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Physical assessment to improve the identification of modifiable physiological fall risk factors in healthy community-dwelling older adults
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Brown, Spencer (2019) Physical assessment to improve the identification of modifiable physiological fall risk factors in healthy community-dwelling older adults. PhD thesis, University of Warwick.
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Abstract
As the population aged >60 years grows, the number of people falling and subsequent injury increases. Falls have a devastating effect on older adults living in the community in terms of morbidity, mortality, and loss of independence. In general, a positive answer to falls screening questions, or opportunistic identification of fall risk through primary care pathways, establishes an older adult as being at risk of a fall and warrants further investigation using multifactorial fall risk assessments (MFRA). At the MFRA stage, standardised fall risk assessment tools are directed at identifying the presence of physiological impairments and risk of falling in older adults. Although these tools identify which intervention domain a person needs, information from these assessments does not inform the health professional of the underlying causes of poor physical function and performance. Therefore, the purpose of this project was to develop an assessment tool that may potentially identify modifiable fall risk factors in this population.
A conceptual framework for objectively measuring modifiable physical impairments and a novel assessment procedure (Performance Deficit Test for Community-dwelling older adults (PDT-Com)) were introduced (Chapter 2). This was followed by a brief description of the scoring criteria of the PDT-Com assessment and discussion of the validity of its contents (Chapters 3 and 4). Chapter 5 reviewed current literature on falls prevention guidelines and assessment procedures which identified a need to better detect modifiable risk factors. The first study was a systematic review examining the objective measurement of lower-extremity muscle strength in community-dwelling older adults (Chapter 6). The second study was another systematic review (Chapter 7) examining current assessment tools which are used to identify modifiable functional status and fall risk factors in this population. The results further supported the need for a newly designed assessment tool that can objectively measure modifiable physical impairments to better inform the contents of an exercise intervention.
The first experimental study (Chapter 7) was carried out to determine reference values of strength for ten lower-extremity muscle actions using hand-held dynamometry in a small cohort of community-dwelling older adults. These data were used to develop an objective scoring system. A second experimental study (Chapter 8) investigated intra- and inter-rater reliability of the PDT-Com in community-dwelling older adults. Assessment of movement competency is reliable and can confidently be applied by suitably trained individuals when a standardised procedure is used.
A final experimental study examined the effect and feasibility of a three-month home and group exercise intervention directed by initial assessment using the PDT-Com. For the experimental group, a corrective exercise programme was prescribed based on each person’s PDT-Com score. The mean total PDT-Com scores for the exercise group were significantly improved compared to baseline scores. Conversely, mean PDT-Com scores in the control group marginally decreased over time from baseline scores. Between groups differences in mean PDT-Com scores were observed between groups suggesting that those subjects receiving an individualised exercise programme improved their physical function compared to the control group. This new assessment tool is a promising but untested approach to reducing falls and falls-related injury through the identification, and possible causes, of modifiable fall risk factors at the MFRA stage. A physiological assessment paradigm serves to promote a primary preventative approach to the management of falls in active community-dwelling older adults.
| Item Type: | Thesis (PhD) | ||||
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| Subjects: | R Medicine > RD Surgery R Medicine > RM Therapeutics. Pharmacology |
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| Library of Congress Subject Headings (LCSH): | Physical therapy, Older people, Joints -- Wounds and injuries, Fractures, Bones -- Wounds and injuries | ||||
| Official Date: | March 2019 | ||||
| Dates: |
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| Institution: | University of Warwick | ||||
| Theses Department: | Warwick Medical School | ||||
| Thesis Type: | PhD | ||||
| Publication Status: | Unpublished | ||||
| Supervisor(s)/Advisor: | Gates, Simon ; Bruce, Julie | ||||
| Format of File: | |||||
| Extent: | xxiv, 15, 2-30, 3-14, 4-6, 5-31, 6-14, 7-25, 8-27, 9-35, 10-38, 11-58, lxxvi leaves: illustrations, charts | ||||
| Language: | eng | ||||
| Related URLs: |
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