Implementation of a Community Walking Program (Walk On!) for Functionally-Limited Older Adults

BACKGROUND

Walking interventions improve physical function, reduce fall risk, and prevent mobility disability-even in those with compromised walking ability. However, most prior studies have been conducted in controlled research settings, with no dissemination of an evidence-based walking program for older adults who have mobility limitations and/or are socially isolated.

OBJECTIVES

This study reports data on the feasibility and acceptability of a community-based walking program (Walk On!) for older adults who are functionally limited, and assesses changes in physical function among attendees. The program sessions focused on long-distance walking, and took place for one-hour, for two days/week, and for 12 weeks at a time.

DESIGN

Pilot implementation study.

SETTING

Local church in Winston-Salem, NC.

PARTICIPANTS

49 program participants; Measurements: Physical function battery and satisfaction survey data, as well as formative evaluation data from six attendees of a focus group, are reported.

RESULTS

The majority of the participants were >75 years (71%), female (65%), and presented with low levels of physical function (usual gait speed=0.79±0.16; 30.6% used an assistive device). Satisfaction with the program was high (100% would recommend it to others) and focus group results were overwhelmingly positive. Mean attendance to scheduled sessions was 77%±21%, and 63% of participants attended at least 75% of scheduled sessions (n=8 attended 100%). On average, participants improved their 6-min walk distance by 8.9%, their SPPB score by 15.4%, their timed-up-go time by 9.0%, and their usual gait speed by 11.4%.

CONCLUSION

The results of the initial evaluation of Walk On! show high feasibility and acceptability of the program, as well as efficacy for improving physical function. Further research is needed to evaluate a delivery method for wider implementation of the program and to definitively test its effectiveness for improving function and other health benefits.

The diagnostic accuracy of the Revised Westmead PTA Scale as an adjunct to the Glasgow Coma Scale in the early identification of cognitive impairment in patients with mild traumatic brain injury

BACKGROUND

Assessment of patients with mild traumatic brain injury (mTBI) is predominantly done using the Glasgow Coma Scale (GCS). While the GCS is universally accepted for assessment of severity of traumatic brain injury, it may not be appropriate to rely on the GCS alone when assessing patients with mTBI in prehospital settings and emergency departments.

OBJECTIVE

To determine whether administering the Revised Westmead Post-traumatic Amnesia (PTA) Scale (R-WPTAS) in addition to the GCS would increase diagnostic accuracy in the early identification of cognitive impairment in patients with mTBI.

METHODS

Data were collected from 82 consecutive participants with mTBI who presented to the emergency department of a level 1 trauma centre in Australia. A matched sample of 88 control participants who attended the emergency department for reasons other than head trauma was also assessed. All patients were assessed using the GCS, R-WPTAS and a battery of neuropsychological tests.

RESULTS

Patients with mTBI scored poorly compared with control patients on all measures. The R-WPTAS showed greater concurrent validity with the neuropsychological measures than the GCS and significantly increased prediction of group membership of patients with mTBI with cognitive impairment.

CONCLUSIONS

The R-WPTAS significantly improves diagnostic accuracy in identifying patients with mTBI who may be in PTA. Administration takes less than 1 min, and since early identification of a patient's cognitive status facilitates management decisions, it is recommended for routine use whenever the GCS is used.

Quality of life issues in patients dying from haematological diseases

Patients with haematological diseases do not have ready access to hospice services in South Australia. They remain in close contact with a specialist haematology or oncology unit, and are more likely than are patients with solid tumours to receive intensive therapy during a terminal admission. The course of the final month of life was compared for three groups of patients suffering from colorectal cancer, non-Hodgkins lymphoma and acute leukaemia by a review of hospital records. All leukaemia patients died in hospital and few received a palliative care consultation. Measures of symptom control and quality of life are not recorded for these patients. It seems probable that adults with acute leukaemia will continue to die in hospital. Some of the lessons learnt from hospice practice may be appropriately applied in hospital for those patients.

Certain features of erythrocytes of normal and glutathione-deficient sheep

Studies were made of certain characters of erythrocytes of normal and glutathione (GSH)-deficient sheep. The results indicate that erythrocytes of GSH-deficient sheep are no more sensitive to oxidative damage than those of normal sheep.