Psychological and physical activity training for older persons: who does not attend?

Compliance with CBT referral in nursing home residents diagnosed with depression: Results from a feasibility study

Objectives

Patient-level factors that influence compliance with a recommendation for CBT in nursing home residents diagnosed with depression were identified.

Methods

Within a cluster-randomized trial on stepped care for depression in nursing homes (DAVOS-study, Trial registration: DRKS00015686), participants received an intake interview administered by a licensed psychotherapist. If psychotherapy was required, patients were offered a referral for CBT. Sociodemographic characteristics, severity of depression, loneliness, physical health, antidepressant medication, prior experience with psychotherapy, and attitudes towards own aging were assessed. A binary regression determined predictors of compliance with referral.

Results

Of 123 residents receiving an intake interview, 80 were recommended a CBT. Forty-seven patients (58.8 %) followed the recommendation. The binary logistic regression model on compliance with recommended CBT was significant, χ2(9) = 21.64, p = .010. Significant predictors were age (Odds Ratio (OR) = 0.9; 95 % Confidence Interval (CI) = 0.82, 0.99; p = .024) and depression (OR = 1.33; 95 % CI = 1.08, 1.65; p = .008).

Conclusion

Within the implemented setting compliance rate was comparable to other age groups. Future interventions should include detailed psychoeducation on the benefits of psychotherapy on mild depressive symptoms in older age and evidence-based interventions to address the stigma of depression. Interventions such as reminiscence-based methods or problem-solving could be useful to increase compliance with referral, especially in very old patients (80+). Language barriers and a culturally sensitive approach should be considered when screening residents.

Exploring the Relationships Between Four Aging Ideals: A Bibliometric Study

When examining research articles on the aging strategies, four ideals (i.e., successful aging, healthy aging, productive aging and active aging) could be explored by conducting bibliometric analyses. For the literature analysis, general information on the four aging ideals was understood through visualization analysis; the intellectual base and research hotspots were intuitively observed. CiteSpace was used as the method to conduct the co-occurrence analysis of keywords in order to obtain research trends and cutting-edge knowledge in the field of aging-related policies. Subsequently, the study revealed the nature of the link between these four aging ideals and disclosed the connection between their fundamental principles. The study ultimately enhanced the understanding of the diverse contexts that have impacted the way in which these ideals influence policy, which has caused dissimilar strategies for policy development. The study also extended the discussion of the definitions of and relationships between these four ideals with the goal of identifying new directions for aging-related practice and providing innovative insights and references for investigators.

Ready to participate? Using qualitative data to typify older adults' reasons for (non-) participation in a physical activity promotion intervention

BACKGROUND

A sufficient amount of regular moderate physical activity (PA), at least 2.5 h of moderate to vigorous PA per week as recommended by the WHO, is one of the most important lifestyle factors for maintaining good health in old age. However, less than one in four older adults (65 years or older) in Germany meets this recommendation for PA. Although previous research has found several factors related to participation in PA programmes, little is known about how these factors simultaneously affect participation decisions of older adults and how PA programmes can accommodate these dynamics. Taking an everyday life perspective, this study aimed to identify multidimensional types of PA behaviour among older adults.

METHODS

In this qualitative study, 25 episodic interviews were conducted with participants and non-participants (ratio 1:3) of a structured PA intervention for older adults (65 years or older). Direct and indirect recruitment methods (e.g. pick up, gatekeeper) were used in different municipalities in Northwest Germany. The interviews were analysed according to the Grounded Theory methodology and a typology of PA participation behaviour was derived from the responses of the interviewees.

RESULTS

Four types of PA participation behaviour were identified based on different activity goals and time management preferences: 'Health designer', 'Flexible function-oriented type', 'Comparison and competition type' and 'Fun and wellness-oriented type'. The results indicate that the structured PA intervention was better able to reach the health designer and the competitive type but was less successful in accommodating the function- or wellness-oriented type.

CONCLUSIONS

In order to improve older adults' participation in PA, preventive offers should take various activity goals and the desire for flexible time management in everyday life into account. The typology of PA participation behaviour contributes to a better understanding of the target group and can thus help to improve the development, communication and implementation of tailored PA interventions.

Effects of Three Different Chair-Based Exercise Programs on People Older Than 80 Years

This study aimed at comparing the effects of three chair-based exercise programs on people older than 80 years. Thirty-six participants (87.91 ± 4.70 years) were randomly allocated to an aerobic, muscular resistance, or joint mobility exercise program. The participants exercised 3 days per week during 3 months. A hand-held dynamometer, the Tinetti Gait Balance, the Barthel Index, and the Timed Up and Go Test (TUG) (assessed by means of the Wiva^® science sensor) were used to evaluate the effects of the programs on the participants' strength, balance, functional independence, and functional mobility, respectively. After the intervention, it was observed that only the elastic-band program resulted in significant improvements in strength and balance. These results imply that when choosing a low-cost exercise program for very old people, the use of elastic bands stands as a far better option than pedaling on a pedal exerciser or performing mobility exercises.

Adherence of older women with strength training and aerobic exercise

Background

Participation of older people in a program of regular exercise is an effective strategy to minimize the physical decline associated with age. The purpose of this study was to assess adherence rates in older women enrolled in two different exercise programs (one aerobic exercise and one strength training) and identify any associated clinical or functional factors.

Methods

This was an exploratory observational study in a sample of 231 elderly women of mean age 70.5 years. We used a structured questionnaire with standardized tests to evaluate the relevant clinical and functional measures. A specific adherence questionnaire was developed by the researchers to determine motivators and barriers to exercise adherence.

Results

The adherence rate was 49.70% in the aerobic exercise group and 56.20% in the strength training group. Multiple logistic regression models for motivation were significant (P=0.003) for the muscle strengthening group (R²=0.310) and also significant (P=0.008) for the aerobic exercise group (R²=0.154). A third regression model for barriers to exercise was significant (P=0.003) only for the muscle strengthening group (R²=0.236). The present study shows no direct relationship between worsening health status and poor adherence.

Conclusion

Factors related to adherence with exercise in the elderly are multifactorial.

Physical predictors of cognitive performance in healthy older adults: a cross-sectional analysis

There is ample evidence that physical and cognitive performance are related, but the results of studies investigating this relationship show great variability. Both physical performance and cognitive performance are constructs consisting of several subdomains, but it is presently unknown if the relationship between physical and cognitive performance depends on subdomain of either construct and whether gender and age moderate this relationship. The aim of this study is to identify the strongest physical predictors of cognitive performance, to determine the specificity of these predictors for various cognitive subdomains, and to examine gender and age as potential moderators of the relationship between physical and cognitive performance in a sample of community-dwelling older adults. In total, 98 men and 122 women (average age 74.0±5.6 years) were subjected to a series of performance-based physical fitness and neuropsychological tests. Muscle strength, balance, functional reach, and walking ability (combined score of walking speed and endurance) were considered to predict cognitive performance across several domains (i.e. memory, verbal attention, visual attention, set-shifting, visuo-motor attention, inhibition and intelligence). Results showed that muscle strength was a significant predictor of cognitive performance for men and women. Walking ability and balance were significant predictors of cognitive performance for men, whereas only walking ability was significant for women. We did not find a moderating effect of age, nor did we find support for a differential effect of the physical predictors across different cognitive subdomains. In summary, our results showed a significant relationship between cognitive and physical performance, with a moderating effect of gender.

[Spanish experiences to promote personal autonomy in the elderly]

OBJECTIVES

To identify studies analyzing the development of initiatives and the requisite characteristics of programs that promote personal autonomy, to identify the initiatives and policies developed in Spain to promote active aging and to determine whether the programs developed are consistent with the evidence in this field.

METHOD

We performed a literature review and analyzed the policies developed in each Spanish region. Programs to promote personal autonomy were identified and analyzed through a questionnaire sent to the autonomous regions.

RESULTS

Personal autonomy should be promoted through interventions to improve physical, cognitive, social and psycho-affective functions and by eliminating barriers that hamper independent living. Functional capacities are promoted through leisure activities (83%), reading and cognitive rehabilitation. Independent living is encouraged through podiatry services (38.9%) and food services at home (38.9%). Thirteen autonomous communities and the Biscay Regional Council have developed specific policies to promote personal autonomy. Personal autonomy activities are often conducted in senior or day centers.

CONCLUSIONS

There are differences in the provision of programs to promote active aging. The development and implementation of these programs depends on the competent authority (Institute for the Elderly and Social Services, town councils, subsidized private entities, etc.). More evidence and a framework that defines common standards and criteria for the development of effective programs are required.

Leisure-time physical activities for community older people with chronic diseases

AIMS

(1) To explore the types and three components (frequency, duration and caloric expenditure) of leisure-time physical activity in community older people with chronic diseases. (2) To identify leisure-time physical activity-related factors in these community older people.

BACKGROUND

Previous research has focused primarily on measuring the actual physiological or psychological benefits of exercise or leisure-time physical activity, little is known about the factors that determine the frequency, intensity and duration of exercise or leisure-time physical activity. The identification of reliable predictors of the various components of leisure-time physical activity will enable healthcare providers to intervene and change the patterns of leisure-time physical activity in the sedentary older people more effectively.

DESIGN

A cross-sectional design was used for this study.

METHODS

Participants were recruited from the Xinyi District in Taipei, Taiwan. A total of 206 older people were recruited and were asked to complete three questionnaires during a face-to-face interview with a researcher at the activity setting.

RESULTS

The results showed that walking leisurely was the most frequent leisure-time physical activity for participants. The age, gender, living arrangement, affective feeling and environmental control were significant variables of leisure-time physical activity.

CONCLUSIONS

The study constructs accounted for moderate amounts of variance (22% for leisure-time physical activity frequency, 27% for leisure-time physical activity duration and 24% for leisure-time physical activity caloric expenditure). This study also showed that different variables play different influential roles in the different components of LTPA.

RELEVANCE TO CLINICAL PRACTICE

An effective intervention strategy for improving leisure-time physical activity of older people may involve tailoring the type, format, intensity, frequency and duration of a physical activity according to an individual's needs. This study described some environmental barriers to LTPA and recommended an increase in the accessibility to LTPA areas.

Active ageing--another way to oppress marginalized and disadvantaged elders?: Aboriginal Elders as a case study

This article questions whether the concept of active ageing unintentionally devalues the life experiences of disadvantaged groups of older people. It is argued that talking up the expectation that older people will continue to be physically active may further marginalize significant groups of elders, including those from diverse non-dominant cultural groups. The article draws on a study of Australian Aboriginal Elders to illustrate this point, with suggestions about culturally appropriate ageing policies. The article concludes that alternative conceptions of ageing, such as 'ageing well' or 'authentic ageing', may better capture the cultural diversity of ageing and promote social inclusion.

Influence of psychological characteristics and social relations on receiving preventive home visits in older men and women

The purpose was to analyze whether psychological characteristics and social relations in older men and women were related to accepting and receiving preventive home visits during 3 years, when offered as part of a national scheme. The study was based on secondary data from the Danish Intervention Study on Preventive Home Visits in 34 municipalities. The study population included 3,377 men and women who answered questions about psychological characteristics and social relations at baseline, survived and took part in the three year follow-up study. Number of preventive home visits was registered during 3 years in a specially designed software installed in the municipalities. Psychological characteristics were measured by questions on sadness, aggressiveness, life satisfaction, mood, loneliness and sense of coherence. Social relations were measured by questions on cohabitation status, diversity in social relations and social participation. Covariates included age and disability. Older men with poor psychological rating on most of the variables had larger odds ratios of accepting and receiving preventive home visits compared to older men with higher ratings. Older women with poor rating on the psychological characteristics and high social participation had larger odds of accepting and receiving preventive home visits, and women with a strong sense of coherence had larger odds of receiving many visits. It is concluded that psychological characteristics and social relations in older persons seem to influence whether they accept and receive preventive home visits, but patterns of associations are complex and vary for men and women.

A Qualitative Evaluation of Fire Safety Education Programs for Older Adults

This article presents a qualitative evaluation of six fire safety education programs for older adults delivered by public fire educators. Our main aims were to explore how these programs are implemented and to determine important factors that may lead to program success, from the perspectives of the public fire educators and the older adults. For each program, we interviewed the public fire educator(s), observed the program in action, and conducted focus groups with older adults attending the program. Analysis revealed three factors that were believed to facilitate program success (established relationships with the older adult community, rapport with older adult audiences, and presentation relevance) as well as three challenges (lack of a standardized curriculum and program implementation strategies, attendance difficulties, and physical limitations due to age). More fire safety education should be developed for older adult populations. For successful programs, public fire educators should address the specific needs of their local older adult community.