Interventions For Older Adults Research Articles

RISK OF HEART FAILURE AFTER CATHETER ABLATION VS. MEDICAL THERAPY FOR ATRIAL FIBRILLATION IN OLDER ADULTS

Abstract Background Age increases the risk of atrial fibrillation (AF). Catheter ablation (CA) proved being safer and superior to anti-arrhythmic drugs (AADs) in maintaining sinus rhythm and preventing readmissions. However, data on the risk of developing heart failure (HF) following each treatment in older adults is limited. Methods A retrospective study was conducted using the PearlDiver database (PearlDiver Technologies, Fort Wayne, IN). Using ICD 9 and 10 codes, a cohort of patients without a history of HF, aged 65 to 75, with an Elixhauser Comorbidity Index (ECI) of >4 and new-onset AF (index event) was identified. The cohort was then divided into two groups based on treatment received following the index event and matched considering age, gender, ECI, and other cardiovascular diseases. Records from both groups were reviewed for the first episode of HF over 12 months following the initiation of treatment. Pearson’s chi-squared test was used to compare groups. The strength of association was reported using Risk Ratios (RR). A p-value < 0.05 was deemed significant. Results 6,446 were included in each group. The mean age, gender and ECI were indifferent. 958 (15%) of patients treated with AADs and 987 (15.3%) of patients treated with CA had a first episode of HF over a year after the treatment which was not significantly different between groups (RR=1.03, CI95% = 0.95- 1.11, p=0.49). Conclusion The modality of treatment after the first episode of AF in older population doesn’t significantly affect the risk of HF over the first year.

A self-administered moxibustion-cum-massage intervention for older adults with chronic pain in the community: A randomized controlled trial

ObjectivesTo determine the effectiveness of a simple, self-administrable moxibustion-cum-massage intervention for relieving chronic pain and improving psychological well-being for older adults in the community. DesignA randomized controlled trial. SettingSeventy-eight participants with chronic pain were randomly assigned to the intervention and waitlist control groups. InterventionsParticipants received two moxa sticks a day to use the moxibustion-cum-massage procedure with the help of trained volunteers or caregivers for five consecutive days. Main outcome measuresParticipates’ pain level, sleep quality, depression and subjective well-being were measured before the intervention (T0), immediately after the intervention (T1), and one week after the intervention (T2). ResultsRepeated measures ANOVA revealed a significant group × time interaction effect in subjective well-being with a medium effect size. Regarding within-group effects in the intervention group at post-intervention (T1), the subjective pain level was significantly reduced with a small effect size, while sleep quality and depression significantly improved with large effect sizes. The control group showed no significant within-group effects in these variables. Maintenance effects at follow-up (T2) were not significant. ConclusionDespite the short intervention timeframe of five days, the study revealed preliminary evidence that the moxibustion-cum-massage intervention can be an effective, self-administrable pain relief regime for older adults. A longer period of intervention time is suggested for future studies.

Effectiveness of interventions in older adults with cognitive frailty: a systematic review and meta-analysis of randomised controlled trials.

interventions targeting older adults with cognitive frailty have grown rapidly in recent years with inconsistent findings. However, there is no meta-analysis that has synthesised pooled estimates. to synthesise the pooled effect of current targeted interventions in older people with cognitive frailty. we conducted a systematic search in PubMed, Embase, Web of Science, the Cochrane Library, the JBI database and three Chinese databases (CNKI, Wan-Fang and VIP) for literature from the inception of the database until 8 March 2022. The mean difference or standardised mean difference with 95% CIs was calculated. The methodological quality was assessed by the Cochrane RoB 2.0. The certainty of evidence was assessed using the GRADE criteria. thirteen randomised controlled trials with a total of 1,089 participants were included. The results of the meta-analysis showed that older adults with cognitive frailty in the intervention groups had significant improvement in frailty score [MD = -1.67, 95% CI (-2.39, -0.95), P < 0.00001, I2= 97%], global cognitive function [MD = 3.38, 95% CI (1.90, 4.85), P < 0.00001, I2= 93%], mobility [MD = -0.96, 95% CI (-1.27, -1.66), P < 0.00001, I2= 0%], muscle strength [SMD = 0.75, 95% CI (0.09, 1.41), P = 0.03, I2= 85%] and nutritional status [MNA:MD = 5.64, 95% CI (3.99, 7.29), P < 0.00001, I2= 89%; ALB: MD = 3.23, 95% CI (0.76, 5.71), P = 0.01, I2= 93%; PALB: MD = 54.52, 95% CI (25.26, 83.77), P = 0.0003, I2= 96%; TRF: MD = 0.64, 95% CI (0.22, 1.06), P = 0.003, I2= 97%]. The overall certainty of the evidence ranged from low to moderate. interventions targeting older adults with cognitive frailty are effective in improving physical frailty, global cognitive function, physical function and nutritional status with low to moderate certainty. More research is still needed in the future to further enrich the evidence in these fields. CRD42022318758.

Baseline Measures of Cortical Inhibition Predict Motor Performance Changes after Exercise Interventions

<h3>Research Objectives</h3> To investigate the relationship of transcranial magnetic stimulation (TMS) measures on cortical inhibition before and after an exercise intervention in older adults. Our hypothesis is that higher levels of cortical inhibition would predict greater motor skill acquisition. We predicted that persons randomized to an aerobic spin exercise intervention would increase cortical inhibition and motor performance as compared to light strength training. <h3>Design</h3> The study design is randomized controlled trial with two groups investigating a balance and strength training intervention (both lasting 12-weeks or 36 sessions) against an Aerobic Cycling Intervention. The assessment sessions included behavioral testing, TMS taken at study baseline and after 12-weeks. <h3>Setting</h3> This project involved community dwelling older adults and was performed in a medical center. The main study sites were the Atlanta VA and Emory University. <h3>Participants</h3> We randomized 20 participants to either an exercise intervention or a balance and strength training group after obtaining informed consent. Participants were required to be over the age of 60 years and reportedly healthy at inclusion. This report is on 13 completers. <h3>Interventions</h3> Participants were randomized to either a 12-week interval aerobic spin cycling (HIIT spin) or a 12-week intervention involving light strength training both under supervised trainers thrice weekly for up to 45 minutes per session. <h3>Main Outcome Measures</h3> We acquired transcranial magnetic stimulation measures of: cortical excitability (motor threshold), Short intracortical inhibition, Long Intracortical Inhibition, Short Interhemispheric inhibition, long interhemispheric inhibition. Speed and accuracy of motor learning was the behavioral outcome. <h3>Results</h3> Baseline measures of SICI and LICI showed participants with higher levels of disinhibition showed better motor performance. We found no effect for group. Contrary to our hypothesis, individuals with greater increases in TMS inhibition showed lower motor skill performance after interventions. <h3>Conclusions</h3> We can conclude from the preliminary data that measures of cortical inhibition taken from TMS do show change associated with interventions in older adults and predict improvement in motor skill acquisition. Additional study is needed to identify the mechanisms of change in cortical inhibition. <h3>Author(s) Disclosures</h3> None.

Outdoor Community Ambulation Interventions to Improve Physical and Mental Health in Older Adults: A Systematic Review and Meta-Analysis.

Limited community ambulation, defined as independent mobility outside the home, predicts adverse outcomes in older adults. We performed a systematic review and meta-analysis to examine outdoor community ambulation intervention effectiveness in older adults. We searched six databases until October 2021. Studies with an evaluative research objective, older adult population, and outdoor community ambulation interventions were eligible. After reviewing 23,172 records, five studies were included. The meta-analysis found no significant difference in walking endurance and depression outcomes between outdoor community ambulation and comparison interventions. For outcomes not suitable for meta-analysis, studies showed no significant difference in walking activity, anxiety, and general and health-related quality of life, and possible improvements in gait speed and lower extremity function and strength. Most evidence was of low to very low certainty. Considering the limited evidence base, the design, implementation, and evaluation of outdoor community ambulation interventions in older adults should be prioritized in primary research.

Choice of Inversion Time for Arterial Spin Labeling MRI in the U.S. POINTER Lifestyle Intervention Trial

AbstractBackgroundThe U.S. Study to Protect Brain Health Through Lifestyle Intervention to Reduce Risk (U.S. POINTER) is a 2‐year randomized controlled trial to evaluate the effect of lifestyle interventions in older adults (60‐79 years). The POINTER Imaging ancillary study is collecting Arterial Spin Labeling (ASL) MRI data to map cerebral blood flow (CBF) and evaluate the effect of interventions in the perfusion imaging biomarker. The optimization of timing parameters is essential for robust and efficient acquisition of ASL MRI.MethodA subset (n=83; F/M=51/32; age=69.0±5.5) of POINTER Imaging participants at two imaging sites underwent two ASL MRI scans during the same baseline session. Two 3D Pulsed ASL were obtained with TI1 of 790ms and TI2 values of 2000ms or 2750ms, which provide the delay times (between labeling and imaging) of 1210ms or 1960ms. ASL images were quantified into a physiological unit of CBF, ml/100g/min, using a single compartment kinetic model. CBF maps from two scans were normalized into a standard space and a voxel‐wise paired t‐test was performed after site variations were harmonized and covariates (age and sex) were adjusted. The age and sex effects in the difference of CBF values between two scans were also examined using linear regression. To control false positives, clusters smaller than 41ml were removed based on a simulation with α=0.05.ResultThe CBF values in ASL MRI rely on the timing of image acquisition: only a fraction of label bolus arrives in the tissue with a short delay while images suffer from low signal due to the magnetization decay with a long delay. Figure 1 shows the regions that require a long delay time (red) or a short delay (blue). The difference in CBF is proportional to arterial transit time (ATT) and the analysis shows females have shorter ATT mainly in the peri‐Sylvian region (Figure 2). No cluster survived correction in the analysis of the aging effect.ConclusionThe acquisition of two CBF maps not only offers optimization of acquisition timing but provides an additional perfusion parameter, arterial transit time, which may be a potential biomarker of cerebrovascular pathophysiology.

Barriers and facilitators of digital interventions use to reduce loneliness among older adults: a protocol for a qualitative systematic review

IntroductionDigital interventions are considered as a potential solution to loneliness in older adults. However, this type of intervention has had limited acceptance among older adults (aged ≥60 years). To ensure...

Adherence to in‐person vs. virtual delivery of a multi‐domain behavioral intervention to prevent cognitive decline: The US POINTER Study

AbstractBackgroundIn response to the global pandemic, U.S. POINTER procedures were adapted to include virtual intervention delivery. Here we describe the impact of this adaptation on adherence in a large community‐based lifestyle intervention trial.MethodU.S. POINTER is conducted through a partnership between the Alzheimer’s Association (AA) and five clinical sites. A total of 2000 older adults at risk for cognitive decline are assigned to one of two 24‐month multi‐domain lifestyle interventions. The Self‐Guided (SG) group works toward lifestyle goals that best meet their individual needs and schedules. The Structured (STR) group follows a coordinated program with specific goals for physical activity, diet, cognitive/social challenge, and health monitoring. Both groups meet in teams of 12‐15 participants throughout the study for support and guidance, which are led by trained staff. SG teams meet six times over 24 months, and STR teams meet weekly for the first 4 months, then 2x/month for 2 months, and then monthly. Although Team Meetings for both intervention groups were planned as in‐person events, the global pandemic necessitated a pivot to virtual delivery.ResultFrom January through December 2021, N = 2103 Team Meetings were conducted in‐person and N = 4663 Team Meetings were conducted virtually for 824 participants. For both intervention groups, in‐person and virtual Team Meeting attendance was the same, at 90%. When Team Meetings were held in‐person, STR participants completed a median of 93 very active Fitbit minutes/week (IQR = 38,185) and reported a median MIND Diet score of 11.0 (IQR = 9.5,12.0). When Team Meetings were virtual, adherence metrics were comparable with median values of 101 very active Fitbit minutes/week (IQR = 43,192) and a MIND Diet score of 11.0 (IQR = 9.8,12.0). Blood pressure monitoring and cognitive training metrics were also comparable without regard to Team Meeting delivery format.ConclusionOur findings demonstrate that a shift to virtual participant contact during the pandemic did not compromise adherence to a complex multi‐domain lifestyle intervention in older adults. These findings have high relevance for other ongoing lifestyle intervention studies within and outside of WW‐FINGERS, and highlight the importance of adaptability in clinical trial design and implementation to foster sustainability under challenging life circumstances.

Effectiveness of reminiscence therapy interventions for older people: Evidence mapping and qualitative evaluation.

INTRODUCTION: Reminiscence therapy is an alternative to pharmaceutical intervention provided during long-term care, especially for older people with mental and psychological problems. However, the effects of reminiscence therapy remain inconclusive. The present study aimed to systematically identify, synthesize and describe the research evidence and quality of systematic reviews (SRs) related to reminiscence interventions for older people through an evidence-mapping approach. Commonly used English and Chinese databases, including PubMed, EMBASE, The Cochrane Library, Web of Science, CNKI, WANFANG, VIP and SinoMed, were searched from inception till 31 March 2022. The study type was restricted to SRs with or without meta-analysis. The methodological quality of the included SRs was assessed by A Measurement Tool to Assess Systematic Reviews (AMSTAR-2). The Microsoft Excel 2019 tool was used for data extraction and coding, and bubble charts were used to synthesize information on the study population, intervention category, original study sample size and classification of findings. A total of 28 SRs were enrolled, including 514 original studies, 91.4% of which were randomized controlled trials. The main participants of the study were depressed older people (7 publications), older people with dementia (10 publications) and ordinary older people (8 publications). The findings of 26 (92.8%) publications were categorized as either "beneficial" or "potentially beneficial." The primary outcome indicators of the effectiveness of the reminiscence intervention for older people are mental and psychological problems (especially depressive symptoms and cognitive functioning), quality of life and categories of positive psychology (e.g., life satisfaction, happiness and self-esteem). The main factors influencing the intervention effect were the intervention period, residential setting, intervention format (group/individual) and intervention intensity. The intervention settings/contexts were mainly community and long-term care facilities. However, the methodological quality of 27 (96.4%) of the SRs was scored as either "Low" or "Critically Low." Reminiscence therapy has been used to study the mental health and quality of life of older people in various conditions, with significant results. However, due to the limited evidence included in the studies and the low methodological quality, there is still a need to focus on the issue of effectiveness and evidence gaps for different interventions in the field of recall in the future, in addition to efforts to improve the methodological quality and standardize the reporting process for the evaluation of reminiscence intervention systems. Reminiscence therapy may be considered a useful non-pharmacological intervention for older people with mental and psychological problems. A standard protocol for reminiscence therapy may be necessary for future studies.

Treating Hypertension in Older Adults in Light of the Recent STEP Trial: Can We Implement the Findings in Geriatric Practice?

Recently, major trials have explored blood pressure targets that would provide greater benefit and fewer adverse events in older adult population on antihypertensive treatment. The last study was the STEP study conducted in China, which included 8511 older people aged 60-80 years. When systolic blood pressure below 130 mmHg was targeted in older individuals, there was a 26% risk reduction in cardiovascular outcomes compared with higher (<150mmHg) blood pressure values. At this point, it is necessary to evaluate how much the study group represents the older population because this population group is very heterogeneous, and it is not possible to apply a single treatment strategy to all older people. In this context, when we examined the baseline characteristics of the study group, we saw that the individuals included in the study consisted mostly of young-older people with less accompanying comorbidities. In addition, vulnerable groups, such as those with dementia and nursing home residents who are susceptible to treatment adverse effects, appeared to be excluded from the study. Therefore, this trial is very important as it concludes that the goal of strict blood pressure control is beneficial in fit older individuals, but does not guide treatment strategy for other groups. When planning treatments in older adults, it is essential to consider the biological age of individuals and to determine a strategy by evaluating frailty, functionality and cognitive status. As stated in the STEP study protocol, additional analyses considering frailty and cognitive performance will aid in a healthier interpretation of the study in the future.

The Effect of Older Age and Frailty on the Time to Diagnosis of Cancer: A Connected Bradford Electronic Health Records Study.

Over 60% of cancer diagnoses in the UK are in patients aged 65 and over. Cancer diagnosis and treatment in older adults is complicated by the presence of frailty, which is associated with lower survival rates and poorer quality of life. This population-based cohort study used a longitudinal database to calculate the time between presentation to primary care with a symptom suspicious of cancer and a confirmed cancer diagnosis for 7460 patients in the Bradford District. Individual frailty scores were calculated using the electronic frailty index (eFI) and categorised by severity. The median time from symptomatic presentation to cancer diagnosis for all patients was 48 days (IQR 21-142). 23% of the cohort had some degree of frailty. After adjustment for potential confounders, mild frailty added 7 days (95% CI 3-11), moderate frailty 23 days (95% CI 4-42) and severe frailty 11 days (95% CI -27-48) to the median time to diagnosis compared to not frail patients. Our findings support use of the eFI in primary care to identify and address patient, healthcare and system factors that may contribute to diagnostic delay. We recommend further research to explore patient and clinician factors when investigating cancer in frail patients.

Blinatumomab Alternating With Low-Intensity Chemotherapy (CT) Treatment for Older Adults With Newly Diagnosed Philadelphia (Ph)-Negative B-Cell Precursor Acute Lymphoblastic Leukemia (BCP-ALL) is Well Tolerated and Efficacious: Safety Run-In Results for the Phase 3 Randomized Controlled Golden Gate Study

Introduction: Outcomes have improved for younger adults with BCP-ALL through better understanding of the biological mechanisms of BCP-ALL and development of intensive CT regimens (overall survival [OS], ≥60%). However, outcomes in patients (pts) >55 y remain poor (5 y OS, <10-40%) as toxicities limit use of intensive CT regimens. Novel treatment strategies incorporating immunotherapy to reduce CT-related morbidity and mortality may improve outcomes in this older pt population. Blinatumomab, a CD3/CD19-directed bispecific T-cell engager (BiTE®) molecule, directs T cells to lyse CD19+ B-lineage cells and has demonstrated efficacy in pediatric and adult pts with relapsed or refractory CD19+ BCP-ALL or minimal residual disease (MRD) ≥0.1%. We report results from the single-arm safety run-in for the randomized controlled phase 3 Golden Gate Study in older adults with newly diagnosed Ph-negative BCP-ALL (NCT04994717). The safety run-in evaluated blinatumomab alternating with low-intensity CT and a shorter blinatumomab dose step (4 days) than presently included in the blinatumomab label. Methods: Pts aged ≥55 y (or 40 to <55 y with severe, pre-defined comorbidities) with newly diagnosed Ph-negative BCP-ALL, Eastern Cooperative Oncology Group performance status ≤2 and adequate organ function were included. Clearance of central nervous system (CNS) leukemia with intrathecal (IT) CT was required before enrollment. Pts in the safety run-in (Figure) were to receive 7 cycles (C) of blinatumomab (2 in induction, 2 in consolidation and 3 in maintenance) alternating with CT, including IT CT. Rituximab (8 doses) was given if CD20 expression was ≥20%. Permitted pre-phase CT consisted of cyclophosphamide, vincristine, dexamethasone and/or hydroxyurea; IT CT was requested per local standard of care. Primary objective of the safety run-in was to evaluate the safety and tolerability of blinatumomab alternating with low-intensity CT. Secondary objectives were to evaluate efficacy endpoints (complete remission [CR] within 14 weeks of starting induction C1; MRD response, defined as <10-4 by quantitative PCR [central lab] within 14 weeks of starting induction C1; relapse-free survival) and pharmacokinetics (PK) of blinatumomab. Results: Ten pts enrolled in the safety run-in between November 2021 and 28 June 2022. Median age was 69 y (range, 57-77); 4 (40%) pts were ≥70 y (Table). Nine (90%) pts had bone marrow blasts ≥50% at diagnosis; 4 (40%) pts were CD20+ and received rituximab. All 10 pts completed induction C1. Seven pts remain on treatment (induction C2, n=5 [ongoing, n=2; completed, n=3]; consolidation C1 completed, n=1; consolidation C2 ongoing, n=1) and 3 pts discontinued treatment (2 for planned allogeneic stem cell transplant in post C2 induction CR and 1 due to isolated extramedullary relapse during induction C2). From the data cut off (28 June 2022), the most common all-grade treatment emergent adverse events (TEAEs) were cytokine release syndrome (CRS; n=5), decreased neutrophils (n=5) and decreased white blood cell count (WBC; n=5). All pts had grade ≥3 TEAEs; grade ≥3 TEAEs in ≥20% of pts were neutropenia (n=6), decreased WBC (n=5), anemia (n=3), thrombocytopenia (n=3) and bacteremia (n=2). All grade 4 TEAEs were hematologic. No deaths occurred. One pt had a serious adverse event (AE; grade ≥3, bilirubin increased). Grade ≥3 CNS TEAEs occurred in 1 pt (vasovagal and peripheral neuropathy unrelated to blinatumomab); no grade ≥3 CNS or CRS AEs related to blinatumomab occurred. Four pts had COVID-19 (grade 2, n=3; grade 3, n=1); blinatumomab was interrupted in 4/4 pts until COVID-19 negative and treatment then resumed without unusual AEs. After induction C1, all 10 pts achieved CR and 9/10 pts achieved a MRD response <10-4 per central lab. After induction C2, 5 pts had MRD results available; all 5 pts had a MRD response <10-4. Blinatumomab PK results will be presented. Conclusions: Blinatumomab alternating with low-intensity CT had an acceptable safety profile and was well tolerated. No deaths occurred. The regimen was efficacious in this older adult population as all 10 pts achieved CR and 90% had a MRD response <10-4 after induction C1. These data support the planned regimen for the randomized controlled phase 3 study of blinatumomab alternating with low-intensity CT versus standard of care CT. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

'Now I can bend and meet people virtually in my home': The experience of a remotely supervised online chair yoga intervention and visual socialisation among older adults with dementia.

Little research has been conducted on telehealth-based interventions in older adults. There has been no study of the use of telehealth-based online chair yoga (CY) to improve physical activity and manage dementia symptoms and socialisation for older adults with dementia who are socially isolated. The study identified benefits, challenges and facilitators in participating in remotely supervised online CY from the perspective of older adults with dementia and their caregivers, including what would help them to participate in online interventions. In a qualitative descriptive design, four online focus groups (two pre-intervention and two post-intervention) conducted via videoconference explored the benefits, challenges and facilitators in participating in a remotely supervised twice-weekly, 8-week online CY intervention. A total of 17 participants (eight people with dementia and nine family caregivers) attended the focus groups. The data were subjected to thematic analysis. Thematic analysis of data identified three themes from the perspectives of older adults with dementia and their caregivers: (a) benefits (e.g. sleep and relaxation, emotional regulation, flexibility, muscle strength, convenience, caregiver-participant connection), (b) challenges (e.g. technological setup) and (c) lessons learned (e.g. inclusion of caregiver, yoga instructor, visual cues, socialisation, safety). The online intervention was beneficial to participants, who reported that they wanted to continue home-based online CY practice. Convenience was the major advantage for the participant to continue to practice online CY. The online intervention offered virtual socialisation, which could be significant for motivating older adults to continue the CY program. Gerontological nurses could add CY as a nonpharmacological component of a treatment plan and monitor older adults' progress during the online intervention. The home-based online CY intervention should be prioritised to promote health and wellness in socially isolated older adults with dementia.

Sarcopenia is associated with mild-to-moderate chronic kidney disease in Chinese community-dwelling older men but not in women

To determine whether a relationship exists between sarcopenia, including its individual components (muscle mass, muscle strength and gait speed), and mild-to-moderate chronic kidney disease (CKD) in Chinese older adults. This cross-sectional study comprised participants aged ≥60 years from Tianjin and Shanghai, China, who joined a national free physical examination program between 2014 and 2019, and consented to study inclusion. Sarcopenia was defined according to the Asian Working Group for Sarcopenia (2019 version). Mild-to-moderate CKD was defined as estimated glomerular filtration rate (eGFR) between 45 ml/min/1.73 m2 and 60 ml/min/1.73 m2. A total of 1627 participants were included (mean age, 69.32 ± 6.17 years; 43.8% male). Sarcopenia was significantly associated with mild-to-moderate CKD in men but not women. Among three physical performance components, slow gait speed (odds ratio 1.89, 95% confidence interval 1.38, 2.58) was associated with mild-to-moderate CKD in both men and women after adjusting for all other variables. Sarcopenia was closely associated with mild-to-moderate CKD in older men, and slow gait speed was related to mild-to-moderate CKD in men and women. These findings may help guide better diagnosis and management of CKD in the context of slow gait speed, and facilitate earlier CKD detection and appropriate intervention in older adults.

Interventions Including Smart Technology Compared With Face-to-face Physical Activity Interventions in Older Adults: Systematic Review and Meta-analysis.

This is a systematic review of randomized controlled trials and a meta-analysis comparing smart technology with face-to-face physical activity (PA) interventions in community-dwelling older adults (mean age 60 years). This study aims to determine the effect of interventions including smart technology components compared with face-to-face PA interventions on PA and physical function in older adults. The secondary outcomes are depression, anxiety, and health-related quality of life. We searched MEDLINE, Embase, CINAHL, and AMED electronic databases from inception to February 2021. Two independent reviewers screened titles, abstracts, and full texts and performed data extraction and risk of bias assessments using the Cochrane risk of bias tool. The Grading of Recommendations Assessment, Development and Evaluation was used to evaluate the quality of the evidence. We provided a narrative synthesis on all included studies and, where possible, performed meta-analyses for similar outcomes. This review included 19 studies with a total of 3455 participants. Random effects meta-analyses showed that interventions with smart technology components resulted in improved step count (mean difference 1440 steps, 95% CI 500-2390) and total PA (standardized mean difference 0.17, 95% CI 0.02-0.32) compared with face-to-face alone. There was no difference between groups in terms of the measures of physical function. Smart technology alone did not show significant differences between groups in any outcome. The quality of the evidence was very low based on the Grading of Recommendations Assessment, Development and Evaluation criteria. Interventions that include smart technology may improve daily step counts by an average of 1440 steps in community-dwelling older adults; however, the quality of the evidence was very low. Future studies are needed to improve the certainty of these results. PROSPERO CRD42020135232; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=135232.

Feasibility of EMDR in Older Adults with PTSD to Reduce Frailty and Improve Quality of Life

ABSTRACT Objectives Posttraumatic stress disorder (PTSD) after exposure to multiple (childhood) trauma’s is strongly associated with accelerated aging and high psychiatric and somatic comorbidity, influencing frailty and Quality of Life (QoL) in older adults. Eye Movement Desensitization therapy (EMDR) addresses psychological and physiologic symptoms stemming from adverse life events and therefore could influence frailty and QoL in older adults. Methods We conducted a multi-center feasibility study (two psychiatric hospitals) in Dutch older outpatients (N = 24; ≥60 years) with PTSD. Participants received weekly EMDR-treatment during the course of the trial (3 months to a maximum of 9 months). Frailty (Groninger Frailty Indicator) and QoL (EuroQol 5D-3L), were assessed pre- and posttreatment. Results A linear mixed-model approach showed significant reduction of frailty (F(1,23) = 9.019, p = .006) and improvement of QoL (F(1,23) = 13.787, p = .001). For both frailty and QoL, there was no significant influence of Clinician-Administered PTSD Scale (CAPS-5) pre-treatment score, therapy duration, and neither an interaction effect of therapy duration x CAPS-5 pre-treatment score. Conclusions EMDR with older adults with PTSD showed a significant reduction of frailty and improvement of QoL. Randomized controlled studies are needed to more precisely study the impact of trauma-focused treatment in older adults on frailty and QoL and the implications this might have for lessening disease burden. Clinical implications Screening for PTSD in older frail adults is important to treat PTSD as a possible way to reduce frailty and improve QoL.

60 POWER-AGERS: IMPLEMENTING PROGRESSIVE RESISTANCE TRAINING TO MANAGE SARCOPENIA AMONG COMMUNITY DWELLING OLDER ADULTS

Abstract Background The prevalence of sarcopenia among community dwelling older adults is between 10-40%. Progressive Resistance Training (PRT) improves sarcopenia and functional performance among older-adults. A PRT programme was introduced to a Day Hospital service as part of a sarcopenia management quality improvement initiative. Methods The PRT programme was implemented on a phased basis. Phase 1 evaluated the feasibility, safety and participant satisfaction. Phase 2 then collected pre and post outcome measures (gait-speed, grip strength and 5-Times-Sit-to-Stand [5TSTS]), and a patient perception questionnaire. The intervention consisted of a physiotherapist-lead PRT programme (weekly in phase 1 and biweekly in phase 2). Recent community dwelling Day Hospital attendees were recruited by the physiotherapist to participate. The class consisted of a circuit of 4-6 exercises targeting upper and lower limbs, along with an educational component. Exercises were progressively overloaded on an individual basis. Results Ten participants attended the PRT programmes (phase 1 [n=5], phase 2 [n=5]). Most were female (n=6), mean age was 84 years. None had prior formal experience of PRT. The phase 1 PRT group was deemed feasible and safe in an outpatient setting. All phase 1 participants (n=5) felt it was beneficial and rated it 5/5. All phase 2 participants had improvements in sarcopenia markers (grip strength [range=1kg-9kg], gait-speed [range=0.04m/s-0.19m/s], and 5TSTS [range=5.1sec-11sec]). All participants reported that the programmes improved their confidence in PRT and that they were interested in continuing PRT in the future. Conclusion This supports that PRT a clinical setting with community dwelling older adults is safe, feasible and effective in improving sarcopenia markers. Furthermore, the high rate of satisfaction supports its use with this population. Further research is required to examine the impact of combined nutritional education with strength training as an intervention for older adults with sarcopenia.

Humanoid robot intervention vs. treatment as usual for loneliness in long-term care homes: Study protocol for a pilot randomized controlled trial.

Loneliness affects up to 42% of long-term care residents and is associated with poor health outcomes. Humanoid robot interventions hold promise for reducing loneliness and decreasing barriers to social interaction in long-term care settings, such as the current COVID-19 safety measures in many countries, limited mobility, and poor health. We present a protocol describing an assessor-blinded randomized controlled trial comparing the effects of a humanoid robot intervention to treatment as usual, on loneliness and mental health outcomes in long-term care residents. Seventy-four (n = 74) older adults experiencing loneliness in 3 long-term care homes will be randomized 1:1 to an 8-week, twice a week social intervention with the Grace humanoid robot vs. a treatment as usual active control. We will assess change (baseline to week 8) in (1) loneliness (primary outcome), (2) depression severity, and (3) stress (secondary outcomes), as well as (4) other exploratory outcomes: anxiety, quality of life and reduction in acute healthcare utilization. We will also assess the feasibility and acceptability of the intervention using qualitative methods. The proposed study will assess the effects of a social robot on loneliness and other mental health outcomes, as well as the feasibility of the intervention in older adults living in long-term care settings. NCT05423899.

The Effect of 12-Weeks Recreational Football (Soccer) for Health Intervention on Functional Movement in Older Adults.

There is growing evidence that recreational football offers health benefits for older adults and an important pathway for physical activity for older adult groups. Despite anecdotal evidence that recreational football is beneficial for older adults, no empirical data are available to support this assertion. This study addressed this issue and examined the effects of a 12-week recreational football intervention on the functional fitness of older adults. Using a pre–post case–control design, thirteen males, aged 61–73 years (mean age ± SD = 66 ± 4 years) undertook a twice-weekly, 12-week recreational football for health intervention, and were matched with a control group, comprising thirteen males, aged 62–78 years (mean age ± SD = 66 ± 4 years) who maintained their typical exercise habits during the intervention period. Pre- and postintervention, participants underwent assessment of functional fitness, using the Rikli and Jones functional fitness battery as well as an assessment of body fatness, via bioelectrical impedance analysis and dominant handgrip strength using handgrip dynamometry. Results from a series of 2 (pre–post) X 2 (intervention vs. control) repeated-measures ANOVAs indicate significant pre–post X group interactions for the 30-second chair stand (p = 0.038, Pƞ2 = 0.168), 8-foot timed up and go (p = 0.001, Pƞ2 = 0.577) and 6 min walk test (p = 0.036, Pƞ2 = 0.171). In all cases, performance improved significantly after the intervention for the football intervention group but not the control group. There were no significant differences in the 30 s arm curl test or dominant handgrip strength (p > 0.05). There was a non-significant trend (p = 0.07, Pƞ2 = 0.127) towards a pre–post X group interaction for body fatness, showing a decreased percent body fat for the intervention group over the control group. The results of the present study demonstrate the utility of recreational football as a physical activity intervention in older adults to improve functional movement.

A Pilot Study of Virtual Reality (VR) Tai Chi Program on Mental Health among Older Adults during the COVID-19 Pandemic.

Tai Chi, an ancient Chinese martial art, has been credited for improving the physical and mental health of community-dwelling older adults. Virtual reality (VR) has developed as a therapeutic technique for improving health and well-being in older adults. Previous research on exercise-based VR interventions in older adults has focused primarily on the physical and cognitive health effects. The extent to which a program integrating the ancient practice of Tai Chi with virtual reality might benefit older individuals' physical and mental health is an unknown entity. In this pilot study, we examined potential advantages of the virtual Tai Chi program in terms of health outcomes, as well as to gather qualitative data on the barriers to VR program participation. We conducted semi-structured, in-depth interviews with 5 participants who had participated at least 5 years in traditional Tai Chi. Three key salient themes emerged as beneficial results of VR experiences: (1) mindfulness/ meditation, (2) enjoyment, and (3) physical exercise. Participants also reported 3 main challenges: (1) some difficulties with controllers and functions, (2) cybersickness/pain, and (3) absence of group synergy. These challenges suggest further avenues of investigation for researchers in refining this approach.