Physical performance and quality of life of nursing-home residents with mild and moderate dementia

Disaster response self-efficacy of nursing students: Perceived level and associated factors

OBJECTIVES

The study aimed to assess the level of disaster response self-efficacy (DRSE) among nursing students in Bangladesh and examine the factors influencing their level of DRSE.

METHODS

A cross-sectional study design was used for this research. A self-administered descriptive structured questionnaire was used to collect survey data from 573 students of nursing colleges in four districts: Chattogram, Dhaka, Khulna, and Rajshahi. The Bengali version of the DRSE Scale was adopted and used to measure the outcome variable.

RESULTS

The nursing students exhibited a moderate level of disaster response self-efficacy (Mean = 3.63; SD = 0.73), as well as moderate levels of knowledge (Mean = 3.87; SD = 0.71), skills (Mean = 4.24; SD = 0.91), and preparedness (Mean = 4.31; SD = 0.76) in disaster management. Significant positive correlations were found between respondents' disaster knowledge (r = 0.447, p < 0.01), skills (r = 0.516, p < 0.01), and preparedness (r = 0.701, p < 0.01) with disaster response self-efficacy. Gender, age, having children in the household, post-basic BSc in nursing students, and disaster knowledge were significantly associated with nursing students' DRSE. Female respondents had a 0.27-unit lower DRSE (β = -0.270 (95 % CI: -0.389, -0.115), p < 0.001) than male respondents. Besides, the respondents per unit increase in disaster knowledge occurred a 0.438-unit increase in DRSE (β = 0.438 (95 % CI: 0.367, 0.510), p < 0.001). However, no statistically significant associations were found between the respondents' disaster experience and disaster-related training with their DRSE scores.

CONCLUSION

Improving disaster management knowledge by including disaster management-related courses and organizing more training, drills, seminars, and workshops may improve their DRSE.

Vision-based motion capture for the gait analysis of neurodegenerative diseases: A review

BACKGROUND

Developments in vision-based systems and human pose estimation algorithms have the potential to detect, monitor and intervene early on neurodegenerative diseases through gait analysis. However, the gap between the technology available and actual clinical practice is evident as most clinicians still rely on subjective observational gait analysis or objective marker-based analysis that is time-consuming.

RESEARCH QUESTION

This paper aims to examine the main developments of vision-based motion capture and how such advances may be integrated into clinical practice.

METHODS

The literature review was conducted in six online databases using Boolean search terms. A commercial system search was also included. A predetermined methodological criterion was then used to assess the quality of the selected articles.

RESULTS

A total of seventeen studies were evaluated, with thirteen studies focusing on gait classification systems and four studies on gait measurement systems. Of the gait classification systems, nine studies utilized artificial intelligence-assisted techniques, while four studies employed statistical techniques. The results revealed high correlations of gait features identified by classifier models with existing clinical rating scales. These systems demonstrated generally high classification accuracies and were effective in diagnosing disease severity levels. Gait measurement systems that extract spatiotemporal and kinematic joint information from video data generally found accurate measurements of gait parameters with low mean absolute errors, high intra- and inter-rater reliability.

SIGNIFICANCE

Low cost, portable vision-based systems can provide proof of concept for the quantification of gait, expansion of gait assessment tools, remote gait analysis of neurodegenerative diseases and a point of care system for orthotic evaluation. However, certain challenges, including small sample sizes, occlusion risks, and selection bias in training models, need to be addressed. Nevertheless, these systems can serve as complementary tools, equipping clinicians with essential gait information to objectively assess disease severity and tailor personalized treatment for enhanced patient care.

Occupational Therapy Interventions to Improve the Quality of Life of Older Adults with Dementia Living in Nursing Homes: A Systematic Review

The increase in older adults with dementia presents challenges in promoting research to improve the quality of life of this population. The objective of this study was to assess the scientific evidence on the effectiveness of occupational therapy interventions in improving the quality of life of older adults over 65 years old with dementia living in nursing homes. The databases used were PubMed, Web of Science, OTSeeker, clinicaltrials.gov, Dialnet, Scopus, Cochrane, and SciELO between 2013 and 2023. The studies were selected and evaluated according to the Cochrane guidelines. The review was carried out following the PRISMA 2020 Statement. Sixteen articles met the inclusion criteria and were categorized into four groups according to the focus of the intervention: "meaningful activities/occupations", "physical, cognitive and sensory functioning", "performance areas", and "physical and social environment and staff training". The strength of evidence was moderate, and the risk of bias was low. The findings revealed that occupational therapy interventions based on participation in recreational activities, reminiscence, performance-based activities and the physical and social environment, and specialized staff training, could improve the perceived quality of life of older adults with dementia living in nursing homes.

Pain in nursing home residents with dementia and its association to quality of life

OBJECTIVES

We aimed to describe pain, use of analgesics and quality of life (QoL) in people with dementia admitted to a Norwegian nursing home (NH), and to explore if and how pain was associated with their QoL when adjusting for sociodemographic characteristics, other health conditions and use of analgesics.

METHOD

A total of 953 Norwegian NH residents with dementia (mean age 84.0, SD 7.5 years, 35.8% men) were included at admission to the NH. Pain and QoL were assessed using the Mobilization-Observation-Behavior-Intensity-Dementia-2 (MOBID-2) Pain Scale and the Quality of Life in Late-Stage Dementia (QUALID) scale, respectively. Severity of dementia, personal level of activities of daily living, general medical health, neuropsychiatric symptoms, and the use of psychotropic drugs and analgesics were assessed.

RESULTS

In total, 36% of the participants had clinically relevant pain intensity (MOBID-2 ≥ 3) and 52% received analgesics. Paracetamol was most frequently prescribed (45%). In an adjusted linear mixed model, more severe pain was associated with higher QUALID total scores, indicating poorer QoL (regression coefficient 0.52, 95% CI 0.36-0.69).

CONCLUSION

Pain prevalence at NH admission was high in residents with dementia; half used analgesics, particularly paracetamol. More severe pain was associated with poorer QoL when adjusting for sociodemographic characteristics, other health conditions, and use of analgesics. The routine assessment of pain at NH admission can uncover undiagnosed and untreated pain and allow for adequate non-pharmacological and pharmacological pain management and likely increased QoL.

Quality of Life of Older Persons: The Role and Challenges of Social Services Providers

Considering the growing number of older persons, ensuring the quality of life of them, as well as the social services designed for this population category, has become more and more important. Especially in the case of dependent older persons, social services are essential components, as they contribute to a better quality of life. The aim of this paper was to examine the perspectives of social services providers for older persons with respect to their role and the challenges encountered in ensuring the quality of life of older beneficiaries. In order to answer our objectives, we employed a qualitative methodology, using the focus group method to collect information from social services providers (both residential and home care). Multiple factors are related to a good quality of life in old age: some are related to individual characteristics, while others are related to the provision of services. The provision of quality social services that adequately respond to the needs of beneficiaries contributes to increasing the degree of independence and maintaining the physical and mental health of dependent older persons.

Physical and Motor Fitness Tests for Older Adults Living in Nursing Homes: A Systematic Review

This systematic review aimed to identify the physical/motor fitness tests for nursing home residents and to examine their psychometric properties. Electronic databases were searched for articles published between January 2005 and October 2021 using MeSh terms and relevant keywords. Of the total of 4196 studies identified, 3914 were excluded based on title, abstracts, or because they were duplicates. The remaining 282 studies were full-text analyzed, and 41 were excluded, resulting in 241 studies included in the review. The most common physical component assessed was muscle strength; 174 (72.2%) studies assessed this component. Balance (138 studies, 57.3%) and agility (102 studies, 42.3%) were the second and third components, respectively, most widely assessed. In this review, we also describe the most used assessment tests for each physical/motor component. Some potentially relevant components such as manual dexterity and proprioception have been little considered. There are few studies assessing the psychometric properties of the tests for nursing home residents, although the data show that, in general, they are reliable. This review provides valuable information to researchers and health-care professionals regarding the physical/motor tests used in nursing home residences, helping them select the screening tools that could most closely fit their study objectives.

Quality of Life Assessment in Older Adults with Dementia: A Systematic Review

INTRODUCTION

In the absence of a cure, dementia is often managed by minimizing risk factors contributing to quality of life (QOL). Attitudes to dementia in older adults may differ from those in relatively younger adults. The aim was to conduct a systematic review of the literature to determine how QOL was assessed in adults, 65 years and older with dementia, and identify factors that influence the reported scores.

METHODS

A systematic review of full-text articles addressing QOL in older adults with dementia, published in English from January 1995 to September 2020, was conducted using PubMed and PsycINFO. We included studies that assessed QOL and involved participants 65 years and older. Studies were evaluated for inclusion by 2 independent pairs of reviewers. We assessed the quality of the studies using the Joanna Briggs Institute's Critical Appraisal Checklist. Study characteristics and findings were summarized. Analysis was by narrative synthesis. We identified social and clinical factors influencing QOL scores.

RESULTS

Of the 1,010 articles identified, 19 met the inclusion criteria. These 19 studies involved 6,279 persons with dementia, with sample sizes from 32 to 1,366. Mean age of participants ranged from 77.1 to 86.6 years. Five measurement tools were identified; Quality of Life in Alzheimer Disease (QOL-AD), Alzheimer Disease-Related Quality of Life (ADRQL), Quality of Life in Late-Stage Dementia (QUALID), QUALIDEM (a dementia-specific QOL tool), and DEMQOL (health-related QOL for people with dementia). Self-ratings of QOL were higher than proxy ratings. Factors commonly influencing self-ratings of QOL included depression, functional impairment, and polypharmacy. Common factors that influenced proxy ratings included functional impairment, presence of neuropsychiatric symptoms, cognitive impairment, and caregiver burden.

CONCLUSION

In evaluating QOL in dementia, self- and proxy reports may complement each other to ensure that all perspectives are addressed.

Effects of a 16-week multimodal exercise program on activities of daily living in institutionalized individuals with dementia

We aimed to examine the effects of a 16-week multimodal exercise program (MEP) on activities of daily living (ADL) in individuals with dementia (IWD). Furthermore, we investigated the participants’ individual response to the MEP and whether baseline cognitive and motor performance explain ADL performance. We conducted a multicenter randomized controlled trial (RCT) involving 319 participants aged ≥ 65 years with mild to moderate dementia. ADL were assessed at baseline and after the 16-week intervention using the Barthel Index (BI), the Erlangen Test of Activities of Daily Living (E-ADL) and the 7‑item Physical Performance Test (PPT-7). We additionally assessed cognitive and motor performance using standardized and validated assessments. Intervention effects were examined through two-factor analysis of variance with repeated measurements applying a per protocol and an intention-to-treat analysis. We compared baseline cognitive and motor performance between positive-responders (positive-R), non-responders (non-R), and negative-responders (negative-R) and examined cognitive and motor performance as potential cofounders of ADL by conducting multiple regression analyses. There were no significant time×group effects on ADL. Between 20 and 32% of participants responded positively to the intervention, i.e., improved ADL performance from baseline to follow-up. Positive-R had worse baseline motor performance compared to non-R. Cognitive and motor performance explained up to 51.4% of variance in ADL. The MEP had no significant overall effect on ADL in IWD. This may be related to insufficient exercise intensity. However, our results indicate that the response to the MEP depends on individual prerequisites which should thus be considered in further research on individual exercise approaches.

Quality of life of older adults in two contrasting neighbourhoods in Accra, Ghana

As is the case elsewhere in sub-Saharan Africa, Ghana is experiencing a rapid increase in the population of older adults. Despite their rising numbers, the living conditions and wellbeing of older Ghanaians remain woefully understudied. This paper presents the results of a study exploring the quality of life (QoL) of older adults in two contrasting neighbourhoods in Accra, Ghana. The objectives of the study were to: (1) explore and compare the QoL of older slum and non-slum dwellers in Ghana; and (2) determine the extent of QoL disparities between slum and non-slum older adults. To accomplish these objectives, we undertook a cross-sectional survey of older adults (N = 603) residing in a slum and non-slum neighbourhood. QoL was self-assessed in four domains - physical, psychological, social, and environment - using the World Health Organization (WHO) QoL assessment tool (WHOQoL-BREF). Multivariable linear regression analyses of the data revealed no statistically significant difference between the slum and non-slum respondents in physical (coeff: 0.5; 95% CI: -1.7, 2.8; p = 0.642) and psychological (coeff: -0.2; 95% CI: -3.0, 2.6; p = 0.893) QoL. However, the slum respondents reported significantly higher social QoL than the non-slum respondents (coeff: -3.2; 95% CI: -5.6, -0.8; p = 0.010), while the reverse was true in environmental QoL (coeff: 4.2; 95% CI: 2.3, 6.2; p < 0.001). The existence of strong social support systems in the slum and better housing and neighbourhood environmental conditions in the non-slum may have accounted for the observed variation in social and environmental QoL. Thus, contrary to popular discourses that vilify slums as health-damaging milieus, these findings offer a more nuanced picture, and suggest that some features of slums may constitute important health resources for older adults.

Skilled nursing resident adherence with wearable technology to offer safer mobility and decreased fall injuries

Hip fractures are a debilitating event for thousands of older adults each year in our communities and in our care facilities. The outcomes of sustaining a hip fracture include disability, significant cost and increased mortality in a growing population of those at risk of falls and fracture. Traditional methods of injury prevention from falls for those at risk of hip fracture include the wearing of hip protector clothing with limited adherence. A smart wearable designed to overcome barriers to adherence and offer hip protection with fall-sensing technology is emerging in older adult resident facilities to capture the fall as it occurs and avoid injury. This hip protection device has been evaluated in older adult residential settings to decrease fall injuries and support a culture of mobility. Adherence to the wear of the motion sensing technology can be accomplished by embedding the program into the daily care for residents identified as at risk of hip fracture. Successful adherence and shared results are illustrated with specific insight articulated in a single user case study.

Health-Related Quality of Life in Community-Dwelling Older People with Cognitive Impairment: EQ-5D-3L Measurement Properties

BACKGROUND

Assessing quality of life (QoL) in older people with cognitive impairment is a challenge. There is no consensus on the best tool, but a short, user-friendly scale is advised.

OBJECTIVE

This study aimed to assess the psychometric properties of the self-reported and generic EQ-5D (including the EQ index and EQ visual analog scale [VAS]) in community-dwelling older adults with cognitive impairment.

METHODS

Cross-sectional study analyzing the feasibility, acceptability, reliability, and validity of the EQ-5D based on 188 self-administered questionnaires in a sample of community-dwelling older adults with Mini-Mental State Examination (MMSE) scores of 10 to 24 points.

RESULTS

The EQ index was 0.69 (±0.27) and the EQ VAS was 63.8 (±28.54). Adequate measurement properties were found in acceptability and feasibility. Cronbach's alpha was 0.69. Good validity was observed in the correlation of each dimension of the EQ-5D with geriatric assessment scales. Higher validity was observed for the EQ index compared to the EQ VAS.

CONCLUSION

The EQ-5D scale could be a good tool for assessing health-related QoL in community-dwelling older adults with cognitive impairment, though it is necessary to assess the dimensions and the EQ index.

Mobility and cognition at admission to the nursing home - a cross-sectional study

Background

Earlier studies show that the main reasons for admission to long-term nursing home care are cognitive impairment and functional impairments of activities of daily life. However, descriptive evidence of mobility is scant. The aims of this study were to describe mobility at admission to nursing homes and to assess the association between mobility and degree of dementia.

Methods

We included 696 residents at admission to 47 nursing homes in Norway. Inclusion criteria were expected stay for more than 4 weeks and 65 years or older. In addition, younger residents with dementia were included. Residents with life expectancy shorter than six weeks were excluded. Mobility was assessed using the Short Physical Performance Battery (SPPB) and the Nursing Home Life Space Diameter (NHLSD). The Clinical Dementia Rating Scale (CDR) was used to describe the degree of dementia. The associations between mobility and degree of dementia was analysed using the Chi-square and the Kruskal-Wallis test (KW-test). When the KW-test indicated a statistical significant difference, we proceeded with planned group comparisons with the Mann-Whitney U-test. In addition, we performed multiple linear regression analyses to control for potential confounders.

Results

Forty-three percent of the residents were not able to perform the balance test in SPPB. Twenty-four percent of the residents were not able to walk four meters, while only 17.6% had a walking speed of 0.83 m/s or higher. Sixty-two percent of the residents were not able to rise from a chair or spent more than 60 s doing it. The median score on NHLSD area was 22 (IQR 17) and the median score on NHLSD dependency was 36 (IQR 26). Residents with severe dementia had significantly lower levels of mobility than residents with moderate dementia. Cognitive function was associated with SPPB and NHLSD dependency in the adjusted models.

Conclusion

Nursing home residents form a frail, but heterogeneous group both in terms of cognition and mobility at admission. Mobility was negatively associated with cognitive function, and residents with severe dementia had significantly lower levels of mobility than residents with moderate dementia.

Associations between physical function and depression in nursing home residents with mild and moderate dementia: a cross-sectional study

OBJECTIVES

The primary aim of this study is to describe depression and physical function in nursing home residents with dementia, as well as to examine the associations between depression and balance function, lower limb muscle strength, mobility and activities of daily living. The secondary aim is to examine the differences in physical function between the groups classified as depressed and not depressed.

DESIGN

The study has a cross-sectional design.

SETTING

A convenience sample of 18 nursing homes in, and around, Oslo, Norway, participated.

PARTICIPANTS

We included 170 nursing home residents aged 60-100 years with mild or moderate degree of dementia defined by a score of 1 or 2 on the Clinical Dementia Rating Scale (CDR).

OUTCOME MEASURES

Assessments used were Cornell Scale for Depression in Dementia (CSDD), Berg Balance Scale (BBS), 'the 6-metre walking test' (walking speed), 30 s Chair Stand Test (CST) and the Barthel Index (BI).

RESULTS

Nursing home residents with dementia are a heterogeneous group in terms of physical function and depression. By applying the recommended cut-off of ≥8 on CSDD, 23.5% of the participants were classified as being depressed. The results revealed significant associations between higher scores on CSDD (indicating more symptoms of depression) and lower scores on BBS (95% CI -0.12 to -0.02, p=0.006), 30 s CST (95% CI -0.54 to -0.07, p=0.001) as well as maximum walking speed (95% CI -4.56 to -0.20, p=0.003) (indicating lower level of physical function).

CONCLUSION

Better muscle strength, balance and higher walking speed were significantly associated with less depressive symptoms. The potential interaction of dementia with poor physical function and depression indicates an area to explore in future epidemiological studies with a prospective design.

TRIAL REGISTRATION NUMBER

NCT02262104.

An Ecological Framework to Support Small-Scale Shared Housing for Persons with Neurocognitive Disorders of the Alzheimer's and Related Types: A Literature Review

BACKGROUND

Small scale shared housing arrangements (SHAs) is a deinstitutionalized model of care designed to resemble a typical home of <10 people and are increasingly available for persons with neurocognitive disorders of the Alzheimer's and related types (NCD). However, there is little aggregate evidence of their effect on persons with NCD thus, a literature review was performed.

METHODS

Database searches were conducted across CINAHL Complete, OTseeker, PubMed, Ovid, Academic One File, ProQuest Nursing and Allied Health, the World Wide Web and Google Scholar using the several key words that included neurocognitive disorders, Alzheimer's, dementia, quality of life, well-being, occupational performance, activities of daily living, small scale shared housing, sheltered housing and group homes. Bibliographic references from final articles were also examined. Selection criteria involved three steps: screening perspective articles by title and abstract, assessing full text for eligibility and finally, reviewing full-texts.

RESULTS

16 studies were selected for final review where most found the association of SHAs with various occupational performance indicators unique to the NCD population better than or equal to controls (traditional models of long term care). A small minority of studies had mixed or inconclusive results. No study found SHAs necessarily worse than controls.

CONCLUSION

The SHA model has many benefits for person's with NCD and may be especially advantageous for those in the early stages of the disease process. The occupational therapy profession should continue to raise awareness of SHAs and consider ecological theory as a valid basis for their expansion.

Effectiveness of a 16-Week Multimodal Exercise Program on Individuals With Dementia: Study Protocol for a Multicenter Randomized Controlled Trial

BACKGROUND

The increasing prevalence of dementia in the next decades is accompanied by various societal and economic problems. Previous studies have suggested that physical activity positively affects motor and cognitive skills in individuals with dementia (IWD). However, there is insufficient evidence probably related to several methodological limitations. Moreover, to date adequate physical activity interventions specifically developed for IWD are lacking.

OBJECTIVE

This study aims to investigate the effectiveness of a multimodal exercise program (MEP) on motor and cognitive skills in IWD in a high-quality multicenter trial.

METHODS

A multicenter randomized controlled trial with baseline and postassessments will be performed. It is planned to enroll 405 participants with dementia of mild to moderate stage, aged 65 years and older. The intervention group will participate in a 16-week ritualized MEP especially developed for IWD. The effectiveness of the MEP on the primary outcomes balance, mobility, and gait will be examined using a comprehensive test battery. Secondary outcomes are strength and function of lower limbs, activities of daily living, and cognition (overall cognition, language, processing speed, learning and memory, and visual spatial cognition).

RESULTS

Enrollment for the study started in May 2015. It is planned to complete postassessments by the beginning of 2017. Results are expected to be available in the first half of 2017.

CONCLUSIONS

This study will contribute to enhancing evidence for the effects of physical activity on motor and cognitive skills in IWD. Compared to previous studies, this study is characterized by a dementia-specific intervention based on scientific knowledge, a combination of motor and cognitive tasks in the intervention, and high standards regarding methodology. Findings are highly relevant to influence the multiple motor and cognitive impairments of IWD who are often participating in limited physical activity.

TRIAL REGISTRATION

German Clinical Trials Register DRKS00010538; https://drks-neu.uniklinik-freiburg.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00010538 (Archived by WebCite at http://www.webcitation.org/6oVGMbbMD).

Effect of animal-assisted interventions on depression, agitation and quality of life in nursing home residents suffering from cognitive impairment or dementia: a cluster randomized controlled trial

OBJECTIVES

The prevalence of neuropsychiatric symptoms in cognitively impaired nursing home residents is known to be very high, with depression and agitation being the most common symptoms. The possible effects of a 12-week intervention with animal-assisted activities (AAA) in nursing homes were studied. The primary outcomes related to depression, agitation and quality of life (QoL).

METHOD

A prospective, cluster randomized multicentre trial with a follow-up measurement 3 months after end of intervention was used. Inclusion criteria were men and women aged 65 years or older, with a diagnosis of dementia or having a cognitive deficit. Ten nursing homes were randomized to either AAA with a dog or a control group with treatment as usual. In total, 58 participants were recruited: 28 in the intervention group and 30 in the control group. The intervention consisted of a 30-min session with AAA twice weekly for 12 weeks in groups of three to six participants, led by a qualified dog handler. Norwegian versions of the Cornell Scale for Depression, the Brief Agitation Rating Scale and the Quality of Life in Late-stage Dementia scale were used.

RESULTS

A significant effect on depression and QoL was found for participants with severe dementia at follow-up. For QoL, a significant effect of AAA was also found immediately after the intervention. No effects on agitation were found.

CONCLUSIONS

Animal-assisted activities may have a positive effect on symptoms of depression and QoL in older people with dementia, especially those in a late stage. Copyright © 2016 John Wiley & Sons, Ltd.

Differences in quality of life in home-dwelling persons and nursing home residents with dementia - a cross-sectional study

BACKGROUND

Dementia often eventually leads to dependency on others and finally to residential care. However, in Norway about half of the dementia population lives at home, due to individual and political wishes. There is scarce and inconclusive knowledge of how living in a nursing home differs from living at home for persons with dementia (PWDs) with regard to their quality of life (QoL). The first aim of the study was therefore to compare QoL, cognitive and physical functions, social contacts, sleep patterns, physical activity levels, exposure to light, and medication of PWDs in nursing homes and home-dwelling PWDs, and whether living in nursing homes was associated with a lower QoL than living at home for PWDs. A second aim was to examine if possible differences between residencies in QoL were consistent over time.

METHODS

The cross-sectional study was based on baseline data from two RCT studies of PWDs. A total of 15 nursing homes with adapted units for PWDs and 23 adapted day care centres for home-dwelling PWDs recruited 78 and 115 participants respectively. Trained nurses scored sociodemographic data, level of dementia (on the Clinical Dementia Rating scale), amount of medication, and QoL (QUALID). Sleep patterns, physical activity levels, and light exposure were measured by actigraphy. A multiple regression analysis was used to test the association between residency and QoL. The association between residency and change in QoL over time was investigated by linear regression analysis of a subsample with follow-up data.

RESULTS

Home-dwelling PWDs showed significantly higher QoL than PWDs in nursing homes. This difference was maintained even after stratifying on the severity of dementia. Home-dwelling PWDs with moderate dementia showed significantly less use of walking aids, more social contact, higher levels of activity and exposure to daylight, and less use of psychotropic medications. The regression model explained 28 % of the variance in QoL in persons with moderate dementia. However, only residency contributed significantly in the model. Residency also significantly predicted negative change over time in QoL.

CONCLUSION

The study indicated that living at home as long as possible is not only desirable for economic or health political reasons but also is associated with higher QoL for persons with moderate dementia. More studies are needed to investigate how QoL could be increased for PWDs in nursing homes.

Capturing Interactive Occupation and Social Engagement in a Residential Dementia and Mental Health Setting Using Quantitative and Narrative Data

Objectives: Despite an abundance of research acknowledging the value of interactive occupation and social engagement for older people, and the limits to these imposed by many residential settings, there is a lack of research which measures and analyzes these concepts. This research provides a method for measuring, analysing and monitoring interactive occupation and social engagement levels of residents in a secure residential setting for older people with mental health problems and dementia. It proposes suggestions for changes to improve the well-being of residents in residential settings. Method: In this case study design, the Assessment Tool for Occupational and Social Engagement (ATOSE) provided a ‘whole room’ time sampling technique to observe resident and staff interactive occupation and social engagement within the communal sitting room over a five-week period. Researchers made contemporaneous notes to supplement the ATOSE data and to contextualise the observations. Results: Residents in the sitting room were passive, sedentary, and unengaged for 82.73% of their time. Staff, who were busy and active 98.84% of their time in the sitting room, spent 43.39% of this time in activities which did not directly engage the residents. The physical, social and occupational environments did not support interactive occupation or social engagement. Conclusions: The ATOSE assessment tool, in combination with narrative data, provides a clear measurement and analysis of interactive occupation and social engagement in this and other residential settings. Suggestions for change include a focus on the physical, social, occupational, and sensory environments and the culture of care throughout the organization.

Use of the sit-to-stand task to evaluate motor function of older adults using telemetry

Background

Physical exercises are widely used in community programs, but not all older adults are willing to participate. Information and communication technology may solve this problem by allowing older people to participate in fitness programs at home. Use of remote instruction will facilitate physical exercise classes without requiring that participants gather at one place. The aim of this study was to examine use of a sit-to-stand task in evaluating motor function using conventional video communication in a telemetry system to enable real-time monitoring, and evaluation in physical performance of older adults at home.

Methods

The participants were 59 older individuals and 81 university students. Three physical exercise batteries were used: arm curl, figure-of-eight walk test, and functional reach. The knee extension maximum angular velocity (KEMAV) and the iliac elevation maximum velocity (IEMV) during standing up from a chair and the heel rise frequency were used in the motion-capture measurements. The results were assessed using multi-group structural equation modeling (SEM) for the young and older groups.

Results

Young participants consistently performed better than their older counterparts on all items. Analyses with multi-group SEM based on correlations between items yielded a good model-fit for the data. Among all path diagrams for IEMV and KEMAV in the older and young groups, paths from muscular strength to skillfulness showed significant effects. The path from the IEMV to muscular strength was also significant in the older group.

Conclusions

Multi-group SEM suggested that video-based measurements of IEMV during sit-to-stand motion can estimate muscular strength, which suggests that remote monitoring of physical performance can support wellness of community-dwelling older adults.

Increased self-efficacy: the experience of high-intensity exercise of nursing home residents with dementia - a qualitative study

Background

There has been increasing interest in the use of non-pharmacological interventions, such as physical exercise, to improve the well-being of nursing home residents with dementia. For reasons regarding disease symptoms, persons with dementia might find it difficult to participate in exercise programs. Therefore, it is important to find ways to successfully promote regular exercise for patients in residential care. Several quantitative studies have established the positive effects of exercise on biopsychosocial factors, such as self-efficacy in older people; however, little is known regarding the qualitative aspects of participating in an exercise program among older people with dementia. From the perspective of residents, we explored the experiences of participating in a high-intensity functional exercise program among nursing home residents with dementia.

Methods

The participants were eight elderly people with mild-to-moderate dementia. We conducted semi-structured interviews one week after they had finished a 10-week supervised high-intensity exercise program. We analyzed the data using an inductive content analysis.

Results

Five overreaching and interrelated themes emerged from the interviews: “Pushing the limits,” “Being invested in,” “Relationships facilitate exercise participation,” “Exercise revives the body, increases independence and improves self-esteem” and “Physical activity is a basic human necessity—use it or lose it!” The results were interpreted in light of Bandura’s self-efficacy theory. The exercise program seemed to improve self-efficacy through several mechanisms. By being involved, “being invested in” and having something expected of them, the participants gained a sense of empowerment in their everyday lives. The importance of social influences related to the exercise instructor and the exercise group was accentuated by the participants.

Conclusions

The nursing home residents had, for the most part, positive experiences with regard to participating in the exercise program. The program seemed to increase their self-efficacy through several mechanisms. The instructor competence emerged as an important facilitating factor. The participants emphasized the importance of physical activity in the nursing home.

Health and Quality of Life Perception in Older Adults: The Joint Role of Cognitive Efficiency and Functional Mobility

Cognitive and mobility functions are involved in health-related quality of life (HRQoL). The present cross-sectional study aimed at investigating what facets of efficient cognition and functional mobility interactively contribute to mental and physical HRQoL. Fifty-six healthy older individuals (aged 65–75 years) were evaluated for mental and physical HRQoL, core cognitive executive functions (inhibition, working memory, and cognitive flexibility), and functional mobility (walking) under single and dual task conditions. Multiple regression analyses were run to verify which core executive functions predicted mental and physical HRQoL and whether the ability to perform complex (dual) walking tasks moderated such association. Inhibitory efficiency and the ability to perform physical-mental dual tasks interactively predicted mental HRQoL, whereas cognitive flexibility and the ability to perform physical dual tasks interactively predicted physical HRQoL. Different core executive functions seem relevant for mental and physical HRQoL. Executive function efficiency seems to translate into HRQoL perception when coupled with tangible experience of the ability to walk under dual task conditions that mirror everyday life demands. Implications of these results for supporting the perception of mental and physical quality of life at advanced age are discussed, suggesting the usefulness of multicomponent interventions and environments conducive to walking that jointly aid successful cognitive aging and functional mobility.

Effects of experience-based group therapy on cognitive and physical functions and psychological symptoms of elderly people with mild dementia

[Purpose] The purpose of this study was to investigate the effect of experience-based group therapy consisting of cooking and physical activities for elderly people with mild dementia on their cognitive and physical function, as well as on their psychological symptoms. [Subjects] The subjects of this study were 12 older adults with mild dementia (3 males, 9 females; 76.75 ± 3.61 years) who voluntarily consented to participate in the study. [Methods] In total, 12 subjects received experience-based group therapy for 2 hours per session once per week, totaling 10 sessions. Cognitive function was evaluated using the Mini Mental State Examination-Korean (MMSE-K), and physical function was evaluated using the Geriatric Physical health condition measurement Tool (GPT). The Geriatric Depression Scale Korean Version (GDS-K) and Geriatric Quality of Life-Dementia (GQOL-D) were used to measure psychological symptoms. [Results] There were significant differences between the MMSE-K, GPT, GDS-K, and GQOL-D scores of before and after group therapy. [Conclusion] In conclusion, it is regarded that cognitive function, physical function, and psychological health improved through experience-based group therapy.

Stability of daily home-based measures of postural control over an 8-week period in highly functioning older adults

PURPOSE

The focus of this study was to monitor daily objective measures of standing postural control over an 8-week period, recorded in a person's home, in a population of healthy older adults. Establishing natural patterns of variation in the day-to-day signal, occurring in the relative absence of functional decline or disease, would enable us to determine thresholds for changes in postural control from baseline that could be considered clinically important.

METHODS

Eighteen community-dwelling older adults (3 M, 15 F, 72 ± 6 years) participated in a home-based trial where each day they were asked to complete a technology-enabled routine consisting of a short questionnaire, as well as a quiet standing balance trial. Centre of pressure (COP) excursions were calculated over the course of each daily balance trial to generate variables such as postural sway length and mean sway frequency.

RESULTS

The data demonstrated large differences between subjects in centre of pressure measures (coefficients of variation ranging 37-107 %, depending on the variable). Each participant also exhibited variations in their day-to-day trials (e.g. coefficients of variation across 8 weeks ranging ~17-56 %, within person for mean COP distance). Inter- and intra-subject differences were not strongly related to functional tests, suggesting that these variations were not necessarily aberrant movement patterns, but are seemingly representative of natural movement variability.

CONCLUSIONS

The idea of applying a group-focused approach at an individual level may result in misclassifying important changes for a particular individual. Early detection of deterioration can only be achieved through the creation of individual trajectories for each person, that are inherently self referential.