Study protocol: cluster randomized controlled trial on physical-cognitive training for fall prevention in institutionalized older adults with cognitive impairment

Background Older adults are at increased risk of frequent healthcare transitions between health care (hospitals) and social care providers (formal care and institutions). Therefore, our objective was to quantify and characterize the potential risk profiles of multiple transitions between living and care settings for older adults. Methods Data were obtained from the National E-Infrastructure for Aging Research (NEAR), including the Swedish National Study on Aging and Care (SNAC) and the National Patient Register, to evaluate living and care transitions of over 7,000 individuals aged 60+, across homes, formal care, nursing homes, hospitals, and post-acute facilities. A multi-state model was used to represent moving likelihood. Results Over 15 years, the average length of stay was two years at home, one year in home care, one year in institutionalization, eight days in the hospital, and 17 days in post-acute facilities. Older age and being a woman increased the chance of receiving home care after hospital discharge (Hazard Ratio [HR] range 1.35-4.38, 1.06-1.08), whereas multimorbidity and slow walking speed were associated with an 11%-50% increased hazard of hospitalization and home care. Generally, cognitive impairment increased the hazard of institutionalization (HR range 1.99-2.15), and disability was associated with a higher hazard of nursing home placement (HR range 2.57-3.07). Conclusions These findings underscore that care transition patterns are associated with different sociodemographic, clinical, and functional characteristics. This highlights the complex and dynamic interplay between these characteristics and social and health care use. Key messages • The study emphasizes that hospitalization is a major driver of transitions between living and care settings for older adults. • Age, gender, multimorbidity, walking speed, cognitive impairment, and disability all play a role in shaping older adults’ transition patterns between different care settings.

BackgroundOlder adults with cognitive impairment (CI) have higher multimorbidity and frailty prevalence, lower functional status and an increased likelihood to develop dementia, non-cognitive deficits, and adverse health-related events. +AGIL, a real-world program for frail older adults in a primary care area of Barcelona, is a pragmatic, multi-component and integrated intervention implemented since 2016. It includes physical activity, nutrition, sleep hygiene, revision and adequacy of pharmacological treatment, detection of undesired loneliness and screening for CI; to improve physical function in community-dwelling older adults. We aimed to assess the + AGIL longitudinal impact on physical function among community-dwelling frail older persons with CI.MethodsAn interventional cohort study included data from all the + AGIL consecutive participants from July 2016 until March 2020. Based on the comprehensive geriatric assessment, participants were offered a tailored multi-component community intervention, including a 10-week physical activity program led by an expert physical therapist. Physical performance was measured at baseline, three and six months follow-up. The pre-post impact on physical function was assessed by paired sample t-test for repeated samples. Linear mixed models were applied to analyze the + AGIL longitudinal impact. P-values < 0.05 were considered statistically significant.Results194 participants were included (82 with CI, based on previous diagnosis or the Mini-COG screening tool), 68% women, mean age 81.6 (SD = 5.8) yo. Participants were mostly independent in Activities of Daily Living (mean Barthel = 92.4, SD = 11.1). The physical activity program showed high adherence (87.6% attended ≥ 75% sessions). At three months, there was a clinically and statistically significant improvement in the Short Physical Performance Battery (SPPB) and its subcomponents in the whole sample and after stratification for CI [CI group improvements: SPPB = 1.1 (SD = 1.8) points, gait speed (GS) = 0.05 (SD = 0.13) m/s, Chair stand test (CST)=-2.6 (SD = 11.4) s. Non-CI group improvements: SPPB = 1.6 (SD = 1.8) points, GS = 0.08 (SD = 0.13) m/s, CST=-6.4 (SD = 12.1) seg]. SPPB and gait speed remained stable at six months in the study sample and subgroups. CI had no significant impact on SPPB or GS improvements.ConclusionOur results suggest that older adults with CI can benefit from a multidisciplinary integrated and comprehensive geriatric intervention to improve physical function, a component of frailty.

Purpose The purpose of the current study is to better characterize the medical and social health characteristics of older adults in a long-term group care setting and consider the impact of the dual burden of hearing loss and cognitive impairment. Method This descriptive analysis of a convenience sample of 160 adults (M age = 74 years, age range: 59.8-99.7) participating in Program for All-inclusive Care for the Elderly programs in Massachusetts and Rhode Island included data from hearing testing, questionnaires, and medical chart review. Using descriptive statistics, groups are compared across a range of demographic and health variables on the categorical bases of hearing loss and cognitive status. Results Results suggest that hearing loss and cognitive impairment are highly prevalent among this sample of older adults. Forty-three percent of this sample has at least a mild hearing loss in the better hearing ear in addition to cognitive impairment. Descriptive analyses across demographic and health variables suggest there are few differences between those with and without cognitive impairment when compared within degree of hearing loss categories in this convenience sample. Across all participants, there was a high prevalence of other chronic conditions, most notably diabetes (59%), hypertension (90%), cardiovascular disease (80%), and depression (67%). Conclusions In this sample, there were not significant differences on demographic and health variables between the cognitive impairment groups when considered within their degree of hearing loss; however, the prevalence of the dual burden of hearing loss and cognitive impairment in this sample is high. Clinicians serving older adults, especially those accessing group care services, should be cognizant of the high burden of multiple chronic conditions and plan care that can be integrated into a comprehensive approach.

This study is a prospective cluster-randomized controlled clinical trial involving 710 elderly subjects to investigate the long-term effects of low-magnitude high-frequency vibration (LMHFV) on fall and fracture rates, muscle performance, and bone quality. The results confirmed that LMHFV is effective in reducing fall incidence and enhancing muscle performance in the elderly. Falls are direct causes of fragility fracture in the elderly. LMHFV has been shown to improve muscle function and bone quality. This study is to investigate the efficacy of LMHFV in preventing fall and fractures among the elderly in the community. A cluster-randomized controlled trial was conducted with 710 postmenopausal females over 60 years. A total of 364 participants received daily 20 min LMHFV (35 Hz, 0.3 g), 5 days/week for 18 months; 346 participants served as control. Fall or fracture rate was taken as the primary outcome. Also, quadriceps muscle strength, balancing abilities, bone mineral density (BMD), and quality of life (QoL) assessments were done at 0, 9, and 18 months. With an average of 66.0% compliance in the vibration group, 18.6% of 334 vibration group subjects reported fall or fracture incidences compared with 28.7% of 327 in the control (adjusted HR = 0.56, p = 0.001). The fracture rate of vibration and control groups were 1.1 and 2.3 % respectively (p = 0.171). Significant improvements were found in reaction time, movement velocity, and maximum excursion of balancing ability assessment, and also the quadriceps muscle strength (p < 0.001). No significant differences were found in the overall change of BMD. Minimal adverse effects were documented. LMHFV is effective in fall prevention with improved muscle strength and balancing ability in the elderly. We recommend its use in the community as an effective fall prevention program and to decrease related injuries.

BackgroundDigital health twins (DHTs) have been evolving with their diverse applications in medicine, particularly in care settings for older adults, in response to the increasing demands of older adults. Despite its numerous benefits, the optimal implementation of DHTs has faced several challenges, particularly in terms of ethics and quality of care. Given the continuous rise in the need for such care and the evident potential for DHTs to meet these needs, this review seeks to identify and address the gaps in research knowledge to enhance DHT implementation.ObjectiveThe review aims to compile and synthesize the best available evidence regarding the issues associated with quality of care, the ethical implications of DHTs, and the strategies undertaken to overcome those challenges in care settings for older adults.MethodsThe review followed the Joanna Briggs Institute (JBI) methodology as a guide. The published studies were searched through CINAHL, MEDLINE, JBI, and Web of Science. The unpublished studies were searched through Mednar, Trove, OCLC WorldCat, and Dissertations and Theses. Studies published in English from 2016 were considered. This review included studies of older individuals (aged 60 years and older) undergoing care delivery associated with DHTs and respective care providers. The concept involved the application of technology, and the context included studies based on care settings for older adults. A broad scope of evidence, including quantitative, qualitative, text, and opinion studies, was considered. In addition, 2 independent reviewers screened the titles and abstracts and reviewed the full text.ResultsThe results will be presented in a PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flow diagram. A total of 2 draft charting tables were developed and presented. A summary of the characteristics of the included studies was then described in terms of location, study sites, timing, participants, and outcomes measured or phenomena of interest. A result-based convergent (integrated) synthesis design was used to identify 5 key challenges. Those challenges included (1) data security and privacy concerns, (2) equity and accessibility of health care, (3) effectiveness concerning context, timing, and location, (4) ethical implications regarding autonomy, consent, and overdiagnosis, and (5) the impact of DHTs on health care workflows and provider workload.ConclusionsThe studies reviewed reveal several critical characteristics regarding the implementation of DHT technologies and their associated ethical considerations, particularly in terms of safety, equity, timing, location, participant characteristics, and workflow impact. The implications of these challenges emphasize the necessity for more practical ethical guidelines and policy frameworks to mitigate the potential risks associated with DHT application in older care. Further research should be conducted to examine other dimensions of the quality of care, such as access, timeliness, acceptability, and appropriateness.

Although horticultural therapy has been used successfully to reduce neuropsychiatric symptoms in elderly people with cognitive impairment, we do not yet know how it affects balance. The aim of our study was to determine the acceptability and effect of a 12-week horticultural therapy on balance and walking speed among institutionalized older adults with cognitive impairment. This mixed-methods controlled trial included 23 participants. Subjects in the experimental group (n=13) participated in a 60 min horticultural therapy programme twice a week for 12weeks in addition to the institution's usual social activities. Subjects in the control group (n=10) participated in the institution's usual social activities. Static and dynamic balance were measured with the Performance Oriented Mobility Assessment scale. In addition, gait speed was measured. Qualitative data were collected through a semi-structured interview with participants of the experimental group. At the end of the intervention period, the experimental maintained their baseline performance on the static balance, while the control group showed a decline. The gait speed of the experimental improved, while that of the control group did not change. In dynamic balance, no changes were demonstrated. The results of our qualitative data analysis indicate that horticultural therapy increases the possibility of social interactions, encourages older people to engage in conversation. As a conclusion, horticultural therapy should be more widely included in programmes for older people with cognitive impairment.

The focus of this study is to explore how nursing staff experience safety promotion and fall prevention in residential care settings for older adults. The article calls for attentiveness to fall prevention within a broader lifeworld context of well-being and health promotion. There is limited research on fall prevention and safety promotion where the lifeworld and well-being provide a direction for care. This interview study has a hermeneutic phenomenological design. Fourteen interviews with nursing staff were carried out. The ethics of care and vulnerability within a lifeworld approach provide the theoretical framework and guide the interpretive process. The findings can indicate that there is a generalised understanding of the needs of older persons in residential care. The focus of the staff was more on protection and prevention than safety promotion and well-being. Risk prevention is not enough. The residents need protection against falls but they also need to be protected from situations that can be detrimental to their well-being and compromise their dignity. Acknowledging the complexities of safety promotion amongst older persons living in assisted care settings can prevent fall accidents and ensure attentiveness to a more fundamental sense of security that can promote the older person's well-being and health. This study is relevant to clinical nursing practice as it shows that risk management in fall prevention is not enough. The findings show the need for educated nursing home staff that can incorporate contemplative and scientific knowledge into injury prevention practice.

BackgroundThe elderly population worldwide is increasing exponentially which will be associated with more people suffering from cognition and fitness declines. The well-established benefits of exercise training for the elderly’s cognitive and physical functioning have been observed. However, the amalgamated effect of combining cognitive and physical exercises on the older adults’ cognitive functions, physical fitness, or psycho-related health remains unclear. Thus, this study protocol was planned to conduct different combinations of cognitive and/or physical training interventions to community-dwelling older adults and expected to see the multifaceted effects of the varied combination of training on their health.MethodsThis study is a cluster randomized controlled trial (CRCT). A total of 285 older adults (age ≥ 60) from twenty elderly centres as clusters will be randomly selected and assigned to intervention groups (IGs, n = 16) or control groups (CGs, n = 4). Each IG will be randomly assigned to one of the four combinations of three training modes that include cognitive (A), physical (B), and combined cognitive and physical training (CCPT, i.e. C), namely Mixed ABC, A + B, C + A, B + C. The intervention will last for 4 months in which the training is conducted for 16 sessions, 2 sessions per week, and 60 min per session. Four repeated assessments (pre-test, two post-training tests after 2 months and 4 months, and a follow-up test) will be conducted. The CG will only receive the four repeated assessments but no intervention. The outcome measures include cognitive tests (tests of execution, memory, and psych-social status), physical fitness, and dynamic balance tests.DiscussionThis study will provide substantial evidence that the integrated format of cognitive and physical exercises training will have higher cognition and fitness impact than the single training modes, and all these mixed modalities will have greater positive outcomes than the control condition. If the effectiveness is proven, the intervention can be further explored and extended to the nation so that many more elderly would be benefited.Trial registrationThe trial has been registered in the ClinicalTrials.gov in U.S. NIH (ID: NCT04727450, date: January 27, 2021).Supplementary InformationThe online version contains supplementary material available at 10.1186/s12877-022-03031-5.

Globally, falls are a major public health problem that can cause morbidity, including fracture and disability, and mortality in older people. Exercise therapy is widely recommended, and it is frequently regarded as the gold-standard strategy for preventing falls in both community-dwelling and institutionalized older people. This review synthesizes published findings on feasible, low-technology, low-cost equipment, and easy-to-follow effective fall prevention interventions in healthy older adults. According to the evidence presented in this review, home-based balance and strengthening training programs utilizing low-cost equipment such as foam balance pads, steps, dumbbells, and elastic bands are more cost-effective and feasible exercises for fall prevention in older adults who do not have cognitive impairments. The Otago program, Lifestyle Approach to reducing Falls through Exercise (LiFE) program, and Ossébo exercise program are some of the best-known examples. Physiotherapists will benefit from this updated review, which rates different simple fall prevention programs used worldwide for both community-dwelling and institutionalized older adults.

Falls can be identified as one of the main issues in elderly population which can lead to serious consequences. Elderly population can be subdivided as community dwelling older adults and institutionalized older adults. The components of health-related physical fitness factors play an important role in the perspective of healthy ageing. The objective of the study was to determine the prevalence of falls and to compare health-related physical fitness factors between different fall categories among institutionalized older adults. This descriptive cross-sectional study comprised of one hundred and seventy-two elders above 60 years of age, living in registered elder’s homes in Kandy District. The prevalence of falls was determined by the number of falls reported by the subjects. They were further categorized as non-fallers, fallers, and frequent fallers depending on the number of falls. Body Mass Index (BMI) for body composition, 2-minute walk test for cardiovascular endurance, 30 second sit to stand test for muscle strength and endurance, hand grip strength for upper body strength, chair sit and reach test for lower body flexibility and back scratch test for upper body flexibility were the measures used to assess health-related physical fitness factors. The prevalence of falls is presented as percentage and the health-related factors were compared between the three faller categories using one-way ANOVA and pairwise comparison was performed using Scheffe test. The prevalence of falls was 47.1%. There was a significant difference in BMI, cardiovascular endurance, and lower body flexibility between the three categories of fallers. Higher BMI, lower cardiovascular endurance and lower flexibility in the lower body were associated with increased prevalence of falls (p<0.05). There was no significant difference in body fat percentage, hand grip strength, lower body muscle strength and endurance and upper body flexibility (p>0.05). The findings suggest that, BMI, cardiovascular endurance, and lower body flexibility must be addressed and managed, while designing intervention programs for falls prevention among institutionalized older adults.

Falls can be identified as one of the main issues in elderly population which can lead to serious consequences. Elderly population can be subdivided as community dwelling older adults and institutionalized older adults. The components of health-related physical fitness factors play an important role in the perspective of healthy ageing. The objective of the study was to determine the prevalence of falls and to compare health-related physical fitness factors between different fall categories among institutionalized older adults. This descriptive cross-sectional study comprised of one hundred and seventy-two elders above 60 years of age, living in registered elder's homes in Kandy District. The prevalence of falls was determined by the number of falls reported by the subjects. They were further categorized as non-fallers, fallers, and frequent fallers depending on the number of falls. Body Mass Index (BMI) for body composition, 2-minute walk test for cardiovascular endurance, 30 second sit to stand test for muscle strength and endurance, hand grip strength for upper body strength, chair sit and reach test for lower body flexibility and back scratch test for upper body flexibility were the measures used to assess health-related physical fitness factors. The prevalence of falls is presented as percentage and the health-related factors were compared between the three faller categories using one-way ANOVA and pairwise comparison was performed using Scheffe test. The prevalence of falls was 47.1%. There was a significant difference in BMI, cardiovascular endurance, and lower body flexibility between the three categories of fallers. Higher BMI, lower cardiovascular endurance and lower flexibility in the lower body were associated with increased prevalence of falls (p<0.05). There was no significant difference in body fat percentage, hand grip strength, lower body muscle strength and endurance and upper body flexibility (p>0.05). The findings suggest that, BMI, cardiovascular endurance, and lower body flexibility must be addressed and managed, while designing intervention programs for falls prevention among institutionalized older adults.

PURPOSE: Cognitive impairment is a highly prevalent, poorly managed, and disabling consequence of dementia. Exercise training that improves physical fitness can represent a promising approach for managing cognitive impairment in persons with dementia. This study aimed to exam the relationship between Cardiorespiratory Fitness with cognitive function in institutionalized older adults with dementia. METHODS: Fifty institutionalized older adults (mean age 79.1 ± 9.0 years old) clinically diagnosed with dementia (Alzheimer´s Disease, Lewy body dementia, Vascular dementia) were enrolled. The subjects participated in supervised in a multicomponent exercise program (including aerobic exercises, muscular resistance and strength training, flexibility and postural exercises) 45/55 minutes/session, twice a week, for six months.Cardiorespiratory Fitness (2-min step test) and Global Cognitive Function (MMSE) were assessed before (M1) and after 6-month (M2) exercise training. RESULTS: A paired sample test revealed a significant increase of CRF (2-min step test) (t= -2.702; p=0.09) and a significant increase in Global cognitive function (MMSE) (t= -2.594; p=0.012) from M1 to M2. Positive associations were observed between CRF and Global cognitive function at the baseline (M1) (r= 0.286; p=0.044) and after the intervention program (M2) (r= 0.383; p=0.006). CONCLUSIONS: The increase of CRF thru regular physical activity could represent an important and potent protective factor to preserve/improve global cognition function in institutionalized older adults with dementia.

Epidemiology of infectious and non-communicable diseases and effect of health interventions on children's physical fitness in Port Elizabeth, South Africa

REVIEW QUESTION / OBJECTIVE The objective of this review is to identify the effectiveness of combined cognitive and physical interventions on the risk of falls in cognitively impaired older adults. INCLUSION CRITERIA Types of participants Older persons who are 65 years or older will be included. Studies where the majority of participants have been indicated through mean ages and standard deviations will also be eligible for inclusion. Participants who have been diagnosed or identified as having a cognitive impairment will be included in this review. The participants will be characterized as having a cognitive impairment through: 1. Diagnosis of a dementia or cognitive impairment or other condition which directly results in reduced cognition. 2. Reduced Mini Mental State Examination or other such global assessment of cognition, e.g. through the Montreal Cognitive Assessment. Participants will not be limited by dementia diagnosis (i.e. Alzheimer's disease, vascular, mild cognitive impairment), but their cognitive impairment must be acquired and progressive in nature. Studies with a population of older adults with an increased risk of falls will be considered but will only be included if more than 75% of the total sample has reduced cognition identified in the criteria above. Types of intervention(s)/phenomena of interest This review will consider publications that describe multifactorial or multiple interventions where a physical and cognitive element has been noted by the authors or reviewers. It is the aim of this review to capture studies which have a combined physical and cognitive element in the intervention; however studies which TRUNCATED AT 250 WORDS

To synthesize qualitative evidence on nurses' end-of-life care practices in long-term care settings for older adults. Qualitative evidence on how nurses describe their own end-of-life care practice has not been reviewed systematically. Qualitative systematic review. Databases MEDLINE, CINAHL, PsycINFO, EMBASE, Mednar, Google Scholar, and Ichushi were searched for published and unpublished studies in English or Japanese. The review followed the Joanna Briggs Institute approach to qualitative systematic reviews. Each study was assessed by two independent reviewers for methodological quality. The qualitative findings were pooled to produce categories and synthesized through meta-aggregation. Twenty studies met all inclusion criteria. Their 137 findings were grouped into 10 categories and then aggregated into three synthesized findings: playing multidimensional roles to help residents die with dignity, needing resources and support for professional commitment, and feeling mismatch between responsibilities and power, affecting multidisciplinary teamwork. Nurses play multidimensional roles as the health care professionals most versed in residents' complex needs. Managers and policymakers should empower nurses to resolve the mismatch and help nurses obtain needed resources for end-of-life care that ensures residents die with dignity.