Gender perspectives on views and preferences of older people on exercise to prevent falls: a systematic mixed studies review

Background: To offer fall prevention exercise programs that attract older people of both sexes there is a need to understand both womens and mens views and preferences regarding these programs. This paper aims to systematically review the literature to explore any underlying gender perspectives or gender interpretations on older peoples views or preferences regarding uptake and adherence to exercise to prevent falls. Methods: A review of the literature was carried out using a convergent qualitative design based on systematic searches of seven electronic databases (PubMed, CINAHL, Amed, PsycINFO, Scopus, PEDro, and OTseeker). Two investigators identified eligible studies. Each included article was read by at least two authors independently to extract data into tables. Views and preferences reported were coded and summarized in themes of facilitators and barriers using a thematic analysis approach. Results: Nine hundred and nine unique studies were identified. Twenty five studies met the criteria for inclusion. Only five of these contained a gender analysis of mens and womens views on fall prevention exercises. The results suggests that both women and men see women as more receptive to and in more need of fall prevention messages. The synthesis from all 25 studies identified six themes illustrating facilitators and six themes describing barriers for older people either starting or adhering to fall prevention exercise. The facilitators were: support from professionals or family; social interaction; perceived benefits; a supportive exercise context; feelings of commitment; and having fun. Barriers were: practical issues; concerns about exercise; unawareness; reduced health status; lack of support; and lack of interest. Considerably more women than men were included in the studies. Conclusion: Although there is plenty of information on the facilitators and barriers to falls prevention exercise in older people, there is a distinct lack of studies investigating differences or similarities in older womens and mens views regarding fall prevention exercise. In order to ensure that fall prevention exercise is appealing to both sexes and that the inclusion of both men and women are encouraged, more research is needed to find out whether gender differences exists and whether practitioners need to offer a range of opportunities and support strategies to attract both women and men to falls prevention exercise.Funding Agencies|Swedish Research Council [2015-03481]; Strategic Research Programme in Care Sciences, Umea University; Karolinska Institute, Sweden; Umea University</p

The Ankle Injury Management (AIM) trial: a pragmatic, multicentre, equivalence randomised controlled trial and economic evaluation comparing close contact casting with open surgical reduction and internal fixation in the treatment of unstable ankle fractures in patients aged over 60 years

BACKGROUND: Close contact casting (CCC) may offer an alternative to open reduction and internal fixation (ORIF) surgery for unstable ankle fractures in older adults. OBJECTIVES: We aimed to (1) determine if CCC for unstable ankle fractures in adults aged over 60 years resulted in equivalent clinical outcome compared with ORIF, (2) estimate cost-effectiveness to the NHS and society and (3) explore participant experiences. DESIGN: A pragmatic, multicentre, equivalence randomised controlled trial incorporating health economic evaluation and qualitative study. SETTING: Trauma and orthopaedic departments of 24 NHS hospitals. PARTICIPANTS: Adults aged over 60 years with unstable ankle fracture. Those with serious limb or concomitant disease or substantial cognitive impairment were excluded. INTERVENTIONS: CCC was conducted under anaesthetic in theatre by surgeons who attended training. ORIF was as per local practice. Participants were randomised in 1 : 1 allocation via remote telephone randomisation. Sequence generation was by random block size, with stratification by centre and fracture pattern. MAIN OUTCOME MEASURES: Follow-up was conducted at 6 weeks and, by blinded outcome assessors, at 6 months after randomisation. The primary outcome was the Olerud-Molander Ankle Score (OMAS), a patient-reported assessment of ankle function, at 6 months. Secondary outcomes were quality of life (as measured by the European Quality of Life 5-Dimensions, Short Form questionnaire-12 items), pain, ankle range of motion and mobility (as measured by the timed up and go test), patient satisfaction and radiological measures. In accordance with equivalence trial US Food and Drug Administration guidance, primary analysis was per protocol. RESULTS: We recruited 620 participants, 95 from the pilot and 525 from the multicentre phase, between June 2010 and November 2013. The majority of participants, 579 out of 620 (93%), received the allocated treatment; 52 out of 275 (19%) who received CCC later converted to ORIF because of loss of fracture reduction. CCC resulted in equivalent ankle function compared with ORIF at 6 months {OMAS 64.5 points [standard deviation (SD) 22.4 points] vs. OMAS 66.0 points (SD 21.1 points); mean difference -0.65 points, 95% confidence interval (CI) -3.98 to 2.68 points; standardised effect size -0.04, 95% CI -0.23 to 0.15}. There were no differences in quality of life, ankle motion, pain, mobility and patient satisfaction. Infection and/or wound problems were more common with ORIF [29/298 (10%) vs. 4/275 (1%)], as were additional operating theatre procedures [17/298 (6%) vs. 3/275 (1%)]. Malunion was more common with CCC [38/249 (15%) vs. 8/274 (3%); p  95% from NHS perspective and 85% from societal perspective). Experiences of treatments were similar; both groups endured the impact of fracture, uncertainty regarding future function and the need for further interventions. LIMITATIONS: Assessors at 6 weeks were necessarily not blinded. The learning-effect analysis was inconclusive because of limited CCC applications per surgeon. CONCLUSIONS: CCC provides a clinically equivalent outcome to ORIF at reduced cost to the NHS and to society at 6 months. FUTURE WORK: Longer-term follow-up of trial participants is under way to address concerns over potential later complications or additional procedures and their potential to impact on ankle function. Further study of the patient factors, radiological fracture patterns and outcomes, treatment responses and prognosis would also contribute to understanding the treatment pathway. TRIAL REGISTRATION: Current Controlled Trials ISRCTN04180738. FUNDING: The National Institute for Health Research Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 20, No. 75. See the NIHR Journals Library website for further project information. This report was developed in association with the National Institute for Health Research Oxford Biomedical Research Unit funding scheme. The pilot phase was funded by the AO Research Foundation

Vardagslivet i bostad med särskild service med institutionell prägel - en studie av personer med intellektuell funktionsnedsättning och personalens erfarenheter

The general intention of recent Swedish legislation concerning adults with intellectual disabilities has been to provide care and support for this group in small settings in the community. It has been shown that adults with intellectual disabilities are better equipped to exert influence over their own care and support when living in group homes in the community and other forms of independent living as opposed to large institutional settings. Recent research on this group has to a great extent concerned the study of how life is in small group homes for this group and has highlighted obstacles preventing them from participating in society. Previous research has indicated that living in institutional settings makes it difficult for them to exert influence on their lives. A small number of large institutional care settings still exist, however, in Sweden and there is a dearth of research that focuses on how adults with intellectual disabilities experience everyday life in such settings. In addition, little research has been carried out on the role of the care workers who work in such settings. The aim of this research has thus been to describe the experiences of adults with intellectual disabilities and care workers of living and working in an institutional care setting in Sweden.   An ethnographic approach including participant observation and in-depth interviews was used to gain a deeper understanding of how adults with intellectual disabilities and staff experience their everyday life in an institutional care setting. The result showed that the residents experienced;  I) a sense of belonging, which was connected to having access to a private sphere and being part of social togetherness;  II) a feeling of insecurity in relation to other residents and care workers;  III) a longing for independence and a desire to get away. The study of the staff revealed three main themes that represent their approach; I) creating a family-like atmosphere; II) making the everyday life ordered and structured; III) being exposed to stress factors.   The results revealed the importance of paying close attention to what adults with intellectual disabilities and their care workers have to say about their everyday lives when living and working in an institutional care setting. It may be concluded that adults living in an institutional care setting experience their everyday lives in existential terms such as belonging, insecurity and longing. For caring science and in caring practices of people with intellectual disabilities, it is not satisfactory that residents experience such an insecure existence in a care setting. In order to provide individual care and support, staff need to be more open and vigilant as to the residents’ vulnerability and be able to guide them in matters  concerning emotional aspects. It was seen that care workers in their everyday work with residents in an institutional care setting used experiences from their personal lives in situations where they lacked formal care training. Such experiences may have helped to create meaningfulness but at the same time risked preserving inequality and gender stereotyping. In order to avoid these risks care workers should receive clear directives from the management about the care objectives, and guidelines about how best to care for adults with intellectual disabilities and offer them individualized care. Furthermore, it also became evident that care workers need additional support, training and opportunities for reflection to cope with their complex work situation. The results of this research can contribute to a greater insight and deeper knowledge of what adults with intellectual disabilities experience in an institutional care setting in the 2000’s , enabling the staff and management to further enhance the well-being for this group of individuals. The findings can provide feedback to staff, managers and researchers working in the intellectual disabilities field.   Keywords: adults with intellectual disabilities, care, care workers, ethnography, institutional care setting, Swede

Experiences of everyday life and participation for people with intellectual disabilities : from four perspectives

People with intellectual disabilities are dependent in many ways on the support ofothers if they are to have access to social life, services and support in society. Inorder to participate in various activities, they need intellectual and social support.This means that participation for them, depends in several ways on other people´swillingness to facilitate and promote participation. This imposes high demands onthose professionals providing formal support for them. Hence, the overall aim ofthis thesis was to explore and describe from four perspectives the experiences ofeveryday life and participation for people with intellectual disabilities. The thesiscontains four qualitatively oriented studies, which have evolved over time. StudiesI-II, including participant observations and interviews, and were conducted ingroup homes with staff and adults with intellectual disabilities. Furthermore, itemerged that adults with intellectual disabilities experienced different limitationsin their everyday life, which indicates a lack of opportunity for participation (StudyII). From the findings of these two studies, it became clear that participation is acentral focus and that leadership is of particular significance for how participationis implemented; therefore, interviews were conducted with service managers (Study III). Lastly, within the framework of this thesis, the aim was directed atfocus groups with significant others as the fourth perspective to provide a broadframing of what participation can mean for people with intellectual disabilities.Despite the fact that the disability policy has contributed to improvements forthis target group, there are currently extensive shortcomings. This study hasrevealed deficiencies such as the lack of working methods to help staff facilitateparticipation (Study I); the lack of care worker´ continuity and the existence ofmany routines and rules in the group homes (Study II); more overarchingly, thefinancial situation was not adequate to promote participation (Studies III and IV).Consequently, there were also strengths and opportunities for a good everyday life and for participation. All four perspectives are important as, together, theycontribute with a deeper understanding of what participation is and is not, inrelation to people with ID. From the findings presented in this thesis, it can be saidthat participation is double-edged as the four studies highlight both the absenceand presence of participation

Experiences of everyday life and participation for people with intellectual disabilities : from four perspectives

People with intellectual disabilities are dependent in many ways on the support ofothers if they are to have access to social life, services and support in society. Inorder to participate in various activities, they need intellectual and social support.This means that participation for them, depends in several ways on other people´swillingness to facilitate and promote participation. This imposes high demands onthose professionals providing formal support for them. Hence, the overall aim ofthis thesis was to explore and describe from four perspectives the experiences ofeveryday life and participation for people with intellectual disabilities. The thesiscontains four qualitatively oriented studies, which have evolved over time. StudiesI-II, including participant observations and interviews, and were conducted ingroup homes with staff and adults with intellectual disabilities. Furthermore, itemerged that adults with intellectual disabilities experienced different limitationsin their everyday life, which indicates a lack of opportunity for participation (StudyII). From the findings of these two studies, it became clear that participation is acentral focus and that leadership is of particular significance for how participationis implemented; therefore, interviews were conducted with service managers (Study III). Lastly, within the framework of this thesis, the aim was directed atfocus groups with significant others as the fourth perspective to provide a broadframing of what participation can mean for people with intellectual disabilities.Despite the fact that the disability policy has contributed to improvements forthis target group, there are currently extensive shortcomings. This study hasrevealed deficiencies such as the lack of working methods to help staff facilitateparticipation (Study I); the lack of care worker´ continuity and the existence ofmany routines and rules in the group homes (Study II); more overarchingly, thefinancial situation was not adequate to promote participation (Studies III and IV).Consequently, there were also strengths and opportunities for a good everyday life and for participation. All four perspectives are important as, together, theycontribute with a deeper understanding of what participation is and is not, inrelation to people with ID. From the findings presented in this thesis, it can be saidthat participation is double-edged as the four studies highlight both the absenceand presence of participation

Experiences of everyday life and participation for people with intellectual disabilities : from four perspectives

People with intellectual disabilities are dependent in many ways on the support of others if they are to have access to social life, services and support in society. In order to participate in various activities, they need intellectual and social support. This means that participation for them, depends in several ways on other people´s willingness to facilitate and promote participation. This imposes high demands on those professionals providing formal support for them. Hence, the overall aim of this thesis was to explore and describe from four perspectives the experiences of everyday life and participation for people with intellectual disabilities. The thesis contains four qualitatively oriented studies, which have evolved over time. Studies I-II, including participant observations and interviews, and were conducted in group homes with staff and adults with intellectual disabilities. Furthermore, it emerged that adults with intellectual disabilities experienced different limitations in their everyday life, which indicates a lack of opportunity for participation (Study II). From the findings of these two studies, it became clear that participation is a central focus and that leadership is of particular significance for how participation is implemented; therefore, interviews were conducted with service managers (Study III). Lastly, within the framework of this thesis, the aim was directed at focus groups with significant others as the fourth perspective to provide a broad framing of what participation can mean for people with intellectual disabilities. Despite the fact that the disability policy has contributed to improvements for this target group, there are currently extensive shortcomings. This study has revealed deficiencies such as the lack of working methods to help staff facilitate participation (Study I); the lack of care worker´ continuity and the existence of many routines and rules in the group homes (Study II); more overarchingly, the financial situation was not adequate to promote participation (Studies III and IV). Consequently, there were also strengths and opportunities for a good everyday life and for participation. All four perspectives are important as, together, they contribute with a deeper understanding of what participation is and is not, in relation to people with ID. From the findings presented in this thesis, it can be said that participation is double-edged as the four studies highlight both the absence and presence of participation

Service managers' experiences of how the participation of people with intellectual disabilities can be promoted in Swedish group homes

BACKGROUND: People with intellectual disabilities in staffed group homes often need lifelong support and dependency on others. Thereby, special demands are placed on staff and service managers to ensure opportunities for participation in everyday life. This study aims to explore how service managers promote participation in Swedish group homes for adults with intellectual disabilities. METHOD: A qualitative research design involving individual interviews with 14 service managers was used to gain an understanding of how the participation of adults with intellectual disabilities can be promoted in Swedish group homes. RESULTS: The results comprise two main themes; Creating preconditions for participation and Barriers for promotion of participation. CONCLUSIONS: Service managers experienced that promoting service user participation in group homes was an important part of their responsibility. The findings indicate that structural strategies such as coaching, supervision and reflection are important and should be further developed

Elderly women´s experiences of living with fall risk in a fragile body: a reflective lifeworld approach

The purpose of this qualitative study was to explore the lived experience of fall risk from a life-world perspective in elderly women with previous fragility fractures. Thirteen elderly women with a high risk of fall and fracture, aged 76-86, living in their own homes in rural areas, were recruited from a voluntary fracture prevention programme. All women had a history of fragility fractures and were interviewed in their homes from spring to autumn 2004. A phenomenological reflective life-world approach was chosen to analyse in-depth interview data. The study was conducted within an interdisciplinary research group inspired by dialogical research. Elderly women's life space has been narrowed due to advanced age, physical injury or by efforts to prevent new injuries leading to changes in self-perception. However, the women seek strategies to challenge limitations and insecurity, and strive to retain mobility and daily life routines. The four major constituents of the phenomenon 'elderly women's experiences of fall risk' emerged in this study: a changing body, living with precaution, ambiguous dependency and influence and need for understanding. Employing the women's thoughts and resources in trust-based dialogues with caregivers may strengthen their concord and the prospects to continue an active life. Elderly women seek strategies to challenge limitations and feelings of insecurity, and strive to maintain mobility and daily life routines. A trust-based care respecting the preferences of the women seemed to stimulate behavioural change in maintaining an active life

Older people's experiences of falling and perceived risk of falls in the community: A narrative synthesis of qualitative research

© 2017 John Wiley & Sons Ltd Aim: To examine qualitative research exploring older people's experiences of falling and the perceived risk of falling in the community. This will contribute new insights into how falling is perceived by the older community. Background: Falls are a major problem for older people and healthcare services across the world. Accidental falls in the community are a persistent problem that is generally recognised as an intrinsic risk of ageing. This review provides a new synthesis of evidence that considers older people's perception of falls in the community as new insights are needed if the increasing problems of falls are to be addressed. Design: Synthesis of the qualitative literature employing Noblit and Hare's method of reciprocal translation. CINAHL, Medline, EMBASE, PsychINFO and BNI were searched 1999–2015. Methods: Noblit and Hare's method of reciprocal translations was used to conceive this meta-ethnographic synthesis. The ENTREQ statement was employed as a tool for reporting the synthesis of qualitative research. The PRISMA statement was used for reporting the different phase of the literature search, and the Critical Appraisal Skills Programme qualitative research checklist was used as an appraisal framework. Results: Eleven papers fit the inclusion criteria and revealed a series of themes. These were falls as a threat to personal identity, falls as a threat to independence, falls as a threat to social interaction and carefulness as a protective strategy. Conclusion: Many older people reject the label of “at risk of falling” because of the perceived implication of dependency and incompetence. To be considered “at risk” of falling is perceived as threatening the identity of individuals who are comfortable maintaining their own independence. However, there are also those who accept the risk of falling and in doing so choose carefulness as a personal strategy to manage the risk. For the majority of older people, maintaining independence is the key motivator influencing their actions. Independence to pursue social interaction safeguards against loss of identity, social isolation and negative feelings of dependency. Falling in the community is a problem that persists, despite intervention of local health teams. This article contributes to a body of evidence on older people's experience of falling in the community with the aim of providing new insights for nurses as they approach the issues with patients. Implications for practice: Management of falls risk improves through constructive, proactive health behaviour. Promoting a positive attitude towards living well encourages older people to engage in healthy, risk reducing behaviours. Older people reject the designation of “at risk of falling” due to a perceived association with dependency and incompetence. The negative association is a barrier to engaging at-risk populations with fall prevention interventions