Cognitive, physical and emotional determinants of activities of daily living in nursing home residents-a cross-sectional study within the PROCARE-project.

BACKGROUND: Interdependencies of health, fitness, cognition, and emotion can promote or inhibit mobility. This study aimed to analyse pathways and interactions between individual subjective and objective physical performance, cognition, and emotions with activities of daily living (ADLs) as mobility indicators in multimorbid nursing home residents. METHODS: The study included n = 448 (77.1% females, age = 84.1 ± 7.8 years) nursing home residents. To describe the participant's demographics, frailty, number of falls, and participating institutions' socioeconomic status (SES) were assessed. ADLs were measured with the Barthel Index (BI; dependent variable). Independent variables included objective physical performance, subjective physical performance, cognition, and emotions. A structural equation model (SEM) with maximum likelihood estimation was conducted with AMOS. Direct and indirect effects were estimated using standardized coefficients (significance level of 0.05). RESULTS: Indices showed (Chi2(148) = 217, PCMIN/DF = 1.47; p < .001; Comparative Fit Index = .940; Tucker Lewes Index = .902, RMSEA = .033) that the model fitted the data adequately. While there was no direct association between emotions, subjective physical performance, and ADLs, objective physical performance and cognition predicted higher ADLs (p < .01). Emotions had a strong relationship with subjective physical performance, and cognition had a moderate relationship with objective physical performance. DISCUSSION AND CONCLUSION: Objective performance and cognition predicted higher functional status, as expressed by higher BI scores. ADLs, such as mobility, dressing, or handling tasks, require motor and cognitive performance. Subjective performance is an important predictor of ADLs and is only partly explained by objective performance, but to a large extent also by emotions. Therefore, future interventions for nursing home residents should take a holistic approach that focuses not only on promoting objective physical and cognitive performance but also on emotions and perceived physical performance. TRIAL REGISTRATION: Trial registration number: DRKS00014957.

Health status, resources, and job demands in geriatric nursing staff: A cross-sectional study on determinants and relationships.

BACKGROUND: According to current estimates, the number of people needing care will double in the next 40 years. It is expected that between 130,000 and 190,000 additional nurses will be needed by 2030 in Germany. Physical and psychological burdens associated with nursing in long-term care facilities can develop into serious health risk factors and significantly impact occupational factors such as absenteeism, especially when linked to difficult working conditions. However, demands and resources specific to the nursing profession have not been analyzed extensively to preserve and promote nurses' workability and health adequately. OBJECTIVE: Our study aimed to examine the extent to which perceived health among geriatric nursing staff in Germany is predicted by personal resources, job demands, and job resources. In addition, we analyzed the impact of different behavior and experience patterns on these relationships. DESIGN, SETTING, AND PARTICIPANTS: An observational study was conducted between August 2018 and February 2020 in 48 nursing home facilities with 854 staff members in Germany as part of the project 'PROCARE - Prevention and occupational health in long-term care'. METHODS: The survey contained instruments that measure workplace exposure, musculoskeletal complaints, physical and mental well-being, chronic stress, and work-related behavior and experience patterns. In addition, health-related information on physical activity and nutrition was collected. Data were analyzed using structural equation modeling. RESULTS: The combined physical and mental workload for geriatric nurses is very high, with 75 % showing chronic stress. In the overall model, job and personal resources have a stronger association with mental health than physical health, while job demands have an equal impact on mental and physical health. Coping behavior also plays an important key role that should be assessed and considered. A behavior and experience risk pattern (health-endangering) is more strongly associated with a lower health status than a health-promoting behavior pattern. Results of the multigroup test showed that work-related behavior and experience patterns significantly moderate the relationship between physical health and mental health (χ2 = 392/p ≤ .001/df = 256/RMSEA = 0.028/CFI = 0.958/TLI = 0.931). Only 43 % show a health-friendly coping pattern. CONCLUSIONS: Our findings underline the importance of holistic health promotion, which not only aims at changes at the behavioral level and the development of coping strategies but also takes on the task of reducing the workload and including measures to improve the working climate. TRIAL REGISTRATION NUMBER: DRKS.de (DRKS00015241); August 9, 2018. TWEETABLE ABSTRACT: Healthier coping patterns can benefit geriatric nurses' health. However, this is not a substitute for improving working conditions.

The effects of visual impairment on motor imagery in children and adolescents.

BACKGROUND: While the development of motor imagery (MI) has been extensively studied in sighted children, it is not clear how children with different severities of visual impairment (VI) represent motor actions by using the motor representations constructed through the remaining intact senses, especially touch. AIMS: Mental chronometry and generation/manipulation of MI were examined in children with and without VI. METHODS AND PROCEDURES: Participants included 64 youth with and without VI (33 without visual impairments, 14 moderate-to-severe, and 17 blind). Mental chronometry was assessed with the imagined Timed-Up-and-Go-Test (iTUG), and generation/manipulation of MI with the Controllability-of-Motor-Imagery-Test (CMI). In addition, the effect of working memory performance (Letter-Number-Sequencing) and physical activity upon MI were evaluated. RESULTS: Mental duration for the iTUG was significantly shorter than the active durations. Results also provided evidence of better haptic representation than motor representation in all participants; however, only for the CMI-regeneration condition controls outperformed children with visual impairments and blindness (CVIB). Exercise and working memory performance showed a significant contribution only on a few MI tests. CONCLUSION AND IMPLICATIONS: Our results suggest a possible relationship between motor performance, body representation deficits and visual impairment which needs to be addressed in the evaluation and treatment of CVIB. The design of new rehabilitation interventions that focus on strengthening adequate body perception and representation should be proposed and tested to promote motor development in CVIB.

Motor imagery of body movements that can't be executed on Earth.

BACKGROUND: Before participating in a space mission, astronauts undergo parabolic-flight and underwater training to facilitate their subsequent adaptation to weightlessness. A quick, simple and inexpensive alternative could be training by motor imagery (MI). OBJECTIVE: An important prerequisite for this training approach is that humans are able to imagine movements which are unfamiliar, since they can't be performed in the presence of gravity. Our study addresses this prerequisite. METHODS: 68 young subjects completed a modified version of the CMI test (Schott, 2013). With eyes closed, subjects were asked to imagine moving their body according to six consecutive verbal instructions. After the sixth instruction, subjects opened their eyes and arranged the segments of a manikin into the assumed final body configuration. In a first condition, subjects received instructions only for moving individual body segments (CMIground). In a second condition, subjects received instructions for moving body segments or their full body (CMIfloat). After each condition, subjects were asked to rate their subjective visual and kinesthetic vividness of MI. RESULTS: Condition differences emerged for the CMI scores and for the duration of correct trials with better performance in the CMIground condition. Condition differences were also represented for the subjective MI performance. CONCLUSION: Motor imagery is possible but degraded when subjects are asked to imagine body movements while floating. This confirms that preflight training of MI while floating might be beneficial for astronauts' mission performance.

Motor imagery: lessons learned in movement science might be applicable for spaceflight.

Before participating in a space mission, astronauts undergo parabolic-flight and underwater training to facilitate their subsequent adaptation to weightlessness. Unfortunately, similar training methods can't be used to prepare re-adaptation to planetary gravity. Here, we propose a quick, simple and inexpensive approach that could be used to prepare astronauts both for the absence and for the renewed presence of gravity. This approach is based on motor imagery (MI), a process in which actions are produced in working memory without any overt output. Training protocols based on MI have repeatedly been shown to modify brain circuitry and to improve motor performance in healthy young adults, healthy seniors and stroke victims, and are routinely used to optimize performance of elite athletes. We propose to use similar protocols preflight, to prepare for weightlessness, and late inflight, to prepare for landing.

Age-related differences in motor imagery: working memory as a mediator.

UNLABELLED: BACKGROUND/STUDY CONTEXT: Although motor imagery is a well-established phenomenon in healthy younger adults, it seems necessary to determine if older adults are still able to accurately perform imagery tasks before investigating the application of motor imagery in rehabilitation. Therefore, the purpose of this study was to determine if there is a progressive decline in motor imagery performance with age. Furthermore, we wanted to verify whether the effects of age on motor imagery were due to (or mediated by) deficits of working memory. METHODS: This study examined the key characteristics of the motor imagery ability in three groups of healthy older men and women (60-69, 70-79, and ≥80 years; mean age M = 73.8, SD = 8.3) and 40 younger subjects aged 20 to 30 years (M = 28.87, SD = 2.5). Imagery ability was measured using the Movement Imagery Questionnaire (MIQ), the Controllability of Motor Imagery (CMI) test, and two different chronometry tests. To estimate the mediational effect of working memory on age differences in the imagery measures, we employed latent variable structural equation modeling (SEM). RESULTS: The main findings indicated that motor imagery ability (generation, visual and kinesthetic imagery ability, controllability, and temporal organization) were better in young adults compared with older adults 70 years and older, but not in older adults 60 to 69 years of age. The analysis of the mediational effect of working memory on age differences in the motor imagery measures showed that the inclusion of working memory increased the amount of explained variance in the MIQ (ΔR (2) = .03), in the CMI test (ΔR (2) = .15), as well as in the mental chronometry tests (ΔR (2) = .16) CONCLUSION: Our findings suggest that there is potential for motor imagery to be compromised in the older age ranges, which may limit motor imagery as a rehabilitative strategy in older and in cognitively impaired individuals.