Resistive training and long-term function in older adults

The purpose of this study was to evaluate the effects of a 24-month moderate-intensity resistive-training intervention on strength and function in older adults. A repeated-measures experimental research design was employed as a sample of 55 apparently healthy, older, community-dwelling volunteers (30 exercisers- 25 women and 5 men; 25 comparisons- 16 women and 9 men) were evaluated for strength of 5 muscle groups that influence lower extremity movement and physical function. Strength and function were evaluated at 6-month intervals. The findings from this study indicate that a moderate-intensity resistive-training program increases strength in older adults and that the strength benefits are retained for the duration of the intervention. Furthermore, a long-term strength-training program can increase independent-function skills in older adults and might therefore aid in prolonging functional independence.     

Exercise behavior in older adults: a test of the transtheoretical model

The transtheoretical model (TTM) was developed as a guide for understanding behavior change. Little attention has been given, however, to the appropriateness of the TTM for explaining the adoption of exercise behavior in older adults. The purposes of this study were to determine the reliability of the TTM instruments and validate TTM predictions in 86 community-dwelling older adults (mean age 75.1 +/- 7.0 years, 87% women) who were participants in a 16-week walking program. TTM construct scales--self-efficacy, decisional balance (pros and cons), and processes of change (behavioral and cognitive)--were generally reliable (all>.78). Behavioral processes of change increased from baseline to follow-up, but pros, cons, and cognitive processes did not change among participants who became regular exercisers. Stage of change did not predict exercise adoption, but baseline self-efficacy predicted walking behavior. These results lend partial support to the TTM in predicting exercise behavior.     

The effect of habitual exercise on respiratory- muscle function in older adults

Older adults' participation in habitual exercise might be affected by alterations to respiratory mechanics such as decreased respiratory-muscle strength. This reduction can cause a decrease in efficiency of the ventilatory pump, potentially compromising exercise participation. This research examined the role of habitual exercise in respiratory-muscle function and the associated implications for exercise performance. Seventy-two healthy older adults (36 men, 64.9 +/- 8.6 years, 177.2 +/- 8.4 cm, 82.5+/- 11.9 kg; 36 women, 64.9 +/- 9.5 years, 161.7+/- 6.4 cm, 61.6 +/- 9.2 kg) undertook respiratory-function and walking-performance tests. Active men and women achieved higher scores than their inactive counterparts for all tests except spirometry, where no differences were evident. The results indicate that a significant amount of the elevated fitness level might be accounted for by increased endurance capacity of the inspiratory muscles. Inactive older individuals might be at risk for inadequate respiratory-muscle strength, so interventions should be considered.     

Effect of resistance-exercise training on cognitive function in healthy older adults: a review

Several studies have demonstrated that exercise helps reduce or prevent cognitive deterioration among older adults, and recent studies have further examined the effects of resistance-exercise training on cognition. The purpose of this review was to examine the role of resistance-exercise training on cognition in healthy older adults. Specifically, it describes the definition, health benefits, and the design of resistance-exercise training. The authors also review the research related to resistance exercises and cognition and found that this exercise modality may enhance specific cognitive performances. Next, they examine the potential mechanisms underlying resistance exercise and cognitive enhancement. Finally, they consider potential therapeutics and recommendations for further research on resistance-exercise training and cognition in older adults.     

A measuring instrument to evaluate e-service quality in a revenue authority setting

Tax revenue forms the backbone of any economy. The quality of the e-services provided by a revenue authority is therefore crucial, as e-service quality directly influences the burden of complying with tax obligations, and hence affects the tax compliance climate in a country. The aim of the study is the development of a measuring instrument that encapsulates the ‘lens of a tax practitioner’ in an e-service revenue authority setting. In order to develop a conceptual framework, an in-depth, qualitative approach was used to identify a comprehensive range of service attributes and dimensions that potentially drive e-service quality in the revenue authority setting. This framework is then compared with other relevant service quality models to derive at a proposed e-service quality-measuring instrument. Findings from this study may advance the understanding and the management of the e-service quality of the e-services in a revenue authority setting.     

Schizophrenia in older adults

Although the number of people older than 55 with schizophrenia is expected to double during the next 20 years, the research data on older adults with schizophrenia are limited. This appears to be because until the middle of the 20th century, it was assumed that mental illness in older adults was a part of the aging process and because older adults are often excluded from research investigations. Nursing research is needed to explore how people with schizophrenia learn to manage their problems as they age, as well as how those who are first diagnosed with schizophrenia in later life adapt to their illness. Mental health nurses need to be cautious in assigning premature labels to older adults with mental illness that may lead to unsubstantiated assumptions about levels of disability. Instead, nurses should realize individual potential regarding undiscovered strengths and should attempt to create interventions that recognize and foster personal development for older adults with schizophrenia.     

Self-regulatory strength depletion and muscle-endurance performance: a test of the limited-strength model in older adults

Self-regulation consumes a form of strength or energy. The authors investigated aftereffects of self-regulation depletion on muscle-endurance performance in older adults. Participants (N = 61, mean age = 71) were randomized to a self-regulation-depletion or control group and completed 2 muscle-endurance performance tasks involving isometric handgrip squeezing that were separated by a cognitive-depletion task. The depletion group showed greater deterioration of muscle-endurance performance than controls, F(1, 59) = 7.31, p = .009. Results are comparable to those of younger adults in a similar study and support Baumeister et al.'s limited-strength model. Self-regulation may contribute to central-nervous-system fatigue; however, biological processes may allow aging muscle to offset depletion of self-regulatory resources affecting muscle-endurance performance.     

The mistreatment of older adults: perpetrator-victim relationships and interventions

ABSTRACT The characteristics of the mistreatment of older adults were investigated in a sample of 128 older adults identified as potential mistreatment cases in three community-based agencies in Quebec. Practitioners completed questionnaires to collect quantitative and qualitative data. The study also examined: (1) difficulties in identifying mistreatment, (2) interventions and outcomes, and (3) reasons for the refusal of services. The major finding (with important implications for practice) was the association between type of treatment and perpetrator relationship to victim. The harm reduction model is suggested as a useful approach to guide interventions.     

Health literacy in older adults

Health literacy is a critical goal for nurses to address. Consider the patient who stated: They told me I was taking double the medication I was supposed to. I had two bottles, and I was taking one from each bottle, but it turned out they were the same medication. But since I didnt know how to read. I didn't know. (University of Virginia Health Systems, 2003). Many older adults struggle daily to manage their health care problems; compounding these dificulties with low literacy skills can be devastating. They need our help.     

Understanding hoarding in older adults

Compulsive hoarding is a debilitating disorder that is only recently becoming understood. Hoarding has been studied primarily in the general population, with only a few researchers focusing on hoarding in older adults, even though the prevalence and severity of the disorder appears to increase with aging. Hoarding seriously affects the quality of one's life and can also cause safety and health problems for individuals and the community. Established treatments for hoarding are relatively new and often need to be extended over a long period of time. Nurses can play an important role in helping identify the problem of hoarding in older adults, determining the types of safety and health hazards that need to be addressed, and contacting the appropriate community agencies.     

Design of ISD-1: an instrument for social diagnosis in care homes for older persons*

This article describes the design process and main features of an instrument developed for use in the specialist area of intervention in care homes for older persons. The essential aim of ISD-1 (instrument for social diagnosis) is to permit the correct formulation of social diagnoses and to standardise and define the professional language used by social workers. Its content has been organised into 4 dimensions of social diagnosis, divided into 15 sub-dimensions containing 83 diagnostic categories. This work was performed in Spain, in the 24 care homes of the Madrid Social Care Agency of the Community of Madrid, involving the participation of the 40 social workers practising in these centres. ISD-1 is an easily understood and used tool, of potential use for social workers practising in care homes for older persons and capable of being adapted for use in other institutional environments, as well as being capable of adaptation and translation for its application in other countries.     

Barriers to exercise behavior among older adults: a focus-group study

Longer life expectancy, rapid population growth, and low exercise-participation rates of adults 65 and older justify the need for better understanding of older adults' exercise behavior. The objectives of this focus-group study were to determine barriers to the exercise behavior of older adults. Six focus groups, three with exercisers and three with nonexercisers, were conducted at various sites throughout Rhode Island. The majority (n = 57) of the 66 individuals who participated were women, and all stated that they were 65 and older. Results from the focus-group data identified 13 barriers to exercise behavior. The most significant barriers mentioned by nonexercisers were fear of falling, inertia, and negative affect. Exercisers identified inertia, time constraints, and physical ailments as being the most significant barriers to exercise. Implications from these focus-group data can be useful in the development of exercise interventions for older adults, which could increase exercise participation.     

The Phone-FITT: a brief physical activity interview for older adults

The purpose of this study was to develop a brief physical activity interview for older adults (Phone-FITT) and evaluate its test-retest reliability and validity. Summary scores were derived for household, recreational, and total PA. Reliability was evaluated in a convenience sample from a fall-prevention study (N = 43, 79.4 +/- 2.9 years, 51% male), and validity, in a random sample of individuals in older adult exercise programs (N = 48, 77.4 +/- 4.7 years, 25% male). Mean time to complete the Phone-FITT was 10 min for participants sampled from exercise programs. Evaluation of test-retest reliability indicated substantial to almost perfect agreement for all scores, with intraclass correlation coefficients (95% confidence intervals) ranging from .74 (.58-.85) to .88 (.8-.94). For validity, Spearman's rho correlations of Phone-FITT scores with accelerometer counts ranged from .29 (.01-.53) to .57 (.34-.73). Correlations of Phone-FITT recreational scores with age and seconds to complete a self-paced step test ranged from -.29 (-.53 to -.01) to -.45 (-.68 to -.14). This study contributes preliminary evidence of the reliability and validity of the Phone-FITT.     

The decision making process of older adults who elect to receive ECT

Although there is extensive literature on electroconvulsive therapy (ECT), little documentation exists about how an individual makes the decision to receive ECT. This phenomenological study is an exploratory examination of the decision making process of older adults with mental illness who elect to receive ECT. Study participants included 7 older adults without dementia from a suburban geriatric medicine/psychiatry practice who elected to receive ECT. The lived experience of decision making as perceived by these 7 participants was a process that moved them toward wellness. The data revealed four significant themes: Support, Trust, Past Experience, and Desperation. An overriding substantive theme identified as an obstacle was the Stigma of Mental Illness. This study provided a basis for planning clinical practice and building further research.     

Frailty in self-neglecting older adults: A secondary analysis

ABSTRACT

Self-neglect (SN) and frailty in older adults is associated with increased disability and mortality. Despite these commonalities, there have been no studies objectively assessing frailty in older adults who SN. This secondary analysis classified frailty in N = 37 older adults with Adult Protective Services validated SN using the Fried Frailty Phenotype (FFP) of weight loss, weakness, exhaustion, activity level, and walking speed. Overall, 3% were classified as robust, 62% as prefrail, and 35% as frail. Most (72%) were overweight/obese, with clinically significant decreases in activity level (60%) and walking speed (97%). Compared to the original FFP population, older adults who SN exhibit important differences in frailty phenotypes, and finding that the largest percentage of older adults who SN were prefrail may indicate a critical opportunity for intervening in this population to reduce future functional decline and mortality.     

The Multisurface Obstacle Test for Older Adults (MSOT): development and reliability of a novel test for older adults

Locomotion is an essential component of independence and well-being at old age. Performance deficits in the gait of older adults most often become evident on multisurface and varying terrains. Research results substantiate that falls occur in everyday movement situations that are characterized by instability. A test track, the Multisurface Obstacle Test for Older Adults (MSOT), was developed to diagnose individual performance. The 10-m track consists of different obstacles and varying surfaces, which represent everyday movement situations in a compact way. Twenty-nine untrained, healthy older adults (11 men, 18 women) were tested on three different days at 1-week intervals in a test–retest design by the same conductor. Mean age of the participants was 68.8?±?5.3 years with a mean body mass index of 24.4?±?2.5 kg/m². The measured outcome variable was the required time (seconds) on the MSOT. The feasibility for the tested sample of untrained older adults was very good. The MSOT was undertaken safely by the participants, and no falls occurred. The range of the mean for time was between 8.12?±?1.53 s and 9.00?±?1.62 s. Regarding intertrial reliability, mean differences (MD) of ?3.39 to ?5.52 % and coefficients of variation (CV) of 2.72 to 4.19 % between the first and second trials and MD of ?0.69 to ?0.85 % and CV of 2.57 to 4.54 % over the three test sessions were observed. The correlation coefficients between the sessions were .92–.98. There were significant differences (p?<?.05) between the first and second trials of each session and between the first and second sessions. The smallest detectable differences (SDD) revealed that a small improvement is enough to detect changes in performance in the MSOT. Selecting tasks from real-life situations of older adults contributes to substantiate practical usability of the MSOT. The measured time on the MSOT showed high relative and absolute reliability in the target group of older adults between 60 and 80 years.