Clinical teaching in applied health science: effects of a student-led journal club on aging and physical activity.

BACKGROUND: This project aims to investigate the effects of a student-led journal club on students' critical thinking and clinical application skills in the academic field of aging and physical activity. METHODS: A pre-post design analysis with data collected in four successive cohorts of the program M.Sc. Sport and Movement Gerontology was conducted. Each student assigned himself/herself to a study, and then led the journal club discussion and published a summary of the journal club via graphical abstract on social media. The students rated their perceived confidence in the beginning (T0) and after the semester (T1) via questionnaire and 5-point Likert scales addressing their ability to review and summarize the evidence, to present it in a journal club and to lead the discussion. RESULTS: 41 students (32 women, M = 25 years SD 1.9 years) were included. The journal club was rated as "very good" (median 2, IQR 1). Students' confidence on participating, leading the journal club and transferring the results into clinical practice improved significantly (r ≥ 0.6, p < 0.01) - e.g.: "I feel confident in leading a discussion on the literature presented", T0: "undecided" (median 3, IQR 2) to T1: "rather agree" (median 4, IQR 1, Z= -5.41, r = 0.85, p < 0.01). DISCUSSION: The student-led journal club shows to be an effective teaching approach for the field of aging and physical activity within applied health science education. Especially the students' self-assignment to the studies and involving the scientific community via social media was rated as useful and highly motivating for students and lecturers.

Circadian aspects of mobility-related behavior in patients with dementia: An exploratory analysis in acute geriatric psychiatry.

BACKGROUND: Analyzing patients' mobility-related behavior may improve the assessment of motor behavior in dementia, however, few studies addressed circadian aspects of mobility. This cross-sectional explorative study analyzed the timing of peak mobility-related behavior, the prevalence of mobility-related sundowning and nocturnal mobility-related behavior and associated clinical characteristics in acute geriatric psychiatry. METHODS: Mobility-related behavior of 73 patients (M: 81 years) was measured over 48 h using lower-back worn hybrid motion sensors. We derived the start of the 30-min period with peak gait activity (highest number of steps) for each day and the number of nocturnal steps taken from 10PM to 7AM. Professional caregiver ratings of the patients' motor behavior were conducted within the Neuropsychiatric Inventory (NPI). RESULTS: The mean start time of peak gait activity was 2:37PM, but large variations in timing were found (range: 3:25AM-9:30PM). Twenty-five patients (34%) were identified as "sundowners". Nocturnal mobility-related behavior was measured in 35 patients (53%), whereas professional caregivers assessed night-time disorders in only 19 patients (26%). Clinical characteristics of "sundowners" were not significantly different from other patients, except for lower doses of antipsychotics as compared to non-sundowners (M:1.6 mg/day; p = 0.015). The number of nocturnal steps was significantly associated to corresponding NPI ratings (Spearman's rho = 0.4; p < 0.001). CONCLUSION: Analyzing the timing of peak gait activity and nocturnal step-count seem to provide clinical applicable information on the circadian aspects of mobility-related behavior in acute geriatric psychiatry. Even though the clinical validity needs to be evaluated, objective information on the individual circadian aspects of mobility-related behavior could help to personalize treatment with benefits for patients and caregivers.

Physical activity monitoring-based interventions in geriatric patients: a scoping review on intervention components and clinical applicability.

OBJECTIVE: To identify and analyze the components applied in interventions using physical activity (PA) monitoring in geriatric patients and determine their feasibility and applicability. METHODS: A systematic search in six databases (PubMed, Embase, SPORTDiscus, CINAHL, Web of Science, and GeroLit) was conducted to identify studies reporting interventions that included the application of a PA monitor in adults aged ≥ 60 years with a clinical diagnosis. PA monitor interventions were analyzed regarding their feedback, goal-setting and behavior change technique (BCT) components. To determine the feasibility and applicability of interventions, the participants' adherence to the intervention, their experience as well as adverse events were analyzed. RESULTS: Seventeen eligible studies, applying 22 interventions, were identified. Studies included a total of 827 older patients with a median age of 70.2 years. In thirteen interventions (59%), the PA monitor was embedded in a structured behavioral intervention, an indication-specific intervention or usual care. Most frequently applied intervention components were goal setting and self-monitoring (n = 18), real-time PA monitor feedback complemented by feedback from the study team (n = 12), use of further BCTs (n = 18), and regular counseling with the study team (n = 19). Comprehensive information on the participants' intervention adherence and experience were reported for 15 (68%) and 8 (36%) interventions, respectively. CONCLUSION: The components included in PA monitoring-based interventions varied considerably especially regarding the extent, frequency, and content of feedback, goal setting and BCTs counseling. Future research should evaluate which components are most effective and clinically applicable to promote physical activity in geriatric patients. To be able to precisely analyze the effects, trials should seek to report details on intervention components, adherence and adverse events, while future reviews may use the findings of this scoping review to conduct analyses with less heterogeneity in study characteristics and intervention strategies.

Short-term aerobic exercise for depression in acute geriatric psychiatry: study protocol for a randomized controlled trial.

BACKGROUND: Major depression is one of the main mental illnesses in old age, with acute exacerbated episodes requiring treatment in geriatric psychiatry. A meta-analysis showed that aerobic exercise in moderate intensity has large effects in older adults with major depression, but there is no evidence of aerobic exercise in geriatric psychiatry. Therefore, this study aims to analyze the feasibility and effects of an ergometer-based aerobic exercise on depressive symptoms. METHODS: A single-center randomized controlled trial will be conducted in an acute geriatric psychiatric hospital. Inpatients allocated to the intervention group will receive a 2-week aerobic ergometer program. The control group will receive seated flexibility exercise in addition to usual care. The overall effects on the patients' depressive symptoms will be measured by clinical global impression of change (CGI) as the primary outcome. Changes in depressive symptom domains, physical (in)activity, and aerobic performance as well as the dosage of applied antidepressants will be examined as secondary outcomes. DISCUSSION: This short-term aerobic exercise program is expected to decrease depressive symptoms in acute exacerbated periods in older adults. The results may increase the evidence for implementing physical activity interventions in acute hospital settings. The disease-related motivation for exercise in acute exacerbated depressive periods will be the most challenging aspect. The treatment of depression requires new cost-effective approaches, especially in acute geriatric psychiatry with potential benefits for patients, family members, and clinicians. TRIAL REGISTRATION: German Clinical Trial Register ID: DRKS00026117 TRIAL STATUS: Protocol Version 1.2 dated February 23, 2022. By February 23, 2022, the trial had recruited a total of 15 participants in two wards at the Department of Geriatric Psychiatry at the LVR-Hospital Cologne. Recruitment started on November 12, 2021. The recruitment is expected to continue for at least 12 months.

Post-discharge Mortality in Patients With Delirium and Dementia: A 3-Year Follow Up Study.

Background: Delirium and dementia are prominent psychiatric diseases in old age and connected with poor outcomes for people affected. Nevertheless, there is a lack of knowledge concerning the long-term prognosis of patients with dementia and delirium. This study analyzes mortality, readmission rates and discharge destinations of patients with dementia or delirium superimposed on dementia (DSD) within 3 years after discharge from hospital. Methods: A cross-sectional, monocentric cohort study was conducted at the department of geriatric psychiatry of the LVR hospital cologne, using structured telephone interviews and analyses from the clinical information system. All patients with dementia and DSD, admitted between December 2014 and November 2015, were screened for eligibility. Results: In total, 113 patients were included, 49 patients with dementia (M 80 years, female 49%) and 64 with DSD (M 82 years, female 47%). Three years after discharge, 66 patients (58%) had died (95% CI 91.9-112.5; p = 0.53). Within the first 3 months, 9 patients (14%) with DSD deceased, but no patient from the dementia group (95% CI 11.3-12.7; p = 0.01). Out of all patients, 17 patients were readmitted and nursing homes were the predominant discharge destination (55%). Conclusions: This analysis revealed a high post-discharge mortality rate of patients with dementia and DSD. For patients with DSD, a close clinical monitoring, mainly within the first 3 months after discharge, should challenge the significantly increased acute-mortality. These findings should set the pattern for a comprehensive analysis of long-term effects of dementia and DSD. More studies are required for better understanding and comparability in this field of research and healthcare.

Quantifying Circadian Aspects of Mobility-Related Behavior in Older Adults by Body-Worn Sensors-An "Active Period Analysis".

Disruptions of circadian motor behavior cause a significant burden for older adults as well as their caregivers and often lead to institutionalization. This cross-sectional study investigates the association between mobility-related behavior and subjectively rated circadian chronotypes in healthy older adults. The physical activity of 81 community-dwelling older adults was measured over seven consecutive days and nights using lower-back-worn hybrid motion sensors (MM+) and wrist-worn actigraphs (MW8). A 30-min and 120-min active period for the highest number of steps (MM+) and activity counts (MW8) was derived for each day, respectively. Subjective chronotypes were classified by the Morningness-Eveningness Questionnaire into 40 (50%) morning types, 35 (43%) intermediate and six (7%) evening types. Analysis revealed significantly earlier starts for the 30-min active period (steps) in the morning types compared to the intermediate types (p ≤ 0.01) and the evening types (p ≤ 0.01). The 120-min active period (steps) showed significantly earlier starts in the morning types compared to the intermediate types (p ≤ 0.01) and the evening types (p = 0.02). The starting times of active periods determined from wrist-activity counts (MW8) did not reveal differences between the three chronotypes (p = 0.36 for the 30-min and p = 0.12 for the 120-min active period). The timing of mobility-related activity, i.e., periods with the highest number of steps measured by hybrid motion sensors, is associated to subjectively rated chronotypes in healthy older adults. The analysis of individual active periods may provide an innovative approach for early detecting and individually tailoring the treatment of circadian disruptions in aging and geriatric healthcare.

Quantifying Habitual Physical Activity and Sedentariness in Older Adults-Different Outcomes of Two Simultaneously Body-Worn Motion Sensor Approaches and a Self-Estimation.

Applicable and accurate assessment methods are required for a clinically relevant quantification of habitual physical activity (PA) levels and sedentariness in older adults. The aim of this study is to compare habitual PA and sedentariness, as assessed with 1) a wrist-worn actigraph, 2) a hybrid motion sensor attached to the lower back, and 3) a self-estimation based on a questionnaire. Over the course of one week, PA of 58 community-dwelling subjectively healthy older adults was recorded. The results indicate that actigraphy overestimates the PA levels in older adults, whereas sedentariness is underestimated when compared to the hybrid motion sensor approach. Significantly longer durations (hh:mm/day) for all PA intensities were assessed with the actigraph (light: 04:19; moderate to vigorous: 05:08) when compared to the durations (hh:mm/day) that were assessed with the hybrid motion sensor (light: 01:24; moderate to vigorous: 02:21) and the self-estimated durations (hh:mm/day) (light: 02:33; moderate to vigorous: 03:04). Actigraphy-assessed durations of sedentariness (14:32 hh:mm/day) were significantly shorter when compared to the durations assessed with the hybrid motion sensor (20:15 hh:mm/day). Self-estimated duration of light intensity was significantly shorter when compared to the results of the hybrid motion sensor. The results of the present study highlight the importance of an accurate quantification of habitual PA levels and sedentariness in older adults. The use of hybrid motion sensors can offer important insights into the PA levels and PA types (e.g., sitting, lying) and it can increase the knowledge about mobility-related PA and patterns of sedentariness, while actigraphy appears to be not recommendable for this purpose.

Assessment of Functional Performance in Acute Geriatric Psychiatry - Time for New Strategies?

OBJECTIVES: The aim of this study was to investigate the feasibility and reliability of functional performance tests in people living with dementia and depression. METHOD: A cross-sectional study was conducted in a geriatric psychiatry hospital. People living with dementia, depression, and healthy older adults were included. Feasibility of the timed up and go test (TUG), the short physical performance battery (SPPB), and the multisurface obstacle test for older adults (MSOT) was assessed based on valid test executions. Test-retest reliability was evaluated by mean difference (MD), coefficient of variation (CV), standardized MD, intraclass correlation coefficient (ICC), and correlation coefficient (rs). RESULTS: A total of 53 people in acute geriatric psychiatry and 21 healthy older adults were included. In people living with dementia (n = 23), feasibility was 65.2% (MSOT), 8.7% (TUG), and 8.7% (SPPB). In people living with depression (n = 30), feasibility was 83.3% (MSOT), 80.0% (TUG), and 46.7% (SPPB). Intraclass correlation coefficients and rs for the MSOT were high (ICC > 0.70) in both groups. Coefficient of variations of the MSOT were between 10.7% and 18.0% (dementia) and 7.1% and 17.0% (depression). Reliability of the TUG and SPPB was not analyzed in people living with dementia, due to low feasibility. In people living with depression, ICCs and rs were between 0.86 and 0.87 with CVs of 7.2% (TUG) and 0.69 and 0.95 with CVs of 7.8% and 15.1% (SPPB). CONCLUSION: Feasibility and reliability of established functional performance tests in acute geriatric psychiatry are limited, especially in people living with dementia. New strategies, for example, sensor-based approaches, may allow measurement of functional performance apart from standardized instruction-based test procedures in this clinical population.

Assessing Older Adults' Daily Mobility: A Comparison of GPS-Derived and Self-Reported Mobility Indicators.

Interest in global positioning system (GPS)-based mobility assessment for health and aging research is growing, and with it the demand for validated GPS-based mobility indicators. Time out of home (TOH) and number of activity locations (#ALs) are two indicators that are often derived from GPS data, despite lacking consensus regarding thresholds to be used to extract those as well as limited knowledge about their validity. Using 7 days of GPS and diary data of 35 older adults, we make the following three main contributions. First, we perform a sensitivity analysis to investigate how using spatial and temporal thresholds to compute TOH and #ALs affects the agreement between self-reported and GPS-based indicators. Second, we show how daily self-reported and GPS-derived mobility indicators are compared. Third, we explore whether the type and duration of self-reported activity events are related to the degree of correspondence between reported and GPS event. Highest indicator agreement was found for temporal interpolation (Tmax) of up to 5 h for both indicators, a radius (Dmax) to delineate home between 100 and 200 m for TOH, and for #ALs a spatial extent (Dmax) between 125 and 200 m, and temporal extent (Tmin) between 5 and 6 min to define an activity location. High agreement between self-reported and GPS-based indicators is obtained for TOH and moderate agreement for #ALs. While reported event type and duration impact on whether a reported event has a matching GPS event, indoor and outdoor events are detected at equal proportions. This work will help future studies to choose optimal threshold settings and will provide knowledge about the validity of mobility indicators.

Trunk Muscle Activation During Dynamic Sling Training Exercises.

The purpose of this study was to examine the level of trunk muscle activation to characterize different dynamic sling training exercises. Thirty-six young adults (25±3 years, 1.78±0.1 m, 71.5±10.4 kg) performed six different sling training exercises while muscle activation of eight different trunk muscles was measured unilaterally by surface electrodes. Four of the exercises were conducted at two different difficulty levels (an easy and a hard version) by changing the body angle. The six sling training exercises differed regarding muscle activation, with significant differences (p< 0.05) between the three body parts (front, side, back). High muscle activations (76-87%) of the (front) trunk flexor muscles were measured. The back muscles tested reached more than half of their peak reference trial values only during one exercise tested. Regarding the side muscles, three of the sling exercises achieved muscle activations of 60% and higher (66-92%). All eight trunk muscles tested demonstrated a significantly (p< 0.05) higher muscle activation in the harder version compared with the easy version. Based on the results, the sling training exercises tested in this study seem to be most effective for the abdominal muscles. As assumed based on the former literature, changing the body angle during sling training exercises is shown to be a feasible way of adjusting the intensity of sling training. This could potentially be used in longitudinal sling training studies to assure a controlled, progressively increasing training intervention.