A case management strategy to reduce falls in older people with a history of falls: A randomized controlled trial.

The present study aimed to determine whether a remotely delivered intervention, based on an individual case management, can reduce falls and their consequences in community-dwelling older people with a history of multiple falls. In this randomized controlled trial, 32 participants were randomized to the intervention group, which comprised a 16-week case management program involving a multidimensional assessment, targeted interventions according to the identified fall risk factors, and development of individualized care plans. The intervention was performed by trained gerontologists, under weekly supervision of professionals with experience in falls. The control group (n = 30) received usual care. Falls were monitored over 12 months with monthly falls calendars and telephone calls. Remotely delivered case management presented an 82 % uptake of recommendations. There was a trend toward a reduced fall incidence in the intervention vs control group, with lower fall, fall injury and fracture rates in the intervention group compared with the control group at both the 16-week and 12-month time-points, with the difference statistically significant for injurious fall rates at 12 months - IRR=0.18 (95 % CI = 0.04 to 0.74).

Effects of a case management-based intervention on non-motor risk factors for falls in older people with history of falls: a randomised clinical trial.

BACKGROUND: Falls are directly related to morbidity and mortality of older people. Multifactorial approaches that are individualised and based on fall risk factors are necessary. This study aims to verify the effects of a case management-based intervention on non-motor risk factors for falls in community-dwelling older people with a history of falls. METHODS: The intervention applied a multidimensional assessment of risk factors for falls, a discussion about the identified risk factors, the preparation of an individualised plan with the participant, and the application, monitoring and review of the plan. RESULTS: There was a significant interaction between groups and assessments only in the visuospatial domain (P = 0.031). After simple main effects analysis, differences between groups and assessments were not significant, although there was a tendency of worse visuospatial performance in the control group in the follow-up assessment (P = 0.099). There were no significant differences between groups or between assessments in other variables. CONCLUSION: The intervention has the potential to maintain non-motor risk factors for falls in community-dwelling older people with a history of falls. However, more clinical trials are needed to prove its effects.

Effects of a cognitive stimulation program on physical and cognitive dimensions in community-dwelling faller older adults with cognitive impairment: study protocol.

BACKGROUND: Cognitive functioning is an important dimension among the elderly. Cognitive maintenance is vital for aging due to its association with autonomy and independence. Considering the importance of preventive programs in older adults' health, this study aims to share an intervention protocol of a falls prevention program for community-dwelling faller older adults with cognitive impairment. METHODS: This is the protocol of an experimental and longitudinal study, consisting of cognitive stimulation associated with physical exercise in a 16-week fall prevention program. For cognitive intervention, the APG Cognitive Training Protocol will be used. Participants will be assessed pre-and post-intervention and will be randomly allocated to experimental or control groups. The screening protocol is composed of the TUG, FES-I, LAWTON & BRODY, ACE-R, GAI and fall survey instruments, focusing on the assessment of balance and mobility, fear of falling, performance on IADL, cognitive and anxiety tracking, respectively. DISCUSSION: This study can determine the long-term effects of multimodal cognitive training, providing evidence for its replication in the provision of care for the elderly. The objective is to promote improvements in the cognitive performance, mobility and balance of the elderly, with a focus on reducing the number of falls, fractures, hospitalizations and institutionalization, serving as an alternative to interrupt the cycle of falls. TRIAL REGISTRATION: The research was approved by the Research Ethics Committee with Human Beings at the Federal University of São Carlos, CAAE: 3654240.9.0000.5504 and Brazilian Registry of Clinical Trials (REBEC) RBR-3t85fd, registered on the 25th of September, 2020.

Treatment fidelity and satisfaction with an intervention based on case management for older people with falls history: Randomized clinical trial.

PURPOSE: To verify the treatment fidelity and satisfaction with a multifactorial intervention based on case management in community-dwelling older people with falls history and related sociodemographic and clinical factors. METHODS: This is a single-center, randomized, parallel-group controlled clinical trial. 62 community-dwelling older people with falls history were distributed into two groups. The Intervention Group (IG) underwent a case management involving multidimensional evaluation, explanation of the risk factors for falls identified, implementation of an intervention proposal based on the identified risks, elaboration of an individualized falls intervention plan, implementation, monitoring and review of the intervention plan. The Control Group (CG) was accompanied by a monthly phone call. After 16 weeks, the volunteers answered two closed questionnaires about treatment fidelity or non-fidelity to intervention (IG) and satisfaction with intervention (both groups). In addition, the frequency of intervention, adherence to each recommendation of the case management and satisfaction with general care were evaluated. RESULTS: There was good treatment fidelity based on case management, as well as good adherence to recommendations. In addition, the satisfaction of both groups was positive, although the IG had a better score (p<0.05). There was a significant influence of monthly income and general health on treatment fidelity (IG). Also, age, years of schooling, general health and physical mobility significantly influenced satisfaction with the IG. There was a significant influence of number of falls on satisfaction with monitoring conducted in the CG. CONCLUSIONS: Clinical and sociodemographic factors can influence treatment fidelity and satisfaction of older people with falls history to a falls prevention program.

Family caregivers' satisfaction with telerehabilitation and follow-up intervention for older people with dementia: Randomized clinical trial.

The present study aimed to assess caregiver satisfaction with a telerehabilitation program and remote monitoring for older adults with dementia and their caregivers during the COVID-19 pandemic, as well as to identify the factors influencing caregiver satisfaction. This study adopted a mixed-methods approach and was part of a randomized clinical trial, with blinded assessors, comprising two groups: the Intervention Group (IG) receiving a telerehabilitation program involving standardized physical exercises for older adults with dementia, along with caregiver guidelines for the caregiver; and the Control Group (CG) receiving remote monitoring. At baseline, factors related to older adults with dementia and their caregivers were measured. After 12 weeks, caregiver satisfaction with the interventions was assessed. The final sample consisted of 64 pairs of family caregivers and older people with dementia. Caregivers in the IG showed higher satisfaction levels with the intervention, Internet-based treatment, and healthcare received compared to caregivers in the CG. Both groups expressed positive views towards the treatment, with excellent ratings for audio and video quality, and a preference for Internet-based treatment over face-to-face. In the IG, only the amount of time dedicated to caregiving influenced satisfaction with the intervention, whereas in the CG, cognitive and functional performance of the older people influenced satisfaction with remote monitoring. Our findings suggest the potential of the program in providing effective care for older people with dementia and their caregivers.

Effects of case management based on preventing falls in older people: A systematic review.

BACKGROUND: Falls among older adults can lead to negative consequences with physical, functional, social, and psychological functioning, and a high prevalence of mortality. However, it is still unclear whether case management can reduce the number of falls in this population. AIMS: The aims of this review were to analyze the effects of case management on preventing falls and reducing risk factors for falls in older people. METHODS: A systematic review was conducted, searching for and synthesizing clinical trials involving case management in older people who had falls or risk for fall outcomes. Two authors extracted data using predefined data fields, and risk of bias was assessed by the Physiotherapy Evidence Database (PEDro) scale. RESULTS: Twelve studies were included in the final review. Case management in older people did not significantly reduce the number of falls, falls per person, or severity of falls compared to control groups. Adherence to recommendations in case management ranged from 25% to 88%. LINKING EVIDENCE TO ACTION: There is limited evidence of reduced rates of falls and specific risk factors for falls among people who received case management interventions. Randomized trials with good quality are needed.

Effects of Aquatic Physical Exercise on Motor Risk Factors for Falls in Older People During the COVID-19 Pandemic: A Randomized Controlled Trial.

OBJECTIVE: The aim of this study was to assess the effects of aquatic training on motor risk factors for falls in older people during the COVID-19 pandemic. METHODS: A randomized controlled trial was carried out with older people, divided into an aquatic training group (ATG) (n = 24) and a control group (CG) (n = 25). Muscle strength was assessed by the 5-Times Sit-to-Stand Test, mobility by the simple and dual-task Timed Up and Go Test, and postural stability through stabilometric data (force platform). The CG received monthly calls to monitor general health. The ATG carried out training lasting 16 weeks, with two 1-hour sessions per week. RESULTS: Both groups improved muscular strength and cognitive-motor tasks, and they performed a dual task with fewer errors in the secondary task after 16 weeks regardless of the pandemic and COVID-19 diagnosis. There was a significant decrease in the area of center of pressure displacement in the tandem posture with eyes closed in the CG. When analyzing participants who adhered at least 50% to the intervention, the ATG significantly reduced the number of steps on the Timed Up and Go Test performance. Both groups improved muscular strength and cognitive-motor tasks and increased the cognitive task cost. In the CG, there was a significant decrease in the mean amplitude of the anteroposterior center of pressure displacement in the feet together with eyes open. CONCLUSION: We found that aquatic physical exercise presented positive effects on some potentially modifiable motor risk factors for falls (mobility and muscle strength) regardless of the COVID-19 pandemic and COVID-19 diagnosis, especially among people who adhered to the intervention.

Six-month change in gait speed to discriminate between those with and without falls history in older people with Mild Cognitive Impairment and mild Alzheimer disease.

BACKGROUND AND PURPOSE: The purposes of this study were to identify differences in gait speed performance over 6 months between older people with Preserved Cognition (PrC), with Mild Cognitive Impairment (MCI) and with Alzheimer disease (AD) in mild stage; and to verify if the change in gait speed could discriminate fallers in older people with MCI and AD in a mild stage METHODS: A longitudinal study was conducted with community-dwelling older adults, including 40 with PrC, 36 with MCI and 34 with AD in the mild stage. Gait speed (in m/s) changes were captured through a 10-meter walk test. We documented the number of self-reported falls by monthly calendars that were returned after a 6-month follow-up. During this period, the participants received monthly telephone calls to remind them to fill in the calendar RESULTS: There was a significant difference in terms of sex and age between the groups: 23%, 31% and 19% were female and had a mean age of 72.8, 75.9 and 76.9 years in the PrC, MCI and AD groups respectively. During the follow-up, 45%, 52.7% and 52.9% of the PrC, MCI and AD groups fell. The MCI and AD groups presented lower gait speed compared to the PrC Group at both moments. There was no significant difference in the change of gait speed between groups. In the model adjusted by age, the change in gait speed failed to discriminate fallers in older people with MCI and with AD CONCLUSION: Older people with MCI and AD in the mild stage present lower gait speed compared to older people with PrC. Changes in gait speed over a short period of time do not discriminate fallers in older people with MCI or AD in a mild stage.

User and family satisfaction with nursing homes: a systematic review.

BACKGROUND: Implementation of person-directed care planning is a challenge for nursing home services. User satisfaction is indispensable to implement it. OBJECTIVE: The aim of this study was to address user and family satisfaction with nursing homes and the scales used and to identify the determinants of satisfaction with this service. METHODS: A systematic review was conducted, and the Cochrane Library, PubMed, Scopus, Web of Science and CINAHL databases were searched between December 2019 and April 2020. Studies involving assessment of user or family satisfaction with nursing homes and users ≥65 years old or their families were included in this review. The methodological quality of the included studies was assessed by the Joanna Briggs Institute reviewer's manual. RESULTS: Eight articles were included based on the eligibility criteria, from a total of 2378 records found in the electronic search. All studies presented a cross-sectional design, and the total sample of this review was 57 214 older people. Most of the studies included showed positive overall satisfaction with nursing homes. There was no consensus about the best scale to assess satisfaction because of the huge variety of tools among studies. The most common determinants of satisfaction among studies were quality of life (mental and physical components), anxiety and social and health factors. CONCLUSION: The findings of our review may contribute to a better view of satisfaction with nursing homes experienced by users and families and to an improvement of care in these institutions.

Effects of the Addition of a Dual Task to a Supervised Physical Exercise Program on Older Adults' Cognitive Performance.

The purpose of this study was to investigate the effects of the addition of a dual task to multicomponent training on cognition of active older adults. Eighty physically active older adults were divided into an intervention group (IG) and a control group (CG). Both groups performed multicomponent training over 12 weeks. The IG simultaneously performed exercises and cognitive tasks. The Mini-Mental State Examination, the Montreal Cognitive Assessment, and the Clock Drawing Test were used for cognitive assessments. The Timed Up and Go Test associated with a cognitive task was used for dual-task assessment. Significant interactions were not observed between groups in terms of the cognitive variables or the dual-task performance. An interaction was observed only for Timed Up and Go Test performance, which was better in the CG than in the IG. Active older adults showed no improvement in cognition following the addition of the dual task to the multicomponent training.

Relationship between dual task walking, cognition, and depression in oldest old people.

BACKGROUND: The purpose of the study was to investigate the relationship between dual task walking, cognition, and depression in oldest old people living in the community. METHODS: We conducted an observational cross-sectional study at Federal University of São Carlos (Brazil). We assessed 67 community-dwelling older adults aged 80 years and over, who were able to walk alone and did not present with a risk of dementia (assessed by Mini-Mental State Examination, MMSE). The assessment consisted of anamnesis, dual task using the Timed Up and Go test associated with a motor task (TUGT-motor) and a cognitive task (TUGT-cognitive); cognitive measures using MMSE, Montreal Cognitive Assessment (MoCA), Clock Drawing test (CDT) and verbal fluency, and depressive measures by the Geriatric Depression Scale (GDS). RESULTS: There was a correlation with higher magnitude between cognitive tests and TUGT-cognitive, compared to TUGT-motor. For TUGT-motor, the highest correlations with cognitive tests were found between time and MMSE, MoCA (total score), and MoCA visuospatial/executive domain. For TUGT-cognitive, the highest correlations with cognitive tests were between number of steps and MMSE and between time and MMSE. GDS showed a significant weak correlation with number of steps taken in TUGT-motor, wrong words, and correct/time of TUGT-cognitive. CONCLUSIONS: Dual task performances are associated with cognition in oldest old. Furthermore, dual task tests have less influence of educational level, are functional, fast, and easily applicable in clinical practice. Future studies are needed to confirm if dual task test is useful for cognitive screening in oldest old.

Effects of a Multifactorial Program with Case Management for Falls Prevention on Functional Outcomes in Community-Dwelling Older People: A Randomized Clinical Study.

Falls are among the top 10 causes of years lived with disability in people aged 75 and over. Preventive programs like case management (CM) are crucial. OBJECTIVES: To evaluate the effects of a multifactorial fall prevention program based on CM on physical performance, the presence of pain, and the risk of falls and fractures in older people who have suffered falls. METHODS: This randomized, single-blind clinical trial with parallel groups, Intervention Group (IG) and Control Group (CG), was composed of 55 older people with a history of falling, living in the community. All participants underwent an initial assessment via video call (containing anamnesis, timed up-and-go test, falls risk score, short physical performance battery, and clinical frax). The IG underwent CM, the physical exercise protocol, and the cognitive stimulation protocol. The CG was monitored through telephone calls and received general health and fall guidance. RESULTS: No significant results were found in the physical capacity, the presence of pain, the risk of falls, or the fractures between the Intervention and Control Groups and between assessments. CONCLUSION: This program was not effective in improving functional performance, but it was important for characterizing pain and the probability of fracture in the next 10 years in this population.

Efficacy of Transcranial Direct Current Stimulation (tDCS) on Cognition, Anxiety, and Mobility in Community-Dwelling Older Individuals: A Controlled Clinical Trial.

Transcranial direct current stimulation (tDCS) has gained popularity as a method of modulating cortical excitability in people with physical and mental disabilities. However, there is a lack of consensus on its effectiveness in older individuals. This study aimed to assess the efficacy of a 2-month tDCS program for improving physical and mental performance in community-dwelling older individuals. In this single-blinded, controlled clinical trial, forty-two participants were allocated to one of three groups: (1) the tDCS group, which received, twice a week, 20 min sessions of 2 mA electric current through electrodes placed on the dorsolateral prefrontal cortex; (2) the tDCS-placebo group, which underwent the same electrode placement as the tDCS group but without actual electric stimulation; and (3) the cognitive-control group, which completed crossword puzzles. Main outcome measures were cognition, mobility, and anxiety. Multivariate analyses of variance were employed. Significance was set at 5% (p < 0.05). Regarding the results, no significant benefits were observed in the tDCS group compared with the tDCS-placebo or cognitive-control groups for cognition (p = 0.557), mobility (p = 0.871), or anxiety (p = 0.356). Cognition exhibited positive oscillations during the assessments (main effect of time: p = 0.001). However, given that all groups showed similar variations in cognitive scores (main effect of group: p = 0.101; group × time effect: p = 0.557), it is more likely that the improvement reflects the learning response of the participants to the cognitive tests rather than the effect of tDCS. In conclusion, a 2-month tDCS program with two sessions per week appears to be ineffective in improving physical and mental performance in community-dwelling older individuals. Further studies are necessary to establish whether or not tDCS is effective in healthy older individuals.

Fall accidents in older people: a time trend analysis of the period 2000-2020 and the estimated economic burden on the Brazilian health system in 2025. / Acidentes por quedas na população idosa: análise de tendência temporal de 2000 a 2020 e o impacto econômico estimado no sistema de saúde brasileiro em 2025.

Longitudinal monitoring of indicators of accidental falls can facilitate the planning of effective care and prevention actions. This article aims to analyze temporal trends in variables related to falls among older persons in Brazil and in the state of São Paulo during the period 2000-2020 and estimate the projected economic burden on the health system in 2025. We conducted a quantitative retrospective observational study using data from the Health Information System. The Joinpoint Regression Program version 4.7.0 and SPSS version 20.0 were used to perform linear regression and calculate the Average Annual Percent Change (AAPC), adopting a 95% confidence interval. There was an increase in mean and total admissions costs due to falls at national level in both intervals of the study period. There was an increase in total admissions costs and the total number of admissions due to falls in the state of São Paulo (AAPC of 8.5% and 4.3%, respectively). Projections for the year 2025 suggest that the total number of admissions due to falls in Brazil will be around 150,000, resulting in costs of approximately R$ 260 million. There was an increase in the variables analyzed by this study, revealing the importance of fall prevention programs associated with national public policies.

O acompanhamento longitudinal de indicadores, como os relacionados às quedas acidentais, pode facilitar o planejamento de ações mais eficazes de assistência e prevenção. O objetivo deste artigo é analisar a tendência temporal das variáveis relacionadas aos acidentes de quedas na população idosa no Brasil e no estado de São Paulo entre 2000 e 2020 e estimar o impacto econômico para o SUS em 2025. Este é um estudo observacional retrospectivo com abordagem quantitativa, com dados do Sistema de Informação em Saúde. Foram utilizados os softwares Joinpoint Regression Program versão 4.7.0 e SPSS versão 20.0 para a realização de regressões lineares, além da análise Average Annual Percent Change (AAPC), adotando um intervalo de confiança de 95%. No país, houve aumento das internações nos dois períodos analisados, assim como os gastos totais, em todos os segmentos analisados. Em concordância no estado de São Paulo, o valor total e as internações apresentaram aumento (AAPC, sendo 8,5% e 4,3% respectivamente). No ano de 2025, as internações por quedas no Brasil estarão próximas a 150 mil, gerando custos em torno de R$ 260 milhões. Houve o aumento das variáveis analisadas, mostrando a importância de programas de prevenção de quedas associados a políticas públicas nacionais.

Can timed up and go subtasks predict functional decline in older adults with cognitive impairment?

Even in the early stages of cognitive impairment, older people can present important motor alterations. However, there are no studies that have investigated Timed Up and Go (TUG) and its subtasks in predicting impairment of functional capacity over time in this population. Objectives: The aim of this study was to verify if the TUG test and its subtasks can predict functional decline over 32 months in older adults with mild cognitive impairment (MCI) and mild Alzheimer's disease (AD). Methods: This is a prospective 32-month follow-up study, including at baseline 78 older adults (MCI: n=40; AD: n=38). The TUG and its subtasks (e.g., sit-to-stand, walking forward, turn, walking back, and turn-to-sit) were performed at baseline using the Qualisys Motion system. Functional capacity was assessed at baseline and after 32 months. Results: After follow-up, the sample had 45 older adults (MCI: n=25; AD: n=20). Of these, 28 declined functional capacity (MCI: n=13; AD: n=15). No TUG variable significantly predicted (p>0.05) functional decline in both groups, by univariate logistic regression analysis with the covariate gender. Conclusions: Although older adults with MCI and mild AD declined functional capacity, the TUG test and its subtasks could not predict this decline over 32 months.

Mesmo nos estágios iniciais do comprometimento cognitivo, os idosos podem apresentar alterações motoras importantes. No entanto, não há estudos que tenham investigado o timed up and go (TUG) e suas subtarefas como preditores do comprometimento da capacidade funcional ao longo do tempo nessa população. Objetivos: O objetivo deste estudo foi verificar se o teste timed up and go (TUG) e suas subtarefas podem predizer o declínio funcional ao longo de 32 meses em idosos com comprometimento cognitivo leve (CCL) e doença de Alzheimer leve (DA). Métodos: Este é um estudo prospectivo de acompanhamento de 32 meses, que incluiu no início do estudo 78 idosos (CCL: n=40; DA: n=38). O TUG e suas subtarefas (sentar para levantar, caminhar para frente, virar, caminhar para trás e girar para sentar) foram realizados na linha de base pelo sistema Qualisys Motion. A capacidade funcional foi avaliada no início e após 32 meses. Resultados: Depois do seguimento, a amostra foi composta de 45 idosos (CCL: n=25; DA: n=20). Destes, 28 tiveram a capacidade funcional diminuída (CCL: n=13; DA: n=15). Nenhuma variável do TUG previu declínio funcional significativamente estatístico (p>0,05) em nenhum dos grupos, por meio da análise de regressão logística univariada com a covariável sexo. Conclusões: Embora os idosos com CCL e DA leve tenham tido sua capacidade funcional diminuída, o teste TUG e suas subtarefas não puderam prever esse declínio em 32 meses.

A Case Management Program at Home to Reduce Fall Risk in Older Adults (the MAGIC Study): Protocol for a Single-Blind Randomized Controlled Trial.

BACKGROUND: Individual case management programs may be particularly effective in reducing fall risk as they can better identify barriers and facilitators to health recommendations. OBJECTIVE: This paper describes the protocol for a single-blind, parallel-group randomized controlled trial that aims to investigate the effectiveness and cost-effectiveness of a home-based multifactorial program targeting fall risk factors among people aged 60 years and over who have fallen at least twice in the past 12 months (the MAGIC trial). METHODS: Older people with a history of at least 2 falls in the last year will be divided into 2 groups. The intervention group will receive case management at home for reducing the risk of falls, including a multidimensional assessment, explanation of fall risk factors, and elaboration and monitoring of an individualized intervention plan based on the identified fall risk factors, personal preferences, and available resources. The control group will be monitored once a month. Assessments (clinical data, fall risk awareness, physical and mental factors, safety at home, feet and shoes, and risk and rate of falls) will be carried out at baseline, after 16 weeks of the intervention, and at the posttrial 6-week and 1-year follow-up. After 16 weeks of the intervention, satisfaction and adherence to the intervention will also be assessed. Economic health will be evaluated for the period up to the posttrial 1-year follow-up. RESULTS: Data collection started in April 2021, and we expected to end recruitment in December 2021. This case management program will address multifactorial assessments using validated tools and the implementation of individualized intervention plans focused on reducing fall risk factors. CONCLUSIONS: This trial may provide reliable and valuable information about the effectiveness of case management for increasing fall risk awareness and reducing fall risk in older people. TRIAL REGISTRATION: Brazilian Clinical Trials Registry (ReBec) RBR-3t85fd; https://ensaiosclinicos.gov.br/rg/RBR-3t85fd. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/34796.

Self-management strategies and multicomponent training to mitigate the effects of the interruption of physical exercise programmes in the pandemic context on functionality, sedentary behaviour, physical capacity, mental health, body composition and quality of life in older adults: a blinded randomized controlled study protocol.

BACKGROUND: Considering the confinement recommended by the World Health Organization due to the pandemic caused by COVID-19, many community physical exercise programmes for older adults have had their activities cancelled. In this context, proposing strategies to recover the possible adverse effects of the confinement period is pertinent. The use of self-management strategies associated with regular physical activity reduces sedentary behaviour and improves physical capacity in older adults. Thus, the purpose of this study was to describe a multicomponent training programme combined with a self-management strategy protocol to mitigate the effects of interruptions in physical exercise programmes on functionality, physical capacity, mental health, body composition and quality of life in older adults. METHODS: This will be a blinded, randomized and controlled clinical trial performed in São Carlos, SP, Brazil. Eighty older adults will be divided into two groups: multicomponent training (Multi) and multicomponent training + self-management strategies (Multi+SM). The intervention will be performed over 16 weeks on three alternate days of every week, with 50-min sessions. The assessment of physical capacity will be performed before the interruption of physical exercise programmes (T0: initial assessment, March 2020), preintervention (T1: immediately after the return of the exercise programme) and postintervention (T2). The assessments of physical activity level, quality of life, mental health, functionality and body composition will be performed at T1 and T2. DISCUSSION: The results from this MC+SM protocol will allow us to contribute clinical support to evaluate the variables analysed and to guide future public health policies with the aim of minimizing the possible deleterious effects arising from the physical exercise interruption periods caused by epidemics and pandemics. TRIAL REGISTRATION: RBR-10zs97gk . Prospectively registered in Brazilian Registry of Clinical Trials (ReBEC) on 17 June 2021. Registry name: Use of self-management strategies combined with multicomponent training to mitigate the effects of social distancing due to COVID-19 on capacity, physical capacity, mental health and quality of life in older adults - A blind, randomized and controlled clinical trial.

Home-based multimodal exercise program in older people with Alzheimer disease: Randomized controlled trial protocol.

BACKGROUND: At-home physical exercise may be an important intervention strategy for older people with Alzheimer disease (AD) due to the greater adherence and ease for the caregivers. PURPOSE: Determine the effects home-based multimodal exercise program in older people with AD on muscle strength, balance, functioning, cognition, dual task performance, frailty, and physical activity level. METHODS: This is a trial with 40 older people with mild and moderate AD, randomized into intervention group (IG) and control group (CG). The participants will be evaluated by blinded examiners at baseline and after 16 weeks of training. The evaluations will investigate functioning (Timed Up and Go test, Direct Assessment of Functional Status, WHO Disability Assessment Schedule, Short Physical Performance Battery, and Activities of Daily Living Questionnaire), muscle strength (manual dynamometer and Sit-to-Stand test), frailty (FRAIL Scale and Edmonton Frail Scale), cognition (Addenbrooke's Cognitive Examination, Trail Making Test, Walking Trail-Making Test, and Frontal Assessment Battery), balance (force platform, Figure-of-Eight Walking Test, Functional Reach Test, Alternate Step Test, and Calf-Raise Senior), dual task (force platform), and physical activity level (Modified Baecke Questionnaire and Life-Space Assessment). The IG will perform 16 weeks of exercise at home that involve functioning, strength, balance, and aerobic endurance in 60-min sessions three times a week. The CG will not undergo any intervention. CONCLUSION: Improvements in the aspects evaluated are expected in the IG compared to CG. The protocol will provide a theoretical basis for the creation of clinical interventions and health promotion measures for older people with AD.

Effects of aquatic physical exercise on neuropsychological factors in older people: A systematic review.

BACKGROUND: . There is a lack of standardized protocols and clinical trials for older adults involving neuropsychological factors in the literature. Furthermore, no systematic review has been published investigating this theme. PURPOSE: . The purpose of this systematic review was to analyze the effects of aquatic physical exercise on neuropsychological factors in older adults. METHODS: . A systematic review (CRD42020176899) was conducted, using articles from Pubmed, Web of Science, Scopus, Cochrane Library, Science Direct and Medline published until March 2020 (without limit of previous year). Eligibility criteria for selecting studies were: clinical trials; samples with a mean age of 65 years old and over; articles involving aquatic physical exercise; and presenting neuropsychological outcomes (behavior, cognition, psychological, mental health). RESULTS AND DISCUSSION: . The search yielded 801 records and 16 studies were included, totaling: 1707 older adults, with a mean age of 71.3 years old (range of mean ages in the studies: 65.3 to 88.4 years old) and a predominance of women. Aquatic physical exercise showed positive results in the mental component of quality of life, fear of falling, mood, anxiety and internal health locus of control in healthy sedentary older adults. Only one study out of 5 carried out with older adults with osteoarthritis showed improvements in psychological well-being after aquatic intervention. Older women with osteopenia or osteoporosis showed improvements in the mental component of quality of life. Studies on dementia showed a significant improvement in behavioral and psychological symptoms after aquatic intervention and no effect on depressive symptoms. CONCLUSION: . Based on the results of this systematic review, aquatic physical exercise has positive effects on quality of life, fear of falling, cognitive functions, mood, anxiety and internal health locus of control in sedentary community-dwelling older people. It can be a great resource for carrying out physical activities in this population.

Effects of listening to music and practicing physical exercise on functional and cognitive aspects in institutionalized older adults with dementia: Pilot study.

AIM: Determine the effects of listening to music and practicing physical exercise on functional and cognitive aspects in institutionalized older adults with dementia. METHODS: A randomized clinical pilot trial was conducted involving 17 institutionalized older adults with moderate to advanced dementia. The participants were allocated to two groups: training with music (TWM) and training without music (TWtM). The TWtM group performed light exercises with a focus on mobility. The TWM group was initially submitted to a cognitive stimulus with music, followed by the same exercises as those performed in the TWtM Group. Sessions were held once a week for 12 weeks. Functional and cognitive assessments were performed at baseline and after the 12-week intervention. RESULTS: No significant differences in functional or cognitive performance were found between groups or evaluation times. Both groups maintained their performances after 12 weeks. CONCLUSIONS: Listening to music combined with physical exercise training did not exert an effect on functional or cognitive performance in institutionalized older adults with moderate to advanced dementia.