Control In Older Adults Research Articles

Coercive control of older adults in filial relationships: a hybrid concept analysis

Purpose This study aims to synthesise published evidence relating to filial coercive control to generate an understanding of this under-explored concept. This paper identifies its defining characteristics and explores the circumstances under which the phenomenon manifests in the lives of older adults. Design/methodology/approach A scoping review methodology was adopted to guide the literature review, while a concept analysis methodology guided data extraction and analysis. Drawing on Rodgers’s (1989) evolutionary concept analysis method, a co-constructed research methodology was developed for this study. Findings The concept of filial coercive control was understood in the context of the following antecedents: ageist norms, a parental relationship (both biological and non-biological), physical proximity and the controlling characteristics and tendencies of the abusive adult child. The defining attributes included the exercise of power through control, dependency and entrapment, isolation and confinement and fear and intimidation. Using the dominant themes, models and contrary cases were constructed to illustrate the findings. Originality/value Existing bodies of theory fail to adequately describe the phenomenon of filial coercive control adequately; as a consequence, a co-constructed concept analysis was conducted. A tentative operational definition and a conceptual model are proposed providing a starting point for future research and informing professional practice and education.

Vibration Thresholds Using Conventional Audiometry are Clinically Useful Indicators of Postural Instability in Older Adults.

Falls are a major health concern with potentially dramatic consequences for people over 65 years of age. One crucial determinant in the risk of falls in older adults is postural control, a complex process that requires the contribution of different sensory modalities, namely visual, vestibular, auditory, and somatosensory. While there are well-established methods to screen for age-related vision, hearing, tactile, and vestibular impairments, there are very few widely available methods to screen for somatosensory function, but studies indicate that ankle audiometry (vibration thresholds) using a common B-71 bone vibrator can serve that purpose. To date, unfortunately, this technique has received little attention as a tool to measure postural instability in older adults. The objective of the present study was to examine postural control in older adults with and without degradation of the somatosensory functions, as determined with ankle audiometry. This was standard group comparison. In total, 36 healthy elderly aged between 65 and 80 years old were divided into two groups (low vibration threshold [n = 18] and high vibration threshold [n = 18]). Standard audiometry, video head impulse test, vibration thresholds (big toe, ankle, and tibia), and static postural control task using a force platform were performed. Greater postural instability in participants with higher (worse) vibration thresholds as compared with participants with lower (better) vibration thresholds was observed even though both groups were comparable on hearing threshold and vestibular function. The results indicate that performing a simple vibration threshold evaluation, using a clinically available B-71 with a cut-off value of 42 dB hearing loss, could be an effective, fast, and easy-to-use procedure for detecting people at risk of falls.

Incidental Physical Activity and Physical Fitness Associate with Sustained Attention and Impulse Control in Older Adults

Age-related changes have been observed in sustained attention and impulse control. Deficits in these functions are related to pathological aging. However, research suggests that an active lifestyle may exert a protective effect on cognition in aging. While the association between physical activity and cognitive functioning in older adults has been previously described, few studies have explored the relationship between incidental physical activity and fitness with sustained attention and impulse control in this population. Therefore, this study aimed to evaluate the association between incidental physical activity and various components of fitness and sustained attention and impulsivity in older adults. Fifty-four older adults were recruited (41 females and 13 males) with a mean age of 76.76 years (SD = 8.94). Physical activity levels were assessed using the Yale Physical Activity Survey (YPAS), physical function in healthy older adults was evaluated with the Senior Fitness Test, and sustained attention and impulsivity were measured using a computerized continuous performance task. Significant correlations were found between higher energy expenditure during housework and yardwork activities, and fewer commission errors and shorter reaction times during sustained attention task, and higher sensitivity during impulse control task (rho between 0.35 and 0.40, p < .01, β = 0.80). Additionally, higher scores between agility and balance were associated with better accuracy during the sustained attention task, and faster speed processing correlated to better performance impulse control task (rho between 0.33 and 0.36, p < .05, β = 0.80). Our study highlights the importance of incidental physical activity and various components of fitness on sustained attention and impulse control in aging.

Hypertension Control Is Associated with Telomere Length in Older Adults.

Hypertension is the leading risk for cardiovascular disease and worldwide mortality. Uncontrolled blood pressure worsens with age and its control is part of public health strategies especially for older adults. Telomere length (TL) has been associated with hypertension, with age and sex as relevant confounding factors, but it is not clear whether hypertension control in older adults impacts on TL and if this relationship is consistently age and sex dependent. TL was assessed in leukocytes of 369 hypertensive patients. Individuals were >60 years male (169) and female (200) and have been diagnosed and treated for hypertension for at least four years. TL was measured by RT-PCR using a commercial probe. Regression models were developed considering systolic and diastolic blood pressure control as dependent variables and age, sex, glucose, and lipid levels as confounding factors. TL showed a mean of 7.5 ± 5.1 Kb, and no difference between males and females was observed. We identified a significant association between systolic blood pressure control and TL (p value = 0.039) and a trend for diastolic blood pressure (p value = 0.061). These observations confirm and expand previous reports showing that hypertension control can have an impact on TL and consequently on other factors of healthy aging.

Effects of Motor and Cognitive Dual-Task Demands on Ankle Dorsiflexor and Plantarflexor Force Control in Older Adults

ABSTRACT Background Force steadiness can be impaired under dual-task conditions in older adults. Since this impairment is attributed to their limited attentional resources, we hypothesized that the degree of cortical activity involved in muscle contraction would affect force steadiness under dual-task conditions. To test this hypothesis, based on the premise that dorsiflexion requires more cortical resources than plantarflexion, we compared the effects of additional motor and cognitive task demands on force steadiness between dorsiflexion and plantarflexion contractions in young and older adults. Method Eighteen young and eighteen older adults performed a force tracking task by applying either isometric dorsiflexion or plantarflexion force concurrently with and without (control) secondary upper-limb motor or cognitive task. Results Force steadiness was impaired by both secondary upper-limb motor and cognitive tasks for the dorsiflexors and plantarflexors in older adults. While force steadiness was impaired similarly by additional task demands regardless of the secondary task type for the dorsiflexors, the impairment effect was larger in the secondary cognitive than motor task for the plantarflexors. Conclusion The effects of dual-task demand on force steadiness could depend on the degree of cortical activity involved in muscle contraction in older adults.

Diabetes knowledge, health literacy and diabetes self-care among older adults living with diabetes in Alexandria, Egypt

BackgroundType 2 diabetes is a rising health problem, especially in older adults. Health literacy and the degree of diabetes knowledge are among the factors that may influence diabetes self-care activities. The aim of this study was to assess factors affecting self-care activities among older adults living with type 2 diabetes in Alexandria, Egypt.MethodsA cross-sectional study included 400 older adults over the age of 60 with type 2 diabetes, recruited from diabetes outpatient clinics affiliated to the health insurance organization in Alexandria, Egypt. A predesigned, structured interview questionnaire was used to assess sociodemographic factors, personal habits, medical history, and drug history. The All Aspects of Health Literacy Scale (AAHLS) and the numeracy section of the Short Test of Functional Health Literacy in Adults (STOFHLA) were used to assess the level of health literacy. Diabetes Knowledge Test 2 (DKT2) was used to assess diabetes knowledge and Summary of Diabetes Self-care Activities scale was used to assess self-care activities. Multiple logistic regression analysis was used to examine the relationship between health literacy and self-care.ResultsThe mean age of the participants was 65.75 ± 5.15 years, and 56.2% of them were males. The mean duration of diabetes was 10.61 ± 5.28 years, 14.3% were illiterate, and 37.2% were university graduates. Positive correlations were found between health literacy, diabetes knowledge, and diabetes self-care activities (p < 0.001). Health literacy and diabetes knowledge were found to be significant predictors of diabetes self-care activities in older adults (aOR = 1.132; 95% CI:1.062–1.207, p < 0.001 and aOR = 1.313; 95% CI: 1.178–1.464, p < 0.001; respectively).ConclusionsHealth literacy and diabetes knowledge were found to be predictors of good self-care activities in older adults living with diabetes. Health educators and health care professionals should focus on health education and the enhancement of diabetes knowledge to improve self-care activities and eventually glycemic control in older adults living with diabetes.

The association between oral frailty and HbA1c among older adults with T2DM: the chain mediating effect of nutritional status and physical frailty.

The present study aimed to explore the association between oral frailty and glycated hemoglobin (HbA1c), and the chain mediating role of nutritional status and physical frailty among older adults with type 2 diabetes mellitus (T2DM). Patients with T2DM aged > 60years were recruited from the endocrinology department of a national metabolic center from October 2023 to March 2024. Oral frailty, nutritional status, and physical frailty were assessed with Oral Frailty Index-8 (OFI-8), the Nutrition Risk Screening 2002 (NRS2002), Fatigue, Resistance, Ambulation, Illness and Loss of Weight Index (FRAIL), respectively. Their HbA1c were collected at the same time. In order to reveal the interaction and influence between multiple variables, chain mediation analyses were conducted using the "Process" macro in SPSS 26.0 to estimate the direct and indirect effects of oral frailty on nutritional status, physical frailty and HbA1c. A total of 292 participants (50.7% male) were enrolled in this study at a median age of 70.0 (65.2, 76.0) years and a T2DM disease duration of (16.5 ± 9.4) years. After adjustment for age, oral frailty of older people with T2DM significantly positively predicted their HbA1c (β = 0.198, P < 0.001). In addition, oral frailty affect HbA1c through two indirect pathways, including an independent mediating effect of physical frailty (effect = 0.046) and a chain-mediating effect of nutritional status and physical frailty (effect = 0.004). Our findings suggest that less oral frailty of older adults with T2DM could optimize their nutritional status and physical frailty and, thus, their HbA1c. Consequently, improving oral health is expected to be a promising intervention target for reaching optimal glycaemic control in older adults with T2DM.

Frailty, Body Composition, and Glycemic Control in Older Adults with Type 2 Diabetes.

The relationship between frailty and glycemic control in older adults with diabetes remains uncertain, mainly due to the fact that previous studies have not accounted for measures of body composition. In older adults with diabetes, we examined the association between three types of frailty measures and glycemic control, while accounting for fat-free mass (FFM) and waist circumference (WC). Eighty older adults (age ≥65, 27 women and 53 men, mean age 80.5±0.6 years) had gait speed, Cardiovascular Health Study Index (CHSI), Rockwood Clinical Frailty Scale (RCFS), and glycosylated hemoglobin (HgA1C) measured. HgA1C showed a negative association only with CHSI (standardized β=-0.255±0.120, p=0.038), but no association with gait speed or the RCFS. Even after accounting for FFM and WC, we demonstrated a negative association between glycated hemoglobin and increasing frailty in older adults with diabetes.

Concern about falling is related to threat-induced changes in emotions and postural control in older adults

BackgroundConcern about falling is reportedly related to mobility and balance in older adults. While increased concern about falling may be directly related to balance deficits, establishing a causal relationship remains limited. This study aimed to investigate whether concern about falling affects threat-induced changes in emotions and postural control in older adults. Research questionHow does concern about falling affect threat-induced changes in emotions and postural control among older adults? MethodsSixty-two older adults (age; 78.8 ± 5.7 years, height; 152.7 ± 6.3 cm) were exposed to height-related fear while standing, leaning forward, and leaning backward on the floor and a higher surface. The mean position, root mean square, and mean velocity of the center of pressure (COP) displacement were measured during the standing task, as well as the forward and backward limits of stability (LOS) tasks. The degree of self-reported fear of falling (FoF) was also obtained during the standing and LOS tasks. The participants were categorized into lower and higher concerns about falling based on the short form of the Falls Efficacy Scale International (FESI). ResultsLower and higher concern about falling groups scored 10.2 ± 2.2 and 17.3 ± 3.3 in the short FESI. Both groups experienced increased FoF during the standing and forward LOS tasks on a higher surface. Leaning away from the edge of the surface resulted in increased COP velocity, decreased COP amplitude while standing, and decreased forward LOS. Participants with higher concern about falling had increased FoF during the backward LOS task and decreased backward LOS on a higher surface, while those with lower concern about falling did not. SignificanceConcern about falling can directly affect emotions and balance control owing to the occurrence of threat-related changes.

Doing Community Amid Tension and Vulnerability: Involvement and Control in Older Adults’ Accounts of Their Neighbourhood

Rather than fixed entities, urban communities are in a constant process of making: They are practised in and through everyday relational settings and are therefore necessarily tension‐laden. Drawing from focus group interviews with older adults living in the third‐largest city in Finland, we aim to further the understanding of “doing community” amid tensions and vulnerability. We analyse older people’s accounts of their everyday dealings and doings in their neighbourhood with an emphasis on the intensities of involvement and control when relating with others. As a result, four types of relational settings are identified: being‐with others; cooperation with others; contesting and being contested by others; and ruling and being ruled by others. Through close reading of each type, we illustrate the variety in which older adults negotiate involvement and control. To conclude, we propose that, in addition to previously identified privacy and access, involvement and control are significant dimensions of the relational settings of belonging in an urban community. We suggest that focusing on involvement and control may particularly well illuminate the position of neighbourhood residents in vulnerable circumstances. Therefore, involvement and control offer a useful extension for analyses of doing community through everyday encounters and practices.

Brain activation in older adults with hypertension and normotension during standing balance task: an fNIRS study.

Hypertension (HT) is a common chronic disease in older adults. It not only leads to dizziness and other symptoms affecting balance in older adults with HT but also affects the hemodynamics of the cerebral cortex. At present, potential neural mechanisms of balance control in older adults with HT are still unclear. Therefore, this study aimed to explore the differences in the center of pressure (COP) and cerebral cortex activation between older adults with HT and normotension (NT) during standing balance tasks. This study May provide guidance for the early detection of the risk of falls among older adults with HT and the development of clinical rehabilitation strategies. In this cross-sectional study, 30 older adults with NT (NT group) and 27 older adults with HT (HT group) were subjected to three conditions: task 1, standing with eyes open on a stable surface; task 2, standing with eyes closed on a stable surface; and task 3, standing with eyes open on the surface of the foam pad. Cortical hemodynamic reactions were measured using functional near-infrared spectroscopy, and COP parameters were measured using a force plate. The mean velocity of the COP in the medial-lateral direction in the NT group was significantly higher than that in the HT group (F = 5.955, p = 0.018) during task 3. When proprioception was disturbed, the activation of the left premotor cortex and supplementary motor cortex in the HT group was significantly lower than that in the NT group (F = 14.381, p < 0.001). The standing balance function of older adults with HT does not appear to be worse based on COP parameters than those of older adults with NT. This study revealed that the changes in the central cortex related to standing balance appear to be more indicative of balance control deficits in older adults with HT than changes in peripheral COP parameters, suggesting the importance of the early evaluation of cortical activation in older adults with HT at risk of falls.

Tai Chi Practice Buffers Aging Effects in Functional Brain Connectivity.

Tai Chi (TC) practice has been shown to improve both cognitive and physical function in older adults. However, the neural mechanisms underlying the benefits of TC remain unclear. Our primary aims are to explore whether distinct age-related and TC-practice-related relationships can be identified with respect to either temporal or spatial (within/between-network connectivity) differences. This cross-sectional study examined recurrent neural network dynamics, employing an adaptive, data-driven thresholding approach to source-localized resting-state EEG data in order to identify meaningful connections across time-varying graphs, using both temporal and spatial features derived from a hidden Markov model (HMM). Mann-Whitney U tests assessed between-group differences in temporal and spatial features by age and TC practice using either healthy younger adult controls (YACs, n = 15), healthy older adult controls (OACs, n = 15), or Tai Chi older adult practitioners (TCOAs, n = 15). Our results showed that aging is associated with decreased within-network and between-network functional connectivity (FC) across most brain networks. Conversely, TC practice appears to mitigate these age-related declines, showing increased FC within and between networks in older adults who practice TC compared to non-practicing older adults. These findings suggest that TC practice may abate age-related declines in neural network efficiency and stability, highlighting its potential as a non-pharmacological intervention for promoting healthy brain aging. This study furthers the triple-network model, showing that a balancing and reorientation of attention might be engaged not only through higher-order and top-down mechanisms (i.e., FPN/DAN) but also via the coupling of bottom-up, sensory-motor (i.e., SMN/VIN) networks.

Using an in-office passive leg raise to identify older adults with suboptimal blood pressure control.

Passive leg raise (PLR) is a simple, dynamic maneuver that has been used to increase preload to the heart. We hypothesize that PLR may offer a new and efficient office-based tool for assessing blood pressure (BP) control in older adults. One hundred and three veterans (≥60 years old) without known cardiovascular disease and varying degrees of blood pressure control were included in this cross-sectional cohort study. Twenty-four hour ambulatory BP monitoring identified Veterans with optimal and suboptimal BP control (≥125/75 mmHg). Bioimpedance electrodes (Baxter Medical, Deerfield, Illinois, USA) and brachial BP were used to calculate hemodynamic parameter changes across PLR states [pre-PLR, active PLR (3 min), and post-PLR]. Multiple linear regression was used to assess associations between BP control status with changes in hemodynamic parameters between PLR states. The 24-h ambulatory BP monitoring identified 43 (42%) older Veterans with optimal BP control (mean age of 70.5 ± 7.0 years) and 55 (54%) with suboptimal BP (mean age of 71.3 ± 8.7 years). Veterans with suboptimal BP control had significantly reduced change in total peripheral resistance (ΔTPR) (7.0 ± 156.0 vs. 127.3 ± 145.6 dynes s/cm5; P = 0.002) following PLR compared with Veterans with optimal BP control. Suboptimal BP control (β = -0.35, P = 0.004) had a significant association with reduced ΔTPR, even after adjusting for demographic variables. Measuring PLR-induced hemodynamic changes in the office setting may represent an alternative way to identify older adults with suboptimal BP control when 24-h ambulatory BP monitoring is not available.

Effect of adult day care centre attendance on hypertension management.

Hypertension (HT) silently threatens one in three adults, especially older adults, who struggle with blood pressure (BP) control because of limited health access, poor adherence to medication and failure to make lifestyle changes. This increases their risk for heart disease, kidney failure and dementia. Fortunately, adult day care centres (ADCCs) offer hope. These community facilities provide daytime care, including health support services, social activities and exercise. This study investigated the perceived effect of adult daycare centre attendance on BP control and treatment adherence. A mainly descriptive study at MUCPP Community Health Centre (CHC) in Bloemfontein, South Africa, between July 2020 and September 2020, used questionnaires researchers completed during interviews. The researchers approached 372 hypertensive patients of a minimum of 60 years old and at least 2 years since being diagnosed. Of the 90 who attended ADCCs, 71.1% had controlled hypertension compared to 51.4% of those who did not. While treatment adherence showed no difference, a positive association between ADCC attendance and BP control is evident. The findings suggest a promising link between ADCC attendance and improved BP control in older adults with hypertension. Adult Day Care Centres warrant further exploration as it seems to be an encouraging support intervention for this vulnerable population.Contribution:This study highlights the positive impact ADCCs have on hypertension management in older adults, urging increased physician awareness and patient referrals.

Decline in use of high-risk agents for tight glucose control among older adults with diabetes in New York City: 2017-2022.

This study aimed to examine the prevalence of inappropriate tight glycemic control in older adults with type 2 diabetes and other chronic conditions in New York City, and to identify factors associated with this practice. We conducted a retrospective cohort study using the INSIGHT Clinical Research Network. The study population included 11,728 and 15,196 older adults in New York City (age ≥ 75 years) with a diagnosis of type 2 diabetes, and at least one other chronic medical condition, in 2017 and 2022, respectively. The main outcome of interest was inappropriate tight glycemic control, defined as HbA1c <7.0% (<53 mmol/mol) with prescription of at least one high-risk agent (insulin or insulin secretagogue). The proportion of older adults with inappropriate tight glycemic control decreased by nearly 19% over a five-year period (19.4% in 2017 to 15.8% in 2022). There was a significant decrease in insulin (27.8% in 2017; 24.3% in 2022) and sulfonylurea (29.4% in 2017; 21.7% in 2022) medication prescription, and increase in use of GLP-1 agonists (1.8% in 2017; 11.4% in 2022) and SGLT-2 inhibitors (5.8% in 2017; 25.1% in 2022), among the total population. Factors associated with inappropriate tight glycemic control in 2022 included history of heart failure (adjusted odds ratio [aOR] 1.38), chronic kidney disease ([aOR] 1.93), colorectal cancer ([aOR] 1.38), acute myocardial infarction ([aOR] 1.28), "other" ([aOR] 0.72) or "unknown" ([aOR] 0.72) race, and a point increase in BMI ([aOR] 0.98). We found an encouraging trend toward less use of high-risk medication strategies for older adults with type 2 diabetes and multiple chronic conditions. However, one in six patients in 2022 still had inappropriate tight glycemic control, indicating a need for continued efforts to optimize diabetes management in this population.

Dominance of attentional focus: a comparative study on its impact on standing postural control in healthy younger and older adults.

Attentional focus is a phenomenon in which shifting the focus of attention alters performance of standing postural control. It can be categorized as internal focus (IF), which directs attention to the body parts, or external focus (EF), which directs attention to the external environment. Although attentional focus that improves standing postural control in younger people exhibits individual dominance, the dominance of attentional focus in standing postural control in older adults remains ambiguous. Therefore, this study aimed to compare the dominance of attentional focus in standing postural control between healthy younger and older adults, a crucial step for understanding the aging process. The participants performed a standing postural control task under the IF and EF conditions. Based on the condition during which they exhibited superior performance, the participants were divided into two groups: IF-dominant and EF-dominant. The standing postural control performance in each group under the IF and EF conditions was subsequently compared. The results showed that the participants, encompassing both younger and older adults, were divided into the IF-dominant and EF-dominant groups, confirming the dominance of attentional focus. The performance under the EF condition in older adults was also influenced by the dominance of attentional focus. These results highlight the potential importance of intervention methods based on the dominance of attentional focus, providing valuable insights into future research and clinical practice.

Factors associated with poor glycemic control in older adults with sarcopenia

Factors associated with poor glycemic control in older adults with sarcopenia

Reduced trunk movement control during motor dual-tasking in older adults

Older adults have a decreased trunk movement control which is linked to their higher fall risk. While motor/cognitive dual-tasking deteriorates balance and walking in older adults, there is limited understanding on how trunk kinematics and kinetics are affected by dual-tasking in scenarios where falls can occur. Therefore, the purpose of the study was to determine the impacts of a challenging motor dual-task, specifically obstacle avoidance during walking, on trunk and lower-body kinematics and kinetics of older adults compared to young adults. The study captured three-dimensional kinematic and kinetic data from 12 young adults and 10 older adults as they walked on a treadmill and stepped over an obstacle with both legs. The study analyzed trunk, hip, knee, and ankle angles and torques. Trunk torque was further broken down to trunk muscle torque, gravitational torque, and inertia torque. A linear mixed effects model was used to investigate the difference in each variable between the two groups. Older adults exhibited significantly increased trunk flexion angle and trunk extension muscle torque compared to young adults, with the trunk being the only segment/joint showing differences in both kinematics and kinetics. Trunk torque breakdown analysis revealed that larger trunk flexion led to a larger gravitational torque, which contributed to an increased compensatory trunk muscle torque. Moreover, older adults' less controlled trunk flexion during weight shifting from trail leg to the lead leg, necessitated a compensatory trunk deceleration during trail leg obstacle avoidance which was achieved by generating additional increase in trunk muscle torque. The study demonstrated that motor dual-tasking has the most negative effects on trunk control in older adults compared to young adults. This exposes older adults to a higher fall risk. Therefore, future work should focus on supporting trunk control during daily multi-tasking conditions where falls can occur.

0441 Sleep Disturbance in MCI: A Pilot Study of a Cognitive Behavioural Therapy Digital Intervention (SUCCEED)

Abstract Introduction Insomnia is common in older adults with mild cognitive impairment (MCI) and predicts future cognitive decline. Cognitive Behavioural Therapy for insomnia (CBT-I) is the first-line treatment for insomnia but is often unavailable. We tested the feasibility of a randomised controlled trial comparing 12-weeks of digital CBT-I vs wait-listed control in older adults with MCI and insomnia. Methods This was an investigator-initiated (NCT05568381), parallel open-label randomised-controlled feasibility trial. Participants were randomised to digital CBT-I (Sleepio, 6-weekly sessions) or a wait-listed control (3 fortnightly online modules of a sleep health education package) via a secure centralised platform which was also used to collect the outcome data. This study was undertaken remotely without in-person visits. Potential participants were recruited through online advertising and a memory clinic in Sydney, Australia. Those who met initial eligibility were invited to a screening and informed consent telehealth consultation. Inclusion criteria included adults aged ≥50 years, with an Insomnia Severity Index (ISI)&amp;gt;10, who met the clinical criteria of MCI on a neuropsychological battery (performed over telehealth for participants recruited online). The primary outcomes were the proportion of participants who met screening and randomisation criteria. A secondary outcome was the effect sizes and 95%CIs of the difference in ISI between the groups at week 12. Results Recruitment occurred March 23, 2023 to August 11, 2023 stopping when we reached our pre-defined sample size (digital CBT-I=19; control=21; 30 females; mean [SD] age=59.7 years [7.3]; ISI=17.0 [3.7]). 37% of participants issued a pre-screening number (n=246), were eligible to attend online screening. 47% of those issued a screening number (n=90) were eligible to be randomised (n=42). All randomised participants (n=40) were recruited through the online pathway. At 12-weeks there was a difference in ISI between the digital CBT-I (mean±SE 7.8±1.1 points) and control groups (13.7±1.05 points) (Cohen’s D [95%CI] -1.6 [-2.4 to 2.1]). 79% of participants completed ≥4 out of the CBT-I 6 sessions. All adverse events were minor and transient. Conclusion This population can be recruited through online pathways and follow the protocol as well as adhere to the intervention of this remotely conducted trial. Support (if any) CogSleep CRE Seed Funding Grant. BigHealth- intervention in-kind.

The effects of Tai Chi on standing balance control in older adults may be attributed to the improvement of sensory reweighting and complexity rather than reduced sway velocity or amplitude.

Tai Chi has proved to be an effective therapy for balance performance and cognition. However, non-consistency exists in the results of the effect of Tai Chi training on standing balance control in older adults. This study aimed to use traditional and non-traditional methods to investigate the effect of Tai Chi on standing balance in older adults. Thirty-six Tai Chi practitioners (TC group) and thirty-six older adults with no Tai Chi practice (control group) were recruited in this study. A Nintendo Wii Balance Board was used to record the center of pressure (COP) during standing balance over 20 s in the condition of eyes closed with three repetitions. The wavelet analysis, multiscale entropy, recurrence quantification analysis, and traditional methods were used to evaluate the standing balance control in the anterior-posterior (AP) and mediolateral (ML) directions. (1) Greater sway mean velocity in the AP direction and sway Path length were found in the TC group compared with the control group; (2) lower Very-low frequency band (0.10-0.39 Hz) and higher Moderate frequency band (1.56-6.25 Hz) in the AP and ML directions were found in the TC group compared with the control group; (3) greater complexity index (CI) and lower determinism (DET) in the AP and ML directions were observed in the TC group compared with control group; (4) greater path length linked with smaller Very-low frequency band in the AP and ML directions and higher Moderate frequency band in the AP direction in both groups; (5) greater path length linked with lower DET and higher CI in the AP direction only in the TC group. Long-term Tai Chi practice improved sensory reweighting (more reliance on the proprioception system and less reliance on the vestibular system) and complexity of standing balance control in older adults. In addition, greater sway velocity may be as an exploratory role in standing balance control of TC older adults, which correlated with greater complexity, but no such significant relationship in the control group. Therefore, the effects of Tai Chi practice on standing balance control in older adults may be attributed to the improvement of sensory reweighting and complexity rather than reduced sway velocity or amplitude.