Mobility In Older Adults Research Articles

Psychometric testing of the continence and mobility in older adults knowledge quiz

AbstractWhat are the psychometric properties of the Continence and Mobility in Older Adults Knowledge Quiz? Our previous research revealed gaps in practicing and student nurses' knowledge of mobility and continence in older people. To address this gap, we developed a self‐directed e‐learning module on continence and mobility to enhance student nurses knowledge. The module provided education about continence, mobility, and the links between them. Since we were unable to locate a continence and mobility measure that captured both lower urinary track symptoms and elements of mobility, we developed a continence and mobility knowledge quiz. For researchers and educators to be able to use this quiz with confidence, psychometric testing of our continence and mobility knowledge quiz was required. When caring for older people, two geriatric challenges—continence and mobility—are often linked and viewed as indicators of frailty. Functional changes related to continence and/or mobility can indicate an acute illness in older persons and, if left untreated, can result in permanent changes managing continence needs. Continence care is often viewed negatively and is not prioritized by nurses. We employed stages in development of the Continence and Mobility Knowledge Quiz. In stage one, we developed 18 item true/false items from the literature with the guidance of a continence expert. In stage two, we tested the Quiz with nursing students from three universities in Canada. In stage three, (the current stage) we assessed the validity of the scale using a factor analysis and a reliability analysis (via standardized Cronbach's alpha). From our sample of 420, factor analysis indicated a two‐factor model (as suggested by Kaiser's rule), explained 22% of the variation in responses to the assessment items. We recommend removing item 7 as it does not contribute to the internal consistency of the tool. Cronbach's alpha after removing 7 is 0.65, indicating satisfactory reliability. To our knowledge, this is the first validated tool for measuring nurse knowledge about continence and mobility that addresses both a range of lower urinary tract symptoms and elements of mobility in older adults.

Effect of Blood Flow Restriction on Gait and Mobility in Older Adults: A Systematic Review and Meta-Analysis.

Older adults demonstrate gait impairments that increase their risk for falls. These age-related mobility impairments are in part due to declines in muscle mass and strength. High-intensity exercise can improve muscle strength and mobility but may not be tolerable for older adults due to musculoskeletal injury and pain. Blood flow restriction (BFR) with lower-intensity exercise offers a strategy that may be more tolerable for older adults, but whether BFR improves gait and mobility in older adults is unclear. The purpose of this systematic review and meta-analysis was to determine the effect of BFR on gait and mobility in healthy older adults. PubMed, Embase, Cochrane Library, and CINAHL were systematically searched for articles utilizing BFR in older adults. Articles were included if adults were over 60 years, did not have chronic health conditions, had undergone randomized controlled trials, and presented objectively measured gait outcomes. The search identified 1501 studies, of which 9 were included in the systematic review and 8 studies in the meta-analysis. Outcome measures included the Timed Up and Go (TUG), 6-Minute Walk Test (6MWT), 400 m walk test, Short Physical Performance Battery (SPPB), and 10 m walk test. Meta-analyses found improvements in the TUG (mean difference (MD) = -0.71; 95% CI = -1.05, -0.37; p < 0.001) and SPPB (MD = -0.94; 95% CI = -1.48, -0.39; p < 0.001) in BFR compared to no BFR. There were no differences in gait speed (MD = 0.59; 95% CI = -0.22, 1.41; p = 0.16). BFR may be effective for gait and mobility tasks over shorter distances. Clinicians may consider incorporating BFR to improve mobility and gait function in older adults.

Evidence-based exercise recommendations to improve functional mobility in older adults - A study protocol for living systematic review and meta-analysis

Background and objectives This is a protocol for a living systematic review and meta-analysis. This review will assess the effects of state-of-the-art exercise interventions designed to promote mobility. Therefore, after identifying all potential interventions, we will use the F.I.T.T. principles as well as the physical and health status of the participants as moderators to analyse the mechanisms for the positive benefits of exercise interventions. The main research questions are: Which exercise types are most beneficial for improving functional mobility in various populations of older adults? Which physical exercise characteristics in terms of frequency, intensity, time and duration will achieve the greatest benefit in terms of the defined outcomes, i.e, the functional mobility of older adults? Methods The systematic literature research according to PRISMA guidelines will search databases like MEDLINE, APA Psych-Info and Web of Science. Inclusion criteria are: healthy older people ≥ 50 years, randomized-controlled trials including exercise intervention and a walking or mobility assessments (eg., TUG, SPPB) as an outcome measure. A preliminary search revealed more than 33,000 hits that will be screened by pairs of independent reviewers. The results will be summarized according to the effects regarding functional mobility and potential dose-response relations via respective meta-analysis. Conclusion The systematic review will comprise the knowledge of the existing literature with regards to the effects of the physical activity interventions compared to an active or inactive control group. We will summarize the effects with respect to the F.I.T.T principles. If possible, we will also compare interventions from the different categories (cardiovascular exercise, resistance exercise, motor-coordinative exercise, multicomponent exercise, mind-body exercise, exergames, hybrid exercise, and concurrent training) as a network analysis and report the influence of moderator variables. Based on the results evidence-based guidelines following GRADE for physical exercise interventions to improve mobility in older adults will be provided.

On the Move in the community: Protocol for a hybrid 1 trial examining effectiveness and fidelity of a community-based group exercise program for older adults

On the Move (OTM), a group exercise program to improve mobility in older adults, is efficacious when delivered by research staff. The next step in the development of OTM as a fully implementable intervention is to conduct an effectiveness study in which the intervention is delivered in community settings by community providers. We describe the methods of a hybrid 1 cluster randomized, single-blind, intervention trial to compare the effectiveness of OTM to a delayed intervention control in 502 community-dwelling older adults across 44 sites. OTM classes are taught by certified instructors in the community twice a week for 12weeks. Control centers receive no intervention for the first 12weeks followed by 12-weeks of OTM classes. Participants are assessed at baseline, 12 and 24weeks. The primary outcome is gait speed. Intervention fidelity, measured by adherence and competence in intervention delivery, is assessed by review of instructor intervention diaries and observation. Organizational, instructor, and participant-level factors which may impact fidelity are assessed using questionnaires, focus groups, and structured interviews. The findings of this trial will 1) establish the effectiveness of OTM on improvements in walking and post-intervention persistence of benefits, 2) assess intervention fidelity and identify the impact of organizational, instructor, and participant level factors on fidelity, and 3) determine the extent to which fidelity moderates the effectiveness of OTM. The information derived from this project will provide valuable insight into the real-world effectiveness of OTM as a health promotion program for improving mobility in older adults.

Perspectives on the COVID-19 pandemic and life-space mobility in older adults.

The COVID-19 pandemic significantly affected the physical health of older adults around the world, causing day-to-day disruptions in routines and changes to usual patterns of mobility. Despite the passing of 2 years since vaccinations, older adults continue to experience detriments, including social isolation and reduced mobility. This study aims to understand how views of the COVID-19 pandemic are associated with life-space mobility-moving about the community. We hypothesize that endorsing stronger perspectives about the persistence of COVID-19 is correlated with reduced life-space mobility. Survey data were collected via online questionnaire in October and November of 2022. Linear regression models were used to examine the relationship between five perspectives on the COVID-19 pandemic (e.g., agreeing that "I wish people would take COVID-19 more seriously") and life-space mobility, measured using a modified version of the life space assessment, in older adults (n = 510). Analyses were adjusted for demographic factors and mental and physical health indicators, including depressive symptoms and number of chronic conditions. In fully adjusted models, the study found that endorsing a stronger lingering impact of the COVID-19 pandemic across any of the five perspectives was associated with significantly lower life-space mobility. The results of this study show that endorsing a stronger lingering impact of the COVID-19 pandemic is associated with reduced life-space mobility, which underscores the importance of designing public health strategies that carefully balance the safety concerns of older adults with opportunities for physical activity and social interaction.

Clinical and physiological risk factors contributing to the restricted mobility in older adults: a longitudinal analysis

BackgroundMobility limitations (e.g., using wheelchair) have been closely linked to diminished functional independence and quality of life in older adults. The regulation of mobility is pertaining to multiple neurophysiologic and sociodemographic factors. We here aimed to characterize the relationships of these factors to the risk of restricted mobility in older adults.MethodsIn this longitudinal study, 668 older adults with intact mobility at baseline completed the baseline assessments of clinical characteristics, cognitive function, sleep quality, activities of daily living (ADL), walking performance, beat-to-beat blood pressure, and structural MRI of the brain. Then 506 of them (mean age = 70.7 ± 7.5 years) responded to the follow-up interview on the mobility limitation (as defined by if using wheelchair, cane, or walkers, or being disabled and lying on the bed) after 18 ± 3.5 months. Logistic regression analyses were performed to examine the relationships between the baseline characteristics and the follow-up mobility restriction.ResultsAt baseline, compared to intact-mobility group (n = 475), restricted-mobility group (n = 31) were older, with lower score of ADL and the Montreal Cognitive Assessment (MoCA), greater score of Pittsburgh Sleep Quality Index (PSQI), poorer cardio- and cerebral vascular function, and slower walking speeds (ps < 0.05). The logistic regression analysis demonstrated that participants who were with history of falls, uncontrolled-hypertension, and/or greater Fazekas scale (odds ratios (ORs):1.3 ~ 13.9, 95% confidence intervals (CIs) = 1.1 ~ 328.2), walked slower, and/or with lower ADL score (ORs: 0.0026 ~ 0.9; 95%CI: 0.0001 ~ 0.99) at baseline, would have significantly greater risk of restricted mobility (p < 0.05; VIFs = 1.2 ~ 1.9).ConclusionsThese findings provide novel profile of potential risk factors, including vascular characteristics, psycho-cognitive and motor performance, for the development of restricted mobility in near future in older adults, ultimately helping the design of appropriate clinical and rehabilitative programs for mobility in this population.

Predicting sit-to-stand motions with a deep reinforcement learning based controller under idealized exoskeleton assistance

AbstractMaintaining the capacity for sit-to-stand transitions is paramount for preserving functional independence and overall mobility in older adults and individuals with musculoskeletal conditions. Lower limb exoskeletons have the potential to play a significant role in supporting this crucial ability. In this investigation, a deep reinforcement learning (DRL) based sit-to-stand (STS) controller is developed to study the biomechanics of STS under both exoskeleton assisted and unassisted scenarios. Three distinct conditions are explored: 1) Hip joint assistance (H-Exo), 2) Knee joint assistance (K-Exo), and 3) Hip-knee joint assistance (H+K-Exo). By utilizing a generic musculoskeletal model, the STS joint trajectories generated under these scenarios align with unassisted experimental observations. We observe substantial reductions in muscle activations during the STS cycle, with an average decrease of 68.63% and 73.23% in the primary hip extensor (gluteus maximus) and primary knee extensor (vasti) muscle activations, respectively, under H+K-Exo assistance compared to the unassisted STS scenario. However, the H-Exo and K-Exo scenarios reveal unexpected increases in muscle activations in the hamstring and gastrocnemius muscles, potentially indicating a compensatory mechanism for stability. In contrast, the combined H+K-Exo assistance demonstrates a noticeable reduction in the activation of these muscles. These findings underscore the potential of sit-to-stand assistance, particularly in the combined hip-knee exoskeleton scenario, and contribute valuable insights for the development of robust DRL-based controllers for assistive devices to improve functional outcomes.

Effects of a 12-week intrinsic foot muscle strengthening training (STIFF) on gait in older adults: a parallel randomized controlled trial protocol

BackgroundFalling is highly prevalent among older adults and has serious impact. Age-induced mobility impairments, such as gait modifications, are strongly associated with increased fall risk. Among fall prevention interventions, those including exercises are most effective. However, there is an urgent need to further improve these kinds of interventions. Strengthening the plantar intrinsic foot muscles might benefit mobility in older adults, which may contribute to the reduction of fall risk. The aim of this paper is to provide a protocol to investigate the effect of a plantar intrinsic foot muscle strengthening training versus no training on gait and intrinsic foot muscle function in older adults who are involved in a functional exercise program.MethodsFor this assessor-blinded RCT, older adults (> 65 years) are recruited who are involved in a group-based functional exercise program. Eligibility criteria include: being able to ambulate 10 m barefoot without using a walking aid and reporting to have either fear of falling or experienced a fall in the previous 12 months or have difficulties with mobility, gait, or balance in daily life. Participants are randomly assigned to an intervention and a control group. The intervention group follows a 12-week plantar intrinsic foot muscle strengthening training. The training consists of isolated and functional foot exercises to be performed 5 times a week, each session lasting approximately 20 min. The training is supervised once a week and the intensity gradually increases based on the participant’s progression. Both groups keep a diary to report physical activities, fall incidents and movement related discomfort. The control condition is limited to keeping this diary. Data are collected at baseline and post-intervention. The trial outcomes are the between group differences in the mean change from baseline in maximum gait speed (primary outcome measure), capacity and strength of the plantar intrinsic foot muscles, foot and ankle biomechanics during gait, and various other fall risk-related variables. ANCOVA’s are used to analyze the trial outcomes.DiscussionThe results of this RCT will offer recommendations, related to plantar intrinsic foot muscle strengthening, to existing fall preventive exercise programs.Trial registrationThe trial is registered in the United States National Library of Medicine through ClinicalTrials.gov (NCT05531136, 07/26/2022).

Student nurses’ views on an E-Learning module on comfort, safety, and mobility with older adults: a cross-sectional study

ABSTRACT Background Nursing students often receive insufficient training in older adults’ care. Purpose Examine nursing students’ perceptions of an e-learning module developed to enhance their knowledge about the comfort, safety, and mobility of older adults. Methods A cross-sectional survey was administered to third-year baccalaureate nursing students at a Canadian university after they had completed the comfort, safety, and mobility module. The survey assessed students' perceptions of the e-learning module using four 5-pointLikert-type items. The survey also contained demographic questions and one open-ended question that invited participants to make any comments they wished. Descriptive statistics were used to summarize participants’demographic characteristics. Responses to the open-ended quesiton were summative content analyzed. Results The survey was completed by 119 participants, who reported that the module increased their confidence, perceptions and knowledge in working with older adults. Participants also found the method of instruction to be convenient, interactive, and enjoyable. Conclusions Results suggest that the learning module has the potential to facilitate student nurses’ learning about comfort, safety, and mobility.

Aquatic Cognitive–Motor Exercise for Cognition, Balance, and Functional Mobility in Older Adults

ABSTRACT Introduction Cognitive declines and mobility challenges in older adults often hinder exercise, leading to a sedentary lifestyle. Addressing both cognitive and physical health is crucial for enhancing overall well-being in older adults. The purpose of this study was to assess the feasibility and effectiveness of aquatic cognitive–motor exercise on cognition, balance, and functional mobility in older adults. Methods This pilot randomized controlled study included 25 participants from two retirement communities who were randomly assigned to a control (n = 12, 81 ± 8 yr old) or aquatic exercise group (n = 13, 83 ± 7 yr old). The aquatic exercise group received 45 min of moderate-intensity cognitive–motor exercise three times per week for 8 wk. The control group received one fall prevention education class. Results The session attendance rate for the aquatic exercise program was 95%. Between-group comparisons showed that 8 wk of aquatic exercise improved various measures of cognition with a medium effect size, as assessed by the Stroop Color and Word Test (∆ 2.8, d = 0.51) and the Trail Making Test part B (∆ −19.2 s, d = −0.59). Gait speeds while walking forward (∆ 0.04 m·s−1, d = 0.43) and counting backward by serial 7s (∆ 0.05 m·s−1, d = 0.43) were improved with a small effect size in the aquatic exercise intervention. This change was recognized as a clinically meaningful improvement in older adults. The aquatic intervention group had a medium to large effect size improvement in speed with the Four Square Step Test (∆ −0.6 s, d = −0.42), Timed Up and Go test (∆ −1.1 s, d = −0.50), and Timed Up and Go cognitive test (∆ −1.0 s, d = −0.56), whereas only negligible to small changes were noted with single-leg balance measures. Conclusions The aquatic cognitive–motor exercise program is feasible and enhanced cognition and functional mobility in older adults.

Frontal cortex neurometabolites and mobility in older adults: a preliminary study.

The frontal cortex, relevant to global cognition and motor function, is recruited to compensate for mobility dysfunction in older adults. However, the in vivo neurophysiological (e.g., neurometabolites) underpinnings of the frontal cortex compensation for mobility dysfunction remain poorly understood. The purpose of this study was to investigate the relationships among frontal cortex neurophysiology, mobility, and cognition in healthy older adults. Magnetic Resonance Spectroscopy (MRS) quantified N-acetylasparate (tNAA) and total choline (tCho) concentrations and ratios in the frontal cortex in 21 older adults. Four inertial sensors recorded the Timed Up & Go (TUG) test. Cognition was assessed using the Flanker Inhibitory Control and Attention Test which requires conflict resolution because of response interference from flanking distractors during incongruent trials. Congruent trials require no conflict resolution. tNAA concentration significantly related to the standing (p = 0.04) and sitting (p = 0.03) lean angles. tCho concentration (p = 0.04) and tCho ratio (p = 0.02) significantly related to TUG duration. tCho concentration significantly related to incongruent response time (p = 0.01). tCho ratio significantly related to both congruent (p = 0.009) and incongruent (p < 0.001) response times. Congruent (p = 0.02) and incongruent (p = 0.02) Flanker response times significantly related to TUG duration. Altered levels of frontal cortex neurometabolites are associated with both mobility and cognitive abilities in healthy older adults. Identifying neurometabolites associated with frontal cortex compensation of mobility dysfunction could improve targeted therapies aimed at improving mobility in older adults.

Validation of the Indian (Hindi) version of the life-space assessment scale among community-dwelling older adults: a multicentric cross-sectional study

BackgroundThe Life-Space Assessment (LSA) is an instrument that measures mobility in older adults as they reach different areas, defined as life-spaces extending from home to beyond towns or regions. The purpose of the study was to develop the Hindi version of the LSA (LSA- H) and to investigate the validity and reliability of the Hindi version as well as its cultural adaptation.MethodsA cross-sectional study of two hundred forty-five older adults participated in the study from four different study practice areas. Following forward backwards translation, the LSA-H was developed, and the scores were correlated with those of the Activities-Specific Balance Confidence Scale Hindi (ABC- H), the Physical Health Subscale of the WHO-BREF Questionnaire and the Geriatric Depression Scale: Short Form Hindi (GDS-SFH) to test the criterion and concurrent validity.ResultsThe mean score and standard deviation of the LSA-H questionnaire were 56.53 ± 35.99, those of the Physical Health Subscale of the WHO-BREF instrument were 18.54 ± 7.87, those of the GDS-SFH questionnaire were 6.95 ± 4.21 and those of the ABC- H questionnaire were 54.40 ± 28.96. The Pearson correlation coefficient (r) between the LSA-H score and ABC-H score was 0.707 (p value < 0.0001), that between the LSA-H score and the Physical Health Subscale of the WHO-BREF was 0.766 (p value < 0.0001), and that between the LSA-H score and GDS-SFG score was − 0.674 (p value < 0.0001).ConclusionThis study demonstrated that the Hindi version of the LSA is a valid and reliable instrument for assessing living space among older adults in the Hindi language in an Indian population. Furthermore, the LSA-H was significantly correlated with other health assessment tools in terms of functional mobility, general health status and mental well-being.

Prevalence and factors associated with low functional mobility in older adults.

To analyze the factors associated with low functional mobility in older adults residing in Alcobaça, BA. This is an epidemiological survey with a cross-sectional design, conducted in 2015 with 473 older adults (62.4% women; mean age 70.2 ± 8.2 years) from Alcobaça, BA. The interview script addressed sociodemographic characteristics, health, and behavioral aspects. Functional mobility was assessed using the Short Physical Performance Battery (≤6 points). Inferential analyses were conducted using the Mann-Whitney U test and Poisson regression (with robust variance and estimation of prevalence ratios and their respective 95.0% confidence intervals). The prevalence of low functional mobility was 9.6%, with associated factors including the use of alcoholic beverages (PR = 1.7, 95% CI: 1.01-1.13) and the number of repetitions in elbow flexion (PR = 1.01, 95% CI: 1.01-1.05). Additionally, older adults with low mobility had lower height, thigh circumference, and lower performance in handgrip strength tests, elbow flexion, and flexibility. They also spent more time in sedentary behavior and less time in physical activity compared to older adults with preserved mobility (p < 0.05). Older adults with low mobility exhibit poorer values in anthropometric parameters, lower performance in motor tests, spend less time engaged in physical activities, and more time in sedentary behavior.

Cost-effectiveness of lower limb prosthetic devices for mobility in older adults with dysvascular amputations

Background: There is limited consensus regarding the economic value of prosthetic devices with advancing age. We aimed to meet this knowledge gap by studying the cost-effectiveness of lower limb prostheses (LLPs) for older adults with dysvascular amputations. Methods Design: We constructed a decision analytic model nested with Markov models with a lifetime horizon to compare LLP recipients (LLP) with non-recipients (no-LLP) from a health care sector perspective. A 3% annual rate was applied to obtain the present value of the main outcome measures. One-way sensitivity analyses that modeled clinically extreme scenarios were conducted on LLP cost, change, abandonment rate, fall rate, mortality, and utility. Data sources: Model parameters were obtained from literature, with many source studies utilizing Medicare data and focusing on dysvascular amputations. Parameters included the “annual probability” of fall, LLP abandonment and mortality, costs associated with decreased physical inactivity or deconditioning, falls (rate and cost), abandonment (rate), mortality, and “utilities associated” with Markov model health states. All costs were adjusted to 2022 price levels. Intervention: Lower limb prosthesis. Main Outcome Measures: Lifetime cost, quality-adjusted life-years (QALYs), incremental cost-effectiveness ratio (ICER). Results: The LLP group incurred a lifetime cost of $36,789 and yielded 4.54 QALYs. The no-LLP group incurred a lifetime cost of $23,909 and yielded 2.58 QALYs. The ICER was $6588/QALY, which is below the most conservative willingness-to-pay threshold of $50,000/QALY and indicated that LLP was cost-effective compared with no-LLP. Sensitivity analyses for increasing LLP replacement to annual (ICER = $33,477/QALY), abandonment rate to 22% (ICER=$6367), fall rate to 70% (ICER = $7140/QALY), and increasing No-LLP EuroQol–five-dimension to 0.71 (ICER = $10,819/QALY) were all below the willingness-to-pay as well. Conclusions: LLP for older adults with dysvascular amputations was cost-effective for most clinically realistic scenarios.

Understanding older adults' travel behaviour and mobility needs during the COVID-19 pandemic through the lens of the hierarchy of travel needs: a systematic review

Abstract The aim of this article is to critically review the scientific literature about the changes in travel behaviour and mobility amongst older adults caused by the COVID-19 pandemic across various countries, identify unmet travel needs and highlight patterns of inequalities in older adults' mobility. We have collected articles from four academic databases: PubMed, Scopus, Transportation Research International Documentation (TRID) and Web of Science. Papers were considered for inclusion if they were published online in 2020 or later, written in English, and referred to urban or rural changes in travel behaviour and mobility of older adults over 50 years old. We examined the pre-existing models developed before the outbreak and classified the articles based on Musselwhite and Haddad's hierarchy of older adults' travel needs. The synthesis of the selected 25 articles shows a general decline in literal mobility amongst older adults, an increased share of virtual travel and their decreased capacity to fulfil different levels of travel needs. Findings also indicate an increased gap in older adults' mobility across geographical regions with various levels of transport infrastructure and digital capital. We conclude the paper with the lessons learned, the opportunities ahead, and the challenges that must be overcome to achieve sustainable development and the United Nations Decades of Healthy Ageing goals in the post-pandemic world.

State Department of Motor Vehicles Reporting Mandates of Dementia Diagnoses and Dementia Underdiagnosis

With older drivers representing the fastest growing segment of the driver population and dementia prevalence increasing with age, policymakers face the challenge of balancing road safety and mobility of older adults. In states that require reporting a dementia diagnosis to the Department of Motor Vehicles (DMV), individuals with dementia may be reluctant to disclose symptoms of cognitive decline, and clinicians may be reluctant to probe for those symptoms, which may be associated with missed or delayed diagnoses. To assess whether DMV reporting policies for drivers with dementia are associated with primary care clinicians' underdiagnosing dementia. This cross-sectional study used data from the 100% Medicare fee-for-service program and the Medicare Advantage plans from 2017 to 2019 on 223 036 primary care clinicians with at least 25 Medicare patients. Statistical analysis was performed from July to October 2023. State DMV reporting policies for drivers with dementia. The main outcome was a binary variable indicating whether the clinician underdiagnosed dementia or not. Each clinician's expected number of dementia cases was estimated using a predictive model based on patient characteristics. Comparing the estimation with observed dementia diagnoses identified clinicians who underdiagnosed dementia vs those who did not, after accounting for sampling errors. Four states have clinician reporting mandates, 14 have mandates requiring drivers to self-report dementia diagnoses, and 32 states and the District of Columbia do not have explicit requirements. Among primary care clinicians in states with clinician reporting mandates (n = 35 620), 51.4% were female, 91.9% worked in a metropolitan area, and 19.9% of the patient panel were beneficiaries dually eligible for Medicare and Medicaid. Among primary care clinicians in states with patient self-reporting mandates (n = 57 548), 55.7% were female, 83.1% worked in a metropolitan area, and 15.4% of the patient panel were dually eligible for Medicare and Medicaid. Among clinicians in states without mandates, 55.7% were female, 83.0% worked in a metropolitan area, and 14.6% of the patient panel were dually eligible for Medicare and Medicaid. Clinicians in states with clinician reporting mandates had an adjusted 12.4% (95% CI, 10.5%-14.2%) probability of underdiagnosing dementia compared with 7.8% (95% CI, 6.9%-8.7%) in states with self-reporting and 7.7% (95% CI, 6.9%-8.4%) in states with no mandates, an approximately 4-percentage point difference (P < .001). Results of this cross-sectional study of primary care clinicians suggest that mandatory DMV policies for clinicians to report patients with dementia may be associated with a higher risk of missed or delayed dementia diagnoses. Future research is needed to better understand the unintended consequences and the risk-benefit tradeoffs of these policies.

Effect of hypertension on muscle strength, balance, and mobility in older adults

Purpose: Hypertension (HT) can exacerbate impaired blood pressure regulation and thus increase the risk of falls. The higher incidence of HT and impaired balance in older adults may lead to the hypothesis of an association between HT and physical function in older individuals. The purpose of this study was to investigate the effects of HT on muscle strength, balance, and mobility in older adults and the relationship between them. Methods: Sixty-one older adults were included in the study and individuals with systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg formed the Hypertensive group (n=31), while the others formed the Normotensive group (n=30). Quadriceps Femoris (QF) muscle strength was evaluated with a hand-held dynamometer, mobility was evaluated with the Timed Up and Go Test (TUG), balance performance was evaluated with the Nintendo Wii Fit Balance Board (NWBB), and physiological age was evaluated with Wii Fit Age (WFA). The systolic and diastolic blood pressure were measured before the balance test. Results: TUG and NWBB scores between groups were significantly better in the Normotensive group (p&amp;lt;0.05). In both Hypertensive and Normotensive groups, there was a negative correlation between QF muscle strength and TUG score, and a positive correlation between QF muscle strength and NWBB score (p&amp;lt;0.05). Conclusion: HT may worsen mobility and balance in older adults. Further studies are required to better understand HT and establish better appropriate interventions for older hypertensive adults.

Walking net O2 rises with advancing age in older women: where to go from here?

Walking net O2 tends to increase with advancing age; however, factors contributing to this relationship have not been widely described. The implications of such findings could inform targeted strategies to promote independent mobility in older adults. Herein, we evaluated the relationship between net O2 and age at two submaximal workloads while exploring potential moderators of this relationship. Secondary analyses were performed on 35 older (65 ± 3years) women who completed a battery of physical assessments including fixed-speed, non-graded and graded (+ 2.5%) treadmill walking with indirect calorimetry to determine net O2. Maximal oxygen uptake ( O2max), knee extensor maximal isometric voluntary contraction (MVC), peak rate of torque development (RTD), and plantar flexor range-of-motion (PFROM) were also measured. Bivariate correlations showed non-graded (r = 0.403, p = 0.017) and graded (r = 0.413, p = 0.014) net O2 were positively related to age. Notably, these relationships strengthened after adjusting for O2max. Regression modeling showed age, RTD:MVC ratio (composite of muscle performance), and PFROM together explained 49% and 34% of the variance in non-graded and graded net O2, respectively. Further analyses suggested knee extensor MVC moderates the relationship between non-graded net O2 and age, accounting for 9% of the variance [ΔR2 = 0.090, F (1,31) = 4.13, p = 0.05]. These data support the premise that, in older women, walking net O2 rises with advancing age, and additionally, the RTD:MVC ratio and PFROM are independent correlates of non-graded net O2. Exercise interventions with a high degree of training specificity including explosive, velocity-based elements may promote independent mobility in older women.

Risk of sarcopenia and mobility of older adults during the COVID-19 pandemic: the longitudinal data from the REMOBILIZE study

BackgroundWe assessed whether clinical, functional and behavioral factors were associated with the decrease in mobility trajectories reported in older people at risk of sarcopenia (RS) and without risk of sarcopenia (NRS) during COVID-19 pandemic.MethodsWe prospectively analyzed mobility trajectories reported in older adults with RS and NRS over 16-month follow-up (Remobilize study). The self-perceived risk of sarcopenia and mobility were assessed using the SARC-F and the Life-Space Assessment (LSA) tools, respectively. Gender, age, comorbidities, pain, functional limitation, physical activity (time spent in walking; min/week), and sitting time (ST; hours/day) were assessed. We used a multilevel model to determine changes in mobility between groups and over time.ResultsMobility was lower in RS than in NRS. Older people at RS, who were women, aged 70–79 years and 80 years or older, inactive, and with moderate to severe functional limitation experienced reduced mobility trajectories reported over the pandemic. For older people at NRS, trajectories with reduce mobility reported were experienced by women with comorbidities, for those with insufficient walking time and aged 70–79 years; aged 70–79 years and with ST between 5 and 7 hours/day; for those with insufficient walking time and increased ST; and for those with pain and increased ST.ConclusionMobility trajectories reported in older people at risk of sarcopenia were negatively influenced by insufficient level of physical inactivity and pre-existing moderate to severe functional limitation. Health and social interventions should be target to avoid mobility limitation during and after the COVID-19 pandemic.

Does Obesity Affect the Rate of Force Development in Plantar Flexor Muscles among Older Adults?

The literature offers limited information on the effect of obesity on the rate of force development (RFD), a critical parameter for mobility in older adults. The objectives of this study were to explore the influence of obesity on the RFD in older adults and to examine the association between this neuromuscular parameter and walking speed. The participants (42 older adults) were classified into two groups: the control group (CG, n = 22; mean age = 81.13 ± 4.02 years; body mass index (BMI) = 25.13 ± 3.35 kg/m2), and the obese group (OG, n = 20; mean age = 77.71 ± 2.95 years; BMI = 34.46 ± 3.25 kg/m2). Walking speed (m/s) was measured using the 10 m walking test. Neuromuscular parameters of the plantar flexors were evaluated during a maximal voluntary contraction test using a dynamometer. The RFD was calculated from the linear slop of the force-time curve in the following two phases: from the onset of the contraction to 50 ms (RFD0-50) and from 100 to 200 ms (RFD100-200). The gait speed was lower in the OG compared to the CG (p < 0.001). The RFD50/100 and RFD100/200 were lower in the OG compared to the CG (p < 0.001). The RFD50/100 was found to be the predominant influencer on gait speed in the OG. In conclusion, obesity negatively impacts the RFD in older adults and RFD stands out as the primary factor among the studied parameters influencing gait speed.