The fall descriptions and health characteristics of older adults with hip fracture : a mixed methods study

Background: In light of the multifactorial etiology of fall-related hip fracture, knowledge of fall circumstances may be especially valuable when placed in the context of the health of the person who falls. We aimed to investigate the circumstances surrounding fall-related hip fractures and to describe fall circumstances in relation to participants' health and functional characteristics. Methods: The fall circumstances of 125 individuals (age >= 50 years) with hip fracture were investigated using semi-structured interviews. Data concerning participants' health (comorbidities and medications) and function (self-reported performance of mobility, balance, personal activities of daily living and physical activity, previous falls and hand grip strength) were collected via medical records, questionnaires and dynamometry. Using a mixed methods design, both data sets were analysed separately and then merged in order to provide a comprehensive description of fall events and identify eventual patterns in the data. Results: Fall circumstances were described as i) Activity at the time of the fall: Positional change (n = 24, 19%); Standing (n = 16, 13%); Walking (n = 71, 57%); Balance challenging (n = 14, 11%) and ii) Nature of the fall: Environmental (n = 32, 26%); Physiological (n = 35, 28%); Activity-related indoor (n = 8, 6%) and outdoor (n = 8, 6%); Trips and slips on snow (n = 20, 16%) and in snow-free conditions (n = 12, 10%) and Unknown (n = 10, 8%). We observed the following patterns regarding fall circumstances and participants' health: those who fell i) during positional change had the poorest functional status; ii) due to environmental reasons (indoors) had moderate physical function, but high levels of comorbidity and fall risk increasing medications; iii) in snow-free environments (outdoors) appeared to have a poorer health and functional status than other outdoor groups. Conclusions: Our findings indicate that patterns exist in relation to the falls circumstances and health characteristics of people with hip fracture which build upon that previously reported. These patterns, when verified, can provide useful information as to the ways in which fall prevention strategies can be tailored to individuals of varying levels of health and function who are at risk for falls and hip fracture.

Att bekämpa det onda eller främja det goda : Fyra verksamhetsperspektiv på individer i våldsbejakandemiljöer samt preventionsarbete runt dessa

To fight evil or promote good: Four organizational perspectives on individuals inviolent environments and prevention work around them. The purpose of this article is to examine organizational understandings and perceptions that can affect the current work with defectors from and members in violent and extremist environments. The empirical material consists primarily of answers to open questions in a survey, where professionals from four organizations are represented: social services, school, police and politics. The material is analyzed with direct qualitative content analysis and shows two contradict approaches to the problem; one that argues for ”fighting the evil” and another that argues for ”promoting the good”. The theoretical framework presented is Erving Goffmans’ frame analysis, Howard S. Beckers’ labelling process and Ingrid Sahlins’ discussion about different kinds of prevention strategies. The results show how organizational understandings and perceptions are far from uniform but rather disparate, and also that assumptions made by professionals have wide implications – often related to morally based approaches grounded on notions of good and evil.