Johanne Filiatrault

An Exploratory Study of Individual and Environmental Correlates of Fear of Falling Among Community-Dwelling Seniors

Objective: The objective of this study was to identify individual and environmental correlates of fear of falling among community-dwelling seniors. Method: The study sample involved 288 community-dwelling adults aged 65 years or older going through the normal aging process. Fear of falling and a series of individual and environmental characteristics were measured with a questionnaire during home interviews. Results: Multivariate logistic regression procedures showed that the strongest correlates of fear of falling are gender, support from a spouse or partner, and residential area. Being a female as well as living in a smaller city or rural area were shown to be risk factors for fear of falling, whereas the availability of support from a spouse or partner was a protective factor. Discussion: Findings from this study suggest that researchers should adopt an ecological perspective to understanding the phenomenon of fear of falling among seniors and collect data on a broader range of individual and environmental factors.

Implementing a Community-Based Falls-Prevention Program: From Drawing Board to Reality

Plusieurs études ont démontré,à l’aide de devis randomisés, l’efficacité de programmes de prévention des chutes destinés aux aînés vivant dans la communauté. Cependant, on connaît peu de choses quant à la faisabilité d’implanter ces programmes dans des conditions naturelles et quant à l’efficacité de ces programmes lorsqu’ils sont offerts dans de telles conditions. Les objectifs de cet article sont de: (a) décrire un programme multifactoriel de prévention des chutes (pIED) destiné à des aînés autonomes vivant dans la communauté et (b) présenter les résultats d’une analyse de la faisabilité d’une implantation du programme dans les organismes communautaires. Le programme aété implanté dans 10 organismes du milieu communautaire situés dans la région métropolitaine de Montréal dans le contexte d’une étude d’efficacité. Les résultats concernant la population recrutée et la façon dont le programme a été offert, ainsi que le niveau de participation au programme montrent qu’un programme de prévention des chutes visant plusieurs facteurs de risque peut être implanté avec succès dans des milieux communautaires. Several studies have demonstrated the efficacy of falls-prevention programs designed for community-dwelling seniors using randomized designs. However, little is known about the feasibility of implementing these programs under natural conditions and about the success of these programs when delivered under such conditions. The objectives of this paper are to (a) describe a multifactorial falls-prevention program (called Stand Up!) designed for independent community-dwelling seniors and (b) present the results of an analysis of the practicability of implementing this program in community-based settings. The program was implemented in the context of an effectiveness study in 10 community-based organizations in the Montreal metropolitan area. Data pertaining to the reach and delivery of the program as well as participation level show that a falls-prevention program addressing multiple risk factors can be successfully implemented in community-based settings.

Impact of a community-based falls prevention program on maintenance of physical activity among older adults.

Objective: This study examines the 9-month impact of a 12-week falls prevention program (called Stand Up!) which included balance exercises and educational components on maintenance of physical activity among community-dwelling seniors. Method: Data were collected among 98 experimental and 102 control participants at baseline, immediately after the program and 9 months later. Involvement in physical activity was measured with three indicators. Program effects were examined using linear and logistic regression procedures. Results: Both groups showed similar increases in weekly frequency of exercise at the 9-month posttest. However, the programs participants showed higher increases in their variety of exercises at the 9-month posttest (especially among those with greater baseline scores). Among seniors reporting lower levels of energy expenditure at baseline, the programs participants showed significantly greater increases in energy expenditure than control participants. Discussion: These preliminary findings suggest that programs such as Stand Up! have the potential to stimulate continued involvement in physical activity.

Coping Strategies Used by Seniors Going through the Normal Aging Process: Does Fear of Falling Matter?

Background: Recent studies show that fear of falling, a frequent fear of community-dwelling seniors, can have a negative impact on their health and quality of life. When fear of falling is intense, it can prompt individuals to limit or avoid certain activities. This activity restriction can lead to premature physical and functional decline and, ultimately, increase the risk for falls. Although activity avoidance/restriction is a common strategy used by seniors to cope with fear of falling, they may use other strategies as well to cope with this fear. However, these other strategies have received little attention to date. Objective: This study aimed at examining and comparing coping strategies used by seniors with and without fear of falling. It also examined if fear of falling is an independent correlate of the use of coping strategies among seniors. Methods: 288 seniors aged 65 years or over and going through the normal aging process were assessed during structured home interviews. Fear of falling was assessed through a single question (Are you afraid of falling?) and a 4-category response scale (never, occasionally, often, very often). Coping strategies used by participants were assessed with the Inventory of Coping Strategies Used by the Elderly. Results: Findings show that seniors with fear of falling use several coping strategies other than activity avoidance/restriction in their daily functioning. Compared with nonfearful seniors, they tend to use a wider range of coping strategies and use them more frequently. Results also indicate that fear of falling is an independent correlate of diversity and frequency of use of behavioral coping strategies. Conclusion: This study suggests that fall prevention practitioners and researchers should document the range and frequency of use of strategies that seniors may employ to cope with fear of falling. These data could help improve interventions and evaluative research in the domain of fall prevention.

A static dynamometer measuring multidirectional torques exerted simultaneously at the hip and knee

The function of a static dynamometer measuring torques exerted simultaneously in the different anatomical planes of the hip (flexion-extension, abduction-adduction and internal-external rotation) and knee (flexion-extension) is described. Muscular torques were calculated in real time using a desktop computer from measurements of orthogonal forces applied at two locations and the lever arm values measured in each subject. The reliability of the force transducers was explored by examining their output, using calibrated weights, on three different days. The results were identical over this period of time, indicating that the transducers are highly reliable. A mechanical simulator of a lower limb was constructed to generate specific or combined torques of known values at the hip and knee. The torques measured by the dynamometer were found to be highly concordant with the known torques applied by the simulator, indicating that the torque measurements were valid. The usefulness of the dynamometer is demonstrated by evaluating the activity of the rectus femoris and biceps femoris muscles during static efforts exerted in various directions at the hip. In addition, the mechanical action of biarticular muscles at the hip was evaluated by quantification of hip torques during efforts exerted at the knee. From these results, it has been concluded that the present biarticular and multidirectional dynamometer is a valid, reliable and precise instrument that may prove to be useful in evaluating the muscular function of the lower limb.

Directional patterns of muscle activation at the lower limb in subjects with hemiparesis and in healthy subjects: A comparative study

This article reports the results of a comparative study on directional patterns of muscle activation at the lower limb in 15 subjects with hemiparesis and 18 healthy subjects. Subjects were required to exert static hip and knee torques using multidirectional and biarticular dynamometers designed for the lower limbs. Hip torques were performed in abduction, adduction, flexion, extension, and in combined directions (e.g., hip flexion and abduction) and knee torques were exerted in flexion and extension. The required torque levels corresponded to approximately 5% of the maximal voluntary contraction of healthy subjects. Electromyographic (EMG) activities of the rectus femoris, biceps femoris, gracilis, gluteus medius, gluteus maximus, vastus lateralis, tibialis anterior, and soleus were recorded during these torques. The descriptive analysis involved comparison between either the polar plots (for hip tasks) or the histograms (for knee tasks) representing the mean muscle activity obtained across subjects during torques exerted in each direction for the three groups of muscles analyzed (normal, paretic, and nonparetic muscles). Ciucular statistics were also used to characterize directional patterns of activation in each muscle during hip tasks while linear statistics permitted one to analyze these patterns during knee tasks. In general, the results of both the descriptive and inferential statistical analyses indicated that directional patterns of muscle activation during hip and knee torques are not altered in subjects with hemiparesis. These results are in contrast to the disturbances observed previously in a study of directional patterns of muscle activation at the upper extremity in this population. It is suggested that the contrast between the present results and those obtained at the upper limb in subjects with hemiparesis may reflect the difference in the motor recovery of upper and lower paretic limbs or in the severity of spasticity in the muscles involved at the studied joints. Results of this study also showed that the paretic muscles often demonstrate larger EMG signals than normal and nonparetic muscles, especially during knee flexion torques. These last observations, in addition to the fact that some subjects with hemiparesis could not complete all of the tasks with their paretic limb, under-score the muscle weakness inherent to this population.

Fear of Falling among Seniors: A Target to Consider in Occupational and Physical Therapy Practice?

ABSTRACT Fear of falling, a frequent fear among community-dwelling seniors, can interfere with their activity level and social participation and negatively impact on their health and quality of life. Thus, it is an important factor to consider by occupational and physical therapists involved with this population. Based on the most recent studies in this field of research, this paper aims to provide occupational and physical therapists with a better understanding of the impact of fear of falling on seniors’ health and quality of life, and offer them guidance on how to assess fear of falling and other fall-related psychological factors and how to intervene on these factors.

Partnership for fragility bone fracture care provision and prevention program (P4Bones): study protocol for a secondary fracture prevention pragmatic controlled trial

BackgroundFractures associated with bone fragility in older adults signal the potential for secondary fracture. Fragility fractures often precipitate further decline in health and loss of mobility, with high associated costs for patients, families, society and the healthcare system. Promptly initiating a coordinated, comprehensive pharmacological bone health and falls prevention program post-fracture may improve osteoporosis treatment compliance; and reduce rates of falls and secondary fractures, and associated morbidity, mortality and costs.Methods/designThis pragmatic, controlled trial at 11 hospital sites in eight regions in Quebec, Canada, will recruit community-dwelling patients over age 50 who have sustained a fragility fracture to an intervention coordinated program or to standard care, according to the site. Site study coordinators will identify and recruit 1,596 participants for each study arm. Coordinators at intervention sites will facilitate continuity of care for bone health, and arrange fall prevention programs including physical exercise. The intervention teams include medical bone specialists, primary care physicians, pharmacists, nurses, rehabilitation clinicians, and community program organizers.The primary outcome of this study is the incidence of secondary fragility fractures within an 18-month follow-up period. Secondary outcomes include initiation and compliance with bone health medication; time to first fall and number of clinically significant falls; fall-related hospitalization and mortality; physical activity; quality of life; fragility fracture-related costs; admission to a long term care facility; participants’ perceptions of care integration, expectations and satisfaction with the program; and participants’ compliance with the fall prevention program. Finally, professionals at intervention sites will participate in focus groups to identify barriers and facilitating factors for the integrated fragility fracture prevention program.This integrated program will facilitate knowledge translation and dissemination via the following: involvement of various collaborators during the development and set-up of the integrated program; distribution of pamphlets about osteoporosis and fall prevention strategies to primary care physicians in the intervention group and patients in the control group; participation in evaluation activities; and eventual dissemination of study results.Study/trial registrationClinical Trial.Gov NCT01745068Study ID numberCIHR grant # 267395

An Empirical Comparison of Different Models of Active Aging in Canada: The International Mobility in Aging Study

Purpose Active aging is a concept that lacks consensus. The WHO defines it as a holistic concept that encompasses the overall health, participation, and security of older adults. Fernández-Ballesteros and colleagues propose a similar concept but omit security and include mood and cognitive function. To date, researchers attempting to validate conceptual models of active aging have obtained mixed results. The goal of this study was to examine the validity of existing models of active aging with epidemiological data from Canada. Methods The WHO model of active aging and the psychological model of active aging developed by Fernández-Ballesteros and colleagues were tested with confirmatory factor analysis. The data used included 799 community-dwelling older adults between 65 and 74 years old, recruited from the patient lists of family physicians in Saint-Hyacinthe, Quebec and Kingston, Ontario. Results Neither model could be validated in the sample of Canadian older adults. Although a concept of healthy aging can be modeled adequately, social participation and security did not fit a latent factor model. A simple binary index indicated that 27% of older adults in the sample did not meet the active aging criteria proposed by the WHO. Implications Our results suggest that active aging might represent a human rights policy orientation rather than an empirical measurement tool to guide research among older adult populations. Binary indexes of active aging may serve to highlight what remains to be improved about the health, participation, and security of growing populations of older adults.

Effect of a Fall Prevention Program on Balance Maintenance Using a Quasi-experimental Design in Real-World Settings

Objectives: To examine the effect of a fall prevention program offered under real-world conditions on balance maintenance several months after the program. To explore the program’s impact on falls. Method: A quasi-experimental study was conducted among community-dwelling seniors, with pre- and postintervention measures of balance performance and self-reported falls. Ten community-based organizations offered the intervention (98 participants) and 7 recruited participants to the study’s control arm (102 participants). An earlier study examined balance immediately after the 12-week program. The present study focuses on the 12-month effect. Linear regression (balance) and negative binomial regression (falls) procedures were performed.falls. Results: During the 12-month study period, experimental participants improved and maintained their balance as reflected by their scores on three performance tests. There was no evidence of an effect on falls.falls. Discussion: Structured group exercise programs offered in community-based settings can maintain selected components of balance for several months after the program’s end.