Physical and mental health status and their correlations among older wheelchair users with dementia in long-term care facilities.

PURPOSE: To investigate the physical health (daily functioning and functional fitness) and mental health (depression and behavioral dysfunction) of older wheelchair users with dementia in long-term care facilities, examine the correlations between physical and mental health, and identify the independent variables of their daily functioning. METHODS: A descriptive correlational method was adopted, which was conducted in six long-term care facilities in three cities, south Taiwan. Participants comprised 98 older wheelchair users with dementia. Data were collected using structured questionnaires (Mini-Mental State Examination, Barthel Index, Cornell Scale for Depression in Dementia, and Clifton Assessment Procedures for the Elderly Behavior Rating Scale) and from functional fitness testing (cardiopulmonary functioning, body flexibility, joint mobility, and muscle strength and endurance). RESULTS: Older adults with dementia who had high depression scores were likely to have more behavioral dysfunctions, poorer performance in shoulder flexion and abduction, and lower upper limb muscle strength and endurance. More behavioral dysfunctions were associated with poorer daily functioning, lung capacity, body flexibility, shoulder flexion, and upper limb muscle strength and endurance. Those with better lung capacity, body flexibility, upper limb muscle strength, and endurance were likely to have high daily functioning scores (all p < .05). The key independent variables associated with daily functioning were behavioral dysfunction, lower body flexibility, and lung capacity, which together explained 59.3% of the total variance. CONCLUSIONS: Further research should develop appropriate activity-based intervention programs for older wheelchair users with dementia to delay their deterioration and promote their physical and mental health.

Elastic Band Exercises Improved Activities of Daily Living and Functional Fitness of Wheelchair-bound Older Adults with Cognitive Impairment: A Cluster Randomized Controlled Trial.

OBJECTIVE: The purpose of this study was to test the effects of a 6-month Wheelchair-bound Senior Elastic Band (WSEB) exercise program on the activities of daily living (ADL) and functional fitness of wheelchair-bound older adults with cognitive impairment. DESIGN: Cluster randomized controlled trial was used. A convenience sample of 138 wheelchair-bound older adults with cognitive impairment were recruited from 8 nursing homes in southern Taiwan and were randomly assigned based on the nursing homes they lived to the experimental (4 nursing homes; n = 73) or the control group (4 nursing homes; n = 65). The experimental group performed WSEB exercises 3 times per week and 40 minutes per session for 6 months. The ADL and functional fitness (cardiopulmonary function, body flexibility, range of joint motion, and muscle strength and endurance) were examined at baseline, 3 months, and the end of 6-month study. RESULTS: The ADL and functional fitness indicators of participants in the experimental group showed significant improvements compared to the control group (all P < 0.05). CONCLUSIONS: The WSEB exercises have positive benefits for the ADL and functional fitness of wheelchair-bound older adults with cognitive impairment. It is suggested that WSEB exercises be included as a routine activity in nursing homes. TO CLAIM CME CREDITS: Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCMECME OBJECTIVES:: Upon completion of this article the reader should be able to: (1) Understand the risk factors for functional decline in older adults with dementia; (2) Articulate the benefits of structured activities and exercises in the older adult with dementia; and (3) Incorporate elastic band exercises into the treatment plan of wheelchair bound older adults with dementia. LEVEL: AdvancedACCREDITATION:: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The Association of Academic Physiatrists designates this activity for a maximum of 1.5 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.