Intervention For Community-dwelling Older Adults Research Articles

Sleep efficiency in community-dwelling persons living with dementia: exploratory analysis using machine learning.

Sleep disturbances lead to negative health outcomes and caregiver burden, particularly in community settings. This study aimed to investigate a predictive model for sleep efficiency and its associated features in older adults living with dementia in their own homes. This was an exploratory, observational study. A total of 69 older adults diagnosed with dementia were included in this study. Data were collected via actigraphy for sleep and physical activity for 14 days, a sweat patch for cytokines for 2-3 days, and a survey of diseases, medications, psychological and behavioral symptoms, functional status, and demographics at baseline. Using 730 days of actigraphy, sweat patches, and baseline data, the best prediction model for sleep efficiency was selected and further investigated to explore its associated top 10 features using machine learning analysis. The CatBoost model was selected as the best predictive model for sleep efficiency. In order of importance, the most important features were sleep regularity, number of medications, dementia medication, daytime activity count, instrumental activities of daily living, neuropsychiatric inventory, hypnotics, occupation, tumor necrosis factor-alpha, and waking hour lux. This study established the best sleep efficiency predictive model among community-dwelling older adults with dementia and its associated features using machine learning and various sources, such as the Internet of Things. This study highlights the importance of individualized sleep interventions for community-dwelling older adults with dementia based on associated features.

Effectiveness of Community-Based Multidisciplinary Integrated Care for Older Adults with General Practitioner Involvement: A Systematic Review and Meta-Analysis

Abstract Background Changing demographics has led to healthcare systems reorientating healthcare delivery towards the community setting and implementing integrated models of care worldwide. A knowledge gap exists with regards to what elements of integrated care facilitate effective age-attuned healthcare delivery. This systematic review examines the effectiveness of community-based multidisciplinary integrated care strategies with General Practitioner (GP) participation for community-dwelling older adults and describes the level of care integration in each study. Methods PUBMED, EMBASE, CINAHL, Central Register of Controlled Trials in the Cochrane Library and MEDLINE were systematically searched in April 2023. Randomised controlled trials (RCTs) or cluster RCTs that focused on interventions for community-dwelling older adults delivered by health and social care professionals with GPs were included. Two reviewers independently conducted the risk of bias assessment, applied the GRADE tool to quantify the certainty of evidence and used the Rainbow Model of Integrated Care taxonomy to describe the elements of integrated care used within studies. The primary outcome was functional status. Meta-analyses were performed using Review Manager 5.4. Results Twelve trials (14 reports) recruiting 8069 participants across 8 countries were included. Community-based multidisciplinary team (MDT) integrated care demonstrated significant improvements in functional status (standardised mean difference (SMD) 0.21, 95% confidence interval (CI) 0.05-0.37; low certainty evidence), hospitalisation (risk ratio (RR) 0.77, 95% CI 0.63-0.95; very low certainty evidence) and participant satisfaction with care (SMD 0.46, 95%c CI 0.15-0.76; low certainty evidence) from 12-36 months. No statistically significant effects favouring community-based MDT interventions for functional status at 6-month follow-up, Emergency Department presentation, mortality, health-related quality of life, or nursing home admission were established. Conclusion Community-based MDT integrated care with GP participation improves clinical and process outcomes for community-dwelling older adults. Future research should focus on models of integrated care that respond to the needs and preferences of older adults.

A Polysocial Approach in Exploring Racial and Ethnic Differences in Dementia and Cognitive Decline Among U.S. Older Adults: Health and Retirement Study.

The racial or ethnic disparity in the burden of dementia exists among older adults in the United States, whereas gaps remain in understanding the synergic effect of multiple social determinants of health on diminishing this disparity. We aim to build a polysocial score for dementia and investigate the racial or ethnic difference in dementia risk among older persons with different polysocial score categories. In this prospective cohort study, we utilized longitudinal data from the Health and Retirement Study in the United States recruiting 6 945 participants aged ≥65 years who had data on 24 social determinants of health in 2006/2008. The dementia status of participants was measured by a modified version of the Telephone Interview of Cognitive Status. The stepwise Cox regression was applied to select social determinants of health associated with incident dementia to construct a polysocial score. The multivariable Poisson model and linear mixed model were utilized to investigate the associations between polysocial score and incident dementia and cognitive decline, respectively. Eight social determinants of health were used to build the polysocial score. Non-Hispanic Black older participants had a higher incidence rate (incidence rate difference [IRD] = 22.7; 95% confident interval [95% CI] = 12.7-32.8) than non-Hispanic White older adults in the low polysocial score, while this difference was substantially attenuated in the high polysocial score category (IRD = 0.5; 95% CI = -6.4 to -7.5). The cognitive decline of non-Hispanic older Black adults with high polysocial score was 84.6% slower (averaged cognitive decline: non-Hispanic White: -2.4 [95% CI = -2.5 to -2.3] vs non-Hispanic Black: -1.3 [95% CI = -1.9 to -0.8]) than that of non-Hispanic older White persons. These findings may help comprehensively understand and address racial and ethnic disparities in dementia risk and may be integrated into existing dementia prevention programs to provide targeted interventions for community-dwelling older adults with differentiated social disadvantages.

Therapeutic Quality Affects Physical Fitness Benefits of Home Exercise Interventions in Older Adults: A Systematic Review, Meta-Analysis, and Meta-Regression.

The international Consensus on Therapeutic Exercise aNd Training (i-CONTENT) tool is a new instrument developed to evaluate the therapeutic quality of exercise interventions. Home-based exercise has been shown to improve physical fitness in older adults, but its effects may be influenced by therapeutic quality. The purpose of this systematic review was to describe the therapeutic quality of home-based exercise interventions for community-dwelling older adults and examine the relationship between therapeutic quality and changes in physical fitness. Six electronic databases and 2 clinical trial registries were searched for randomized controlled trials investigating the effects of home-based exercise on physical fitness in community-dwelling older adults (≥60 years). Therapeutic quality was evaluated using the i-CONTENT tool for items of patient selection, type of exercise, safety, type/timing of outcomes, exercise dose, and adherence. International Consensus on Therapeutic Exercise aNd Training items were used to explain heterogeneity in meta-regression analyses. Risk of bias, certainty of evidence and credibility of analyses were assessed. Thirty-six trials (n = 6157 participants) were identified. Most studies (≥66.7%) had high or probably high therapeutic quality for i-CONTENT items, except exercise dose (47.2%) and adherence (16.7%). Interventions improved upper- (N = 20 trials; standardized mean difference [SMD] = 0.39; 95% CI, 0.13-0.64; low certainty of evidence) and lower-body strength (N = 28; SMD = 0.42; 95% CI, 0.08-0.77; very low certainty), and aerobic fitness (N = 8; SMD = 0.42; 95% CI, 0.08-0.77; very low certainty). For exercise dose, low- or probably low-quality studies negatively influenced effects on upper- (estimated β = -.48; P = .049; moderate credibility) and lower-body strength (estimated β = -.77; P = .048; moderate credibility). For adherence, low- or probably low-quality studies negatively influenced effects on aerobic fitness (estimated β = -.97; P = .02; low credibility). Home-based exercise may improve upper- and lower-body strength, as well as aerobic fitness in older adults. However, the effectiveness of interventions is affected by inadequate dosing of exercise programs and adherence issues. Physical therapists should have the best available evidence to support their clinical decision making, especially when designing and monitoring home programs.

Lifestyle redesign, quality of life, depressive symptoms in older adults

ABSTRACT The aim of this study was to explore the effects of the Israeli Lifestyle Program (ILP) on older adults’ quality of life (QoL) and depressive symptoms. The study employed a non-randomized controlled pre-post intervention design, (N = 99), ages 60+ years, living independently in the community. The ILP group (n = 79) participated in 15 weekly group meetings and two individual sessions. The control group (n = 20) received an educational booklet based on the ILP content. Participants completed the (WHOQoL-BREF) and a Personal Health Questionnaire (PHQ-9) pre and post intervention. At baseline, no significant differences were found between the groups. Post-intervention, the ILP group values improved in the psychological (p < .001, η2 = .154), social relationship (p < .001, η2 = .131), and environmental (p = .002, η2 = .105) domains of the WHOQoL- BREF, whereas no change was found in these domains among the control group. Physical QoL increased beyond group (p = .020, η2 = .056), although not significantly. ILP participants showed no change in the depressive symptom report (p = .424, η2 = .007), whereas participants in the control group, reported more depressive symptoms (p = .009, η2 = .070). The ILP was found to increase participants’ QoL and deemed as a promising health enhancement intervention for community-dwelling older adults.

Identification and development of implementation strategies: the important role of codesign.

To date, implementation strategies reported in the literature are commonly poorly described and take the implementation context insufficiently into account. To unravel the black box of implementation strategy development, insight is needed into effective theory-based and practical-informed strategies. The current study aims to describe the stepwise development of a practical-informed and theory-based implementation strategy bundle to implement ProMuscle, a nutrition and exercise intervention for community-dwelling older adults, in multiple settings in primary care. The first four steps of Implementation Mapping were adopted to develop appropriate implementation strategies. First, previously identified barriers to implementation were categorized into the constructs of the Consolidated Framework for Implementation Research (CFIR). Second, the CFIR-ERIC matching tool linked barriers to existing implementation strategies. Behavioral change strategies were added from the literature where necessary. Third, evidence for implementation strategies was sought. Fourth, in codesign with involved healthcare professionals and implementation experts, implementation strategies were operationalized to practical implementation activities following the guidance provided by Proctor et al. These practical implementation activities were processed into an implementation toolbox, which can be tailored to a specific context and presents prioritized implementation activities in a chronological order. A previous study identified and categorized a total of 654 barriers for the implementation of a combined lifestyle intervention within the CFIR framework. Subsequently, the barriers were linked to 40 strategies. Due to the fact that many strategies impacted multiple barriers, seven overarching themes emerged based on the strategies: assessing the context, network internally, network externally, costs, knowledge, champions, and patient needs and resources. Codesign sessions with professionals and implementation experts resulted in the development of supported and tangible implementation activities for the final 20 strategies. The implementation activities were processed into a web-based implementation toolbox, which allows healthcare professionals to tailor the implementation activities to their specific context and guides healthcare professionals to prioritize implementation activities chronologically during their implementation. A theory-based approach in combination with codesign sessions with stakeholders is a usable Implementation Strategy Mapping Method for developing a practical implementation strategy bundle to implement ProMuscle across multiple settings in primary care. The next step involves evaluating the developed implementation strategies, including the implementation toolbox, to assess their impact on the implementation and adoption of ProMuscle.

Smart Technology for Aging and Reducing Disability (STAReD): Study protocol for a randomized pragmatic clinical trial

BackgroundThere is a critical need to improve quality of life for community-dwelling older adults with disabilities. Prior research has demonstrated that a smart, in-home sensor system can facilitate aging in place for older adults living in independent living apartments with care coordination support by identifying early illness and injury detection. Self-management approaches have shown positive outcomes for many client populations. Pairing the smart, in-home sensor system with a self-management intervention for community-dwelling older adults with disabilities may lead to positive outcomes. MethodsThis study is a prospective, two-arm, randomized, pragmatic clinical trial to compare the effect of a technology-supported self-management intervention on disability and health-related quality of life to that of a health education control, for rural, community-dwelling older adults. Individuals randomized to the self-management study arm will receive a multidisciplinary (nursing, occupational therapist, and social work) self-management approach coupled with the smart-home sensor system. Individuals randomized to the health education study arm will receive standard health education coupled with the smart-home sensor system. The primary outcomes of disability and health-related quality of life will be assessed at baseline and post-intervention. Generalizable guidance to scale the technology-supported self-management intervention will be developed from qualitatively developed exemplar cases. ConclusionThis study has the potential to impact the health and well-being of rural, community-dwelling older adults with disabilities. We have overcome barriers including recruitment in a rural population and supply chain issues for the sensor system. Our team remains on track to meet our study aims.

The effectiveness of a home-based dietetic intervention for community-dwelling older adults.

The aim of this study was to describe the characteristics of clients receiving home-based dietetic intervention and to evaluate the effectiveness of these interventions in improving nutritional status, functional status, and quality of life in a culturally and socioeconomically diverse client group. Participants referred to a home-based dietetic service were recruited to this prospective cohort study. Dietetic interventions were recommended at baseline and reviewed at 3-month follow-up. Assessment of nutritional, functional and quality of life markers was measured using the Mini Nutritional Assessment (MNA), Timed Up and Go (TUG) and EQ-5D-5L, respectively, at baseline and after home-based dietetic intervention. Participants (n = 99) were recruited from consecutive referrals. Participant's weight, body mass index (BMI), total daily energy and protein intake, MNA total score, and TUG significantly improved after a 3-month nutrition intervention (effect sizes 0.257, 0.257, 0.580, 0.533, 0.577 and 0.281, respectively). The most common interventions dietitians utilised were nutrition education, use of oral nutritional supplements (ONS) and meal fortification. In total, 339 dietetic interventions were recommended to participants at baseline with 197 (58.11%) implemented at 3 months, with meal planning and referral to other relevant allied health or Commonwealth Home Support Program (CHSP) services the most implemented interventions. Home-based dietetic intervention improves nutritional status, functional status and quality of life in community-dwelling older adults referred for dietetic input. Improvements observed in nutritional and functional status were consistent with benchmarks of change from published literature.

Telehealth dignity therapy for community-dwelling older adults: feasibility and potential efficacy

ABSTRACT Research investigating accessible positive psychology interventions for older adults is lacking. We examined the feasibility and potential efficacy of Telehealth dignity therapy (TDT), a brief psychotherapy involving life review, culminating in the creation of a transcribed life story. Feasibility was measured by participant satisfaction levels and attrition rates. In accordance with past dignity therapy research, we investigated changes in participants’ meaning in life (MiL) before TDT, after TDT, and at three-month follow-up. Other secondary wellbeing outcomes were assessed. Twenty participants completed the program and reported high levels of satisfaction. Participants’ MiL and life satisfaction significantly improved between before and after TDT, and MiL gains were maintained at three-month follow-up. The program was found to be a feasible, timely, and potentially efficacious positive psychology intervention for community-dwelling older adults. Future larger-scale, controlled research is required to consolidate these findings.

EVERYDAY DIGITAL LITERACY QUESTIONNAIRE (EDLQ): DEVELOPMENT AND VALIDATION FOR KOREAN OLDER ADULTS

Abstract Aging in the digitalizing society demands digital literacy, a core competency that involves identifying, evaluating, and communicating information using various digital devices or relevant programs. This study aimed to develop the Everyday Digital Literacy Questionnaire [EDLQ], a scale to assess digital literacy, and to evaluate its psychometric properties among community-dwelling older adults in South Korea. The EDLQ was developed using an instrument development design. A nationwide survey was conducted in 1,016 community-dwelling older adults aged 60 to 94 years. To evaluate psychometric properties, following analyses were conducted in two randomly selected subsamples (n=508 per each): internal consistency (Cronbach’s alpha), construct validity (exploratory factor analysis [EFA] and confirmatory factor analysis [CFA]), and concurrent validity with the eHealth Literacy Scale (e-HEALS). Among initial 30 items of the EDLQ, 22 items with a 3-factor solution showed 77% of explained variance in total. The subscales includes “Information and Communication” (9 items), “Contents Creation and Management” (4 items) and “Safety and Security” (9 items). CFA was conducted with this 3-factor solution (χ²/df=1.675, CFI=0.997, TLI=0.997, RMSEA=0.036, SRMR=0.050, CR=0.903-0.959, AVE=0.699−0.724, r²=0.616−0.773). Concurrent validity with the e-HEALS demonstrated a strong correlation (r=0.75). The Cronbach’s α coefficient was .98. Our study findings suggest psychometric properties of the 22-item EDLQ is valid and reliable to assess digital literacy for everyday technology use in Korean older adults. The EDLQ will be useful while developing technology-based interventions for community-dwelling older adults.

Barriers and facilitators for implementation of a combined lifestyle intervention in community-dwelling older adults: a scoping review.

Lifestyle interventions, combining nutrition and exercise, are effective in improving the physical functioning of community-dwelling older adults and preventing healthcare risks due to loss in muscle mass. However, the potential of these types of interventions is not being fully exploited due to insufficient implementation. Having insight into the determinants that could hinder or facilitate the implementation of a combined lifestyle intervention could improve the development of matching implementation strategies and enhance the implementation of such lifestyle interventions. The aim of this study was to identify barriers and facilitators for the successful implementation of a combined lifestyle intervention for community-dwelling older adults. A scoping review was conducted. A literature search was conducted in four electronic databases, and references were checked for additional inclusion. Studies were screened if they met the inclusion criteria. Barriers and facilitators were extracted from the included studies. To validate the results of the literature search, healthcare professionals and community-dwelling older adults were interviewed. Barriers and facilitators were categorized by two researchers according to the constructs of the Consolidated Framework for Implementation Research (CFIR). The search identified 12,364 studies, and 23 were found eligible for inclusion in the review. Barriers and facilitators for 26 of the 39 constructs of the CFIR were extracted. The interviews with healthcare professionals and older adults yielded six extra barriers and facilitators for implementation, resulting in determinants for 32 of the 39 CFIR constructs. According to literature and healthcare professionals, cosmopolitanism (network with external organizations), patient needs and resources, readiness for implementation, costs, knowledge and beliefs about the intervention, network and communication, and engaging were found to be the most important determinants for implementation of a combined lifestyle intervention. A broad range of barriers and facilitators across all domains of the CFIR framework emerged in this study. The results of this review reflect on determinants that should be taken into account when planning for the implementation of a combined lifestyle intervention. A further step in the implementation process is the development of implementation strategies aiming at the identified determinants to enhance the implementation of a combined lifestyle intervention in community care.

Demographics moderated the association of symptom burden with falls and fall-related outcomes

ObjectivesTo examine whether (1) prior-year symptom burden predicted later-year falls and fall-related outcomes and (2) demographics moderated the longitudinal effects of symptom burden on falls and fall-related outcomes among community-dwelling older adults. MethodsWe used 2011–2018 National Health and Aging Trends Study data that included 9,060 community-dwelling older adults (contributed 34,327 observations). Falls and fall-related outcomes included self-reported falls, multiple falls, fear of falling (FOF), and FOF limiting activity. Symptom burden was defined as the presence of pain, insomnia, breathing difficulty, depressive symptoms, anxiety, and fatigue, and calculated the number of symptoms (range from 0 to 6). Binomial logistic regression was used to examine the associations between symptom burden and falls and fall-related outcomes and the moderation effects of demographic factors. ResultsThe majority of the sample were aged between 65 and 79 years old (57.7%), non-Hispanic White (70.5%), and female (58.4%). Each additional symptom was associated with an increased risk of falls (Adjusted Odds Ratio [AOR]: 1.13, 95% CI: 1.10–1.15), multiple falls (AOR: 1.15, 95% CI: 1.12–1.18), FOF (AOR: 1.20, 95% CI: 1.18–1.23), and FOF limiting activity (AOR: 1.24, 95% CI: 1.20–1.28). Age, race/ethnicity, education, and living arrangement statistically significantly moderated the relationships between symptom burden and falls and fall-related outcomes. ConclusionsSymptom burden predicted falls, multiple falls, FOF and FOF limiting activity, and demographics may differentially modify this risk. Individually tailored symptom assessment and management plans should be incorporated into fall risk assessment and interventions for community-dwelling older adults living.

Effects of virtual reality guided meditation in older adults: the protocol of a pilot randomized controlled trial.

Virtual reality (VR) based meditation has been shown to help increase relaxation and decrease anxiety and depression in younger adults. However, this has not been studied in Randomized Controlled Trials (RCT) in the older adult population. The aim of this RCT is to assess the feasibility and acceptability of a VR-guided meditation intervention for community-dwelling older adults and its effect on stress and mental health. We will recruit 30 participants aged ≥ 60 years, whose perceived stress score (PSS) is > 14 (moderate stress), and randomize them 1:1 to the intervention or control waitlist group. The intervention will involve exposure to eight 15-min VR-guided meditation sessions distributed twice weekly for 4-weeks. Two modalities will be offered: in-home and at the hospital. Baseline and post-intervention assessments will evaluate perceived stress, anxiety, depression, sleep quality, quality of life, and mindfulness skills. Analyses will employ mixed methods repeated ANOVA tests. Qualitative analyses through semi-structured interviews and participant observation will be used to assess participants' experiences. Study outcomes include: (A) feasibility and acceptability compared to a waitlist control (B) stress, using the Perceived Stress Scale (PSS); (C) anxiety, and depression, using the Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9); (D) insomnia, quality of life and mindfulness skills, using the Athens Insomnia Scale (AIS), Quality of Life Questionnaire (EQ-5D-5L) and Five Facets Mindfulness Questionnaire Short Forms (FFMQ-SF), respectively. We will also measure immersive tendencies, sickness and sense of presence using the Simulator Sickness Questionnaire (SSQ) and the Presence Questionnaire (PQ). Virtual reality-guided meditation could be an acceptable, feasible, safe, and cost-effective novel alternative health intervention for improving older adults' mental health.Clinical trial registration: NCT05315609 at https://clinicaltrials.gov.

Non-pharmacological interventions for possible sarcopenia or sarcopenia in community-dwelling older adults: a scoping review protocol

IntroductionEarly prevention of sarcopenia is a recommendation to reduce morbidity, mortality and improve quality of life. Several non-pharmacological interventions to reduce the risk of sarcopenia in community-dwelling older people have...

Effectiveness of community-based multidisciplinary integrated care for older people: a protocol for a systematic review

IntroductionThe increasing number of older adults with multiple complex care needs has placed increased pressure on healthcare systems internationally to reorientate healthcare delivery. For many older adults, their first point...

P10-04 Effects of a web-based versus a print-based physical activity intervention for community-dwelling older adults: Results of a randomized trial with a cross-over design

BackgroundDespite the crucial role of regular physical activity (PA) for preventing chronic non-communicable diseases, fewer than half of older adults in Germany engage in the recommended levels.Objective: The aim of this study was to compare acceptance and effectiveness of two interventions for PA promotion among initially inactive community-dwelling adults aged 60 years and above in a nine-month randomized trial with a cross-over design.MethodsParticipants were recruited offline and randomized to (a) a print-based intervention (PRINT n = 113) and (b) a web-based intervention (WEB, n = 129). Thirty percent (n = 38) of those in group (b) received a PA tracker in addition to WEB (WEB+, (c)). All intervention groups were offered ten weekly face-to-face group sessions led by trained student assistants. Afterwards, participants could choose to stay in their group or cross over to one of the other groups. Group sessions were continued monthly for another six months. Three-dimensional accelerometers to assess PA at baseline (T0), three-months (T1) and nine-months (T2) were employed. Intervention acceptance was assessed via self-administered paper-based questionnaires. Linear mixed models were used to calculate differences in moderate-to-vigorous PA (MVPA) between time points and intervention groups.ResultsOf the initially recruited n = 242 participants, n = 91 (37.6%) were randomized to the WEB group, n = 38 (15.7%) to WEB+ and n = 113 (46.7%) to PRINT and n = 195 participants completed T1. Only n = 1 moved from WEB to PRINT and n = 15 from PRINT to WEB (WEB-WEB: n = 103, PRINT-PRINT: n = 76), when offered to cross over at T1. One-hundred and sixty participants completed T2. MVPA in min per day increased between baseline and T1, but these within-group changes in time disappeared after adjusting for covariates. MVPA decreased by 9 min/day between baseline and T2 (βtime = -9.37, 95% CI: [-18.58; -0.16]), regardless of intervention group (WEB vs. PRINT: βgroup*time = -3.76, 95% CI: [-13.33; 5.82], WEB+ vs. PRINT: βgroup*time = 1.40, 95% CI: [-11.04; 13.83]). Intervention acceptance was generally high.ConclusionsDespite high levels of acceptance of web- and print-based interventions for PA promotion and little movement between groups at T1, when given the choice, participation was not associated with increases in PA over time.

Community-based group physical activity and/or nutrition interventions to promote mobility in older adults: an umbrella review

BackgroundPhysical activity and a healthy diet are important in helping to maintain mobility with aging. This umbrella review aims to identify group-based physical activity and/or nutrition interventions for community-dwelling older adults that improve mobility-related outcomes.MethodsFive electronic databases (MEDLINE, Embase, CINAHL, Cochrane CENTRAL, Sociological s) were searched from inception to December 2021. Eligibility criteria included systematic reviews exploring the effectiveness of physical activity or structured exercise, alone or combined with nutrition interventions on mobility-related outcomes (aerobic capacity, physical function, balance, falls/safety, muscle strength, health-related quality of life/wellbeing). Interventions must have been delivered in a group setting to community-dwelling older adults aged 55+. Two reviewers independently performed eligibility screening, critical appraisal (using AMSTAR 2) and data extraction. The GRADE approach was used to reflect the certainty of evidence based on the size of the effect within each mobility-related outcome category. Older adult/provider research partners informed data synthesis and results presentation.ResultsIn total, 62 systematic reviews (1 high, 21 moderate, 40 low/critically low quality) were identified; 53 included physical activity only, and nine included both physical activity and nutritional supplements. No reviews included nutrition interventions alone. Combined aerobic/resistance, general physical activity, and mind-body exercise all improved physical function and balance (moderate-high certainty). Aerobic/resistance training improved aerobic capacity (high certainty). Resistance training and general physical activity improved muscle strength (moderate certainty). Aerobic/resistance training and general physical activity are likely to reduce falls among older adults (moderate certainty). There was no evidence of benefit for nutritional supplementation with physical activity.ConclusionsGroup-based physical activity interventions that combine aerobic and resistance, general PA and mind-body exercise can improve measures of mobility in community-dwelling older adults. We found no reviews focused on nutrition only, highlighting a gap in the literature.

Nurse-led home modification interventions for community-dwelling older adults with dementia and their impact on falls prevention

This quasi-experimental study aimed to investigate the effects of nurse-led home modification interventions on the family members of home-dwelling older adults with dementia. The sample consisted of 42 older adults diagnosed with dementia and their family members. A number of validated tools were used. Three home visits were undertaken, a training package with family members was instigated, and the patients were followed up for a 6-month period. It was determined that there was a decrease in falls in the first 3-month period (p=0.002). The number of falls in the second 3-month period was lower in the older adults who had their homes modified (p=0.000). Family-centred, nurse-led home-modification interventions can be effective in the prevention and reducing of falls in older adults with dementia.

Community-based physical activity and/or nutrition interventions to promote mobility in older adults: An umbrella review.

Background: Physical activity and a healthy diet are important in helping to maintain mobility and quality of life with aging. Delivery of physical activity and nutrition interventions in a group setting adds the benefits of social participation. Several published systematic reviews have explored a broad range of PA and/or nutrition interventions for older adults, making it challenging to bring together the best scientific evidence to inform program design and to inform multicomponent intervention development. This umbrella review aims to identify group-based physical activity and nutrition interventions for community-dwelling older adults that improve mobility. Methods: Five electronic databases (MEDLINE, Embase, CINAHL, Cochrane CENTRAL, Sociological Abstracts) were searched from inception to April 28, 2020. Eligibility criteria included systematic reviews exploring the effectiveness of physical activity and/or nutrition interventions, delivered in a group setting for community-dwelling older adults. Two reviewers independently performed eligibility screening, critical appraisal (using AMSTAR 2) and data extraction. The GRADE approach was used to assess the overall certainty of the evidence. Older adult/provider research partners informed data synthesis and results presentation. Results: In total, 54 systematic reviews (1 high, 21 moderate, 32 low/critically low quality) were identified; 46 included physical activity only, and eight included both physical activity and nutritional supplements. No reviews included nutrition interventions alone. Combined aerobic/resistance, general physical activity, and mind-body exercise all improved physical function and balance (moderate-high certainty). Aerobic/resistance training improved aerobic capacity (high certainty). Resistance training and general physical activity improved muscle strength (moderate certainty). Aerobic/resistance training and general physical activity are likely to reduce falls among older adults (moderate certainty). There was no evidence of benefit for nutritional supplementation with physical activity. Conclusions: Multicomponent group-based physical activity interventions can improve measures of mobility in community-dwelling older adults. We found no reviews focused on nutrition only, highlighting a gap in the literature.

Web-Based Versus Print-Based Physical Activity Intervention for Community-Dwelling Older Adults: Crossover Randomized Trial.

BackgroundFewer than half of older German adults engage in the recommended levels of endurance training.ObjectiveThe study aim is to compare the acceptance and effectiveness of two interventions for physical activity (PA) promotion among initially inactive community-dwelling older adults ≥60 years in a 9-month, crossover randomized trial.MethodsParticipants were recruited in person and randomized to one of the following interventions for self-monitoring PA: a print-based intervention (PRINT: 113/242, 46.7%) or a web-based intervention (WEB: 129/242, 53.3%). Furthermore, 29.5% (38/129) of those in the web-based intervention group received a PA tracker in addition to WEB (WEB+). After randomization, the participants and researchers were not blinded. The participants’ baseline intervention preferences were retrospectively assessed. All the intervention groups were offered 10 weekly face-to-face group sessions. Afterward, participants could choose to stay in their group or cross over to one of the other groups, and group sessions were continued monthly for another 6 months. 3D accelerometers to assess PA and sedentary behavior (SB) at baseline (T0), 3-month follow-up (T1), and 9-month follow-up (T2) were used. Adherence to PA recommendations, attendance of group sessions, and intervention acceptance were assessed using self-administered paper-based questionnaires. Linear mixed models were used to calculate differences in moderate to vigorous PA (MVPA) and SB between time points and intervention groups.ResultsOf the 242 initially recruited participants, 91 (37.6%) were randomized to the WEB group; 38 (15.7%) to the WEB+ group; and 113 (46.7%) to the PRINT group. Overall, 80.6% (195/242) of the participants completed T1. Only 0.4% (1/242) of the participants changed from the WEB group to the PRINT group and 6.2% (15/242) moved from the PRINT group to the WEB group (WEB-WEB: 103/249, (41.4%); PRINT-PRINT: 76/249, 30.5%) when offered to cross over at T1. Furthermore, 66.1% (160/242) of participants completed T2. MVPA in minutes per day increased between baseline and T1, but these within-group changes disappeared after adjusting for covariates. MVPA decreased by 9 minutes per day between baseline and T2 (βtime=−9.37, 95% CI −18.58 to −0.16), regardless of the intervention group (WEB vs PRINT: βgroup*time=−3.76, 95% CI −13.33 to 5.82, WEB+ vs PRINT: βgroup*time=1.40, 95% CI −11.04 to 13.83). Of the participants, 18.6% (38/204) met the PA recommendations at T0, 16.4% (26/159) at T1, and 20.3% (28/138) at T2. For SB, there were no significant group differences or group-by-time interactions at T1 or T2. Intervention acceptance was generally high. The use of intervention material was high to moderate at T1 and decreased by T2.ConclusionsThere was little movement between intervention groups at T1 when given the choice, and participation was not associated with increases in PA or decreases in SB over time.Trial RegistrationGerman Clinical Trials Register DRKS00016073; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00016073