Dissertations / Theses on the topic 'Chutes (accidents) – Chez la personne âgée – Prévention'
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Dumas, Eric. "Prévention de la récidive des chutes de la personne âgée : étude interventionnelle menée en service de court séjour gériatrique au Centre Henri Choussat de Bordeaux." Bordeaux 2, 2000. http://www.theses.fr/2000BOR2M095.
Carette, Pierre. "Développement d’un programme multifactoriel de prévention à domicile des facteurs de risque de chute des personnes âgées : évaluation de l’efficacité du programme et de l’apport de la posturographie." Poitiers, 2012. http://www.theses.fr/2012POIT1408.
Introduction: Falls have become a major public health problem in industrialized countries with an ageing population. It has been estimated that one third of the population over 65 years experience one or more falls per year. Fall consequences may be traumatic, psychological, economical and/or social. It is well-known the aetiology of falling is multifactorial and falls risk factors are quite numerous. Therefore in other to be effective in prevention it would be logical to develop intervention that would include a multifactorial approach. In this context, it seems also reasonable to include postural control assessment in such program. Aim: To develop a multidisciplinary/multisensory intervention program to prevent falls in elderly subjects. Design, subjects and methods: Randomized intervention with a multidisciplinary/multisensory approach including assessment of postural control vs a control group in 80 elderly subjects living at home. The follow was for twelve months. The main criterion of judgment was the fall. Other criteria were the postural control and the quality of life. Results: After one year, a significant decrease in the number of fallers was detected in the group that followed the intervention program when compared with the control group (from xx to 19. 5% vs xx to 90% of fallers, respectively). Postural control and quality of life also significantly increased in the former group when compared with the latter one. Discussion/Conclusion: Our approach was effective and our multidisciplinary/multisensory and individualized prevention program should now be investigated on a larger scale (e. G. Multicentric study) to determine its global efficiency including economical aspects
Chaccour, Kabalan. "Elaborating the Actimetric Profile of Fall Sensitive Patients for Early Detection of Fall Incidents." Thesis, Bourgogne Franche-Comté, 2017. http://www.theses.fr/2017UBFCA016/document.
Growth is the normal change of the human body and getting old is inevitable to human race. As a result, elderly people are subject to many forms of diseases and dangers among which falls are considered very serious in terms of quality of life and socio-economic costs. But falls can be manageable. Health practitioners, scientists and researchers currently combine efforts to develop systems capable of detecting and predicting falls. In the context of fall prediction, the goal of this thesis is to elaborate the actimetric profile of fall sensitive patients to alert them from a potential fall. It mainly consists of developing a system capable of monitoring gait and balance parameters during their daily activities with minimum intrusiveness. These are usually assessed in clinical settings using high-cost tools. In our first contribution, we proposed a generic classification of fall-related systems based on their sensors deployment. These are classified as Wearable, Non-Wearable and Fusion Systems. Based on the generic classification, we proposed the WMFL v1.0 platform in our second contribution. WMFL fuses a Foot Wear Force Sensing device with an Ambient system using IR-sensing floor tiles. The platform can be deployed at homes or in clinics. It ensures an indoor-outdoor protection. In a third contribution, we proposed an early fall detection approach to determine the risk of falling by analyzing the displacement of the Center of Pressure projecting the amount of sway of the Center of Mass on the foot plantar surface. The method uses the spatio-temporal sliding window to alert the patient of a potential fall
Toulotte, Claire. "La chute chez la personne âgée : identification des facteurs de chutes et prévention par l'entraînement." Lille 2, 2003. http://www.theses.fr/2003LIL2MT04.
Langeard, Antoine. "Prévention de la chute chez la personne âgée : de la détection du risque à la réhabilitation par électrostimulation." Thesis, Normandie, 2017. http://www.theses.fr/2017NORMC210/document.
The objective of this work was to improve the prevention of falls in seniors by (i) improving the detection of people at risk, (ii) providing new tools for assessing postural control and (iii) studying the effects of rehabilitation program by electrostimulation on the markers of the risk of falling. In order to meet these three objectives, three parts were developed:The aim of Part I was to provide tools for better detection of persons at risk of falls or fractures through the identification of factors responsible for a decline in postural control. We have been able to establish through three studies that (i) elderly patients who take five or more drugs per day are at higher risk of cognitive and mobility impairments, (ii) subjects who undergo fractures have a stabilization deficit after obstacle crossing and (iii) fractured fallers reduce their walking speed less during dual-task walking.In Part II we evaluated for the first time the braking of the center of mass, a parameter correlated with the quality of the postural control, with a kinematic analysis technique. It has been demonstrated that the technic usually used, the force-plate analysis, presents greater variability and leads to an underestimation of the braking index in comparison with this new method of analysis.In Part III we tested the effectiveness of a training program by electrostimulation of the ankle plantar and dorsiflexors on the parameters related to the fall or its severity. This training increased the strenght, and probably the contraction speed of the ankle muscles. Although the rehabilitation of other muscles seems necessary to improve gait,the training program has rehabilitated dynamic balance
El-Khoury, Fabienne. "The Effect of Fall Prevention Exercise Programmes on Fall Induced Injuries in Community-Dwelling Older Adults." Thesis, Paris 11, 2015. http://www.theses.fr/2015PA11T023/document.
Context: Exercise programmes can prevent falls in older community-dwellers. However, evidence that these programmes can also prevent injurious falls was poor.Objectives : Systematic review of evidence of the effect of exercise interventions on injurious fall prevention from randomised controlled trials (RCT).Evaluate the effectiveness of ‘Ossébo’, a multi-centre RCT assessing the effectiveness of a 2-year injurious fall prevention balance training programme.Methods:Systematic reviewThe definitions of injurious falls from included studies were classified into more homogeneous categories. This allowed the estimation of a pooled rate ratio for each injurious falls category based on random effects models. Ossébo trial706 women aged 75-85 years ; home-living with diminished functional capacities were included. The 2 groups were compared for rates of injurious falls with a frailty model. Other outcomes included physical functional capacities, and quality of life indicators. Results:Systematic review17 trials involving 4305 participants were included. Four categories were identified: all injurious falls, falls resulting in medical care, severe injurious falls, and falls resulting in fractures. Exercise had a significant preventive effect in all categories.OsséboThere were 305 injurious falls in the intervention group and 397 in the control group, for a HR of 0.81 (0.67 to 0.99). At 2 years, women in the intervention group had significantly better performances on all physical tests and a better perception of their overall physical function. Conclusion:Fall prevention exercise programmes are effective in preventing injurious falls, and are feasible for long-term, wide-spread dissemination
Saboune, Jamal. "Développement d'un système passif de suivi 3D du mouvement humain par filtrage particulaire." Phd thesis, Troyes, 2008. http://www.theses.fr/2008TROY0002.
The main idea behind the PARAChute project is to reduce the number of falls in the elderly by preventing them. This thesis work which is a part of this project aims to develop a new non intrusive human gait analysis system which would be a component of a fall risk evaluation system. Many methods have been used to evaluate dynamic equilibrium of a person while walking. By studying these methods, we were able to identify some gait parameters which are pertinent for fall risk detection. All these methods previously used, are based on clinical tests, or on using wearable sensors. Thus, we opted to develop a new approach based on a completer marker less 3D human motion capture system. The new system we created uses video feeds, a virtual 3d body model and a novel particle filtering algorithm we developed. This algorithm reorganizes the model’s configurations search space in a efficient, optimal and deterministic way. In order to reduce the complexity of this algorithm, we also developed a factorized version of it, using a dynamic Bayesian network. In terms of quality of 3D reconstruction, the results of our method are satisfactory
Nowakowski, Katharine. "The prediction and management of muscle ageing : 3D musculoskeletal simulations and multi-scale biomechanical modeling for the analysis of human falls and fall prevention strategies through the application of artificial intelligence approaches." Electronic Thesis or Diss., Compiègne, 2023. http://www.theses.fr/2023COMP2763.
The age-related decline in muscle function is linked to both sarcopenia and an increased risk for falls. In this doctoral project, an analysis of the morphological, functional, mechanical and biophysical parameters known to be affected by ageing is presented. The data has been analysed with statistical and machine learning techniques. These results influenced the development of a deep reinforcement learning simulation for both young adult and elderly falls, based on the parameters sensitive to ageing such as maximum isometric force, contraction velocity, deactivation time, passive muscle strain, hip extension range and a mass shift from the legs to the trunk. Testing of the sensitivity of the results then led to the development of a coupled simulation to study falls recovery, where the effects of sensory nerves and proprioception was considered. The strategy for coupling allows for recovery for any fall position to be analysed to further test the limits of recovery produced by the given model. The results from each aspect of the project suggest that muscle ageing can be further elucidated through the development of a multi-scale model that could consider fatigue and the effect of biophysical changes on movement outcomes. A multi-scale model, where agent-based modelling is coupled to a reinforcement learning environment is proposed. The model accounts for the conversion of type II muscle fibres to type I fibres, as well as considers the dynamics of calcium, inorganic phosphate, and ATP, with prospective for further adaptations. This work demonstrates the interest in further exploration of complex human system modelling by leveraging artificial intelligence techniques
Tchalla, Achille Edem. "Contribution à l’étude de l’efficacité des interventions Domotiques et Téléassistances dans la prévention des chutes à domicile des personnes âgées en perte d’autonomie et Alzheimer au stade léger à modéré." Limoges, 2013. http://aurore.unilim.fr/theses/nxfile/default/7d54c165-c1fc-4609-a57f-e9b12f3634d8/blobholder:0/2013LIMO310K.pdf.
Aging is associated with a high prevalence of unintentional fall in the elderly with a third of the population aged over 65 years fall at least once a year and half of those over 80 years. In Alzheimer's Disease (AD) and related patients, the risk of falling is 3 times more and four times more at Home Care. In the first week and especially the risk of fracture in AD patient is multiplied by 3 and at 6 months the mortality is 50%. Forty percent of admissions in Home care are due to these falls. An exhaustive review of the literature on falls prevention shows that several types of interventions have been implemented and evaluated using the identified risk factors. None has so far concerned the evaluation of interventions from a technological device for both the prevention and early detection of the fall and thus better target prevention strategies
Trevidy, Frédérique. "Vieillir en santé à son domicile : apprendre pour mieux gérer le risque d'isolement social. Une modélisation de l'identité-logement au service de la prévention de la chute." Thesis, Paris 13, 2013. http://www.theses.fr/2013PA131029.
A third of adult above 65 years of age, fall every year. Nevertheless, professional recommendations to reduce home hazards are rarely followed by the inhabitants due to their reticence to accept the modification of their living space that is imposed on them. At the origin of this phenomenon, what we term Home-Identity, a form of constructed spatial identity, which would render the relation between the individual and where he/she lives more complex. Objectives: This qualitative research aims to establish the model of the learning processes constituting Home-Identity so as to envisage a Therapeutic Patient Education (TPE) which would allow elderly fallers to fully participate in the modification of his/her home. Method: Using the grounded theory method we developed our model by continually comparing our results and the acquired data. Ten older adults fallers were interviewed with semi-direct guidance and a mental map of the home (MPH). Results: Home-Identity includes two feelings. At the center, the feeling of temporal continuity arises from the individual's present cycle of routines and knowledge which are linked to memories and projections into the future. The feeling of unity and coherence contains the feeling of continuity. It creates in the inhabitant defense strategies to protect his/her Home-Identity and learning processes to make it change. Discussion: Home-Identity leads to “competently acting” in situation at home. It is made dynamic by "constructivists” learning strategies which would allow the individual to assimilate new knowledge and to accommodate the changes of situation. Our model leads to envisage TPE in the form of educational support to home hazards modification. The MPH would be used to characterize the evolution in Home-Identity. Conclusion: Additional research will allow to validate the MPH and empirically test our model
Boyer, Sophie. "Contribution à l'étude du rôle de l’hyponatrémie légère et chronique dans la survenue de la chute grave du sujet âgé fragile admis en unité de Médecine d'Urgence de la Personne Agée (MUPA)." Thesis, Limoges, 2018. http://www.theses.fr/2018LIMO0067/document.
Falls are a precursor to the loss of autonomy and represent a major public health problem. Falls involve multiple factors determining the risk of falling. A better knowledge of the risk factors of falls is important in order to prevent falls as well as loss of autonomy in the elderly. Among these risk factors, biological factors are poorly studied. Better knowing these biological factors would better guide the etiological diagnosis of the fall and therefore target personalized preventive actions and define environmental interventions (physical activity, nutritional counseling) or medical, to prevent the risk of falling and the loss of autonomy. Hyponatremia is the most common electrolyte disorder in geriatric practice. It is defined by a serum Na concentration of less than 136 mmol/L. Hyponatremia can be divided into 3 stages: mild chronic hyponatremia, moderate hyponatremia, and severe hyponatremia. Recent studies have shown that mild chronic hyponatremia may present significant clinical signs in patients and may be associated with impaired cognitive functions, gait disturbances and even fractures. What is the prevalence of mild chronic hyponatremia in patients admitted to MUPA unit? What is the association between mild chronic hyponatremia and falls in our population? Prevalence of mild chronic hyponatremia is particularly high at MUPA unit. Patients admitted to MUPA unit with mild chronic hyponatremia at the first blood test performed on arrival have a higher risk of serious falls. Mild chronic hyponatremia may be considered as a risk factor for serious falls in the elderly
Huard, Yannick. "Objectivation de l'équilibre en stabilité debout et lors du cycle de marche chez le sujet âgé autonome chuteur : apport de l'Ostéopathie." Thesis, Reims, 2015. http://www.theses.fr/2015REIMS024/document.
Balance disorders, as the fall, remain frequently in the elderly, with adverse consequences on the autonomy. Three randomized trials have been conducted to identify the parameters distinguishing the “fallers autonomous elderly” and to analyze the impact of an osteopathic treatment. The 1st study concerns 33 elderly patients: 15 fallers (68,3 ± 2,7 years) and 18 no-fallers (67,7 ± 2,5years). Three stabilometric parameters and three clinical tests distinguish the two populations (p <0,05). Moreover, the osteopathic treatment improves the evaluated characteristics of fallers elderly (no significant difference). The 2nd study concerns 40 fallers and lombalgic elderly: 20 receiving an osteopathic treatment (69,5 ±3,9 years) and 20 without the osteopathic treatment (69,9 ± 3,4 years). This study identifies that the lumbar mobility is restricted for every fallers elderly and the osteopathic treatment improves the lumbar motion just after the treatment, as well as seven days after it (p ≤ 0,01). The 3rd study concerns 34 elderly patients: 17 fallers (71,3 ± 3,5 years) and 17 no-fallers (71,5 ± 4,2years). Four cinematic parameters distinguish the two populations (p ≤ 0,04). The coefficient ofdetermination R2 and the Gait Variability Index confirm that distinction. The osteopathic treatment improves the evaluated characteristics of fallers elderly (no significant difference)
Attoh, mensah Kouakou. "Risques de chutes et de troubles cognitifs consécutifs à la consommation de certains médicaments chez les seniors : approche translationnelle Psychotropic Polypharmacy in Adults 55 Years or Older: A Risk for Impaired Global Cognition, Executive Function, and Mobility Adverse Effects of Anticholinergic Drugs on Cognition and Mobility: Cutoff for Impairment in a Cross-Sectional Study in Young-Old and Old-Old Adults : Chronic tramadol administration impairs reversal learning in a touchscreen-based visual discrimination task in mice." Thesis, Normandie, 2020. http://www.theses.fr/2020NORMC427.
Psychotropic drugs and drugs with anticholinergic properties (anti-muscarinics) have been associated with risks of falls and cognitive impairment in the elderly. Our work aimed at improving knowledge about the role of these drugs in gait and cognitive impairment. We first showed that daily consumption of 2 or more psychotropic drugs per day and / or only 1 drug with anticholinergic properties, regardless of its anticholinergic burden, is associated with impaired scores on gait and cognitive test in a population of seniors from the age of 55 years. With regard to drugs with anticholinergic properties, these adverse effects were more pronounced in people aged 75 years or older. Executive functions were the severely affected by these drugs consumption. We have also shown that among the most prescribed drugs with anticholinergic properties, the consumption of tramadol, a level 2 analgesic, was the most associated with harmful effects on gait and cognition. However, it is difficult to ascertain that these observed adverse effects are solely driven by the consumption of tramadol due to the polypharmacy in this population. To identify the drugs most at risk, animal studies, in which the administration of drugs can be controlled, may be of great interest. Hence, as a second step, we showed that the chronic administration of tramadol impairs executive functions as measured by cognitive flexibility in young adult mice. Altogether these results should alert physicians on the fact that it is crucial to reduce polypharmacy of psychotropic drugs as well as the prescription of all types of drugs with anticholinergic properties. Alternative treatments should be prioritized as soon as possible. With regard to tramadol, these results suggest the need to strengthen the measures taken recently to combat the misuse of this analgesic
Muhla, Frédéric. "Impact de l’utilisation d’un dispositif de réalité virtuelle immersive sur le contrôle moteur lors d’un Timed Up and Go." Thesis, Université de Lorraine, 2020. http://www.theses.fr/2020LORR0206.
Risk of fall in the elderly is a major public health issue. Its early detection would make it possible to intervene before the first fall or prevent its recurrence by offering suitable preventive physical activity. However, the assessment of a fall risk with frequently used tests and scales is not fully satisfactory. Recent technological innovations in the field of immersive virtual reality suggest that its use in the assessment of fall risk could fill some gaps in contextualization and uniformity of current tests. However, before using these technologies in the fall risk assessment, it is important to know their impact on motor behavior. To do this, we chose to test a locomotor task, the Timed Up and Go (TUG - a clinical test widely used by clinicians and a real “gold standard” in the evaluation of the risk of falls in the elderly), in a real environment. and in a virtual environment with the elderly as well as young adults. Differences are observed with increases in time and number of steps in virtual reality. Thus, immersive virtual reality could be an avenue of choice in the assessment of the risk of falls by increasing the sensitivity and specificity of the tests since it allows to contextualize the test environment. However, this solution could only be temporary given the promises of mixed reality which would allow both to contextualize the test in the real environment with digital control of the constraints that can be added to this environment
Dubois, Amandine. "Mesure de la fragilité et détection de chutes pour le maintien à domicile des personnes âgées." Electronic Thesis or Diss., Université de Lorraine, 2014. http://www.theses.fr/2014LORR0095.
Population ageing is a major issue for society in the next years, especially because of the increase of dependent people. The limits in specialized institutes capacity and the wish of the elderly to stay at home as long as possible explain a growing need for new specific at home services. Technologies can help securing the person at home by detecting falls. They can also help in the evaluation of the frailty for preventing future accidents. This work concerns the development of low cost ambient systems for helping the stay at home of elderly. Depth cameras allow analysing in real time the displacement of the person. We show that it is possible to recognize the activity of the person and to measure gait parameters from the analysis of simple feature extracted from depth images. Activity recognition is based on Hidden Markov Models and allows detecting at risk behaviours and falls. When the person is walking, the analysis of the trajectory of her centre of mass allows measuring gait parameters that can be used for frailty evaluation. This work is based on laboratory experimentations for the acquisition of data used for models training and for the evaluation of the results. We show that some of the developed Hidden Markov Models are robust enough for classifying the activities. We also evaluate de precision of the gait parameters measurement in comparison to the measures provided by an actimetric carpet. We believe that such a system could be installed in the home of the elderly because it relies on a local processing of the depth images. It would be able to provide daily information on the person activity and on the evolution of her gait parameters that are useful for securing her and evaluating her frailty
Nguyen, Quang Vinh. "Contribution à l'étude de la physiologie de la chute du senior, application aux systèmes couplés pied-poignet." Rennes 1, 2012. http://www.theses.fr/2012REN1E006.
Rossat, Arnaud. "Politique de prévention des chutes chez les plus de 65 ans : ciblage de la population, efficacité et efficience des interventions et contribution spécifique des Centres d’Examen de Santé de l’Assurance Maladie (C.E.S.)." Thesis, Lyon 1, 2010. http://www.theses.fr/2010LYO10218/document.
The prevention of falls amongst the elderly population is a major public health concern. Since the elderly live longer and longer, it is crucial to think of efficient measures in order to prevent such falls. Falls amongst the elderly can have dramatic consequences such as a decrease in quality of life, a loss of autonomy as will cause financial difficulty due to high cost of rehabilitation. However, depending upon the complexity of the fall and its multiple determinants, diagnosing and evaluating the risk of a fall remains complicated, particularly amongst those in "good health". While multi interventional programs may exist such as equilibrium coordination and muscular reinforcement, these programs are rarely proved to be efficient in fall prevention. An adapted and efficient method of prevention must be centered on quality and satisfaction of the patient in the offered care. Such method would imply replacement of an older organization with a system defined in a network activity. However, this method would go hand in hand with the modifications in professional practices and identities. In this thesis I will examine the success rate to implement a structured method of health care prevention against falls. To achieve this prevention, we must first present the necessary conditions and tools which will homogenize and standardize these success rates. Next, I will analyze the characteristics of current methods to prevent falls in order to modernize and rationalize the process. In order to be successful, this process needs to be targeted towards a network strategy
Fayad, Moustafa. "Health care platform development based on multimedia sensors." Electronic Thesis or Diss., Université Paris Cité, 2021. http://www.theses.fr/2021UNIP5204.
All countries are facing significant demographic changes on an unprecedented scale. Seniors are the fastest-growing segment of the world's population. It increases dependent and vulnerable older adults marked by loss of autonomy and chronic illness. These complications increase mortality and morbidity rates in our societies. In recent years, the socio-economic consequences on seniors and their families and the high prices in specialized accommodation establishments have drawn attention to home support by using new reliable and inexpensive technologies. However, developing a critical healthcare system for the elderly is a real challenge that can only be met by ensuring reliability and high performance. Within the framework of the future health care system named Family Heroes, we are interested in this thesis in its reliability and safety. Thus, we studied the automatic detection of falls using the Kinect camera. More precisely, we have proposed a methodology combining the CATWOE method and UML notions to analyze and model our system. We have shown the steps to take to consider system requirements and constraints in the development process effectively. Thus, we used the MARTE concepts to face the time constraints in the modeling phase. Then, to ensure the reliability of our system, we proposed a formal verification approach based on the UML / MARTE models presented in the modeling stage. We modeled them with timed automata and deployed the UPPAAL model checker to specify and verify properties. To ensure the security of our system, we have presented a formal approach to deal with cyber-attack issues that may arise in the Family Heroes system. Thus, we adopted a scenario of cyberattacks linked to this context and proposed reconfiguring our system to face cyberattacks. In addition, formal verification has been proposed to ensure the reliability of the proposed solution. The results showed the respect of the properties (No deadlock, accessibility, security, and liveliness) in Family Heroes.For automatic fall detection, we used the multimedia sensor of Kinect technology. We have proposed a new approach based on thresholds that analyzes the variation in height, the angles of the upper body during the cycle of movement, and the person's inactivity on the ground. In addition, we have proposed a new lightweight model based on Deep Learning LSTM using geometric features. This lightweight model is designed to work on limited devices like the Raspberry Pi. The results are very promising
Shaafi, Aymen. "Secured and trusted remote wireless health monitoring systems for assisted living of elderly people." Electronic Thesis or Diss., Université Paris Cité, 2021. http://www.theses.fr/2021UNIP5208.
Aging population is one of the key problems for the vast majority of many countries. The number of elderly people who suffer from multiple diseases and need continuous monitoring of their vital signs increases everyday, resulting in additional healthcare costs. Modern healthcare systems in geriatric medicine often require elderly presence at the hospital which conflict with their demand for independence and privacy. Recent developments on remote e-health monitoring, provides a wide range of solutions. However, most of the devices are designed for specific medical sensing and operate independently from each other. There is still a lack of integrated framework with high interoperability and continuous online monitoring support for further correlation analysis. This thesis is a step towards a remote, complete, and continuous data gathering system for elderly people with various types of health problems. Our research spirit is motivated by immediate demand in a secured and trusted remote wireless health monitoring System for assisted living Elderly people, combining various data sources. To create such a complete system we divide it into subsystems, in order to make it feasible and easy to implement, thus allowing us to update each subsystem individually in the future studies without affecting other integrated subsystems. The main focus is on a complete remote e-health monitoring system. The list of main contributions contains (1) propose a new approach for security of monitored devices and propose a solution to prevent MiTM attacks and reduce energy consumption, (2) we propose reliable fall detection,(3) investigating and developing a novel recognition method of daily activities for monitored elderly patient, (4) propose an approach to enhance the reliability of the system and to reduce false alarms and unnecessary interventions, (5) propose and develop a sign language to text converter algorithm using multi-sensor fusion analysis. As a result, we expect to provide a monitoring system with reliable accuracy in the detection of abnormal events, and raise an alarm upon detection of such events to seek help and assistance
Bassement, Jennifer. "Identification of fall-risk factors degradation using quality of balance measurements." Thesis, Troyes, 2014. http://www.theses.fr/2014TROY0035/document.
Falls concern a third of the people aged over 65y and lead to the loss of functional ability. The detection of risks factors of falls is essential for early intervention. Six intrinsic risk factors of fall: vision, vestibular system, joint range of motion, leg muscle strength, joint proprioception and foot cutaneous proprioception were assessed with clinical tests before and after temporarily degradation. Standing balance was recorded on a force plate.From the force plate, 198 parameters of the centre of pressure displacement were computed. The parameters were used as variables to build neural network and logistic regression model for discriminating conditions. Feature selection analysis was performed to reduce the number of variables.Several models were built including 3 to 10 conditions. Models with 5 or less conditions appeared acceptable but better performance was found with models including 3 conditions. The best accuracy was 92% for a model including ankle range of motion, fatigue and vision contrast conditions. Qualities of balance parameters were able to diagnose impairments. However, the efficient models included only a few conditions. Models with more conditions could be built but would require a larger number of cases to reach high accuracy. The study showed that a neural network or a logistic model could be used for the diagnosis of balance impairments. Such a tool could seriously improve the prevention and rehabilitation practice
Mendes, da Costa Elise. "Vieillissement et santé: étude de la santé subjective, de la problématique des chutes et des enjeux méthodologiques rencontrés." Doctoral thesis, Universite Libre de Bruxelles, 2014. http://hdl.handle.net/2013/ULB-DIPOT:oai:dipot.ulb.ac.be:2013/209241.
Notre premier objectif général était de décrire et d’identifier quels facteurs influencent la santé subjective des personnes âgées non-institutionnalisées. Il est tout d’abord intéressant de noter qu’une proportion importante de personnes âgées non-institutionnalisées (entre 50 à près de 80% selon les études) évalue sa santé de manière positive, alors qu’une part non négligeable des études s’intéresse plutôt à ce qui est associé à une mauvaise santé perçue. Ensuite, les facteurs influençant la santé subjective, facteurs mesurés de manières diverses selon les auteurs, sont nombreux. La morbidité et le statut fonctionnel jouent un rôle. D’autres facteurs, hors du champ biomédical, interviennent également. On peut citer certaines caractéristiques sociodémographiques, comme l’âge, le sexe, le niveau socio-économique (en particulier le niveau d’instruction), le statut marital, les conditions de résidence ou l’origine ethnique. Certaines variables relatives à la santé mentale ont aussi une influence, de même que certains aspects du support social. D’autres types de facteurs, comme les difficultés de vision ou d’audition, l’indice de masse corporelle, ou certains comportements tels que le tabagisme ou la consommation d’alcool, doivent aussi être considérés. Ainsi, par rapport à la perception que les personnes âgées ont de leur santé, si certains éléments comme l’âge ou le sexe ne sont pas modifiables, il y a néanmoins des éléments sur lesquels on peut agir pour améliorer cette perception. Il est par exemple important d’être attentif à la présentation par les personnes âgées de symptômes de types dépressifs, et de sensibiliser les professionnels de la santé à les rechercher, les prendre en charge et à en identifier les causes. Encourager la pratique d’une activité physique adaptée ou le développement d’activités sociales répondant aux envies des personnes âgées et se déroulant dans des lieux sûrs et accessibles peut aussi être utile, de même que lutter contre l’isolement des personnes. Corriger d’éventuelles difficultés de vision ou d’audition peut aussi être bénéfique. Réfléchir et garantir l’accessibilité à ce type de soins pour les personnes âgées est donc essentiel.
Notre deuxième objectif général était d’analyser, d’un point de vue épidémiologique, la problématique des chutes chez les personnes âgées vivant à domicile. Celles-ci touchent au moins un tiers des personnes âgées de 65 ans et plus chaque année. Elles relèvent de multiples facteurs de risque, qui peuvent être regroupés en quatre catégories :1. des facteurs biologiques, médicaux, psychologiques, fonctionnels, reliés à la mobilité et sensoriels, 2. des facteurs comportementaux, 3. des facteurs environnementaux, et 4. des facteurs socio-économiques. Les chutes se passent le plus fréquemment dans l’environnement domiciliaire des personnes, lors d’activités fréquentes et habituelles de la vie quotidienne. Le plus souvent, elles sont liées à des glissades ou des trébuchements. Elles peuvent avoir des conséquences importantes, dont des lésions corporelles, souvent mineures, mais parfois graves également. Un recours aux soins peut aussi suivre la chute, celui-ci pouvant engendrer des coûts considérables. Les chutes peuvent de plus causer des détériorations fonctionnelles parfois sérieuses, et de là altérer l’autonomie des personnes, leur qualité de vie, et entraîner leur institutionnalisation. Des répercussions ou difficultés psychologiques peuvent aussi survenir, dont la peur de tomber et la restriction d’activités par peur de tomber. La peur de tomber et la restriction d’activités par peur de tomber sont fréquentes, touchant jusqu’à 60% des personnes âgées pour la peur de tomber et autour de 40% des personnes âgées pour la restriction d’activités. Elles concernent des activités importantes du quotidien et touchent les chuteurs mais aussi les non-chuteurs. Il est donc important de sensibiliser les personnes âgées à la problématique des chutes et à sa prévention, ce avant même la survenue de la première chute ou d’une chute aux conséquences sérieuses. Il est aussi nécessaire d’attirer l’attention des professionnels de la santé travaillant avec des personnes âgées sur cette problématique, sur le fait qu’un certain nombre de chutes ne sont pas rapportées, et sur l’importance de la peur de tomber et de la restriction d’activités conséquente. Il nous semble par ailleurs utile d’aborder directement avec les personnes âgées l’existence éventuelle de cette peur ou de cette restriction d’activités, sachant qu’un certain nombre de celles-ci peuvent être réticentes à les évoquer spontanément. La multifactorialité des chutes souligne par ailleurs l’implication nécessaire, pour sa prévention et sa prise en charge, de professionnels de différents domaines, que ce soient des médecins, des kinésithérapeutes ou des architectes par exemple.
Notre troisième objectif général était d’examiner les questions et aspects méthodologiques pouvant être reliés à la réalisation d’études auprès de personnes âgées. Tout d’abord, les personnes âgées peuvent présenter différents types de troubles (troubles cognitifs, visuels, auditifs, physiques ou fonctionnels) qui peuvent interférer à divers niveaux de la réalisation des études. Nous avons examiné les éventuelles différences dans les facteurs influençant la bonne santé subjective selon que l’on excluait ou non les personnes présentant des troubles cognitifs. Nous n’avons pas observé de différence importante dans ces facteurs. Comme recommandé par certains auteurs, nous pensons cependant qu’il est important d’évaluer le statut cognitif des personnes, même si cela ne constitue pas l’objectif premier des études menées. Nous ne préconisons pas d’exclure d’office des études les personnes présentant ce type de troubles mais bien de tenir compte du statut cognitif des personnes et de l’influence que celui-ci peut avoir sur les résultats observés. Ensuite, dans un certain nombre de cas lors d’études auprès de personnes âgées, il peut être nécessaire de recourir à l’assistance de proxies, c’est-à-dire de personnes répondant à la place d’une autre personne. Nous avons dans notre travail observé que le fait qu’une personne se fasse aider pour répondre à un questionnaire était associé à une fréquence rapportée plus élevée de la restriction d’activités par peur de tomber, et cela même après prise en compte de possibles co-variables. Ainsi, si le recours à un proxy s’avère nécessaire, il est important d’en tenir compte dans l’interprétation des résultats sachant que, pour pouvoir examiner l’influence des proxies sur les résultats observés, il est nécessaire de recueillir un certain nombre d’informations (caractéristiques des proxies, caractéristiques des personnes concernées, …). Il faut également garder à l’esprit que l’influence des proxies peut se marquer même si ceux-ci interviennent uniquement en fournissant une aide ponctuelle ou minime pour remplir les questionnaires. Les non-réponses, les valeurs manquantes et les déperditions de personnes lors d’études longitudinales peuvent également constituer un problème non négligeable dans la population âgée. La question de la fiabilité des informations données par les personnes âgées peut aussi être posée. D’autres aspects méthodologiques doivent être considérés, que ce soient des aspects en lien avec la construction des questionnaires, la manière dont le recrutement des personnes est effectué, le consentement informé recueilli, ou les préoccupations spécifiques que les comités d’éthique peuvent avoir par rapport à la population âgée. De plus, la réalisation d’études auprès de personnes âgées en maison de repos ou en hôpital présente également certaines spécificités. Enfin, il semble utile de former les enquêteurs aux caractéristiques liées à la réalisation d’enquêtes dans la population âgée. Un certain nombre de considérations et spécificités méthodologiques doivent donc être prises en compte lors de l’élaboration, la planification et la mise en œuvre d’études auprès de personnes âgées, études dont le nombre sera fort probablement amené à augmenter dans les futures années. En outre, nous avons noté, au fil de notre travail, une grande hétérogénéité dans les données collectées et/ou la manière de les catégoriser, ce qui rend la comparaison et la mise en commun des résultats parfois difficiles. Il nous semble donc important de veiller à une meilleure uniformité dans les données collectées, en tenant cependant compte des contextes et des spécificités culturelles, qui peuvent faire varier la manière dont on mesure un même élément ou un même concept.
Pour conclure, que nos résultats concernent la santé subjective ou la problématique des chutes, ceux-ci montrent la nécessité d’approcher la personne âgée et sa santé de manière globale, sans se limiter aux aspects uniquement médicaux ou fonctionnels. Il est par ailleurs important d’aborder la santé de cette population de manière positive et de sortir de l’idée préconçue que les personnes âgées sont nécessairement et inévitablement des personnes malades ou en mauvaise santé. Une part non négligeable de celles-ci évaluent en effet leur santé de manière positive. De plus, des pistes existent, que ce soit pour améliorer la perception que les personnes âgées ont de leur santé ou pour prévenir les chutes par exemple. Par rapport à cette approche globale et positive de la santé de la population âgée, il est intéressant de s’interroger sur l’application de celle-ci dans la prise en charge au quotidien des personnes âgées et également d’en tenir compte dans l’élaboration des politiques qui leur sont destinées. Des pistes de recherche restent à explorer et la confrontation de certains de nos résultats à des données plus actuelles serait utile. De même, il serait intéressant d’élargir nos recherches au contexte des pays en développement, étant donné le vieillissement rapide de la population auquel ceux-ci devront faire face.
Doctorat en Santé Publique
info:eu-repo/semantics/nonPublished
Martin, Natacha. "Contribution à la question du sens de la chute du sujet âgé : les raisons de la chute, la chute de la raison." Thesis, Lyon 2, 2014. http://www.theses.fr/2014LYO20142.
With the increase of life expectancy, psychological writings about ageing have not developed as much as those concerning adults and children. It seemed to us interesting, fascinating and fruitful to think about this senescence period by restating the « somat/psyche » duality throughout the deterioration event. The use of a quantitative and qualitative methodology allows us to tackle the fall event as a traumatic experience according to physical data (fragile ou valid subject, somatic or psychomotor consequences…), temporal (since the last fall, moment of the fall, objective and subjective age of the fall…) and psychic (defenses set up, reminiscence, the work of getting old…) So we specifically looked at the turning point of this event in the context of expensive treatment of conflicts emerging at that time to discover obsessive defense mechanisms and primary maternal regression. In consequence, the development of psychological and psychoanalytical reasoning on the observation of the fall of the ageing subject can only be appreciated by not « falling » in the belief of a unique link of casuality, within an indistinguishable demographic class where age would be seen as an etiological factor. The use of quantitative and qualitative analysis of the discourse gives access to postfall reactive data but also to psychic treatment methods of the conflicts and affects which emerged from this event. We combined verbal communication with the drawing technique to get an insight of the mental images set in the historical narrative of memory. The fall is then exposed as an action, to mitigate the failure of the protective shield system and the capacities of development and connection to the narcissistic injury of senescence. However, it can also be appreciated as a coming back an elaborative resumption of attachment that leads to an inevitable end. It was then that "what is called a reason for living is also an excellent reason for dying" (Albert Camus). Indeed writings on the subject of the psychological deterioration of the ageing person are mainly studied in the context of the psychopathological or deficient process of the frail person in question, hospitalized without really taking into account the individual and collective complex alterations common to the process of ageing. We therefore concentrated on the psychic process of a valid old subject in order to glean more clinical reflections on the type of anxiety and object interaction. The TAT/SAT proposed concerning our study has established the psychic constitution of an internal model of an insecure relationship of the ageing, linked with an infringing relational experience with a failing and disappointing maternal object
Nicolaï, Alice. "Interpretable representations of human biosignals for individual longitudinal follow-up : application to postural control follow-up in medical consultation." Electronic Thesis or Diss., Université Paris Cité, 2021. http://www.theses.fr/2021UNIP5224.
Individual longitudinal follow-up, which aims at following the evolution of an individual state in time, is at the heart of numerous public health issues, particularly in the field of medical prevention. The increasing availability of non-invasive sensors that record various biosignals (e.g., blood glucose, heart rate, eye movements), has encouraged the quantification of human physiology, sensorimotricity, or behavior with the purpose of deriving markers for individual follow-up. This objective raises however several challenges related to signal modelling. Indeed, this particular type of data is complex to interpret, and, a fortiori, to compare across time. This thesis studies the issue of extracting interpretable representations from biosignals through the problematic of balance control follow-up in medical consultation, which has crucial implications for the prevention of falls and frailty in older adults. We focus in particular on the use of force platforms, which are commonly used to record posturography measures, and can be easily deployed in the clinical setting thanks to the development of low cost platforms such as the Wii Balance Board. For this particular application, we investigate the pros and cons of using feature extraction methods or alternatively searching for a generative model of the trajectories. Our contributions include first the review and study of a wide range of state-of-the-art variables that are used to assess fall risk in older adults, derived from the center of pressure (CoP) trajectory. This signal is commonly analyzed in the clinical literature to infer information about balance control. Secondly, we develop a new generative model, ``Total Recall'', based on a previous stochastic model of the CoP, which has shown to reproduce several characteristics of the trajectories but does not integrate the dynamic between the CoP and the center of mass (CoM) -- a dynamic which is considered to be central in postural control. We also review and compare the main methods of estimation of the CoM in quiet standing and conclude that it is possible to obtain an accurate estimation using the Wii Balance Board. The results show the potential relevance of the Total Recall model for the longitudinal follow-up of postural control in a clinical setting. Overall, we highlight the benefit of using generative models, while pointing out the complementarity of features-based and generative-based approachs. Furthermore, this thesis is interested in introducing representations learned on labeled data and tailored for a particular objective of follow-up. We propose new classification algorithms that take advantage of a priori knowledge to improve performances while maintaining complete interpretability. Our approach relies on bagging-based algorithms that are intrinsically interpretable, and a model-space regularization based on medical heuristics. The method is applied to the quantification of fall risk and frailty. This dissertation argues for the importance of researching interpretable methods, designed for specific applications, and incorporating a-priori based on expert knowledge. This approach shows positive results for the integration of the selected biosignals and statistical learning methods in the longitudinal follow-up of postural control. The results encourage the continuation of this work, the further development of the methods, especially in the context of other types of follow-up such as continuous monitoring, and the extension to the study of new biosignals
Vannier-Nitenberg, Christiane. "La recherche-action au service de l’examen périodique de santé senior." Thesis, Lyon 1, 2013. http://www.theses.fr/2013LYO10190/document.
The increase of life expectancy is a major issue to face in the decades to come. A consequence of this increasing life expectancy is the emergence of chronic diseases. It is now acknowledged that individual ageing is strongly influence by biological, psychological, environmental and social variables. Prevention begins at birth and continues throughout life. It is for this reason, that a prevention consultation at certain key moments in life, such as at retirement, is strongly advised. Our doctorate work consisted of documenting the setup of periodic health examinations dedicated to seniors. This was supported by scientific proof provided by carrying out many action researches in the Health Examination centres of French Health Insurance, an approach similar to ‘Evidence Based Medicine’. The action researches were directed towards three main public health issues amongst the elderly which include falling, memory cognitive impairment and macular degeneration related to age. Each action research contributed to the establishment of this health examination for seniors. Indeed, now there is a better recognition of characteristics amongst seniors who have suffered falls thanks to the development of a tool which gives a predictive score a falling, and in turn action strategies. In addition, there is a tool to spot and identify mild cognitive impairment and screening for macular degeneration related to age through the use of telemedicine. Other health topics will need to be explored but French Health Examination Centres already position themselves as responsible decisive actors for the ageing population