Evaluating the reliability and validity of the Icelandic translation of the Mini-BESTest in rehabilitation patients: an international implication for balance assessment.

BACKGROUND: The Mini-BESTest (Balance Evaluation Systems Test) is a standardized balance evaluation tool. The psychometric properties of the Mini-BESTest are being established around the world. PURPOSE: This study aimed to evaluate the reliability and validity of the Icelandic translation of the Mini-BESTest. METHODS: Thirty rehabilitation inpatients (16/14 women/men), with mixed diagnoses and a range of self-assessed balance, were assessed with the: Mini-BESTest on two occasions; Activities-specific Balance Confidence Scale; Berg Balance Scale; Timed Up and Go test; and 10 Meter Walk Test. Statistical analyses included the Intraclass Correlation Coefficient (ICC), standard error of measurement (SEM), Cronbach's alpha (α), Pearson's r, and the independent t-test. RESULTS: Relative reliability demonstrated good test-retest (ICC3.1 = 0.84), intra-rater reliability (ICC3.1 = 0.86), and excellent inter-rater reliability (ICC2.1 = 0.96). Absolute reliability (SEM) was 1.607, and internal consistency (α) was 0.80. Construct validity was supported by a high correlation between the Mini-BESTest and other standardized measures (r = ±0.6-0.73). The Mini-BESTest discriminated between patients with poor versus good self-rated balance (p ˂ 0.001), with no floor or ceiling effects. CONCLUSION: The psychometric properties of the Icelandic translation of the Mini-BESTest are comparable with the original version and other translations. These results for this mixed patient group should be relevant to clinicians and researchers internationally.

Improving the Evidence-Based Practice Skills of Entry-Level Physiotherapy Students through Educational Interventions: A Scoping Review of Literature.

Evidence-based practice (EBP) is an essential approach in healthcare, attracting growing interest among both practitioners and researchers. This scoping review aims to (1) systematically investigate the effectiveness of pedagogical methods used to facilitate learning of the EBP approach, and (2) explore the perceptions, experiences, and issues related to these learning methods. The overarching purpose is to identify the state of the art in pedagogical methods, instruments, influences, and barriers in teaching and learning EBP within entry-level physiotherapy education programs. This scoping review was conducted following PRISMA guidelines, with PubMed and Eric databases being searched for peer-reviewed original research articles using a combination of keywords. Excluding non-pertinent articles from the initial 465 identified, 12 were eligible for final inclusion (5 quantitative, 3 qualitative, and 4 mixed-methodology studies). A range of pedagogical methods and instruments for teaching EBP in physiotherapy education were detected, all of which having the capability to positively affect physiotherapy outcomes. Findings from this study support the significant influence that EBP exerts on the improving of the quality of teaching, together with the necessities that the involvement of EBP in physiotherapy education programs provide. Several barriers were identified, which should be taken into consideration when designing population-specific EBP strategies tailored to these particular needs.

A survey of patient education practices and perceptions of physiotherapists: a mixed methods study.

INTRODUCTION: Patient education is an integral part of physiotherapy practice. The use of patient education and the adoption of a patient-centered approach to education has not been examined in a European setting. OBJECTIVE: To explore the frequency and perceived importance of patient education practices of physiotherapists in Iceland. METHODS: A convergent mixed methods study design was utilized. A cross-sectional, web-based survey was completed by 216 physiotherapists (35.1% response rate). Transformed qualitative data played a secondary role to quantitative results measuring frequencies of use and perceived importance of a spectrum of patient education practices. RESULTS: Providing exercise and diagnostic information had the highest rated frequency and importance. Advising on social support and having the patient explain why their home exercises were important were rated lowest. A large difference was reported between frequency and importance when collaborating with patients on goal-setting. Therapists reported delivering education through discussions and physical demonstrations, while relying on visual cues and return demonstrations to evaluate education effectiveness. Patient-specific education, including preferred learning style, was not always considered. The highest-rated barriers to patient education were patient characteristics that were psychosocial in nature. Results regarding readiness for education indicated needs to assess patient motivation while managing external barriers. CONCLUSION: The results indicate that physiotherapists engage in a wide variety of patient education activities that they consider important. Barriers to patient education identified by therapists may be managed by further skill development in a collaborative patient-centered approach to patient education.

Age differences in functioning and contextual factors in community-dwelling stroke survivors: A national cross-sectional survey.

BACKGROUND: Our study aimed to map functioning and contextual factors among community-dwelling stroke survivors after first stroke, based on the International Classification of Functioning, Disability and Health (ICF), and to explore if these factors differ among older-old (75 years and older), younger-old (65-74 years), and young (18-65 years) stroke survivors. METHODS: A cross-sectional population-based national survey among community-dwelling stroke survivors, 1-2 years after their first stroke. Potential participants were approached through hospital registries. The survey had 56.2% response rate. Participants (N = 114, 50% men), 27 to 94 years old (71.6±12.9 years), were categorized as: older-old (n = 51), younger-old (n = 34) and young (n = 29). They answered questions on health, functioning and contextual factors, the Stroke Impact Scale (SIS) and the Behavioural Regulation Exercise Questionnaire-2. Descriptive analysis was used, along with analysis of variance for continuous data and Fisher´s exact tests for categorical variables. TukeyHSD, was used for comparing possible age-group pairings. RESULTS: The responses reflected ICF´s personal and environmental factors as well as body function, activities, and participation. Comparisons between age-groups revealed that the oldest participants reported more anxiety and depression and used more walking devices and fewer smart devices than individuals in both the younger-old and young groups. In the SIS, the oldest participants had lower scores than both younger groups in the domains of activities of daily living and mobility. CONCLUSION: These findings provide important information on needs and opportunities in community-based rehabilitation for first-time stroke survivors and reveal that this population has good access to smart devices which can be used in community integration. Moreover, our results support the need for analysis in subgroups of age among the heterogenous group of older individuals in this population.

Basic mobility, accidental falls, and lifetime physical activity among rural and urban community-dwelling older adults: a population-based study in Northern Iceland.

The objective of this research was to investigate late-life physical functioning and lifetime history of physical activity (PA) among older adults in rural and urban Arctic communities. Data was collected in a cross-sectional, population-based study among 65 to 92-year-old community-dwelling Icelanders (N = 175, 41% ≥75-year-old, 43% women, 40% rural). Late-life physical functioning was operationalised as: basic mobility (Timed Up and Go in seconds, TUG); fall risk (TUG≥12 sec); a fall (≥1 fall/year); and recurrent falls (≥2 falls/year). PA history was based on a self-assessment. Compared to urban participants, rural participants were more likely to have fallen recently, be at fall risk, and describe more PA history. Among urban participants, no fall in the past year was independently associated with more PA in middle adulthood; and worse basic mobility and late-life fall risk were independently associated with being in the ≥75-year-old group. Among rural participants, recurrent falls were independently associated with being a man; and better basic mobility was independently associated with more PA in late adulthood. To conclude, this evidence supports an important association between better late-life physical functioning and more mid- and late-life PA and encourages further research to understand high fall risk among older men in Arctic rural areas.

Making Europe health literate: including older adults in sparsely populated Arctic areas.

BACKGROUND: Older people have been identified as having lower health literacy (HL) than the general population average. Living in sparsely populated Arctic regions involves unique health challenges that may influence HL. The research aim was to explore the level of HL, its problematic dimensions, and its association with the selection of contextual factors among older adults living in sparsely populated areas in Northern Iceland. METHOD: This was a cross-sectional study based on a stratified random sample from the national register of one urban town and two rural areas. The study included 175 participants (57.9% participation rate) who were community-dwelling (40% rural) and aged 65-92 years (M 74.2 ± SD 6.3), 43% of whom were women. Data were collected in 2017-2018 via face-to-face interviews, which included the standardised European Health Literacy Survey Questionnaire-short version (HLS-EU-Q16) with a score range from 0 to 16 (low-high HL). RESULTS: The level of HL ranged from 6-16 (M 13.25, SD ± 2.41) with 65% having sufficient HL (score 13-16), 31.3% problematic HL (score 9-12) and 3.7% inadequate HL (score 0-8). Most problematic dimension of HL was within the domains of disease prevention and health promotion related to information in the media. Univariate linear regression revealed that better HL was associated with more education (p=0.001), more resiliency (p=0.001), driving a car (p=0.006), good access to health care- (p=0.005) and medical service (p=0.027), younger age (p=0.005), adequate income (p=0.044) and less depression (p=0.006). Multivariable analysis showed that more education (p=0.014) and driving a car (p=0.017) were independent predictors of better HL. CONCLUSION: Difficulties in HL concern information in the media. HL was strongly associated with education and driving a car however, not with urban-rural residency. Mobility and access should be considered for improving HL of older people.

Outpatient physical therapy population has been aging faster than the general population: a total population register-based study.

BACKGROUND: The Icelandic population is aging like other populations in the world, the life expectancy is high, and the national focus is to help people to age in their own homes. The objectives of this research was to describe 17 years of demographic changes among outpatient physical therapy (OPT) clients and to determine if these changes reflect aging in the total population. METHODS: Data was obtained from a national registry with information on all OPT clients reimbursed by Icelandic Health Insurance from 1999 to 2015, and general population data from the Statistics Iceland registry covering the same 17 years. Simple counts, proportions, Rate Ratios (RR) and 95 % Confidence Intervals (CI) were used to describe and compare the two time-points (1999 and 2015) in both populations, and regression analyses were used to estimate linear changes for each of these 17 years. RESULTS: Comparing the endpoints of the 17-year period, the proportion of older adults within the total OPT clientele increased by 23 % (from 18.3 % to 1999 to 23.5 % in 2015; RR 1.23; 95 %CI 1.19-1.27).) while in the general Icelandic population, the proportion of older adults increased by 15 % (from 11.6 % to 1999 to 13.5 % in 2015; RR 1.15; 95 % CI 1.1-1.21). For each of these 17 years, there was an overall 5 % yearly increase in the rate of older adults from the general older Icelandic population who used an OPT (accounting for population aging), and an overall 3.5 % yearly increase in the proportional contribution of older adults to the total OPT clientele. Adjusting for sex and older age group revealed that this increase in rate and proportion was most pronounced among ≥ 85-year-old men. CONCLUSIONS: This case of Iceland is an example of how health-related and population-based registers may potentially be used to routinely inform and facilitate optimal planning of future health care services for older adults.

Activities and participation of 65-91-year-old adults: population-based study among residents of a sparsely populated and remote area in Iceland.

Southern Westfjords of Iceland is a sparsely populated, remote area with rather high proportion of older residents. This study´s aim was to investigate activities and participation in this population, using a descriptive cross-sectional population-based design. The participants were 129 community-dwelling residents, 65-91 years old. The Late Life Function and Disability Instrument was used to measure participants' activities and participation. It provides interval scale scores where a higher score means less difficulties in activities, more frequent participation, and fewer participation restrictions. Participants had most difficulties in Advanced Lower Extremity functioning and least in Upper Extremity functioning and scored lower on participation frequency than participation restriction. Overall, men reported fewer difficulties in activities than women and the 65-74 years group fewer difficulties than the 75-91 years group. Frequency of participation was higher for women than men and higher for the younger group than the older one who also experienced their participation to be more limited, but men and women did not differ. The participants described barriers limiting their participation in self-care and social life. The results provide valuable information on activities and participation of older residents living rurally and have practical implications for community services in remote arctic areas.

Physical Activity of Older Women Living in Retirement Communities: Capturing the Whole Picture Through an Ecological Approach.

BACKGROUND AND PURPOSE: Interventions to increase physical activity among older populations may prevent or delay disability in activities of daily living and premature death. In our research, we focused on older women living independently in retirement communities, who commonly experience declining health. The purpose was to identify factors influencing physical activity in older women and to create a practical checklist to guide physical therapists in physical activity interventions within retirement communities. METHODS: The study was qualitative and guided by the Vancouver School of Doing Phenomenology. The data set comprised 12 in-depth interviews with 10 women, as 2 of the women were interviewed twice to deepen the understanding of their experience. They were aged 72 to 97 years (median = 84 years, interquartile range = 11 years) and lived in 7 different apartment buildings in the same urban area. The interviews were recorded, transcribed, and analyzed to identify factors influencing the physical activity behavior of the women. We then linked these factors to the Bronfenbrenner's ecological model and finally constructed a checklist for mapping the influencing factors. RESULTS: The physical activity experience of the older women reflected both facilitating and hindering factors from all layers of the ecological model. The largest part of the women's description was constructed around personal factors and the immediate physical and social environment. Yet, important influencing factors were expressed reflecting community, society, and the lifespan. Finally, the practical checklist created to guide physical activity interventions included 40 questions reflecting 24 influencing factors covering important layers of the ecological model. CONCLUSION: To deal with the epidemic of a sedentary lifestyle in older populations, physical therapists must join forces with health authorities and work with the complexities of physical activity promotion at appropriate levels. Our results and the checklist are a potential resource to aid in identifying physical activity influencing factors that are appropriate for physical therapy intervention, within retirement communities. Moreover, this checklist may be used to recognize factors that are more suitable for public health interventions at the community or national levels.

[Physical activity and depression among older community-dwelling adults in urban and rural areas: Population based study].

INTRODUCTION: The aim was to explore physical activity (PA) in different daily contexts, among older adults in Northern Iceland; and by urban-rural living, age-group and sex. Moreover, to study the association between PA and depression. MATERIAL AND METHODS: The study was cross-sectional, population based and data was collected in 2017-'18 in Northern Iceland. The 175 community-dwelling participants (participation rate 59.7%) were 65-92 years old, 43% were women, and 40% lived in rural areas. The Physical Activity Scale for the Elderly (PASE) was used to obtain a total PA score and three subs-scores reflecting PA associated with leisure-time, household and work. The Geriatric Depression Scale was used to detect depressive symptoms. RESULTS: Total PA was the same for urban and rural people, men were more active than women, and the 65-74 years age-group was more active than the 75-92 years age-group. People in rural areas were more likely to do work-related PA than people in urban areas, as was the 65-74 years age-group compared to the 75-92 years age-group. Men were more PA during household than women. Higher total PA and the sub-scores of PASE had significant association with fewer depressive symptoms. PA in leisure-time was the only PASE sub-score with a significant and independent association with fewer depressive symptoms. CONCLUSION: The results improve the knowledge on PA among older community-dwelling adults, and its relationship with depressive symptoms. Although PA in different contexts has various health benefits, an emphasis on leisure-time PA may have the most beneficial effect on mental health.

'We have different needs': Specifying support for classroom and clinical sessional educators.

CONTEXT: Both classroom and clinical sessional educators are often overlooked in faculty development, even though they play an important role in student learning. Our aim was to contrast classroom and clinical sessional educators´ experiences of and perceived needs for connectedness, appreciation and support, in relation to their teaching quality. We then utilised these results to make suggestions for supporting these educators. METHODS: The participants (11 physical therapy sessional educators: four clinical; seven clinical, and classroom) took part in three focus groups. We based the interview guide questions on previous survey results, used a critical theory research paradigm and performed thematic analysis. RESULTS: We identified four emerging differences between physical therapy sessional educators with experience in the classroom and clinic. Classroom sessional educators needed: (a) more connectedness; (b) more appreciation; (c) more access to the learning management system, and (d) both different and similar faculty development when compared to clinical sessional educators. Differences were greater in classroom sessional educators who taught more hours. We also saw similarities in the need for feedback on teaching, orientations and communication, a better salary and clinical workplace support their role of an educator. Suggestions for context-dependent support for sessional educators were designed to address these similarities and differences. CONCLUSIONS: Talking to various types of sessional educators about their teaching needs is the first step in providing effective faculty development. Varying needs for connectedness, appreciation, pedagogy and access to the learning management system amongst physical therapy sessional educators highlighted the need for an investment in classroom educators who teach multiple hours and want to grow as health science educators. Differences between classroom and clinical sessional educators brought to the forefront the importance of individualised, contextual faculty development and administrative or departmental action that supports sessional educators. The resulting context-dependent suggestions for improvement of support of sessional educators have the potential to improve the quality of health science teaching overall.

The importance of different frailty domains in a population based sample in England.

BACKGROUND: The aim was to estimate the prevalence of frailty and relative contribution of physical/balance, nutritive, cognitive and sensory frailty to important adverse health states (falls, physical activity levels, outdoor mobility, problems in self-care or usual activities, and lack of energy or accomplishment) in an English cohort by age and sex. METHODS: Analysis of baseline data from a cohort of 9803 community-dwelling participants in a clinical trial. The sample was drawn from a random selection of all people aged 70 or more registered with 63 general practices across England. Data were collected by postal questionnaire. Frailty was measured with the Strawbridge questionnaire. We used cross sectional, multivariate logistic regression to estimate the association between frailty domains and known correlates and adjusted for age. Some models were stratified by sex. RESULTS: Mean age of participants was 78 years (sd 5.7), range 70 to 101 and 47.5% (4653/9803) were men. The prevalence of overall frailty was 20.7% (2005/9671) and there was no difference in prevalence by sex (Odds Ratio 0.98; 95% Confidence Interval 0.89 to 1.08). Sensory frailty was the most common and this was reported by more men (1823/4586) than women (1469/5056; Odds Ratio for sensory frailty 0.62, 95% Confidence Interval 0.57 to 0.68). Men were less likely than women to have physical or nutritive frailty. Physical frailty had the strongest independent associations with adverse health states. However, sensory frailty was independently associated with falls, less frequent walking, problems in self-care and usual activities, lack of energy and accomplishment. CONCLUSIONS: Physical frailty was more strongly associated with adverse health states, but sensory frailty was much more common. The health gain from intervention for sensory frailty in England is likely to be substantial, particularly for older men. Sensory frailty should be explored further as an important target of intervention to improve health outcomes for older people both at clinical and population level. TRIAL REGISTRATION: ISRCTN71002650.

Translation and cross-cultural adaptation of the European Health Literacy Survey Questionnaire, HLS-EU-Q16: the Icelandic version.

BACKGROUND: Health literacy (HL) is defined as the knowledge and competences of people to meet the complex demands of health in modern society. It is an important factor in ensuring positive health outcomes, yet Iceland is one of many countries with limited knowledge of HL and no valid HL measurement. The aim of this study was to translate the European Health Literacy Survey Questionnaire- short version (HLS-EU-Q16) into Icelandic, adapt the version, explore its psychometric properties and establish preliminary norms. METHODS: The HLS-EU-Q16 translation model included three steps: 1) translation-back-translation of HLS-EU-Q16 including specialists' review (n = 6); 2) cognitive interviewing of lay people (n = 17); and 3) psychometric analysis with survey participants. The HLS-EU-Q16 includes 16 items, with scores ranges from zero (low/no HL) to 16 (high HL). Statistics included were descriptive, internal consistency measured by Cronbach's α, exploratory factor analysis, and multivariate linear regression. RESULTS: After the translation and cognitive interviewing, 11 of the HLS-EU-Q16 items were reworded to adapt the instrument to Icelandic culture while maintaining their conceptual objectives. Survey participants were 251. Internal consistency of the translated and adapted instrument was α = .88. Four factors with eigenvalues > 1.0 explained 62.6% of variance. Principal component analysis with Oblimin rotation presented four latent constructs, "Processing and Using Information from the Doctor" (4 items, α = .77), "Processing and Using Information from the Family and Media" (4 items, α = .85), "Processing Information in Connection to Healthy Lifestyle" (5 items, α = .76), and "Finding Information about Health Problems/Illnesses" (3 items, α = .73). Lower self-rated health was an independent predictor of lower HL (ß = -.484, p = .008). Preliminary norms for HL ranged from five to 16 (M 13.7, SD ± 2.6) with 72.5% with sufficient HL (score 13-16), 22% with problematic HL (score 9-12) and 5.5% with inadequate HL (score 0-8). CONCLUSIONS: The Icelandic version of HLS-EU-Q16 is psychometrically sound, with reasonably clear factor structure, and comparable to the original model. This opens possibilities to study HL in Iceland and compare the results internationally. The translation model introduced might be helpful for other countries where information on HL is missing based on lack of validated tools.

Self-rated health and socio-economic status among older adults in Northern Iceland.

Little is known about self-rated health (SRH) of older people living in more remote and Arctic areas. Iceland is a high-income country with one of the lowest rates of income inequality in the world, which may influence SRH. The research aim was to study factors affecting SRH, in such a population living in Northern Iceland. Stratified random sample according to the place of residency, age and gender was used and data collected via face-to-face interviews. Inclusion criteria included community-dwelling adults ≥65 years of age. Response rate was 57.9% (N = 175), average age 74.2 (sd 6.3) years, range 65-92 years and 57% were men. The average number of diagnosed diseases was 1.5 (sd 1.3) and prescribed medications 3.0 (sd 1.7). SRH ranged from 5 (excellent) to 1 (bad), with an average of 3.26 (sd 1.0) and no difference between the place of residency. Lower SRH was independently explained by depressed mood (OR = 0.88, 95% CI = 0.80-0.96), higher body mass index (OR = 0.93, 95% CI = 0.87-0.99), number of prescribed medications (OR = 0.88, 95% CI = 0.78-1.00) and perception of inadequate income (OR = 0.45, 95% CI = 0.21-0.98). The results highlight the importance of physical and mental health promotion for general health and for ageing in place and significance of economic factors as predictors of SRH.

Attitudes Toward Adoption of Evidence-Based Practice Among Physical Therapists and Social Workers: A Lesson for Interprofessional Continuing Education.

INTRODUCTION: Professionals who embrace evidence-based practice (EBP) continually search for research evidence, appraise, and apply it, while interacting with each client in his/her situation. This dynamic learning process takes a substantial commitment from professionals and requires a positive attitude toward EBP. The main objective of this research was to explore the following: 1) distinct dimensions of attitudes toward adoption of EBP among physical therapists and social workers and 2) the relationship between these dimensions of attitudes and selected background characteristics of the compared professions. METHODS: Cross-sectional web-based surveys were conducted in 2012 and 2013 on a population-based sample from the Icelandic Physical Therapy Association and the Icelandic Association of Social Workers. The participants were 214 physical therapists (76.3% women) and 163 social workers (92.2% women). The Evidence-Based Practice Attitude Scale (EBPAS) and its four subscales were used to survey dimensions of attitudes toward EBP. Scores on the total EBPAS range from zero to five, with a higher score indicating a more positive attitude toward EBPs. Linear regression was used to explore the relationship between the EBPAS scales and selected background variables. RESULTS: The overall response rate was 39%. Both professions generally held positive attitudes toward adoption of EBP, with an average EBPAS total score of 3.06 (SD = 0.46). The professionals' background characteristics were independently related to at least one dimension of attitudes toward EBP. More positive attitudes were associated with being a physical therapist, a woman, in a younger age group, having a graduate degree, working with individual clients, and having at least five same-profession coworkers. DISCUSSION: The results may be useful to design continuing education focusing on EBP. Such inventions should be targeted to professional attitudes, background, and other contextual factors.

Icelandic Physical Therapists' Attitudes Toward Adoption of New Knowledge and Evidence-Based Practice: Cross-Sectional Web-Based Survey.

BACKGROUND: A positive attitude toward evidence-based practice (EBP) has been identified as an important factor in the effectiveness of the dissemination and implementation of EBP in real-world settings. OBJECTIVE: The objectives of this study were: (1) to describe dimensions of Icelandic physical therapists' attitudes toward the adoption of new knowledge and EBP and (2) to explore the association between attitudes and selected personal and environmental factors. DESIGN: This study was a cross-sectional, Web-based survey of the total population of full members of the Icelandic Physiotherapy Association. METHODS: The Evidence-Based Practice Attitude Scale (EBPAS) was used to survey attitudes toward EBP; the total EBPAS and its 4 subscales (requirements, appeal, openness, and divergence) were included. Linear regression was used to explore the association between the EBPAS and selected background variables. RESULTS: The response rate was 39.5% (N=211). The total EBPAS and all of its subscales reflected physical therapists' positive attitudes toward the adoption of new knowledge and EBP. Multivariable analysis revealed that being a woman was associated with more positive attitudes, as measured by the total EBPAS and the requirements, openness, and divergence subscales. Physical therapists with postprofessional education were more positive, as measured by the EBPAS openness subscale, and those working with at least 10 other physical therapists demonstrated more positive attitudes on the total EBPAS and the openness subscale. LIMITATIONS: Because this was a cross-sectional survey, no causal inferences can be made, and there may have been unmeasured confounding factors. Potential nonresponse bias limits generalizability. CONCLUSIONS: The results expand understanding of the phenomenon of attitudes toward EBP. They reveal potentially modifiable dimensions of attitudes and the associated characteristics of physical therapists and their work environments. The findings encourage investigation of the effectiveness of strategies aimed at influencing various dimensions of attitudes toward EBP.

Socioeconomic status and differences in medication use among older people according to ATC categories and urban-rural residency.

AIMS: To study how selected indicators of socioeconomic status and urban-rural residency associate with medication use in form of number of daily medications, polypharmacy, and medication use according to Anatomic Therapeutic Classification (ATC) system. METHODS: Cross-sectional, population-based study among older community-dwelling Icelanders. Criteria for participation were: age ≥65 years, community-dwelling, and able to communicate verbally and to set up a time for a face-to-face interview. Information on medication use was obtained by interviews and by examining each person's medication record. Medications were categorised according to ATC system. A questionnaire and the physical and mental health summary scales of SF-36 Health Survey were used to assess potential influential factors associated with medication use. RESULTS: On average, participants (n=186) used 3.9 medications, and the prevalence of polypharmacy was 41%. No indicators of socioeconomic status had significant association to any aspects of medication use. Compared to urban residents, rural residents had more diagnosed diseases, were less likely to live alone, were less likely to report having adequate income, and had fewer years of education. Controlling for these differences, urban people were more likely to use medication from the B and C categories. Moreover, older urban men, with worse physical health, and greater number of diagnosed diseases used more medications from the B category. CONCLUSIONS: There are unexplained regional differences in medications use, from categories B and C, by older Icelanders. Further studies are needed on why urban residents used equal number of medications, or even more medications, compared to rural residents, despite better socioeconomic status and fewer diagnosed diseases.

Facilitators of and barriers to physical activity in retirement communities: experiences of older women in urban areas.

BACKGROUND: Older people are being encouraged to be physically active for as long as possible as a preventive measure against disease and functional decline. It remains, however, uncertain how living in a retirement community affects physical activity (PA). OBJECTIVES: This study was conducted to understand the PA experiences of older women living in retirement communities and what they experience as facilitators of and barriers to PA. DESIGN: The study was qualitative and guided by the Vancouver School of doing phenomenology, a unique blend of phenomenology, hermeneutics, and constructivism. METHOD: Participants were 10 women, aged from 72 to 97 years (mean=84 years). In-depth interviews were conducted, recorded, transcribed, and thematically analyzed. RESULTS: A model was constructed with 3 main themes: (1) the women themselves, including their experienced health condition, individual aspects of functioning, and various personal factors; (2) the physical environment; and (3) the social environment. These main themes all include subthemes of experienced influences on PA, such as health, design of housing and environment, and local culture. These influences could both facilitate and hinder PA, depending on the context. The facilitating effects of good outdoor areas, accessible physical training facilities, a familiar neighborhood, and finding joy in PA were clear in the study. The barriers included worsening health, a colder climate with ice and wind, and lack of a PA culture within the retirement community. CONCLUSIONS: An older woman's residence may strongly influence her ability and motivation to be physically active. Physical therapists should acquaint themselves with the facilitators of and barriers to PA of women within retirement communities and use that knowledge to influence the physical and social environment and to target PA interventions to the women themselves.

Determinants of self-rated health in old age: a population-based, cross-sectional study using the International Classification of Functioning.

BACKGROUND: Self-rated health (SRH) is a widely used indicator of general health and multiple studies have supported the predictive validity of SRH in older populations concerning future health, functional decline, disability, and mortality. The aim of this study was to use the theoretical framework of the International Classification of Functioning, Disability and Health (ICF) to create a better understanding of factors associated with SRH among community-dwelling older people in urban and rural areas. METHODS: The study design was population-based and cross-sectional. Participants were 185 Icelanders, randomly selected from a national registry, community-dwelling, 65-88 years old, 63% urban residents, and 52% men. Participants were asked: "In general, would you say your health is excellent, very good, good, fair, or poor?" Associations with SRH were analyzed with ordinal logistic regression. Explanatory variables represented aspects of body functions, activities, participation, environmental factors and personal factors components of the ICF. RESULTS: Univariate analysis revealed that SRH was significantly associated with all analyzed ICF components through 16 out of 18 explanatory variables. Multivariate analysis, however, demonstrated that SRH had an independent association with five variables representing ICF body functions, activities, and personal factors components: The likelihood of a better SRH increased with advanced lower extremity capacity (adjusted odds ratio [adjOR] = 1.05, p < 0.001), upper extremity capacity (adjOR = 1.13, p = 0.040), household physical activity (adjOR = 1.01, p = 0.016), and older age (adjOR = 1.09, p = 0.006); but decreased with more depressive symptoms (adjOR = 0.79, p < 0.001). CONCLUSIONS: The results highlight a collection of ICF body functions, activities and personal factors associated with higher SRH among community-dwelling older people. Some of these, such as physical capacity, depressive symptoms, and habitual physical activity are of particular interest due to their potential for change through public health interventions. The use of ICF conceptual framework and widely accepted standardized assessments should make these results comparable and relevant in an international context.

Participation frequency and perceived participation restrictions at older age: applying the International Classification of Functioning, Disability and Health (ICF) framework.

PURPOSE: To identify variables from different components of International Classification of Functioning, Disability and Health (ICF) associated with older people's participation frequency and perceived participation restrictions. METHOD: Participants (N = 186) were community-living, 65-88 years old and 52% men. The dependent variables, participation frequency (linear regression) and perceived participation restrictions (logistic regression), were measured using The Late-Life Function and Disability Instrument. Independent variables were selected from various ICF components. RESULTS: Higher participation frequency was associated with living in urban rather than rural community (ß = 2.8, p < 0.001), physically active lifestyle (ß = 4.6, p < 0.001) and higher cognitive function (ß = 0.3, p = 0.009). Lower participation frequency was associated with being older (ß = -0.2, p = 0.002) and depressive symptoms (ß = -0.2, p = 0.029). Older adults living in urban areas, having more advanced lower extremities capacity, or that were employed had higher odds of less perceived participation restrictions (adjusted odds ratio [OR] = 5.5, p = 0.001; OR = 1.09, p < 0.001; OR = 3.7, p = 0.011; respectively). In contrast, the odds of less perceived participation restriction decreased as depressive symptoms increased (OR = 0.8, p = 0.011). CONCLUSIONS: Our results highlight the importance of capturing and understanding both frequency and restriction aspects of older persons' participation. ICF may be a helpful reference to map factors associated with participation and to study further potentially modifiable influencing factors such as depressive symptoms and advanced lower extremity capacity.