Participation in Physical, Cognitive, and Social Activities and the Association with Mobility Disability Transitions in Older Adults.

Development of late-life mobility disability is a dynamic process of transitions between worsening and improving. We tested associations between participation in physical, social, and cognitive activity with mobility disability transitions. Participants (N=2,758, age 78.1 years [SD: 7.7]) from two Rush Alzheimer's Disease Center cohorts completed annual mobility disability questionnaires for 7.6 (SD: 4.4) years. First-order Markov transition models tested associations between baseline self-reported physical, social, and cognitive activity with bidirectional transitions in mobility disability score increases (worsening) and decreases (improving) between consecutive visits. Overall, 75.5% of participants experienced ≥1 transition among 18,318 pairs of consecutive visits-4,174 of which were worsening and 2,606 were improving transitions. Adjusting for covariates, higher participation in each activity type was associated with lower odds of worsening (physical OR=0.71, 95% CI: 0.67-0.75; social OR=0.64, 95% CI: 0.58-0.70; and cognitive OR=0.79, 95% CI: 0.74-0.85), and higher odds of improving (physical OR=1.20, 95% CI: 1.11-1.28; social OR=1.45, 95% CI: 1.30-1.61; and cognitive OR=1.12, 95% CI: 1.03-1.22) in separate models. In combined models, physical and social activity remained associated with worsening and improving; cognitive activity was only associated with worsening. Physical, social, and cognitive activity engagement contributes to lower odds of worsening mobility disability and may promote recovery.

Separate and combined associations of cognitive impairment and body pain with functional and mobility disabilities among older women and men in India.

This study examined the separate and combined associations of cognitive impairment and body pain with functional and mobility disabilities (FMDs) among older women and men in India. Multivariable linear regression models were applied using data from the Longitudinal Aging Study in India (2017-18) comprising 31,464 adults aged 60+. Older adults with cognitive impairment and pain reported higher levels of FMDs than peers without any pain and cognitive impairment. The likelihood of FMDs was significantly greater among older Indians enduring both cognitive impairment and pain (p < 0.05). Moreover, the association between cognitive impairment and functional disability was noticeably stronger in older women, particularly those with frequent pain, while the link between cognitive impairment and mobility disability was more pronounced in men with pain. Integrated cognitive rehabilitation and pain management programs, along with guided physical therapy, gender-specific support groups, and community-based health promotion activities, should be considered to reduce FMDs in older Indians.

Social vulnerability and new mobility disability among adults with polymerase chain reaction (PCR)-confirmed SARS-CoV-2: Michigan COVID-19 Recovery Surveillance Study.

OBJECTIVE: Understanding the relationship between social factors and persistent COVID-19 health outcomes, such as onset of a disability after a SARS-CoV-2 (the virus that causes COVID-19) infection, is an increasingly important public health issue. The purpose of this paper is to examine associations between social vulnerability and new onset of a mobility disability post-COVID-19 diagnosis. METHODS: We used data from the Michigan COVID-19 Recovery Surveillance Study, a population-based probability survey of adults with PCR-confirmed SARS-CoV-2 infection in Michigan between January 2020-May 2022 (n = 4295). We used the Minority Health Social Vulnerability Index (MHSVI), with high county-level social vulnerability defined at or above the 75th percentile. Mobility disability was defined as new difficulty walking or climbing stairs. We regressed mobility disability on the overall MHSVI, as well as sub-themes of the index (socioeconomic status, household composition/disability, minority and language, housing type, healthcare access, and medical vulnerability), using multivariable logistic regression, adjusting for age, race, sex, education, employment, and income. RESULTS: Living in a county with high (vs. low) social vulnerability was associated with 1.38 times higher odds (95% confidence interval [CI]:1.18-1.61) of reporting a new mobility disability after a COVID-19 diagnosis after adjustment. Similar results were observed for the socioeconomic status and household composition/disability sub-themes. In contrast, residents of highly racially diverse counties had lower odds (odds ratio 0.74, 95% CI: 0.61, 0.89) of reporting a new mobility disability compared to low diversity counties. CONCLUSIONS: Mitigating the effects of social vulnerabilities requires additional resources and attention to support affected individuals.

Comparison of healthspan-related indicators between adults with and without HIV infection aged 18-59 in the United States: a secondary analysis of NAHNES 1999-March 2020.

BACKGROUND: As persons with HIV (PWH) live longer they may experience a heightened burden of poor health. However, few studies have characterized the multi-dimentional health of PWH. Thus, we aimed to identify the extent and pattern of health disparities, both within HIV infection status and across age (or sex) specific groups. METHODS: We used cross-sectional data from the US National Health and Nutrition Examination Survey, 1999-March 2020. The adjusted prevalence of six healthspan-related indicators-physical frailty, activities of daily living (ADL) disability, mobility disability, depression, multimorbidity, and all-cause death-was evaluated. Logistic regression and Cox proportional hazards analyses were used to investigate associations between HIV status and healthspan-related indicators, with adjustment for individual-level demographic characteristics and risk behaviors. RESULTS: The analytic sample consisted of 33 200 adults (170 (0.51%) were PWH) aged 18-59 years in the United States. The mean (interquartile range) age was 35.1 (25.0-44.0) years, and 49.4% were male. PWH had higher adjusted prevalences for all of the 6 healthspan-related indicators, as compared to those without HIV, ranged from 17.4% (95% CI: 17.4%, 17.5%) vs. 2.7% (95%CI: 2.7%, 2.7%) for all-cause mortality, to 84.3% (95% CI: 84.0%, 84.5%) vs. 69.8% (95%CI: 69.7%, 69.8%) for mobility disability. While the prevalence difference was largest in ADL disability (23.4% (95% CI: 23.2%, 23.7%); P < 0.001), and least in multimorbidity (6.9% (95% CI: 6.8%, 7.0%); P < 0.001). Generally, the differences in prevalence by HIV status were greater in 50-59 years group than those in 18-29 group. Males with HIV suffered higher prevalence of depression and multimorbidity, while females with HIV were more vulnerable to functional limitation and disabilities. HIV infection was associated with higher odds for 3 of the 6 healthspan-related indicators after fully adjusted, such as physical frailty and depression. Sensitivity analyses did not change the health differences between adults with and without HIV infection. CONCLUSIONS: In a large sample of U.S. community-dwelling adults, by identifying the extent and pattern of health disparities, we characterized the multi-dimentional health of PWHs, providing important public health implications for public policy that aims to improve health of persons with HIV and further reduce these disparities.

Implications of Physical Access Barriers for Breast Cancer Diagnosis and Treatment in Women with Mobility Disability.

Objective: More than 30 years since enactment of the Americans with Disabilities Act, people with disability continue to face physical access barriers, notably inaccessible medical diagnostic equipment, in clinical settings. Access barriers affect breast cancer screening and treatment for women with disability. Methods: We used standard diagnosis codes and natural language processing to screen electronic health records (EHRs) in a digital data repository from a large healthcare delivery system for patients with pre-existing mobility disability diagnosed with breast cancer between 2005-2017. We reviewed EHRs of 20 patients, using conventional content analysis to examine breast cancer diagnosis and treatment experiences. Results: Clinicians noted challenges positioning patients for routine procedures including manual breast exam, screening mammography, and breast biopsies. Given challenges accommodating disability for adjuvant therapies, mastectomy was favored over breast-conserving options despite early stages of diagnosis. Notations contained little information about proactive problem-solving for arranging accommodations. Conclusions: Notations described physical access barriers for breast cancer detection and treatment, with limited planning for mitigating barriers. Despite 2017 promulgation of federal Standards for Accessible Medical Diagnostic Equipment, implementing these standards requires further rulemaking.

Perspectives of Patients with Pre-existing Mobility Disability on the Process of Diagnosing Their Cancer.

BACKGROUND: Mobility disability is the most common disability among adult Americans, estimated at 13.7% of the US population. Cancer prevalence is higher among people with mobility disability compared with the general population, yet people with disability experience disparities in cancer screening and treatment. OBJECTIVE: We explored experiences of patients with mobility disability with the process of cancer diagnosis. DESIGN: Open-ended individual interviews, which reached data saturation. Interviews were transcribed verbatim for conventional content analysis. PARTICIPANTS: We interviewed 20 participants with pre-existing mobility disability that required the use of an assistive device or assistance with performance of activities of daily living and who were subsequently diagnosed with cancer (excluding melanoma). KEY RESULTS: Concerns coalesced around five broad categories: inaccessibility of medical diagnostic equipment affecting the process of cancer diagnosis, attitudes of clinical staff about accommodating disability, dismissal of cancer signs/symptoms as emotional responses to chronic health conditions, misattributing cancer signs/symptoms to underlying disability, and attitudes about pursuing legal action for substandard care. Participants provided examples of how erroneous assumptions and potentially biased attitudes among clinicians interfered with the process of their cancer diagnosis, sometimes contributing to an insufficient workup and diagnostic delays. CONCLUSIONS: Physical and attitudinal barriers affect the process of cancer diagnosis in people with mobility disability. Though people with mobility disability may be clinically complex, clinicians should be aware of the risks of diagnostic overshadowing (i.e., the misattribution of cancer signs/symptoms to underlying disability) and other erroneous assumptions that may affect timeliness of cancer diagnosis and quality of care. Further efforts, including educating clinicians about challenges in caring for persons with disability, should be considered to improve the process of cancer diagnosis for this population. TRIAL REGISTRATION: N/A.

Physical activity recommendation by health care providers to adults with and without functional limitations.

Adults with functional limitations are more likely to be physically inactive than those without functional limitations, despite evidence that regular physical activity (PA) slows the progression of functional decline. The health care setting provides an opportunity to communicate with patients about positive behavior changes, including increased PA, but there is little information about provider recommendation for PA to adults with functional limitations. This study investigated health care provider recommendation to increase PA among adults with and without functional limitations. Adults (≥18 years) who participated in the 2016 National Health Interview Survey and reported ≥1 primary care encounter within the previous 12 months were included (unweighted n = 23,540; weighted N = 170,004,764). Receipt of PA recommendation and physical functioning limitations were self-reported. Statistical analyses were weighted to account for complex survey sampling design. One-third (35.88%) of adults received a PA recommendation and 19.71% reported functional limitations. Adults who received a PA recommendation were more likely to have a functional limitation than those who did not (28.64% vs. 14.70%; p < 0.001), even after adjusting for covariates and current activity level (aOR = 1.48; 95% CI:1.33,1.65). PA recommendation for those with functional limitations appeared to increase during middle age and peak for adults aged 65-75 years (57.01%) but declined substantially for adults ≥75 years. Only one-third of adults in the United States received PA recommendations. Health care providers recommended PA to approximately half of adults with functional limitations. Continued efforts to leverage health care encounters for behavior change should be explored, particularly for middle aged and older adults.

Visceral fat area is the measure of obesity best associated with mobility disability in community dwelling oldest-old Chinese adults.

BACKGROUND: Although obesity can be clinically defined by body mass index (BMI), waist circumference, percent body fat, or visceral fat area, it is unclear which specific measure is best associated with mobility disability in oldest-old adults. METHODS: Among 589 Chinese participants aged 85 years and older in a population-based cohort in Singapore, we measured waist circumference, computed BMI, estimated appendicular skeletal muscle mass, percent body fat, and visceral fat area using bioelectrical impedance analysis, and evaluated mobility disability using the Loco-Check questionnaire. We computed areas under the receiver operating characteristic curves (AUCROC) to compare how well these measures discriminated between those with and without mobility disability. Logistic regression models were used to estimate the odds ratios (OR) and 95% confidence intervals (CI) for the associations between obesity defined by these measures and mobility disability. RESULTS: Compared to BMI, which had an AUCROC (95% CI) of 0.68 (0.64-0.72) for the discrimination of mobility disability, only visceral fat area had a significantly higher discriminative performance [AUCROC (95% CI) of 0.71 (0.67-0.75) (Padjusted = 0.002)]. The optimal cut-offs of visceral fat area for the discrimination of mobility disability were ≥ 104 cm2 in men and ≥ 137 cm2 in women. In fully adjusted models, only obesity defined by visceral fat area was significantly associated with mobility disability [OR (95% CI) of 2.04 (1.10-3.77)]; obesity defined by the other measures were not associated with mobility disability after adjusting for visceral fat. CONCLUSION: In oldest-old adults, visceral fat area was the best discriminator for obesity associated with mobility disability.

Risk Factors for Mobility Decline in Community-Dwelling Older Adults: A Systematic Literature Review.

Mobility is essential to maintaining independence for older adults. This systematic review aimed to summarize evidence about self-reported risk factors for self-reported mobility decline; and to provide an overview of published prognostic models for self-reported mobility decline among community-dwelling older adults. Databases were searched from inception to June 2, 2020. Studies were screened by two independent reviewers who extracted data and assessed study quality. Sixty-one studies (45,187 participants) were included, providing information on 107 risk factors. High-quality evidence and moderate/large effect sizes for the association with mobility decline were found for older age beyond 75 years, the presence of widespread pain, and mobility modifications. Moderate-high quality evidence and small effect sizes were found for a further 21 factors. Three model development studies demonstrated acceptable model performance, limited by high risk of bias. These findings should be considered in intervention development, and in developing a prediction instrument for practical application.

Association of changes in cardiorespiratory fitness with health-related quality of life in young adults with mobility disability: secondary analysis of a randomized controlled trial of mobile app versus supervised training.

BACKGROUND: Young adults with mobility disability report lower health-related quality of life (HRQoL) than their able-bodied peers. This study aims to examine potential differences between the effects of mobile app versus supervised training and the association of cardiorespiratory fitness change with HRQoL in young adults with mobility disability. METHODS: This is a secondary analysis of a parallel randomized controlled trial of a mobile app (n = 55) and a supervised health program (n = 55) that was provided for 12 weeks to 110 adults (18-45 years) with self-perceived mobility disability. Recruitment took place at rehabilitation centers in Stockholm, Sweden. Cardiorespiratory fitness was estimated from the results of a submaximal cycle ergometer test and HRQoL was assessed with the SF-36 questionnaire. Follow up was at 6 weeks, 12 weeks, and 1-year and all examinations were performed by blinded investigators. Between group differences of changes in HRQoL at follow up were estimated in intention-to-treat analysis using linear regression models. Crude and adjusted mixed-effects models estimated the associations between cardiorespiratory fitness change and HRQoL. Stratified analysis by intervention group was also performed. RESULTS: In total, 40/55 from the mobile app group and 49/55 from the supervised training group were included in the intention to treat analysis. No significant differences were observed between the effects of the two interventions on HRQoL. In both crude and adjusted models, cardiorespiratory fitness change was associated with the general health (adjusted ß = 1.30, 95% CI: 0.48, 2.13) and emotional role functioning (adjusted ß = 1.18, 95% CI: 0.11, 2.25) domains of SF-36. After stratification, the associations with general health (adjusted ß = 1.88, 95% CI: 0.87, 2.90) and emotional role functioning (adjusted ß = 1.37, 95% CI: 0.18, 2.57) were present only in the supervised group. CONCLUSION: This study found positive associations between cardiorespiratory fitness change and HRQoL in young adults with mobility disability who received supervised training. The effects of mobile app versus supervised training on HRQoL remain unclear. TRIAL REGISTRATION: International Standard Randomized Controlled Trial Number (ISRCTN) registry ISRCTN22387524 ; Prospectively registered on February 4th, 2018.

Incident Mobility Disability, Mild Cognitive Impairment, and Mortality in Community-Dwelling Older Adults.

BACKGROUND/AIMS: Mobility disability and mild cognitive impairment (MCI) are common in aging and both are associated with risk of death. This study tested the hypothesis that risk of death differs by the order in which mobility disability and MCI occurred. METHODS: One thousand two hundred and sixty-two community-dwelling older adults were unimpaired at baseline and followed annually. Mobility disability was based on measured gait speed, and MCI was based on cognitive performance tests. A multistate Cox model simultaneously examined incidences of mobility disability and MCI to determine whether the order of their occurrence is differentially associated with risk of death. RESULTS: The average age was 75.3 years and 70% were female. While mobility disability occurred more frequently than incident MCI, the subsequent risk of death was higher in participants who developed MCI alone compared to those who developed mobility disability alone (hazard ratio [HR] 1.70, p = 0.018). Of the participants who initially developed mobility disability, about half subsequently developed MCI that doubled their risk of death (HR 2.17, p < 0.001). By contrast, over two-third who developed MCI subsequently developed mobility disability, which did not further increase their risk of death. CONCLUSION: Mobility disability occurs more frequently in community-dwelling older adults, but MCI is more strongly associated with mortality.

To initiate the conversation - Public health nurses' experiences of working with obesity in persons with mobility disability.

AIM: Developing a theory explaining how public health nurses accomplish and adapt counselling in lifestyle habits to decrease obesity in people with mobility disability. DESIGN: Empirical research - qualitative. METHOD: Classic grounded theory with face-to-face interviews, 2017-2018, using inductive approach to understand public health nurses' intervening experiences with obesity patients. RESULTS: To initiate the conversation emerged as the main concern meaning having difficulties initiating conversations about obesity with patients. Public health nurses' facilitators to communicate lifestyle changes emerged as the pattern generating the theory, which consists of the categories; person-centeredness in the situation, experience and knowledge, strengthening conditions, access to other professionals and prioritization in everyday work. CONCLUSIONS: Public health nurses hesitate to raise topics of obesity in patients with mobility disability. They advocate increased integration with lifestyle changes in everyday work including multi-professional cooperation. The implication is testing the emerged theory at primary health care centres. IMPACT: Obesity is more common in people with mobility disability than in those without. There is a need to understand how public health nurses adapt counselling in lifestyle habits. Public health nurses hesitate to talk about obesity with patients in fear of offending anyone. Public health nurses did not distinguish between patients with or without mobility disability. Several facilitators could be helpful initiating conversation with the patients. Public health nurses need more time and resources to facilitate conversation with patients with mobility disability to counsel lifestyle changes.

The effect of intervening hospitalizations on the benefit of structured physical activity in promoting independent mobility among community-living older persons: secondary analysis of a randomized controlled trial.

BACKGROUND: Among older persons, disability is often precipitated by intervening illnesses and injuries leading to hospitalization. In the Lifestyle Interventions and Independence for Elders (LIFE) Study, a structured moderate-intensity physical activity program, compared with a health education program, was shown to significantly reduce the amount of time spent with major mobility disability (MMD) over the course of 3.5 years. We aimed to determine whether the benefit of the physical activity program in promoting independent mobility was diminished in the setting of intervening hospitalizations. METHODS: We analyzed data from a single-blinded, parallel group randomized trial (ClinicalTrials.gov: NCT01072500). In this trial, 1635 sedentary persons, aged 70-89 years, who had functional limitations but were able to walk 400 m, were randomized from eight US centers between February 2010 and December 2013: 818 to physical activity (800 received intervention) and 817 to health education (805 received intervention). Intervening hospitalizations and MMD, defined as the inability to walk 400 m, were assessed every 6 months for up to 3.5 years. RESULTS: For both the physical activity and health education groups, intervening hospitalizations were strongly associated with the initial onset of MMD and inversely associated with recovery from MMD, defined as a transition from initial MMD onset to no MMD. The benefit of the physical activity intervention did not differ significantly based on hospital exposure. For onset of MMD, the hazard ratios (HR) were 0.79 (95% confidence interval [CI] 0.58-1.1) and 0.77 (0.62-0.95) in the presence and absence of intervening hospitalizations, respectively (P-interaction, 0.903). For recovery of MMD, the magnitude of effect was modestly greater among participants who were hospitalized (HR 1.5, 95% CI 0.71-3.0) than in those who were not hospitalized (HR 1.2, 95% CI 0.88-1.7), but this difference did not achieve statistical significance (P-interaction, 0.670). CONCLUSIONS: Intervening hospitalizations had strong deleterious effects on the onset of MMD and recovery from MMD, but did not diminish the beneficial effect of the LIFE physical activity intervention in promoting independent mobility. To achieve sustained benefits over time, structured physical activity programs should be designed to accommodate acute illnesses and injuries leading to hospitalizations given their high frequency in older persons with functional limitations. TRIAL REGISTRATION: ClinicalTrials.gov identifier NCT01072500 .

Towards a postponement of activities of daily living dependence and mobility limitations: Trends in healthy life years in old age in Sweden.

AIMS: To investigate the development of healthy life expectancy from 65 years (HLE65) in Sweden in the period 1980-2011 using the health indicators activities of daily living (ADL) and mobility limitations within the framework of the postponement, compression and expansion theories. METHODS: Sources of data for the HLE computations were Swedish national mortality statistics and the nationwide Swedish Surveys of Living Conditions, conducted biennially by Statistics Sweden since 1974. We used the Sullivan method for calculations of HLE and a decomposition into mortality and disability effects was made. RESULTS: Life expectancy at age 65 (LE65) increased by 3.1 years for women and 4.0 years for men from 1980-1985 to 2006-2011. HLE65 calculated according to ADL and mobility limitations increased more rapidly than LE65 for both men and women ( p<0.05). CONCLUSIONS: Our results for trends in the Swedish LE65 and HLE65, computed on the basis of ADL and mobility limitations and using the Swedish Surveys of Living Conditions study, are in line with the postponement hypothesis and there is also a tendency for compression. Thus the years with ADL dependence and mobility limitations are postponed to a higher age and the numbers of these years have decreased.

The association of mobility disability, weight status and job strain: A cross-sectional study.

AIMS: The study investigated whether people with mobility disability (MD) and/or obesity had higher job strain than people without it, and whether social support at work modifies this association. METHODS: The study included 35,160 individuals (25-64 years of age) from the Stockholm Public Health Surveys of 2006 and 2010. Data on MD and obesity (BMI ⩾ 30 kg/m(2)calculated from weight (kg) and height (m)) were self-reported. According to the Demand-Control-Support theory job strain, collective strain, and isolated strain were calculated for six groups of people based on the presence of MD and obesity, using the subtraction approach (demand minus control). Differences in job strain mean scores were estimated by multivariate linear regression. Social support at work was analyzed as a potential effect modifier (high/low). RESULTS: Obese people with MD had the highest job strain (ß = 0.92, 95% CI 0.64-1.19), compared to normal weight people without MD (reference group). We found that social support at work significantly (p<0.001) modifies the association between job strain, MD and obesity. Obese people with MD had the highest isolated strain (ß = 2.92, 95% CI 2.52-3.31), and the highest collective strain, although of smaller magnitude (ß = 0.34, 95% CI 0.05-0.63), compared to the reference group. CONCLUSIONS: Obese people with MD perceive higher job strain than non-disabled people of normal weight. Strategies aiming to increase the social support at work may be important for this group of people to prevent them from experiencing unhealthy job strain.

Socio-demographic risk factors of mobility dysfunction and limitations in physical functioning disability among the elderly in Iran: A nationwide cross sectional survey.

OBJECTIVE: To examine self-reported mobility and limitation in physical functioning among the elderly and associated socio-demographic risk factors. METHODS: The population-based cross-sectional study was conducted from January 2012 to January 2013 and comprised subjects from five provinces of Iran. The variables were measured using a questionnaire. Self-reported mobility disability and physical functioning disability were defined as having no problems in daily activities and physical tasks. Logistic regression was used to calculate the odds ratio for association of socio-demographic risk factors and outcomes. RESULTS: Of the 1325 subjects, 636(48%) were men. The overall mean age was 69.14±7.37 years. Prevalence of mobility disability and limitation in physical functioning was 401(63%) and 553(87%) in men, and 524(76%) and 641(93%) in women. There was a significant association between mobility disability and family composition and satisfaction with financial situation and housing tenure in both genders (p<0.05 each). Physical functioning had a significant relationship with family composition, and satisfaction with financial situations and housing tenure in men and women and population density in men and marital status in women (p<0.05 each). CONCLUSIONS: The elderly had a high risk of disability. Social factors had more association with mobility disability and limitation in physical functioning and required specific social support.

What would Darwin say? A historical perspective on the next steps in developing a rehabilitation classification system.

This article uses a historical framework to review the rehabilitation treatment taxonomy (RTT). The needs and challenges in creating a comprehensive classification system for rehabilitation treatments are identified based on review of (1) the development of other biological classification systems and (2) the historical foundations for rehabilitation and related theoretical underpinnings. The historical overview is used to identify needs for refining the RTT, including (1) changes needed in the structure of the RTT to address the varied roles of environmental factors in the rehabilitation treatment process, (2) changes needed to link the RTT with clinical documentation and third-party reimbursement, and (3) revisions in the nomenclature for the RTT to enhance clear communication. Finally, challenges with the next steps in developing a comprehensive classification system for rehabilitation are discussed, including (1) the complexity needed to classify a dynamic process and to account for the agents, mechanisms, and objects targeted by that process and (2) the importance of a continued multidisciplinary approach to ensure a classification system that will be broadly useful for a highly diverse and rapidly evolving field.

Prognostic factors in mobility disability among elderly patients in the emergency department: A single-center retrospective study.

Aim: We aimed to evaluate the clinical characteristics and outcomes of elderly critically ill patients and identify prognostic factors for mobility disability at discharge. Methods: This single-center, retrospective cohort study investigated the period from April 2020 to January 2021. Patients ≥75 years old transferred to our emergency department and admitted to the intensive care unit (ICU) or intermediate unit in our hospital were eligible. Demographics, clinical characteristics, nutritional indicators, and nutritional screening scores were collected from chart reviews and analyzed. The primary outcome was the prevalence of mobility disability, compared to that of no mobility disability. Results: A total of 124 patients were included in this present study. Median age was 83.0 years (interquartile range [IQR], 79.8-87.0 years) and 48 patients (38.7%) were female. Fifty-two patients (41.9%) could not walk independently at discharge (mobility disability group). The remaining 72 patients were in the no mobility disability group. Multiple logistic regression analyses revealed clinical frailty scale (CFS) score ≥5 (odds ratio [OR] = 6.63, 95% confidence interval [CI] = 2.51-17.52, p < 0.001), SOFA score ≥6 (OR = 6.11, 95% CI = 1.57-23.77, p = 0.009), and neurological disorder as the main cause on admission (OR = 4.48, 95% CI = 1.52-13.20, p = 0.006) were independent and significant prognostic factors for mobility disability at discharge. Conclusion: Among elderly patients admitted to the emergency department, CFS ≥5, SOFA ≥6, and neurological disorders were associated with mobility disability at hospital discharge.

Subjective Successful Aging in the Presence of Mobility Disability.

BACKGROUND AND OBJECTIVES: Researchers often define successful aging as freedom from disability and disease, yet the perceptions of older adults living with disability challenge this conception, demonstrating that they can indeed age successfully. This paper adapts a framework of successful aging with disability, basing it on the subjective assessment of key components contributing to success among older adults living with mobility disability due to multiple sclerosis. RESEARCH DESIGN AND METHODS: Employing a qualitative, theory-grounded methodology, we conducted semi-structured interviews with 20 individuals aged 60-75 who live with mobility disability attributed to multiple sclerosis. The open-ended questions explored their perspectives on the aging process, their definition of successful aging, and the coping strategies they employ in navigating challenges associated with age and their condition. RESULTS: Despite facing mobility disabilities, the majority (16 out of 20) expressed a sense of successful aging, identifying five key themes: accepting reality, maintaining a positive attitude, fostering independence, nurturing a social life, and preserving cognitive abilities. They achieved successful aging by focusing on alternatives, relying on external support, having a good attitude and faith, and accepting their challenges. DISCUSSION AND IMPLICATIONS: The themes identified in this research contribute to redefining successful aging in future studies and facilitating the development of interventions aimed at improving the quality of life for older adults coping with mobility disability.

Rationale and methodology for examining the combination of aerobic exercise and cognitive rehabilitation on new learning and memory in persons with multiple sclerosis and mobility disability: Protocol for a randomized controlled trial.

BACKGROUND: This paper describes the protocol for a Phase I/II, parallel-group, single-blind randomized controlled trial (RCT). The RCT investigates the combined effects of 12-weeks of aerobic exercise training (AET) integrated with virtual reality (VR) and cognitive rehabilitation (CR) on new learning and memory in 78 persons with multiple sclerosis (MS) who have mobility disability and objective impairments in learning and memory. METHODS: Participants will undergo baseline assessments consisting of neuropsychological testing, neuroimaging, self-report questionnaires, and cardiorespiratory fitness. Participants will then be randomized into one of two conditions using concealed allocation: aerobic cycling exercise that incorporates VR combined with CR or stretching and toning (i.e., active control; S/T) combined with CR. Participants will be masked regarding the intent of the conditions. After 7-weeks of exercise alone, the 5-week Kessler Foundation modified Story Memory Technique (KF-mSMT®) will be integrated into the training. After the 12-week training period, participants will complete the same measures as at baseline administered by treatment-blinded assessors. Primary study outcomes include new learning and memory (NLM) measured by a small battery of neuropsychological assessments that assess list learning (California Verbal Learning Test-II), prose memory (Memory Assessment Scale), visuospatial memory (Brief Visuospatial Memory Test-Revised), and everyday memory (Ecological Memory Simulations). Secondary study outcomes include neuroimaging outcomes of hippocampal structure, function, and connectivity. CONCLUSION: If successful, this trial will provide the first Class I evidence supporting the unique combination of aerobic cycling exercise with VR and CR for treating MS-related learning and memory impairments in persons with mobility disability.