Adjustment Of Older Adults Research Articles

Analysis of the characteristics of anticipatory postural adjustments in older adults using smartphones: Association between cognitive and balance functions

ObjectivesUsing smartphones, we aimed to clarify the characteristics of anticipatory postural adjustments (APA) in older adults and examine the relationship between cognitive and balance functions. MethodsThe study participants were 10 young and 13 older adults. An accelerometer built into a smartphone was attached to the lower back (L5) of the participant, and acceleration in the mediolateral direction was measured using a one-leg stance (OLS). As APA features, we analyzed the time to the peak value in the stance direction (peak latency [PL]) and the amount of displacement to the peak value in the stance direction (peak magnitude [PM]). Additionally, the measured PL was divided by PM for each group to obtain the APA ratio (APAr). We investigated the relationship between the APAr and Mini-BESTest subitems. ResultsOlder adults showed delayed PL and decreased PM levels (p < 0.01). While in the Mini-BESTest sub-items, deductions were most common in the order of dual-task and single-leg standing, and most participants with low APAr scores were degraded in APA of sub-items. The correlation was observed between APAr and both TUG and dual-task cost (DTC) (r= −0.56, r= −0.67). According to the receiver operating characteristic curve, the APAr value was 1.71 in the older age group. ConclusionsOlder adults showed delayed PL and decreased PM, and APAr was associated with cognitive and locomotor functions. By evaluating the APAr at the initiation of movement, it may be possible to distinguish the APA of the older adluts from the possible to the impossible of OLS movement.

Reconsideration of the current models of estimated kidney function-based drug dose adjustment in older adults: The role of biological age.

Human lifespan has increased from a median of 46.5 years in 1950 to 71.7 years in 2022. As people age, one of the inevitable consequences is a decline in kidney function and glomerular filtration rate (GFR) which can have direct or indirect effects on the pharmacokinetic and pharmacodynamic profiles of many drugs. Numerous equations have been developed to generate estimated GFR (eGFR) using the two principal biomarkers: serum creatinine and serum cystatin C. However, the trajectory of changes with aging is dissimilar in these equations. In addition, there is recognition that chronological age (lifespan) often does not reflect biological age (healthspan) as an essential parameter in kidney function equations. In the past decade, there has been an increasing interest in quantifying biological age and new commercially available assays have entered the marketplace. In this narrative review, we illustrate how dominant equations of eGFR model the fractional change in this parameter very differently across chronological age. In addition, we review various biological age indicators (aging clocks) and challenges to their application in clinical practice. Importantly, by comparing vancomycin's mean clearance as a drug with limited metabolism and unchanged elimination between two age milestones in some recent population pharmacokinetic models, we show how efforts to quantify kidney function in older adults optimally remain under-explored, particularly those at the upper end of their lifespan. We also propose considering new models that integrate biological age as a new pathway to improve precision drug dosing in older adults.

Post-error behavioral adjustments under reactive control among older adults.

This study analyzed the effects of aging on post-error behavioral adjustments from the perspective of cognitive control. A modified error awareness task was administered to young (n = 50) and older (n = 50) adults. In this task, two buttons were placed on the left and right sides in front of the participants, who were instructed to use the right button to perform a go/no-go task, and were notified if they made an error. There were three experimental conditions (A, B, and C): participants had to push the right button once in Condition A and twice in Condition B and C when a go-stimulus was presented. Conversely, participants were asked to withhold their response when a no-go stimulus was presented. Response inhibition differed depending on the experimental condition. The participants were asked to push the left button as quickly as possible when an error occurred. The results showed relatively longer reaction times to sudden errors among older adults compared with young adults. Furthermore, the difference in the error responses (i.e., accidentally pushing the right button once or twice when a no-go stimulus was presented) strongly influenced older adults' response time after an error. These results suggest that the shift from proactive to reactive control may significantly influence post-error behavioral adjustments in older adults.

The effect of the predictability of perturbation magnitudes in older adults with mild cognitive impairment.

Balance impairment is common in older adults with mild cognitive impairment (MCI). The ability to predict the magnitude of the body disturbance is essential to balance maintenance. The purpose of the study was to investigate the effect of the predictability of the perturbation magnitudes on anticipatory (APAs) and compensatory (CPAs) postural adjustments in older adults with MCI and healthy older adults. Fifteen individuals with MCI and fourteen age-matched control participants stood on the force platform and received the pendulum perturbations of small or large magnitudes applied to their upper body. Electromyographic activity of eight leg and trunk muscles and displacements of the center of pressure (COP) were recorded and analyzed during the APA and CPA phases of postural control. Individuals with MCI demonstrated smaller APAs in the conditions of the perturbation of unpredictable magnitude and required more trials to optimize their postural adjustments, as compared to healthy older adults. Moreover, individuals with MCI had reduced postural stability in the conditions of unpredictable magnitude of the perturbation. The findings suggest that cognitive decline adversely affects the ability to predict the magnitude of the perturbations.

Quantitative Electroencephalography and Surface Electromyography Correlations upon Predictable and Unpredictable Perturbation in Older Adults.

Background: Quantitative Electroencephalography (qEEG) is a non-invasive method used to quantify electrical activity over the cortex. QEEG provides an accurate temporal resolution of the brain activity, making it a useful tool for assessing cortical function during challenging tasks.Objective: This study aimed to investigate postural adjustments in older adults in response to an external perturbation.Material and Methods: In this observational study, nineteen healthy older adults were involved. A 32-channel qEEG was employed to track alterations in beta power on the electrodes over the two sensory-motor areas. Integrated electromyographic activity (IntEMG) of the leg muscles was evaluated in response to perturbations under predictable and unpredictable conditions.Results: The results indicated higher beta power during late-phase in the Cz electrode in both conditions. IntEMG was significantly greater in the tibialis anterior muscle during both conditions in the CPA epoch. In predictable condition, a positive correlation was found between the beta power over C4 (r = 0.560, p = 0.013) and C3 (r = 0.458, p = 0.048) electrodes and tibialis anterior muscle amplitude, and between beta power in C4 and gastrocnemius amplitude (r = 0.525, p = 0.021). In unpredictable condition, there was a positive correlation between beta power over the C4 and the tibialis anterior amplitude (r = 0.580, p = 0.009) and also it over the C3 and the tibialis anterior amplitude (r = 0.452, p = 0.049).Conclusion: Our findings demonstrate that sensorimotor processing occurs in the brain during response to perturbation. Furthermore, cortical activity appeared to be greatest during the recruitment of the muscles upon late-phase in older adults.

Entry and Passage Variables Associated with Nursing Home Adjustment in Older Adults with Dementia

A theory-guided non-experimental, descriptive, correlational design was used to evaluate how entry and passage variables were related to nursing home adjustment for individuals with dementia. Older adults with dementia may be unable to speak for themselves, therefore proxy responses of Certified Nursing Assistants (CNAs) provided the data for completion of the Nursing Home Adjustment Scale.1 Guided by the Meleis’ Theory of Transitions, entry level factors (i.e. age, previous residence, gender, and choice), and passage variables (i.e. length of stay, extent of dementia, functional abilities, and depression) were entered into a regression equation as predictors of nursing home adjustment. Information about extent of dementia, functional abilities and depression was derived from the Minimum Data Set (MDS) maintained for all residents per Medicare and Medicaid guidelines. Descriptive and inferential statistics were calculated using IBM Statistical Package for the Social Sciences (SPSS) 26.0 software. Results indicated an inverse relationship between nursing home adjustment and depression as measured by the PHQ-9. There was no support for relationships among other variables. CNA proxy responses were found to be reliable in that they were significantly correlated with nursing responses on the same measure. This study supports the use of CNA proxy responses as a method to evaluate the experience of individuals with dementia.

Psychotherapeutic Interventions for Dementia: a Systematic Review.

Background and ObjectivesWhile a range of psychotherapeutic interventions is available to support individuals with dementia, comprehensive reviews of interventions are limited, particularly with regard to outcomes related to adjustment and acceptance. The current review assesses studies that evaluated the impact of various forms of psychotherapeutic interventions on acceptance and adjustment to changing life circumstances for older adults with cognitive impairment.Research Design and MethodsA systematic search of PubMed, PsycINFO, and CINAHL databases was conducted, restricted to articles published in English within the last 16 years (from 2003 to 2019). Twenty-four articles were identified that examined the effects of psychotherapeutic interventions on outcomes related to acceptance and adjustment which included internalizing symptoms, quality of life, self-esteem, and well-being. Fifteen studies examined interventions targeted towards individuals with cognitive impairment, while nine studies also targeted their caregivers.ResultsInterventions that impacted outcomes related to acceptance and adjustment (e.g., adaptation, depressive symptoms, helplessness, self-esteem, and quality of life) varied in their theoretical approach, which incorporated elements of cognitive behavioural therapy (CBT), problem-solving therapy, psychotherapy, reminiscence therapy, interpersonal therapy, mindfulness-based therapy, and meaning-based, compassion-focused therapy. Among all interventions, reductions in depression were the most commonly reported treatment outcome particularly among interventions that incorporated problem-focused and meaning-based therapies. Mixed findings were reported with regard to outcomes related to helplessness, quality of life, self-esteem, and life satisfaction indices for individuals with cognitive impairment.Discussion and ImplicationsThere is some support for the effectiveness of psychotherapeutic interventions on improving acceptance and adjustment in older adults with cognitive impairment, particularly with regard to reducing depressive symptoms.

Institutional Environment of Old Age Homes and Its Relation to Adjustment of Older Adults: Evidence from Pakistan

The study investigated the role of institutional environment in adjustment of older adults living in old age homes of Punjab, Pakistan. The study was conducted on a sample of 270 residents, living in 18 old age facilities across Punjab. The data was collected through a structured interview questionnaire and was analyzed through SPSS (v. 22). The multiple regression analyses suggested that institutional environment along with number of children and number of visitors was a significant predictor of adjustment of older adults. Interventions such as higher support from staff and residents, autonomy, and engagement can help older adults to adjust better in old age homes.

Interventions for Improving Psychosocial Adjustment in Nursing Home Residents: A Network Meta-Analysis

This study aimed to identify the evidence of interventions for improving psychosocial adjustment in older adults relocating to nursing homes. We followed PRISMA-NMA guidelines to conduct a network meta-analysis. 12 electric databases were used to search for eligible randomized controlled trials (RCTs) and clinical trials (CCTs) from inception to August 27th, 2019. Two reviewers independently conducted article screening, data extraction, and risk of bias appraisal with the Revised Cochrane risk-of-bias tool for RCT and Risk Of Bias for CCT. The network plots were plotted to provide a visual representation of the evidence base. Bayesian fixed-effects pairwise and network meta-analysis were exhibited in the forest plot. A Bayesian network meta-analysis was performed on 30 eligible RCTs with 2119 participants, and 12 eligible CCTs with 491 participants. The quality of the most included studies was rated as moderate in RCTs and low in CCTs. Treatment effects showed that compared to conventional treatment, group reminiscence and group counseling resulted in significant improvements in loneliness (MD: 11, 95%, CI: 2.7–17, SUCRA: 99.5%; MD: 7.7, 95%, CI: 0.53–15, SUCRA: 53.9%, respectively). Similar results were obtained for art therapy (MD: 5.5, 95%CI: 0.8–10, SUCRA: 97.3%) in self-esteem. The model fit was good, and the inconsistency was low. Group reminiscence, group counseling, and art therapy are recommended for reducing loneliness and enhance self-esteem in nursing practice.

The role of self-compassion in the psychological (mal)adjustment of older adults: a scoping review.

The identification of protection factors regarding older adults' mental health is essential. Self-compassion, the capacity to be kind towards the self during challenging times, may be one such factor. Although still scarce, some research in this field has already been conducted with older adults. Our research question was the following: what is currently known about the role of self-compassion in the psychological (mal)adjustment of older adults? To review any study designs, in any setting, where self-compassion and any indicators of psychological (mal)adjustment were assessed in participants aged ≥60 years. A scoping review of English, Portuguese, and Spanish published and unpublished materials, using the EBSCOhost Research and PubMed databases and reference lists. Search terms included self-compassion, self compassion, older adults, elderly, seniors, and geriatrics. After screening and selection of the studies, we charted the relevant data. Eleven published studies (2012-2018) were reviewed. Self-compassion was associated with, and a predictor of, diverse mental health indicators in older adults. Self-compassion was also associated with indicators of physical health, moderated the relationship between physical health indicators and mental health indicators, and mediated the relationship between diverse mental health indicators. Results were obtained with participants of different nationalities and age. All studies had a cross-sectional design, and most studies recruited well-functioning community residents. Self-compassion is beneficial for the psychological adjustment of older adults and may also benefit their biological functioning. Self-compassion seems particularly relevant for those experiencing more negative life events. Studies with more robust methodologies are needed in order to replicate these findings.

THE DOCTOR-PATIENT RELATIONSHIP, PERSONALITY, MOOD, AND FUNCTIONING IN OLDER ADULTS

Personality pathology has been tied to mental and physical health in older adulthood. Less is known regarding the combined impact of personality and the doctor-patient relationship on mental health outcomes. This study examined relationships between personality, mood, and trust in physicians. Participants (N=170) were a sample of primary care older adults ages 60-99 (M = 70.73, SD = 7.054) who completed self-report measures of personality traits (NEO-FFI), processes (IIP-PD-25), depression (GDS-30; PHQ-9), social adjustment (SAS-SR) and trust in one’s physician (GTIP). Medical burden data (CIRS) were retrieved from medical records. After adjusting for relevant covariates such as age, perceived health, cumulative illness burden, and income security there were several significant predictive relationships. In combined models more neuroticism (NEO-N, ß = .082, p < .000) and lower trust (GTIP, ß = -.025, p = .014) but not agreeableness (NEO-A, ß = -.006) or interpersonal problems (IIP-25, ß = .254) predicted depression. In combined models, higher neuroticism (NEO-N, ß = .018, p < .000) and interpersonal problems (IIP-25, ß = .186, p = .002) but not agreeableness (NEO-A, ß = -.003) or trust (GTIP, ß = -.002) predicted social adjustment. The results are consistent with previous findings that neuroticism predicts both depression and social adjustment in older adults. In addition, lower trust augmented neuroticism to predict depression. Results suggest that apart from general personality risk factors, situational personality processes such as trust in physicians may affect mood state, whereas personality processes such as interpersonal problems contribute to longer term functional impairment.

Till depression do us part? Examining the prospective associations between depression and marital adjustment in older adults

IntroductionThe association between marital adjustment and depression in young couples is well established. However, little is known about the longitudinal associations between marital adjustment and depression in older adults. ObjectiveTo explore if such associations are significant in older adults and determine their direction of effects. MethodThe cross-sectional and 12-month prospective associations between diagnostic depression and marital adjustment in a representative sample of community-dwelling older adults (age≥65years, n=847) from Quebec, Canada, were assessed through cross-lagged, multiple regression analyses. ResultsData suggest a cross-sectional association between marital adjustment and depression. As for longitudinal associations, marital adjustment predicted subsequent diagnostic depression but there was no support for the inverse path, suggesting a unidirectional relation between these variables. ConclusionWhile significant, the association between initial marital adjustment and later depression was weak. Based on our and previously reported findings, the importance of the prospective relations between marital quality and depression in older adults is discussed.

Ten years of experience with DPP-4 inhibitors for the treatment of type 2 diabetes mellitus.

Achieving and maintaining recommended glycemic targets without causing adverse e ffects, including hypoglycemia, is challenging, especially in older patients with type 2 diabetes mellitus (T2DM). The introduction of dipeptidyl peptidase-4 (DPP-4) inhibitors, more than 10years ago, has provided an alternative to conventional medications for the intensification of glucose-lowering treatment after failure of metformin monotherapy, and therefore, marked an important advance in the management of T2DM. By prolonging the activity of incretin hormones, DPP-4 inhibitors induce insulin release and decrease glucagon secretion in a glucose-dependent manner. This results in a more physiologic glycemic control as compared to that ensured by insulin secretagogues (sulfonylureas and glinides). Overall, DPP-4 inhibitors have a favorable safety profile and can be used without dose adjustments in older adults and in patients with mild renal impairment; they have a neutral effect on body weight and do not cause hypoglycemia by themselves. Safety issues, reported mainly in post-marketing surveillance programs and including cardiovascular outcomes and the risk of acute pancreatitis, are being extensively investigated. The aim of this review is to discuss the impact of DPP-4 inhibitors on the treatment of T2DM, after 10years of experience, with an emphasis on diabetes care in Italy. We will first describe T2DM treatment in Italy and then provide an overview of the main findings from randomized controlled trials, real-world studies and post-marketing surveillance programs with DPP-4 inhibitors.

Anodal Transcranial Direct Current Stimulation Over the Supplementary Motor Area Improves Anticipatory Postural Adjustments in Older Adults.

We examined the influence of anodal transcranial direct current stimulation (tDCS) over the supplementary motor area (SMA) on anticipatory postural adjustments (APAs) and center of pressure (COP) sway in older adults. The study enrolled 12 healthy older adult volunteers. Subjects received anodal tDCS (2 mA) or sham stimulation over the SMA for 15 min and performed a self-paced rapid upward arm movement task on a force plate before, immediately after, and 15 min after the stimulation condition. APAs were measured as the temporal difference between activation onset in the deltoid anterior (AD) and biceps femoris (BF) muscles. The root mean square (RMS) area of COP sway, sway path length, medio-lateral mean velocity, and antero-posterior mean velocity of standing posture were also measured before and after the stimulation condition during the task. Anodal tDCS of the SMA extended APAs and decreased COP sway path length immediately after and 15 min after stimulation compared to baseline. These findings suggest that anodal tDCS over the SMA enhanced APAs function and improved postural sway during rapid upward arm movement in older adults.

Delayed Compensatory Postural Adjustments After Lateral Perturbations Contribute to the Reduced Ability of Older Adults to Control Body Balance.

The goal of this study was to investigate the timing of compensatory postural adjustments in older adults during body perturbations in the mediolateral direction, circumstances that increase their risk of falls. The latencies of leg and trunk muscle activation to body perturbations at the shoulder level and variables of center of pressure excursion, which characterize postural stability, were analyzed in 40 older adults (nonfallers and fallers evenly split) and in 20 young participants. The older adults exhibited longer latencies of muscular activation in eight out of 15 postural muscles as compared with young participants; for three muscles, the latencies were longer for the older fallers than nonfallers. Simultaneously, the time for the center of pressure displacement reached its peak after the perturbation was significant longer in both groups of older adults. The observed delays in compensatory postural adjustments may affect the older adults' ability to prompt control body balance after postural disturbances and predispose them to falls.

The Effect of a Four-Week Balance Training Program on Anticipatory Postural Adjustments in Older Adults: A Pilot Feasibility Study

Balance deterioration in older adults limits their activities of daily living, community participation, and is a significant risk factor for falls. One contributory element to this functional decline is impairment of anticipatory postural adjustments (APAs). To evaluate the role and feasibility of a novel training program in improving APAs for balance control of older adults. Six older adults (73.3±5.0 years) were randomly assigned into the Experimental (EG) and Control groups (CG). The EG participated in four weeks of APA-focused training involving catching a medicine ball while standing. All subjects were exposed to predictable external and self-initiated perturbations before and after training. EMG activity of eight trunk and leg muscles was recorded bilaterally and muscle onsets were analyzed during the anticipatory phase of postural control. Clinical tests of balance (Timed-Up and Go, Single limb stance, and Activities-specific Balance Confidence scale) were implemented. Early onsets of APA activity prior to the external perturbations were seen in the EG following training. Moreover, early APA activity was observed in the EG prior to bilateral arm flexion, a task that was not a part of training, indicating a transfer of the learning effect of training. The improvement of APAs in the EG also resulted in improved performance on clinical outcome measures. There were no improvements seen in the CG for both the APA activity and the clinical balance tests. The study outcome suggests that a four-week APA-based training program is feasible and could be effective in improving postural control, functional balance, mobility, and quality of life in older adults.

Enhancement of anticipatory postural adjustments in older adults as a result of a single session of ball throwing exercise.

The aim of the study was to investigate the role of short-term training in improvement of anticipatory postural adjustments (APAs) and its effect on subsequent control of posture in older adults. Nine healthy older adults were exposed to self-initiated and predictable external perturbations before and after a single training session consisting of throwing a medicine ball. EMG activity of eight trunk and leg muscles and ground reaction forces were recorded before and immediately after the training session. Muscle onsets and center of pressure displacements were analyzed during the anticipatory and compensatory phases of postural control. The training involving throwing of a medicine ball resulted in enhancement of the generation of APAs seen as significantly early onsets of leg and trunk muscle activity prior to the bilateral arm flexion task. Significantly early activation of postural muscles observed prior to the predictable external perturbation, the task that was not a part of training, indicates the transfer of the effect of the single training session. The observed training-related improvements of APAs suggest that APA-focused rehabilitation could be effective in improving postural control, functional balance, mobility, and quality of life in the elderly.

P-1022 - Psychological adjustment of older adults: measuring the impact on aging

Introduction There has been little attention in the research literature on the relationships between psychological adjustment and aging. Objectives This research aims at examining the relationships between older adults' psychological adjustment, and aging. Methods The measures used to in the study were selected to assess the reliability and validity of one new instrument, Adjustment to Aging Schedule (ATAS). Measures were completed using a variety of culturally appropriate methods, including mail-outs, self-administration and interviews. For the purposes of this study, the Health Survey Questionnaire (SF-6D), one measure of cognitive functioning - the Mini-Mental State Examination (MMSE) and demographics, were included. All variables had fewer than 2% missing values and there complete data were available for 212 older adults (mean age 86.2, SD = 5.4, (range 74–101)) from eight different nationalities. Exploratory factor analyses were run for data reduction and for exploring theoretical structure. Controlling for age, gender and country of origin, we assessed the level of psychological adjustment of elderly people, and its impact on aging. Results Psychological adjustment appears to be a catalyst to attitudinal markers of maturity and internal development which in turn impact aging, across cultures. All estimates were statistically significant (p Conclusions This cross-cultural study illuminates links among psychological adjustment and aging in older age, warranting further study across cultures among frailer populations over time. Recommendations for future research on older adults' psychological adjustment and clinical interventions are also presented.

Social support as a mediator in the relation between sensation seeking (need for stimulation) and psychological adjustment in older adults

This article investigates the potential role of social support as a mediator between sensation seeking (in the sense of a basal need for stimulation) and psychological adjustment in older adults. A sample of 325 individuals aged between 65 and 95 years were tested using questionnaires, which assess social support, sensation seeking, global self-worth, sense of coherence, and satisfaction with life. Path analyses provided support for a mediator model in which the relationship between sensation seeking and psychological adjustment was fully mediated by social support (the path coefficient between sensation seeking and psychosocial adjustment declines from β = .27 to β = .02, when adding an indirect path mediated by social support). Findings further suggest that this mediation effect was independent of sex and age. The study demonstrates the relevance of measuring sensation seeking as a personality trait in older adults.

Impaired Reactive Stepping Adjustments in Older Adults

BackgroundThe ability to redirect the path of the foot during walking is critical for responding to perturbations and maintaining upright stability. The purpose of the current study was to compare mechanisms of reactive stepping adjustments in young versus older adults when responding to an unexpected perturbation during voluntary step initiation.MethodsWe tested 13 healthy community-dwelling older adults and an equal number of young control participants performing stepping movements onto a visual target on the floor. In some trials, perturbations were introduced by unexpectedly shifting the target, at various time points, from its usual location to a new location 20 cm to the right. We measured ground reaction forces under the supporting leg and three-dimensional kinematics of the stepping leg in baseline and target shift trials.ResultsDuring target shift trials, that is, when reactive adjustments were required, older adults demonstrated the following: delayed responses in modifying the lateral propulsive forces under the supporting foot, reduced rates of lateral force production, delayed responses in modifying the stepping foot trajectory, and prolonged movement execution times.ConclusionsThe current study quantitatively distinguishes between healthy older and young adults in generating reactive stepping adjustments to an unpredictable shift of a visual target. The decreased capability for rapidly planning and executing an effective voluntary step modification could reveal one potential cause for the increased risk of falls in the older population.