Factors associated with the risk for falls in PACE participants

Effect of Pilates combined with pelvic floor muscle training on continence of post-prostatectomy incontinence in patients with different body mass index

BACKGROUND

Urinary incontinence symptoms severely affect older people with different body mass index (BMI).To compare the efficacy of the pelvic floor muscle training (PFMT) in patients with post-prostatectomy incontinence with different BMI.

METHODS

Thirty-seven patients with post-prostatectomy incontinence were included. They were divided into group A (BMI ≤ 25,12), group B (26 ≤ BMI ≤ 30,14), and group C (BMI ≥ 31,11) based on difference BMI. Three groups of patients underwent the same Pilates combined with kegel training. Participants were assessed with 1-hour pad test, the number of incontinence episodes, International Consultation on Incontinence Questionnaire and Oxford Grading Scale.

RESULTS

In the 1-hour pad test, the differences before and after training were statistically significant in all three groups of participants. Group A decreased from 81.83 ± 8.79 to 31.08 ± 5.64 g (P < 0.01). Group B decreased from 80.57 ± 8.87 to 35.85 ± 5.66 g (P < 0.01). Group C decreased from 83.55 ± 10.24 to 40.18 ± 7.01 g (P < 0.01). The number of incontinent episodes in group A decreased from 9.33 ± 1.07 to 3.25 ± 0.62 (P < 0.01). Group B decreased from 8.86 ± 1.09 to 3.79 ± 0.80 (P < 0.01). Group C decreased from 9.27 ± 1.10 to 4.09 ± 0.70 (P < 0.01). The correlation between the three groups of participants and the 1-hour pad test, with an R2 of 0.51. The correlation between the three groups of participants and the number of urinary incontinence episodes with a R2 of 0.43.

CONCLUSIONS

Pelvic floor muscle training can affect the recovery of urinary continence in patients with different BMI. Maintaining a lower BMI can be beneficial for improving urinary control.

TRIAL REGISTRATION

Date of trial registration: November 27, 2023.

Effect of different postures of Pilates combined with Kegel training on pelvic floor muscle strength in post-prostatectomy incontinence

PURPOSE

Urinary incontinence seriously affects the daily ability of older males. This study compared the effect of different postures of Pilates combined with Kegel training on pelvic floor muscle strength in post-prostatectomy incontinence.

METHODS

We included 38 valid samples [group A = 13 (less than 3 months after surgery), group B = 15 (4-6 months after surgery), group C = 10 (more than 6 months after surgery)] and surface electromyography (EMG) was used to record the maximum, and root mean square values of participants in the three groups under four postures.

RESULTS

There were significant differences in the maximum and mean values among the three groups. In group A, the mean values were 13.04 ± 1.56, 16.98 ± 1.76, 41.58 ± 4.17, and 24.53 ± 2.45 (P < 0.01), respectively. In group B, the mean values were 13.85 ± 1.55, 18.63 ± 1.44, 45.87 ± 3.31, and 28.63 ± 2.02 (P < 0.01), respectively. In group C, the mean values were 14.80 ± 1.32, 19.59 ± 1.55, 47.85 ± 5.05, and 30.11 ± 2.26 (P < 0.01), respectively. The mean and peak values of surface EMG in the three groups correlated with the four basic movements. R² values were 0.76 and 0.85, 0.77 and 0.88, 0.77 and 0.91, respectively.

CONCLUSIONS

Pilates with Kegel training was superior to Kegel training alone in unit recruitment ability of the pelvic floor muscles. Pilates training in different positions is recommended according to the patient's condition.

The Program of All-Inclusive Care for the Elderly: An Update after 25 Years of Permanent Provider Status

PACE is the gold standard for community-based integrated care. Over the 25 years as permanent provider status by Centers for Medicare and Medicaid Services, it has evolved in design and grown in numbers served. We review the evidence base, history, and future direction of PACE.

Self-reported symptom causes of mobility difficulty contributing to fear of falling in older adults

BACKGROUND

Self-reported symptom causes of mobility difficulty that contribute to  fear of falling (FOF) in older adults has not been fully explored as an area for intervention.

AIMS

Identify the prevalence of self-reported symptoms causing mobility difficulties and to examine the difference in FOF by symptom category.

METHODS

Conduct a secondary data analysis of a population-based cohort of community-dwelling older adults, ≥ 70 years, enrolled in the MOBILIZE Boston study. The analysis included 242 older adults reported difficulty walking ¼ mile (0.4 km) and/or climbing one flight of stairs. Participants identified the main symptom cause of the mobility difficulty from a list of 32 symptoms, grouped into five categories. FOF was measured using the Tinetti Falls Efficacy Scale.

RESULTS

Pain was the primary symptom causing mobility difficulty (38%), followed by endurance (21%), weakness (13%), balance (9%), and other (3%). Although a greater proportion of participants who identified balance as the primary symptom category had significantly higher FOF compared to others, there was a greater number overall who reported pain as their main symptom who also had FOF. Therefore, pain contributed to a higher relative burden of FOF in the population than did balance symptoms.

DISCUSSION

Various symptoms affect mobility and are associated with FOF, a known fall risk factor. Many older adults identify pain as the main cause of their mobility difficulty and report FOF.

CONCLUSIONS

Improving pain symptoms for older adults may improve mobility and reduce fear of falling, potentially averting further decline in mobility and independence.

Factors associated with fear of falling among frail older adults

Some factors increase the fear of falling in frail older adults. Our aim is to quantify the influence of these factors. This cross-sectional study involved 229 community-dwelling prefrail and frail older adults aged 70 years and older. Fear of falling was moderate in 38.9% of our sample and high in 12.2%. Higher values were observed in women, those living alone, and those meeting criteria for slowness and feelings of exhaustion. A linear regression showed that being a woman, a history of falls, and depressive symptoms were related to higher fear of falling, while high levels of independence in basic and instrumental activities of daily living, along with good gait and balance, were associated with lower fear of falling. Screening for depressive symptoms and fear of falling in the comprehensive geriatric assessment of frail community-dwelling older adults could help to support preventive strategies.

SUMAMOS EXCELENCIA® Project: Results of the Implementation of Best Practice in a Spanish National Health System (NHS)

The use of certain strategies for the implementation of a specific recommendation yields better results in clinical practice. The aim of this study was to assess the effectiveness of an evidence-based model using clinical audits (GRIP model), for the implementation of recommendations in pain and urinary incontinence management as well as fall prevention, in the Spanish National Health System during the period 2015-2018. A quasi-experimental study has been conducted. The subjects were patients treated in hospitals, primary care units and nursing home centers. There were measures related to pain, fall prevention and urinary incontinence. Measurements were taken at baseline and at months 3, 6, 9, and 12. The sample consisted of 22,114 patients. The frequency of pain assessment increased from 59.9% in the first cycle to a mean of 71.6% in the last cycle, assessments of risk of falling increased from 56.8% to 87.8% in the last cycle; and finally, the frequency of assessments of urinary incontinence increased from a 43.4% in the first cycles to a mean of 62.2% in the last cycles. The implementation of specific evidence-based recommendations on pain, fall prevention, and urinary incontinence using a model based on clinical audits improved the frequency of assessments and their documentation.

Application of Ferrans et al.'s conceptual model of health-related quality of life: A systematic review

Ferrans, Zerwic, Wilbur, and Larson proposed the conceptual model of health-related quality of life (HRQOL) in 2005 to explicate the constructs associated with HRQOL and to describe the associations among those constructs. In this systematic review, the authors aimed to describe empirical studies that used Ferrans et al.'s model and to examine the evidence related to the hypothesized model concepts. This review followed Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Relevant articles were identified using Crossref, CINAHL, and PubMed. To be included, studies had to employ the model as a theoretical framework and be published in English between 2005 and 2020. Type of theory use was coded using four designations: informed by theory, applied theory, testing theory, and building theory. Thirty-one studies were included. Most studies involved adult patients with chronic illnesses (n = 20) and were conducted in Western countries (n = 22). The most common type of theory use was testing theory (74.19%). Among the seven concepts in Ferrans et al.'s model, all 20 hypothesized associations were tested and 19 were supported by study results. The three associations most frequently supported were between symptoms and functional status (n = 13), environmental characteristics and quality of life (n = 10), and individual characteristics and functional status (n = 8). No studies found an association between environmental characteristics and biological function. Our review found that Ferrans et al.'s model has been used extensively to guide HRQOL research. An emerging body of research provides preliminary support for the associations hypothesized in the model. Additional research is needed to confirm the hypothesized associations among model concepts.