Disability In Old Age Research Articles

Improving Healthy Aging by Monitoring Patients’ Lifestyle through a Wearable Device: Results of a Feasibility Study

Population aging is related to a huge growth in healthcare and welfare costs. Therefore, wearable devices could be strategic for minimizing years of disability in old age and monitoring patients’ lifestyles and health. The purpose of this study was to assess the feasibility of using smart devices to monitor patients’ physical activity in a primary care setting. To assess the acceptance of this novel technology from the point of view of both patients and healthcare professionals, two questionnaires (one paper-based and one ex-novo developed) were administered to 11 patients with type 2 diabetes mellitus and a non-compliant behavior towards the therapeutic indications of their general practitioner (GP). Seven participants would continue to use a wearable activity tracker to monitor their health. We observed that 75% of patients reported a device’s characteristics satisfaction level of over 80% of the total score assigned to this dimension. No differences were observed in the questionnaire’s scores between the two professionals categories (GPs and nurses). Three dimensions (equipment characteristics, subjective norm, perceived risks, perceived ease-of-use and facilitating conditions) correlated > 0.5 with the device’s acceptability level. Some weak correlations were observed between healthcare professionals’ perception and patients’ parameters, particularly between the dimensions of collaboration and web interface ease-of-use and patients’ median number of steps and hours of sleep. In conclusion, despite the limited number of subjects involved, a good acceptance level towards these non-medical devices was observed, according to both patients’ and healthcare professionals’ impressions.

Mild Cognitive Impairment and its Lifestyle-Related Risk Factors in the Elderly

Context: Alzheimer's dementia (AD), an irreversible condition is an important cause of disability in old age. Mild cognitive impairment (MCI) is an intermediate state between normal cognition and dementia. Amnestic MCI (aMCI) is the precursor of AD. Identification of modifiable lifestyle risk factors help in the prevention of aMCI, and thereby in the prevention of AD. Aim: The purpose of this study was to determine the prevalence of aMCI and different lifestyle factors associated with types of MCI. Methods: This cross-sectional study was conducted amongst the elderly (≥60 years). A sample of 576 persons was selected using a multistage sampling technique. Vernacular adaptation of Hindi Mini-Mental State Examination tool was used to screen dementia and MCI. Geriatric Depression Scale-15 was used for screening depression. Data were collected using a pre-designed and pretested schedule and SPSS was used for data entry and analysis. Results: The prevalence of MCI was found to be 22.4% among the elderly. Out of all MCI cases, the prevalence of aMCI was 38.8% in this study. The lack of social and leisure engagement was found to be significantly associated with the type of MCI. Conclusion: The comparatively higher prevalence of aMCI is just the tip of the iceberg. Lack of social and leisure engagement is a highly predictive risk factor.

Laying the foundation for an ICF core set for community dwelling older adults in primary care: an expert survey.

Aholistic biopsychosocial model focused on functioning in individual contexts (environment, task) is better suited to meet the needs of older patients than disease only based models. The International Classification of Functioning, Disability and Health (ICF) is the official standard for describing functional health. As the ICF is too detailed to be used in practice, brief core sets have been developed. This study aimed to identify relevant aspects of functioning for older primary care patients from the perspective of healthcare professionals in Germany. An internet-based cross-sectional expert survey was conducted in preparation for the development of an ICF core set for community-dwelling patients aged 75years and older. Open-ended questions to identify the most important aspects of functioning and disability in old age were used. Responses were analyzed based on acontent analysis approach to identify relevant concepts in the care of the target population. These concepts were then linked to ICF categories according to established linking rules. A total of 63 experts participated in this survey. Across all responses, 2240 meaningful concepts were identified. Atotal of 75ICF categories (4first level categories, 67second level categories, 4code combinations) were identified by at least 5% of respondents and will thus be considered as candidate categories for the final ICF core set. Most of concepts were associated with the environmental factors component. The most frequently identified categories were immediate family and family relationships. This survey provides alist of relevant ICF categories from the experts' perspective and together with other preparatory studies will be used for developing an ICF core set for community-dwelling older adults in primary care.

How can dementia and disability be prevented in older adults: where are we today and where are we going?

Ageing of the population, together with population growth, has brought along an ample increase in the number of older individuals living with dementia and disabilities. Dementia is the main cause of disability in old age, and promoting healthy brain ageing is considered as a key element in diminishing the burden of age‐related disabilities. The World Health Organization recently launched the first risk reduction guidelines for cognitive impairment and dementia. According to recent estimates, approximately 40% of dementia cases worldwide could be attributable to 12 modifiable risk factors: low education; midlife hypertension and obesity; diabetes, smoking, excessive alcohol use, physical inactivity, depression, low social contact, hearing loss, traumatic brain injury and air pollution indicating clear prevention potential. Dementia and physical disability are closely linked with shared risk factors and possible shared underlying mechanisms supporting the possibility of integrated preventive interventions. FINGER trial was the first large randomized controlled trial indicating that multidomain lifestyle‐based intervention can prevent cognitive and functional decline amongst at‐risk older adults from the general population. Within the World‐Wide FINGERS network, the multidomain FINGER concept is now tested and adapted worldwide proving evidence and tools for effective and easily implementable preventive strategies. Close collaboration between researchers, policymakers and healthcare practitioners, involvement of older adults and utilization of new technologies to support self‐management is needed to facilitate the implementation of the research findings. In this scoping review, we present the current scientific evidence in the field of dementia and disability prevention and discuss future directions in the field.

“how to dance / sitting down”: Aging, Innovation, and the Graying of Disability

The topic of aging has been somewhat overlooked in disability studies, perhaps owing to the adage that "everyone is disabled if they live long enough." If the life course is simply a state of debility, why create a distinct category for bodily and sensory impairment? Disability in old age, I argue, is not a mark of precarity but of capability. The work of writers and artists who continue to experiment formally while becoming increasingly disabled in later years (Beethoven, Henry James, Merce Cunningham) offers an opportunity to complicate "late style" as developed by Theodor Adorno and Edward Said and account for the role of complex embodiment in the production of new work. Finally, I consider Samuel Beckett, whose characters are often aging and disabled and for whom bodily and sensory decline are central to their ability to "go on."

Effect of Intermittent Pneumatic Compression on Functional Level and Quality of Life in Community-Dwelling Older Adults with Limited Ambulation Due to Leg Pain: A Randomized Controlled Trial

Background and Purpose: Walking difficulties are defined as any reduction in speed, balance, or change of gait, causing limited ambulation. These difficulties are a common problem in older adults and may greatly affect their quality of life (QOL) and restrict their personal independence and participation. This study aimed to determine the effect of intermittent pneumatic compression (IPC) on lower leg pain, walking capacity, functional mobility, ankle range of motion (AROM), and QOL of community-dwelling older people with walking difficulties. Methods: In this randomized controlled trial, 34 eligible participants with self-reported lower limb pain and limited ambulation were randomized either to the intermittent pneumatic compression intervention group (IPCIG) or static compression control group (SCCG). The IPCIG and SCCG were trained to receive IPC and SC respectively for both lower legs and instructed to continue the application independently at home for 15 minutes per session, 2 sessions a day, 7 days per week for 4 weeks independently at the home. Outcome measures of lower leg pain, AROM, walking capacity, and functional mobility were assessed at baseline and at the first, second, third, and fourth weeks after randomization. Quality of life was assessed at baseline and immediately after the intervention. Results and Discussion: IPCIG showed a more significant improvement compared to the SCCG at the post-interventional stage for QOL and all the subscales. The findings show that “80% improved QOL” is 53% higher with the application of IPC than with SC for 4 weeks. The IPCIG showed a more significant improvement in the 6-minute walk test (6 MWT) at the third and fourth weeks compared to the SCCG. A pairwise comparison of mean values of 6 MWT over 4 weeks within the IPCIG showed a significant difference between all the weeks. Pairwise comparisons between groups at each time point showed that the IPCIG showed a more significant improvement in the timed up and go (TUG) test at the third and fourth weeks compared to the SCCG. Pairwise comparison of mean values of TUG test within the IPCIG showed a significant difference over 4 weeks, except between the second and third weeks, fourth week, and third and fourth weeks. The IPCIG showed a more significant improvement in lower leg pain between all weeks except the first week compared to the SCCG. Pairwise comparison of mean values of lower leg pain over 4 weeks within the IPCIG showed a significant difference among all weekly outcomes except between 1 and 2 weeks. The IPCIG showed a more significant improvement in left and right ankle dorsiflexion ROM at the third and fourth weeks compared to the SCCG. Conclusions: The IPC was effective in reducing lower leg pain and increasing the AROM and improving the walking capacity, functional mobility level, and QOL of community-dwelling older people with walking disabilities. Walking disability in old age is a common condition requiring physical therapy. Intermittent pneumatic compression can be used as a physical therapy modality for this patient group.

Physical Activity and Health: Does the Pattern Matter?

It is well-known that physical activity is key in the prevention of many diseases and disability in old age. Much less is, however, known about the pattern of activity in relation to health. While there are differences in how people spread their activity and sedentary behavior over the day or over the week, we don’t know which activity pattern of most beneficial for health. This symposium focuses on patterns of physical activity and sedentary behavior and health in five different studies with accelerometry data in Europe and the USA. Dr. Rosenberg will show how sedentary behavior patterns are associated with various health outcomes in the Adult Changes in Thought (ACT) study. Using data from The Maastricht Study, Dr. Vandercappellen will present how weekly activity patterns, in particular comparing regularly actives to weekend warriors, are associated with arterial stiffness. Dr. Shiroma will show how patterns of physical activity and sedentary behavior, taking the volume, intensity, and frequency of sessions into account, are associated with mortality in the Women’s Health Study. Dr. Caserotti will present the association between physical activity fragmentation and physical function in the SITLESS Study. Dr. Stenholm will present data from the Finish Retirement and Aging Study, using latent class trajectory analyses to identify daily activity patterns and how these patterns are associated with health-related physical fitness. Taken together, this symposium will provide insight into different ways patterns of activity can be operationalized using accelerometer data and if the patterns of activity and sedentary behavior are associated with health.

Healthy, Wealthy, Wise, and Happy? Assessing Age Differences in Evaluative and Emotional Well-Being Among Mature Adults from Five Low- and Middle-Income Countries

This study assesses the relationship between age and two dimensions of subjective well-being—evaluative and emotional—among mature adults from five low-and middle-income countries. We use data from the World Health Organization’s Study on Global AGEing and Adult Health to contrast the associations of age with subjective well-being when controlling only for gender with the corresponding partial associations when including a richer set of covariates. Adjusting only for gender, we find negative associations of age with evaluative well-being, while the corresponding age gradients for emotional well-being are relatively flat. By contrast, adjusting for further socio-demographic factors results in positive associations of age with both evaluative and emotional well-being. Oaxaca-Blinder decompositions allow us to explore the roles of two factors to account for any unadjusted age differences in subjective well-being: age-group differences in individual characteristics and life circumstances, and age-specific associations of individual characteristics and life circumstances with subjective well-being. While adverse circumstances such as poor health and low income contribute to lower levels of evaluative well-being among older adults, age per se is—ceteris paribus—positively associated with subjective well-being. Even in poorer countries, older age does not need to be a time of low subjective well-being. Policies aimed at preserving income and limiting or compensating old-age disability appear to be key for maintaining subjective well-being among older adults.

The effects of socioeconomic conditions on old-age mortality within shared disability pathways.

ObjectiveHow disability manifests itself in an individual is a highly complex process influenced by a wide range of individual and environmental factors. Its complexity makes the search for generalizable characteristics of the disablement process a challenging task. Consequentially, little is known about how the effect on other health outcomes such as life expectancy are modified after the onset of chronic ailments. In this paper we posit an alternative approach to generalize health trajectories of older people with disability and then analyze how socioeconomic conditions affect the longevity within these trajectory groups.MethodsIndividual level information about the first three successive onsets of chronic disability after age 50 is transformed into state-sequences. We extract trajectory groups based on onset time and the time spent in a certain state. Mortality hazards are then estimated with a Gompertz proportional hazards model to compare effects of different socioeconomic measures within the trajectory groups.ResultsThree distinct trajectory groups are identified, the mild (1), the early severe (2), and late severe (3) pathway. Estimates of the mortality analysis suggest that social inequalities in longevity are less pronounced after onset of old-age disability. We found a consistent survival prolonging effect for individuals who engage in daily activities (such as meeting with friends, walking) that ranged between 33.2% and 77.3%. The importance of other variables varies between trajectory groups.DiscussionThis study shows how health trajectories of individuals with disability can be generalized when information on the onset and severity of single conditions is available. Such an approach may help us to better predict health and care expenditures and help families and individuals with their personal care planning. The findings from the subsequent survival analysis suggest a substantial reduction of socioeconomic mortality differences after onset of old-age disability, which appears to be independent of its nature.

I\u2019ve got to be independent\u2019: views of older people on recovery following road traffic injury in New South Wales, Australia

BackgroundMild to moderate road traffic injury (RTI) in people of working age is associated with limited recovery. Less is known about RTI recovery in older age. This study explored the perspectives and factors associated with recovery and health-related quality of life following mild to moderate RTI in older age in New South Wales, Australia.MethodsA qualitative study using content analysis was undertaken. Participants aged 65 or more years were purposively selected from a larger inception cohort study of health outcomes following mild to moderate RTI conducted in New South Wales, Australia. Semi-structured interviews were undertaken at approximately 12 or 24 months post-injury. Content analysis was used to code and analyse the data, with methodological rigour obtained by double-coding and discussing findings to reach consensus. Results were reported using the consolidated criteria for reporting qualitative research (COREQ).ResultsNineteen participants were invited to participate in the study of which 12 completed interviews. Data saturation was reached at the twelfth interview. Recovery experiences were diverse. Five main themes were identified: recovery is regaining independence; injury and disability in older age; the burden of non-obvious disability; the importance of support; and positive personal approaches.Key facilitators of recovery were: regaining independence; support from family and friends; and positive personal approaches. Key barriers were: threats to independence; passive coping behaviours; non-obvious disabilities (chronic pain, psychological impacts); and reluctance to raise ongoing issues with General Practitioners. Threats to independence, especially not driving and self-care, appeared to have a more profound effect on recovery than physical functioning.ConclusionOlder people view injury as a threat to independent functioning. This is somewhat different to what younger people report. Regaining independence is key to older people’s recovery and health-related quality of life following RTI, and should be a key consideration for health professionals, services and supports working with this unique cohort. Greater efforts to help older people regain their independence following RTI are needed and can be facilitated by health professionals and appropriate service provision.Trial registrationAustralia New Zealand clinical trial registry identification number ACTRN12613000889752.

ESTABLISHING HEALTHY AND ACTIVE AGEING POLICIES IN POLAND, THE CZECH REPUBLIC AND BULGARIA

Central and Eastern European populations are entering a period of rapid aging. Older people are experiencing numerous problems associated with deteriorating health and functional limitations, creating pressure for adequate response from the state’s health and social policy. The article is based on information collected in the two international projects: CEQUA LTC Network and Pro-Health 65+ and its goal is to review policies on healthy and active aging formulated in recent decades in three countries: Czech Republic, Bulgaria and Poland. The health promotion programs in these countries are aimed at improving the health and well-being of the population, referring to the concept of healthy aging in relation to health risks, prevention of chronic diseases and disability in old age. At the same time, in the social sector, strategies and programs were brought to life referring to the concept of active aging, underlying the need for participation of older people in social life, creation of an elderly friendly environment and development of services supporting older people. Implementation of these policies and programmes is affected by limited financial resources, low awareness of the problems of the older population in local communities, and lack of local resources to create the appropriate infrastructure. The effectiveness of programs’ implementation is also influenced by the sectoral nature of programmes and poor intersectoral cooperation.

Active Women over 50 online information and support to promote physical activity behaviour change: study protocol for a pilot trial

BackgroundPhysical activity has many physical and mental health benefits and can delay the development of disability in older age. However, uptake of this health behaviour is sub-optimal in women in their middle and older age. This trial aims to establish the acceptability and feasibility of the Active Women over 50 programme involving online information, telephone health coaching and email or SMS support to promote physical activity behaviour change among women aged 50 years and over.MethodsSixty community-dwelling women who are insufficiently active according to national guidelines, will be recruited and randomised to 1) receive the Active Women over 50 programme or 2) a wait-list control. Active Women over 50 is a 3-month physical activity programme guided by behaviour change science, providing access to a website, one telephone-delivered health coaching session from a physiotherapist and 8 email or 24 SMS messages. The primary outcome is the proportion of participants at 3 months post-randomisation who would recommend participation in the programme to another person like themselves. Secondary outcomes are feasibility measures: rates of recruitment, retention, completeness of outcome data and uptake of telephone support; and intervention impact measures: accelerometer-assessed average steps/day, proportion of participants meeting national guidelines on moderate to vigorous physical activity; and questionnaire-assessed quality of life, exercise perceptions, mood, physical functioning and self-reported physical activity. Intervention participants will also complete a follow-up survey to assess impressions of the intervention and adoption of strategies for physical activity participation. Data will be analysed descriptively to guide the design of a larger trial. Between-group differences in secondary outcomes will be used to estimate effect sizes for sample size calculations for a fully powered randomised controlled trial.DiscussionThis feasibility pilot trial of an efficient eHealth and health coaching intervention guided by user input and behaviour change theory, will inform future interventions to address low physical activity participation among an under-active group at risk of future disability.Trial registrationANZCTR, ACTRN12619000490178, registered 26 March 2019

The Prevention of Cardiovascular Disease in Older Adults.

Cardiovascular disease (CVD) is common in older adults. CVD is a significant cause of both death and disability in old age. Though the prevention and treatment of CVD have been extensively studied, historically older adults and especially those older than 75 years have been underrepresented in clinical investigations designed to determine the best way to prevent or treat CVD. As a result, geriatrics clinicians frequently need to decide which interventions to recommend for their patients by extrapolation from existing data, which may or may not be applicable to the patients they are caring for. This narrative review summarizes existing data regarding the prevention of three common CVDs in older adults: stroke, coronary artery disease, and peripheral artery disease. Special emphasis is given to the prevention of CVD in those aged 75 years or older. J Am Geriatr Soc 68:1098-1106, 2020.

Frailty Phenotype: Evidence of Both Physical and Mental Health Components in Community-Dwelling Early-Old Adults.

BackgroundDemographic aging results in increased incidence of old-age disability. Frailty is a major factor contributing to old-age disability. The aim of this study was to investigate the prevalence of the frailty phenotype as defined by Fried et al and to estimate the need for associated preventative interventions in early-old community-dwelling inhabitants of the southern industrial region of Poland, as well as to investigate the defining components of the frailty phenotype.MethodsThe study group consisted of 160 individuals with an average age of 66.8 ± 4.2 years (nbar xn ± SD), 71 (44.4%) of study participants were women. The cohort was randomized out of over 843 thousand community-dwelling Upper Silesian inhabitants aged 60–74 years, who agreed to participate in this project. A comprehensive geriatric assessment (CGA), frailty phenotype test (as described by Fried et al) blood tests and bioimpedance body structure analysis was completed for study participants. Functional assessment included Barthel Index of Activities of Daily Living (Barthel Index), Instrumental Activities of Daily Living Scale (IADL), Mini-Mental State Examination (MMSE), the Timed Up and Go (TUG) test, Tinetti Performance-Oriented Mobility Assessment (POMA), and Geriatric Depression Scale – Short Form (GDS-SF).ResultsPrefrailty was diagnosed in 24.4% of the subjects (95% Confidence Interval (CI) = 17.7–31.0%; 31% in women and 19.1% in men, P=0.082) and frailty in 2.5% subjects (95% CI 0.1–4.9%; more frequently in women: 4.2% versus 1.1% in men, P=0.046). Having one or more positive frailty criteria was positively associated with depression (odds ratio (OR)=2.85, 95% CI=1.08–7.54, P=0.035) and negatively associated with MMSE score (OR=0.72, 95% CI=0.56–0.93, P=0.012) and fat-free mass (OR=0.96, 95% CI=0.92–0.99, P=0.016) in multivariate logistic regression analysis adjusted for age, sex, disease prevalence, number of medications, functional tests (Barthel Index, IADL, MMSE, GDS-SF), BMI, bioimpedance body composition score, and blood tests.ConclusionAt least 25% of the early-old community-dwelling population would benefit from a frailty prevention program. The frailty phenotype reflects both physical and mental health in this population.

Determinants of Healthy Aging in Internally Displaced Communities in Nigeria

The main objective of this research article, is to assess the effect of socio-economic and environmental determinants on the healthy aging status amongst internally displaced migrants and non-migrants nestled within the environmentally stressed regions of Northeastern Nigeria. Methodologically the study utilized secondary data from the Nigerian IDP Survey 2018 (Location-Northeastern States; n-1293 adults aged 50; male n-63.1%, female n-36.9%) using a multi-stage stratified random sample. Varied statistical techniques such as cross-tabulation and binary logistic regression were used to analyze the dataset. The study results show a high mean prevalence of old-age disability within the study area, irrespective of migration status in Northeastern Nigeria. Secondly, socio-economic and environmental determinants were robust predictors of later-life health outcomes. In addition, the regression revealed that concomitant factors such as age, gender and sanitation have a negative effect on older adult wellness and well-being. Meanwhile, the migration status of internally displaced persons (IDPs), although in most cases forced, significantly improves the odds of aging healthily. Conclusively, the quality of life of the older adults, irrespective of migration status, is poorly impacted by diminishing familial supports, social exclusion, non-existent social security program and non-existence of healthcare infrastructure. Based on the study results, we recommend that the proposed Economic Community of West African States (ECOWAS) Sahelian Green belt afforestation project targeted, especially to areas around the Chad basin be fully implemented, as this project will help mediate the perennial conflicts between the herdsmen and farming communities.

The effect of a water jogging exercise course on older men with knee osteoarthritis

<p>Knee osteoarthritis is one of the most common joint disorders and a major cause of disability and disability in old age. Although previous research has shown the positive effects of exercise on land to some extent, but due to high pressure on land, the elderly does not want to participate in these exercises. Water exercise has recently been considered to reduce pain in patients with osteoarthritis of the knee, although its effects have not yet been fully elucidated. So, the objective of this study was to investigate the effect of a water jogging training program on the symptoms of knee osteoarthritis in elderly men. 15 elderly men with knee osteoarthritis were purposefully selected as subjects. We used global questionnaire of the consequences of knee injuries and osteoarthritis (KOOS) to collect data. The subjects performed a jogging in water program for 10 weeks under the supervision of a hydrotherapy instructor level. Correlated t-test was used to analyze the data at the significance level (P<0.05). Between pre-test and post-test, the mean symptoms (P=0.033), knee pain (P=0.024), motor function in daily activities (P=0.014), motor function in recreational sports activities (P=0.006) and Quality of life (P=0.005) was significantly different after the program. The results of this study show that regular practice of jogging in water can be a new, safe, effective and low-cost way to improve pain and quality of life in people with knee osteoarthritis. These exercises may reduce the need for surgery and knee replacement in patients with knee arthritis.</p>

Do psychosocial factors modify the negative association between disability and life satisfaction in old age?

ContextMany assume that having poor physical health in old age lowers life satisfaction, but in fact there are large differences in life satisfaction among older people who experience disability.ObjectiveTo investigate whether psychosocial factors modify the negative association between disability and life satisfaction in older people and whether these differ across the life course.DesignCross sectional study.Setting66,561 community-dwelling Survey of Health, Ageing, and Retirement in Europe (SHARE) participants aged 50–106 with a mean age of 67.8 ± 9.9 (SD) years from 17 European countries and Israel.MethodsPsychosocial factors included depression (EURO-D scale), perceived loneliness, having a spouse, having children, contact with children, and participation in social activities. Disability was assessed by limitations in (Instrumental) Activities of Daily Living ((I)ADL) and life satisfaction by Cantril’s ladder. We also ran the analyses with the Control Autonomy Self-realization Pleasure (CASP-12) Index, a normative measure of quality of life. We used multiple linear regressions to estimate associations and proportion of variance explained.ResultsThe variance in life satisfaction that could be attributed uniquely to ADL and IADL disability was 0.17% and 0.33% respectively (both p < 0.001). The impact of (I)ADL disabilities on life satisfaction was strongest at age 50 and gradually decreased with increasing age (p trend < 0.001). Mental health explained more variance; 5.75% for depressive symptoms and 2.50% for loneliness and for social resources this ranged from 0.09% to 0.47% (all p < 0.001). While disability has a negative effect on life satisfaction, the effect was not stronger in older persons who were depressed, neither in those who felt lonely nor in those without social resources. Similar outcomes were found when using CASP-12 as the explained variable.ConclusionThe impact of (I)ADL disabilities on life satisfaction in community-dwelling older people decreases with age. These associations are not affected by psychosocial factors and these patterns cannot be explained by people changing their norms and values.

The “Fierce Urgency of Now”: Geriatrics Professionals Speaking up for Older Adult Care in the United States

The “Fierce Urgency of Now”: Geriatrics Professionals Speaking up for Older Adult Care in the United States

Active women over 50: study protocol for RCT of a low-dose information and support program to promote physical activity behaviour change

BackgroundThere is compelling evidence that physical activity has many physical and mental health benefits and can delay the development of disability in older age. However, uptake of this health behaviour is sub-optimal in working women in their middle age. This trial aims to establish the impact of a low-dose information program, incorporating follow-up support using behaviour change techniques, compared with a wait-list control group, on physical activity among women aged 50+ years.Methods100 female university or health service employees aged 50 years and over who are not sufficiently active according to national guidelines will be recruited and randomised to: [1] attend one information session at the worksite with follow-up email support and provision of resources including use of an activity tracker (Fitbit) for 3 months and free trial class at the university sports facility, or [2] a wait-list control to receive the intervention after the 3-month follow-up period. The primary outcome will be the proportion of people achieving 10,000 steps/day at 3 months post randomisation. Secondary outcomes will include the proportion of people achieving national guideline-recommended physical activity levels, the average self-reported hours of physical activity per week, perceived benefits of and barriers to exercise participation, physical functioning, and mood. Analyses will be planned, conducted while masked to group allocation and will use an intention-to-treat approach.DiscussionThis randomised controlled trial will evaluate the impact of a simple intervention using behaviour change techniques to increase physical activity participation in insufficiently active working women over the age of 50.Trial registrationACTRN12617000485336, prospectively registered, approved 04/04/2017.

Is SPPB useful as a method for screening functional capacity in patients with advanced chronic kidney disease?

Introduction and objectiveOne of the consequences of the CKD, is the deterioration of the functional capacity, being able to manifest from different stages of the disease, until renal replacement therapy.The objective of this study was to determine the functionality of patients with CKD through functional capacity test, valuing the usefulness of the SPPB as a screening test in parallel. Materials and methodsIt assessed the functional capacity of patients with CKD, using the test SPPB, 6MM, TUTG and STS. Also found the muscle strength with manual dynamometry. ResultsOf 121 patients who came to the CKD query, 118 presented a minimum functionality to perform tests of functional capacity, a 71.2% of the patients were able to perform 4 tests, a 28.8% only could make the SPPB test.To a 71.43% of patients who presented a low score in SPPB, not could follow assessed them with the rest of the test, while the 92.31% of which had a high score, continued with the rest of the evidence. To differentiate by age ranges, the majority of young patients have minimal limitations, finding higher rates of disability in older age ranges. A good score in SPPB meant to present good functional capacity and allowed to continue evaluating the patient, obtaining better results with the rest of test and more muscle strength. A good nutritional better status and body composition was a better functionality. ConclusionIn the absence of a consensus of what is the best method of determining the functional capacity of the kidney patient, and to assess all patients, propose to use the test SPPB as screening method, and depending on the result used as the rest of the test to more complete if it is necessary to study.