A New Approach to Individualize Physical Activity Interventions for Individuals With Dementia: Cluster Analysis Based on Physical and Cognitive Performance.

BACKGROUND AND PURPOSE: Physical activity (PA) can have a beneficial effect on cognitive and physical performance in individuals with dementia (IWD), including those residing in nursing homes. However, PA interventions in nursing homes are usually delivered using a group setting, which may limit the effectiveness of the intervention due to the heterogenous nature of IWD. Therefore, the purpose of this study was to identify clusters based on cognitive and physical performance values, which could be used to improve individualization of PA interventions. METHODS: Based on the cognitive and physical performance variables of 230 IWD, a cluster analysis was conducted. Global cognition (Mini-Mental State Examination), mobility (6-Meter Walking Test), balance (Frailty and Injuries: Cooperative Studies of Intervention Techniques-subtest-4), and strength and function of lower extremities (30-Second Chair-Stand Test) were assessed, and values were used to perform a hierarchical cluster analysis with Ward's method. Differences in physical and cognitive performance as well as other secondary outcomes (age, sex, body mass index, use of walking aids, diagnosis and etiology of dementia, number of medications, and Cumulative Illness Rating Scale) were tested using 1-factorial analyses of variance. RESULTS AND DISCUSSION: Out of 230 data sets, 3-cluster solutions were identified with similar cluster sizes of 73 to 79. The silhouette coefficients for all calculated clusters ranged between 0.15 and 0.34. The cluster solutions were discussed in the context of cognitive and physical functions as well as training modalities and opportunities. The 4-cluster solution appears to be best suited for providing or developing an individualized PA intervention. CONCLUSIONS: The identified clusters of the 4-cluster solution may be used in future research to improve individualization of dementia-specific PA interventions. By assigning IWD to these clusters, more homogenous groups with regard to cognitive and physical performance can be formed. This allows for more individualized PA interventions and may result in a higher effectiveness, particularly in nursing homes. Our findings are relevant for therapists and nursing staff who design or deliver PA interventions in nursing homes or similar settings.

Mid- and Late-Life Physical Activity and Neuropsychiatric Symptoms in Dementia-Free Older Adults: Mayo Clinic Study of Aging.

OBJECTIVE: This study examined associations between physical activity (PA) and neuropsychiatric symptoms (NPS) in older adults free of dementia. METHODS: This cross-sectional study included 3,222 individuals ≥70 years of age (1,655 men; mean±SD age=79.2±5.6; cognitively unimpaired, N=2,723; mild cognitive impairment, N=499) from the population-based Mayo Clinic Study of Aging. PA (taken as a presumed predictor) in midlife (i.e., when participants were 50-65 years of age) and late life (i.e., the year prior to assessment) was assessed with a self-reported, validated questionnaire; PA intensity and frequency were used to calculate composite scores. NPS (taken as presumed outcomes) were assessed with the Neuropsychiatric Inventory Questionnaire, Beck Depression Inventory (BDI-II), and Beck Anxiety Inventory (BAI). Regression analyses included midlife and late-life PA in each model, which were adjusted for age, sex, education, apolipoprotein E ɛ4 status, and medical comorbidity. RESULTS: Higher late-life PA was associated with lower odds of having apathy (OR=0.89, 95% CI=0.84-0.93), appetite changes (OR=0.92, 95% CI=0.87-0.98), nighttime disturbances (OR=0.95, 95% CI=0.91-0.99), depression (OR=0.94, 95% CI=0.90-0.97), irritability (OR=0.93, 95% CI=0.89-0.97), clinical depression (OR=0.92, 95% CI=0.88-0.97), and clinical anxiety (OR=0.90, 95% CI=0.86-0.94), as well as lower BDI-II (ß estimate=-0.042, 95% CI=-0.051 to -0.033) and BAI (ß estimate=-0.030, 95% CI=-0.040 to -0.021) scores. Higher midlife PA was associated only with higher BDI-II scores (ß estimate=0.011, 95% CI=0.004 to 0.019). Sex modified the associations between PA and NPS. CONCLUSIONS: Late-life PA was associated with a lower likelihood of clinical depression or anxiety and subclinical NPS. These findings need to be confirmed in a cohort study.

Usability and Effectiveness of an Individualized, Tablet-Based, Multidomain Exercise Program for People With Dementia Delivered by Nursing Assistants: Protocol for an Evaluation of the InCoPE-App.

BACKGROUND: The COVID-19 pandemic has had drastic consequences on everyday life in nursing homes. Limited personnel resources and modified hygiene and safety measures (eg, no external exercise instructors, no group settings) have often led to interrupted physical exercise treatments. As a consequence, people with dementia benefiting from individualized exercise programs are affected by the pandemic's impact. OBJECTIVE: Our goal is to develop an easily applicable mobile application (Individualized Cognitive and Physical Exercise [InCoPE] app) allowing nursing assistants to test cognitive function and physical performance and subsequently train people with dementia through a multidomain, individualized exercise program. METHODS: We will evaluate the usability and effectiveness of the InCoPE-App by applying a mixed method design. Nursing assistants will use the InCoPE-App for 18 weeks to assess the cognitive function and physical performance of 44 people with dementia every 3 weeks and apply the individualized exercise program. We will record overall usability using questionnaires (eg, Post-Study System Usability and ISONORM 9241/10), log events, and interviews. Perceived hedonic and pragmatic quality will be assessed using the AttrakDiff questionnaire. Effectiveness will be evaluated by considering changes in quality of life as well as cognitive function and physical performance between before and after the program. RESULTS: Enrollment into the study will be completed in the first half of 2022. We expect an improvement in the quality of life of people with dementia accompanied by improvements in cognitive function and physical performance. The usability of the InCoPE-App is expected to be rated well by nursing assistants. CONCLUSIONS: To date, there is no scientifically evaluated app available that enables nursing assistants without expertise in sports science to deliver an individualized exercise program among people with dementia. A highly usable and effective InCoPE-App allows nursing assistants to test cognitive function and physical performance of people with dementia and, based thereon, select and deliver an appropriate individualized exercise program based on the cognitive and physical status of an individual, even in times of a pandemic. TRIAL REGISTRATION: German Register of Clinical Trials DRKS00024069; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00024069. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/36247.

ICT-Based Individualized Training of Institutionalized Individuals With Dementia. Evaluation of Usability and Trends Toward the Effectiveness of the InCoPE-App.

Physical activity interventions can alleviate the course of disease for individuals with dementia (IWD) who have been extraordinarily affected by the COVID-19 pandemic. Information and Communication Technology (ICT) provides new opportunities not only to mitigate negative effects of the pandemic but also to sustainably improve everyday life of IWD in nursing homes. The aim of the present study was to evaluate the ICT-based InCoPE-App, which was used to assess physical and cognitive performance and deliver individualized exercise for IWD, with regard to 1) user experience of nursing assistants, and 2) trends toward the effectiveness of the intervention on physical and cognitive performance of IWD. An 18-week individualized multidomain intervention (2 × 60 min/session) was delivered to an intervention group (IG; n = 10, mean age 88.4 ± 5.6, 70% female) by nursing assistants (n = 10, mean age 56.1 ± 10.4, 90% female) using the InCoPE-App. A control group (CG; n = 3, mean age 87.3 ± 3.5, 100% female) received conventional treatment. User experience was assessed among nursing assistants by different questionnaires, i.e., PSSUQ and ISONORM 9241/110-S for usability, and AttrakDiff2 for pragmatic (PQ), hedonic quality-identity and stimulation (HQI and HQS), and attractiveness (ATT). Trends toward the effectiveness of the intervention were assessed using MMSE (global cognitive function), FICSIT-4 (balance), 6MWT and TUG (mobility), and m30CST (function of lower limbs). Usability of the InCoPE-App was rated as high by nursing assistants (mean ± SD; overall PSSUQ 2.11 ± 0.75; overall ISONORM 9241/110-S 1.90 ± 0.88; ATT 1.86 ± 1.01; PQ 1.79 ± 1.03; HQI 1.8 ± 0.79; and HQS 1.37 ± 0.69). Dropout was high in the total sample (36.7%). Trends toward the effectiveness were observed within IG in nine IWD who showed positive or neutral trends in at least two physical performance outcomes. Seven participants had positive or neutral trends in the FICSIT-4, seven participants in m30CST, and four and seven participants in 6MWT and TUG, respectively. In conclusion, the InCoPE-App has good nursing assistant-rated usability, whereas training effects and intervention adherence were rather low most likely due to COVID-19 restrictions. Single-subject research revealed more positive than negative trends in IG of IWD. Further research is needed to evaluate feasibility, suitability, and effectiveness of the InCoPE-App.

Effectiveness and Acceptability of e- and m-Health Interventions to Promote Physical Activity and Prevent Falls in Nursing Homes-A Systematic Review.

Age-related decreases in physical activity (PA) and a decline in physical functioning lead to increased fall risk. As falls are a major cause of accidental deaths and hospitalization in older adults, PA promotion and fall prevention are important measures, especially in nursing homes (NH). With advances in information and communication technology, e- and m-health solutions have been developed to positively influence various health-related factors. To date, only little research exists on the implementation of these technologies to promote health in NH. Therefore, the objective of this systematic review was to provide an overview of the effectiveness, acceptability, and feasibility of e- and m-health interventions aimed at promoting PA and preventing falls in NH. Additionally, the effectiveness of such interventions regarding the secondary outcomes physical function, cognitive function, neuropsychiatric symptoms, and psychosocial status was examined. A systematic literature search was performed in five databases and studies published until 15 November 2021, were considered for inclusion. All studies that examined the effectiveness and/or the acceptability and feasibility of e- or m-health interventions in promoting PA and preventing falls in NH, without restriction on language or date of publication, were included in the final synthesis. Of the 1,358 records retrieved, 28 studies were included in this systematic review. Twenty-four studies contained digital exergaming as an intervention or as a part of the intervention, the four additional studies on e-health interventions only examined a small number of outcomes. No m-health intervention study was identified. Data synthesis indicates that exergaming may be effective in reducing the number of falls and fall risk in NH residents. Several significant improvements were also reported regarding secondary outcomes albeit not consistent across studies. No conclusion can be drawn about the effects of exergaming and other e-health interventions on PA, as data is scarce. E-health interventions were mostly reported as feasible and well accepted by NH residents. However, these findings may not be applicable to NH residents with advanced physical and/or cognitive impairments, since they were excluded in many studies. Therefore, more research examining other digital solutions besides exergaming to promote PA in this specific population is critical. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42021289488.

Sensor-based fall risk assessment in older adults with or without cognitive impairment: a systematic review.

BACKGROUND: Higher age and cognitive impairment are associated with a higher risk of falling. Wearable sensor technology may be useful in objectively assessing motor fall risk factors to improve physical exercise interventions for fall prevention. This systematic review aims at providing an updated overview of the current research on wearable sensors for fall risk assessment in older adults with or without cognitive impairment. Therefore, we addressed two specific research questions: 1) Can wearable sensors provide accurate data on motor performance that may be used to assess risk of falling, e.g., by distinguishing between faller and non-faller in a sample of older adults with or without cognitive impairment?; and 2) Which practical recommendations can be given for the application of sensor-based fall risk assessment in individuals with CI? A systematic literature search (July 2019, update July 2020) was conducted using PubMed, Scopus and Web of Science databases. Community-based studies or studies conducted in a geriatric setting that examine fall risk factors in older adults (aged ≥60 years) with or without cognitive impairment were included. Predefined inclusion criteria yielded 16 cross-sectional, 10 prospective and 2 studies with a mixed design. RESULTS: Overall, sensor-based data was mainly collected during walking tests in a lab setting. The main sensor location was the lower back to provide wearing comfort and avoid disturbance of participants. The most accurate fall risk classification model included data from sit-to-walk and walk-to-sit transitions collected over three days of daily life (mean accuracy = 88.0%). Nine out of 28 included studies revealed information about sensor use in older adults with possible cognitive impairment, but classification models performed slightly worse than those for older adults without cognitive impairment (mean accuracy = 79.0%). CONCLUSION: Fall risk assessment using wearable sensors is feasible in older adults regardless of their cognitive status. Accuracy may vary depending on sensor location, sensor attachment and type of assessment chosen for the recording of sensor data. More research on the use of sensors for objective fall risk assessment in older adults is needed, particularly in older adults with cognitive impairment. TRIAL REGISTRATION: This systematic review is registered in PROSPERO ( CRD42020171118 ).

Family health climate: a qualitative exploration of everyday family life and health.

BACKGROUND: The family is an important social environment for children's, adolescents' and adults' health. However, studies mostly focused on dyadic and unidirectional influences of parents on their children. Studies addressing influences arising from daily family life and including family-level influences are rare and the existing studies solely focus on the relevance for children's health or health-related behaviors. We use a qualitative approach to explore how daily family life and its inherent health-related cues affect family members' physical activity and eating behavior. METHODS: Semi-structured interviews utilizing an interview guide were conducted. Since we aimed to examine family life, we analyzed both parents' and their children's views on health-related interaction patterns and family environmental influences on individuals' health-related behavior. Twenty-two members of seven families were interviewed. Transcripts of the interviews were systematically analyzed following Grounded Theory principles. RESULTS: The interviews revealed that various individual as well as environmental factors shape health-related aspects of daily family life. A model was developed that organizes these influencing factors on family life with regard to health-related interactions and the emergence of the Family Health Climate (FHC) - reflecting shared perceptions and cognitions regarding a healthy lifestyle within families - and its consequences. Family interactions and family time, often realized through shared family meals, are key factors for families' health with regard to nutrition and physical activity. The FHC showed to affect various aspects related to health behavior of individual family members. CONCLUSIONS: The model sheds light on underlying processes and mechanisms of family life that influences individuals' health-related behavior. Based on a better understanding of the association between family life and individual health behavior the development of family-based interventions can be informed. Furthermore, the insights can help to guide further research focusing on families as a system.

Physical Activity and Trajectory of Cognitive Change in Older Persons: Mayo Clinic Study of Aging.

BACKGROUND: Little is known about the association between physical activity (PA) and cognitive trajectories in older adults. OBJECTIVE: To examine the association between PA and change in memory, language, attention, visuospatial skills, and global cognition, and a potential impact of sex or Apolipoprotein E (APOE) ɛ4 status. METHODS: Longitudinal study derived from the population-based Mayo Clinic Study of Aging, including 2,060 cognitively unimpaired males and females aged ≥70 years. Engagement in midlife (ages 50-65) and late-life (last year) PA was assessed using a questionnaire. Neuropsychological testing was done every 15 months (mean follow-up 5.8 years). We ran linear mixed-effect models to examine whether mid- or late-life PA at three intensities (mild, moderate, vigorous) was associated with cognitive z-scores. RESULTS: Light intensity midlife PA was associated with less decline in memory function compared to the no-PA reference group (time x light PA; estimate [standard error] 0.047 [0.016], p = 0.004). Vigorous late-life PA was associated with less decline in language (0.033 [0.015], p = 0.030), attention (0.032 [0.017], p = 0.050), and global cognition (0.039 [0.016], p = 0.012). Females who were physically inactive in midlife experienced more pronounced cognitive decline than females physically active in midlife and males regardless of PA (p-values for time interaction terms with midlife PA levels and sex were all p < 0.05 for global cognition). APOE ɛ4 carriership did not moderate the association between PA and cognition. CONCLUSION: Engaging in PA, particularly of vigorous intensity in late-life, was associated with less pronounced decline in global and domain-specific cognition. This association may differ by sex.