Effect of resistance training on strength, postural control, and gait velocity among older adults.

The purpose of this study was to examine the effects of a 14-week resistance training program on the ankle strength, training intensity, postural control, and gait velocity of older adults. Forty-two older adults (mean age = 72), 21 in the resistance and control groups, completed the 14-week project. The resistance training group participated in 14 weeks of resistance training three times per week using elastic bands (Theraband) for resistance. Isokinetic ankle strength, training intensity, postural stability, and gait velocity were measured prior to and following the 14-week intervention. Following the training, the resistance group exhibited improved ankle dorsiflexion, training resistances, and gait velocity, but showed no change in plantar flexion or postural control. The control group also exhibited improvements in dorsiflexion, but these gains were approximately one-half of the gains observed in the resistance training group. Finally, when adjusted for baseline differences, subjects in the resistance training group demonstrated no changes in the dependent measures over the control group.

Balance and muscle strength as predictors of frailty among older adults.

The term frailty is increasingly used in gerontological literature and in practice. However, indicators differentiating frail from nonfrail are not well delineated. Identifying factors discriminating between frail and nonfrail older community-residing adults may lead to more comprehensive clinical assessments and targeted interventions to minimize or prevent frailty. Eighty-four adults, ages 60 to 88 (mean = 74) living independently in the community completed a functional performance questionnaire and a perceived health questionnaire that were combined as measures of frailty. Predictor variables of frailty included four measures of balance and three measures of lower leg strength. Discriminant analysis revealed that one balance score and dorsiflexion correctly classified 65% of group membership, with better prediction of the nonfrail than frail group. This study clarifies that the predictors of frailty include the combination of dorsiflexion strength and balance, specifically the contribution of vision to balance when the support surface is compliant. Recommendations are proposed for conceptualizing and operationalizing frailty and adding variables to enhance discrimination between frailty and nonfrailty. Nursing implications include adding clinical assessments of specific components of balance and ankle strength to develop a more comprehensive evaluation of frailty.

The initial RNF research survey: rehabilitation nursing research interests of ARN members.

The data from this survey provide baseline information for comparison with subsequent surveys. Respondents to this initial survey demonstrate involvement in research activities, primarily for the direct improvement of care. Findings from the data suggest that the research climate is right for collaborative efforts between rehabilitation nurses caring directly for clients and nurses with research degrees to conduct multisite research projects and to encourage enhanced research preparation, including computer literacy, for nurses at the graduate level.

Factors associated with nursing interventions to reduce incontinence in hospitalized older adults.

INTRODUCTION: The problem of incontinence in hospitalized elderly patients is rarely documented, and there is little research that determines why nurses choose to help or not help with this problem. Are hospital-based acute care nurses' attitudes and beliefs about incontinence associated with the perceived opportunity to assist the patient with the problem? What do hospital nurses know about causes and interventions relative to incontinence? METHODS: Two vignettes, one describing a patient with stress incontinence and one describing a patient with urge incontinence, were created. Questions measuring variables of a help-giving model were developed, and nurses were asked to mark on a Likert-type scale when answering each question. RESULTS: One hundred-fifty respondents returned completed questionnaires along with three nurse experts. Many hospital nurses believed incontinence was temporary and part of being old. As a group they had a more positive attitude toward intervening for urge incontinence and believed the physician and their nurse manager expected them to assist the patient with urge incontinence. Respondents tended to believe the patient was least likely to expect help. Respondents were evenly divided about opportunity to provide assistance for stress or urge incontinence. Less than half of the nurses correctly listed causes and interventions for stress or urge incontinence. CONCLUSIONS: Other clinical problems perceived as more pressing and lack of knowledge concerning appropriate helping measures affect nurses' perceptions of opportunity to intervene when elderly hospital patients are incontinent. Assessment and intervention are essential to quality nursing care. Undergraduate nursing education and ongoing staff education about incontinence are crucial if assessments and interventions are to be correct. Patients, as health care consumers, have to be more educated about incontinence and choose to have the problem addressed during hospitalization. The Agency for Health Care Policy and Research Clinical Practice Guidelines is a major recommended reference.

A hard hand-positioning device to decrease wrist and finger hypertonicity: a sensorimotor approach for the patient with nonprogressive brain damage.

To investigate whether a hand-positioning device placed in the palm of a patient with nonprogressive brain damage will decrease hypertonicity of the flexor muscles of the hand through proprioreceptive sensory input to the alpha-gamma coactivation loop, a hard cone was placed in the affected hand of 11 subjects who had sustained cerebrovascular accidents and had flexor hypertonicity of the upper extremity. Measurements of hypertonicity and functionality were made weekly for four weeks. All subjects experienced a significant decrease in flexor hypertonicity. Only slight changes were observed in functionality.

Postural control and strength and mood among older adults.

Falls are a significant problem among older adults. Reported correlates of older adult falls have included determinations in leg muscle strength and declines in postural control. However, some investigators have reported low correlations between measures of strength and postural control among older adults. Other investigators have reported that attention demands in this group are inversely related to their postural control. No study has attempted to predict postural control from mood precursors or from knee and ankle strength among older adults. The purpose of this study was to examine relationships between postural control and strength and mood precursors to attention among older adults. Twenty-seven older adults (m = 73.8 years) completed the 16-item Mood Response Scale, which measures total mood, and three subscales conceptualized to be precursors of the subject's ability to focus attention: alertness, contentedness, and calmness. Measures of each subject's isometric knee and ankle strength and postural control also were collected. Using stepwise regression analysis the investigators found that alertness accounted for the greatest amount of variance in all three measures of postural control (R2 = 20 to 27). Additionally, ankle strength, calmness, and age considerably increased the explained variance in postural sway with eyes closed (total R2 = 416). Age was not a significant predictor of the other two measures of postural control. The findings suggest that alertness, a precursor to attention among older adults, is a significant predictor of postural control when vision is intact but that other factors assume importance when vision is impaired. These findings indicate that the postural stability of older adults may be improved, and falls reduced, through interventions which enhance the alertness and attention among older adults.