Time In Older People Research Articles

Anchor-Based and Distributional Responsiveness of the Spanish Version of the Edinburgh Feeding Evaluation in Dementia Scale in Older People with Dementia: A Longitudinal Study.

Patients with dementia present with feeding difficulties (FDs) since diagnosis, conditioning their progression. Early identification is vital for preventing deterioration due to nutritional problems. The Edinburgh Feeding Evaluation in Dementia Scale (EdFED) identifies the FDs of patients with dementia by studying their behaviours while eating or being fed. The aim of this study was to assess the responsiveness of the EdFED over time in older people with cognitive impairment and to compare its effectiveness in identifying malnutrition and risk with that of the gold standard Mini Nutritional Assessment (MNA) method. This was a multicentre, prospective, observational, longitudinal, analytic study with a follow-up period of 18 months (with patients participating in nursing homes and in the community). Sociodemographic and nutritional data (body mass index (BMI), MNA, forearm circumference (FC), calf circumference (CC), and a nutritional blood test) were collected; EdFED score was reported by nurses, nursing assistants, and family caregivers. The total sample consisted of 359 individuals-60.7% residential participants and 39.3% community participants. In the last follow-up there were 149 remaining (41.5%). Malnutrition was more than 30%, and the risk was 40% at the three follow-ups. The results suggest that the EdFED scale is a useful tool for assessing feeding difficulties (FDs) in older persons with dementia. It demonstrated good sensitivity and specificity in detecting malnutrition, similar to the MNA, and, more importantly, detecting risk and also identifying changes in nutritional status over time. The EdFED scale provides a means of evaluating nutritional problems, making it possible to work on prevention.

Relationship between cleaning frequency and pressure ulcer healing time in older people receiving home care

Relationship between cleaning frequency and pressure ulcer healing time in older people receiving home care

Changes in strength-related outcomes following velocity-monitored resistance training with 10 % and 20 % velocity loss in older adults

We compared the effects of velocity-monitored resistance training with an intra-set velocity loss (i.e., the decrement in repetition velocity over the set) of 10 % vs. 20 % on strength-related outcomes in older adults. We randomly assigned eighteen older adults to a velocity loss group of 10 % (n = 10; 78 ± 12 years) or 20 % (n = 8; 73 ± 10 years) to perform a 10-week training program. The primary outcomes were the one-repetition maximum (1RM) and the average mean velocity against absolute loads associated with loads <60 % 1RM (MVlow) and ≥ 60 % 1RM (MVhigh) in the leg and chest press exercises, assessed at pre-, mid- (week 5), and post-test. Secondary outcomes included handgrip strength, 1-kg medicine ball throw distance, 10-m walking time, and five-repetition sit-to-stand time. No differences between groups were found in any outcome at any time (p > 0.05). Both groups improved the 1RM leg press from pre- to mid- and post-test and the MVlow and MVhigh from pre- to mid-test (p < 0.05). No group improved the 1RM chest press (p > 0.05), but both increased the MVlow from pre- to mid-test (p < 0.05). Furthermore, both groups improved the sit-to-stand time, while only the 20 % velocity loss group significantly improved handgrip strength and 10-m walking time (p < 0.05). The results showed that both velocity losses improved leg press strength and velocity, chest press velocity, and sit-to-stand time in older adults, although a 10 % velocity loss was more efficient as it required less volume (i.e., total repetitions) than 20 %. Nevertheless, the latter seems required to optimize handgrip strength and 10-m walking time in older people.

Effect of robot for medication management on home care professionals’ use of working time in older people’s home care: a non-randomized controlled clinical trial

BackgroundMedication management has a key role in the daily tasks of home care professionals delivered to older clients in home care. The aim of this study was to examine the effect of using a robot for medication management on home care professionals´ use of working time.MethodsA pragmatic non-randomized controlled clinical trial was conducted. The participants were home care professionals who carried out home care clients’ medication management. Home care clients were allocated into intervention groups (IG) and control groups (CG) (n = 64 and 46, respectively) based on whether or not they received the robot. Data were collected using the Working Time Tracking Form prior to and 1 and 2 months after introducing the intervention. The t-test was used to compare the groups at each three timepoints. Analysis of Covariance was used to examine the groups’ differences for the total time for medications as the number of visits per day as the covariate.ResultsWith robot use, the total amount of home visits decreased by 89.4% and 92.4% after 1 and 2 months of intervention use, respectively, compared to pre-intervention (p < 0.001). The total working time used for medication management considering the number of visits per day decreased from 54.2 min (95% CI 49.6–58.8) to 34.9 min (31.4–38.3), i.e., by slightly over 19 min (p < 0.001) in the IG group. During the follow-up, the total working time used for medication management considering the number of visits per day remained the same in the CG group.ConclusionUsing a robot for medication management had a notable effect on decreasing the use of working time of home care professionals. For health services, decreased use of working time for medication management means that the time saved can be assigned to services that cannot be replaced otherwise. More digital solutions should be developed based on home care clients’ and professionals’ needs to meet the challenge of the growing number of older people in need of home care and ensure their safety.Trial registrationClinicalTrials.gov Identifier: NCT05908604 retrospectively registered (18/06/2023).

1070 IMPACT OF ECONOMIC FACTORS, SOCIAL HEALTH AND RECENT STRESSORS ON PHYSICAL HEALTH-RELATED QUALITY OF LIFE TRAJECTORIES

Abstract Introduction Poorer physical health-related quality of life (HRQoL) has been shown to predict a higher risk of adverse health outcomes including cognitive decline, cardiovascular disease, and mortality among community-dwelling older individuals. However, little is known about how physical HRQoL changes over time in older people and the predictors of this trajectory. This study (a) identified trajectories of physical HRQoL among older people and (b) explored whether economic factors, social health, or recent stressors impact physical HRQoL trajectories. Method A cohort of 12,506 community-dwelling Australians aged ≥70 years (54.4% females), enrolled in the ASPREE Longitudinal Study of Older Persons (ALSOP) study and was followed for six years. Physical HRQoL was assessed by using a validated instrument (SF-12; version-2) at baseline and over up to six annual follow-ups. Economic factors, social health, and recent stressors (i.e. stressful life events in the last 12 months) were assessed through a questionnaire at baseline. Growth mixture and structural equation modelling were used to identify physical HRQoL trajectories and their predictors. Results Four physical HRQoL trajectories were identified—stable low (7.1%), declining (9.0%), stable intermediate (17.9%) and stable high (66.0%). Living in more disadvantaged areas, having economic burden, no voluntary work, loneliness, or recent stressors (i.e. spousal illness, friend/family illness, financial problem, pet died) were associated with a 10%–152% higher likelihood of being in the stable low or declining physical HRQoL trajectory than the stable high group. Conclusion Specific stressors including financial hardship had a greater impact on adverse physical HRQoL trajectories in older people than other factors. This study highlights that grassroots approaches are needed to emphasize economic autonomy and social support networks in order to support the wellbeing of older people. Volunteering may prevent physical HRQoL decline and requires further investigation.

Impact of economic factors, social health and stressful life events on physical health-related quality of life trajectories in older Australians.

PurposePhysical health-related quality of life (HRQoL) is associated with adverse health outcomes, including hospitalizations and all-cause mortality. However, little is known about how physical HRQoL changes over time in older people and the predictors of this trajectory. This study (a) identified trajectories of physical HRQoL among older people and (b) explored whether economic factors, social health or stressful life events impact physical HRQoL trajectories. MethodA cohort of 12,506 relatively ‘healthy’ community-dwelling Australians aged ≥ 70 years (54.4% females), enrolled in the ASPREE Longitudinal Study of Older Persons (ALSOP) study and was followed for six years. Economic factors, social health and life events in the last 12 months were assessed through a questionnaire at baseline. Physical HRQoL was measured by using the 12-item short form at baseline and annual follow-ups. Growth mixture and structural equation modelling were used to identify physical HRQoL trajectories and their predictors.ResultsFour physical HRQoL trajectories were identified—stable low (7.1%), declining (9.0%), stable intermediate (17.9%) and stable high (66.0%). Living in more disadvantaged areas, having a lower household income, no paid work, no voluntary work, loneliness and stressful life events (i.e. spousal illness, friend/family illness, financial problem) were associated with a 10%–152% higher likelihood of being in the stable low or declining physical HRQoL trajectory than the stable high group.ConclusionSpecific stressful life events had a greater impact on adverse physical HRQoL trajectories in older people than other factors. Volunteering may prevent physical HRQoL decline and requires further investigation.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11136-021-03021-x.

Does the length of institutionalization matter? Longitudinal follow-up of persons with severe mental illness 65 years and older: shorter-stay versus longer-stay.

As part of the process of de-institutionalization in the Swedish mental healthcare system, a reform was implemented in 1995, moving the responsibility for services and social support for people with severe mental illness (SMI) from the regional level to the municipalities. In many ways, older people with SMI were neglected in this changing landscape of psychiatric care. The aim of this study is to investigate functional levels, living conditions, need of support in daily life, and how these aspects changed over time for older people with SMI. In this study we used data from surveys collected in 1996, 2001, 2006, and 2011 and data from national registers. A group of older adults with severe persistent mental illness (SMI-O:P) was identified and divided into those who experienced shorter stays (less than 3 years) in a mental hospital (N=118) and longer stays (N=117). After correcting for longitudinal changes with age, the longer-stay group was more likely than the shorter-stay group to experience functional difficulties and as a result, were more likely to have experienced 're-institutionalization' to another care setting, as opposed to living independently. The length of mental illness hospitalization has significant effects on the living conditions of older people with SMI and their ability to participate in social life.

A randomized controlled feasibility study to evaluate the effects of a goal-setting coaching intervention using feedback from an accelerometer on sedentary time in older people at risk of falls (SMART-MOVE): a study protocol

BackgroundSedentary behaviour and falls are important interrelated health issues in older people. One in three people aged 65 years and above fall at least once a year and sedentary behaviour has been identified as one of the risk factors for falls. Studies have shown that the duration of sedentary time increases with age. These dual problems need to be addressed effectively as the ageing population grows. Accelerometers enable accurate measurement of sedentary time. This study aims to establish the feasibility and effect of an individualized goal-setting health coaching intervention using feedback initially from an accelerometer and then pedometer over a period of 12 weeks (intervention) compared with providing a one-off advice through a brochure (control), on sedentary time in older people with a recent fall or at risk of one.MethodsA single-blinded randomized controlled feasibility trial involving 80 community-dwelling people aged 65 years and above will be conducted with 40 randomized to the intervention and another 40 to control. Primary outcomes will be the feasibility of the intervention and change in total sedentary time at 12 and 24 weeks. Secondary outcomes include a change in fear of falling based on the falls efficacy scale, gait speed, self-reported sedentary time, the proportion of fallers and number of falls. Four focus groups (two from each arm) will be conducted at the end of the study to evaluate the feasibility and effectiveness of this intervention. Feasibility findings will be primarily descriptive. Mean group differences will be examined using independent samples t test for normally distributed data and nonparametric tests (Kruskal-Wallis and Mann-Whitney U) for non-normally distributed data. Differences in frequency of variables will be compared using chi-square test. Analysis of variance (ANOVA) will be used to test the post-intervention difference between the two groups at 12 and 24 weeks.DiscussionThe trial will address a key gap in evidence about sedentary behaviour and falls amongst older people and will evaluate the feasibility of an intervention that could be implemented within the primary health care settings.Trial registrationAustralian New Zealand Clinical Trials Registry 12617001186347, Registered 11 August 2017.

Association Between Objectively Measured Physical Activity and Opioid, Hypnotic, or Anticholinergic Medication Use in Older People: Data from the Physical Activity Cohort Scotland Study

Centrally acting medications cause cognitive slowing and incoordination, which could reduce older people's physical activity levels. This association has not been studied previously. The aim of this study was to examine the association between opioid, hypnotic and anticholinergic medication, and objectively measured physical activity, in a cohort of older people. We used data from the Physical Activity Cohort Scotland, a representative cohort of community-dwelling older people aged 65years and over who were assessed at baseline and again 2-3years later. Objective physical activity was measured using Stayhealthy RT3 accelerometers over 7days. Baseline medication use (opioid use, hypnotic use, modified Anticholinergic Risk Scale [mARS]) was obtained from linked, routinely collected community prescribing records. Cross-sectional and longitudinal associations between baseline medication use and both baseline activity and change in activity over time were analysed using unadjusted and adjusted linear regression models. Overall, 310 participants were included in the analysis; mean age 77years (standard deviation 7). No association was seen between baseline use of any medication class and baseline physical activity levels in unadjusted or adjusted models. For change in activity over time, there was no difference between users and non-users of hypnotics or opioids. Higher anticholinergic burden was associated with a steeper decline in activity over the follow-up period (mARS 0: -7051counts/24h/year; mARS1-2: -15,942counts/24h/year; mARS ≥ 3: -19,544counts/24h/year; p = 0.03) and this remained robust to multiple adjustments. Anticholinergic burden is associated with greater decline in objectively measured physical activity over time in older people, a finding not seen with hypnotic or opioid use.

Factors associated with change in objectively measured physical activity in older people \u2013 data from the physical activity cohort Scotland study

BackgroundCross-sectional relationships between physical activity and health have been explored extensively, but less is known about how physical activity changes with time in older people. The aim of this study was to assess baseline predictors of how objectively measured physical activity changes with time in older people.MethodsLongitudinal cohort study using data from the Physical Activity Cohort Scotland. A sample of community-dwelling older people aged 65 and over were recruited in 2009–2011, then followed up 2–3 years later. Physical activity was measured using Stayhealthy RT3 accelerometers over 7 days. Other data collected included baseline comorbidity, health-related quality of life (SF-36), extended Theory of Planned Behaviour Questionnaire and Social Capital Module of the General Household Survey. Associations between follow-up accelerometer counts and baseline predictors were analysed using a series of linear regression models, adjusting for baseline activity levels and follow-up time.ResultsFollow up data were available for 339 of the original 584 participants. The mean age was 77 years, 185 (55%) were female and mean follow up time was 26 months. Mean activity counts fell by between 2% per year (age < =80, deprivation decile 5–10) and 12% per year (age > 80, deprivation decile 5–10) from baseline values. In univariate analysis age, sex, deprivation decile, most SF-36 domains, most measures of social connectedness, most measures from the extended Theory of Planned Behaviour, hypertension, diabetes mellitus, chronic pain and depression score were significantly associated with adjusted activity counts at follow-up. In multivariate regression age, satisfactory friend network, SF-36 physical function score, and the presence of diabetes mellitus were independent predictors of activity counts at follow up after adjustment for baseline count and duration of follow up.ConclusionsHealth status and social connectedness, but not extended Theory of Planned Behaviour measures, independently predicted changes in physical activity in community dwelling older people.

Validity and reliability of a simple ‘low-tech’ test for measuring choice stepping reaction time in older people

Objective: To establish the psychometric properties of a simple ‘low-tech’ choice stepping reaction time test (CSRT-M) by investigating its validity and test–retest reliability. Design: Cross-sectional. Setting: Community. Subjects: A total of 169 older people from the control arm of a clinical trial and a convenience sample of 30 older people. Main measures: Demographic, physical, cognitive and prospective falls data were collected in addition to CSRT-M. The CSRT-M time was taken as the total time to complete 20 steps onto four targets printed on a portable rubber mat. Assessment of the original electronic version (CSRT-E) and re-administration of the CSRT-M the next day was done in 30 participants. Results: Multivariate regression analysis showed that the CSRT-M time was best explained by leaning balance control, quadriceps strength and cognitive functioning (R2 = 0.44). Performance on the CSRT-M was worse in older participants and participants with a presence of fall risk factors, supporting good discriminant validity. The odds of suffering multiple future falls increased by 74% (odds ratio (OR) = 1.74, 95% CI (confidence interval) = 1.14–2.65, p = 0.010) for each standard deviation increase in CSRT-M, supporting good predictive validity. Criterion validity was confirmed by a strong bivariate correlation between CSRT-M and CSRT-E (0.81, p < 0.001). Test–retest reliability for the CSRT-M was good (intraclass correlation coefficient = 0.74, 95% CI = 0.45–0.88, p < 0.001). Conclusions: A simple test of unplanned volitional stepping (CSRT-M) has excellent predictive validity for future falls, good inter-day test–retest reliability and excellent criterion validity with respect to the well-validated CSRT-E. The CSRT-M, therefore, may be a useful fall risk screening tool for older people.

Is the naturalistic course of depression in older people related to received support over time? Results from a longitudinal population-based study.

To test the interrelation of the naturalistic course of depression in older people with long-term support received. Longitudinal cohort study. A sample of 277 adults age 55-85 years participating in the Longitudinal Aging Study Amsterdam, with clinically relevant depressive symptoms at baseline (scores ≥16 on the Center for Epidemiological Studies Depression Scale) were followed up over a period of 13 years. General estimating equations were used to examine the relation between depression course and emotional/instrumental support received over time. In addition, partner status, gender, and age were tested as modifiers. A 2-way interaction between depression courses types and time showed significant differences in instrumental support received over time in older people with a late-life depression. Three-way interactions showed that associations between depression course and support variables were modified by gender and partner status. Both men and singles, with a chronic course of depression may be at risk to lose emotional and instrumental support over time. Professional attention is needed to prevent a chronic course of late-life depression, and to preserve personal social networks. Copyright © 2016 John Wiley & Sons, Ltd.

Visual Impairment, Hearing Loss and Cognitive Function in an Older Population: Longitudinal Findings from the Blue Mountains Eye Study.

The presence of visual impairment (VI) and hearing loss (HL) with may be a marker for subsequent cognitive decline over time in older people. A prospective, longitudinal population-based study of the 3654 participants of the Blue Mountains Eye Study were assessed for the associations between VI and HL and a decline in mini-mental state examination (MMSE) scores over a duration of 10 years from the 5-year (baseline of this report) to the 15-year follow-up visits. MMSE was assessed at the 5-, 10- and 15-year follow-up visits. A decline ≥3 scores from 5-year to 10- or 15-year visits indicated possible cognitive decline. VI was defined as best-corrected visual acuity <6/12 in the worse-eye, HL was defined as pure-tone average >40 decibels in the worse-ear and dual sensory impairment (DSI) was defined by the co-presence of VI and HL, detected at 5-year follow-up (baseline of this report). Participants with no VI and HL over the same 5- or 10-year corresponding period were controls. Associations of VI, HL and DSI with possible cognitive decline were assessed using logistic regression models adjusting for age and sex after excluding subjects with a stroke history. The presence of VI, HL or DSI was not associated with possible cognitive decline over 5 years (odds ratio (OR) 0.84, 95% confidence-intervals (CI) 0.40–1.79, OR 1.02, 95% CI 0.61–1.70 and 1.41, 95% CI 0.54–3.72, respectively) or 10 years (OR 1.09, 95% CI 0.52–2.30, OR 1.09, 95% CI 0.65–1.82 and 1.15, 95% CI 0.28–4.73, respectively). There were no changes to these findings after adjustment for other potential confounders. Age was significantly associated with possible cognitive decline (OR 1.07, 95% CI 1.04–1.10 for both periods). Neither visual impairment, hearing loss nor dual sensory impairment was independently associated with subsequent decline in cognition.

Development of hand phenotypes and changes in hand pain and problems over time in older people.

Hand disabilities are frequent causes of pain and disability in older people, yet knowledge regarding the characteristics and patterns of hand pain and problems over time is lacking. The main aim of this study was to identify subgroups of older individuals with distinct presentations (phenotypes) of hand pain and function, investigate how these might change over a 6-year period, and explore what characteristics and factors are associated with long-term status. The study population stemmed from the North Staffordshire Osteoarthritis Project, a large, general population-based, prospective, cohort study of adults aged 50 years and older. Information on hand pain and problems was collected using questionnaires at baseline, 3 years, and 6 years. Overall, 5617 participants responded at all time points and were included in the analysis. Five phenotypes were identified using latent transition analysis ("least affected," "high pain," "poor gross function," "high pain and poor gross function," and "severely affected") based on 8 hand pain and functional items. The most common transition between phenotypes was from "high pain" at baseline to "least-affected" group. There was a high level of stability in individuals in the "least-affected" or "severely affected" group at baseline. Individuals with widespread body pain, nodes, sleep problems, and pain in both hands at baseline were more likely to be in a severe hand phenotype at 6 years. The results provide clinically relevant information regarding the pattern of hand pain and problems over time and factors that predict transition to more severe hand phenotypes.

A 36-month follow-up of decline in activities of daily living in individuals receiving domiciliary care.

BackgroundThere have been few studies of how personal and instrumental activities of daily living (P-ADL and I-ADL) develop over time in older people receiving domiciliary care. This study aimed at assessing variables associated with the development of P-ADL and I-ADL functioning over a 36-month follow-up period, with a particular focus on cognitive functioning.MethodIn all, 1001 older people (≥70 years) receiving domiciliary care were included in a longitudinal study with three assessments of P-ADL and I-ADL functioning during 36 months. P-ADL and I-ADL were assessed using the Lawton and Brody’s Physical Self-Maintenance Scale and Instrumental Activities of Daily Living Scale, respectively. Mini Mental State Examination (MMSE), diagnosis of dementia and MCI, neuropsychiatric symptoms and use of psychotropic medication were also evaluated during the three assessments. Baseline demographic and general medical health information and information of being a nursing home resident at follow-up were recorded. Linear mixed models were estimated.ResultsThere was a significant decline in P-ADL and I-ADL functioning throughout the follow-up. A lower MMSE sum-score, diagnosed MCI and dementia, a higher level of neuropsychiatric symptoms and the use of antipsychotics and antidepressants recorded at each assessment were associated with a decline in both P-ADL and I-ADL functioning. Furthermore, a decline in P-ADL and I-ADL functioning at follow-ups was associated with being male, a higher baseline age and in poorer medical health as well as residing in a nursing home at follow-up.ConclusionP-ADL and I-ADL functioning in older people worsened over time. The worsening was associated with lower MMSE sum-score, diagnosed MCI and dementia, poorer medical health, neuropsychiatric symptoms, use of psychotropic medication and being transferred to nursing home care. Clinicians should pay close attention to the assessment and treatment of these factors to help older people maintain their level of functioning for as long as possible.

Developing osteoarthritis phenotypes and predicting changes in hand conditions over time in older people

Developing osteoarthritis phenotypes and predicting changes in hand conditions over time in older people

Never had it so good? Boom time for older people

Purpose – Increasing longevity, while welcome, has far-reaching implications for the social contract between generations. These include eye-watering costs for health and social care, intense pressure on the old-age dependency ratio, changing power relations in politics and voting, and increasing pressure on in-work families. In a period of austerity, policy makers have chosen to protect older generations’ benefits and paid for this by slashing benefits for the young, in spite of growing evidence that wealth distribution has changed with older generations becoming wealthier than once thought. The paper concludes that age alone can no longer be used as a proxy for need. The paper aims to discuss these issues. Design/methodology/approach – This discussion paper uses original quantitative research and analysis undertaken by the Intergenerational Foundation (IF) (www.if.org.uk) which includes Freedom of Information requests to government departments. It brings together the think tank's research into demographics, ageing, policy, government debt and liabilities, benefit reform and spending patters in order to investigate the changing distribution of wealth across the generations. Findings – It is clear that with changing distributions of wealth that age alone can no longer be used as a proxy for need. While older generations are becoming wealthier younger generations are becoming increasingly burdened by debt, with poorer prospects and being asked to maintain the current status quo. Originality/value – The paper contains original research conducted by the IF (www.if.org.uk) into spending patterns across the generations and annual public sector pensions.

Pain at multiple body sites and health-related quality of life in older adults: results from the North Staffordshire Osteoarthritis Project.

Objectives. Number of pain sites (NPS) is a potentially important marker of health-related quality of life (HRQoL) but remains unexplored in older people. This cross-sectional study investigated whether, in older people including the oldest old, NPS was independently associated with poorer mental and physical HRQoL and if the association was moderated by age.Methods. A postal questionnaire sent to a population sample of adults aged ≥50 years in North Staffordshire, UK, included the 12-item Short Form Health Survey (SF-12) mental component summary (MCS) and physical component summary (PCS), a blank body pain manikin, socio-demographic, health behaviour and morbidity questions. Participants shaded sites of pain lasting ≥1 day in the past 4 weeks on the manikin. OA consultation data were obtained for participants consenting to medical records review.Results. A total of 13 986 individuals (adjusted response 70.6%) completed a questionnaire, of which 12 408 provided complete pain data. The median NPS reported was 4 [interquartile range (IQR) 0–8]. General linear models showed that an increasing NPS was significantly associated with poorer MCS (β = −0.43, 95% CI −0.46, −0.40) and PCS (β = −0.87, 95% CI −0.90, −0.84). Adjustment for covariates attenuated the associations but they remained significant (MCS: β = −0.28, 95% CI −0.31, −0.24; PCS: β = −0.63, 95% CI −0.66, −0.59). The association between NPS and MCS or PCS was moderated by age, but the strongest associations were not in the oldest old.Conclusion. NPS appears to be a potentially modifiable target for improving physical and mental HRQoL in older people. Future analyses should investigate the influence of NPS on HRQoL over time in older people.

Older people’s perception of their readiness for discharge and postdischarge use of community support and services

To examine older patients perception of their readiness for discharge from hospital to home and use of community supports postdischarge, including readmission. Early discharge leaves little time for older people, families and professionals to prepare. The perspectives of patients are essential to therapeutic caring; however, few studies have examined patient's perception of their readiness for discharge. A quantitative, descriptive and correlational design was used. Data were collected from older patients (n = 335) at discharge and postdischarge using the Readiness for Discharge Scale (Weiss & Piacentine; Journal of Nursing Measurement, 14, 2006, 163) and a Demographic and Community Resource Questionnaire. At 6 weeks postdischarge, almost one-quarter had been readmitted. Family support had increased, yet a minimal increase in formal services was found. At discharge, differences in readiness existed between the younger and older old. Significant relationships existed between lower perception of readiness at discharge and increased use of informal and formal support post-discharge. Lower perception of readiness had a significant relationship with readmission in the older old. Perceptions of readiness reflect the patient's reality and may be significant to discharge preparation and arrangements for support. Older patients' perspectives should be included in discharge decisions and in individualised approaches by nurses to discharge preparation.

White matter hyperintensities and impaired choice stepping reaction time in older people

White matter hyperintensities (WMHs) are associated with impaired mobility in older people, but no studies have identified neuropsychological and sensorimotor mediating factors for this association. Our objective was to determine whether neuropsychological and sensorimotor functions mediate the association of WMHs and choice stepping reaction time (CSRT) under standard and dual-task conditions using structural equation modeling. Two hundred fifty-four older community dwellers (77.8 ± 4.5 years) underwent structural magnetic resonance imaging, CSRT tests, neuropsychological and sensorimotor assessments. WMH volumes were quantified using an automated method. WMH volumes were significantly associated with neuropsychological tests and dual task CSRT performance. All neuropsychological and sensorimotor variables were also significantly associated with standard and dual task CSRT. The structural equation modeling revealed that impaired sensorimotor function was the only factor influencing impaired stepping performances in the standard condition. In the dual task condition, the association between WMHs and CSRT was mediated through slowed cognitive processing and not through reduced sensorimotor functioning. The conclusion was that WMHs are associated with slowed performance on a dual task CSRT task and this relationship is explained primarily by underlying neuropsychological impairments.