Elizabeth W. Peterson

Fear of Falling among the Community-Dwelling Elderly

To assess the incidence of falls and the prevalence, intensity, and covariates of fear of falling among community-dwelling elderly, the authors surveyed a random sample of 196 residents (≥ 58 years of age) of housing developments for the elderly in Brookline and Plymouth, Massachusetts. Forty-three percent reported having fallen in recent years, 28% in the last year. Of those who had fallen within the year prior to the interview, 65% reported injury, 44% sought medical attention, and 15% required hospitalization as a consequence of their fall(s). Fear of falling ranked first when compared to other common fears (i.e., fear of robbery, financial fears). Self-rated health status and experience of previous falls were significantly associated with fear of falling. Further analysis suggests that fear of falling may affect social interaction, independent of risks for falling.

Akinesia in Parkinson's disease

IN 3 of 5 patients described by Parkinson1 in 1817, weakness and profound muscular fatigue were conspicuous symptoms in addition to tremor and rigidity. In 1925, Kinnier Wilson2 further emphasized this striking di5culty in motor strength and endurance in patients with parkinsonism but could not specifically correlate it with either rigidity or amount of tremor present. He commented, “It seems as if the patient does not care to continue the task or put an adequate amount of effort into a particular movement.” No pathologic evidence exists that any break occurs in the continuity of the voluntary motor system such as is found in pyramidal tract disease caused by stroke or in lower motor neurons affected by neuritis or poliomyelitis. Strong motivation in the ordinary patient with Parkinson’s disease will produce a perfectly normal level of muscle power. Therefore, the word paralysis in the term paralysis agitans is not really justified. For this study of akinesia, we have developed a special, accurate ergograph in which the first dorsal interosseous muscle in the hand is specifically studied. The rest of the hand and wrist are held in a fixed position. The patient can, by using this muscle, abduct his index finger toward his thumb, pulling a lever on which is an adjustable weight. The movement of the finger is registered on moving paper as an ergogram (Fig. 1 ) . A half-hour after a voluntary muscle ergogram has been obtained, the apparatus with the identical settings of finger, wrist, and arm positioning points is again connected to the patient. Then, the electrode from a Batrow muscle stimulator is placed over the motor point of the first dorsal interosseous muscle and the electronic3 ergogram produced as previously described. Figure 2 shows examples on the left, under A, of a normal ergogram obtained by an apparatus with a 10-oz. weight on the bar. The rested subject was able to perform this amount of work indefinitely; amplitude was even and sustained. On the right of A, the same muscle is being stimulated and is producing the electronic ergogram. When the electrode approximates 2 cm. in diameter over the motor point of the muscle, the amount of weight the normal muscle can pull is only 4 oz.; the muscle does not have more than 60% of the amplitude of the voluntary ergogram. This is because the electrical stimulation is limited to the area mentioned 2 cm. of muscle while, with voluntary use, the entire muscle and the adductor pollicis muscle are utilized. Therefore, with the voluntary ergogram versus the electronic ergogram of the same muscle, we have a ratio of \rolunt? of approximately 5 to 1. This ratio varies in some individuals according to skill in locating the motor point and may be 3 to 1, 2 to 1, or even 6 to 1. Using a 10-oz. weight, a patient with Parkinson’s disease tires easily (Fig. 2B, left). However, at the arrow, the patient is told to make a strong effort and immediately returns the ergogram to normal levels for 1 contraction only; the ergogram then falls back to greatly diminished value. When a patient with Parkinson’s disease uses a 4-oz. weight, repetition of the test an hour later shows little improvement. Again on urging the patient, the ergogram reaches toward normal values as indicated under the arrow. Figure 2B, left, represents 4 oz. In Figure 2C, the other arm of the same patient, as shown in B, is tested demonstrating the impairment with the 10-02. or the 4-02. Electronic

Injurious Falls Among Middle Aged and Older Adults With Multiple Sclerosis

OBJECTIVE To determine the prevalence of, and risk factors for, receiving medical attention for a recent injurious fall among middle-aged and older adults who have multiple sclerosis (MS). DESIGN Survey. SETTING United States. PARTICIPANTS Seven hundred people with MS, age 55 years or older and living in the United States, were randomly selected from the North American Research Committee on Multiple Sclerosis Registry and invited by mail to participate in the study. A total of 354 people, aged 55 to 94 years, completed the survey. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Participants self-report regarding receipt of medical care for a fall-related injury (received care within the past 6mo, >6mo ago, or never). RESULTS More than 50% of study participants reported injurious falls; 12%, in the 6 months before the interview. Proportional odds models were used to identify factors associated with increased odds of receiving medical attention for a fall-related injury within the past 6 months. Compared with study participants who reported receiving medical attention for a fall-related injury more than 6 months ago or never, participants who reported receiving medical attention for a fall-related injury within the past 6 months were more likely to report fear of falling (odds ratio [OR]=1.94; 95% confidence interval [CI], 1.27-2.96) and osteoporosis (OR=1.65; 95% CI, 1.03-2.62). CONCLUSIONS Injurious falls were commonly reported by survey participants. Findings suggest that management of fear of falling and osteoporosis are important components of comprehensive fall-injury prevention programs for people aging with MS.

Fear of falling and associated activity curtailment among middle aged and older adults with multiple sclerosis

The purpose of this study was to identify factors associated with increased likelihood of reporting fear of falling (FoF) among people with multiple sclerosis (MS) and factors associated with activity curtailment among the subset of individuals reporting FoF. Cross-sectional data from telephone interviews with 1064 individuals with MS, aged 45—90 years living in the Midwestern United States were used. Logistic regression models examined factors associated with FoF and with activity curtailment among individuals reporting FoF. Of the participants, 63.5% reported FoF. Increased likelihood of reporting FoF was associated with being female, experiencing greater MS symptom interference during everyday activities, history of a fall in the past 6 months, and using a walking aid. Among participants reporting FoF, 82.6% reported curtailing activity. Increased likelihood of activity curtailment among people reporting FoF was associated with using a walking aid, needing moderate or maximum assistance with instrumental activities of daily living, and having less than excellent self-reported mental health. We concluded that FoF and associated activity curtailment are common among people aged 45—90 with MS. While FoF and associated activity curtailment may be appropriate responses to fall risk, the findings suggest that factors beyond realistic appraisal of fall risk may be operating. Multiple Sclerosis 2007; 13: 1168—1175. http://msj.sagepub.com

Falls, Aging, and Disability

Falls are a major public health problem, contributing to significant morbidity and mortality among older adults in the United States. This article summarizes and compares (1) fall prevalence rates, (2) fall risk factors, (3) consequences of falls, and (4) current knowledge about fall prevention interventions between community-dwelling older adults and people aging with physical disability. In this latter group, the article focuses on individuals with multiple sclerosis, late-effects of polio, muscular dystrophies, and spinal cord injuries.

A cognitive-behavioural model for promoting regular physical activity in older adults

Abstract Although a lack of physical activity has been identified as a key health risk factor, the majority of older adults remain sedentary. Activity restriction is often rooted in misconceptions about the ageing process. Many adults believe that physical decrement is inevitable and irreversible with advancing age, i.e. uncontrollable. Thus, motivation is low because it is assumed that exercise will not do any good or may even cause harm. Based on research in the area of cognitive ageing, we propose a model of the relationship between control beliefs and ageing-related decrements, which specifies that interventions to encourage regular physical activity should focus on teaching skills as well as promoting a sense of control. We recommend that cognitive behavioural strategies be used to promote confidence in ones abilities to exercise (self-efficacy), to instil the belief that ones efforts will make a difference (outcome expectations), and to encourage adaptive responses in the face of difficulties (att...

Educating Scholars of Practice: An Approach to Preparing Tomorrow's Researchers

SUMMARY Occupational therapys scholarship too often fails to result in a cumulative body of knowledge that is directly relevant to practice, and links theory and research to practice. This problem has its basis in how therapists are prepared to make scholarly contributions to the field. This article describes an educational strategy for preparing scholars of practice whose work will contribute to building a knowledge base that examines and enhances practice. The strategy is based upon social learning theory, employs principles of situated learning and cognitive apprenticeship, and involves students as members of an ongoing community of scholars. Steps to and benefits of creating this scholarly community and implementing this educational strategy are discussed.

Predicting radon testing among university employees.

To determine covariates of radon testing behavior, we surveyed by mail a random sample of all Boston University employees (N = 915) six to nine months after they had been informed of the availability of radon testing services through the Universitys medical center. The response rate was 58%. Analysis suggests blue collar workers were underrepresented within the response rate. Slightly more than half of the respondents (51%) were men. The majority (69%) were under the age of 45. Twenty-seven percent of the respondents (N = 143) had tested their homes for radon. Bivariate analysis revealed important differences between radon testers and nontesters. Testers were 12 times more likely to be home owners than renters (p = 0.00), and were more knowledgeable about radons characteristics and testing procedures (p = 0.00). Testers were more likely to view radon as a serious problem (p = 0.00), to consider radon testing efficacious (p = 0.00), and to consider themselves susceptible to exposure (p = 0.00). Testers were also less likely to perceive barriers to radon testing. We used logistic regression to compare the usefulness of the Health Belief Model and the Diffusion of Innovations Model in predicting radon testing. We concluded that the knowledge deficits and barriers to radon testing identified in this study should be targeted in radon educational interventions.

Occurrence and Predictors of Falls in People With Stroke: Six-Year Prospective Study

Background and Purpose— The purpose was to investigate the occurrence of self-reported falls in people with stroke at 3, 6, and 12 months and 6 years post stroke and predictors for falls during 6 years. Methods— A prospective study involving 121 people with stroke. Data were obtained through structured interviews and assessments. Generalized estimating equation modeling using proportional odds was used to explore the predictive value of fall history, functioning/disability, and personal factors during 6 years. Results— The proportion of fallers constituted of 35%, 26%, 33%, and 35% of the sample at 3, 6, and 12 months and 6 years of follow-up, respectively. Higher perceived effect of stroke on activities of daily living (odds ratio, 1.37; 95% confidence interval, 1.04–1.80), falls at 3 months (odds ratio, 1.0; 95% confidence interval, 1.01–3.94), and no gait/balance disability at baseline (odds ratio, 7.29; 95% confidence interval, 1.99–26.73) were predictors for future falls. During the 6 years, the odds for a fall decreased for participants with gait/balance disability at baseline but increased for those with no gait/balance disability. Conclusions— Results highlight the importance of performing fall risk evaluations over time among people with stroke, even when gait and balance functioning initially post stroke is good.

Fall risk and incidence reduction in high risk individuals with multiple sclerosis: a pilot randomized control trial

Objective: To determine the feasibility of three fall prevention programs delivered over 12 weeks among individuals with multiple sclerosis: (A) a home-based exercise program targeting physiological risk factors; (B) an educational program targeting behavioral risk factors; and (C) a combined exercise-and-education program targeting both factors. Design: Randomized controlled trial. Setting: Home-based training with assessments at research laboratory. Participants: A total of 103 individuals inquired about the investigation. After screening, 37 individuals with multiple sclerosis who had fallen in the last year and ranged in age from 45–75 years volunteered for the investigation. A total of 34 participants completed postassessment following the 12-week intervention. Intervention: Participants were randomly assigned into one of four conditions: (1) wait-list control (n = 9); (2) home-based exercise (n = 11); (3) education (n = 9); or (4) a combined exercise and education (n = 8) group. Measures: Before and after the 12-week interventions, participants underwent a fall risk assessment as determined by the physiological profile assessment and provided information on their fall prevention behaviors as indexed by the Falls Prevention Strategy Survey. Participants completed falls diaries during the three-months postintervention. Results: A total of 34 participants completed postintervention testing. Procedures and processes were found to be feasible. Overall, fall risk scores were lower in the exercise groups (1.15 SD 1.31) compared with the non-exercise groups (2.04 SD 1.04) following the intervention (p < 0.01). There was no group difference in fall prevention behaviors (p > 0.05). Conclusions: Further examination of home-based exercise/education programs for reducing falls in individuals with multiple sclerosis is warranted. A total of 108 participants would be needed in a larger randomized controlled trial. ClinicalTrials.org #NCT01956227