Forskningsartikler

Abstract

Bernt Bratsberg, Jennifer R Harris, Vegard Skirbekk, Yaakov Stern, Asta Kristine Håberg, Geir Selbæk, Bjørn Heine Strand, Trine Holt Edwin

Abstract:
Background/Objectives:
Old age and cognitive impairment/dementia are risk factors for falling and fall-related injuries. We have, in a previous study in persons with cognitive impairment, shown that falls were associated with frailty, reduced physical fitness, and cognitive reduction. Falls were independent of the disorders causing the impaired functions. Because most falls are innocent, knowledge of predictors of fall-related injuries seems more clinically relevant than the predictors of falls. Predictors of falls and fall-related injuries are not necessarily identical. The aim of this follow-up study to our previous one in the same population was to explore predictors of fall-related injuries in fallers and compare these predictors with those of falls.
Methods:
This study and our previous study used data from the “The Norwegian Registry of Persons Assessed for Cognitive Symptoms” (NorCog), a Norwegian research and quality registry with a biobank. The registry included consecutive home-dwelling persons referred to Norwegian specialist healthcare units for assessment of cognitive decline. This study included 3774 persons from our previous study who experienced falls last year and compared persons with and without a fall-related injury. A fall-related injury was defined as admittance to a hospital for the injury.
Results:
The annual incidence of fall-related injuries in the fallers was 884/3774 (23.4%). Female sex, older age, lower BMI, in need of public health service and walking assistance, and low Hb and Ca were independent predictors of fall-related injuries, indicating reduced physical fitness and state of health and a high burden of comorbidity. Injuries were not associated with the degree of cognitive impairment or the dementia diagnosis.

Conclusions:
In home dwelling persons with impaired cognitive functions and falls, fall-related injuries were associated with reduced physical fitness and state of health. In contrast to predictors of falls, neither the degree of cognitive impairment nor the dementia diagnosis was associated with fall-related injuries. The difference is comprehensible. Persons with cognitive impairment or dementia might have reduced power of judgment and be inattentive, unconcerned and careless, which increases the fall incidence but not the risk of injury once falling. Prevention of fall-related injuries should focus on relieving comorbidities, improving physical fitness and general health rather than on cognitive improvement.

Per G. Farup, Knut Hestad and Knut Engedal

Abstract:

Introduction: Understanding factors that influence care service use is crucial for developing preventive strategies to maintain independence among older adults. In this study, we aimed to identify distinct trajectory groups of municipal care service use among community-dwelling older adults to determine whether daily physical activity is associated with future care service use.

Methods: This prospective cohort study included 981 community-dwelling older adults from the HUNT4 Trondheim 70+ study. At baseline, physical activity was assessed over seven consecutive days using two accelerometers attached to the thigh and lower back. An activity type machine learning model was used to classify the physical activity types: walking, standing, cycling, running, sitting, and lying. Municipal care service use was retrieved monthly from medical records for 3 years. Using group-based trajectory modeling, we identified distinct trajectories of care service use. Multinomial regression models adjusted for age, sex, education level, dementia, and physical performance were used to evaluate the associations between daily physical activity at baseline and care service group belonging.

Results: We identified four distinct trajectory groups of municipal care service use, labeled steady low (72.7%), low increasing (9.0%), medium increasing (12.0%), and high increasing (6.3%). Daily time spent in total physical activity was not associated with trajectory group belonging when adjusted for age, sex, education level, dementia, and physical performance. However, more time spent walking, in bouts lasting longer than a minute, was associated with a reduced relative risk of belonging to the high increasing compared to the steady low group. Furthermore, age, physical performance, and dementia were all significantly associated with trajectory group belonging, and sex differences were observed. Compared to women, men had a reduced relative risk of belonging to the low increasing, medium increasing, or high increasing trajectory groups.

Conclusion: This study identified four distinct trajectories of municipal care service use among older adults over 3 years. Total daily physical activity was not associated with trajectories of care service use, but more time spent walking in longer bouts was independently associated with lower care service use, even when adjusted for the strong predictors of physical performance, dementia diagnosis, and age.

Astrid Ustad, Trine Holt Edwin, Kjerstin Næss Melsæter, Karen Sverdrup, Gro Gujord Tangen, Øystein Døhl, Pernille Thingstad, Beatrix Vereijken and Nina Skjæret-Maroni

Samandrag
Hensikt: Å undersøkje fysioterapeutar sine erfaringar med å rekruttere, lære opp og rettleie frivillige instruktørar som skal ha ansvar for å leie Sterk og stødig-treningsgrupper som ein del av kommunen sitt fallførebyggande tilbod til heimebuande eldre.

Metode: Fire individuelle djupneintervju med fysioterapeutar tilsett i ulike kommunar vart analysert med systematisk tekstkondensering.

Funn: Fem tema vart funne: (1) Ei naturleg rolle som skapar variasjon i arbeidskvardagen, (2) Rekruttering – ei ny rolle, (3) Frivillige som brubyggjarar for kunnskapsformidling, (4) Kontinuerleg rettleiing for å sikre riktig dosering og (5) Sterk og stødig for målgruppa?

Studien syner at opplærings- og rettleiingsrolla i Sterk og stødig vart opplevd som naturleg, og prega av tryggheit, kompetanse og ei positiv haldning til å arbeide førebyggande med målgruppa. Frivillige instruktørar fungerte som kunnskapsformidlarar om trening og fallførebygging til gruppedeltakarane. Å rekruttere eigna frivillige instruktørar var essensielt for både treningseffekt og drift av tilbodet, men var også ressurskrevjande for fysioterapeutane. Synet på å inkludere deltakarar utanfor målgruppa varierte.

Konklusjon: Fysioterapeutane opplever at arbeidsoppgåver knytt til Sterk og stødig integrerast naturleg inn i eiga rolle. Trass krevjande rekrutteringsarbeid, vert samarbeidet med frivillige gruppeinstruktørar ein viktig ressurs i det fallførebyggande arbeidet. Å finne gode løysingar knytte til rekrutteringsarbeid er sentralt.

Ane Brekke, Bård Erik Bogen, Ingebjørg Kyrdalen & Lill Anette Juvik