Pamela J. Holliday

Aging and postural control : A comparison of spontaneous- and induced-sway balance tests

Two different balance testing methods were compared: (1) measurement of spontaneous postural sway during quiet standing, and (2) measurement of induced postural sway in response to an applied postural perturbation. Eyes‐open tests were performed in 64 healthy young and elderly adults and in five elderly subjects with a history of falling. In both balance tests, the sway was defined in terms of the displacement of the center of pressure on the feet. Spontaneous sway was quantified using a number of different amplitude‐ and frequency‐based parameters. Induced sway was measured in response to anterior‐posterior acceleration of a platform on which the subject stood. The induced‐sway test was specially designed to be safe and nonthreatening for elderly subjects; thus, the platform perturbation was confined to small accelerations and a gentle pseudorandom motion was used. To derive a measure of postural stability, the data from this test were fitted with a model that was then used to predict the response to sudden (transient) perturbations, thereby simulating the response in actual falls. Although both induced‐ and spontaneous‐sway measures demonstrated significant aging‐related decreases in stability, the differences were more pronounced for the induced‐sway data. Conversely, some of the spontaneous‐sway measures were much more successful in distinguishing the fallers from the nonfallers. There was a significant correlation between induced‐sway and certain spontaneous‐sway measures in the normal young adults; however, in the elderly normals and fallers, the data from the two types of balance tests either showed no correlation or, for certain spontaneous‐sway measures, tended to show an inverse relationship.

Are Activity‐Based Assessments of Balance and Gait in the Elderly Predictive of Risk of Falling and/or Type of Fall?

To determine whether an activity‐based test of balance and gait is predictive of the risk of: (1) falling in situations that are related to specific tasks evaluated as part of the test, (2) experiencing falls precipitated by different classes of biomechanical events, or (3) falling in general; and to compare the predictive ability of the activity‐based test for the falls described in (2) and (3) to that of a posturography test that has been found previously to be predictive of falling risk.

A Posture Control Model and Balance Test for the Prediction of Relative Postural Stability

A balance testing methodology has been developed based on a posture control model which defines relative stability by the degree to which a transient postural perturbation causes the center-of-pressure on the feet to approach the limits of the base-of-support. To minimize anticipatory adaptations and to ensure subject safety, the balance test uses a small-amplitude continuous random or pseudo-random perturbation. The data are used to identify an input-output model, which is then used to predict large-amplitude transient response. Sixtyfour normal subjects were tested, as well as five patients with vestibular lesions and five elderly subjects with a history of falling. Tests were performed with eyes open (EO) and blindfolded (BF), and the EO/BF ratio was calculated. The results showed highly significant differences between young (20-40) and elderly (61-79) normals, but no differences between males and females. In using the balance test to identify the balance-impaired individuals, the BF and EO/BF data provided higher success rates than the EO data. Depending on the modeling method used, the balance test was able to identify up to three of five vestibular patients and five of five elderly fallers, at a false positive rate of 25 percent in the normal subjects.

Urinary Dysfunction in a Geriatric Long-Term Care Population: Prevalence and Patterns*

ABSTRACT: More complete data on the prevalence and types of urinary dysfunction in geriatric institutional patients are essential for the management of their urologic problems. Over a 13‐month period, a prospective study was conducted of all new admissions to a hospital for long‐term care. Eighty percent (277/347) of the newly admitted patients were geriatric (65 or older). Urinary dysfunction was identified in 69.3 percent of the geriatric group; 38.3 percent were incontinent, 20.2 percent bore a urinary diversion device, and 10.8 percent were symptomatic without incontinence. Obtaining reliable information about urologic status posed a significant problem, particularly as 27 percent of the subjects had a mental disorder, including organic brain syndrome or confusion. Thirty percent of all patients questioned were unable to give any history of their own health status. Questioning of both staff and patient to determine reliability of the data revealed that the given information was correct in 77 percent of patients who acknowledged genitourinary dysfunction, and in 83 percent of those who denied it. The study failed to elicit useful data concerning the specificity of symptoms, urologic history, diagnosis and management of urinary dysfunction in this series of geriatric patients under long‐term institutional care.

Acceptability of a wearable hand hygiene device with monitoring capabilities

Transmisssion of infection within healthcare institutions is a significant threat to patients and staff. One of the most effective means of prevention is good hand hygiene. A research team at Toronto Rehabilitation Institute, Ontario, Canada, developed a wearable hand disinfection system with monitoring capabilities to enhance hand wash frequency. We present the findingsof the first phase of a larger study addressing the hypothesis that an electronic hand hygiene system with monitoring and reminding propertieswill increase hand hygiene compliance. This first phase focused on the acceptability and usability of the wearable electronic hand wash device ina clinical environment. The feedback from healthcare staff to the first prototype has provided evidence for the research team to continue with the development of this technology.

The impact of new lifting technology in long term care: a pilot study.

1. The researchers conducted a pilot study to test a new lifting system developed with the assistance of nurses. 2. The lift system consists of a portable battery operated power unit that the nurse carries to the bedside and attaches to an overhead track; the ability to share the portable power unit among several track locations is economical. 3. The new lifting system was found to reduce the number of staff necessary to execute patient lifts. This staff saving amounted to 50% of one full time equivalent person per nursing unit. 4. Nurses perceived that less effort was required using the new lifting system compared to a conventional floor model wheeled lifting device.

A biomechanical assessment of floor and overhead lifts using one or two caregivers for patient transfers.

This study investigated the differences in peak external hand forces and external moments generated at the L5/S1 joint of the low back due to maneuvering loaded floor-based and overhead-mounted patient lifting devices using one and two caregivers. Hand forces and external moments at the L5/S1 joint were estimated from ground reaction forces and motion capture data. Caregivers gave ratings of perceived exertion as well as their opinions regarding overhead vs. floor lifts. Use of overhead lifts resulted in significantly lower back loads than floor lifts. Two caregivers working together with a floor lift did not reduce loads on the primary caregiver compared to the single-caregiver case. In contrast, two-caregiver operation of an overhead lift did result in reduced loads compared to the single-caregiver case. Therefore, overhead lifts should be used whenever possible to reduce the risk of back injury to caregivers. The use of two caregivers does not compensate for the poorer performance of floor lifts.

Design of built environments to accommodate mobility scooter users: Part II

Purpose. To determine the minimum dimensions needed to allow five models of powered mobility scooters to manoeuvre within five commonly encountered indoor spatial configurations. Method. We measured manoeuvrability of five scooters judged by their manufacturers to have a good combination of indoor mobility and outdoor performance (including in rural environments). We determined the minimum space needed to manoeuvre the scooters through the following five spatial configurations: turning 180° in a corridor, performing U-turns around 50 mm (2″) and 1200 mm (4′) obstacles, turning 90° from a doorway and approaching a counter or work surface from the side. Free-standing styrofoam walls were used to define each configuration. An expert driver repeatedly manoeuvred the scooters through each configuration while we incrementally decreased the dimension of interest until it was no longer possible to complete the manoeuvre. Each scooters turning diameter was also measured and compared to the manufacturers specification. Results. Minimum space requirements for each scooter for five spatial configurations are given and compared to existing standards. Conclusions. None of the scooters tested were capable of completing all manoeuvres within the space allowed by existing standards. These findings will contribute to recommendations for new standards for built environments that can accommodate scooter users.

Care Challenges in the Bathroom: The Views of Professional Care Providers Working in Clients' Homes.

In home care, bathroom activities—particularly bathing and toileting—present a unique set of challenges. In this focus group study, professional home care providers identified factors that increase the danger and difficulty of assisting their clients with bathing and toileting. These included small restrictive spaces, a poor fit between available equipment and the environment, a reliance on manual handling techniques (but insufficient space to use optimal body mechanics), attempts to maintain normalcy, and caring for unsteady and unpredictable clients. Specific elements of each activity that care providers found difficult included multitasking to support client stability while performing care below the waist (dressing/undressing, providing perineal care) and helping clients to lift their legs in and out of a bathtub. Participants did not feel that available assistive devices provided enough assistance to reduce the danger and difficulty of these activities.

Secondary measures of hand hygiene performance in health care available with continuous electronic monitoring of individuals

HIGHLIGHTSThe monitoring of both time and place of hand hygiene (HH) activity is central to calculating HH performance and improved understanding of related behaviors.HH performance of individual staff within health care professional groups varies greatly and is masked with aggregate performance reporting.Eighty‐three percent of missed HH opportunities occur as part of a consecutive series of missed events with no hand washing in between.Electronic monitoring systems can easily be configured to collect HH performance data in zones that contribute to risk of infection outside of the patient environment such as the soiled utility room. Background: Hand hygiene (HH) compliance in health care is usually measured against versions of the World Health Organizations “Your 5 Moments” guidelines using direct observation. Such techniques result in small samples that are influenced by the presence of an observer. This study demonstrates that continuous electronic monitoring of individuals can overcome these limitations. Methods: An electronic real‐time prompting system collected HH data on a musculoskeletal rehabilitation unit for 12 weeks between October 2016 and October 2017. Aggregate and professional group scores and the distributions of individuals’ performance within groups were analyzed. Soiled utility room exits were monitored and compared with performance at patient rooms. Duration of patient room visits and the number of consecutive missed opportunities were calculated. Results: Overall, 76,130 patient room and 1,448 soiled utility room HH opportunities were recorded from 98 health care professionals. Aggregate unit performance for patient and soiled utility rooms were both 67%, although individual compliance varied greatly. The number of hand wash events that occurred while inside patient rooms increased with longer visits, whereas HH performance at patient room exit decreased. Eighty‐three percent of missed HH opportunities occurred as part of a series of missed events, not in isolation. Conclusions: Continuous collection of HH data that includes temporal, spatial, and personnel details provides information on actual HH practices, whereas direct observation or dispenser counts show only aggregate trends.