Mobility Decline in Old Age

The impact of exercise and vitamin D supplementation on physical function in community-dwelling elderly individuals: A randomized trial

BACKGROUND

We investigated the impact of exercise and vitamin D supplementation on physical function and locomotor dysfunction in community-dwelling elderly individuals.

METHODS

In total, 148 community-dwelling elderly individuals (aged ≥60 years) who were not taking osteoporosis medications participated in a 24-week intervention. The participants were randomly divided into an exercise group, vitamin D group, and exercise and vitamin D group. The participants and outcome-assessing staff were not blinded to group assignment. Exercise comprised three daily sets each of single-leg standing (1 min/leg/set) and squatting (5-6 repetitions/set); vitamin D supplementation was 1000 IU/day. Participants were contacted every 2 weeks to check on their condition and encourage continued participation. The primary outcome was lower limb muscle strength and mass; secondary outcomes were several physical function measurements, serum 25-hydroxyvitamin D levels, and results of a self-assessment questionnaire completed pre- and post-intervention.

RESULTS

We analyzed data from 45, 42, and 43 participants in the exercise, vitamin D, and exercise and vitamin D groups, respectively, who completed the intervention. Locomotive syndrome, which involves reduced mobility due to locomotive organ impairment, was diagnosed in 99 participants (76.2%). Many physical function measurements improved in all groups. Lower limb muscle mass increased significantly in all three groups, with no significant differences between the groups in the degree of change. The average serum 25-hydroxyvitamin D of all vitamin D-supplemented participants increased from 28.1 ng/ml to 47.3 ng/ml after vitamin D supplementation.

CONCLUSIONS

Both exercise and vitamin D supplementation independently improved physical function and increased muscle mass in community-dwelling elderly individuals. Moreover, the combination of exercise and vitamin D supplementation might further enhance these positive effects.

CLINICAL TRIAL REGISTRY

UMIN Clinical Trial, UMIN000028229.

Normal Changes in Gait and Mobility Problems in the Elderly

There are normal physiologic changes that occur as people age. Gait and mobility are altered with aging, and these changes are a combination of alterations in the gait pattern and in the function of organs. Changes in gait are associated with functional decline, less independence, and impaired quality of life. Reduced walking speed is the most consistent age-related change, but there are other contributors to an altered gait: impaired balance and stability, lower extremity strength, and the fear of falling.

Biomechanical Comparison of Countermovement Jumps Performed on Land and in Water: Age Effects

Context:The aquatic environment provides a low-impact alternative to land-based exercise and rehabilitation in older adults.Objective:Evaluate the biomechanics of older adults and young adults performing jumping movements on land and in water.Design and Setting:Cross-sectional, mixed-factorial experiment; adjustable-depth pool at sports medicine research facility.Participants:Fifty-six young adults (age = 22.0 [3.9] y) and 12 healthy older adults (age = 57.3 [4.4] y).Interventions:Each participant performed 6 maximal effort countermovement jumps: 3 jumps were performed on land, and 3 other jumps were performed with participants immersed in chest-deep water.Main Outcome Measures:Using data from the amortization and propulsive phases of jumping, the authors computed the following kinetic and kinematic measures: peak and mean mechanical power, peak force, amortization time and rate, unweighting and propulsive times, and lower-extremity segment kinematics.Results:Mechanical power outputs were greater in younger adults (peak: 7322 [4035] W) versus older adults (peak: 5661.65 [2639.86] W) and for jumps performed in water (peak: 9387 [3981] W) versus on land (peak: 4545.84 [1356.53] W). Peak dorsiflexion velocities were greater for jumps performed in water (66 [34] deg/s) versus on land (4 [7] deg/s). The amortization rate was 26% greater in water versus on land. The amortization time was 20% longer in older adults versus young adults.Conclusions:Countermovement jumps performed in water are mechanically specific from those performed on land. Older adults jumped with longer unweighting times and increased mechanical power in water. These results suggest that aquatic-based exercise and rehabilitation programs that feature jumping movements may benefit older adults.

‘It makes your life worthwhile. It gives you a purpose in living’: mobility experiences among active older adults with low income

The World Health Organization claims that mobility is vital to healthy ageing and is the best guarantee of older adults being able to cope and remain in their homes and communities. Mobility enables older adults to maintain their physical health, independence and participation in society. In general, mobility is examined objectively, from a quantitative perspective where mobility is measured as physical movement (e.g.physical activity) and/or travel behaviour (e.g.trips, modes and distances). The predominant focus on the functional aspects of mobility tends to overlook the subjective (e.g.perceptions, attitudes and motivations) and temporal dimensions of older adults’ mobility experiences. Using a constructivist grounded theory methodology, we conducted 24 in-depth interviews with six highly active community-dwelling older adults with low income, aged 65 or over, over a period of four years. Our analysis identified the following themes: maintaining a sense of self, being resourceful, openness to engagement, engaging in superficial contact, experiencing social capital, accessing transportation, leaving the immediate neighbourhood and facing affordability. Findings illustrate that intrapersonal factors, in addition to environmental (built, social and cultural) and temporal-level factors, play a crucial role in mobility. In the future, this gained knowledge can be incorporated into approaches to study the multiple interrelated factors and their interrelations that influence older adults’ mobility.

The walk ratio: Investigation of invariance across walking conditions and gender in community-dwelling older people

BACKGROUND

The step length-cadence ratio, also called the walk ratio (WR; cm/steps/min) is a measure of cautious gait, poor balance control or impaired gait, but has not been investigated for both genders in a general population of older adults across different speeds and conditions.

METHOD

The participants were community-dwelling volunteers between 70 and 81 years. They walked 6.5 m under four different conditions: At preferred speed, fast speed, during a dual task condition and on an uneven surface. Step length (cm) and cadence (steps/minute) was captured using a body-worn sensor. Both cadence and step lengths were adjusted for body height.

RESULTS

70 older adults participated (mean age 75.5 (SD 3.4), 60 percent women). The WR was 0.60 cm/steps/min (SD 0.07) during preferred speed walking, 0.58 cm/steps/min (SD 0.07) during fast walking, 0.68 cm/steps/min (SD 0.18) during dual task-walking and 0.59 cm/steps/min (0.07) during uneven surface-walking. In planned pairwise comparisons, the WR during dual task was significantly different from preferred speed walking (mean difference -0.087 cm/steps/min, 95% CI -0.140, -0.033), from fast speed walking (mean difference -0.098 cm/steps/min, 95% CI -0.154, -0.041) and uneven surface walking (mean difference 0.092 cm/steps/min, 95% CI 0.040, 0.145). There were no gender differences except during the fast walking condition, where women had a significantly lower WR than the men (0.56 cm/steps/min vs 0.61 cm/steps/min, p = 0.002).

DISCUSSION

We found that the WR is invariant during different speeds, and during an uneven surface condition, but is affected during a dual task-condition, when attention must be divided between a cognitive and a motor task.

A tailored counseling and home-based rehabilitation program to increase physical activity and improve mobility among community-dwelling older people after hospitalization: protocol of a randomized controlled trial

BACKGROUND

Physical activity (PA) decreases during hospitalization. In particular, the amount of PA engaged in by older people who are hospitalized following musculoskeletal injury is likely to be limited for months after discharge home. Given the importance of an active lifestyle for their recovery and the prevention of future adverse outcomes, there is clearly a need for interventions to increase PA. This article describes the protocol of a randomized controlled trial set up to investigate the effects of a physical activity oriented home rehabilitation program (ProPA) on PA and the restoration of mobility in community-dwelling older people.

METHODS

Men and women aged 60 years or older hospitalized due to a musculoskeletal injury or disorder in the back or lower limbs are recruited. After discharge from hospital to home, participants are randomized into a six-month ProPA program or a standard care (control) group. The ProPA program consists of a motivational interview, goal attainment process, guidance for safe walking, a progressive home exercise program and physical activity counseling. In addition, frail participants who are not able to go outdoors alone receive support from volunteers. Primary outcomes are PA measured using a 3-dimentional accelerometer, and mobility assessed by the Short Physical Performance Battery and self-reports. Secondary outcomes are life space mobility, participation restriction, fear of falling, pain, mood, and grip strength. Information on barriers to and enablers of PA participation are also collected. Data on mortality and use of health services are collected from the national register. In this 6-month intervention, all participants are assessed in their homes at baseline and after three and six months, and at 12 months after randomization they will receive a follow-up questionnaire.

DISCUSSION

This study investigates the effects of a rehabilitation program on PA and mobility among older people at risk for increased sedentary time and mobility problems. If positive effects are observed, the program can be considered for incorporation into the health care system and thereby contribute to the rehabilitation of older people who have recently been discharged from hospital.

TRIAL REGISTRATION

ISRCTN13461584 . Registered 27 January 2016.

Mobility care in nursing homes: development and psychometric evaluation of the kinaesthetics competence self-evaluation (KCSE) scale

BACKGROUND

Impaired mobility is a prevalent condition among care-dependent persons living in nursing homes. Therefore, competence development of nursing staff in mobility care is important. This study aimed to develop and initially test the Kinaesthetics Competence Self-Evaluation (KCSE) scale for assessing nursing staff's competence in mobility care.

METHODS

The KCSE scale was developed based on an analysis of the concept of nurses' competence in kinaesthetics. Kinaesthetics is a training concept that provides theory and practice about movement foundations that comprise activities of daily living. The scale contains 28 items and four subscales (attitude, dynamic state, knowledge and skills). Content validity was assessed by determining the content validity index within two expert panels. Internal consistency and construct validity were tested within a cross-sectional study in three nursing homes in the German-speaking region of Switzerland between September and November 2015.

RESULTS

The content validity index for the entire scale was good (0.93). Based on a sample of nursing staff (n = 180) the internal consistency results were good for the whole scale (Cronbach's alpha = 0.91) and for the subscales knowledge and skills (α = 0.91, 0.86), acceptable for the subscale attitude (α = 0.63) and weak for the subscale dynamic state (α = 0.54). Most items showed acceptable inter-item and item-total correlations. Based on the exploratory factor analysis, four factors explaining 52% of the variance were extracted.

CONCLUSION

The newly developed KCSE scale is a promising instrument for measuring nursing staff's attitude, dynamic state, knowledge, and skills in mobility care based on kinaesthetics. Despite the need for further psychometric evaluation, the KCSE scale can be used in clinical practice to evaluate competence in mobility care based on kinaesthetics and to identify educational needs for nursing staff.

The Relationship between the Neighborhood Built Environment and Active Transportation among Adults: A Systematic Literature Review

Active transportation (AT) has aroused great interest in recent years as it may benefit public health and reduce the dependency on cars. This article aims to summarize recent findings on the relationship between the objectively measured built environment and AT among adults, to examine if different study designs may generate different results, and to provide directions for future research. A systematic literature review of journal articles from different databases was conducted. Fifty-one articles published between 2005 and 2017 were identified, and twelve built environment factors were extracted. The results showed that residential density, land use mix, street connectivity, retail land use, walkability, sidewalk, and access to destinations had a convincing positive relationship with walking for transport. Regarding cycling for transport, while street connectivity and bike lane showed a convincing positive relationship, neighborhood aesthetics and access to destinations showed a convincing negative relationship. Studies that use different analyzed geographic units and different measurements of AT may generate different results, so choosing suitable geographic units and measurement of AT is necessary to reduce the mismatch in the relationships. In addition, we need more longitudinal studies, more studies on cycling for transport, and more studies in countries outside North America and Australasia.

Influence of age, gender and test conditions on the reproducibility of Dual-Task walking performance

BACKGROUND

The review of methodological problems (confounding factors) of gait analysis in intervention studies with seniors is underrepresented.

AIM

This study focusses on two common problems of gait analysis under single-task (ST) and dual-task (DT) conditions (visual verbal Stroop test): (1) reproducibility of walking variables and (2) the effects of gait velocity, gender and age on peak plantar pressure to identify confounding effects on relevant outcome parameters.

METHODS

The participants (N = 86, 71.9 ± 4.6 years) were divided into a (1) reproducibility (n = 28) and an (2) outcome parameter group (n = 58). Gait kinematics (step length; cadence) and kinetics (peak plantar pressure under heel, midfoot and forefoot) were analyzed walking barefoot on a treadmill (100 Hz) at self-selected speed for the reproducibility and at two different speeds (v = 3.5; 4.5 km/h) for outcome parameters. ICC analysis combined with the repeatability coefficient and SEM calculation, an ANOVA with repeated measurements and determination of effect sizes (η _p² ) as well as a partial correlation analyses with body mass were done.

RESULTS

The reproducibility of the walking variables under ST and DT conditions was excellent with ICC values of .67 to .99. The SEM and CR results as presented in Table 2 support these findings for some of the parameters.

DISCUSSION

Plantar pressure values were influenced by gait velocity but less by age and gender. For DT walking the differences between preferred and fixed gait speed have to be controlled to assign the DT effects.

CONCLUSION

Effects of intervention studies should be carefully interpreted regarding the absolute reproducibility.

The role of environmental factors for the onset of restricted mobility outside the home among older adults with osteoarthritis: a prospective cohort study

OBJECTIVES

The study examines how environmental factors contribute to the onset of restricted mobility outside the home among older adults with osteoarthritis.

METHODS

This is a prospective cohort study of adults aged 50 years and older with osteoarthritis (n=1802). Logistic regression tested the association between the onset of restricted mobility outside the home and health, sociodemographic and perceived environmental barriers (hills and steep slopes, inaccessible public buildings, poor pavement condition, lack of access to public parks or sport facilities, heavy traffic or speeding cars and poor weather). The potential moderating role of environmental barriers on the association between health factors and onset was examined using interaction terms and stratified analysis.

RESULTS

Of 1802 participants, 13.5% (n=243) reported the onset of restricted mobility outside the home at 3-year follow-up. Walking disability, anxiety, depression, cognitive impairment and obesity and all environmental barriers were associated with onset after adjustment for confounders. Environmental barriers had an added contribution to the effect of the health conditions on onset of restricted mobility, which was attenuated when adjusted for confounders. The added contribution remained only for walking disability and the presence of hills and steep slopes; in the presence of both, the association with onset of restricted mobility was stronger (OR 7.66, 95% CI 4.64 to 12.64) than in the presence of walking disability (3.60, 2.43 to 5.32) or the presence of hills and steep slopes alone (4.55, 2.89 to 7.16).

CONCLUSION

For older adults with osteoarthritis, environmental barriers are associated and add a contribution to that of morbidities and walking disability on the onset of restricted mobility outside the home. Awareness of environmental barriers is important when aiming to maintain mobility and activities outside the home despite health conditions in older adults.

The impact of multimorbidity on grip strength in adults age 50 and older: Data from the health and retirement survey (HRS)

BACKGROUND

Multimorbidity, the presence of two or more chronic diseases, is a public health concern. The measurement of grip strength has been proposed as a measure of overall body strength and is reliable and easy to measure. The purpose of this study was to investigate the relationship between the number of chronic diseases and common co-occurring chronic diseases with grip strength.

METHODS

A cross-sectional analysis was conducted of 5877 respondents (2744=male, 3103=female) from the 2008 Health and Retirement Study (HRS) who completed grip strength measurements (kg).

RESULTS

As the number of chronic diseases increased, an incremental decrease in grip strength occurred and became more pronounced with ≥3 chronic diseases present (b=3.1, 95% CI=2.3-3.9, p<0.001). No statistically significant relationship was identified between specific chronic diseases (except for stroke) and grip strength.

CONCLUSION

Multimorbidity has a statistically significant negative relationship on grip strength. Grip strength should be considered as a physical performance measure to incorporate into the care of patients with multimorbidity.

Residential proximity to urban centres, local-area walkability and change in waist circumference among Australian adults

Consistent associations have been observed between macro-level urban sprawl and overweight/obesity, but whether residential proximity to urban centres predicts adiposity change over time has not been established. Further, studies of local-area walkability and overweight/obesity have generated mixed results. This study examined 4-year change in adults' waist circumference in relation to proximity to city centre, proximity to closest suburban centre, and local-area walkability. Data were from adult participants (n=2080) of a cohort study on chronic conditions and health risk factors in Adelaide, Australia. Baseline data were collected in 2000-03 with a follow-up in 2005-06. Multilevel regression models examined in 2015 the independent and joint associations of the three environmental measures with change in waist circumference, accounting for socio-demographic covariates. On average, waist circumference rose by 1.8cm over approximately 4years. Greater distance to city centre was associated with a greater increase in waist circumference. Participants living in distal areas (20km or further from city centre) had a greater increase in waist circumference (mean increase: 2.4cm) compared to those in proximal areas (9km or less, mean increase: 1.2cm). Counterintuitively, living in the vicinity of a suburban centre was associated with a greater increase in adiposity. Local-area walkability was not significantly associated with the outcome. Residential proximity to city centre appears to be protective against excessive increases in waist circumference. Controlled development and targeted interventions in the urban fringe may be needed to tackle obesity. Additional research needs to assess behaviours that mediate relationships between sprawl and obesity.

A relação entre autopercepção do estado de saúde e a condição física em septuagenários e octogenários

Resumo O processo de envelhecimento tem inerente uma diminuição das capacidades fisiológicas. Os testes Handrip (HT) e 6-Minutos-Andar (6MW) são utilizados na avaliação da aptidão física do idoso. O questionário SF-36v2, que inclui Componente Física (CF), Função Física (FF) e Desempenho Físico (DF), é usado na avaliação da percepção de saúde. O objetivo deste artigo é comparar a aptidão física e a percepção de saúde em septuagenários (70’) e octogenários (80’) e examinar a relação entre variáveis. Cinquenta e sete 70’ e vinte e seis 80’, recrutados na população de Ponte de Lima, preencheram o questionário SF-36v2 e realizaram os testes HT e 6MW. Teste t e Coeficiente de Pearson foram usados para análise estatística, significância p < 0.05. Foram encontradas diferenças significativas entre grupos no Desempenho Físico (p = 0.025), Força Manual (p <0.05) e Capacidade Cardiorrespiratória (p < 0.001). Correlações moderadas foram encontradas entre Força Manual, Capacidade Cardiorrespiratória e DF (p < 0.001) nos dois grupos. A CF e FF foram correlacionadas com Força Manual (p < 0.001) nos 70’. Os 70’ são mais fortes e com maior capacidade cardiorrespiratória que os 80’. A força muscular, nos 70’, e a capacidade cardiorrespiratória, nos 70’ e 80’, promovem a percepção de saúde.

Resistance training and redox homeostasis: Correlation with age-associated genomic changes

Regular physical activity is effective as prevention and treatment for different chronic conditions related to the ageing processes. In fact, a sedentary lifestyle has been linked to a worsening of cellular ageing biomarkers such as telomere length (TL) and/or specific epigenetic changes (e.g. DNA methylation), with increase of the propensity to aging-related diseases and premature death. Extending our previous findings, we aimed to test the hypothesis that 12 weeks of low frequency, moderate intensity, explosive-type resistance training (EMRT) may attenuate age-associated genomic changes. To this aim, TL, global DNA methylation, TRF2, Ku80, SIRT1, SIRT2 and global protein acetylation, as well as other proteins involved in apoptotic pathway (Bcl-2, Bax and Caspase-3), antioxidant response (TrxR1 and MnSOD) and oxidative damage (myeloperoxidase) were evaluated before and after EMRT in whole blood or peripheral mononuclear cells (PBMCs) of elderly subjects. Our findings confirm the potential of EMRT to induce an adaptive change in the antioxidant protein systems at systemic level and suggest a putative role of resistance training in the reduction of global DNA methylation. Moreover, we observed that EMRT counteracts the telomeres' shortening in a manner that proved to be directly correlated with the amelioration of redox homeostasis and efficacy of training regime, evaluated as improvement of both muscle's power/strength and functional parameters.

Self-reported Mobility in Older Patients Predicts Early Postoperative Outcomes after Elective Noncardiac Surgery

BACKGROUND

Specific geriatric assessment tools may complement traditional perioperative risk stratification. The aim of this study was to evaluate whether self-reported mobility is predictive of postoperative outcomes in older patients undergoing elective noncardiac surgery.

METHODS

Patients aged 69 yr or older (n = 197) underwent (1) traditional risk assessments (American Society of Anesthesiologists physical status classification and Revised Cardiac Risk Index), (2) five-point frailty evaluation, (3) self-reported mobility assessment using the Mobility Assessment Tool-short form (range, 30.21 [poor] to 69.76 [excellent]), and (4) measurements of high-sensitivity C-reactive protein. Outcomes were postoperative complications, time to discharge, and nursing home placement (NHP).

RESULTS

In the sample of this study (mean age, 75 ± 5 yr; 51% women), 72% had intermediate- or high-risk surgery. Median time to discharge was 3 days (interquartile range, 1 to 4 days). Thirty patients (15%) developed postoperative complications, and 27 (13%) required NHP. After controlling for age, sex, body mass index, pain score, Revised Cardiac Risk Index, American Society of Anesthesiologist physical status, surgical risk, and high-sensitivity C-reactive protein, worse self-reported mobility (per 10-point decrease in Mobility Assessment Tool, which is equivalent to 1 SD) was associated with more postoperative complications (odds ratio [OR], 1.69; 95% CI, 1.05 to 2.73), later time to discharge (hazards ratio, 0.81; 95% CI, 0.68 to 0.96), and increased NHP (OR, 2.01; 95% CI, 1.13 to 3.56). By using the same model, intermediate frailty or frailty increased NHP (OR, 3.11; 95% CI, 1.02 to 9.54) but was not related to either postoperative complications or time to discharge.

CONCLUSIONS

Preoperative self-reported mobility using a novel and brief assessment may help identify elderly patients at risk for adverse postoperative events.

Does telomere length predict decline in physical functioning in older twin sisters during an 11-year follow-up?

Leukocyte telomere length (LTL) is known to be associated with mortality, but its association with age-related decline in physical functioning and the development of disability is less clear. This study examined the associations between LTL and physical functioning, and investigated whether LTL predicts level of physical functioning over an 11-year follow-up. Older mono- (MZ) and dizygotic (DZ) twin sisters (n = 386) participated in the study. Relative LTL was measured by qPCR at baseline. Physical functioning was measured by 6-min walking distance and level of physical activity (PA). Walking distance was measured at baseline and at 3-year follow-up. PA was assessed by questionnaire at baseline and at 3- and 11-year follow-ups. The baseline analysis was performed with path models, adjusted with age and within-pair dependence of twin pairs. The longitudinal analysis was performed with a repeated measures linear model adjusted for age and longitudinal within-pair dependence. A nonrandom missing data analysis was utilized. At baseline, in all individuals, LTL was associated with PA (est. 0.14, SE 0.06, p = 0.011), but not with walking distance. Over the follow-up, a borderline significant association was observed between LTL and walking distance (est. 0.14, SE 0.07, p = 0.060) and a significant association between LTL and PA (est. 0.19, SE 0.06, p = 0.001). The results suggest that LTL is associated with PA and may, therefore, serve as a biomarker predicting the development of disability. Longitudinal associations between LTL and PA were observed only when nonrandom data missingness was taken into account in the analysis.

Pain and Cognitive Function Among Older Adults Living in the Community

BACKGROUND

Pain related to many age-related chronic conditions is a burdensome problem in elderly adults and may also interfere with cognitive functioning. The purpose of this study was to examine the cross-sectional relationship between measures of pain severity and pain interference and cognitive performance in community-living older adults.

METHODS

We studied 765 participants in the Maintenance of Balance Independent Living Intellect and Zest (MOBILIZE) Boston Study, a population-based study of persons aged 70 and older. Global pain severity and interference were measured using the Brief Pain Inventory subscales. The neuropsychological battery included measures of attentional capacity (Trail Making Test A, WORLD Test), executive function (Trail Making Test B and Delta, Clock-in-a-Box, Letter Fluency), memory (Hopkins Verbal Learning Test), and a global composite measure of cognitive function. Multivariable linear regression models were used to analyze the relationship between pain and cognitive functioning.

RESULTS

Elderly adults with more severe pain or more pain interference had poorer performance on memory tests and executive functioning compared to elders with none or less pain. Pain interference was also associated with impaired attentional capacity. Additional adjustment for chronic conditions, behaviors, and psychiatric medication resulted in attenuation of many of the observed associations. However, the association between pain interference and general cognitive function persisted.

CONCLUSIONS

Our findings point to the need for further research to understand how chronic pain may contribute to decline in cognitive function and to determine strategies that may help in preventing or managing these potential consequences of pain on cognitive function in older adults.

How Genetics Might Affect Real Property Rights: Currents in Contemporary Bioethics

New developments in genetics could affect a variety of real property rights. Mortgage lenders, mortgage insurers, real estate sellers, senior living centers, retirement communities, or other parties in residential real estate transactions begin requiring predictive genetic information as part of the application process. One likely use would be by retirement communities to learn an individual's genetic risk for Alzheimer's disease. The federal Fair Housing Act prohibits discrimination based on disability, but it is not clear that it would apply to genetic risk assessments. Only California law explicitly applies to this situation and there have been no reported cases.

Theory-based physical activity beliefs by race and activity levels among older adults

OBJECTIVE

Given the benefits of physical activity and the high proportion of inactivity among older adults, the purpose was to elicit theory-based behavioral, normative, and control physical activity beliefs among 140 educationally and economically diverse older adults and compare their beliefs by race (Blacks vs. Whites) and physical activity levels (inactive/underactive vs. highly active individuals).

DESIGN

This was an elicitation study that took place in eight, mostly rural community settings in a Southeastern US state, such as Council of Aging Offices, retirement centers, and churches. Participants' behavioral, normative, and control beliefs were elicited via in person interviews. A valid and reliable questionnaire was also used to assess their physical activity levels.

RESULTS

According to the content analysis, inactive/underactive participants reported fewer physical activity advantages than highly active participants. Common physical activity advantages between the two groups were overall health, emotional functioning, and physical functioning. Similar physical activity advantages were reported among Blacks and Whites with overall health being the most important advantage. The most common physical activity disadvantages and barriers for all four groups were falls, injuries, pain, and health issues. Inactive/underactive individuals and Blacks tended to report more disadvantages and barriers than their peers. Common physical activity supporters were family members, friends and peers, and health-care professionals.

CONCLUSION

In their physical activity motivational programs, health promoters should reinforce physical activity benefits, social support, access to activity programs, and safety when intervening among older adults.

Neuromotor training in older women living in long-term care setting: a pilot study

This pilot study identified the effect and the feasibility of neuromotor training in a group of ageing women living in a long-term care setting. Thirty-five older women (mean age, 84.18 years; SD = 5.92 years) participated in the study. Twenty women were in the intervention group, and 15 women were in the control group. Data on mobility, activities of daily living (ADL) and fear of falling were collected before and after the 16-week training period. The neuromotor training program was based on concepts from motor control and motor learning. All participants completed the training program, and no adverse events occurred. The intervention group showed steady and significant improvements in mobility, ADL and fear of falling after the intervention, but the control group did not exhibit significant changes. Moreover, mediation analysis demonstrated the role of mobility as a mediator between participation in physical training and fear of falling.

Influence of Knee Pain and Low Back Pain on the Quality of Life in Adults Older Than 50 Years of Age

OBJECTIVES

To investigate the impact of knee pain and low back pain (LBP) on quality of life (QoL) in people ≥50 years of age.

DESIGN

Cross-sectional study.

SETTING

A nationwide survey.

PARTICIPANTS

A total of 1295 men and 1658 women aged ≥50 years from the Fifth Korea National Health and Nutrition Examination Survey, conducted in 2010.

METHODS

Knee pain and LBP were assessed by a questionnaire, and QoL was assessed by the EuroQol (EQ)-5D, consisting of the EQ-5D descriptive system and the EuroQol visual analogue scale (EQ-VAS). Multiple linear regression models were used to evaluate associations between knee pain or LBP and the EQ-5D index or EQ-VAS score.

MAIN OUTCOME MEASUREMENTS

Standardized coefficient (β) for QoL according to the presence of knee pain or LBP.

RESULTS

Both men and women with knee pain or LBP had a lower QoL than those without them in all dimensions of the EQ-5D, EQ-5D index, and EQ-VAS scores. Compared with most other chronic diseases, knee pain and LBP showed stronger negative correlations with the EQ-5D index and EQ-VAS score. In men, LBP showed a stronger negative correlation with the EQ-VAS score than knee pain. The relative impact of LBP on knee pain was greater in people aged ≥65 years than in people aged 50-64 years, especially men.

CONCLUSIONS

These results suggest that knee pain and LBP are important factors affecting QoL in middle-aged and elderly people and that LBP may be relatively more important than knee pain in elderly people, especially men. Proper management and prevention of these conditions can help to improve QoL.

Heterogeneity of physical function responses to exercise training in older adults

OBJECTIVES

To describe the interindividual variability in physical function responses to supervised resistance and aerobic exercise training interventions in older adults.

DESIGN

Data analysis of two randomized, controlled exercise trials.

SETTING

Community-based research centers.

PARTICIPANTS

Overweight and obese (body mass index (BMI)≥27.0 kg/m2) sedentary men and women aged 65 to 79 (N=95).

INTERVENTION

Five months of 4 d/wk of aerobic training (AT, n=40) or 3 d/wk of resistance training (RT, n=55).

MEASUREMENTS

Physical function assessments: global measure of lower extremity function (Short Physical Performance Battery (SPPB)), 400-m walk, peak aerobic capacity (VO2 peak), and knee extensor strength.

RESULTS

On average, both exercise interventions significantly improved physical function. For AT, there was a 7.9% increase in VO2 peak; individual absolute increases varied from 0.4 to 4.3 mL/kg per minute, and four participants (13%) showed no change or a decrease in VO2 peak. For RT, knee extensor strength improved an average of 8.1%; individual increases varied from 1.2 to 63.7 Nm, and 16 participants (30%) showed no change or a decrease in strength. Usual gait speed, 400-m walk time, chair rise time, and SPPB improved for the majority of AT participants and usual gait speed, chair rise time, and SPPB improved for the majority of RT participants, but there was wide variation in the magnitude of improvement. Only change in 400-m walk time with RT was related to exercise adherence (correlation coefficient=-0.31, P=.004).

CONCLUSION

Despite sufficient levels of adherence to both exercise interventions, some participants did not improve function, and the magnitude of improvement varied widely. Additional research is needed to identify factors that optimize responsiveness to exercise to maximize its functional benefits in older adults.

Acquiring visual information for locomotion by older adults: a systematic review

Developments in technology have facilitated quantitative examination of gaze behavior in relation to locomotion. The objective of this systematic review is to provide a critical evaluation of available evidence and to explore the role of gaze behavior among older adults during different forms of locomotion. Database searches were conducted to identify research papers that met the inclusion criteria of (1) study variables that included direct measurement of gaze and at least one form of locomotion, (2) participants who were older adults aged 60 years and above, and (3) reporting original research. Twenty-five papers related to walking on a straight path and turning (n=4), stair navigation (n=3), target negotiation and obstacle circumvention (n=13) and perturbation-evoked sudden loss of balance (n=5) were identified for the final quality assessment. The reviewed articles were found to have acceptable quality, with scores ranging from 47.06% to 94.12%. Overall, the current literature suggests that differences in gaze behavior during locomotion appear to change in late adulthood, especially with respect to transfer of gaze to and from a target, saccade-step latency, fixation durations on targets and viewing patterns. These changes appear to be particularly pronounced for older adults with high risk of falling and impaired executive functioning.

Work-related stress in midlife is associated with higher number of mobility limitation in older age-results from the FLAME study

The aim of this study is to investigate whether work-related stress symptoms in midlife are associated with a number of mobility limitations during three decades from midlife to late life. Data for the study come from the Finnish Longitudinal Study of Municipal Employees (FLAME). The study includes a total of 5429 public sector employees aged 44-58 years at baseline who had information available on work-related stress symptoms in 1981 and 1985 and mobility limitation score during the subsequent 28-year follow-up. Four midlife work-related stress profiles were identified: negative reactions to work and depressiveness, perceived decrease in cognition, sleep disturbances, and somatic symptoms. People with a high number of stress symptoms in 1981 and 1985 were categorized as having constant stress. The number of self-reported mobility limitations was computed based on an eight-item list of mobility tasks presented to the participants in 1992, 1997, and 2009. Data were analyzed using joint Poisson regression models. The study showed that depending on the stress profile, persons suffering from constant stress in midlife had a higher risk of 30-70 % for having one more mobility limitation during the following 28 years compared to persons without stress after adjusting for mortality, several lifestyle factors, and chronic conditions. A less pronounced risk increase (20-40 %) was observed for persons with occasional symptoms. The study suggests that effective interventions aiming to reduce work-related stress should focus on both primary and secondary prevention.

Characteristics of outdoor falls among older people: a qualitative study

Background

Falls are a major threat to older people’s health and wellbeing. Approximately half of falls occur in outdoor environments but little is known about the circumstances in which they occur. We conducted a qualitative study to explore older people’s experiences of outdoor falls to develop understanding of how they may be prevented.

Methods

We conducted nine focus groups across the UK (England, Wales, and Scotland). Our sample was from urban and rural settings and different environmental landscapes. Participants were aged 65+ and had at least one outdoor fall in the past year. We analysed the data using framework and content analyses.

Results

Forty-four adults aged 65 – 92 took part and reported their experience of 88 outdoor falls. Outdoor falls occurred in a variety of contexts, though reports suggested the following scenarios may have been more frequent: when crossing a road, in a familiar area, when bystanders were around, and with an unreported or unknown attribution. Most frequently, falls resulted in either minor or moderate injury, feeling embarrassed at the time of the fall, and anxiety about falling again. Ten falls resulted in fracture, but no strong pattern emerged in regard to the contexts of these falls. Anxiety about falling again appeared more prevalent among those that fell in urban settings and who made more visits into their neighbourhood in a typical week.

Conclusions

This exploratory study has highlighted several aspects of the outdoor environment that may represent risk factors for outdoor falls and associated fear of falling. Health professionals are recommended to consider outdoor environments as well as the home setting when working to prevent falls and increase mobility among older people.

Decreased functional capacity and muscle strength in elderly women with metabolic syndrome

Purpose

To compare the metabolic parameters, flexibility, muscle strength, functional capacity, and lower limb muscle power of elderly women with and without the metabolic syndrome (MetS).

Methods

This cross-sectional study included 28 older women divided into two groups: with the MetS (n = 14; 67.3 ± 5.5 years; 67.5 ± 16.7 kg; 1.45 ± 0.35 m; 28.0 ± 7.6 kg/m²), and without the MetS (n = 14; 68.7 ± 5.3 years; 58.2 ± 9.9 kg; 1.55 ± 0.10 m; 24.3 ± 3.8 kg/m²). Body composition was evaluated by dual-energy X-ray absorptiometry and dynamic muscle strength was assessed by one-maximum repetition (1RM) tests in leg press, bench press and biceps curl exercises. Six-minute walk test, Timed Up and Go (TUG); 30-second sitting-rising; arm curl using a 2-kg dumbbell, sit-and-reach (flexibility), and vertical jump tests were performed.

Results

There was no difference between groups regarding age (P = 0.49), height (P = 0.46), body fat (%) (P = 0.19), systolic (P = 0.64), diastolic (P = 0.41) and mean blood pressure (P = 0.86), 30-second sitting-rising (P = 0.57), 30-s arm curl (P = 0.73), leg press 1RM (P = 0.51), bench press 1RM (P = 0.77), and biceps curl 1RM (P = 0.85). However, women without the MetS presented lower body mass (P = 0.001), body mass index (BMI) (P = 0.0001), waist circumference (P = 0.02), waist-to-height ratio (P = 0.02), fat body mass (kg) (P = 0.05), lean body mass (kg) (P = 0.02), blood glucose (P = 0.05), triglycerides (P = 0.03), Z-score for the MetS (P = 0.05), higher high-density lipoprotein-cholesterol (HDL-C) (P = 0.002), better performance on TUG (P = 0.01), flexibility (P = 0.03), six-minute walk test (P = 0.04), vertical jump (P = 0.05) and relative muscle strength for leg press (P = 0.03), bench press (P = 0.04) and biceps curl (P = 0.002) exercises as compared to women with the MetS.

Conclusion

Elderly women with the MetS have higher metabolic risk profile and lower functional capacity, muscle strength, lower limb power and flexibility as compared to women without the MetS. The evaluation of functional capacity may help to determine the degree of physical decline in older persons with the MetS, while exercise interventions should be encouraged.