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Ferentinos P, Douki S, Yotsidi V, Kourkouni E, Dragoumi D, Smyrnis N, Douzenis A. Family in Crisis: Do Halfway Houses Perform Better Than Families with Expressed Emotion toward Patients with Schizophrenia? A Direct Adjusted Comparison. Healthcare (Basel) 2024; 12:375. [PMID: 38338260 PMCID: PMC10855104 DOI: 10.3390/healthcare12030375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 01/27/2024] [Accepted: 01/30/2024] [Indexed: 02/12/2024] Open
Abstract
Expressed emotion (EE) toward patients with schizophrenia is typically reported to be lower in psychiatric halfway houses than in families. This is the first study directly comparing EE between these settings and investigating the pathways mediating EE differences. We included 40 inpatients in halfway houses and 40 outpatients living with their families and recorded 22 psychiatric nurses' and 56 parents' EE, respectively, through Five Minutes Speech Samples. Each inpatient was rated by 2-5 nurses and each outpatient by 1-2 parents. As EE ratings had a multilevel structure, generalized linear mixed models were fitted, adjusting for patient-related confounders and caregiver demographics. Mediatory effects were investigated in multilevel structural equation models. Outpatients were younger, less chronic, and better educated, with higher negative symptoms and perceived criticism than inpatients. Nurses were younger and better educated than parents. Before adjustment, EE rates were equally high across settings. After adjusting for patient-related confounders, emotional overinvolvement was significantly higher in parents. However, after also adjusting for caregiver demographics, only criticism was significantly higher in nurses. Patients' age, negative symptoms, and perceived criticism and caregivers' age and sex significantly mediated EE group differences. Our findings highlight pathways underlying EE differences between halfway houses and families and underscore the importance of staff and family psychoeducation.
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Affiliation(s)
- Panagiotis Ferentinos
- 2nd Department of Psychiatry, National and Kapodistrian University of Athens, “Attikon” University General Hospital, 12 462 Athens, Greece; (N.S.); (A.D.)
| | - Stamatina Douki
- Department of Psychiatry, “Evangelismos” General Hospital, 106 76 Athens, Greece; (S.D.); (D.D.)
| | - Vasiliki Yotsidi
- Department of Psychology, Panteion University of Social and Political Sciences, 176 71 Athens, Greece;
| | - Eleni Kourkouni
- Center for Clinical Epidemiology and Outcomes Research, 15 451 Athens, Greece;
| | - Dimitra Dragoumi
- Department of Psychiatry, “Evangelismos” General Hospital, 106 76 Athens, Greece; (S.D.); (D.D.)
| | - Nikolaos Smyrnis
- 2nd Department of Psychiatry, National and Kapodistrian University of Athens, “Attikon” University General Hospital, 12 462 Athens, Greece; (N.S.); (A.D.)
| | - Athanasios Douzenis
- 2nd Department of Psychiatry, National and Kapodistrian University of Athens, “Attikon” University General Hospital, 12 462 Athens, Greece; (N.S.); (A.D.)
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Taube C, Mentzel C, Glue P, Barak Y. Aging of persons with schizophrenia: analysis of a national dataset. Int Psychogeriatr 2024; 36:43-50. [PMID: 36876332 DOI: 10.1017/s1041610223000145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
OBJECTIVES The number of older adults suffering from schizophrenia is increasing. Despite this, less than 1% of published studies about schizophrenia focus on those older than 65 years. Research indicates these individuals may age differently from the general population due to lifestyle, medication factors, and effects of the disease itself. We aimed to analyze whether schizophrenia was associated with a younger age at first assessment for social care as a proxy measure for accelerated aging. DESIGN We analyzed the effect of schizophrenia diagnosis, demographics, mood, comorbidities, falls, cognition, and substance use on age at first assessment for social care using linear regression. PARTICIPANTS We used data from 168,780 interRAI Home Care and Long-Term Care Facility (HC; LTCF) assessments completed from July 2013 to June 2020. RESULTS When corrected for confounding factors, schizophrenia contributed to age at first assessment being 5.5 years younger (p = 0.0001 Cohen's D = 1.0) than in people free from schizophrenia. Its effect on age at first assessment was second only to smoking. People suffering from schizophrenia also required a higher level of care (long-term care facility rather than home care). People suffering from schizophrenia had significantly higher rates of diabetes mellitus and chronic obstructive pulmonary disease but otherwise had lower rates of comorbidity than people free from schizophrenia who required care. CONCLUSIONS Aging with schizophrenia is associated with needing increased social care at a younger age. This has implications for social spending and developing policies to decrease frailty in this population.
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Affiliation(s)
- Clare Taube
- Dunedin School of Medicine, University of Otago, New Zealand
| | | | - Paul Glue
- Dunedin School of Medicine, University of Otago, New Zealand
| | - Yoram Barak
- Dunedin School of Medicine, University of Otago, New Zealand
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Smoking Habits and Attitudes toward Smoking in Patients with Severe Mental Illness in Residential Facilities in Insular Greece. Healthcare (Basel) 2023; 11:healthcare11050642. [PMID: 36900647 PMCID: PMC10001183 DOI: 10.3390/healthcare11050642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 02/14/2023] [Accepted: 02/19/2023] [Indexed: 02/24/2023] Open
Abstract
Smoking may contribute to increased cardiovascular morbidity and mortality in patients with schizophrenia spectrum disorders. The objective of the present study is to explore the attitudes toward smoking in patients with severe mental illness in residential rehabilitation facilities in insular Greece. The patients (n = 103) were studied with the use of a questionnaire based on a semi-structured interview. Most of the participants (68.3%) were current regular smokers, had been smoking for 29 years and started smoking at an early age. The majority (64.8%) reported having tried to quit smoking in the past, and only half had been advised by a physician to quit. The patients agreed on the rules for smoking and believed that the staff should avoid smoking in the facility. The years of smoking were statistically significantly correlated to the educational level and the treatment with antidepressant medication. A statistical analysis showed that longer stay period in the facilities correlates with current smoking, an effort to quit and increased belief that smoking causes harm to health. Further research on the attitudes of patients in residential facilities toward smoking is needed, which could guide interventions for smoking cessation and should be assumed by all health professionals who are involved in the care of those patients.
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Oliva V, Fanelli G, Zamparini M, Zarbo C, Rocchetti M, Casiraghi L, Starace F, Martinelli A, Serretti A, de Girolamo G. Patterns of antipsychotic prescription and accelerometer-based physical activity levels in people with schizophrenia spectrum disorders: a multicenter, prospective study. Int Clin Psychopharmacol 2023; 38:28-39. [PMID: 36165505 PMCID: PMC9722380 DOI: 10.1097/yic.0000000000000433] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Antipsychotic polypharmacy (APP) in patients with schizophrenia spectrum disorders (SSDs) is usually not recommended, though it is very common in clinical practice. Both APP and SSDs have been linked to worse health outcomes and decreased levels of physical activity, which in turn is an important risk factor for cardiovascular diseases and premature mortality. This real-world, observational study aimed to investigate antipsychotic prescribing patterns and physical activity in residential patients and outpatients with SSDs. A total of 620 patients and 114 healthy controls were recruited in 37 centers across Italy. Each participant underwent a comprehensive sociodemographic and clinical evaluation. Physical activity was monitored for seven consecutive days through accelerometer-based biosensors. High rates of APP were found in all patients, with residential patients receiving more APP than outpatients, probably because of greater psychopathological severity. Physical activity was lower in patients compared to controls. However, patients on APP showed trends of reduced sedentariness and higher levels of light physical activity than those in monopharmacy. Rehabilitation efforts in psychiatric residential treatment facilities were likely to result in improved physical activity performances in residential patients. Our findings may have important public health implications, as they indicate the importance of reducing APP and encouraging physical activity.
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Affiliation(s)
- Vincenzo Oliva
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Giuseppe Fanelli
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
- Department of Human Genetics, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, the Netherlands
| | - Manuel Zamparini
- Unit of Epidemiological and Evaluation Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia
| | - Cristina Zarbo
- Unit of Epidemiological and Evaluation Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia
| | - Matteo Rocchetti
- Department of Mental Health and Dependence, ASST of Pavia
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia
| | - Letizia Casiraghi
- Department of Mental Health and Dependence, ASST of Pavia
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia
| | - Fabrizio Starace
- Department of Mental Health and Dependence, AUSL of Modena, Modena
| | - Alessandra Martinelli
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona
- Unit of Clinical Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Alessandro Serretti
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Giovanni de Girolamo
- Unit of Epidemiological and Evaluation Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia
| | - the DiAPASon Consortium
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
- Department of Human Genetics, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, the Netherlands
- Unit of Epidemiological and Evaluation Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia
- Department of Mental Health and Dependence, ASST of Pavia
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia
- Department of Mental Health and Dependence, AUSL of Modena, Modena
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona
- Unit of Clinical Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
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Cohen CI. Social Networks and Residential Status in Community-Dwelling Older Adults With Schizophrenia: Compensation by Reconfiguration? Am J Geriatr Psychiatry 2022; 30:1159-1167. [PMID: 35654726 DOI: 10.1016/j.jagp.2022.04.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 04/25/2022] [Accepted: 04/26/2022] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To address the paucity of data on the structure and content of social networks of older adults with schizophrenia (OAS). METHODS The OAS group comprised 249 persons aged 55 and older with early-onset schizophrenia living in supportive housing (SS; n = 151), independently (SI; n = 70), or with family (SF; n = 28). The community comparison (CC) group comprised 113 individuals. Social network analysis was used. Multinomial logistic regression with p ≤0.001 and p ≤0.05 was used for overall and pairwise comparisons, respectively. RESULTS Each OAS subgroup had more total, nonkin, and formal linkages than the CC group. The SS and SI subgroups had fewer kin linkages than the CC group. The CC group had more confidants than the SS subgroup, more reliable linkages than the SS and SI subgroups, and more sustenance linkages than each of the OAS subgroups. Nearly everyone in the CC, SI, and SF subgroups had a confidant, a reliable contact, and a sustenance linkage; 33% of the SS subgroup had no confidants. The SS subgroup displayed more psychiatric symptoms than the SI and SF subgroups. There were no differences in loneliness or relationship satisfaction between the CC and the schizophrenia subgroups. CONCLUSION Networks were expressed differentially across residential arrangements and differences may reflect dissimilarities in psychiatric functioning. OAS generally had ample levels of companionship and emotional and instrumental support, often comparable to their age peers. Whereas social networks typically decline at illness onset and may be predominantly family-focused, later life may be a time of network reconfiguration and reconstitution.
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Affiliation(s)
- Carl I Cohen
- Division of Geriatric Psychiatry, SUNY Downstate Health Sciences University, Brooklyn, NY.
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Alikhajeh Y, Afroundeh R, Mohammad Rahimi GR, Mohammad Rahimi N, Niyazi A, Ghollasimood M. The effects of a 12-week aquatic training intervention on the quality of life of healthy elderly men: a randomized controlled trial. SPORT SCIENCES FOR HEALTH 2022. [DOI: 10.1007/s11332-022-00938-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Lien WC, Wang WM, Wang HMD, Lin FH, Yao FZ. Environmental Barriers and Functional Outcomes in Patients with Schizophrenia in Taiwan: The Capacity-Performance Discrepancy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:315. [PMID: 35010575 PMCID: PMC8751039 DOI: 10.3390/ijerph19010315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 12/24/2021] [Accepted: 12/26/2021] [Indexed: 06/14/2023]
Abstract
Environmental factors are crucial determinants of disability in schizophrenic patients. Using data from the 2014-2018 Certification of Disability and Care Needs dataset, we identified 3882 adult patients (46.78% females; age, 51.01 ± 13.9 years) with schizophrenia. We found that patients with severe schizophrenia had lower capacity and performance than those with moderate schizophrenia. The chances of having an access barrier to environmental chapter 1 (e1) products and technology in moderate schizophrenic patients and in severe schizophrenic patients were 29.5% and 37.8%, respectively. Logistic regression analyses demonstrated that the performance score was related to accessibility barriers in the categories described in e1, with adequate fitness of models in category e110 for personal consumption, e115 for personal usage in daily living activities, and e120 for personal outdoor and indoor mobility and transportation. Furthermore, the capacity-performance discrepancy was higher in moderate schizophrenic patients with accessibility barriers in the e110, e115, and e120 categories than that in moderate schizophrenic patients without accessibility barriers. However, severe schizophrenic patients with category e120 accessibility barriers were prone to a lower discrepancy, with institutional care a potentially decreasing factor. In conclusion, providing an e1 barrier-free environment is necessary for patients with schizophrenia to decrease their disability.
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Affiliation(s)
- Wei-Chih Lien
- Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan;
- Department of Physical Medicine and Rehabilitation, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan
- Ph.D. Program in Tissue Engineering and Regenerative Medicine, National Chung Hsing University, Taichung 402, Taiwan;
| | - Wei-Ming Wang
- Department of Statistics, College of Management, National Cheng Kung University, Tainan 701, Taiwan;
| | - Hui-Min David Wang
- Ph.D. Program in Tissue Engineering and Regenerative Medicine, National Chung Hsing University, Taichung 402, Taiwan;
- Graduate Institute of Biomedical Engineering, National Chung Hsing University, Taichung City 402, Taiwan
| | - Feng-Huei Lin
- Ph.D. Program in Tissue Engineering and Regenerative Medicine, National Chung Hsing University, Taichung 402, Taiwan;
- Institute of Biomedical Engineering, College of Medicine and Engineering, National Taiwan University, Taipei 100, Taiwan
- Institute of Biomedical Engineering and Nanomedicine, National Health Research Institutes, Zhunan, Miaoli 350, Taiwan
| | - Fen-Zhi Yao
- Department of Senior Citizen Services, National Tainan Junior College of Nursing, Tainan 700, Taiwan
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8
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Ang MS, Rekhi G, Lee J. Associations of living arrangements with symptoms and functioning in schizophrenia. BMC Psychiatry 2021; 21:497. [PMID: 34635064 PMCID: PMC8507381 DOI: 10.1186/s12888-021-03488-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 09/20/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Living arrangements and accommodation are closely related, but no study had concurrently investigated their associations with outcomes in schizophrenia. This study seeks to describe and compare socio-demographic, clinical and functioning profiles of people with schizophrenia in different living arrangements and accommodation, and to examine the associations of living arrangements and accommodation with symptomatic remission and functioning. METHODS Community dwelling outpatients with schizophrenia (n = 276) were inquired on living arrangements, accommodation, socio-demographics and assessed on the Positive and Negative Syndrome Scale (PANSS) and the Social and Occupational Functioning Scale (SOFAS). Socio-demographics, symptoms and functioning of outpatients in different living arrangements and accommodation were compared. Symptomatic remission was investigated using logistic regression with living arrangements, socio-demographics and clinical variables as independent variables. Functioning was investigated using multiple regression with the same set of independent variables and the addition of PANSS factors. The same analyses were conducted with accommodation as independent variable. RESULTS 185 (67.03%) participants lived with family and 195 (70.65%) participants lived in owned accommodation. People living with their spouses had significantly higher SOFAS, lower PANSS Total and PANSS Positive than people living with family, independently, or in rehabilitation centres. They also had lower PANSS Negative than people living with family and a higher likelihood to have achieved symptomatic remission. Types of accommodation was not associated with symptoms, symptomatic remission, and functioning. CONCLUSION Living arrangements, but not types of accommodation, were associated with symptoms and functioning in schizophrenia. Family education and support is important to help maintain a conducive environment for people with schizophrenia. People living independently may need more support.
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Affiliation(s)
- Mei San Ang
- Research Division, Institute of Mental Health, Singapore, Singapore.
| | - Gurpreet Rekhi
- grid.414752.10000 0004 0469 9592Research Division, Institute of Mental Health, Singapore, Singapore
| | - Jimmy Lee
- grid.414752.10000 0004 0469 9592Research Division, Institute of Mental Health, Singapore, Singapore ,grid.414752.10000 0004 0469 9592North Region & Department of Psychosis, Institute of Mental Health, Singapore, Singapore ,grid.59025.3b0000 0001 2224 0361Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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Abstract
PURPOSE OF REVIEW The aim of this review was to summarize the recent literature on the clinical symptoms, functioning, outcomes and treatments for older adults with chronic schizophrenia. RECENT FINDINGS The number and proportion of older adults with schizophrenia is rapidly increasing. Schizophrenia is a heterogeneous disorder and older adults with schizophrenia display significant variability in symptom severity, quality of life and overall outcomes. Many achieve stable disease remission, some display persistent nonremission and others experience fluctuating symptoms. Depression is commonly reported, and although rates of suicide are higher when compared with age-matched peers, the excess mortality seen in this population is mainly attributed to natural causes of death. Cognitive decline and reduced illness awareness have important implications for functional status and quality of life. Antipsychotics remain essential in the treatment regimen, although elderly patients with chronic disease may be good candidates for gradual dose reduction. Interdisciplinary treatment approaches as well as nonpharmacologic psychosocial interventions play a critical adjunctive role in the treatment of older adults with schizophrenia. SUMMARY Research focusing on schizophrenia in late life is sparse. Too often, older patients are eliminated from research studies or averaged in with all age groups. Thus, there continues to be gaps in our understanding of modifiable predictors of remission and recovery, and the most efficacious and safest treatment approaches for this age group.
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COVID-19-related psychological distress and engagement in preventative behaviors among individuals with severe mental illnesses. NPJ SCHIZOPHRENIA 2021; 7:7. [PMID: 33536446 PMCID: PMC7859192 DOI: 10.1038/s41537-021-00136-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 12/22/2020] [Indexed: 11/08/2022]
Abstract
Individuals with severe mental illnesses (SMIs) may be disproportionately vulnerable to COVID-19 infection and psychological distress. This study investigated the prevalence of engagement in COVID-19 preventative behaviors, predictors of these behaviors, and COVID-19-related psychological distress. One hundred and sixty-three individuals with SMIs (94 with schizophrenia spectrum illnesses and 69 with affective disorders) and 27 psychiatrically healthy comparison participants were recruited from ongoing studies across 3 sites, to complete a phone survey querying implementation of 8 specific COVID-19 preventative behaviors that participants engaged in at least once in the past month as well as standard assessments of depression, anxiety, perceived stress, loneliness, and coping. Data were collected between 3 April 2020 and 4 June 2020. The large majority of our SMI sample, which consisted of outpatients with relatively mild symptom severity, endorsed engaging in multiple preventative behaviors. Relatively few differences were found between groups; however, individuals with SMI were less likely to work remotely than healthy individuals and individuals with schizophrenia spectrum illness were less likely to stay home as a preventative measure, wear face masks, and work remotely than individuals with affective disorders. Differences in staying home remained after controlling for potential confounds. Although individuals with SMI reported more psychological distress related to COVID-19, this distress was largely unrelated to engagement in preventative behaviors. The large majority of individuals with SMI in this outpatient sample, regardless of broad diagnostic category, reported performing multiple behaviors intended to prevent COVID-19 infection at least once a month and reported distress associated with the pandemic. These findings suggest a good level of awareness of COVID-19 among stable outpatients with SMI. The degree to which more acutely ill persons with SMI engage in such preventative behaviors, however, remains to be examined.
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Nahand MS, Najafababdi MG, Naghdi N, Sheikh M, Shaw BS. Effect of combined aquatic and cognitive training on quality of life, fall self-efficacy, and motor performance in aged with varying cognitive status: a proof-of-concept study. J Exerc Rehabil 2020; 16:148-153. [PMID: 32509699 PMCID: PMC7248439 DOI: 10.12965/jer.2040076.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 03/22/2020] [Indexed: 11/24/2022] Open
Abstract
With the increasing number of aged individuals, research pertaining to their cognitive functions and physical-motor has become exponentially imperative. The purpose of the study was to investigate the effect com-bined aquatic and cognitive training on quality of life (QoL), fall self-effi-cacy and motor performance (static and dynamic balance) in aged with varying cognitive status levels. Thirty participants were assigned to a high cognitive status group (n=10), low cognitive status group (n=10), or nonintervention control group (n=10). Participants completed a 6-week motor-cognitive training regime with increasing intensity. QoL, fall self-efficacy, static balance, and dynamic balance were assessed. Preliminary results suggest proof-of-concept significant (P<0.05) im-provements were found in both the high and low cognitive status groups for static and dynamic balance and fall self-efficacy. However, QoL was only found to be significantly improved in the low cognitive status group. Aqua training along with cognitive training can effectively be used to prevent falls in the elderly and to improve their physical-motor perfor-mance. However, when attempting to improve QoL, the cognitive status of the individual should be considered.
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Affiliation(s)
| | | | - Nasser Naghdi
- Department of Physiology and Pharmacology, Pasteur Institute of Iran, Tehran, Iran
| | - Mahmoud Sheikh
- Department of Motor Behavior, Faculty of Physical Education and Sport Science, University of Tehran, Tehran, Iran
| | - Brandon S Shaw
- Department of Human Movement Science, University of Zululand, KwaDlangezwa, South Africa
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