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Research description

Internationally, gerontology focuses on an emerging paradigm of healthy ageing where the goal is to extend the senior years in absence of morbidity by improving human health. A major threat to healthy ageing is accidental falls, as falls are the second-leading cause of unintentional injury or deaths worldwide. For the individual who falls, it is crucial to be able to continue living an active, independent life in one’s senior years. Additionally social engagement, valued activities, as well as exercise are known to be essential for longevity. Accidental falls in older age are increasingly problematic worldwide, and are the focus of several research projects. Although multi-factorial fall-prevention interventions have been shown to reduce falls, the translation of research into the practical field, e.g. primary health care, has been limited. An occupational perspective was applied in this thesis, in order to capture the efficacy of a falls-prevention programme in relation to everyday occupations. 
The programme Active lifestyle all your life was implemented among older adults, over the age of 65, at nine different primary care units in Stockholm, Sweden, during 2011. Each group met for two hours biweekly at the primary health care unit near the older adults’ homes. In total, the groups met 12 times during a nine-month period. At every group meeting, different themes were addressed and all were related to the prevention of falls from multifactorial perspectives. The group leaders encouraged active engagement in discussions, occupations as well as in exercises and in home assignments. The focus in every session was on falls prevention in keeping with the view of valued activities as a prerequisite for health. Throughout the programme, the group leaders used standardised material developed for this programme and every participant was supplied with a complete set of this material in a binder.        
The overall aim of this thesis was to contribute with  new knowledge that reflects experiences from, and efficacy of a multifactorial group-based falls-prevention programme, in relation to everyday occupations among community-dwelling older adults at risk of falling.
The evaluation methods used were a balance between quantitative and qualitative, with an overall RCT design for the participants (n=131). Quantitative outcome measures (Study III & IV) of falls, fear of falling, and participation measures were analysed using descriptive statistics and general estimated equation models (GEE). Focus group interviews (Study I) with the group-leaders (n=15) were analysed using a constant comparative approach and repeated narrative interviews (Study II) with six participants were analysed using thematic analysis. 
The results from the evaluations showed that the participants in the programme had a significant decrease of their risk of falling at follow-up than the controls, and a reduced risk of falls compared to over time. According to the measurements of Fear of falling, the participants in the programme reduced their risk of experiencing fear significantly. Further, the participants in the programme showed positive trends with respect to a decreased risk of experiencing problems with participation at follow-up. The qualitative findings indicated that: the multifactorial approach in general and the group format of the programme specifically, had an important impact on the participants’ engagement in valued activities. The group format worked as an amplifier in the translation of expert knowledge to applied knowledge, which led to increased awareness and behavioural change. In addition, for the process of behavioural change to work, the therapists as group leaders needed to move between the role of the expert and the role of a facilitator to be able to create a safe and benevolent climate for engagement, learning and knowledge translation.  
Falls and Fear of falling could be positively impacted by using multifactorial, occupation focused and occupation-based methods. Small group-learning environments in combination with learning by doing, can be an effective approach used to prevent falls and reduce fear of falling among older individuals at risk. The knowledge derived from this thesis could be of use as a prevention programme model for implementing Evidence Based Practice (EBP) in primary health care and could serve as one attempt to plan ahead, and support active ageing by using an occupational perspective.   
I. Johansson, E., Borell, L., Jonsson, H. (2014). Letting go of an old habit: groupleaders’ experiences of a client-centred multi-disciplinary falls prevention programme. Scandinavian Journal of Occupational Therapy, 21(2): 98–106. Doi:10.3109/11038128.2013.868515 
II. Johansson, E & Jonsson, H. (2013). Thinking and Acting in a new way: Influences of a falls-prevention programme on participants’ everyday life. Physical & Occupational Therapy in Geriatrics. 31(4):281–296. Doi:10.3109/02703181.2013.854858  
III. Johansson, E., Dahlberg, R., Jonsson, H., Patomella, A-H. (2015). Does a fallsprevention program impact on perceived participation in everyday occupations? – A pilot randomized controlled trial. Early on-line. Occupation Participation and Health OTJR 1-9. Doi: 10.1177/1539449215589728 
IV. Johansson, E., Dahlberg, R., Jonsson, H., Patomella., A-H. The efficacy of a multifactorial falls-prevention programme in relation to falls and fear of falling: a pilot randomised controlled trial. Manuscript submitted

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