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  • 1.
    Bonander, Carl
    et al.
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Environmental and Life Sciences.
    Gustavsson, Johanna
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Environmental and Life Sciences.
    Andersson, Ragnar
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Environmental and Life Sciences.
    Evidensbaserade åtgärder för cyklisters säkerhet: kunskapsöversikt2013Report (Other academic)
    Abstract [sv]

    Att cykla förespråkas ofta av hälso-, miljö- och framkomlighetsskäl, men är samtidigt ett av de farligare transportmedlen utifrån ett skadeperspektiv. För att cyklismen ska kunna utvecklas hållbart krävs därmed även att fokus läggs på säkerhetsaspekten vid policybeslut som syftar till att öka cyklandet. Syftet med denna rapport är att återge en samlad bild av det vetenskapliga kunskapsläget när det gäller säkerhetsfrämjande åtgärder för cyklister.

    Cykelhjälmar är ett välbeforskat ämne inom detta område och evidensen pekar relativt entydigt att hjälmar ger ett bra skydd mot huvud- och hjärnskador. Vissa studier har även uppmätt en skyddande effekt mot ansiktsskador, men detta har på senare tid delvis ifrågasatts. En ytterligare aspekt som har belysts är om dagens mjukare cykelhjälmar ger ett lika bra skydd som hjälmar med hårdare skal, som var vanligare förr. Denna hypotes har hittills varken kunnat styrkas eller förkastas, bl a till följd av att man inte registrerar hjälmtyp inom sjukvården. Cykelhjälmslagstiftning är ett annat kontroversiellt ämne där det har hävdats att hjälmlagarna som infördes i Australien och Nya Zeeland på 1990-talet avskräckte människor från att cykla, med åtföljande negativ effekt på folkhälsan till flöjd av minskad motion. Ingen stark evidens för denna hypotes har hittats, och det verkar för övrigt som att cykelhjälmslagar har haft en reducerande effekt på antalet cykelrelaterade huvudskador i de länder som har lyckats implementera dem på ett sätt som faktiskt ökar hjälmanvändningen i populationen. Effekten förefaller dock kulturellt betingad, och skillnader i bötesavgift eller risken att bli bötfälld är troligtvis av stor betydelse. Utbildning och ekonomiska styrmedel kan fungera som alternativ till lagstiftning, men evidensen för att utbildning verkligen ökar hjälmanvändningen är svag. Gällande ekonomiska styrmedel pekar evidensen mot att gratis hjälmutdelning är det som fungerar bäst. Större satsningar på samhällsnivå verkar fungera bättre än hjälmprogram som inriktar sig på skolor.

    När det gäller åtgärder för trafikmiljön är evidensen inte helt entydig, men det verkar som att fysiskt separerade cykelbanor är att föredra framför cykelfält (ett fält för cyklister på vägen, avgränsas med en spärrlinje). Fysiskt separerade cykelbanor kan dock vara mer problematiska i väjningsreglerade korsningar, vilket kan bero på att bilister inte uppmärksammar cyklister på samma sätt som när ett cykelfält finns anlagt på sidan av vägbanan. Detta ökar behovet av säkra cykelöverfarter och när det gäller sådana förefaller förhöjda cykelöverfarter fungera bättre än färgmarkerade överfarter. Olycksrisken på kombinerade gång- och cykelvägar bör inte förväxlas med olycksrisken på cykelspecifika banor, och ytterligare forskning behövs för att avgöra effekten av kombinerade banor. Rondeller verkar vara problematiska för cyklister om det inte finns en fysiskt separerad cykelbana i anslutning till dem. Övriga åtgärder som har uppvisat en positiv effekt är belysning på landsbygdsvägar, refuger i bostadsområden och dynamiska hastighetsskyltar i skolzoner.

    Intressant nog ser det ut att finnas få studier som har försökt mäta effekten av synbarhetsökande medel (t.ex. reflexer) med tillförlitliga utvärderingsmått (skaderisk eller olycksrisk). Att montera varselljus på cykeln som går igång automatiskt och inte kan kontrolleras av cyklisten verkar dock minska risken för kollisionsolyckor under dagtid.

    Även allmän cykelsäkerhetsutbildning i skolar har undersökts. Av de få studier som använt tillförlitliga utvärderingsmått har ingen kunnat uppvisa en positiv effekt. Fler studier behövs för att bedöma effekten av sådana åtgärder innan utbildning kan rekommenderas med starkt vetenskapligt stöd.

  • 2.
    Bonander, Carl
    et al.
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Centre for Public Safety.
    Gustavsson, Johanna
    Karlstad University, Faculty of Social and Life Sciences, Department of Health and Environmental Sciences.
    Andersson, Ragnar
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Centre for Public Safety.
    Säker cykling: Vägledning för systematiskt cykelsäkerhetsarbete i lokalsamhället2014Report (Other academic)
    Abstract [sv]

    Cyklismen får en allt viktigare roll i det hållbara transportsystemet. Att cykla förespråkas av hälso-, miljö- och framkomlighetsskäl, men är samtidigt ett av de farligaste färdsätten utifrån ett personskadeperspektiv. Lokala strävanden mot ökat cyklande måste ta säkerhetsaspekten i beaktande om dessa satsningar ska bli lyckade. Enligt målet för trafiksäkerhet i regeringens proposition "Mål för framtida transporter" (prop.2008/09:93) ska antalet döda halveras och allvarligt skadade i trafiken minskas 25 procent fram till år 2020. För att kunna uppnå detta behövs satsningar både nationellt som lokalt. På nationell nivå finns möjlighet att arbeta med övergripande och generaliserbara trafiksäkerhetsproblem, medan det på lokal nivå finns unika möjligheter att identifiera och åtgärda olycksdrabbade platser.

    I SKL:s trafiksäkerhetshandbok "Trafiksäkra staden

    " (Sveriges Kommuner och Landsting 2013), presenteras ett systematiskt sätt att arbeta med trafikskadedata på kommunnivå. Utgångspunkten i handboken är att analysera den lokala skadebilden och sätta igång en systematisk process med verksamhetsövergripande samarbete och kontinuerlig förbättring. Den nu föreliggande vägledningen är tänkt att fungera som ett komplement till SKL:s metodhandbok, med fokus på identifiering och analys av särskilt skadedrabbade platser i lokalsamhället.

    Denna vägledning är tänkt att utgöra ett stöd för det lokala cykelsäkerhetsarbetet mot bakgrund av i lokala förutsättningar och problem. Utgångspunkten är att ta tillvara faktaunderlag som ofta finns tillgängliga lokalt, i kombination med annan lokal kunskap. Dessa underlag kan sedan nyttiggöras vid beslut om utformning av trafikmiljöer. Genom att systematiskt studera och sammanställa uppgifter om olyckor finns möjlighet att hitta typiska olycksmönster eller farliga platser inom en avgränsad befolkning eller geografiskt område. Denna kunskap kan sedan användas vid planering av nya trafikmiljöer, som underlag för löpande trafiksäkerhetsarbete i befintliga miljöer, samt vid utvärdering av satsningar syftande till ökad säkerhet.

  • 3.
    Bonander, Carl
    et al.
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Environmental and Life Sciences (from 2013). Karlstad University, Faculty of Health, Science and Technology (starting 2013), Centre for Public Safety (from 2013).
    Gustavsson, Johanna
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Environmental and Life Sciences (from 2013). Karlstad University, Faculty of Health, Science and Technology (starting 2013), Centre for Public Safety (from 2013).
    Nilson, Finn
    Can the provision of a home help service for the elderly population reduce the incidence of fall-related injuries?2016In: Injury Prevention, ISSN 1353-8047, E-ISSN 1475-5785, Vol. 22, no Suppl.2, p. A181-A181Article in journal (Refereed)
    Abstract [en]

    Background Fall-related injuries are a global public health problem, especially in elderly populations. In this study, the effect of an intervention aimed at reducing the risk of falls in the homes of community-dwelling elderly persons was evaluated. The intervention, which involves home hazards reduction by providing a minor home help service, is provided in the majority of Swedish municipalities.

    Methods Intention-to-treat effect estimates were derived using quasi-experimental time series intervention (ITS) analysis for immediate effects and a difference-in-discontinuity (RD) design for long term effects, and community-level estimates were pooled using meta-analysis. The outcome measure was the incidence of fall-related hospitalizations in the treatment population, the age of which varied by municipality (≥65 years, ≥67 years, ≥70 years or ≥75 years).

    Results We found no statistically significant reductions in injury incidence in the ITS (IRR 1.01 [95% CI: 0.98–1.05]) or RD (IRR 1.00 [95% CI: 0.97–1.03]) analyses. The results are robust to several different model specifications, including segmented panel regression analysis with linear trend change and community fixed effects parameters.

    Conclusions It is unclear whether absence of an effect is due to a low efficacy of the home hazards modifications provided, or a result of low utilisation. Additional studies of the effects on other quality of life measures are recommended before conclusions are drawn regarding the cost-effectiveness of the provision of home help services

  • 4.
    Bonander, Carl
    et al.
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Centre for Public Safety. Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Environmental and Life Sciences.
    Gustavsson, Johanna
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Centre for Public Safety.
    Nilson, Finn
    Karlstad University, Faculty of Social and Life Sciences, Department of Health and Environmental Sciences.
    Can the provision of a minor home help service for the elderly population reduce the incidence of fall-related injuries?: A quasi-experimental study of the community-level effects on hospital admissions in Swedish municipalities2016In: Injury Prevention, ISSN 1353-8047, E-ISSN 1475-5785, Vol. 22, no 6, p. 412-419Article in journal (Refereed)
    Abstract [en]

    Background

    Fall-related injuries are a global public health problem, especially in elderly populations. The effect of an intervention aimed at reducing the risk of falls in the homes of community-dwelling elderly persons was evaluated. The intervention mainly involves the performance of complicated tasks and hazards assessment by a trained assessor, and has been adopted gradually over the last decade by 191 of 290 Swedish municipalities.   

    Methods

    A quasi-experimental design was used where intention-to-treat effect estimates were derived using panel regression analysis and a regression-discontinuity (RD) design. The outcome measure was the incidence of fall-related hospitalizations in the treatment population, the age of which varied by municipality (≥65 years, ≥67 years, ≥70 years or ≥75 years).

    Results

    We found no statistically significant reductions in injury incidence in the panel regression (IRR 1.01 [95% CI: 0.98-1.05]) or RD (IRR 1.00 [95% CI: 0.97-1.03]) analyses. The results are robust to several different model specifications, including segmented panel regression analysis with linear trend change and community fixed effects parameters.

    Conclusions

    It is unclear whether the absence of an effect is due to a low efficacy of the services provided, or a result of low adherence. Additional studies of the effects on other quality of life measures are recommended before conclusions are drawn regarding the cost-effectiveness of the provision of home help service programs.

  • 5.
    Gustasson, Johanna
    et al.
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Centre for Public Safety.
    Grubb, Kristina
    Andersson, Ragnar
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Centre for Public Safety.
    När är en fallskada en vårdskada?: en förstudie2013Report (Other academic)
  • 6.
    Gustasson, Johanna
    et al.
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Centre for Public Safety.
    Olsson, Lena
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Centre for Public Safety.
    Andersson, Ragnar
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Centre for Public Safety.
    Drunkning i Sverige 1997-2011: En sammanställning och granskning av uppgifter från dödsorsaksregistret2013Report (Other academic)
    Abstract [sv]

    En sammanställning och granskning av uppgifter från dödsorsaksregistret. Studien, som omfattar 3 860 drunkningsfall, är utförd av Centrum för personsäkerhet vid Karlstads Universitet.

  • 7.
    Gustasson, Johanna
    et al.
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Centre for Public Safety.
    Schyllander, Jan
    MSB.
    Janson, Staffan
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences.
    Barn, fallskador och anslagsytans hårdhet: statistik, forskningsläget och möjlig studiedesign2013Report (Other academic)
  • 8.
    Gustavsson, Johanna
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Environmental and Life Sciences (from 2013).
    Effekter av stötdämpande golv som fallskadepreventiv åtgärd för äldre på särskilt boende2018Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Fall-injuries pose a considerable public health problem in the globally growing elderly population. Reducing energy in order to prevent injuries has been successfully applied in many injury prevention fields, though less so within fall injury prevention. Compliant flooring has been proposed as a measure to prevent fall-injury, however little is known regarding the implementation aspects in clinical settings. The aim of this thesis is therefore to investigate the primary injury reducing effect of complaint flooring, as well as secondary effects such as the influence on fall frequency, work environment for the staff and living conditions for the elderly in residential care.

    Falls, and the injury outcome, were registered at a residential care facility in Sweden in which some areas had compliant flooring and other areas had PVC flooring. In two quantitative studies, the difference in the outcomes of falls was studied as well as the effect on the risk of falls depending upon the flooring surface in which the event occurred. In addition, in two qualitative studies, the staff and residents were interviewed on their views on fall prevention and compliant flooring. 

    The results indicate that although the evidence is not fully conclusive, compliant flooring seems to reduce the risk of fall-injuries by over 50% without increasing the risk of falls. Results from the interviews showed that staff appreciated the compliant flooring in that it defused the falls as well as leading to greatly improved acoustics. However, there were also some challenges associated with the compliant flooring, especially the maneuvering of heavy equipment. The elderly also appreciated the intervention, even though the general interest for fall prevention was minimal.

    The results from this thesis indicates that for a frail elderly population, compliant flooring has the potential to be an effective injury prevention measure, without increasing the risk of falls. Furthermore, the results show that with some adjustments, it could also work well from the perspective of residents and staff.

  • 9.
    Gustavsson, Johanna
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Environmental and Life Sciences (from 2013).
    Evaluating Compliant Flooring As A Fall Injury Reducing Measure In A Residential Care Setting2018In: Injury Prevention, ISSN 1353-8047, E-ISSN 1475-5785, Vol. 24, p. A225-A226, article id PW 2708Article in journal (Refereed)
  • 10.
    Gustavsson, Johanna
    Karlstad University, Faculty of Social and Life Sciences, Department of Health and Environmental Sciences.
    Mjuka golv – äldreboendets airbag2011Conference paper (Other academic)
    Abstract [sv]

    Mjuka golv – äldreboendets airbag

     

    Sverige är ett av de länder i världen där det är störst risk att drabbas av en höftfraktur under livet (Kanis et al. 2002) trots att det under många år gjorts stora ansträngningar att förebygga fall och fallskador. Fallskador drabbar främst personer 80 år och äldre. Att helt undvika fall är svårt för att inte säga omöjligt. Många av de åtgärder som är tänkta att minska fall begränsar dessutom livskvalitén för de äldre. Det finns stor potential i att skapa förlåtande miljöer för dessa sårbara personer.

    De preventiva åtgärder som visat sig verksamma för att förebygga fall och fallskada kan sammanfattas till fysisk träning och gott näringsintag. Den grupp av äldre som bor på boende har mycket begränsade möjligheter att träna upp sin kapacitet eller att minska viktförlust genom ökat näringsintag. En åtgärd som använts för denna grupp är höftbyxor. Tanken är att byxor med plattor på sidorna ska sprida energin som kommer mot höften vid ett fall i sidled. Byxorna har visat sig vara effektiva för sårbara grupper men problemet är att få de äldre att använda byxorna i tillräcklig omfattning (Gillespie et al. 2009). Genom att använda liknande material som i höftbyxor för att tillverka golv är förhoppningen att åstadkomma en miljö som skyddar de äldre mot skada vid fall (Laing, Robinovitch 2009, Casalena et al. 1998). Golvet kommer att testas på ett boende i Sunne kommun och tas i bruk nu under våren. Effekten på fall och skador kommer att utvärderas av Centrum för personsäkerhet under det första året.

    Att skapa miljöer på äldreboenden som är säkra för de som vistas där ser vi är ett nytt och spännande område med stor utvecklingspotential.

     

    Litteraturlista:

    Casalena, J.A., Badre-Alam, A., Ovaert, T.C., Cavanagh, P.R. & Streit, D.A. 1998, "The Penn State Safety Floor: Part II - Reduction of fall-related peak impact forces on the femur", Journal of Biomechanical Engineering, vol. 120, no. 4, pp. 527-532.

    Gillespie, L.D., Robertson, M.C., Gillespie, W.J., Lamb, S.E., Gates, S. & Cumming, R.G.R., B.H. 2009, "Interventions for preventing falls in elderly people" in .

    Kanis, J.A., Johnell, O., De Laet, C., Jonsson, B., Oden, A. & Ogelsby, A.K. 2002, "International Variations in Hip Fracture Probabilities: Implications for Risk Assessment", Journal of Bone and Mineral Research, vol. 17, no. 7, pp. 1237-1244.

    Laing, A.C. & Robinovitch, S.N. 2009, "Low stiffness floors can attenuate fall-related femoral impact forces by up to 50% without substantially impairing balance in older women", Accident Analysis & Prevention, vol. 41, no. 3, pp. 642-650.

  • 11.
    Gustavsson, Johanna
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Environmental and Life Sciences.
    Preventing fall injuries among elderly in residential care facilities with impact absorbing flooring2017In: Injury Prevention, ISSN 1353-8047, E-ISSN 1475-5785, Vol. 23, p. A40-A40Article in journal (Refereed)
  • 12.
    Gustavsson, Johanna
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Centre for Public Safety (from 2013).
    Preventing fall injuries with impact absorbing flooring in nursing homes: a study of the effects on injuries and work environment2016In: Injury Prevention, ISSN 1353-8047, E-ISSN 1475-5785, Vol. 22, p. A37-A37Article in journal (Other academic)
  • 13.
    Gustavsson, Johanna
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Centre for Public Safety (from 2013).
    Stötdämpande golv som skadepreventiv åtgärd på särskilt boende: En studie av effekten på fallskador och arbetsmiljö2015Licentiate thesis, comprehensive summary (Other academic)
    Abstract [en]

    Fall injuries pose a global and national public health problem. Whilst all elderly are at risk of fall injuries, the risk of injury is 10 times as high amongst elderly living in nursing homes compared to elderly living at home.

    An injury occurs when body tissue is subjected to external kinetic energy exceeding the tissue's tolerance. Reducing this energy in order to prevent injuries has been successfully applied in many injury prevention fields though less so within fall injury prevention. However, the idea of ​​a shock-absorbing floor as an energy reducing measure to prevent fall injuries has been suggested in scientific literature since the early 1990s and since then, different floors have been developed and tested. The aim of this licentiate thesis is to investigate the potential fall injury reducing effects of a shock-absorbing flooring in a nursing home, as well as the staff's experience of working in premises with shock-absorbing flooring.

    The results show that for women the risk of injury following a fall on the shock-absorbing flooring was 59% less compared to falls on ordinary floors, after adjustment for age, BMI, vision impairments, and cognitive impairment. BMI was the only covariate to influence the results, with a lower BMI increasing the risk of injury. With regards to the staff’s experience of the shock-absorbing flooring, the nurses felt that the floor defused the falls and in that way reduced the risk of injury. They were also positively surprised by the change in acoustics. There were also some challenges associated with the floor, for example, adapting to walking on the floor and manoeuvring equipment (eg hoists).

    The results suggest, that for an elderly and frail population, shock-absorbing flooring seems to be an effective injury prevention measure. The intervention was generally perceived as positive by the staff, even though some negative aspects were observed. These aspects need to be studied further.

  • 14.
    Gustavsson, Johanna
    Vård och omsorgsförvaltningen, Karlstads kommun.
    Utemiljö för äldre kring trygghetsboenden i Karlstad – en stad för alla!2012Report (Other (popular science, discussion, etc.))
  • 15.
    Gustavsson, Johanna
    et al.
    Karlstad University, Faculty of Social and Life Sciences, Department of Health and Environmental Sciences.
    Bonander, Carl
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Centre for Public Safety.
    Andersson, Ragnar
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Centre for Public Safety.
    Säker cykel: Faktabaserad prevention av cykelskador i samhället2014Report (Other academic)
    Abstract [sv]

    Sammanfattning

    Att cykla är hälsosamt och miljövänligt, men tyvärr också ganska farligt. Även om forskning tyder på att hälsovinsterna överstiger skaderiskerna, krävs åtgärder för att minska de cykelrelaterade skadorna i samhället.

    Genom att studera och sammanställa uppgifter om olyckor som hänt finns möjlighet att hitta utsatta grupper, typiska olycksmönster eller farliga platser inom en avgränsad befolkning eller geografiskt område. Denna statistikrapport använder sig av data som insamlats av hälso- och sjukvården och polisen i Värmland inom datasystemet STRADA (Swedish Traffic Accident Data Acquisition) kring cykelskadade i Karlstads kommun mellan 2007 och 2011. Mellan dessa år skadade sig 857 cyklister så pass allvarlig att de var tvungna att uppsöka akutmottagningen på Centralsjukhuset i Karlstad.

    Cykelskador inträffar oftare under sommarhalvåret, mellan klockan 14.00 och 21.00 samt på fredagar. Män är något mer representerade i hela skadebilden och åldrarna 10-14 och 40-65 år är överrepresenterade.

    Trots lagliga krav var det en stor andel av 10-14 åringarna som inte bar hjälm vid skadetillfället (flickor; 60 procent och pojkar; 45 procent).

    Geografiskt följer cykelolyckorna i Karlstads kommun befolkningstätheten i stora drag, men särskilda kluster kan identifieras på vissa platser och sträckor som därmed framstår som särskilt olycksdrabbade. Bland annat syns anhopningar av olyckshändelser kring ett antal broar och tunnlar och på dessa platser behöver djupare olycksanalyser genomföras. Rapporten ger också exempel på hur statistiken kan användas för att utvärdera gjorda trafiksäkerhetsförbättringar.

  • 16.
    Gustavsson, Johanna
    et al.
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Environmental and Life Sciences.
    Bonander, Carl
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Centre for Public Safety.
    Andersson, Ragnar
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Centre for Public Safety.
    Nilson, Finn
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Centre for Public Safety.
    Investigating the fall-injury reducing effect of impact absorbing flooring among female nursing home residents: initial results2015In: Injury Prevention, ISSN 1353-8047, E-ISSN 1475-5785, Vol. 21, no 5, p. 320-32-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:Fall-related injuries affect the lives of elderly to a substantial degree. This quasi-experimental study investigates the fall-injury reducing effect of impact absorbing flooring among female nursing home residents.

    METHODS:The intervention site is a nursing home in Sweden where impact absorbing flooring was installed in parts of one of six wards (six out of 10 apartments (excluding bathrooms), the communal dining-room and parts of the corridor). The impact absorbing flooring is a 12 mm thick closed cell flexible polyurethane/polyurea composite tile (500×500 mm) with an exterior surface of polyurethane/polyurea. A generalised linear model (log-binomial) was used to calculate the RR of injury from falls on impact absorbing flooring compared to falls on regular flooring, adjusted for age, body mass index, visual and cognitive impairments.

    RESULTS:During the study period (1 October 2011 to 31 March 2014), 254 falls occurred on regular flooring and 77 falls on impact absorbing flooring. The injury/fall rate was 30.3% for falls on regular flooring and 16.9% for falls on impact absorbing flooring. Adjusted for covariates, the impact absorbing flooring significantly reduced the RR of injury in the event of a fall by 59% (RR 0.41 (95% Cl 0.20 to 0.80)).

    CONCLUSIONS:This is, to our knowledge, the first study evaluating the injury-reducing effect of impact absorbing flooring in a nursing home showing statistically significant effect. The results from this study are promising, indicating the considerable potential of impact absorbing flooring as a fall-related injury intervention among frail elderly.

  • 17.
    Gustavsson, Johanna
    et al.
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Environmental and Life Sciences (from 2013). Karlstad University, Faculty of Health, Science and Technology (starting 2013), Centre for Public Safety (from 2013).
    Bonander, Carl
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Environmental and Life Sciences (from 2013). Karlstad University, Faculty of Health, Science and Technology (starting 2013), Centre for Public Safety (from 2013).
    Nilson, Finn
    Karlstad University, Faculty of Social and Life Sciences, Department of Health and Environmental Sciences. Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Environmental and Life Sciences (from 2013). Karlstad University, Faculty of Health, Science and Technology (starting 2013), Centre for Public Safety (from 2013).
    A quasi-experimental evaluation of compliant flooring in a residential care setting2018In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 13, no 7, article id e0201290Article in journal (Other academic)
    Abstract [en]

    Background

    Fall injuries affect the lives of older people to a substantial degree. This quasi-experimental observational study investigates the potential fall injury reducing effect of a compliant flooring in a residential care setting.

    Methods

    The allocation of the compliant flooring was non-random. Data on fall-events and individual characteristics were collected in a residential care unit during a period of 68 months. The primary outcome was the fall injury rate per fall, and a logistic regression analysis was used to test for the effect of complaint flooring. Falls per 1000 bed days was the secondary outcome, used to measure the difference in fall risk on compliant flooring versus regular flooring.

    Results

    The event dataset is an unbalanced panel with repeated observations on 114 individuals, with 70% women. The mean age was 84.9 years of age, the average Body Mass Index (BMI) was 24.7, and there was a mean of 6.57 (SD: 15.28) falls per individual. The unadjusted effect estimate showed a non-significant relative risk injury reduction of 29% per fall (RR 0.71 [95% CI: 0.46–1.09]) compared to regular flooring. Re-estimating, excluding identified outliers, showed an injury risk reduction of 63% (RR 0.37 [95% CI: 0.25–0.54]). Falls per 1000 bed days showed that individuals living in apartments with compliant flooring had a fall rate of 5.3 per 1000 bed days compared to a fall rate of 8.4 per 1000 bed days among individuals living in regular apartments. This corresponds to an incidence rate ratio (IRR) of 0.63 (95% exact Poisson CI: 0.50–0.80).

    Conclusion

    The results of this non-randomized study indicate that compliant flooring has the potential to reduce the risk of fall injury without increasing the fall risk among older people in a Swedish residential care setting.

  • 18.
    Gustavsson, Johanna
    et al.
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Environmental and Life Sciences (from 2013). Karlstad University, Faculty of Health, Science and Technology (starting 2013), Centre for Public Safety (from 2013).
    Jernbro, Carolina
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences (from 2013). Karlstad University, Faculty of Health, Science and Technology (starting 2013), Centre for Public Safety (from 2013).
    Nilson, Finn
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Environmental and Life Sciences (from 2013). Karlstad University, Faculty of Health, Science and Technology (starting 2013), Centre for Public Safety (from 2013).
    There is more to Life than Risk Avoidance: Elderly Peoples Perspectives of Falls and Compliant Flooring2018In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 13, no 1, p. 1-9, article id 1479586Article in journal (Refereed)
    Abstract [en]

    Background. Falls are the most common cause of injury in all ages and are especiallydifficult to prevent among residential care residents. Compliant flooring has beenproposed as a measure to prevent fall-injury, however little is known regarding theimplementation aspects in clinical settings. The aim of this study was to explore thefrail elderly person's view on falls, the risk of fall-injury, prevention in general andspecifically compliant flooring as an injury preventative measure. Methods. In this qualitative study, we used the grounded theory method and conductedin depths interviews with eight elderly people in residential care.Results. The identified categories were Falling as a part of life, Fearing theconsequences and A wish to prevent falls and injuries. Through the results is was clearthat There is more to life than risk avoidance, permeated the interviews, thereforeforming the grounded theory. The interviewees viewed falls as something common andnormal, and were uninterested in focusing on the risk of falls. Although they wanted toprevent falls, it was often difficult to integrate preventative measures into their everydaylife. They embraced the idea of an injury reducing compliant flooring, but their maininterests lie elsewhere.Conclusions. The results in this paper propose explanations on the obstacles ofimplementing fall prevention measures in an elderly frail population. The findings cangive us insights as to why interest, compliance for active fall prevention measures arelow, and on various factors that have to be taken under consideration in the process ofconstructing prevention. Compliant flooring is a passive fall injury prevention measurethat does not require the target group to make active decisions, adapt or activelyparticipate in the program. Therefore, we conclude that complaint flooring, from theperspective of the residents, can work well in residential care.

  • 19.
    Gustavsson, Johanna
    et al.
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Centre for Public Safety (from 2013).
    Nilson, Finn
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Environmental and Life Sciences (from 2013).
    Fallskador bland äldre: steg för steg2015In: Personsäkerhet - teori och praktik / [ed] Ragnar Andersson, Per Nilsen, Karlstad: Myndigheten för Samhällsskydd och Beredskap (MSB) , 2015, p. 179-199Chapter in book (Other academic)
  • 20.
    Gustavsson, Johanna
    et al.
    Karlstad University, Faculty of Social and Life Sciences, Department of Health and Environmental Sciences.
    Nilson, Finn
    Karlstad University, Faculty of Social and Life Sciences, Department of Health and Environmental Sciences.
    Trends on fall induced injury morbidity and mortality among the elderly in Sweden2011Conference paper (Other academic)
  • 21.
    Gustavsson, Johanna
    et al.
    Karlstad University, Faculty of Social and Life Sciences, Department of Health and Environmental Sciences.
    Nilson, Finn
    Karlstad University, Faculty of Social and Life Sciences, Department of Health and Environmental Sciences.
    Andersson, Ragnar
    Karlstad University, Faculty of Social and Life Sciences, Department of Health and Environmental Sciences.
    Fall och fallskador hos äldre – en introduktion2011Report (Other academic)
  • 22.
    Gustavsson, Johanna
    et al.
    Karlstad University, Faculty of Social and Life Sciences, Department of Health and Environmental Sciences.
    Nilson, Finn
    Karlstad University, Faculty of Social and Life Sciences, Department of Health and Environmental Sciences.
    Andersson, Ragnar
    Karlstad University, Faculty of Social and Life Sciences, Department of Health and Environmental Sciences.
    Preventing fall injuries among elderly by shock absorbing flooring2012Conference paper (Refereed)
    Abstract [en]

    Background. Within nursing homes, the fall-related fracture incidence rate is between 5 and 10 %. For those living in nursing homes there are limited options for active fall injury prevention, due to physical impairments and diseases. Instead, passive fall injury prevention is a more realistic alternative. Shock absorbing flooring has been suggested as a potential passive safety measure for this group of individuals.

    Aims/Objectives/Purpose. To evaluate the fall injury reducing effect of shock absorbing flooring in a nursing home setting in Sunne, Sweden.

    Methods. The study is case controlled, with the shock absorbing flooring installed on one ward with a maximum of 12 residents and the other 5 wards are controls. The total number of residents including control wards is approximately 60. Baseline measurements are made with estimates of the risk of falling as well as the risk of fall-related injury.

    Results/Outcome. After one year, there has been 22 falls on the shock absorbing flooring, with no resulting injury compared to 130 falls and 4 fractures on the control wards. An unexpected finding is that the acoustic environment has improved considerably, creating a calmer environment for the elderly.

    Significance/Contribution to the field. To our knowledge, this is the first time a shock absorbing flooring has been tested and evaluated as a means of injury preventionin a nursing home. Although this is a pilot study, it contributes towards improved passive safety  for this frail group of elderly.

  • 23.
    Gustavsson, Johanna
    et al.
    Karlstad University, Faculty of Social and Life Sciences, Department of Health and Environmental Sciences.
    Nilson, Finn
    Karlstad University, Faculty of Social and Life Sciences, Department of Health and Environmental Sciences.
    Andersson, Ragnar
    Karlstad University, Faculty of Social and Life Sciences, Department of Health and Environmental Sciences.
    Stötabsorberande golv som fallskadepreventiv åtgärd – resultat efter ett år2012Report (Other academic)
    Abstract [sv]

    I april 2011 lades ett stötabsorberande golv, framtaget för att förhindra skador vid fall, in på ett särskilt boende i Sunne kommun. Sedan 1 oktober 2011 har data om fallhändelser samlats in för att följa upp effekter av golvet. Det som undersöks är konsekvenser av fall på olika golvunderlag samt om risken att ramla påverkas.

    Under den tid som studien pågått (12 mån) har 21 fall registrerats på det stötabsorberande golvet, ingen har skadats sig allvarligt och en har skadats lindrigt som en följd av dessa fall. På övriga golvytor med fler boende har 156 fall registrerats, varav fem lett till fraktur och 30 till lindrig skada. Resultaten hittills tyder på att golvet kan ha den eftersträvade effekten.

    Det stötabsorberande golvet bidrar också till en dämpad ljudnivå vilket personalen upplever som positivt.

  • 24.
    Gustavsson, Johanna
    et al.
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Environmental and Life Sciences (from 2013).
    Rahm, GullBritt
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences (from 2013).
    Jernbro, Carolina
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Health Sciences (from 2013).
    Nilson, Finn
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Environmental and Life Sciences (from 2013).
    Effects of Impact-Absorbing Flooring in Residential Care from the Perspectives of Enrolled Nurses2017In: Journal of Housing for the Elderly, ISSN 0276-3893, E-ISSN 1540-353X, Vol. 31, no 4, p. 367-381Article in journal (Refereed)
    Abstract [en]

    Falls are a daily occurrence in nursing homes and few interventions for reducing fall-related injuries have proven to be effective. Impact absorbing flooring (IAF) in residential care has shown promising results in reducing fail-injuries and in the process of developing and implementing IAF all aspects are valuable to explore. Therefore, the aim of this qualitative study is to describe the enrolled nurses (ENs) experiences of IAF. We carried out focus group interviews with ENs and used content analysis to process the data. The ENs experienced both negative and positive aspects with the IAF. Importantly, the ENs perceived the IAF as effective in preventing fall-injuries. They also appreciated the improvements in acoustics. Negative aspects were that the flooring initially was challenging to walk on and that it made it harder to maneuver heavy equipment. A significant and transferable finding in this study was the importance of the ENs' perceived difficulty in preventing fall-injuries amongst elderly people living in nursing homes. This seemed to be a driving force to accept the intervention. Although IAF affects the working conditions in a nursing home, ENs are willing to accept these issues given the perceived effectiveness of the intervention.

  • 25.
    Nilson, Finn
    et al.
    Karlstad University, Faculty of Social and Life Sciences, Department of Health and Environmental Sciences.
    Moniruzzaman, Syed
    Karlstad University, Faculty of Social and Life Sciences, Department of Health and Environmental Sciences.
    Gustavsson, Johanna
    Karlstad University, Faculty of Social and Life Sciences, Department of Health and Environmental Sciences.
    Andersson, Ragnar
    Karlstad University, Faculty of Social and Life Sciences, Department of Health and Environmental Sciences.
    Höftfrakturer i Norge – en internationell, nationell och “Trygge Eldre” jämförelse2012Report (Other academic)
  • 26.
    Nilson, Finn
    et al.
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Environmental and Life Sciences.
    Moniruzzaman, Syed
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Environmental and Life Sciences.
    Gustavsson, Johanna
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Environmental and Life Sciences.
    Andersson, Ragnar
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Department of Environmental and Life Sciences.
    Trends in hip fracture incidence rates among elderly in Sweden 1987-20092013In: Journal of Public Health, ISSN 1741-3842, E-ISSN 1741-3850, Vol. 35, no 1, p. 125-131Article in journal (Refereed)
    Abstract [en]

    Background Previous trend studies have shown large increases in hip fracture incidence rates among the elderly. International research, however, suggests a levelling off, or decline, of hip fracture incidence rates, although for Sweden this remains to be studied.

    Methods Data were obtained regarding hip fractures among individuals 65 years and above from 1987 to 2009. Analysis was performed in three steps. First, age- and sex-specific trends in hip fracture rates per 100 000 and the mean age when sustaining a hip fracture were analysed. Secondly, the annual percentage change was used to compare time periods that helped to quantify changes in secular trends. Finally, linear and Poisson regression models were used to examine the trend data and observed rates.

    Results The absolute number of hip fractures among the elderly in Sweden has largely remained constant between 1987 and 2009, while incidence rates have decreased for all age- and sex-specific groups, with the largest changes in the younger age groups and among women. The mean age of sustaining a hip fracture has increased for both men and women.

    Conclusions This study supports other international studies in showing a decrease in hip fracture incidence rates among the elderly, especially since the mid-1990s.

  • 27.
    Olsson, Lena
    et al.
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Centre for Public Safety.
    Gustasson, Johanna
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Centre for Public Safety.
    Andersson, Ragnar
    Karlstad University, Faculty of Health, Science and Technology (starting 2013), Centre for Public Safety.
    Systematiskt skadeförebyggande arbete inom grundskolan -: Kartläggning av arbetssätt, utvecklingsbehov och behov av stöd2013Report (Other academic)
1 - 27 of 27
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