Annotated Bibliography      Compiled by: GROW Coalition

• Negative Effects Of Wheelchairs

• Preventive Measures

• General Aging Factors that Place Elderly At Risk
   of Being Placed Into a Wheelchair

• Other Related Articles


  Negative Effects Of Wheelchairs:

1. Bootsma-van der Wiel, Annetje, MD., Jacobijn Gussekloo, MD, PhD., Anton de craen, J.M. PhD., Eric van Exel, MD., Bastiaan R. Bloem, MD, PhD., and Rudi G.J. Westerndorp, MD, PhD. (2002). “Common Chronic Diseases and General Impairments as Determinants of Walking Disability in the Oldest-Old Population”. Journal of the American Geriatric Society. 50:1405-1410.
“Objectives: Walking disability affects older people’s autonomy and well being. We investigated the relative effect of common chronic diseases and general impairments on walking disability in the general oldest-old population.” We expressed the effect of common chronic diseases and general impairments as the population attributable risk (PAR), indicating how much disability can be prevented when the identified risk factor is eliminated from the population. This disability was highly associated with poor mobility in daily life, recurrent falls, and poor well-being. General impairments had higher prevalence rates and higher PAR than common chronic diseases. Cognitive impairment, depressive symptoms, and dizziness upon rising contributed most to walking disability. Conclusion: within the general oldest-old population, general impairments contribute more substantially to walking disability than do common chronic diseases. Clinicians should focus not merely on common chronic diseases but particularly on general impairments as targets for diagnostic analysis and treatment to increase walking ability”.

2. Brechtelsbauer, D.A. MD, CMD, and Angie Louis. (l999). “Wheelchair
Use Among Long-Term Care Residents”. MS. Annals of Long Term Care.
ISSN:1524-7929- June;7:Issue 06.
“Objective: wheelchair use is know to be highly prevalent in long-term care facilities. This study focused on temporal variation and perceived reasons for wheelchair use. Wheelchairs are most often thought of as assistive devices to increase mobility. They can, also, however, promote excess dependency, cause deconditioning, and be related to falls and injuries. In long term care setting, where the prevalence of use is usually well over 50%, the negative effects of wheelchairs can be particularly problematic and are easily overlooked or not recognized. There are many reasons to use wheelchairs. The traditional reason is to increase independent mobility. Additional reasons impact use in long-term care setting, including particularly transport efficiency. Wheelchairs can allow staff members to transport frail residents to meals and activities quickly and safely…..Despite the numerous advantages of using a wheelchair, there are also many documented problems. These problems include wheelchair-related falls and trips (especially during transfer attempts out of the wheelchair); collisions with objects or other persons; and de facto use as a (generally unrecognized) restraint. Users may experience discomfort and difficulty propelling the wheelchair because of improper fit, as well as experiencing underlying muscular weakness and painful arthritic conditions. There are no well publicized prescribing guidelines. Most commonly residents obtain wheelchairs already present in and owned by the facility. Given the typical assumption that wheelchairs are used to increase self-mobility, it is striking how infrequently this type of use occurs among residents of the study facility (45% to 4%). A l995 study by Simmons et. al.,showed the frequency of use to self-propulsion was also found to be low (4%)

3. Dian, Larry MD. (2001). Director, Division of Geriatric Medicine. St. Vincent Hospital Providence Health Care. University of British Columbia. May, “Effects of Immobility” A Slide Presentation.
He presented the problems of immobility due to extended bed rest. He stated that the negatives effects of bed rest would also effect elderly people placed in wheelchairs over time. “Small improvements in mobility can result in very significant improvement in lifestyle and caregiver aid, e.g. improvement from a two person transfer to a one person transfer may be very significant.” He quoted Asher from 1947 which stated: “Teach us to live that we may dread unnecessary time in bed. Get people up and we may save our patients from an early grave.”

4. Dworak, Patricia MSOT, OTR/L, ATP., Robin Folland, PTA, ATP., and Amy Kirkner, MPT, APT. (2004). “Age Over Matter”. Rehab Management.
“Geriatric seating, positioning, and functional mobility is an area of assistive technology that provides great rewards as well as unique challenges for the clinician. Clinicians need to address a multitude of factors associated with aging with a disability. Through completion of a thorough evaluation, performed by a skilled technician, a significant impact can be made of the lives of our geriatric population, enhancing the quality of their lives. The elderly population must maintain mobility and function to prevent any
additional medical complications, which would be more difficult for them to overcome. Being mobile thus promotes independence and an optimal quality of life.”

5. Garber, Susan L. MA, OTR, FAOTA., Reynold Bunzel, MOTS, and Tilok N. Monga, MD. (2002). Department of Veterans Affairs (VA) Rehabilitation and Development Center of Excellence on health Aging with Disabilities, Physical Medicine and Rehabilitation Service, VA Medical Center, Baylor College of Medicine, Houston, TX. “Wheelchair Utilization and Satisfaction Following Cerebral Vascular Accident”. Journal of Rehabilitation Research and Development. July/August;39:(4):521-534.
“Often, the wheelchair that is provided for the elderly is the wrong size, is in poor repair, is unsafe, has fixed armrests and foot rests, and has not pressure-reducing or positioning components These factors may result in poor posture, pain, and discomfort, decreased sitting tolerance and function, decreased mobility, and pressure ulcers. Psychological factors associated with inadequate or inappropriate mobility devices may include loss of self-esteem, depression, diminished quality of life, and social isolation.”

6. Gavin-Dreschnack, Deborah. (2004). “Effects of Wheelchair Posture on Patient Safety”. Rehabilitation Nursing Nov.-Dec;29-221-226.
“Wheelchairs originally were designed to transport people from one place to another quickly and easily. They have evolved to rank among the most important therapeutic devices used in rehabilitation….However, the increased use of wheelchairs has been accompanied by many types of adverse events and repetitive stress injuries.”

7. Gavin-Dreschnack, Deborah, PhD. et al. (2005). “Wheelchair- Related Falls: Current Evidence and Directions for Improved Quality Care”
Journal of Nursing Care Quality. April/June;20(2):119-127.
“While much of the research on falls has focused on the ambulatory elderly, little is known about wheelchair-related falls that occur in persons with disabilities.” This article provides an overview of the current data on wheelchair related falls and makes recommendations for avenues for improved quality of care and future research to promote patient safety”.

8. Madhavan, Guruprassad MS., Julian Stewart, MD, PhD., et. al. (2005).
“Effect of Plantar Micromechanical Stimulation on Cardiovascular
Responses to Immobility”. American Journal of Physical Medicine and
Rehabilitation. May;84(5):338-345.
Objective: We investigated the cardiovascular responses of adult women to the influence of extended quiet sitting and to the extent to which these responses may be reversed by micromechanical stimulation of the plantar surface. Conclusion: We interpret these results to suggest that the immobility of quiet sitting has a profound effect on the cardiovascular systems of a large fraction of otherwise healthy women, perhaps due to inadequate muscle tone
leading to venous insufficiency.”

9. Mobily, PR., Skemp Kelly, LS. (1991). “Latrogenesis in the Elderly.
Factors of Immobility”. Journal of Gerontological Nursing.
September;17(9):5-11.
“Impaired Mobility, Whether Self-or Other Imposed, Places the Elderly at Risk for a Multitude of Negative Physiological and Psychological Consequences that can Affect Health, Well-Being, and Quality of Life.”

10. Sheng Chen, Jian, Ian D. Cameron and Robert G. Cumming, et. al. Sydney, Australia. (2006). “Effect of Age-Related Chronic Immobility on Markers of Bone Turnover”. Journal of Bone and Mineral Research, February;21:324-331.
“The effects of acute immobilization on bone turnover are well known, but the effects of chronic hyopmobility with aging have not been studied. The effect of immobility may be more marked on bone formation than on bone resorption.
Conclusions: Our findings suggest that poor mobility contributes to the state of accelerated bone turnover usually seen in the elderly.”

11. Starer, Perry, Antonios Likourezos and Gerardo Dumapit. (2000)
The Jewish Home and Hospital, NY. The Department of Geriatric and Adult
Development, the Mount Sinai School of Medicine, NY. “The Association of
Fecal Impaction and Urinary Retention in elderly Nursing Home Patients”. Arch Gerontological Geriatircs, Jan- Feb;30(1):47-54.
“Rather than implicating an anatomic or neurologic link between poor bladder emptying and poor bowel emptying, a third factor ( e.g. mobility) causing both urinary retention and fecal impaction should be sought.”

12. Taylor and Francis. May (2005). Disability and Rehabilitation. Vol.
27:Number 10/20:581-596, Goutam Mukherjee and Amalendu Samanta.
“Hand rim propelled manual wheelchairs (WC) are conventionally distributed to persons with dysfunctioning lower limbs for independent ambulation….The purpose of the present study was to survey the fate of the….W/C’s and the difficulties encountered by the users by identifying the cause of rejection and to evaluate the performance by assessing physiological strain on the recipients during their routine ambulation using cardiorespiratory parameters…..Locomotive tasks using W/C are highly demanding and contribute to physiological strain.”

13. Van der Woude, Lucas HV and Sonja de Groot. June, (2005).
“Commentary: Wheelchair Propulsion: a Straining Form of Ambulation”, Indian Journal of Medicine Res 121;719-722.
“Manual wheelchair propulsion is a straining form of ambulation both for the cardio-respiratory as well as the musculo-skeletal system. Wheelchair locomotion implies arm work in every other activity in daily life. Compared to leg work, wheelchair arm work is less efficient and more straining and subsequently leads to a lower work capacity. Problems of long-term wheelchair use described in literature are not just discomfort, but (chronic) pain and even structural musculo-skeletal damage with subsequent risk of increasing inactivity."

14. Vrije, Van der Boechorststraat. (Received 2 October 2005, revised 1 December 2005; accepted 3 December 2005. Available on 28 February 2006). 9 Universiteit Amsterdam, the Netherlands. “Manual Wheelchairs: Research and Innovation in Rehabilitation, Sports, Daily Life and Health”; Institute for Fundamental and Clinical Human Movement Sciences, Faculty of Human Movement Sciences. Rehabilitation Centre Amsterdam, The Netherlands.
“Those with lower limb disabilities are often dependent on manually propelled wheelchairs for mobility….This implies a transfer from leg to arm work for ambulation and all other activities of daily living. Compared to the legs, arm work is less efficient and more straining, and leads to a lower physical activity. Also, there is a major risk of mechanical overuse. Problems with long term wheelchair use are not only pain or discomfort, but also risk of a physically inactive lifestyle. Subsequently, serious secondary impairments (obesity, diabetes and cardiovascular problems) may eventually emerge.”

15. Weinberg, Leah E. and Neena L. Chappell. (l996). “Perceived Control
of Learned Helplessness in Older People: Choice, Chance and Powerful Others”. http://www.coag.uvic.ca/publications/pdfs/perceived_control_helplessness.pdf July 3. Draft 1.
“Learned helplessness is a term that is often used to describe elderly persons in nursing homes who appear to behave in a passive, dependent, and helpless manner. The lack of sufficient physical activity among nursing home residents leads to negative outcomes on health, well-being, and functional ability."

16. http://www.sandia.gov/isrc/cushion.html. Wheel Chair Seat Cushion.
“Care for pressure sores in general is a major expense, estimated at $3-5 billion a year in the US. People who use a wheelchair for more that eight years have a better than 80% chance of developing at least one pressure sore. Over 60,000 deaths annually in the US are attributed to pressure sores.”

17. “Immobility”.
http://healthyageing.sph.cuhk.edu.hk/immobility_en.htm
“Immobility is a common pathway by which a host of diseases and problems in the elderly produce further disability. Persons who are chronically ill, aged, or disabled are particularly susceptible to the adverse effects of prolonged bed rest, immobilization, and inactivity. The effects of immobility are rarely confined to only one body system. It may later cause a wide range of complications. Immobility in the elderly often cannot be prevented, but many of its adverse effects can be. Relatively small improvement in mobility can decrease the incidence and severity of complications, improve the well-being of the elderly as well as relieve the burden of caregivers.” (2005).
back to top

Preventive Measures:

1. Bourret,E.M. BScN, MN, RN., L.G. Bemick, BNSc, et al. (2002). “The
Meaning of Mobility for Residents and Staff in Long-Term Care Facilities”. Journal of Advanced Nursing. February;Volume 37:338.
Conclusion: Mobility involves more than the movement from one point to another. The nature of the assistive nurse-client relationship and the resident’s subjective perspective must become central to understanding the meaning of mobility for residents in a long-term care facility.”

2. Graf, Carla, RN, APRN, BC. (2006). “Functional Decline in Hospitalized Older Adults: It’s Often a Consequence of Hospitalization, But Doesn’t Have to Be.” American Journal of Nursing. January;106(1):58-67.
“Routine walking schedules, activities to prevent sensory deprivation, and timely hospital discharge are among the interventions that can help prevent functional decline”.

3. Heath, John M. MD, and Marian R. Stuart, PhD. (2002). “Prescribing Exercise for Frail Elders”. Medical Practice. Department of Family Medicine, Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey. Journal of the American Board of Family Medicine. Vol 15, Issue 3, Pages 218-228.
Conclusions: although barriers exist, physicians can effectively promote exercise as a therapeutic intervention for their frail elderly patients. It is essential that physicians enthusiastically discuss exercise on a regular basis.

4. MacRae., PG., LA. Asplund, JF. Schnelle, et. Al. (1996). Department of Medicine, Pepperdine University, Malibu, CA. “A Walking Program for Nursing Home Residents: Effects on Walk Endurance, Physical Activity, Mobility and Quality of Life.” Journal of American Geriatrics Society. Feb;44(2)175-80.
“Conclusion: Twelve weeks of daily walking at a self-selected walking pace by ambulatory nursing home residents produced significant improvements in walk endurance capacity.”
back to top

General Aging Factors that Place Elderly At Risk of Being Placed Into a Wheelchair:

1. DiGiovanna, Augustine G. (Feb., 2001). “Sarcopenia and Aging of Muscle”. AGHE Meeting San Jose.
Excellent outline on sacropenia, covering muscle mass, possible significance of loss, definition of significant loss, incidence, causes, possible treatments, etc. Most significant aspect of outline is list of causes, which reduced exercise is highlighted, along with malnutrition.

2. Fuller, George F. Col, MC, USA. (April 1, 2000). White House Medical Clinic, Washington, DC. “Falls and the Elderly”. American Family Physician. Published by the American Academy of Family Physicians. 61:2159-68, 173-4.
“Falls are the leading cause of injury-related visits to emergency departments in the United States and the primary etiology of accentual death in person over the age of 65 years. Dr. Fuller talks about physician mobility assessments and referenced the Get-Up and go Test."

3. Haynes, Peggy. (Sept. 2006). Administration on Aging: “Evidence- Based Disease Prevention: Fall Prevention”. Southern Maine Area Agency on Aging. Pages 2007-775.
"Southern Maine will be using the Matter of Balance (MOB) program for their intervention program that aims to reduce the risk of falling, stop the fear of falling cycle, and improve activity levels among community dwelling older adults.…Coping strategies are taught that focus on the fear of falling and ways to reduce the risk of falling, including changing attitudes and self-efficiency, as well as exercising to improve balance and strength.”
back to top

Other Related Articles:

1. Abbott, Robert D., et.al. (2004). “Walking and Dementia in Physically Capable Elderly Men”. Journal of American Medical Association. September 22/29;Vol.292. No 12:1447-1453.

2. Allan, Louise M. MRCP. (2005). “Prevalence and Severity of Gait Disorder in Alzheimer’s and Non-Alzheimer’s Dementias”. Journal of American Geriatric Society. 53:1681.

3. Babayeu, M., Lachmann, E., Nagler, W. American Journal of Physical Medicine and Rehabilitation. (2000). “The Controversy Surrounding Sacral Insufficiency Fractures: To Ambulate or Not to Ambulate?”
July/August;79(4):404-409.

4. Baum, CE., Jarjoura, D., et.al. (2003). “Effectiveness of a Group Exercise Program in a Long-Term Care Facility: A Randomized Pilot Trial.” Journal of American Medical Director Association. Mar-Apr;4(2);74-80.

5. Bernhardt, Julie PhD., Helen Dewey, PhD., et. al. (2004). National Stroke Institute. “Inactive and Alone: Physical Activity Within the First Fourteen Days of Acute Stroke Unit Care”. American Heart Association,
Inc. 35:1005.

6. Buchner, DM. (1997). “Preserving Mobility in Older Adults”. West J Med. Deparment of Health Services, University Washington School of Medicine, Seattle. Oct;167(4):259-64.

7. Capezuti, E., L. Evans, N. Strumpf, G. Maislin. (1996). “Physical Restraint Use and Falls in Nursing Home Residents”. Journal of American Geriatrics Society. Jun;44(6):627-33.

8. de Haarlem, Adrienne P. (2005). “Self-Injurious Behavior in Nursing Home Residents with Dementia”. Wiley Inter Science Journal: Abstract. The Netherlands. International Journal of Geriatric Psychiatry. 7:651 657.

9. Feinsod, Fred M. MD, MPH, CMD., Elizabeth A. Capezuti, PhD, RN and Valarie Felix, BS, PT. (2005). “Review: Reducing Fall Risk in Long-Term Care Residents Through the Interdisciplinary Approach”. Annals of Long Term Care. Article 4365. 13:7:24-33.

10. Gillespie, LB., Gillespie, WJ., et.al.. (2001). “Interventions for Preventing Falls in Elderly People”. Cochrane Database System Review. Department of Health Sciences. University York. York, U.K. (3):CD00340.

11. Gillis, A., B. MacDonald. (2005). School of Nursing, St. Francis Xavior, Antigonish, Nova Scotia. “Deconditioning in the Hospitalized Elderly”. Canadian Nurse. June;101(6):16-20.32.

12. Graafmans, WC. P. Lips, et. al. (2003). “Daily Physical Activity and the Use of a Walking Aid in Relation to Falls in Elderly People in Residential Care Setting”. Gerontological Geriatrics. TNO Prevention and Health, The Netherlands. February;36 (1): 23-8.

13. Hadley, MA., EC. Hornbrook MC., et. al. (1995). Division of Biostatistics, Washington University School of Medicine, St. Louis, MO. “The Effects of xercise on Falls in Elderly Patients. A Pre planned Meta-analysis of the FICIT Trials. Frailty and Injuries: Cooperative Studies of Intervention Techniques.” Province, May 3;273(17):1381-3.

14. Jauer, K, Rost, B, Rutschle, K. et. al. (2001). Heidelberg, Germany. “Exercise Training for Rehabilitation and Secondary Prevention of Falls in Geriatric Patients with a History of Injurious Falls”. Journal American Geriatrics Society. January;49(1):10-20.

15. Kiel, DK., DP. Borrows, AB. Lipsitz. (1998). LA. Hebrew Rehabilitation Center for Aged Research and Training Institute, Boston, MA. “Identifying Nursing Home Residents at Risk for Falling”. Journal of American Geriatric Society. May;46(5):551-5.

16. Lane, AJ. (1999) “Evaluation of the Fall Prevention Program in an Acute Care Setting”. Orthopedic Nursing. College of Nursing, University of Cincinnati Medical Center, Ohio. Nov-Dec;18 (6):37-43.

17. LaStayo, PC., GA. Exy, DD. Pierotti, et. al. (2003). Division of Physical Therapy, University of Utah, Salt Lake City, UT. “The Positive Effects of Negative Work: Increased Muscle Strength and Decreased Fall Risk in a Frail Elderly Population”. Journal of Gerontological A Biology Science Medical Science. May;58(5):M419-24.

18. Leeuwenburgh, Christiaan PhD. (2003). “Role of Apoptosis in Sarcopenia”. Journal of Gerontology: Medical Sciences. Vol58A, No.11,
999-1001.

19. Leeuwenburgh, Christiaan.. (2003). “UF Studies Find Key to Preventing Strength and Muscle Loss in Elderly”. UF News. Nov. 24

20. Li, F., P. Harmer, et. al. (2004). Oregon Research Institute. “Tai Chi: Improving Functional Balance and Predicting Subsequent Falls in Older Persons.” Medical Science Sports Exercise. Dec;36(12):2046-52.

21. Lindgren, Margareta RN,PhD, et. al. (2004). “Immobility-a Major Risk Factor for Development of Pressure Ulcers Among Adult Hospitalized Patients: A Prospective Study”. Blackwell Synergy: Scandinavian Journal of Caring Science. Volume 18, Issue 1, pp. 57-64.

22. Lord, Stephen R., Fitzpatrick, Richard C. (1995) “The effect of a 12-Month Exercise Trial on Balance, Strength, and Falls in Older Women: A Randomized Controlled Trial.” Journal of American Geriatrics Society. Nov;43(11):1198-206.

23. MacNeill, Susan E., Peter A. Lichtenberg. (1998). Rehabilitation Institute of Michigan. “Predictors for Functional Outcome in Older Rehabilitation Patients”. The International Journal of Psychosocial Rehabilitation. Rehabiitation Psychology. Vol. 43:3:246-257.

24. Means KM., DE. Rodell, PS. O’Sullivan, LA. Cranford. (1996). “Rehabilitation of Elderly Fallers: Pilot Study of a Low to Moderate Intensity Exercise Program.” Archives of Physical Medical Rehabilitation. Oct;77(10):1030-6.

25. Mion, LC., S. Gregor, M. Buettner, et. al. (1989). “Falls in the Rehabilitation Setting: Incidence and Characteristics”. Rehabilitation Nursing. Jan-Feb; 14 (3):133.

26. Morton, Susanne M. (2004). Kennedy Krieger Institute and Department of Neurology, John Hopkins University School of Medicine. “Cerebellar Control of Balance and Locomotion”. The Neuroscientist. Vol. 10, No.3, 247-259.

27. Mulow, CD., MB. Gerety, et. al. (1994). “A Randomized Trial of Physical Rehabilitation for Very Frail Nursing Home Residents.” JAMA. Feb;16;271(7):519-24.

28. “Musculoskeletal System”.
http://healthandage.com/html/res/primer/bones.htm.
This article is valuable as it discusses lost bone mass and osteoporosis,
one of the factors that ultimately places a person into a wheelchair. (2006).

29. Norman, GM., JA Gibbs. (1991). “Why Walk When You Can Ride?
Clinical Ambulation Incentives for the Immobile Elderly”. Journal of
Gerentology Nursing. Aug;17(8):28-33.

30. Rasansky, Jeff. (2006). “Immobility and Inactivity.” Rasansky Law
Firm. [Cited 23 May ]. http://www.nursinghomelawyer.com/nursing_home_law_firm/nursing_home_
research/aging_disease/immobility_inactivity.htm

31. Ray, WA., (1997). “A Randomized Trial of a Consultation Service to
Reduce Falls in Nursing Homes”. Journal of the American Medical Association. Department of Preventive Medicine, Vanderbilt University School of Medicine, Nashville, TN. Aug;20:278(7):595-62.

32. Ray, WA., (2005). “Prevention of Fall-Related Injuries in Long-Term Care: A Randomized Controlled Trial of Staff Education”. Archival Internal Medicine. Division of Pharmacoepidemiology and Center for Education and Research on Therapeutics, Department of Preventive Medicine, Vanderbilt University School of Medicine, Nashville, TN.Oct;24;165(19):2293-8

33. Reilly, Evelyn RNID, (2005). Clinical Nurse Specialist in Dementia Care, Daughters of Charity Services, Dublin, Ireland. “Care Planning and Care Management for People with Intellectual Disabilities and Dementia”.
Feature Dementia. Frontline. Winter: 15-19.

34. Robinson, Bruce. (2003). “Costs of Anemia in the Elderly”. Journal of American Geriatrics Society. March;51(3 Supply):S14-17.

35. Rubenstein, LZ., KR. Josephson, PR. Trueblood, et al. (2000). “Effects of a Group Exercise Program on Strength, Mobility, and Falls Among Fall Prone Elderly Men”. Journal of Gerontological A Biology Science Medical Science. 55:M317-M321.

36. Ruchinskas, R. (2003). “Clinical Prediction of Falls in the Elderly”.
American Journal Physical Medicine Rehabilitation. April;82(4):273-8.

37. Sambrook, Phillip N., Chen, Charles JS, March, Lyn, et.al. (2006). “High Bone Turnover is an Independent Predictor of Mortality in the Frail Elderly”. Journal of Bone and Mineral Research. Unversity of Sydney, Sydney, Austrailia. April;21:549-555.

38. Schnellle, John F. PhD., et. al. (2003). “Does Exercise and Incontinence Intervention Save Healthcare Costs in a Nursing Home Population”. Journal of the American Geriatric Society. February;Volume 51:161..

39. Schoenfelder, DP., LM. Rubenstein. (2004). “An Exercise Program to Improve Fall-Related Outcomes in Elderly Nursing Home Residents”. Appl Nurs Res. College of Nursing, University of Iowa. Iowa City, IA. Feb;17(1):21-31.

40. Shobha S. Rao, MD. (2005). University of Texas Southwestern, Dallas, Texas. “Prevention of Falls in Older Patients”. American Family Physician. July 1.

41. Simkin, Berry, D.O. (2002). “Even Frail Elderly Patients Can Benefit
From Exercise”. Geriatric Times. July/Aug;Vol 3: Issue 4.

42. Thapa, PB., KG. Brockman, et. al. (1996). “Injurious Falls in Nonambulatory Nursing Home Residents: A Comparative Study of
Circumstances, Incidence, and Risk Factors”. Journal of American Geriatric Society. Mar;44(3):273-8.

43. Thapa, PB, P Gideon, et.al. (1996). Department of Preventive Medicine, MCM A-1124, Vanderbilt University, School of Medicine, Nashville, TN. “Clinical and Biomechanical Measures of Balance as Fall Predictors in Ambulatory Nursing Home Residents”. Journals of Gerontology, Series, A: Sept;51(5):M239-46.

44. Tilling, Lindsey M., Khaled Dadawil, and Mary Britton. (2006) Department of Elderly Medicine, Homerton University Hospital, Hackney, London, UK. “Falls as a Complication of Diabetes Mellitus in Older People”. Journal Diabetes Complications. May-June;20(3):158-162.

45. “Timed Get Up and Go Test”.
http://www.fallprevention.ri.gov/Module3/tsld006.htm. Rhode Island Long Term Care Coordinating Council.

46. Tinetti, Mary, CS. Williams. (1997). Department of Internal Medicine, Yale University School of Medicine, New Haven, CT. “Falls, Injuries Due to Falls, and the Risk of Admission to a Nursing Home”. New England Journal of Medicine. Vol 337:1279-1284.

47. Tan, T.L., et.al. (2001) “ Impaired Mobility in Older Persons Attending a Geriatric Assessment Clinic; Causes and Management”.
Singapore Medical Journal. Feb;42(2):68-72.

48. Theiler, Robert and Hannes Stahelin, et. al.. (2002). Departments of
Rheumatology, Geriatrics and Endocrine Practice, University of Basel, Switzerland. “Influence of Physical Mobility and Season on 25 Hydroxyvitamin D- Parathyroid Hormone Interaction and Bone Remodeling in the Elderly”. European Journal of Endrocrinology. 143 673-679.

49. Wallace Williams, Sharon PhD., Christianna S. Williams, PhD., Sheryl Zimmerman, PhD., Philip D. Sloane, MD, MPH., John S. Preisser, PhD., Malz Boustani, MD, MPH., and Peter S. Reed, PhD. (1999). “Mobility in Old Age”. Gerodontology. Volume 16, page 69, December. "Characteristics Associated with Mobility Limitation In Long-Term Care Residents with Dementia”. The Gerontologist. Vol. 45; Special Issue I, 62-67.

50. Weintraub, N., Vu, ME., LZ. Ruberstein. (2005). “Falls in the Nursing Home: Are they Preventable?” Journal of American Medical Director Association. May-June;6(3 Supply):S82-7.

51. Wolf, SL, HX. Barnhart, et. al. (1996). Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA. “Reducing Frailty and Falls in Older Persons: an Investigation of TAI CHI and Computerized Balance Training. Atlanta FICSIT Group. Frailty and Injuries: Cooperative Studies of Intervention Techniques.” Journal of American Geriatric Society. May;(5):489-497.

back to top