Stair falls, especially during stair descent, are a major problem for older people. Stair fall risk has typically been assessed by quantifying mean differences between subject groups (e.g. older vs. younger individuals) for a number of biomechanical parameters individually indicative of risk, e.g., a reduced foot clearance with respect to the stair edge, which increases the chances of a trip. This approach neglects that individuals within a particular group may also exhibit other concurrent conservative strategies that could reduce the overall risk for a fall, e.g. a decreased variance in foot clearance. The purpose of the present study was to establish a multivariate approach that characterises the overall stepping behaviour of an individual. Twenty-five younger adults (age: 24.5±3.3 y) and 70 older adults (age: 71.1±4.1 y) descended a custom-built instrumented seven-step staircase at their self-selected pace in a step-over-step manner without using the handrails. Measured biomechanical parameters included: 1) Maximal centre of mass angular acceleration, 2) Foot clearance, 3) Proportion of foot length in contact with stair, 4) Required coefficient of friction, 5) Cadence, 6) Variance of these parameters. As a conventional analysis, a one-way ANOVA followed by Bonferroni post-hoc testing was used to identify differences between younger adults, older fallers and non-fallers. To examine differences in overall biomechanical stair descent behaviours between individuals, k-means clustering was used. The conventional grouping approach showed an effect of age and fall history on several single risk factors. The multivariate approach identified four clusters. Three clusters differed from the overall mean by showing both risky and conservative strategies on the biomechanical outcome measures, whereas the fourth cluster did not display any particularly risky or conservative strategies. In contrast to the conventional approach, the multivariate approach showed the stepping behaviours identified did not contain only older adults or previous fallers. This highlights the limited predictive power for stair fall risk of approaches based on single-parameter comparisons between predetermined groups. Establishing the predictive power of the current approach for future stair falls in older people is imperative for its implementation as a falls prevention tool.
Background
Stair falls are a major health problem for older people, but presently there are no specific screening tools for stair fall prediction. The purpose of the present study was to investigate whether stair fallers could be differentiated from non-fallers by biomechanical risk factors or physical/psychological parameters and to establish the biomechanical stepping profile posing the greatest risk for a stair fall.
Methods
Eighty-seven older adults (age: 72.1±5.2 y) negotiated an instrumented seven-step staircase and performed a range of physical/psychological tasks. K-means clustering was used to profile the overall stair negotiation behaviour with biomechanical parameters indicative of fall risk as input. Falls and events of balance perturbation (combined “hazardous events”) were then monitored during a 12-month follow-up. Cox-regression analysis was performed to examine if physical/psychological parameters or biomechanical outcome measures could predict future hazardous events. Kaplan-Meier survival curves were obtained to identify the stepping strategy posing a risk for a hazardous event.
Results
Physical/psychological parameters did not predict hazardous events and the commonly used Fall Risk Assessment Tool (FRAT) classified only 1/17 stair fallers at risk for a fall. Single biomechanical risk factors could not predict hazardous events on stairs either. On the contrary, two particular clusters identified by the stepping profiling method in stair ascent were linked with hazardous events.
Conclusion
This highlights the potential of the stepping profiling method to predict stair fall risk in older adults against the limited predictability of single parameter approaches currently used as screening tools.
The most effective way of exploring and representing the patient's experience is by using a mixed-method approach. In other words, an integrated approach with the use of surveys and more narrative methods, such as patient stories, will effectively define quality and how it should be measured, ensuring that the focus is always on what matters most to patients.
Introduction: The aim of this literature review is to identify the most common tools used to measure burden in carers of people with Parkinson's Disease (PD), Heart Failure (HF), Multiple Sclerosis (MS) and Chronic Obstructive Pulmonary Disease (COPD).Method: Databases such as Medline, PsycINFO, CINAHL and Academic SearchComplete were searched. Studies in which carer burden was measured were included.Results: Zarit Burden Inventory and Caregiver Reaction Assessment were most commonly used to measure carer burden, regardless of the chronic condition. A wide range of other instruments were also used. Conclusion: Even though a range of tools are available, further improvements are necessary in order to enable healthcare professionals to identify carers experiencing high burden.
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