage = 80.3 ± 4.4 years, range: 75–98) who did not report activity restriction due to concerns about falling at Timepoint-1 (negative response to the following question: “Do concerns about falling stop you going out-and-about?”). Participants completed a battery of physical and psychological assessments at Timepoint-1. Using binary logistic regression, we then assessed which of these variables predicted whether participants reported having started restricting their activity due to concerns about falling at the 12-month follow-up (Timepoint 2). Results 10.1% of the sample started to restrict activity due to concerns about falling at Timepoint 2. Three key predictors significantly predicted activity restriction group status at 12-month follow-up: greater frailty at Timepoint-1 (Fried Frailty Index; OR = 1.58, 95% CI 1.09–2.30), experiencing a fall between Timepoint-1 and 2 (OR = 2.22, 95% CI 1.13–4.38) and poorer functional mobility at Timepoint-1 (Timed up and Go; OR = 1.08, 95% CI 1.01–1.15). Conclusions Frailty, experiencing a fall and poorer functional mobility all predicted the onset of activity restriction due to concerns about falling. Clinicians working in balance and falls-prevention services should regularly screen for frailty, and patients referred to frailty services should likewise receive tailored treatment to help prevent the development of activity restriction due to concerns about falling

The influence of ethnic group composition on focus group discussions

BACKGROUND: Focus groups are commonly used to explore participants' experiences in health and social care research. Although it is suggested that having demographically homogenous groups may help put participants at ease, the evidence is sparse.The aims of the paper are to: explore the impact of relative ethnic homogeneity and heterogeneity of focus group participants on the group discussions; improve understanding of homogeneity and heterogeneity in focus groups; suggest ways to operationalise concepts such as being 'more comfortable' with other focus group participants. METHOD: Digitally recorded focus groups were undertaken with family carers of stroke survivors and were later transcribed and analysed using framework analysis. Groups were designated as more or less ethnically homogenous. More homogenous groups included, for example, only White British or Asian Indian participants whilst more heterogeneous groups comprised a mixture of, for example, Asian, White British and Black Caribbean participants. RESULTS: Forty-one carers participated in seven focus groups. Analysis revealed differences in discussions around ethnicity between the more or less ethnically homogenous groups. For example, participants in more ethnically homogenous focus groups were more likely to say ethnicity might influence perceptions of social care services. On the other hand, more heterogeneous groups emphasised similarity in carers' experiences, irrespective of ethnicity. Participants in the more homogenous groups were also more likely to make potentially controversial comments relating to ethnic differences. Additionally they appeared to be more at ease with each other discussing the topic. For example, they spontaneously mentioned ethnic differences earlier in these groups.In contrast, analysis of topics not specifically related to ethnicity, such as the difficult experiences of being a carer, produced no discernible patterns when comparing more and less homogenous focus groups. CONCLUSION: Considerations around focus group participant demographic homogeneity and heterogeneity are complex and these terms may be most usefully applied only in relative terms.Data derived from more homogenous groups complement data from more heterogeneous groups providing different perspectives. Depending on the focus of the discussion, having characteristics in common, such as being a carer can override other differences

Developing Expertise: Benefits of Generalising Learning from the Graphic Design Project

2019 NSEAD and John Wiley & Sons Ltd The ability to transfer knowledge between design projects has been linked to developing expertise and, as such, is an important skill for designers. However, externalising and analysing the knowledge from the design project in ways that support transfer can be a challenge. This article explores how reflective practice can foster the conditions for knowledge transfer and links these outcomes with design expertise characteristics. A structured and critical approach to reflection was introduced alongside a graphic design project with the aim to foster the conditions for transfer to other projects. A case study strategy of inquiry was employed, drawing on a qualitative research approach, and framed by theories of reflective practice and cognitive psychology. The research demonstrates that graphic design students readily reach an ability to describe, analyse and make judgements from their design experience. However, the types of reflection that supports knowledge transfer from one design experience to another - generalisation and abstraction - are not as apparent. This outcome aligns with the behaviours associated with the expertise characteristics of a novice designer

Assessing suicide ideation among older adults: a systematic review of screening and measurement tools

Objectives: Rates of suicide in older adults may be higher than reported due to poor understandings of presentation of suicide ideation in this group. The objectives of this paper were to (i) review current measurement tools designed for older adults to detect suicide ideation and (ii) assess their psychometric properties. Design: We used a systematic review approach to identify measurement tools developed specifically for older adults without cognitive decline or impairment. Results: Ten articles that reported on a total of seven different measurement tools were identified. These included tools that focused on resiliency to suicide and those that measured risk of suicide behavior. There was wide variation across the articles: some were adaptations of existing scales to suit older populations, others were developed by authors; they varied in length from four to 69 items; a range of settings was used, and there was a mix of self-report and clinician-administered measures. Most displayed good psychometric properties, with both approaches showing similar quality. Limitations in terms of samples, settings, and measurement design are discussed. Conclusion: The case for specific measures for older adults is clear from this review. There appear to be unique factors that should be considered in understanding suicide ideation and behavior among older adults that may not be directly assessed in non-specific measurements. However, there is a need to expand the diversity of individuals included in measurement development to ensure they are appropriate across gender, culture and minority status, and for the views of professionals to be considered

Frailty, falls and poor functional mobility predict new onset of activity restriction due to concerns about falling in older adults: a prospective 12-month cohort study

Purpose: Concerns about falling are common in older adults and often cause activity restriction. This can lead to physical deconditioning, falls and social isolation. However, not every concerned older adult will restrict their activities. This 12-month longitudinal study investigated the physical and psychosocial factors that predict the new onset of activity restriction due to concerns about falling in older people. Methods: Participants were 543 older adults (M age = 80.3 ± 4.4 years, range: 75–98) who did not report activity restriction due to concerns about falling at Timepoint-1 (negative response to the following question: “Do concerns about falling stop you going out-and-about?”). Participants completed a battery of physical and psychological assessments at Timepoint-1. Using binary logistic regression, we then assessed which of these variables predicted whether participants reported having started restricting their activity due to concerns about falling at the 12-month follow-up (Timepoint 2). Results: 10.1% of the sample started to restrict activity due to concerns about falling at Timepoint 2. Three key predictors significantly predicted activity restriction group status at 12-month follow-up: greater frailty at Timepoint-1 (Fried Frailty Index; OR = 1.58, 95% CI 1.09–2.30), experiencing a fall between Timepoint-1 and 2 (OR = 2.22, 95% CI 1.13–4.38) and poorer functional mobility at Timepoint-1 (Timed up and Go; OR = 1.08, 95% CI 1.01–1.15). Conclusions: Frailty, experiencing a fall and poorer functional mobility all predicted the onset of activity restriction due to concerns about falling. Clinicians working in balance and falls-prevention services should regularly screen for frailty, and patients referred to frailty services should likewise receive tailored treatment to help prevent the development of activity restriction due to concerns about falling

Schiffsnägel des 19. Jahrhunderts aus havelländischem Akazienholz

"In the 1860s the writer Theodor Fontane described the relatively short-lived production and trade relationship between the German North Sea and the Havelland, a region southwest of Potsdam. The Havelland supplied shipyards on the Lower Eibe, Weser and jade with high-quality acacia-wood spikes for the construction of large wooden sailing ships until ca. 1890, when that type of ship ceased to be built. There is no documentation of this business relationship in any of the towns in which the respective shipyards operated." (author's abstract

Die Aussagen dreier Bartmannskrüge zur Schiffahrt um 1700

The three bellarmines - or Bartmann jugs - of the German Maritime Museum (DSM) provide information about two very different aspects of shipping. On the one hand they reveal the three important directions taken by Dutch activities in the trade of the jugs of Frechen: The location where the first one (Jug 1 from the Amrum Bank) was found points to trade around the North Sea using coastal ships, and the land in which the second (Jug 2 from Bombay) was used for centuries points to the trading activities with South and Southeast Asia engaged in by the big ships of the Dutch East India Company. The guild-mark on the latter also indicates the third focus of Dutch trade in this context: the presence of Dutch river vessels along the Rhine - the lifeline to the centre of jug production activities. The Dutch constituted, as it were, the cork in the bottleneck of the Rhine, so that everything that entered or left that river passed through their hands. Jug 1 was very probably among the cabin items of a coastal barge captain. On the other hand the function and meaning of the relief designs on the jugs have been deciphered for the first time, and thus serve as an additional historical source for evaluation. The point of departure was the favourable circumstance that Jug 3 bears evidence of the person who commissioned it. This person, who is identifiable by name, was a shipmaster also active as a merchant who functioned as a distributor for Frechen jug-makers. The guild-mark of the shipmaster on the first relief pattern denotes the first profession; the other is revealed by the mark of ownership. Similarly, identified abbreviations of names make it clear that the patterns bearing only trade marks and/or municipal coats of arms refer solely to merchants who acted as distributors and were not cargo shipmasters at the same time. In contrast, potters who worked at their own risk, without contractual obligations to a merchant, decorated their jugs with rosettes and without individual names or marks. The three jugs of the DSM thus provide us with unexpected insights into the forms of organisation employed by the people who made them, transported them by ship and traded in them worldwide, and are consequently highly revealing products of a social class that has otherwise left us with very few objects providing such distinctive information about its daily social conditions. That not only applies to Frechen. The example from Stadtlohn clearly demonstrates that relief designs of a similar type also reveal similar economic structures elsewhere