Functional performance in community-dwelling and institutionalized elderly women

Movement, non-movement behaviors and physical performance in older adults: An isotemporal substitution approach

INTRODUCTION

The time dedicated to movement (e.g., physical activity) and non-movement behaviours (e.g., sitting) has important implications in terms of maintaining physical performance (PP), while it has also been independently associated with better or poorer PP. Physical performance in older adults may be significantly improved by changing daily movement and non-movement behaviours. Therefore, the aims of this study were: (i) to analyse the associations of the time dedicated to movement and non-movement behaviours (i.e., lying down, sitting, standing, and locomotion) with PP (Time up and Go test and the Short Physical Performance Battery); and (ii) to examine how theoretically reallocating time between these behaviours is associated with this outcome.

METHODS

Forty-nine older adults (mean age: 82.9 ± 6.9 yrs) wore an activity monitor to measure periods of lying down, sitting, standing and locomotion. PP measures included the Time up and Go test (TUG) and the Short Physical Performance Battery (SPPB).

RESULTS

Replacing 60 min∙d-1 of lying down time with standing resulted in a significant improvement in TUG (β = -4.99, 95% CI = -8.81, -1.17), and SPPB (β = -0.93, 95% CI = 0.04, 1.82). Likewise, replacing 60 min∙d-1 of sitting time with standing also resulted in a significant improvement in TUG (β = -4.51, 95% CI = -8.67, -0.37). Meanwhile, replacing 60 min∙d-1 of lying down or sitting time with locomotion resulted in a significant improvement in the Sit to Stand test of the SPPB (β = 0.82, 95% CI = 0.14, 1.49, and β = 0.90, 95% CI = 0.23, 1.56, respectively).

DISCUSSION AND CONCLUSION

Isotemporal substitution modelling suggests that replacing 60 min∙d-1 of non-movement or stationary behaviours, such as standing, with an equivalent locomotion time may contribute to improved PP in older adults.

Health behavior among Polish institutionalized older adults: the effect of resiliency mediated by satisfaction with life

Aim

Resiliency and satisfaction with life are identified as factors related to health behavior in the general population. However, little is known about health behavior and its predictors in public nursing home residents. The purpose of the study was to establish the nature of the relationship between resiliency, satisfaction with life, and health behavior in institutionalized older adults in Poland.

Subject and methods

A cross-sectional study with purposive sampling was performed in public nursing homes in Poland. A total of 161 male and female senior residents aged 60 to 99 (Mean = 76.65, SD = 9.23) were examined. Mediation analysis was performed with the Hayes’ PROCESS macro.

Results

This study revealed that resiliency, satisfaction with life, and health behavior are positively associated with each other in older persons. Satisfaction with life plays a mediating role in the relationship between resiliency and health behavior in residents of long-term care institutions.

Conclusion

Our findings underscore the important role played by personal resources in strengthening interventions and supporting the efforts of nursing home residents to engage in health behavior.

The Long-Term Benefits of a Multicomponent Physical Activity Program to Body Composition, Muscle Strength, Cardiorespiratory Capacity, and Bone Mineral Density in a Group of Nonagenarians

Promotion of physical activity among older adults is considered to be one of the main actions that can result in more successful aging. Currently, there are few studies focusing on the effects of long-duration physical activity interventions in older adults. This study examined the effects of an 8-month multicomponent intervention on cardiorespiratory capacity (6-minute walking test), body composition (body-mass index), muscle strength (handgrip and knee extension), and bone mineral density (femoral neck) in a group of nonagenarians. A secondary aim was to determine the impact of the program according to the participant's way of life (institutionalized vs. community dwelling). A total of 14 institutionalized nonagenarians (years: 93.1 ± 1.6; female: 100%) and 16 community-dwelling nonagenarians (years: 93.1 ± 1.6; female: 75%) participated in this study. Our analysis suggested that the multicomponent program significantly improved the levels of strength in handgrip and leg extension in all participants. Intergroup analysis showed that the changes experienced were greater in community-dwelling people. Improvements in the cardiorespiratory capacity of older adults-more distance walked in 6 minutes-who were living in the nursing home (mean distance traveled: 238.5 ± 96.0 vs. 250.7 ± 99.0 m) were observed. Our findings found that an 8-month, multicomponent intervention program results in significant improvements in the levels of strength (handgrip and knee extension) in nonagenarians. This effect is greater in community-dwelling people.

Physical Activity and Sports-Real Health Benefits: A Review with Insight into the Public Health of Sweden

Positive effects from sports are achieved primarily through physical activity, but secondary effects bring health benefits such as psychosocial and personal development and less alcohol consumption. Negative effects, such as the risk of failure, injuries, eating disorders, and burnout, are also apparent. Because physical activity is increasingly conducted in an organized manner, sport’s role in society has become increasingly important over the years, not only for the individual but also for public health. In this paper, we intend to describe sport’s physiological and psychosocial health benefits, stemming both from physical activity and from sport participation per se. This narrative review summarizes research and presents health-related data from Swedish authorities. It is discussed that our daily lives are becoming less physically active, while organized exercise and training increases. Average energy intake is increasing, creating an energy surplus, and thus, we are seeing an increasing number of people who are overweight, which is a strong contributor to health problems. Physical activity and exercise have significant positive effects in preventing or alleviating mental illness, including depressive symptoms and anxiety- or stress-related disease. In conclusion, sports can be evolving, if personal capacities, social situation, and biological and psychological maturation are taken into account. Evidence suggests a dose–response relationship such that being active, even to a modest level, is superior to being inactive or sedentary. Recommendations for healthy sports are summarized.

Acute effects of exergames on cognitive function of institutionalized older persons: a single-blinded, randomized and controlled pilot study

BACKGROUND

Improvements on balance, gait and cognition are some of the benefits of exergames. Few studies have investigated the cognitive effects of exergames in institutionalized older persons.

AIMS

To assess the acute effect of a single session of exergames on cognition of institutionalized older persons.

METHODS

Nineteen institutionalized older persons were randomly allocated to Wii (WG, n = 10, 86 ± 7 year, two males) or control groups (CG, n = 9, 86 ± 5 year, one male). The WG performed six exercises with virtual reality, whereas CG performed six exercises without virtual reality. Verbal fluency test (VFT), digit span forward and digit span backward were used to evaluate semantic memory/executive function, short-term memory and work memory, respectively, before and after exergames and Δ post- to pre-session (absolute) and Δ % (relative) were calculated. Parametric (t independent test) and nonparametric (Mann-Whitney test) statistics and effect size were applied to tests for efficacy.

RESULTS

VFT was statistically significant within WG (-3.07, df = 9, p = 0.013). We found no statistically significant differences between the two groups (p > 0.05). Effect size between groups of Δ % (median = 21 %) showed moderate effect for WG (0.63).

DISCUSSION

Our data show moderate improvement of semantic memory/executive function due to exergames session. It is possible that cognitive brain areas are activated during exergames, increasing clinical response.

CONCLUSION

A single session of exergames showed no significant improvement in short-term memory, working memory and semantic memory/executive function. The effect size for verbal fluency was promising, and future studies on this issue should be developed.

PROTOCOL NUMBER OF BRAZILIAN REGISTRY OF CLINICAL TRIALS

RBR-6rytw2.

Activities of daily living and rehabilitation needs for older adults with a stroke: A comparison of home care and nursing home care

AIM

To compare the changes in benefit levels of activities of daily living (ADLs), rehabilitation, and long-term care services (LTCS) in older adults with a stroke in different modalities of LTCS, which include home care and nursing home care.

METHODS

This study analyzed national data regarding LTCS from 2008 to 2009 in South Korea. The data about 7668 older adults with a stroke were extracted from a pool of 182,535 total beneficiaries. In order to control for the baseline differences between older adults who received home care and those who received nursing home care, propensity score matching (PSM) was carried out and there were 1099 matched pairs of participants ( n  = 2198). After the PSM, the changes in ADLs and rehabilitation between the two groups were analyzed by using a paired t-test and the changes in LTCS benefit levels were compared by using the χ² -test.

RESULTS

The ADLs and rehabilitation needs of the older adults who received home care improved, while the older adults who received nursing home care experienced deterioration. After 1 year, the LTCS benefit levels were significantly different between the home care and the nursing home care groups CONCLUSION: All of the ADLs, rehabilitation needs, and LTCS benefit levels for 1 year had improved in the home care patients, while they worsened in those who received nursing home care. This finding provides evidence to direct the policy of LTCS and offers information to guide older adults with a stroke and their family when deciding between the modalities of LTCS.

A randomized controlled trial of the effect of an intensive 1-year care management program on measures of health status in independent, community-living old elderly: the Eldercare project

BACKGROUND

Primary care practitioners are familiar with the frail elderly and commonly have to deal with their multi-morbidity and their functional decline, both physically and mentally. However, there are well elderly with high quality of life and very few co-morbidities who seldom seek medical care.

OBJECTIVE

To determine if a nurse-based program of home-delivered care, linked directly with the primary care practitioner or primary care team, would improve quality of life, symptoms, satisfaction with care and utilization of community and medical services, in independent community living old elderly.

DESIGN

Randomized controlled trial.

SETTING

St. John's, Newfoundland, Canada.

PARTICIPANTS

Two hundred and thirty-six independent, community-dwelling, cognitively functioning, people aged 80 years and older.

INTERVENTION

A nurse-based program of care, carried out in the patients home, that involved a detailed assessment of needs, the development of a plan to meet the needs, and up to eight visits to the patients home during a 1-year period to facilitate the meeting of those needs.

CONTROL GROUP

Usual care

MAIN OUTCOME MEASUREMENTS

Quality of Life measured using the SF-36 and the CASP-19 scales; symptomology using the Comorbidity Symptom Scale; patient satisfaction using the PSQ-18; and assessment of health care services (community services, emergency room visits, hospitalizations, use of diagnostic services and family doctor visits) through patient recall, family physician chart review and assessment of hospitalization records.

RESULTS

There were no statistical or meaningful differences between the intervention and control groups in any of the outcomes measured.

CONCLUSION

The intensive, home-delivered, program of care for the well old elderly did not have an impact on the outcomes measured.

Correlation between balance and the level of functional independence among elderly people

CONTEXT AND OBJECTIVE

As the overall number of elderly people increases there is a corresponding rise in the number of older persons with disabilities. In order to examine whether there is any relationship between balance and activities of daily living, we evaluated balance and daily activities among elderly people living in the community.

DESIGN AND SETTING

Cross-sectional study at Universidade Estadual Paulista (Unesp), Marília, São Paulo, Brazil.

METHODS

The study included 70 community-dwelling elderly people aged 65 and over. Balance was evaluated using the Berg Balance Scale (BBS) and physical independence in daily activities was evaluated using the Barthel Index (BI). The Spearman correlation coefficient was used to examine the relationship between the parameters evaluated. Significance was set at the level of 5% (P < 0.05).

RESULTS

The population's mean age was 70.5 ± 5 years. The mean BBS score was 50.9 ± 4.1, whereas the mean BI score was 98.1 ± 2.8. Statistically significant relationships were found between the BBS and BI (r = 0.41; P = 0.0004); between age and BI (r = -0.24; P = 0.04); and between age and BBS (r = -0.57; P = 0.0001).

CONCLUSIONS

The results showed that among elderly people, there are correlations between age, balance and independence level.

Exercise for improving balance in older people

BACKGROUND

In older adults, diminished balance is associated with reduced physical functioning and an increased risk of falling. This is an update of a Cochrane review first published in 2007.

OBJECTIVES

To examine the effects of exercise interventions on balance in older people, aged 60 and over, living in the community or in institutional care.

SEARCH METHODS

We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, CENTRAL (The Cochrane Library 2011, Issue 1), MEDLINE and EMBASE (to February 2011).

SELECTION CRITERIA

Randomised controlled studies testing the effects of exercise interventions on balance in older people. The primary outcomes of the review were clinical measures of balance.

DATA COLLECTION AND ANALYSIS

Pairs of review authors independently assessed risk of bias and extracted data from studies. Data were pooled where appropriate.

MAIN RESULTS

This update included 94 studies (62 new) with 9,917 participants. Most participants were women living in their own home.Most trials were judged at unclear risk of selection bias, generally reflecting inadequate reporting of the randomisation methods, but at high risk of performance bias relating to lack of participant blinding, which is largely unavoidable for these trials. Most studies only reported outcome up to the end of the exercise programme.There were eight categories of exercise programmes. These are listed below together with primary measures of balance for which there was some evidence of a statistically significant effect at the end of the exercise programme. Some trials tested more than one type of exercise. Crucially, the evidence for each outcome was generally from only a few of the trials for each exercise category. 1. Gait, balance, co-ordination and functional tasks (19 studies of which 10 provided primary outcome data): Timed Up & Go test (mean difference (MD) -0.82 s; 95% CI -1.56 to -0.08 s, 114 participants, 4 studies); walking speed (standardised mean difference (SMD) 0.43; 95% CI 0.11 to 0.75, 156 participants, 4 studies), and the Berg Balance Scale (MD 3.48 points; 95% CI 2.01 to 4.95 points, 145 participants, 4 studies).2. Strengthening exercise (including resistance or power training) (21 studies of which 11 provided primary outcome data): Timed Up & Go Test (MD -4.30 s; 95% CI -7.60 to -1.00 s, 71 participants, 3 studies); standing on one leg for as long as possible with eyes closed (MD 1.64 s; 95% CI 0.97 to 2.31 s, 120 participants, 3 studies); and walking speed (SMD 0.25; 95% CI 0.05 to 0.46, 375 participants, 8 studies).3. 3D (3 dimensional) exercise (including Tai Chi, qi gong, dance, yoga) (15 studies of which seven provided primary outcome data): Timed Up & Go Test (MD -1.30 s; 95% CI -2.40 to -0.20 s, 44 participants, 1 study); standing on one leg for as long as possible with eyes open (MD 9.60 s; 95% CI 6.64 to 12.56 s, 47 participants, 1 study), and with eyes closed (MD 2.21 s; 95% CI 0.69 to 3.73 s, 48 participants, 1 study); and the Berg Balance Scale (MD 1.06 points; 95% CI 0.37 to 1.76 points, 150 participants, 2 studies).4. General physical activity (walking) (seven studies of which five provided primary outcome data). 5. General physical activity (cycling) (one study which provided data for walking speed). 6. Computerised balance training using visual feedback (two studies, neither of which provided primary outcome data). 7. Vibration platform used as intervention (three studies of which one provided primary outcome data).8. Multiple exercise types (combinations of the above) (43 studies of which 29 provided data for one or more primary outcomes): Timed Up & Go Test (MD -1.63 s; 95% CI -2.28 to -0.98 s, 635 participants, 12 studies); standing on one leg for as long as possible with eyes open (MD 5.03 s; 95% CI 1.19 to 8.87 s, 545 participants, 9 studies), and with eyes closed ((MD 1.60 s; 95% CI -0.01 to 3.20 s, 176 participants, 2 studies); walking speed (SMD 0.04; 95% CI -0.10 to 0.17, 818 participants, 15 studies); and the Berg Balance Scale ((MD 1.84 points; 95% CI 0.71 to 2.97 points, 80 participants, 2 studies).Few adverse events were reported but most studies did not monitor or report adverse events.In general, the more effective programmes ran three times a week for three months and involved dynamic exercise in standing.

AUTHORS' CONCLUSIONS

There is weak evidence that some types of exercise (gait, balance, co-ordination and functional tasks; strengthening exercise; 3D exercise and multiple exercise types) are moderately effective, immediately post intervention, in improving clinical balance outcomes in older people. Such interventions are probably safe. There is either no or insufficient evidence to draw any conclusions for general physical activity (walking or cycling) and exercise involving computerised balance programmes or vibration plates. Further high methodological quality research using core outcome measures and adequate surveillance is required.

The effect of functional mobility and balance on health-related quality of life (HRQoL) among elderly people living at home and those living in nursing home

The present study examined the effect of functional mobility and balance on HRQoL among elderly people living at home and those living in nursing homes. The study included 122 elderly people aged 65 and over. With regard to the individuals whose socio-demographic data were collected in the scope of the study, balance and functional mobility levels were evaluated using the timed up and go test (TUG) and Berg balance scale (BBS); HRQoL was evaluated using the Nottingham health profile (NHP); physical independence in daily activities was evaluated using the Barthel index (BI); and basic mobility in daily life was evaluated using the Rivermead mobility index (RMI). Statistically significant differences were found between the TUG, BBS and NHP values of the elderly people living in a home environment and those living in nursing homes (p<0.05). However, no statistically significant difference could be found between the BI and RMI values (p>0.05). A statistically significant relationship was found between the NHP and TUG, RMI, BI and the use of assistive devices in daily life activities (p<0.05). It is thought that the inclusion of functional mobility and balance training in elderly care and rehabilitation programs would be useful for the elderly people to develop functional independence and in increasing their HRQoL.

Physical activity, quality of life and symptoms of depression in community-dwelling and institutionalized older adults

This study was aimed to investigate in a sample of Spanish elderly whether measures of physical activity are related to health-related quality of life (HRQoL) and symptoms of depression in community dwelling and institutionalized elderly. The sample was a cohort of 436 elderly (234 women and 202 men, aged 60-98 years) from the North of Spain. 58% were community-dwellers and 42% were institutionalized in senior residences. Participants completed measures of physical activity (Yale Physical Activity Survey, YPAS), HRQoL (Medical Outcomes Study 36-item Short Form Health Survey, SF-36) and symptoms of depression (Geriatric Depression Scale, GDS). All SF-36 domains, except role-emotional, were significantly correlated with the YPAS activity dimension summary index. Physical function, role-physical, general health and vitality correlated with total time activity, and correlations were observed between weekly energy expenditure and physical function, role physical, vitality and mental health. Depressive symptom scores correlated significantly with the YPAS activity dimension summary index and the weekly energy expenditure. Scores for various domains of the SF-36 and for depressive symptoms significantly differed among less and more active individuals of the same sex and institutionalization category. Differences generally reached a higher extent in institutionalized subjects in comparison to community dwellers. In conclusion, physical activity was related to different domains of both the physical and mental components of HRQoL and to decreased depressive symptoms. Results emphasize the positive effects of physical activity in both community-dwelling and institutionalized older adults.