Exercise programmes designed to prevent falls in older adults also seem to prevent injuries caused by falls, including the most severe ones. Such programmes also reduce the rate of falls leading to medical care.

Aims: To analyse the effects of age and occupational factors on both the incidence and the disappearance of chronic neck and shoulder pain after a five year follow up period. Methods: A prospective longitudinal investigation (ESTEV) was carried out in 1990 and 1995 in seven regions of France. A random sample of male and female workers born in 1938, 1943, 1948, and 1953 was selected from the occupational physicians' files. In 1990, 21 378 subjects were interviewed (88% of those contacted), and 87% were interviewed again in 1995. Chronic neck and shoulder pain satisfying specific criteria, and psychosocial working conditions were investigated by a structured self administered questionnaire and a clinical examination. Results: Prevalence (men 7.8%, women 14.8% in 1990) and incidence (men 7.3%, women 12.5% for the period 1990-95) of chronic neck and shoulder pain increased with age, and were more frequent among women than men in every birth cohort. The disappearance rate of chronic neck and shoulder pain decreased with age. Some adverse working conditions (repetitive work under time constraints, awkward work for men, repetitive work for women) contributed to the development of these disorders, independently of age. Psychosocial factors seemed to play a role in both the development and disappearance of chronic neck and shoulder pain. Data did not show specific interactions between age and working conditions. Conclusions: The aging of the workforce appears to contribute to the widespread concern about chronic neck and shoulder pain. A better understanding of work activity regulation of older workers can open up new preventive prospects. P ain in the upper limbs is a major work related health problem in many countries.1 In France, according to official statistics of compensation claims, the number of subjects with occupational diseases in the upper limbs was six times higher in 1994 (n = 3963) than in 1985 (n = 673). These disorders accounted for 50% of all reported occupational diseases.2 Among such disorders, pain in the neck and shoulders often causes disability and time lost from work.It has been shown in two recent reviews, 3 4 that there is evidence of a relation between musculoskeletal disorders in the neck and shoulder and physical and psychosocial factors at work. These factors include biomechanical factors, such as posture and static loading of muscles, vibrations, and frequency, duration, and force of repetitive movements. 5-8Administrative and organisational factors, such as job control and psychological job demand, are also important factors. 10However, most of these surveys were limited to cross sectional data, offering weak evidence for causality as a result of uncertainty over the time of exposure and bias by a health related selection of employees.1 Some studies focused on only one or a few risk factors. Many of these studies concerned jobs (construction, dentistry, forestry, nursing, office jobs) without measures of psychosocial factors.11 12 A number of studies used an outcome measure which was a m...

ObjeCtiveTo assess the effectiveness of a two year exercise programme of progressive balance retraining in reducing injurious falls among women aged 75-85 at increased risk of falls and injuries and living in the community. DesignPragmatic multicentre, two arm, parallel group, randomised controlled trial. setting 20 study sites in 16 medium to large cities throughout France.PartiCiPants 706 women aged 75-85, living in their own home, and with diminished balance and gait capacities, randomly allocated to the experimental intervention group (exercise programme, n=352) or the control group (no intervention, n=354).interventiOn Weekly supervised group sessions of progressive balance training offered in community based premises for two years, supplemented by individually prescribed home exercises. OutCOme measuresA geriatrician blinded to group assignment classified falls into one of three categories (no consequence, moderate, severe) based on physical damage and medical care. The primary outcome was the rate of injurious falls (moderate and severe). The two groups were compared for rates of injurious falls with a "shared frailty" model. Other outcomes included the rates of all falls, physical functional capacities (balance and motor function test results), fear of falling (FES-I), physical activity level, and perceived health related quality of life (SF-36). Analysis was by intention to treat. results There were 305 injurious falls in the intervention group and 397 in the control group (hazard ratio 0.81, 95% confidence interval 0.67 to 0.99). The difference in severe injuries (68 in intervention group v 87 in control group) was of the same order of magnitude (0.83, 0.60 to 1.16). At two years, women in the intervention group performed significantly better on all physical tests and had significantly better perception of their overall physical function than women in the control group. Among women who started the intervention (n=294), the median number of group sessions attended was 53 (interquartile range 16-71). Five injurious falls related to the intervention were recorded. COnClusiOnA two year progressive balance retraining programme combining weekly group and individual sessions was effective in reducing injurious falls and in improving measured and perceived physical function in women aged 75-85 at risk of falling. trial registratiOn ClinicalTrials.gov (NCT00545350). IntroductionInjuries related to falls are common in older adults and are major contributors to functional decline and use of healthcare, 1 2 including premature admission to nursing homes. 3 Exercise programmes emphasising balance training are effective in reducing falls among older adults living in the community, 4 5 but randomised controlled trials have generally lacked the power to show an effect on injurious falls.We recently reviewed the current evidence on the effect of fall prevention exercise programmes among older adults living in the community on different outcomes of injurious falls, based on physical damage and medical care. 6 P...

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Objective To assess the association between functional limitations related to mobility and urinary incontinence (UI) in elderly women.Design An observational cross-sectional study.Setting Nine 'balance' workshops in France.Population A total of 1942 community-dwelling women aged 75-85 years, who were invited, based on voter registration lists, to a 'balance assessment'.Methods Mobility and balance test results for incontinent women were compared with those for continent women according to the severity and type of incontinence.Main outcome measures Data on UI were collected using a selfadministered questionnaire (International Consultation on Incontinence Questionnaire-Short Form). Motor-related physical abilities were assessed using standardised balance and functional gait tests.Results Forty-two per cent of women had involuntary urine leakage, with daily leaks in 57% of them; 24% had stress UI, 31% had urge UI, and 37% had mixed UI. Results for each functional test were poorer for women with UI and the limitation was more pronounced when the incontinence was severe. Multivariate logistic regression analyses showed that balance and gait impairments were significantly and independently associated with urge UI (walking speed, lower versus higher quartile, odds ratio (OR) 2.2; 95% confidence interval (95% CI) 1.4-3.5; walking balance, unable versus able to do four tandem steps (OR 1.6; 95% CI 1.2-2.2) but not with stress UI. ConclusionsIn this large population of older women living at home, there was a strong association between limitation of motor and balance skills and UI, which was proportional to the severity of incontinence and related specifically to urge incontinence. These results offer new perspectives on the prevention and treatment of urge incontinence in elderly women.

Background: Sustaining integrated care is difficult, in large part because of problems encountered securing the participation of health care and social service professionals and, in particular, general practitioners (GPs).

These results confirm the links between life satisfaction and the factors generally recognized as its determinants. On the other hand, no effect of past occupational characteristics on life satisfaction long after retirement was shown.

This study's purpose was to identify occupational factors that may influence the age at natural menopause in a random sample of gainfully employed French women born in 1938 (n=1,594). Occupational physicians selected the subjects from their files and interviewed them during their annual visits in 1990 and 1995. The authors used Kaplan-Meier survival curves to estimate median age at menopause (52 years) and multiple Cox models to estimate associations among women's characteristics, occupational factors, and age at menopause separately within two strata distinguished by a self-reported history of depression. Among women without such a history, earlier menopause was associated with smoking more than 10 cigarettes per day in 1990 (p<0.001), a high-strain job (p=0.01) in 1990, and difficult schedules before 1990 (p=0.03). Later menopause was associated with higher educational status (p=0.003) and repetitive work in 1990 (p=0.005). Among women with a history of depression, a later menopause was associated with having at least one child (p<0.001) and menarche later than the age of 13 years (p=0.004). Earlier menopause was associated with a high job control in 1990 (p=0.03) and high school education (p<0.01). These results suggest that certain physical job stressors may be related to age at menopause.