Still WALKing-FOR: 2-year sustainability of the 'WALK FOR' intervention.

BACKGROUND: low mobility of hospitalised older adults is associated with adverse outcomes and imposes a significant burden on healthcare and welfare systems. Various interventions have been developed to reduce this problem; at present, however, their methodologies and outcomes vary and information is lacking about their long-term sustainability. This study aimed to evaluate the 2-year sustainability of the WALK-FOR (walking for better outcomes and recovery) intervention implemented by teams in acute care medical units. METHODS: a quasi-experimental three-group comparative design (N = 366): pre-implementation, i.e. control group (n = 150), immediate post-implementation (n = 144) and 2-year post-implementation (n = 72). RESULTS: mean participant age was 77.6 years (± 6 standard deviation [SD]) and 45.3% were females. We conducted an analysis of variance test to evaluate the differences in primary outcomes: number of daily steps and self-reported mobility. Levels of mobility improved significantly from the pre-implementation (control) group to the immediate and 2-year post-implementation groups. Daily step count: pre-implementation (median: 1,081, mean: 1,530 SD = 1,506), immediate post-implementation (median: 2,225, mean: 2,724. SD = 1,827) and 2-year post-implementation (median: 1,439, mean: 2,582, SD = 2,390) F = 15.778 P < 0.01. Self-reported mobility: pre-implementation (mean:10.9, SD = 3.5), immediate post-implementation (mean: 12.4, SD = 2.2), 2-year post-implementation (mean: 12.7, SD = 2.2), F = 16.250, P < 0.01. CONCLUSIONS: the WALK-FOR intervention demonstrates 2-year sustainability. The theory-driven adaptation and reliance on local personnel produce an effective infrastructure for long-lasting intervention. Future studies should evaluate sustainability from a wider perspective to inform further in-hospital intervention development and implementation.

Shared and distinct factors underlying in-hospital mobility of older adults in Israel and Denmark (97/100).

BACKGROUND: Low in-hospital mobility is widely acknowledged as a major risk factor in acquiring hospital-associated disabilities. Various predictors of in-hospital low mobility have been suggested, among them older age, disabling admission diagnosis, poor cognitive and physical functioning, and pre-hospitalization mobility. However, the universalism of the phenomena is not well studied, as similar risk factors to low in-hospital mobility have not been tested. METHODS: The study was a secondary analysis of data on in-hospital mobility that investigated the relationship between in-hospital mobility and a set of similar risk factors in independently mobile prior to hospitalization older adults, hospitalized in acute care settings in Israel (N = 206) and Denmark (N = 113). In Israel, mobility was measured via ActiGraph GT9X and in Denmark by ActivPal3 for up to seven hospital days. RESULTS: Parallel multivariate analyses revealed that a higher level of community mobility prior to hospitalization and higher mobility ability status on admission were common predictors of a higher number of in-hospital steps, whereas the longer length of hospital stay was significantly correlated with a lower number of steps in both samples. The risk of malnutrition on admission was associated with a lower number of steps, but only in the Israeli sample. CONCLUSIONS: Despite different assessment methods, older adults' low in-hospital mobility has similar risk factors in Israel and Denmark. Pre-hospitalization and admission mobility ability are robust and constant risk factors across the two studies. This information can encourage the development of both international standard risk evaluations and tailored country-based approaches.

Participation in daily activities after acute illness hospitalization among high-functioning older adults: a qualitative study.

AIMS AND OBJECTIVES: To describe high-functioning older adults' experiences of participation in daily activities and perceived barriers and facilitators to participation one- and 3-months post-acute hospitalization. BACKGROUND: Older adults discharged after acute illness hospitalization are at risk for functional decline and adverse health outcomes. Yet, little is known about the subjective experience of resuming participation in meaningful activities beyond the immediate post-discharge period among high-functioning older adults, a mostly overlooked sub-sample. DESIGN: Qualitative descriptive longitudinal study adhering to the COREQ guidelines. METHODS: Forty two participants ages ≥65 years (mean age 75, SD ± 7.9) were recruited from internal medicine wards. Semi-structured interviews were conducted at participants' homes one-month post-discharge, followed by a telephone interview 3-months after. Data were analyzed using thematic analysis. RESULTS: Participants perceived the hospitalization as a disruption of healthy and meaningful routines. This first key theme had unique expressions over time and included two sub-themes. At one month: (1) reduced life spaces and sedentary routines. At 3 months: (2) a matter of quality not quantity - giving up even one meaningful activity can make a difference. The second key theme was described as a combination of physical and psychological barriers to participation over time. These themes demonstrated the profound impact of the hospitalization on behavior (participation) and feelings (e.g., symptoms). The third key theme was described as a dyad of intrinsic and extrinsic facilitators to participation. CONCLUSIONS: Acute illness hospitalization may lead to subtle decreases in participation in meaningful health-promoting activities, even among high-functioning older adults. These changes may impact overall well-being and possibly mark the beginning of functional decline. RELEVANCE TO CLINICAL PRACTICE: This study highlights the need for a more comprehensive assessment of participation, relevant for high-functioning older adults, to enable person-centered care. Intervention programs should address the modifiable barriers and facilitators identified in this study.

Ethiopian immigrants with diabetes in Israel: Oscillating between two narratives.

AIM: The purpose of this project was to examine the role of cultural differences in shaping the management of diabetes among Ethiopian immigrants living in Israel. METHODS: A qualitative, in-depth study involved semistructured interviews with 16 Ethiopian immigrants with diabetes living in Israel. The interviews were audio-recorded, transcribed and translated into Hebrew, if necessary. The authors each identified themes in the responses and then through discussion came to a consensus about the most significant ones and how to categorize them. RESULTS: A main theme was revealed structuring the participants' perception of diabetes: an oscillation between a familiar narrative, associated with traditional life in Ethiopia, and a foreign one. Five additional subthemes were also identified as an oscillation about the causes of disease, between collectivism and individualism, between accessible food and a balanced diet, between relying on bodily sensations and prescribed treatment and between culturally oriented and translated knowledge. CONCLUSION: The participants understood that they could be adversely affected both by the changes in lifestyle following their move and by adhering to the traditional norms. They agreed that professional liaisons and peers who have successfully managed their diabetes could help provide a bridge between the narratives.

"Behind the Scenes" of Accelerometer Use to Quantify In-Hospital Mobility of Older Adults.

Measuring in-hospital mobility of older adults with accelerometers is becoming more common practice. However, neither the unique challenges surrounding accelerometer use within acute hospital settings nor the potential solutions to these challenges have been well documented. The aim of this article is to present and discuss what occurs "behind the scenes" when using accelerometers to quantify in-hospital mobility among older adults in acute hospital wards. The article identifies the challenges related to accelerometer use that emerged over the course of daily data collection for 2 large-scale studies, including matters of recruitment, daily use, technical and methodological issues, loss of devices, missing data, and troubleshooting. The article details the tasks and the strategies we developed for overcoming these challenges and how we implemented them within the acute wards. Finally, the article provides recommendations for researchers and clinicians on how to improve future use of accelerometers or other devices aimed to enhance in- hospital mobility of older adults.

The contribution of functional cognition screening during acute illness hospitalization of older adults in predicting participation in daily life after discharge.

BACKGROUND: Cognitive assessment in acutely hospitalized older adults is mainly limited to neuropsychological screening measures of global cognition. Performance-based assessments of functional cognition better indicate functioning in real-life situations. However, their predictive validity has been less studied in acute hospital settings. The aim of this study was to explore the unique contribution of functional cognition screening during acute illness hospitalization in predicting participation of older adults one and three months after discharge beyond traditional neuropsychological measures. METHODS: This prospective longitudinal study included 84 older adults ≥ 65 years hospitalized in internal medicine wards due to acute illness, followed by home visits at one month and telephone interviews at three months (n = 77). Participation in instrumental activities of daily living, social and leisure activities was measured by the Activity Card Sort. In-hospital factors included cognitive status (telephone version of the Mini-Mental State Examination, Color Trails Test), functional cognition screening (medication sorting task from the alternative Executive Function Performance Test), emotional status (Hospital Anxiety and Depression scale), functional decline during hospitalization (modified Barthel index), length of hospital stay, the severity of the acute illness, symptoms severity and comorbidities. RESULTS: Functional cognition outperformed the neuropsychological measures in predicting participation declines in a sample of relatively high-functioning older adults. According to a hierarchical multiple linear regression analysis, the overall model explained 28.4% of the variance in participation after one month and 19.5% after three months. Age and gender explained 18.6% of the variance after one month and 13.5% after three months. The medication sorting task explained an additional 5.5% of the variance of participation after one month and 5.1% after three months, beyond age and gender. Length of stay and the Color Trails Test were not significant contributors to the change in participation. CONCLUSIONS: By incorporating functional cognition into acute settings, healthcare professionals would be able to better detect older adults with mild executive dysfunctions who are at risk for participation declines. Early identification of executive dysfunctions can improve continuity of care and planning of tailored post-discharge rehabilitation services, especially for high-functioning older adults, a mostly overlooked population in acute settings. The results support the use of functional cognition screening measure of medication management ability in acute settings.

The effect of co-dependent (thinking in motion [TIM]) versus single-modality (CogniFit) interventions on cognition and gait among community-dwelling older adults with cognitive impairment: a randomized controlled study.

BACKGROUND: Cognition and motor skills are interrelated throughout the aging process and often show simultaneous deterioration among older adults with cognitive impairment. Co-dependent training has the potential to ameliorate both domains; however, its effect on the gait and cognition of older adults with cognitive impairment has yet to be explored. The aim of this study is to compare the effects of the well-established single-modality cognitive computerized training program, CogniFit, with "Thinking in Motion (TIM)," a co-dependent group intervention, among community-dwelling older adults with cognitive impairment. METHODS: Employing a single-blind randomized control trial design, 47 community-dwelling older adults with cognitive impairment were randomly assigned to 8 weeks of thrice-weekly trainings of TIM or CogniFit. Pre- and post-intervention assessments included cognitive performance, evaluated by a CogniFit battery, as a primary outcome; and gait, under single- and dual-task conditions, as a secondary outcome. RESULTS: CogniFit total Z scores significantly improved from baseline to post-intervention for both groups. There was a significant main effect for time [F (1, 44) = 17.43, p < .001, ηp2 = .283] but not for group [F (1, 44) = 0.001, p = .970]. No time X group interaction [F (1, 44) = 1.29, p = .261] was found. No changes in gait performance under single and dual-task performance were observed in both groups. CONCLUSIONS: The findings show that single-modality (CogniFit) and co-dependent (TIM) trainings improve cognition but not gait in older adults with cognitive impairment. Such investigations should be extended to include various populations and a broader set of outcome measurements. TRIAL REGISTRATION: ACTRN12616001543471. Date: 08/11/2016.

Can We Quantify Aging-Associated Postural Changes Using Photogrammetry? A Systematic Review.

BACKGROUND: Aging is widely known to be associated with changes in standing posture. Recent advancements in the field of computerized image processing have allowed for improved analyses of several health conditions using photographs. However, photogrammetry's potential for assessing aging-associated postural changes is yet unclear. Thus, the aim of this review is to evaluate the potential of photogrammetry in quantifying age-related postural changes. MATERIALS AND METHODS: We searched the databases PubMed Central, Scopus, Embase, and SciELO from the beginning of records to March 2021. Inclusion criteria were: (a) participants were older adults aged ≥60; (b) standing posture was assessed by photogrammetric means. PRISMA guidelines were followed. We used the Newcastle-Ottawa Scale to assess methodological quality. RESULTS: Of 946 articles reviewed, after screening and the removal of duplicates, 11 reports were found eligible for full-text assessment, of which 5 full studies met the inclusion criteria. Significant changes occurring with aging included deepening of thoracic kyphosis, flattening of lumbar lordosis, and increased sagittal inclination. CONCLUSIONS: These changes agree with commonly described aging-related postural changes. However, detailed quantification of these changes was not found; the photogrammetrical methods used were often unvalidated and did not adhere to known protocols. These methodological difficulties call for further studies using validated photogrammetrical methods and improved research methodologies.

A bridge to cross: Tube feeding and the barriers to implementation of palliative care for the advanced dementia patient.

AIMS AND OBJECTIVES: To elucidate the attitudes and knowledge of nursing home (NH) staff involved in the decision-making process surrounding tube feeding for people with advanced dementia, and regarding palliative care and eating difficulties in this population. BACKGROUND: Dementia's final stage is associated with eating difficulties. "Comfort feeding" is the approach endorsed by the American Geriatrics Society for those with advanced dementia and eating difficulties. Despite this, tube feeding remains a persisting practice in NHs in Israel. DESIGN: A qualitative descriptive study. METHODS: Twenty-seven NH employees from different sectors employed by seven NHs in northern Israel underwent semi-structured, face-to-face interviews. The COREQ checklist was used to aid with reporting and analysis of results. RESULTS: In Israel, there is an emerging palliative care discourse in caring for people with advanced dementia living in the NH setting. However, many interviewed did not demonstrate an accurate understanding of this term or of the term "comfort feeding." Several barriers towards implementation of palliative care were identified and include a lack of formal education regarding nutrition in advanced dementia, socio-economic factors and their association with the two types of NHs operating in Israel (those with exclusively private funding and those reimbursed by the Ministry of Health). CONCLUSIONS: Interviews with NH staff regarding eating difficulties in advanced dementia shed light on the palliative care discourse, which is in a liminal stage in many countries. The themes that emerged may help inform future recommendations regarding palliative care in general and more specifically in NH residents with advanced dementia, in countries where policy is still being developed and refined. RELEVANCE TO CLINICAL PRACTICE: Understanding barriers towards implementation of a palliative approach and comfort feeding specifically could improve the care for people with advanced dementia in the NH setting.

Gait Analysis Using Accelerometry Data from a Single Smartphone: Agreement and Consistency between a Smartphone Application and Gold-Standard Gait Analysis System.

Spatio-temporal parameters of human gait, currently measured using different methods, provide valuable information on health. Inertial Measurement Units (IMUs) are one such method of gait analysis, with smartphone IMUs serving as a good substitute for current gold-standard techniques. Here we investigate the concurrent validity of a smartphone placed in a front-facing pocket to perform gait analysis. Sixty community-dwelling healthy adults equipped with a smartphone and an application for gait analysis completed a 2-min walk on a marked path. Concurrent validity was assessed against an APDM mobility lab (APDM Inc.; Portland, OR, USA). Bland-Altman plots and intraclass correlation coefficients (agreement and consistency) for gait speed, cadence, and step length indicate good to excellent agreement (ICC2,1 > 0.8). For right leg stance and swing % of gait cycle and double support % of gait cycle, results were moderate (0.52 < ICC2,1 < 0.62). For left leg stance and swing % of gait cycle left results show poor agreement (ICC2,1 < 0.5). Consistency of results was good to excellent for all tested parameters (ICC3,1 > 0.8). Thus we have a valid and reliable instrument for measuring healthy adults' spatio-temporal gait parameters in a controlled walking environment.

The relationships between step count and hospitalisation-associated outcomes in acutely hospitalised older adults - A systematic review.

BACKGROUND AND PURPOSE: Although low ambulation among older adults has been linked to a broad range of adverse outcomes during and after acute hospitalisation, a systematic inquiry of the link between step count and these consequences is required. Therefore, the main purpose of this study is to systematically review the relationships between step count and hospitalisation-associated outcomes in acutely hospitalised older adults. METHODS: The electronic databases MEDLINE, CINAHL, and Embase were searched for studies including older adults (above age 65) hospitalised in acute internal wards. The search included the following key terms: 'accelerometer', 'step count', 'hospital', 'internal ward', and 'older adults'. Step count measurement linked to short- and/or long-term outcome(s) during and/or after hospitalisation. All types of articles (except reviews) in English from 1990 to May 2020 were considered. The Newcastle-Ottawa Scale was used to assess the quality of the included observational studies. Randomised controlled trials (RCT) were evaluated using the PEDro scale. The review protocol was registered with PROSPERO International Prospective Register of Systematic Reviews. PRISMA guidelines were followed and a PRISMA checklist for reporting systematic reviews completed. RESULTS: The search yielded 1340 articles, and of those, the inclusion criteria were met by 12 studies: eight prospective, three interventional (one randomised controlled trial), and one case-control. These studies included three major adverse hospitalisation outcomes associated with step count: functional decline, longer length of stay, and higher re-hospitalisation rate; however, the large heterogeneity in the studies' methodology makes meta-analysis impossible. CONCLUSIONS: Daily step count during hospitalisation of older adults is negatively associated with adverse outcomes, but causation cannot be inferred due to inconsistent outcomes and various methodological limitations. More studies are needed to illuminate causal pathways and mechanisms underlying these relationships, especially to differentiate between the relative contribution of personal versus environmental factors.

Symptom clusters in hospitalized older adults: Characteristics and outcomes.

Hospital care in medical patients relies mostly on objective measures with limited assessment of subjective symptoms. We subgrouped 331 hospitalized older adults with medical diagnosis (age 75.5 ± 7.1) according to the severity of multiple symptoms to explore if these subgroups differed in health-related characteristics on admission and functional outcomes one month post-discharge. Cluster analysis identified three subgroups based on experiences with five highly distressing symptoms (fatigue, dyspnea, dizziness, sleep disturbance, pain): low levels of all symptoms, high levels of all symptoms; moderate levels of four symptoms with high dyspnea. Belonging in different subgroups was accompanied by different levels of cognitive and mental, but not physical or health status. Patients in the subgroup "Moderate Levels with High Dyspnea" had significantly lower risk of decline in post-discharge instrumental activities of daily living than other subgroups. Better understanding of older hospitalized adults' symptom profiles may yield important information on health condition and recovery.

Attributes of Physical Activity and Gut Microbiome in Adults: A Systematic Review.

Growing evidence shows the contribution of physical activity interventions to the gut microbiome. However, specific physical activity characteristics that can modify the gut microbiome are unknown. This review's aim was to explore the contribution of physical activity intervention characteristics on human gut microbiome composition, in terms of diversity, specific bacterial groups, and associated gut microbiome metabolites. A literature search in PubMed; Cochrane Library; CINAHL-EBSCO; SCOPUS; Web of Science; ClinicalTrials.gov; PROSPERO; and ProQuest. Five studies met the inclusion criteria of a physical activity intervention duration of at least five weeks, with any description of the type or dose used. All included studies reported an endurance training; two studies used endurance and an additional muscle-strengthening training regimen. All studies reported using a dietary intervention control. Reported gut microbiome α-diversity changes were non-significant, ß-diversity changes were mixed (three studies reported an increase, two reported non-significant changes). All studies reported significant changes in the abundances of specific bacterial/archaea groups and bacteria-related metabolites following interventions. In conclusion, physical activity (regardless of specific characteristics) has significant contribution to gut microbiome composition and associated metabolites. There are no current recommendations for physical activity to promote gut microbiome composition. Future studies should focus on the contribution of current recommended physical activity dose to gut microbiome composition.

Dilemmas for guardians of advanced dementia patients regarding tube feeding.

Background: advanced dementia is an incurable illness, its last stage marked by inability to eat. Tube feeding was deemed a helpful solution at this stage, but in recent years its inefficiency has been proved, and it is no longer practiced in many countries around the world. In Israel, however, the procedure is still accepted. In the gastroenterology department at the Bnai Zion Medical Center, a serious interaction is ongoing with patients' legal guardians, where detailed information is given about the inefficiency of the tube procedure. Nevertheless, the great majority of guardians choose to have it performed. Purpose: to probe the considerations underlying the decision for gastrostomy, despite the data and the recommendations. Method: qualitative research, including participant observation at the clinic and in-depth interviews with guardians. Findings: the families of most patients did not discuss end-of-life issues with them. The overwhelming preference for using the technology was interpreted as life-saving, in contrast to comfort feeding, which was deemed euthanasia. The reasons given for the decision to tube feed were drawn from a range of outlooks: religion, the patient's earlier survival capacity, and pragmatic considerations involving relations with nursing home staff. Conclusion: study of the decision-making process of advanced dementia patients' guardians sheds light on the layers of meaning of the Israeli discourse regarding end-of-life issues.

The role of gender in the association between personality and task priority in older adults' dual-tasking while walking.

BACKGROUND: Falls are a major problem for older adults. Many falls occur when a person's attention is divided between two tasks, such as a dual task (DT) involving walking. Most recently, the role of personality in walking performance was addressed; however, its association with DT performance remains to be determined. METHODS: This cross-sectional study of 73 older, community-dwelling adults explores the association between personality and DT walking and the role of gender in this relationship. Personality was evaluated using the five-factor model. Single-task (ST) and DT assessment of walking-cognitive DT performance comprised a 1-min walking task and an arithmetic task performed separately (ST) and concurrently (DT). Dual-task costs (DTCs), reflecting the proportional difference between ST and DT performance, were also calculated. RESULTS: Gender plays a role in the relationship between personality and DT. Extraversion was negatively associated with DTC-motor for men (ΔR2 = 0.06, p < 0.05). Conscientiousness was positively associated with DTC-cognition for women (ΔR2 = 0.08, p < 0.01). CONCLUSION: These findings may lead to effective personality-based early detection and intervention for fall prevention.

No one size fits all-the development of a theory-driven intervention to increase in-hospital mobility: the "WALK-FOR" study.

BACKGROUND: There is growing evidence that mobility interventions can increase in-hospital mobility and prevent hospitalization-associated functional decline among older adults. However, implementing such interventions is challenging, mainly due to site-specific constraints and limited resources. The Systems Engineering Initiative for Patient Safety (SEIPS 2.0) model has the potential to guide a sustainable, site-tailored mobility intervention. Thus, the aim of the current study is to demonstrate an adaptation process guided by the SEIPS 2.0 model to articulate site-specific, culturally based interventions to improve in-hospital mobility among older adults. METHODS: Six consecutive phases addressed each of the model's elements in the research setting. Phase-1 aimed to determine a measurable outcome: steps/d, measured with accelerometers, associated with functional decline. Phase-2 included interviews with key persons in leadership positions in the hospital to explore organizational factors affecting in-hospital mobility. Phases-3 and 4 aimed to identify attitudes, knowledge, barriers, and current behaviors of medical staff (n = 116) and patients (n = 203) related to patient mobility. Phase-5 included four focus-groups with unit staff aimed at developing an action plan while adapting existing intervention strategies to site needs. Phase-6 relied on a steering committee that developed intervention-adaptation and implementation plans. RESULTS: Nine hundred steps/d was defined as the intervention outcome. 40% of patients walked fewer than 900 steps/d regardless of capability. Assessing or promoting mobility did not exist as a separate task and thus was routinely overlooked. Several barriers to patients' mobility were identified, specifically limited knowledge of practical aspects of mobility. Consequently, staff adopted practical steps to address them. Nurses were designated to assess mobility, and nursing assistants to support mobility. Mobility was defined as a quality indicator to be documented in electronic medical records and closely supervised by hospital and unit management. Preliminary analyses of the "Walk FOR" protocol demonstrates its' ability to reduce barriers, to re-shape staff attitudes and knowledge, and to increase in-hospital mobility of older adults. CONCLUSIONS: The SEIPS-2.0 model can serve as a useful guide for implementing a site-tailored comprehensive mobility intervention. This process, which relies on local resources, may promise sustainable practice change that may support early effective rehabilitation and recovery.

Development and psychometric testing of a measure of older adult patients' attitudes towards mobility during hospitalization (ATM-H).

This paper describes the development and psychometric testing of a questionnaire evaluating attitudes towards mobility during hospitalization of older adults, an understudied phenomenon that lacks a valid and reliable measure. An instrument development procedure, followed by an empirical study, was conducted between December 2013 and June 2014. Instrument development included item generation and analysis of content validity, which was established by six experts. The validation study used a prospective within-patients design with a sample of 100 patients, age 70+, hospitalized in general medical units in a large medical center. Internal consistency, reliability, and divergent and predictive validity of the measure were tested. Reliability analysis revealed an acceptable estimate for the total score (0.76). Predictive validity was good. The divergent validity coefficient was in the expected direction. Preliminary psychometric properties of the measure showed acceptable results. The measure should be explored further in different cultural settings.

The person in the disabled body: a perspective on culture and personhood from the margins.

BACKGROUND: Persons with disabilities (PWD) are one of the most marginalized groups in Western societies. These inequalities are manifested through various disadvantages in the psychosocial, cultural, and economic domains. Inspired by the World Health Organization's holistic conceptualization of disability, the present study examines the relation between the body and personhood in Israeli culture, through cases of newly diagnosed adults with disability. METHOD: Participant observation at a rehabilitation daycare center was carried out for a period of two years. The analysis is based on field notes recorded during these observations, including interviews with individuals with disabilities, their family members, and service providers. RESULTS: The analysis reveals the agonizing experience of individuals who have become disabled in adulthood, who undergo symbolic diminution and social exclusion after their former acceptance as whole and normative persons. This ongoing multifaceted process includes infantilization, denial of their sexuality/sensuality, transgression of gender boundaries, and their construction as categorically different from the "healthy" people around them. At the same time, the analysis also demonstrates the ways in which daily routine at the daycare center also complicates the normative healthy-disabled binary, indicating a continuum on which attendees may attempt to reposition themselves. CONCLUSIONS: This paper aims to make a dual contribution. We draw on anthropological understandings of"person" as a holistic category to resurrect the personhood of individuals with disabilities, as a correction tothe overwhelming tendency to reduce their humanity to their physical injury. We likewise reverse theanalytical gaze by using these individuals' experiences to understand the normative, culture-bound perception of "healthy" persons. We thus highlight Israeli culture's conditioning of normative personhood on having a perfect body, and its concomitant construction of individuals with physical disabilities as lesser persons. By opting to bring back the person into the disabled body, we aim to facilitate a less stigmatized outlook on disability and to create an opportunity for caregivers, researchers, and healthcare professionals to view disabled persons as whole and complex human beings.

Even a small change can make a big difference: the case of in-hospital cognitive decline and new IADL dependency.

BACKGROUND: post-hospitalisation functional decline is a widely described phenomenon, yet factors related to new disability in instrumental activities of daily living (IADL) in previously independently functioning older adults are rarely studied. OBJECTIVE: to test whether change in cognitive status from admission to discharge during short-term acute-care hospitalisation is associated with the incidence of medium-term post-hospitalisation IADL dependency. DESIGN: prospective cohort study. SETTING: internal medicine wards in two Israeli medical centres. SUBJECTS: two hundred and seventy-two hospitalised older adults (≥70) who were independent in self-care and mobility activities at admission, at discharge and 1 month after discharge, and who were independent in IADL pre-admission. METHODS: cognitive status was evaluated at admission and at discharge using Pfeiffer's Short Portable Mental Status Questionnaire (SPMSQ). One-month post-discharge, IADL was assessed using Lawton and Brody's scale by telephone. RESULTS: incidence of IADL dependency was 74/272 (27.2%). Controlling for length of stay, co-morbidities, re-hospitalisation and age, a one-unit decrease in SPMSQ score during hospital stay was associated with 1.57 higher odds (95% CI, 1.14-2.15) of post-hospitalisation new IADL dependency. The odds of new IADL dependency were also significantly higher in participants who were rehospitalised within the previous month (odds ratio = 2.65; 95% CI, 1.25-5.62). CONCLUSIONS: decline in SPMSQ score during acute hospitalisation has a detrimental effect on functional decline after acute hospitalisation, defined by incidence IADL dependency. This finding emphasises the need to identify cognitive decline during hospitalisation to allow timely intervention to prevent post-discharge functional decline in this population.

Anxiety symptoms during hospitalization of elderly are associated with increased risk of post-discharge falls.

BACKGROUND: The aim of this study was to test the association between anxiety at the time of hospitalization and falls occurring within one month of discharge, and to offer potential mechanisms for this association. METHODS: One-month, prospective cohort study of 556 older adults in two medical centers in Israel. Anxiety and functional decline were assessed during hospitalization and falls were assessed one month post-discharge. RESULTS: A total of 72 (12.9%) participants reported at least one fall during the 30-day post-discharge period. Controlling for demographics, functional decline and pre-morbid functional status, the odds of falls between discharge, and 1-month follow-up were almost twice as high among patients with anxiety symptoms (OR = 1.89, 95% CI: 1.04-3.48) compared with those who screened negative for anxiety. After accounting for in-hospital functional decline, the relationship between anxiety symptoms and falls decreased by 11% (from OR = 2.13 to 1.89), indicating that the relationship between anxiety and falls was partially mediated by functional decline during hospitalization. CONCLUSIONS: Anxiety at time of hospitalization is associated with falls 30-days post-discharge, controlling for several well-known confounders. This relationship is partially mediated by functional decline. Identifying patients with anxiety for inclusion in targeted rehabilitation interventions may be an important component of fall prevention strategies.