Effects of Community-Based Physical-Cognitive Training, Health Education, and Reablement among Rural Community-Dwelling Older Adults with Mobility Deficits.

Reablement services are approaches for maintaining and improving the functional independence of older adults. Previous reablement studies were conducted in a home environment. Due to the limited evidence on the effects of multicomponent interventions and reablement in a community-based context, this study aimed to develop and evaluate the effect of community-based physical-cognitive training, health education, and reablement (PCHER) among rural community-dwelling older adults with mobility deficits. The trial was conducted in rural areas of New Taipei City, Taiwan. Older adults with mild to moderate mobility deficits were recruited from six adult daycare centers, and a cluster assignment was applied in a counterbalanced order. The experimental group (n = 16) received a PCHER intervention, comprising 1.5 h of group courses and 1 h of individualized reablement training, while the control group (n = 12) underwent PCHE intervention, comprising 1.5 h of group courses and 1 h of placebo treatment. A 2.5-h training session was completed weekly for 10 weeks. The outcome measures contained the de Morton Mobility Index (DEMMI), the Saint Louis University Mental Status (SLUMS) Examination, the Barthel Index (BI), the Short Physical Performance Battery (SPPB), and the Canadian Occupational Performance Measure (COPM). The PCHER significantly improved the DEMMI, SLUMS, BI, SPPB, and COPM (all p < 0.05), with medium-to-large effect sizes. PCHER also showed an advantage over PCHE in terms of the SPPB (p = 0.02). This study verified that combining individualized reablement with group-based multicomponent training was superior to group courses alone in enhancing the functional abilities of community-dwelling older adults with mobility deficits.

Self-monitored versus supervised walking programs for older adults.

ABSTRACT: Walking is an effective, well accepted, inexpensive, and functional intervention. This study compared the outcomes and changes in walking behavior of self-monitored (SM) and supervised (SU) walking interventions for older adults.Participants were assigned to SM (n = 21) and SU (n = 21) walking groups according to their place of residence. Both groups exercised and wore a pedometer for 3 months.The outcome measures were step count, body mass index (BMI), and physical function. Two-way repeated-measure ANOVA and independent t tests were used to compare the intervention effects. We also plotted the trends and analyzed the walking steps weekly.Only BMI exhibited a group × time interaction. The pre-posttest differences showed knee extension muscle strength (KEMS) and Timed Up and Go test were significantly improved in the SM group, whereas BMI, KEMS, 30-s sit-to-stand, functional reach were significantly improved, but 5-m gait speed significantly slower in the SU group. For participants attending ≥50% of the sessions, those in the SM and SU groups had similar results for all variables, except for 2-min step (2MS) and daily walking step counts.Both self-monitored and supervised walking benefit older adults in most physical functions, especially lower-extremity performance, such as muscle strength, balance, and mobility. The effects of both programs do not differ significantly, except for BMI and 2MS (ie cardiopulmonary endurance). We recommend pedometer-assisted self-monitored walking for older adults because of its ability to cultivate exercise habits over the long term, whereas supervised walking to establish effective exercise intensity.

Developing an assessment scale for long-term care reablement literacy in home care workers in Taiwan using a modified Delphi method.

BACKGROUND: Reablement is a philosophy of change in long-term care (LTC). Assessing the knowledge and competence of LTC professionals who provide reablement services is vital in LTC research. This study aimed to develop a scale for the assessment of long-term care reablement literacy (LTCRL) and employ this scale to assess the performance of home care workers in Taiwan. METHODS: To develop this scale, we employed the modified Delphi technique based on the theoretical framework of health literacy and the content of service delivery in reablement. Home care workers from northern, central, and southern Taiwan were selected through purposive sampling (N = 119). Participants answered a self-administered questionnaire that included items related to basic demographic characteristics and questions to assess LTCRL. RESULTS: Based on the experts' consensus on the procedure of the modified Delphi technique, the LTCRL assessment sale consists of 29 questions on four aspects of knowledge acquisition: the abilities to access/obtain, understand, process/appraise, and apply/use. The results revealed that higher education levels and better Chinese language proficiency are associated with higher LTCRL outcomes among home care workers. CONCLUSIONS: The LTCRL assessment scale based on a modified Delphi technique is useful and feasible for evaluating LTCRL in home care workers who provide reablement services in Taiwan.

Novel Mat Exergaming to Improve the Physical Performance, Cognitive Function, and Dual-Task Walking and Decrease the Fall Risk of Community-Dwelling Older Adults.

Physical exercise and cognitive training were previously demonstrated to improve the physical functioning and decrease the incidence of falls for older adults. This study aimed to utilize an interactive exergame mat system to develop a novel cognitive-physical training program and explore the training effects on physical performance, cognitive function, dual-task walking (DTW), and fall risk compared to the control condition. In this quasi-experimental non-randomized controlled intervention study, 110 community-dwelling older adults participated. The exercise group (n = 56; mean age, 70.7 ± 4.6 years) performed ladder-type, three-by-three grid-type, and circle-type mat exergames with simultaneous cognitive-physical training (EMAT), while the control group (n = 54; mean age, 72.0 ± 5.7 years) underwent a multicomponent exercise intervention focused on physical and cognitive training. A 2 h training session was completed weekly for 3 months. Functional fitness (including upper- and lower-extremity strength and flexibility, grasp strength, aerobic endurance, static balance, dynamic balance and agility), a foot tapping test (FTT), the Montreal Cognitive Assessment (MoCA), DTW, and a fall risk questionnaire (FRQ) were assessed before and after the interventions. The EMAT program enhanced upper-extremity strength, lower-extremity strength and flexibility, aerobic endurance, and dynamic balance and agility; improved DTW and FTT performances; and decreased FRQ score. EMAT also showed a significant advantage over control in terms of lower-extremity strength and flexibility, aerobic endurance, dynamic balance and agility, and FRQ score (all P < 0.05). The current study provides evidence of the effects of a novel mat exergaming program on physical and cognitive performance. EMAT effectively reduced the fall risk and increased the dual-task ability of walking, factors that are important in fall prevention for community-dwelling older adults.

The Effectiveness of a Virtual Reality-Based Tai Chi Exercise on Cognitive and Physical Function in Older Adults with Cognitive Impairment.

BACKGROUND: Tai Chi (TC) is a Chinese mind-body exercise with proven physical and psychological benefits. A modified TC via virtual reality (VR) may be suitable for the elderly owing to the immediate guidance and feedback regarding movement accuracy. This study explored the cognitive and physical effects of a VR-based TC (VRTC) exercise program on older adults with cognitive impairment (CI). METHODS: Sixty older adults with CI were cluster-assigned to either the VRTC or the control group; the intervention was conducted twice weekly for 6 months. Outcomes included cognitive and physical functions. The movement accuracy score and attendance were recorded. Generalized estimating equation (GEE) and multiple regression analyses were performed. RESULTS: Adjusted GEE analysis showed significant interaction effects in the 6-min walk test, 30-s sit-to-stand test, functional reach, 5-m gait speed, and abstract thinking and judgment. Overall, medium to large effect sizes (d = 0.50-0.82) were found in favor of the VRTC group. The average movement accuracy score in the first 3 months significantly predicted improvement in cognitive performance (p = 0.011). CONCLUSIONS: The VRTC exercise posed a protective effect for some cognitive and physical functions in older adults with CI. The more engaging the program, the greater the improvement in the cognitive performance.

Development of Home-Based Frailty Detection Device Using Wireless Sensor Networks.

This study develops a home-based frailty detection device that uses embedded systems and wireless sensing technology. This system helps monitor the impact of aging among the elderly through wireless automatic detection. The detection system consists of four devices. The first device, called eScale, simulates the traditional falling ruler test to measure reaction time. Another device, called eChair, measures the pressure exerted by a test subject through a pressure sensor. It is used to test three symptoms of frailty, namely slowness of movement, physical weakness, and body weight. The third device, called ePad, consists of a soft membrane switch placed on the ground to detect footsteps and is used to test balance. The fourth device, called eReach, measures displacement through ultrasound sensors. It is used to carry out the functional reach test. The sampling rate of each device is the main factor that determines system performance. When the test distance was set to 5 m for Home-Gateway, a 1-Hz sampling rate showed the best performance (98 %). Up to eight devices can be connected simultaneously to the gateway. The proposed system was compared with conventional approaches through testing with test subjects (n = 8). The results of the five tests were as follows: standing forward bend (r = 0.929), balance (r = 0.996), slowness of movement (r = 0.976), and physical weakness (r = 0.991), with p < 0.01. In the reaction time test, r = 0.871, with p < 0.1. All results suggest high correlations. Tests of aging symptoms were performed on 309 people aged over 65 years. Among males, degradation of over 20 % was found in the areas of physical weakness, slowness of movement, and functional reach. Among females, a degradation of 75 % was found in the balance test.

Association between Physical Fitness and Successful Aging in Taiwanese Older Adults.

Population aging is escalating in numerous countries worldwide; among them is Taiwan, which will soon become an aged society. Thus, aging successfully is an increasing concern. One of the factors for achieving successful aging (SA) is maintaining high physical function. The purpose of this study was to determine the physical fitness factors associated with SA in Taiwanese older adults (OAs), because these factors are intervenable. Community-dwelling OAs aged more than 65 years and residing in Northern Taiwan were recruited in this study. They received a comprehensive geriatric assessment, which includes sociodemographic data, health conditions and behaviors, activities of daily living (ADL) and instrumental ADL (IADL) function, cognitive and depressive status, and quality of life. Physical fitness tests included the grip strength (GS), 30-second sit-to-stand (30s STS), timed up-and-go (TUG), functional reach (FR), one-leg standing, chair sit-and-reach, and reaction time (drop ruler) tests as well as the 6-minute walk test (6MWT). SA status was defined as follows: complete independence in performing ADL and IADL, satisfactory cognitive status (Mini-Mental State Examination ≥ 24), no depression (Geriatric Depression Scale < 5), and favorable social function (SF subscale ≥ 80 in SF-36). Adjusted multiple logistic regression analyses were performed. Among the total recruited OAs (n = 378), 100 (26.5%) met the aforementioned SA criteria. After adjustment for sociodemographic characteristics and health condition and behaviors, some physical fitness tests, namely GS, 30s STS, 6MWT, TUG, and FR tests, were significantly associated with SA individually, but not in the multivariate model. Among the physical fitness variables tested, cardiopulmonary endurance, mobility, muscle strength, and balance were significantly associated with SA in Taiwanese OAs. Early detection of deterioration in the identified functions and corresponding intervention is essential to ensuring SA.

Aerobic interval training improves oxygen uptake efficiency by enhancing cerebral and muscular hemodynamics in patients with heart failure.

BACKGROUND: Abnormal ventilatory/hemodynamic responses to exercise contribute to functional impairment in patients with heart failure (HF). This study investigates how interval and continuous exercise regimens influence functional capacity by modulating ventilatory efficiency and hemodynamic function in HF patients. METHODS: Forty-five HF patients were randomized to perform either aerobic interval training (AIT; 3-minute intervals at 40% and 80% VO(2peak)) or moderate continuous training (MCT; sustained 60% VO()for 30 min/day, 3 days/week for 12 weeks, or to a control group that received general healthcare (GHC). A noninvasive bio-reactance device was adopted to measure cardiac hemodynamics, whereas a near-infrared spectroscopy was employed to assess perfusion/O2 extraction in frontal cerebral lobe (∆[THb]FC/∆[HHb]FC) and vastus lateralis (∆[THb]VL/∆[HHb]VL), respectively. RESULTS: Following the 12-week intervention, the AIT group exhibited higher oxygen uptake efficiency slope (OUES) and lower VE-VCO2 slope than the MCT and GHC groups. Furthermore, AIT, but not MCT, boosted cardiac output (CO) and increased ∆[THb]FC, ∆[THb]VL, and ∆[HHb]VL during exercise. In multivariate analyses, CO was the dominant predictor of VO(2peak). ∆[THb]FC and ∆[THb]VL, which modulated the correlation between CO and OUES, were significantly correlated with OUES. Simultaneously, ∆[THb]VL was the only factor significantly associated with VE-VCO2 slope. Additionally, AIT reduced plasma brain natriuretic peptide, myeloperoxidase, and interleukin-6 levels and increased the Short Form-36 physical/mental component scores and decreased the Minnesota Living with Heart Failure questionnaire score. CONCLUSIONS: AIT effectively improves oxygen uptake efficiency by enhancing cerebral/muscular hemodynamics and suppresses oxidative stress/inflammation associated with cardiac dysfunction, and also promotes generic/disease-specific qualities of life in patients with HF.

Relationships between gross motor functions and health-related quality of life of Taiwanese children with cerebral palsy.

OBJECTIVE: To examine the relationships between gross motor functions and physical and psychosocial components of the health-related quality of life of children with cerebral palsy. DESIGN: Participants comprising 90 children (53 boys, 37 girls; mean age +/- SD = 8.2 +/- 2.4 yrs) with cerebral palsy were enrolled by a cross-sectional design. Gross motor function measure was used to quantify their gross motor functions. Their health-related quality of life was determined by the Child Health Questionnaire-Parent Form 50 (traditional Chinese version), completed by their caregivers. RESULTS: A significant moderate positive correlation (r = 0.73, P < 0.01) existed between the physical summary scores of the Child Health Questionnaire-Parent Form 50 and gross motor function measure, 66 scores in Taiwanese children with cerebral palsy. There was no significant correlation between the psychosocial summary scores of Child Health Questionnaire-Parent Form 50 and gross motor function measure, 66 scores in cerebral palsy (r = -0.13, P = 0.23). CONCLUSIONS: Gross motor functions may be good predictors of the physical component of health-related quality of life, but they are poor predictors of the psychosocial component of health-related quality of life in children with cerebral palsy. In the future, more comprehensive information regarding children's comorbidities may need to be objectively gathered to provide professionals a better understanding of their health-related quality of life.

Proxies and other external raters: methodological considerations.

OBJECTIVE: The purpose of this paper is to introduce researchers to the measurement and subsequent analysis considerations involved when using externally rated data. We will define and describe two categories of externally rated data, recommend methodological approaches for analyzing and interpreting data in these two categories, and explore factors affecting agreement between self-rated and externally rated reports. We conclude with a discussion of needs for future research. DATA SOURCES/STUDY SETTING: Data sources for this paper are previous published studies and reviews comparing self-rated with externally rated data. STUDY DESIGN/DATA COLLECTION/EXTRACTION METHODS: This is a psychometric conceptual paper. PRINCIPAL FINDINGS: We define two types of externally rated data: proxy data and other-rated data. Proxy data refer to those collected from someone who speaks for a patient who cannot, will not, or is unavailable to speak for him or herself, whereas we use the term other-rater data to refer to situations in which the researcher collects ratings from a person other than the patient to gain multiple perspectives on the assessed construct. These two types of data differ in the way the measurement model is defined, the definition of the gold standard against which the measurements are validated, the analysis strategies appropriately used, and how the analyses are interpreted. There are many factors affecting the discrepancies between self- and external ratings, including characteristics of the patient, the proxy, and of the rated construct. Several psychological theories can be helpful in predicting such discrepancies. CONCLUSIONS: Externally rated data have an important place in health services research, but use of such data requires careful consideration of the nature of the data and how it will be analyzed and interpreted.