Changing the focus: Facilitating engagement in physical activity for people living with mild dementia in a local community-Protocol for a pre-post mixed methods feasibility study.

This study aims to address and improve the low physical activity levels among people with mild dementia by implementing a novel shared decision-making and motivational support program, named "Changing the Focus". It will utilise a pre-post mixed methods approach, aiming to recruit 60 community living older people with mild dementia and their care-partners. The shared decision-making process will involve the person living with dementia, their care-partner, and a research therapist, using a purpose-designed discussion tool including factors such as preferred physical activities, health status, local opportunities and program accessibility. This process aims to identify personalised local physical activity opportunities. Participants will be supported with the help of a research therapist to engage in targeted community-based physical activities for 12-months, to progress towards the recommended physical activity guidelines of 150 minutes per week. The intervention provided by the research therapist will include three home visits (baseline, 6- and 12-months) and seven motivational support phone calls (within the first six months). Research therapists may provide additional home visits and support calls as needed. Primary outcomes include program participation (participants living with dementia continuing with the program after 12-months), total physical activity time per week (measured using the Active Australia Survey at baseline, 6- and 12- months) and program acceptability (assessed through semi-structured interviews with participants, care-partners, referrers, and physical activity providers). Secondary outcomes include physical performance, mental health, wellbeing measures, and impact on care-partners (evaluated through physical tests or validated scales at baseline, 6- and 12-months). Other implementation aspects include reach, maintenance, safety (falls, other adverse events) and an economic evaluation. Results will inform feasibility, potential benefits, and challenges associated with this innovative shared decision-making and supported physical activity program for people living with mild dementia. Findings will guide future large-scale studies and contribute to enhancing physical activity opportunities for this population.

Outcomes of the My Therapy self-management program in people admitted for rehabilitation: A stepped wedge cluster randomized clinical trial.

BACKGROUND: Self-management programs can increase the time spent on prescribed therapeutic exercises and activities in rehabilitation inpatients, which has been associated with better functional outcomes and shorter hospital stays. OBJECTIVES: To determine whether implementation of a self-management program ('My Therapy') improves functional independence relative to routine care in people admitted for physical rehabilitation. METHODS: This stepped wedge, cluster randomized trial was conducted over 54 weeks (9 periods of 6-week duration, April 2021 - April 2022) across 9 clusters (general rehabilitation wards) within 4 hospitals (Victoria, Australia). We included all adults (≥18 years) admitted for rehabilitation to participating wards. The intervention included routine care plus 'My Therapy', comprising a sub-set of exercises and activities from supervised sessions which could be performed safely, without supervision or assistance. The primary outcomes were the proportion of participants achieving a minimal clinically important difference (MCID) in the Functional Independence Measure, (FIM™) and change in total FIM™ score from admission to discharge. RESULTS: 2550 participants (62 % women) were recruited (control: n = 1458, intervention: n = 1092), with mean (SD) age 77 (13) years and 37 % orthopedic diagnosis. Under intervention conditions, participants reported a mean (SD) of 29 (21) minutes/day of self-directed therapy, compared to 4 (SD 14) minutes/day, under control conditions. There was no evidence of a difference between control and intervention conditions in the odds of achieving an MCID in FIM™ (adjusted odds ratio 0.93, 95 % CI 0.65 to 1.31), or in the change in FIM™ score (adjusted mean difference: -0.27 units, 95 % CI -2.67 to 2.13). CONCLUSIONS: My Therapy was delivered safely to a large, diverse sample of participants admitted for rehabilitation, with an increase in daily rehabilitation dosage. However, given the lack of difference in functional improvement with participation in My Therapy, self-management programs may need to be supplemented with other strategies to improve function in people admitted for rehabilitation. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ACTRN12621000313831), https://www.anzctr.org.au/.

Effects of a 6-month dual-task, power-based exercise program on cognitive function, neurological and inflammatory markers in older adults: secondary analysis of a cluster randomised controlled trial.

Functional power-based exercise training can improve physical performance in older adults and cognitive training can improve measures of cognition, but their combined effects on cognition and related risk factors (neurological and inflammatory markers) remains uncertain. This 6-month cluster randomised controlled trial evaluated the effectiveness of dual-task functional power training (DT-FPT) on cognition and circulating neurological and inflammatory markers in older adults at increased falls risk, and whether intervention responses varied by apolipoprotein-E (ApoE) and brain derived neurotrophic factor (BDNF) polymorphisms. Three hundred residents aged ≥ 65 years at increased falls risk residing in 22 independent-living retirement communities, were randomised by village, to DT-FPT (n = 156, 11 villages) involving a multi-component power-based training program performed simultaneously with cognitive and/or motor tasks (45-60 min, 2/week), or a usual care control (CON) group (n = 144, 11 villages). Cognition (computerized CogState battery), inflammatory cytokines, BDNF, insulin-like growth factor-1, vascular endothelial growth factor, amyloid ß (1-40) and (1-42) were assessed at baseline and 6-months. Overall, 233 (78%) participants completed the intervention and adherence averaged 50.1%. DT-FPT led to a net 0.18-0.20 SD benefit versus CON in psychomotor ability/attention and reaction time/attention (both P < 0.05). There were no significant intervention effects on circulating markers, except for a net 10.5% benefit in amyloid ß (1-40) in DT-FPT versus CON (P < 0.05). Responses were not influenced by APOE or BDNF genotype. In conclusion, DT-FPT in older adults at increased falls risk can provide some cognitive benefits, but these were not related to corresponding changes in inflammatory or neurological markers or influenced by genotype. Australian New Zealand Clinical Trials Registry (ACTRN12613001161718). http://www.anzctr.org.au/ This project was funded by a grant from the National Health and Medical Research Council (NHMRC) Project (APP1046267).

Results from the ENJOY MAP for HEALTH: a quasi experiment evaluating the impact of age-friendly outdoor exercise equipment to increase older people's park visitations and physical activity.

BACKGROUND: Recreational parks can play a significant role in older people's health, with emerging evidence suggesting that changes in the physical environment, such as refurbishments of local parks, can increase park visitations and physical activity engagement. The ENJOY MAP for HEALTH aimed to evaluate the impact of Seniors Exercise Park installations and associated capacity building activities on older people's park visitation, and park-based physical activity. METHOD: The ENJOY MAP for HEALTH was a quasi-experiment study design that involved the installation of specialised Seniors Exercise Park equipment as part of park refurbishment, supported by promotion and community capacity building activities in six municipalities in Victoria, Australia. Direct observations of park users took place prior to park upgrades, one-month post upgrade and 12-months from baseline. The overall number and characteristics of park visitors, and the type and level of physical activity undertaken, were summarised descriptively. Generalised linear models were used to examine the impact of park refurbishment (equipment installation and site activation) on the total number of older people observed in the park, and their engagement in physical activity, accounting for site and seasonal effects. RESULTS: Overall number of visits increased following park upgrades, with the largest number of visitors observed one-month post upgrade (n = 12,501). The proportion of older people observed at the parks remained relatively low prior to and one-month post upgrade compared to other age groups. However, after adjusting for site and seasonal effects, the number of older people observed in the parks increased significantly post upgrade and site activation compared to prior to the refurbishment (incidence rate ratios (IRR) 3.55; 95% CI 2.68, 4.70). The number of older people observed to be exercising at the Seniors Exercise Park also increased by 100% at 12-months post-installation relative to one-month post upgrade (IRR 2.00; 95% CI 1.26, 3.17). CONCLUSION: Installation of the Seniors Exercise Parks and the supportive programs and activities following six park upgrades resulted in an increase in older people's park visitation and engagement in physical activity. Community engagement and training of volunteers with the support of local governments are likely to contribute to the increased park usage by older people. TRIAL REGISTRATION: This trial was registered with the Australian New Zealand Clinical Trials Registry. Trial registration number ACTRN12621000965808. https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380745&isReview=true .

Multigenerational spaces: the usage and activities of different age groups within six community parks in Victoria, Australia.

BACKGROUND: This study investigated how different spaces within multigenerational local parks are being used by older people and other age groups. METHODS: Observation of park visitors occurred in six Victorian parks one month after park refurbishment. Parks were classified into six spaces based on equipment/amenities and associated expected activity. Observations were summarized descriptively, and negative binomial regression models were used to examine the association between visitor counts and classified targeted areas. RESULTS: A total of 12 501 people visited the parks with 4.1% older visitors. The number of older visitors in each park area was consistently less than other age groups, with counts of older visitors being 50% less in mixed spaces (95% confidence interval [CI] 0.38, 0.65), 40% less in adult exercise equipment areas (95% CI 0.46, 0.77) and 59% less in walking paths (95% CI 0.31, 0.55). The number of older visitors engaging in physical activity were significantly greater in walking paths (incidence rate ratios 1.75; 95% CI 1.16, 2.64) compared with children's play spaces. CONCLUSION: The number of visitors across different age groups varied significantly between the park targeted areas. Most spaces were mainly used by the intended target age group/user, with no particular area used by all age groups in similar proportions.

Self-management Programs Within Rehabilitation Yield Positive Health Outcomes at a Small Increased Cost Compared With Usual Care: A Systematic Review and Meta-analysis.

OBJECTIVE: To determine if self-management programs, supported by a health professional, in rehabilitation are cost effective. DATA SOURCES: Six databases were searched until December 2023. STUDY SELECTION: Randomized controlled trials with adults completing a supported self-management program while participating in rehabilitation or receiving health professional input in the hospital or community settings were included. Self-management programs were completed outside the structured, supervised therapy and health professional sessions. Included trials had a cost measure and an effectiveness outcome reported, such as health-related quality of life or function. Grading of Recommendations, Assessment, Development, and Evaluations was used to determine the certainty of evidence across trials included in each meta-analysis. Incremental cost-effectiveness ratios were calculated based on the mean difference from the meta-analyses of contributing health care costs and quality of life. DATA EXTRACTION: After application of the search strategy, two independent reviewers determined eligibility of identified literature, initially by reviewing the title and/or abstract before full-text review. Using a customized form, data were extracted by one reviewer and checked by a second reviewer. DATA SYNTHESIS: Forty-three trials were included, and 27 had data included in meta-analyses. Where self-management was a primary intervention, there was moderate certainty of a meaningful positive difference in quality-of-life utility index of 0.03 units (95% confidence interval, 0.01-0.06). The cost difference between self-management as the primary intervention and usual care (comprising usual intervention/therapy, minimal intervention [including education only], or no intervention) potentially favored the comparison group (mean difference=Australian dollar [AUD]90; 95% confidence interval, -AUD130 to AUD310). The cost per quality-adjusted life year (QALY) gained for self-management programs as a stand-alone intervention was AUD3000, which was below the acceptable willingness-to-pay threshold in Australia per QALY gained (AUD50,000/QALY gained). CONCLUSIONS: Self-management as an intervention is low cost and could improve health-related quality of life.

Physical Activity Levels and Sedentary Behavior of People Living With Mild Cognitive Impairment: A Cross-Sectional Study Using Thigh-Worn Accelerometers.

Community-dwelling people with Mild Cognitive Impairment self-reporting not to be meeting recommended physical activity levels participated in this study to (a) determine compliance of wearing (thigh-worn) accelerometers, (b) describe physical activity levels and sedentary behavior, and (c) determine the validity of the Physical Activity Scale for the Elderly (PASE) compared with activPAL accelerometers. A total of 79 people had valid accelerometer data (median [interquartile range]: age, 71 [54-75] years). Compliance was 86.81%. Participants were sedentary for 10.6 hr per day and engaged in a median of 9 min per day of moderate-intensity physical activity. Fair correlations were found between the PASE and total stepping time per day (r = .35, p < .01), total number of steps per day (r = .36, p < .01), and number of steps in stepping activities completed for ≤1 min (r = .42, p < .01). The PASE and Standing time (r = .04, p = .724) and PASE and Sitting time (r = .04, p = .699) had little to no relationship. The use of thigh-worn accelerometers for this population is achievable. People with Mild Cognitive Impairment have high levels of sedentary behavior and minimal engagement in moderate-intensity physical activity. The PASE has fair, positive criterion validity with activity-based outcomes measured by activPAL accelerometers but not with sedentary behavior, which is high for this population.

A self-management program increases the dosage of inpatient rehabilitation by 26 minutes per day: a process evaluation.

PURPOSE: To evaluate the implementation of a self-management program, My Therapy, designed to increase inpatient rehabilitation therapy dosage via independent practice. MATERIALS AND METHODS: A process evaluation of My Therapy for adult patients admitted for rehabilitation for any condition supervised by physiotherapists and occupational therapists across eight rehabilitation wards compared usual care. Outcomes included reach, dosage, fidelity and adaptation. RESULTS: The mean (SD) age of the process evaluation sample (n = 123) was 73 (11) years with a mean (SD) length of stay of 14.0 (6.6) days. The My Therapy program reached 68% of participants (n = 632/928), and resulted in an average increase in therapy dosage of 26 (95% CI 12 to 40) minutes/day of independent practice. All My Therapy audited programs (n = 28) included body function/structure impairment-based exercises, and half (n = 13/28) included activity/participation-based exercises. On average, participants completed programs 1.8 (SD 1.2) times/day, which were prescribed in accordance with the My Therapy criteria, demonstrating fidelity. There were no between-group differences in daily steps or standing time, however, My Therapy participants spent more time sitting (p ≤ 0.05). Implementation adaptations were minimal. CONCLUSION: A self-management rehabilitation program was implemented with fidelity for two in three rehabilitation patients, resulting in increased therapy dosage with minimal adaptations.

The My Therapy self-management program was implemented with good reach (68% of participants received My Therapy) across four public and private inpatient rehabilitation services.Under My Therapy conditions, the dosage of inpatient rehabilitation therapy participation increased by an average of 26 minutes per day, which will help close the evidence-practice gap between the current rehabilitation dosage of about 1-hour per day, and the recommended rehabilitation dosage of 3-hours per day.My Therapy programs most frequently included impairment-based exercises that were completed in sitting, and did not increase time spent standing and walking.Consideration should be given to prescribing My Therapy (content and dosage) at an optimal level to promote patient functional independence, while maintaining safety.

Older people's views and usage of recreational spaces in parks with age-friendly outdoor exercise equipment.

Recreational spaces are important public spaces for people of all ages to engage in leisure and physical activities, however older people remain one of the lowest users of park. This study investigated older people's perceptions and reasons for visiting parks that have undergone refurbishment with the installation of age-friendly outdoor exercise equipment, the Seniors Exercise Park. On-site intercept surveys took place in six parks in Victoria, Australia. Seniors Exercise Park equipment usage was audited over 12 months using on-site Quick Response (QR). A total of 139 older people were surveyed, 55.4% reported visiting to exercise, 25.9% for walking and 21.5% for fresh air/nature. Proximity to home/family (37.4%) and the availability of the Seniors Exercise Park equipment (36.7%) were the main reasons for visiting these parks. The availability of age-suitable exercise equipment in recreational spaces can support and encourage older people to access local parks and engage in physical activity.

The ENJOY Seniors Exercise Park IMP-ACT project: IMProving older people's health through physical ACTivity: a hybrid II implementation design study protocol.

INTRODUCTION: The health benefits of physical activity are well established; however, most older people are not sufficiently physically active. Despite the availability of various physical activity interventions and programs, implementation of effective prevention strategies to reduce older people's physical inactivity are lacking. The ENJOY IMP-ACT project is an implementation research project, based on a previous evidence-based physical and social activity program utilising specialised outdoor exercise equipment (the Seniors Exercise Park) for older people. The ENJOY IMP-ACT aims to increase participation in physical activity to improve health outcomes for older people in Victoria, Australia. METHOD: The ENJOY IMP-ACT is a hybrid II implementation-effectiveness pre-post mixed method study design. Five local governments (6 public sites/parks) will undergo a 3-month control period followed by 9-months implementation intervention (TERM framework intervention: Training, Engagement, Resources development, Marketing and promotion), and a maintenance phase (3 months). Various methodologies will be employed throughout the project at each site and will include direct observations of park users, intercept surveys with park users, online access monitor platform (using an online app), interviews with stakeholders and exercise program leaders, a process evaluation of physical activity programs, a social return-on-investment analysis, and other related activities. DISCUSSION: Through the implementation framework design, the ENJOY IMP-ACT is uniquely placed to translate an evidenced-based physical and social activity program into real world settings and increase physical activity among older people. If successful, this program will inform scale up across Australia with the goal of improving the health and wellbeing of older people. TRIAL REGISTRATION: This registration trial is prospectively registered with the Australian New Zealand Clinical Trials Registry. Trial number ACTRN12622001256763 . Date registered 20/09/2022.

Experiences of Indonesian people with dementia and carers undertaking an online-delivered exercise program.

Participating in physical activity is beneficial for older people with dementia. Little is known however about the perceptions of people living with dementia undertaking an online-delivered exercise program. This study aimed to explore the experiences and perceptions of older people with dementia and their carers in Indonesia participating in an online-delivered exercise program, and factors that may influence acceptability to the program. An exploratory qualitative study design using semi-structured interviews was used. Data were recorded, transcribed verbatim, translated into English, and analyzed thematically. Twelve participants with dementia (mean age = 63.3 years) and 30 carers (26 family carers and 4 paid carers) (mean age = 37.9 years) were interviewed separately. Seven themes were identified: (i) Motivating factors to participate; (ii) Benefits for people with dementia; (iii) Impacts on carers; (iv) Challenges and enablers to exercising; (v) Carers' strategies for exercise engagement; (vi) Roles, relationships and supports; and (vii) Participants' receptiveness to online delivery of the exercise program. This study illustrated that an online-delivered exercise program was acceptable for people with dementia and their carers in Indonesia and reinforced the importance of carers' support for the exercise program. These findings can help physiotherapists and other exercise practitioners in considering the aspects of delivery that people with dementia and their carers value in participating in online-delivered exercise programs.

Age and Type of Task-Based Impact of Mental Fatigue on Balance: Systematic Review and Meta-Analysis.

The role of cognition in balance control suggests that mental fatigue may negatively affect balance. However, cognitive involvement in balance control varies with the type or difficulty of the balance task and age. Steady-state balance tasks, such as quiet standing, are well-learned tasks executed automatically through reflex activities controlled by the brainstem and spinal cord. In contrast, novel, and challenging balance tasks, such as proactively controlling balance while walking over rugged terrain or reacting to unexpected external perturbations, may require cognitive processing. Furthermore, individuals with preexisting balance impairments due to aging or pathology may rely on cognitive processes to control balance in most circumstances. This systematic review and meta-analysis investigated the effect of mental fatigue on different types of balance control tasks in young and older adults. A literature search was conducted in seven electronic databases and 12 studies met eligibility criteria. The results indicated that mental fatigue had a negative impact on both proactive (under increased cognitive load) and reactive balance in young adults. In older adults, mental fatigue affected steady-state and proactive balance. Therefore, mentally fatigued older individuals may be at increased risk of a loss of balance during steady-state balance task compared to their younger counterparts.

Program Evaluation and Refinement of the "Safe Functional Home Exercise" Program for Improving Physical Activity in Older People with Dementia Who Receive Home Care.

INTRODUCTION: People with dementia who receive home care have low levels of physical activity participation. OBJECTIVES: To evaluate and refine a co-designed exercise program for home care clients with dementia, led by trained care support workers. METHODS: An action research cycle whereby support workers, clients and carers (each n = 26) from the "Safe Functional Home Exercise" feasibility study were invited to complete an evaluation survey. Participants rated statements using Likert-style scales on (1) staff training, (2) staff confidence, (3) program support and (4) satisfaction. The participants could provide comments for situations that affected exercise performance, suggested improvements for staff training, program support and exercises. The co-design panel (original program designers) was reconvened to refine the exercise program. RESULTS: Support workers (n = 19), clients (n = 15) and carers (n = 13) returned their surveys. Support workers (74-90%), carers (77-92%) and clients (100%) rated program support positively and were overall satisfied. Support workers (>80%) agreed that the training course was relevant and were confident in delivering the exercises to clients. Situations included "Covid isolation", the client's "poor medical condition" and "mood fluctuations" that made exercising difficult. Improvements included "making a client video" and "providing tips to motivate clients". The co-design panel modified the exercise program. CONCLUSIONS: The "Safe Functional Home Exercise" program is the first exercise program co-designed for people with dementia. It is well accepted by support workers, people with dementia and carers. Utilising support workers to facilitate physical activity participation is potentially low-cost and scalable in home care. Future studies are needed to evaluate the refined program in home care.

Effects of physical activity on depressive symptoms in older caregivers: The IMPACCT randomized controlled trial.

OBJECTIVES: Physical activity (PA) can reduce depressive symptoms but has not been tested amongst depressed older caregivers and their care-recipients. The aim of this single-blind randomized controlled trial was to investigate the effect of a 6-month tailored PA program on depressive symptoms in older caregivers. METHOD: Caregivers were included if they had scores of ≥5 on the 15-item geriatric depression scale (GDS-15). Care-recipients could have any type of physical, mental or cognitive condition requiring support. The PA intervention group completed an individualized program based on the Otago-Plus Exercise Program. The primary outcome was improvement in depressive symptoms in caregivers measured at six and 12 months. RESULTS: Two hundred and twelve participants (91 dyads and 30 caregivers only) were randomized using a 3:3:1 ratio to PA intervention, social-control, and usual-care control groups. There were no significant differences in depressive symptoms of the caregivers between the three groups at 6 months or 12 months. However, more than 50% of caregivers in all three groups no longer had a GDS-15 score ≥5 at 6 months. Further analysis revealed that caregivers in the PA group caring for someone with a standardised mini-mental state examination (SMMSE) score ≥24 had significantly less depressive symptoms than those caring for someone with a SMMSE score <24 compared with social-control (p < 0.02) and usual-care groups (p < 0.02). CONCLUSIONS: A PA intervention may be beneficial for some caregivers in reducing symptoms of depression but may not be as beneficial to caregivers of people living with cognitive impairment.

Parks Visitation, Physical Activity Engagement, and Older People's Motivation for Visiting Local Parks.

Despite the health benefits of parks and outdoor recreational spaces, small numbers of older people visit parks. This study identified older park visitors' perceptions of their local parks, visit motivation, health, and physical activity level in six parks in Victoria, Australia. Characteristics of general community park visitors and their physical activity engagement were also recorded. Fifty-five older people were surveyed onsite; 92.7% lived within a 5-km distance from the park. Walking was the most common reason for visiting (36.4%), followed by walking the dog (36.4%) and exercise (23.6%). Most older visitors (77.8%) were determined as being sufficiently active. Observation of parks visitors over 1 week recorded 3,770 park visitors, with <5% being older people. Half of all park visitors were inactive, and half of older people visitors (50.5%) engaged in walking. This study supports the importance of parks, park features, and their potential in helping older people to achieve levels of physical activity required for good health.

Exercise for falls prevention in aged care: systematic review and trial endpoint meta-analyses.

BACKGROUND: There is strong evidence that exercise reduces falls in older people living in the community, but its effectiveness in residential aged care is less clear. This systematic review examines the effectiveness of exercise for falls prevention in residential aged care, meta-analysing outcomes measured immediately after exercise or after post-intervention follow-up. METHODS: Systematic review and meta-analysis, including randomised controlled trials from a Cochrane review and additional trials, published to December 2022. Trials of exercise as a single intervention compared to usual care, reporting data suitable for meta-analysis of rate or risk of falls, were included. Meta-analyses were conducted according to Cochrane Collaboration methods and quality of evidence rated using the Grading of Recommendations Assessment, Development and Evaluation approach. RESULTS: 12 trials from the Cochrane review plus 7 new trials were included. At the end of the intervention period, exercise probably reduces the number of falls (13 trials, rate ratio [RaR] = 0.68, 95% confidence interval [CI] = 0.49-0.95), but after post-intervention follow-up exercise had little or no effect (8 trials, RaR = 1.01, 95% CI = 0.80-1.28). The effect on the risk of falling was similar (end of intervention risk ratio (RR) = 0.84, 95% CI = 0.72-0.98, 12 trials; post-intervention follow-up RR = 1.05, 95% CI = 0.92-1.20, 8 trials). There were no significant subgroup differences according to cognitive impairment. CONCLUSIONS: Exercise is recommended as a fall prevention strategy for older people living in aged care who are willing and able to participate (moderate certainty evidence), but exercise has little or no lasting effect on falls after the end of a programme (high certainty evidence).

Risk Factors for the Impairment of Ambulation in Older People Hospitalized with COVID-19: A Retrospective Cohort Study.

(1) Background: Some older people hospitalized with COVID-19 have experienced reduced ambulation capacity. However, the prevalence of the impairment of ambulation capacity still needs to be established. Objective: To estimate the prevalence of, and identify the risk factors associated with, the impairment of ambulation capacity at the point of hospital discharge for older people with COVID-19. (2) Methods: A retrospective cohort study. Included are those with an age > 60 years, of either sex, hospitalized due to COVID-19. Clinical data was collected from patients' medical records. Ambulation capacity prior to COVID-19 infection was assessed through the patients' reports from their relatives. Multiple logistic regressions were performed to identify the risk factors associated with the impairment of ambulation at hospital discharge. (3) Results: Data for 429 older people hospitalized with COVID-19 were randomly collected from the medical records. Among the 56.4% who were discharged, 57.9% had reduced ambulation capacity. Factors associated with reduced ambulation capacity at discharge were a hospital stay longer than 20 days (Odds Ratio (OR): 3.5) and dependent ambulation capacity prior to COVID-19 (Odds Ratio (OR): 11.3). (4) Conclusion: More than half of the older people who survived following hospitalization due to COVID-19 had reduced ambulation capacity at hospital discharge. Impaired ambulation prior to the infection and a longer hospital stay were risks factors for reduced ambulation capacity.

Who cares for the carer? Codesigning a carer health and wellbeing clinic for older care partners of older people in Australia.

INTRODUCTION: Older carers or 'care partners' of older people experiencing care needs often provide essential support, at times while neglecting their own health and well-being. This is an increasingly frequent scenario due to both demographic changes and policy shifts towards ageing in place. Multiple community stakeholders within the care and support ecosystem hold valuable expertise about the needs of older care partners, and the programme and policy responses that may better support their health and well-being. The aim of this study was to identify the perspectives of stakeholders obtained through the codesign phase of a multicomponent research project investigating new models of care and support for older care partners suitable for the Australian context. METHODS: Principles of codesign were used to engage a purposeful sample of older care partners, health professionals, researchers, policy makers and health service administrators. Participants took part in a series of three codesign workshops conducted remotely via video conferencing. The workshops were supported with briefing material and generated consensus-based summaries, arriving at a preferred service model. FINDINGS: This paper reports the research design and structure of the codesign panels, the range of findings identified as important to support the health and well-being of older carers of older people, and the resulting service model principles. The codesigned and preferred model of care is currently being prepared for implementation and evaluation in Australia. PUBLIC CONTRIBUTION: This study was conducted using codesign methodology, whereby stakeholders including older care partners and others involved in supporting older carers, were integrally involved with design, development, results and conclusions.