Gymnastik- och idrottshögskolan, GIH

For older people balance control in standing is critical for performance of activities of daily living without falling. The aims were to investigate reliability of quantification of the usage of the two balance mechanisms M₁ ‘moving the centre of pressure’ and M₂ ‘segment acceleration’ and also to compare calculation methods based on a combination of kinetic (K) and kinematic (Km) data, (K–Km), or Km data only concerning M₂. For this purpose nine physically fit persons aged 70–78 years were tested in narrow and single-leg standing. Data were collected by a 7-camera motion capture system and two force plates. Repeated measure ANOVA and Tukey's post hoc tests were used to detect differences between the standing tasks. Reliability was estimated by ICCs, standard error of measurement including its 95% CI, and minimal detectable change, whereas Pearson's correlation coefficient was used to investigate agreement between the two calculation methods. The results indicated that for the tasks investigated, M₁ and M₂ can be measured with acceptable inter- and intrasession reliability, and that both Km and K–Km based calculations may be useful for M₂, although Km data may give slightly lower values. The proportional M₁:M₂ usage was approximately 9:1, in both anterio-posterior (AP) and medio-lateral (ML) directions for narrow standing, and about 2:1 in the AP and of 1:2 in the ML direction in single-leg standing, respectively. In conclusion, the tested measurements and calculations appear to constitute a reliable way of quantifying one important aspect of balance capacity in fit older people.

'I start my day by thinking about what we're going to have for dinner'- a qualitative study on approaches to food-related activities among elderly men with somatic diseases The aim of this study was to address the question of how older men with somatic diseases living in their own home approach the question of food-related activities (FRA). Further, any adaptations of these activities necessitated by effects of diseases and of altered life circumstances were explored. Interviews were conducted with a purposeful sample of 18 co-living and single-living men, 64-84 years old. They were diagnosed with Parkinson's disease, rheumatoid arthritis or stroke. In the analysis, a thematic framework was used. The findings revealed three food-related approaches, namely 'Cooking as a pleasure', describing joy in cooking; 'Cooking as a need', indicating no habits or skills in cooking; and 'Food is served', that is, being served meals by a partner. It was found that gender-related roles in particular, but also changed life circumstances, activity limitations, personal interests, and a wish to maintain continuity and independence, affected the men's approaches to these activities. This knowledge may be useful in attempts to facilitate and support FRA among elderly men with diseases. Health care efforts to promote FRA should preferably be individualised in respect to older men's approaches to these activities.

Most falls in older people are due to loss of balance during everyday locomotion, e.g., when initiating walking from sitting; sit-to-walk (STW). It has been considered that the broader stride width in walking that is seen in many people with fear of falling (FoF) does not increase stability, but could be predictive of future falls because of increased medio-lateral (ML) velocity of the body centre of mass (CoM). This study was aimed to examine step-, velocity- and stability-related parameters, focusing on ML stability, in STW performance of people with and without FoF. Ten subjects with FoF and 10 matched controls, aged > or = 70 years, were included. Kinematic and kinetic data were collected in a laboratory. Stability parameters were calculated from a formula implying that the vertical projection of the CoM extrapolated by adding its velocity times a factor radicall/g (height of inverted pendulum divided by gravity) should fall within the base of support (BoS). A related spatial margin of stability (SMoS), defined as the minimum distance from the extrapolated CoM (XCoM) to the boundaries of the BoS, was also calculated. In the phase 'seat-off-second-toe-off', the FoF group had significantly (p<0.05) shorter and broader steps, lower forward but similar ML CoM velocity, and broader CoM and XCoM widths. The FoF group therefore exhibited a disproportionately large sideways velocity compared to the controls. This indicates that STW may be a hazardous transfer for older people with FoF, which should be relevant in assessment and training aimed at preventing falls.

The aim of this qualitative study was to explore and describe the perceptions of physical activity held by older urban Swedish and Irish adults. Qualitative interviews were carried out with 30 people age 65 years and older (mean age 74.5), of whom 15 were living in Dublin and 15 were living in Stockholm. The "thematic framework" approach was used to analyze the data. Three central themes were identified regarding people's perceptions of physical activity: physical activity as self-expression, physical activity as interaction, and physical activity as health promotion. Participants' perceptions of physical activity tended to relate to their perceived level of physical activity, regardless of their cultural background. Certain culture-specific motivators and barriers to exercise were also identified. Less active Irish men were more likely to underestimate the health-promoting benefits of exercise.

To improve the understanding of experiences of people with mild Alzheimer's disease (AD) and their significant others, related to the physical activity of the afflicted persons and its perceived importance. A qualitative case study design was used. The study comprised two men with mild AD and their wives. Data were collected by qualitative interviews and participant observations. Data analysis followed a thematic guideline as described by Braun and Clarke ( 2006 ). Three central themes of experiences related to physical activity in AD were identified: 1) physical activity as health reinforcement; 2) barriers to physical activity; and 3) adaptation strategies. Important motivations for outdoor walks were enjoyable experiences of nature, body movement, and positive attitudes toward physical activity. Several factors were experienced as barriers to physical activity (e.g., tiredness, difficulties in finding one's way, and "peculiar behavior"). Significant others made considerable adjustments in everyday life to enable their partners to retain a physically active lifestyle. The findings indicate that in persons with AD, physical activities such as outdoor walking can play an important part in everyday life by creating meaningful routines and improving experienced well-being and health.

A well-developed patient safety culture focusing on prevention of falls will, when successfully achieved, be seen by staff, patients and their significant others as being characteristic of the organization, and will be evident in attitudes, routines and actions. Moreover, it provides potential for positive side-effects concerning organizational and clinical improvements in additional areas.

OBJECTIVES: To explore events and describe phases for temporal coordination of the sit-to-walk (STW) task, within a semistandardized set up, in subjects with stroke and matched controls. In addition, to assess variability of STW phase duration and to compare the relative duration of STW phases between the 2 groups. DESIGN: Cross-sectional. SETTING: Research laboratory. PARTICIPANTS: A convenience sample of persons with hemiparesis (n=10; age 50-67y) more than 6 months after stroke and 10 controls matched for sex, age, height, and body mass index. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Relative duration of STW phases, SE of measurement in percentage of the mean, and intraclass correlation coefficients (ICCs). RESULTS: Four STW phases were defined: rise preparation, transition, primary gait initiation, and secondary gait initiation. The subjects with stroke needed 54% more time to complete the STW task than the controls did. ICCs ranged from .38 to .66 and .22 to .57 in the stroke and control groups, respectively. SEs of measurement in percentage of the mean values were high, particularly in the transition phase: 54.1% (stroke) and 50.4% (controls). The generalized linear model demonstrated that the relative duration of the transition phase was significantly longer in the stroke group. CONCLUSIONS: The present results extend existing knowledge by presenting 4 new phases of temporal coordination of STW, within a semistandardized set-up, in persons with stroke and in controls. The high degree of variability regarding relative STW phase duration was probably a result of both the semistandardized set up and biological variability. The significant difference in the transition phase across the 2 groups requires further study.

The debate concerning older people's life spaces should be based on subjective priorities of the elderly themselves. The purpose of this study was therefore to improve the understanding of preferences of elderly care recipients regarding activity-related life space (ARLS) and life satisfaction. A mainly qualitative design was used. Fifteen persons aged 80-94 years, undergoing geriatric rehabilitation, were interviewed during hospital stay and on two follow-up occasions after discharge. Transcribed interviews were analyzed in line with the thematic framework approach. The results point to three approaches related to preferences of ARLS: hierarchical limitations, changing continuity, and boundary breaking. Adaptive approaches were employed when physical incapacity was considered a hindrance to activity, adaptations which as a rule resulted in limitations of ARLS preferences. Activity related to the area 'close to one's own body' emerged as one of three identified key activities with importance for life satisfaction, the others being socializing and going out of doors. Continuity of activity in a familiar life space was expressed as a common ideal. If the aim of geriatric rehabilitation is to improve care recipients' life satisfaction, attention needs to be paid to the subjective dimensions of the ARLS in the goal setting.

OBJECTIVES: To analyse, describe and compare the frequency and energy intake of eating events, including specific food items, among diseased older men living in ordinary housing. DESIGN: Descriptive and explorative. SETTING: Interviews were performed in the participants' home. PARTICIPANTS: Thirty-five co-living and 26 single-living men, 64-88 years of age. Participants had one of three chronic diseases associated with difficulties in buying and preparing food and with difficulties related to the meal situation: Parkinson's disease, rheumatoid arthritis or stroke. MEASUREMENTS: A repeated 24-h recall was used to assess food intake and meal patterns. RESULTS: Eating events were distributed over a 24-h period. Co-living men had a higher (p=0.001) number of eating events/day; both hot and cold eating events were consumed more frequently. There was no difference between groups concerning energy intake. Co-living men more often had hot eating events cooked from raw ingredients (p=0.001) and a greater mix of vegetables/roots (p=0.003) included in such eating events. CONCLUSION: Single-living men may constitute a vulnerable group from a nutritional perspective, while co-living men, besides the pleasure of eating with another person, seem to get support with food and eating events from their partners. Hence, the group of single-living men, particularly those with a disability, should receive particular attention with regard to possible food-related difficulties.

Sveriges Kommuner och Landsting har tillsammans med landsting och regioner inlett en nationell satsning för att minska vårdskadorna i Sverige. Strategierna är att öka riskmedvetenheten hos alla som kan påverka patientsäkerheten, att förbättra säkerhetskulturen samt att utforma rutiner,  processer och strukturer så att det är lätt att göra rätt och svårt att göra fel. Sist men inte minst ska undersökningar, behandlingar och omvårdnad utgå från vetenskap och beprövad erfarenhet.