The Effects of Multifactorial Fall Prevention on the Psychological Risk Factors of Falling

Psychological factors, such as depression or depressive symptoms and fear of falling are linked to falls among the aged. According to previous studies, they may increase the risk of falls and injurious falls. In addition, depression or a high amount of depressive symptoms and fear of falling may hinder participation in preventive activities. Despite the severe consequences of both conditions and their high prevalence among the aged, they have rarely been studied in the context of fall prevention. The study aimed to assess the effects of multifactorial fall prevention on the psychological risk factors of falling (depressive symptoms and fear of falling) among the community-dwelling aged at increased risk of falling. In addition, it aimed to determine factors predicting high adherence to preventive activities. Volunteers aged 65 or over, who had fallen during the year previous to randomisation were recruited. Participants (n=591) were randomised into an intervention or a control group. The intervention group received a multifactorial fall prevention programme including geriatric assessment, individual guidance on fall and fracture prevention, group- and home-based physical exercise, psychosocial group activities, lectures and home hazards assessment. The control group had a one-time counselling on fall and fracture prevention. The data on psychological risk factors of falling were collected by self-rated questionnaires. Multifactorial fall prevention was not effective in reducing depressive symptoms or fear of falling compared to one-time counselling in the total sample. However, in subgroup analyses, depressive symptoms reduced statistically significantly more among the men and older participants of the intervention group compared to the control group. Female gender, high physical and cognitive abilities and low self-perceived probability of falling were independent predictors of higher adherence in organised activities. In conclusion, few psychological benefits were gained during this multifactorial fall prevention trial. More attention should be focused on adherence, especially among the aged with functional disabilities.Laaja-alaisen kaatumisenehkäisyn vaikutukset kaatumisten psyykkisiin vaaratekijöihin Psyykkiset tekijät, kuten masennus tai masennusoireet ja kaatumisen pelko ovat yhteydessä kaatumisiin ikääntyneillä. Aikaisemmissa tutkimuksissa molempien on todettu lisäävän kaatumisten vaaraa. Lisäksi sekä masennus tai masennusoireet ja kaatumisen pelko voivat rajoittaa yksilön osallistumista kaatumisenehkäisyohjelmiin. Psyykkisiä tekijöitä on harvoin tutkittu kaatumisten ehkäisyn yhteydessä, huolimatta niiden vakavista seurauksista ja yleisyydestä ikääntyneiden keskuudessa. Tutkimuksen tavoitteena oli selvittää laaja-alaisen kaatumisenehkäisyohjelman vaikutuksia kaatumisten psyykkisiin vaaratekijöihin: masennusoireisiin ja kaatumisen pelkoon. Ohjelman vaikutuksia tarkasteltiin kotona tai palveluasunnossa asuviin ikääntyneisiin, joilla oli kohonnut kaatumisen riski. Lisäksi tarkoituksena oli selvittää, mitkä tekijät ennustavat korkeaa osallistumisaktiivisuutta kaatumisenehkäisyinterventioon. Tutkimukseen osallistui vapaaehtoisia, jotka olivat kaatuneet vähintään kerran tutkimusta edeltävän vuoden aikana. Tutkittavat (n=591) satunnaistettiin interventio- tai kontrolliryhmään. Interventioryhmäläiset osallistuivat laaja-alaiseen kaatumisenehkäisyohjelmaan, johon sisältyi geriatrin arviointi, yksilöllistä neuvontaa kaatumisten ja murtumien ehkäisystä, ryhmäliikuntaa, kotivoimistelua, psykososiaalista ryhmätoimintaa, luentoja sekä kodin vaaratekijöiden kartoitus. Aineisto kerättiin itse täytettävin lomakkein. Kun tarkasteltiin koko aineistoa, laaja-alaisella kaatumisenehkäisyohjelmalla ei ollut kertaneuvontaa suurempaa vaikutusta masennusoireisiin tai kaatumisen pelkoon. Alaryhmäanalyyseissa selvisi kuitenkin, että masennusoireet vähenivät tilastollisesti merkitsevästi enemmän interventioryhmän miehillä sekä yli 75-vuotiailla kuin kontrolliryhmän vastaavissa alaryhmissä. Kaatumisenehkäisyohjelmaan osallistumista puolestaan lisäsivät naissukupuoli, korkea kognitiivinen ja fyysinen toimintakyky ja vähäiseksi koettu kaatumisen todennäköisyys. Laaja-alaisen kaatumisenehkäisyohjelman vaikutukset kaatumisten psyykkisiin vaaratekijöihin jäivät vähäisiksi. Erityisesti huonokuntoisten iäkkäiden osallistumisaktiivisuutta tulisi edistää.Siirretty Doriast

Temporal Associations between Daytime Physical Activity and Sleep in Children

Peer reviewe

Effects of risk-based multifactorial fall prevention on health-related quality of life among the community-dwelling aged: a randomized controlled trial

BACKGROUND: This study aimed to assess the effects of a risk-based, multifactorial fall prevention programme on health-related quality of life among the community-dwelling aged who had fallen at least once during the previous 12 months. METHODS: The study is a part of a single-centre, risk-based, multifactorial randomised controlled trial. The intervention lasted for 12 months and consisted of a geriatric assessment, guidance and treatment, individual instruction in fall prevention, group exercise, lectures on themes related to falling, psychosocial group activities and home exercise. Of the total study population (n = 591, 97% of eligible subjects), 513(251 in the intervention group and 262 in the control group) participated in this study. The effect of the intervention on quality of life was measured using the 15D health-related quality of life instrument consisting of 15 dimensions. The data were analysed using the chi-square test or Fisher's exact test, the Mann-Whitney U-test and logistic regression. RESULTS: In men, the results showed significant differences in the changes between the intervention and control groups in depression (p = 0.017) and distress (p = 0.029) and marginally significant differences in usual activities (p = 0.058) and sexual activity (p = 0.051). In women, significant differences in the changes between the groups were found in usual activities (p = 0.005) and discomfort/symptoms (p = 0.047). For the subjects aged 65 to 74 years, significant differences in the changes between the groups were seen in distress (p = 0.037) among men and in usual activities (p = 0.011) among women. All improvements were in favour of the intervention group. CONCLUSION: Fall prevention produced positive effects on some dimensions of health-related quality of life in the community-dwelling aged. Men benefited more than women

Effects of risk-based multifactorial fall prevention on postural balance in the community-dwelling aged: a randomized controlled trial

Abstract: the purpose of the study was to assess the effects of 12-month risk-based multifactorial fall prevention program on postural control of the aged. Five hundred and ninety-one (97%) eligible subjects were randomized into an intervention group (IG) (n =293) and a control group (CG) (n =298). The effects of the program were measured on standing, dynamic, and functional balance. In standing balance, the velocity moment of semi-tandem standing decreased in IG (median change -0.54mm.sup.2/s) but increased in CG (+3.84mm.sup.2/s) among all women (p =0.011) and among the women aged 65-74 years (-1.65mm.sup.2/s and +2.80mm.sup.2/s, correspondingly) (p =0.008). In a dynamic test, performance distance tended to decrease in IG (-26.54mm) and increase in CG (+34.10mm) among all women (p =0.060). The women aged 75 years or over, showed marginally significant differences between the groups as regards changes in performance time (-2.66s and -0.90s) (p =0.068) and distance (-92.32mm and +76.46mm) (p =0.062) of the dynamic balance test in favor of IG. Men showed no significant differences in the changes between the groups in any balance measures

A multifactorial fall prevention programme in home-dwelling elderly people: a randomized-controlled trial

Objectives: to describe the implementation and the effects of a multifactorial fall prevention trial on the specified risk factors of falling, incidence of falls and injurious falls, and on specified secondary outcome measures; to describe the design of the study and to assess the success of randomization. Study design: Randomized-controlled trial. Methods: recruitment started in March 2003 and lasted until the end of January 2005, when a total number of 591 participants was reached. Participants were randomized into two age groups (65–74 years and 75 years and over), then into an intensive multifactorial risk-based prevention programme or into a one-time counselling on fall prevention. The intervention included individual geriatric assessment, guidance and treatment, individual guidance on fall prevention, physical exercise in small groups, psychosocial group activities, lectures, home-exercises and home hazards assessment. Results: a total of 293 people were randomized into the 1-year prevention programme and 298 into the control condition. The mean age was 73.5 years in both groups; 84% of the participants were women. The groups were well balanced at baseline in relation to risk factors of falls, and the only statistically significant difference was found in the amount of regularly taken medicines, which was significantly lower in the control group: mean 3.7 (SD 3.0) vs. 4.2 (SD 3.1), P = 0.028 . Conclusions: participants were successfully randomized into a multifactorial fall prevention trial

: Disability before cardiovascular death

International audienceOur results on working age men and women suggest no gender differences in morbidity prior to death from heart disease and lower morbidity in women prior to death from stroke. These findings challenge the widespread belief that women experience more morbidity symptoms than men

Optimism and pessimism as predictors of work disability with a diagnosis of : a prospective cohort study of onset and recovery.

International audienceBACKGROUND: Personality characteristics are assumed to affect to the vulnerability to depression and its outcomes. The aim of this study was to examine optimism and pessimism as predictors of depression-related work disability and subsequent return to work. METHODS: We conducted a prospective cohort study of 38,214 public sector employees with no record of diagnosed depression. Optimism and pessimism were measured using the Revised Life Orientation Test (LOT-R). Records of long-term (>90 days) work disability with a diagnosis of depression and subsequent return to work until the end of 2005 were obtained from the national health registers. RESULTS: During the mean follow-up of 4.0 (SD=2.3) years, 287 employees encountered work disability with a diagnosis of depression. Of them, 164 (57%) returned to work during the follow-up. One unit increase in the optimism mean score (range 1-4) was associated with a 25% lower risk of work disability due to depression and a 37% higher probability of returning to work after a work disability period when adjusted for age and sex. In the fully-adjusted model hazard ratios per one unit increase in optimism were 0.79 (95% CI 0.66-0.96) for work disability and 1.30 (95% CI 1.01-1.66) for return to work. The pessimism mean score (range 1-4) was only associated with a lower probability of returning to work (fully-adjusted HR per one unit increase 0.66, 95% Cl 0.49-0.88). CONCLUSION: The level of optimism was a stronger predictor of work disability with a diagnosis of depression than the level of pessimism, while both optimism and pessimism predicted returning to work

Effect of retirement on sleep disturbances: the GAZEL prospective cohort study.

International audienceOBJECTIVES: Changes in health following retirement are poorly understood. We used serial measurements to assess the effect of retirement on sleep disturbances. DESIGN: Prospective cohort study. SETTING: The French national gas and electricity company. PARTICIPANTS: Fourteen thousand seven hundred fourteen retired employees (79% men). MEASUREMENTS AND RESULTS: Annual survey measurements of sleep disturbances ranging from 7 years before to 7 years after retirement (a mean of 12 measurements). Before retirement 22.2% to 24.6% of participants reported having disturbed sleep. According to repeated-measures logistic-regression analysis with generalized estimating equations estimation, the odds ratio (OR) for having a sleep disturbance in the postretirement period was 0.74 (95% confidence interval 0.71-0.77), compared with having a sleep disturbance in the preretirement period. The postretirement improvement in sleep was more pronounced in men (OR 0.66 [0.63-0.69]) than in women (OR 0.89 [0.84-0.95]) and in higher-grade workers than lower-grade workers. Postretirement sleep improvement was explained by the combination of preretirement risk factors suggesting removal of work-related exposures as a mechanism. The only exception to the general improvement in sleep after retirement was related to retirement on health grounds. In this group of participants, there was an increase in sleep disturbances following retirement. CONCLUSIONS: Repeated measurements provide strong evidence for a substantial and sustained decrease in sleep disturbances following retirement. The possibility that the health and well-being of individuals are significantly worse when in employment than following retirement presents a great challenge to improve the quality of work life in Western societies in which the cost of the aging population can only be met through an increase in average retirement age