As a preliminary step in developing the physical-functioning measure of the Late-Life Function and Disability Instrument (LLFDI), the authors compared its items with the physical-functioning items (PF-10) on the SF-36 Health Survey. They compared the item coverage, hierarchy, and scale-separation properties of the PF-10 items with those of the physical-functioning items of the LLFDI. Both questionnaires were administered to 50 community-dwelling older adults. A partial-credit, 1-parameter, item-response-theory model was used to scale the items. The LLFDI improved the range of ability of daily activities that was encompassed by the PF-10 items by 46%. By sequentially deleting new items with poor fit to the overall scale and items with redundant content, the authors developed a scale more capable of accurately assessing low-functioning activities. The LLFDI function component incorporates a broader content range and better person and item separation than the PF-10 items. It appears to have potential as a comprehensive functional-activity assessment for community-dwelling older adults.
Stephen M. Haley, Larry H. Ludlow, and Jill T. Kooyoomjian
Sharon L. Olson, Shu-Shi Chen, and Ching-Yi Wang
To determine exercise efficacy in improving dynamic balance in community-dwelling elderly with a fall history.
Thirty-five participants were randomly assigned to a treatment (TG; n = 19, 77 ± 7 yr) or control group (CG; n = 16, 75 ± 8 yr). The TG received an individualized home exercise program, and the CG received phone calls twice per week for 12 weeks. Participants’ dynamic-balance abilities— directional control (DC), endpoint excursion (EE), maximum excursion (ME), reaction time (RT), and movement velocity (MV)—were measured using the Balance Master at 75% limits of stability. Functional reach (FR) was also measured.
At 12 weeks the TG demonstrated significant improvements in DC (p < .0025), EE (p < .0005), and ME (p < .0005), but the CG did not. No significant group differences were found for MV, RT, or FR.
Excursion distances and directional control improved but not reaction time, suggesting that exercises requiring quick responses may be needed.
Claire Peel and Diane Ballard
The primary purpose of this study was to determine the reproducibility of the 6-min-walk test (6MWT) in older women. A secondary purpose was to document heart rate (HR), blood pressure (BP), and ratings of perceived exertion (RPE) in response to the 6MWT. Twenty-eight women with an average age of 80.0 years (±5.2) participated. They performed 2 trials of the 6MWT on 3 separate days, for a total of 6 trials. Heart rate, BP, RPE, and the total distance walked were recorded for each trial. The results indicated a significant increase from Trial 1 to Trial 2, with no differences between Trials 2–6, F(5, 131) = 7.02, p = .000. HR and BP were consistent across the 6 trials, and RPE was higher for the second trial on the second day of testing, F(5, 131) = 2.72, p = .023. The intraclass correlation coefficient for distance walked was .94. After the initial trial, performance on the 6MWT appears to be stable in older women.
Ahmadreza Nematollahi, Fahimeh Kamali, Ali Ghanbari, Zahra Etminan, and Sobhan Sobhani
The aim of this study was to examine and compare the effects of conventional, multisensory, and dual-task exercises on balance ability in a group of older community dwellers over a four-week period. Forty-four older people were randomly assigned to one of the three training groups. The score on the Fullerton Advanced Balance (FAB) scale, gait stability ratio, and walking speed were evaluated at baseline and after four weeks of training. All three groups showed significant (p < .001) improvement in the FAB scores following the three training programs (on average, 3 points for the conventional and multisensory groups and 3.8 points for the dual-task group). The improvements were comparable across the three intervention groups (p = .23). There were no statistically significant differences, neither within nor between groups, in the gait stability ratio and walking speed across the three training groups. In a four-week period, all the training modes were effective in improving balance of older adults, with no significant superiority of one mode of training over another.
Daniel Liebzeit, Cynthia Phelan, Chooza Moon, Roger Brown, and Lisa Bratzke
The purpose of this investigation is to examine differences in rest-activity patterns and sleep characteristics in older adults with heart failure (HF) and healthy older adults. The sample included older adults with HF (n = 20) and a reference group of healthy older adults (n = 20). Traditional cosinor analysis was used to assess three parameters of rest–activity from wrist actigraphy data: amplitude (range of activity), mesor (mean activity), and acrophase (time of peak activity). Traditional sleep characteristics were also determined from actigraphy data: total sleep time (TST), sleep latency (SL), sleep efficiency (SE), and wake after sleep onset (WASO). The HF group demonstrated significantly lower mesor and amplitude than the reference group (p < .01). The HF group had significantly greater TST (p < .01), but the groups had similar SE, SL, and WASO. Despite similar sleep characteristics to healthy older adults, overall rest–activity patterns were significantly dampened in those with HF.
Thomas A. Stoffregen
It is widely assumed that healthy aging includes a decline in the stability of standing body sway. Certainly, the spatial magnitude of postural sway increases with age. However, the interpretation of this effect as a decline in the ability to stabilize posture rests, in part, on assumptions about the nature and definition of stability in stance. In this article, I review data on the control of standing posture in healthy older adults. I focus on a growing list of studies that demonstrate the retention, among healthy older adults, of the ability functionally to modulate postural sway in support of “suprapostural” activities. I address laboratory research, but also field studies carried out in a setting that dramatically challenges the control of stance: life on ships at sea. I argue that it may be possible, and certainly will be useful, to address directly the functional control of stance in older adults.
Lauren M. Robins, K.D. Hill, Lesley Day, Lindy Clemson, Caroline Finch, and Terry Haines
This paper describes why older adults begin, continue, and discontinue group- and home-based falls prevention exercise and benefits and barriers to participation. Telephone surveys were used to collect data for 394 respondents. Most respondents reported not participating in group- (66%) or home-based (78%) falls prevention exercise recently. Reasons for starting group-based falls prevention exercise include health benefits (23–39%), health professional recommendation (13–19%), and social interaction (4–16%). They discontinued because the program finished (44%) or due to poor health (20%). Commonly reported benefits were social interaction (41–67%) and health (15–31%). Disliking groups was the main barrier (2–14%). Home-based falls prevention exercise was started for rehabilitation (46–63%) or upon health professional recommendation (22–48%) and stopped due to recovery (30%). Improvement in health (18–46%) was the main benefit. These findings could assist health professionals in prescribing group-based falls prevention exercise by considering characteristics of older adults who perceive social interaction to be beneficial.
Kelly Birch, Merritt ten Hope, Michael Malek-Ahmadi, Kathy O’Connor, Sharon Schofield, David Coon, and Walter Nieri
Previous research has found that increased physical activity may provide a protective effect on depression status; however, these studies do not account for cognitive function. This study’s aim was to determine whether cognitive function mediates the association between physical activity depression status in older adults. Data from 501 older adults were used for this analysis. Physical activity had a significant protective effect on depression (OR = 0.761, 95% CI [0.65, 0.89], p = .001). Adjusted analysis yielded an attenuated association (OR = 0.81, 95% CI [0.69, 0.95], p = .01) with a significant interaction for physical activity and cognitive function (OR = 0.991, 95% CI [0.985, 0.997], p = .005). MoCA performance also had a significant mediating effect on the relationship between physical activity and depression status (p = .04). These findings suggest that cognitive function is associated with, and does mediate, the relationship between physical activity and depression status.
Nina Sperber, Katherine S. Hall, Kelli Allen, Brenda M. DeVellis, Megan Lewis, and Leigh F. Callahan
Physical and psychological symptoms limit physical activity for people with arthritis. This study examined if self-efficacy mediated a relationship between symptom and physical activity (PA) frequency change.
This was a secondary analysis of older adults with arthritis and joint pain in a trial of a lifestyle PA program (n = 339). Measures were depressive symptoms, pain, fatigue, arthritis self-efficacy, PA self-efficacy, and PA frequency. A panel model was used to analyze relationships at baseline and changes at 20 weeks.
The mean age was 68.8 years. At baseline, depression and fatigue were associated with arthritis self-efficacy (β = –.34 and –.24) and, in turn, PA self-efficacy (β = .63); PA self-efficacy was associated with PA (β = .15). Pain and depression changes were associated with arthritis self-efficacy change (β = –.20 and –.21) and, in turn, PA self-efficacy (β = .32) change; PA self-efficacy change was associated with PA change (β = .36).
Change in symptom severity affected change in PA frequency. These relationships appeared to operate through self-efficacy. Over time, pain appeared to have a stronger relationship than fatigue with self-efficacy and PA. These findings support strategies to help people with arthritis strengthen their confidence for symptom coping and PA participation.
Morten Villumsen, Martin Gronbech Jorgensen, Jane Andreasen, Michael Skovdal Rathleff, and Carsten Møller Mølgaard
Lack of activity during hospitalization may contribute to functional decline. The purpose of this study was to investigate (1) the time spent walking during hospitalization by geriatric patients referred to physical and/or occupational therapy and (2) the development in time spent walking during hospitalization. In this observational study, 24-hr accelerometer data (ActivPal) were collected from inclusion to discharge in 124 patients at an acute geriatric ward. The median time spent walking was 7 min per day. During the first quartile of hospitalization, the patients spent 4 (IQR:1;11) min per day walking, increasing to 10 (IQR:1;29) min during the last quartile. Improvement in time spent walking was primarily observed in the group able to perform the Timed Up & Go task at admission. When walking only 7 min per day, patients could be classified as inactive and at risk for functional decline; nonetheless, the physical activity level increased significantly during hospitalization.