Effects of multicomponent and dual-task exercise on falls in nursing homes: The AgeingOn Dual-Task study.

OBJECTIVE: To compare the effects of a multicomponent exercise program and a dual-task exercise program on the number of falls (fall rate) and number of fallers (fall incidence) and on parameters associated with fall risk in older adults living in long-term nursing homes (LTNH). STUDY DESIGN: This is a secondary analysis of a single-blind randomized controlled trial involving 85 older adults in nine LTNHs (Gipuzkoa, Spain). Participants allocated to the multicomponent group underwent a twice-a-week 3-month individualized and progressive resistance and balance program. The dual-task group performed simultaneous cognitive training with the same multicomponent exercises. MAIN OUTCOMES: Fall rate and incidence were analyzed using Poisson regression (adjusting for cognitive function and previous fall rate) and Kaplan-Meier analysis, respectively. Handgrip asymmetry, single- and dual-task TUG velocity and cost were assessed using two-way ANOVA for repeated measures and paired Student's t-tests. RESULTS: The dual-task group showed a 3.8 times greater risk of falling than the multicomponent group during the intervention, and a 2.59 times greater risk during the 12-month follow-up. There were no between-group differences in fall incidence. There were between-group differences in handgrip strength asymmetry in favor of the multicomponent group. While only the multicomponent group improved on the TUG test, the dual-task group improved on dual-task cost. CONCLUSIONS: Compared with the dual-task program, the multicomponent exercise program showed more benefits in reducing falls and in parameters associated with fall risk in LTNH residents. Future studies are warranted to confirm our results and continue to explore physical and cognitive interventions to prevent falls in LTNHs. Australian New Zealand Clinical Trials Registry ACTRN12618000536268.

Comparison between multicomponent and simultaneous dual-task exercise interventions in long-term nursing home residents: the Ageing-ONDUAL-TASK randomized controlled study.

BACKGROUND: the potential benefits of dual-task interventions on older adults living in long-term nursing homes (LTNHs) from a multidimensional perspective are unknown. We sought to determine whether the addition of simultaneous cognitive training to a multicomponent exercise program offers further benefits to dual-task, physical and cognitive performance, psycho-affective status, quality of life and frailty in LTNH residents. Design: a single-blind randomized controlled trial. SETTING: nine LTNHs in Gipuzkoa, Spain. SUBJECTS: 85 men and women (ACTRN12618000536268). METHODS: participants were randomly assigned to a multicomponent or dual-task training group. The multicomponent group performed two sessions per week of individualized and progressive strength and balance exercises for 3 months. The dual-task group performed simultaneous cognitive tasks to the same tasks as in the multicomponent group. Gait speed under single- and dual-task conditions, physical and cognitive performance, psycho-affective status, quality of life and frailty were measured at baseline and after 3 months of intervention. RESULTS: both groups showed clinically significant improvements on gait performance under single- and dual-task conditions and on the short physical performance battery (P < 0.05). Both interventions were effective in maintaining cognitive function (P > 0.05). Only the multicomponent group significantly improved quality of life, and reduced anxiety and Fried frailty score (P < 0.05). No group-by-time interactions were found except for the chair-stand test in favour of the multicomponent group (P < 0.05). CONCLUSIONS: the addition of simultaneous cognitive training does not seem to offer significantly greater benefits to the evaluated multicomponent exercise program in older adults living in LTNHs.

[In which residential settings do older persons with intellectual disability live? : A quantitative comparison of age groups for Westphalia-Lippe]. / In welchen Wohnsettings leben ältere Menschen mit geistiger Behinderung? : Ein quantitativer Vergleich von Altersgruppen für Westfalen-Lippe.

BACKGROUND: The number of aged persons with intellectual disability (ID) in Germany is increasing; however, reliable data on the residential settings in which they live are missing. The aim of this study was to estimate how adults with ID of different age groups are distributed over the various residential settings using the example of Westphalia-Lippe. MATERIAL AND METHODS: Administrative data on all adults with ID who received aid for social integration were statistically analyzed. Data on persons with ID in long-term nursing homes were collected via telephone interviews and questionnaires. Finally, the results were merged to obtain a comprehensive overview for Westphalia-Lippe. RESULTS: In Westphalia-Lippe aged persons with ID (≥65 years) rarely live independently but mostly with family members or in supported living arrangements. They are living in larger community-based homes or in residential institutions more frequently than younger persons with ID and one fifth have been living in nursing homes for a comparatively long period of time. CONCLUSION: Older persons with ID have so far hardly benefited from the increasing residential options for supported living. All forms of services and residential arrangements for persons with ID have to adapt to the changing needs for support in old age. Long-term nursing homes should not mutate into places where people spend the complete phase of old age.

Sentimentos de residir em uma instituição de longa permanência: percepção de idosos asilados / Feelings about long-term residing in nursing homes: perception of residents / Sentimientos de residir en una institución de larga estancia: percepción de ancianos asilados

O presente estudo é descritivo de natureza qualitativa e teve como objetivo conhecer a percepção do idoso sobre os motivos que levaram à sua institucionalização, bem como seus sentimentos diante desta condição. Dele participaram 10 idosos asilados. Os dados foram coletados no período de maio a junho de 2011, em uma instituição de longa permanência para idosos, no município de Maringá, através de entrevista semiestruturada. Para tratamento dos dados foi utilizada a análise de conteúdo de Bardin. Como um dos resultados foram identificadas duas categorias: Condições determinantes da institucionalização de idosos e Sentimentos dos idosos em relação à institucionalização. Evidenciou-se que conflitos familiares e o fato de não ter família constituída foram os principais motivos para a inserção dos idosos no ambiente asilar, e que essa condição desperta sentimentos negativos (solidão, angústia, ausência de liberdade) e positivos (segurança de moradia e bem-estar).

This is a qualitative-descriptive study aiming at investigating the perception of the elderly on their institutionalization, as well as their feelings about their status. Ten residents of a long-term nursing home for the elderly (ILPIs) in Maringá, PR, Brazil, participated in the study. Data were collected through semi structured interviews, from May to June, 2011. Data analysis was based on Bardin’s content analysis methodology. Results identified two categories: Determining conditions for the institutionalization of the elderly and feelings of the elderly about their institutionalization.  Results show family conflicts and lack of family structure as main reasons accounting for the inclusion of the elderly in a nursing home. Negative feelings such as loneliness, anxiety, lack of freedom, as well as positive feelings, such as safe housing and welfare came out.

Estudio cualitativo-descriptivo que tuvo como objetivo investigar la percepción del anciano sobre las razones que llevaron a su institucionalización, así como sus sentimientos hacia esta condición. El estudio incluyó a 10 ancianos asilados. Los datos fueron recogidos entre mayo y junio de 2011, en una institución de larga estancia para ancianos, en Maringá-PR-Brasil, a través de entrevistas semiestructuradas. Para tratamiento de los datos se utilizó el análisis de contenido de Bardin. Los resultados identificaron dos categorías: Determinar las condiciones para la institucionalización de los ancianos y Sentimientos de los ancianos en relación a la institucionalización. Se encontró que conflictos familiares y la falta de una familia fueron los motivos principales para la inclusión de los ancianos en un asilo. Demostró que esa condición despierta sentimientos negativos (soledad, ansiedad, falta de libertad) y positivos (seguridad de morada y bienestar).