Construct validity and physical performance of older adults in different hierarchical physical-disability level

The purpose of this study was to test the construct validity of the hierarchical levels of self-reported physical disability using health-related variables and physical-performance tests as criteria. The study participants were a community-based sample of 368 adults age 60 years or older. These older adults were grouped into 4 levels according to their physical-disability status (able, mildly disabled, moderately disabled, and severely disabled groups) based on their self-reported measures on the mobility, instrumented activity of daily living (IADL), and activities of daily living (ADL) domains. Health-related variables (body-mass index, number of comorbidities, depression status, mental status, and self-perceived health status) and eight performance-based tests demonstrated significant group differences. Self-reported measures of physical disability can be used to categorize older adults into different stages of physical functional decline.     

Self-reported mobility and instrumental activities of daily living: test-retest reliability and criterion validity

To determine the test-retest reliability and criterion validity of self-reported function in mobility and instrumental activities of daily living (IADL) in older adults, a convenience sample of 70 subjects (72.9 ± 6.6 yr, 34 male) was split into able and disabled groups based on baseline assessment and into consistently able, consistently disabled, and inconsistent based on repeat assessments over 2 weeks. The criterion validities of the self-reported measures of mobility domain and IADL-physical subdomain were assessed with concurrent baseline measures of 4 mobility performances, and that of the self-reported measure of IADL-cognitive subdomain, with the Mini-Mental State Examination. Test-retest reliability was moderate for the mobility, IADL-physical, and IADL-cognitive subdomains (κ = .51-.66). Those who reported being able at baseline also performed better on physical- and cognitive-performance tests. Those with variable performance between test occasions tended to report inconsistently on repeat measures in mobility and IADL-cognitive, suggesting fluctuations in physical and cognitive performance.     

Effects of vibration exercise on muscle performance and mobility in an older population

This study was designed to investigate the effects of vibration on muscle performance and mobility in a healthy, untrained, older population. Forty-three participants (23 men, 20 women, 66-85 y old) performed tests of sit-to-stand (STS), 5- and 10-m fast walk, timed up-and-go test, stair mobility, and strength. Participants were randomly assigned to a vibration group, an exercise-withoutvibration group, or a control group. Training consisted of 3 sessions/wk for 2 mo. After training, the vibration and exercise groups showed improved STS (12.4%, 10.2%), 5-m fast walk (3.0%, 3.7%), and knee-extension strength (8.1%, 7.2%) compared with the control (p < 0.05). Even though vibration training improved lower limb strength, it did not appear to have a facilitatory effect on functional-performance tasks compared with the exercise-without-vibration group. Comparable mobility and performance changes between the experimental groups suggest that improvements are linked with greater knee-extension strength and largely attributed to the unloaded squats performed by both exercise groups.     

The effect of 6 months training on leg power, balance, and functional mobility of independently living adults over 70 years old

Where strength training has been used in conjunction with functional-task training in older people, not only have there been improvements in leg strength but also improved function has been measured (e.g., Skelton & McLaughlin, 1996). Many studies use participants from care homes rather than community dwellers. We investigated changes in leg power, balance, and functional mobility in community-dwelling sedentary men and women over 70 years of age (n = 6 for training group [TR]; n = 10 for control group [CN]). Progressive training took place over 24 weeks using seated and nonseated exercise. For TR, leg power increased 40%, from 108 +/- 40 to 141 +/- 53 W (p < .01); dynamic balance increased 48%, from 22.3 +/- 7.9 to 33.1 +/- 6.1 cm (p < .01; functional reach); and functional mobility increased 12%, from 7.46 +/- 1.32 to 6.54 +/- 1.41 s (p < .05; timed walk). CN showed no significant change. In conclusion, a community-based exercise program led to large improvements in leg-extensor power, dynamic balance, and functional mobility.     

Tai Chi-based exercise for older adults with Parkinson's disease: a pilot-program evaluation

The primary objective of this study was to provide preliminary evaluation of the feasibility, safety, and efficacy of a newly developed Tai Chi-based exercise program for older adults with Parkinson's disease (PD). Using a one-group pretest-posttest design, 17 community-dwelling adults (mean age 71.51 years) with mild to moderate idiopathic PD (Stage I, II, or III on the Hoehn and Yahr scale) and stable medication use completed a 5-day, 90-min/day Tai Chi exercise-evaluation program. Outcome measures included face-to-face exit interviews on appropriateness and safety and physical performance (i.e., 50-ft speed walk, up-and-go, functional reach). At the end of this brief intervention, exercise adherence was 100% and the program was shown to be safe. Exit interviews indicated that the program was well received by all participants with respect to program appropriateness, participant satisfaction and enjoyment, and intentions to continue. Furthermore, a significant pretest-to-posttest change was observed at the end of the 5-day program in all three physical-performance measures (p < .05). The results of this pilot evaluation suggest that Tai Chi is an appropriate physical activity for older adults with PD and might also be useful as a therapeutic exercise modality for improving and maintaining physical function. These preliminary findings warrant further investigation.     

Effects of 10-week walking and walking with home-based resistance training on muscle quality,muscle size,and physical functional tests in healthy older individuals

Background

Older individuals have been shown to present muscle atrophy in conjunction with increased fat fraction in some muscles. The proportion of fat and connective tissue within the skeletal muscle can be estimated from axial B-mode ultrasound images using echo intensity (EI). EI was used to calculate the index of muscle quality. Walking, home-based weight-bearing resistance training, and its combinations are considered simple, easy, and practical exercise interventions for older adults. The purpose of this study was to quantify the effects of walking and walking with home-based resistance training on muscle quality of older individuals.

Methods

Thirty-one participants performed walking training only (W-group; 72?±?5?years) and 33 participants performed walking and home-based resistance training (WR-group; 73?±?6?years). This study was a non-randomized controlled trial with no control group. All participants were instructed to walk 2 or 3 sets per week for 10?weeks (one set: 30-min continuous walking). In addition, the WR-group performed home-based weight-bearing resistance training. EI was measured as a muscle quality index using axial B-mode ultrasound images of the rectus femoris and vastus lateralis of the mid-thigh. We further averaged these parameters to obtain the EI of the quadriceps femoris (QF). Participants further performed five functional tests: sit-ups, supine up, sit-to-stand, 5-m maximal walk, and 6-min walk.

Results

QF EI was significantly decreased in both groups after training (W-group 69.9?±?7.4?a.u. to 61.7?±?7.0?a.u., WR-group 64.0?±?9.5?a.u. to 51.1?±?10.0?a.u.; P?<?0.05), suggesting improved muscle quality. QF EI was further decreased in the WR-group compared with the W-group. The sit-up test in both groups and the sit-to-stand and 5-m maximal walk tests in the W-group were significantly improved after training.

Conclusion

These results suggest that training-induced stimulation is associated with a decrease in EI in some thigh regions. Furthermore, the addition of home-based resistance training to walking would be effective for a greater reduction of EI.

     

The gatekeeper model: implications for social policy

One of the most important needs of an aging population is to insure that older adults are able to live as independently and safely as possible. The question for social policymakers is how to meet this goal in an era of shrinking resources and growing numbers of older adults. The Gatekeeper Model is highlighted as a method to insure that older adults at risk of problems that impact their ability to live independently can be helped by existing systems of care. The model trains employees of community businesses and corporations who work with the public to serve as community gatekeepers by identifying and referring community-dwelling older adults who may be in need of help. A research project was conducted at Spokane Mental Health, Elder Services Division, where the model was developed. The results indicate that community-based gatekeepers found 40% of clients. Gatekeepers find a distinct population of community-dwelling older adults who are not found by more traditional referral sources. The social policy implications of the Gatekeeper Model are discussed.     

Community exercise program for older adults recovering from hip fracture: a pilot study

Community-based rehabilitative exercise programs might be an effective means to improve functional outcomes for hip-fracture patients. The purpose of this study was to evaluate the effectiveness of a community exercise program (CEP) for older adults recovering from hip fracture. Twenty-five older adults (mean age 80.0 +/- 6.0 years; 24 women; 71 +/- 23 days post-hip fracture) participated in this pilot study (17 exercise, 8 control). The CEP involved functional stepping and lower extremity-strengthening exercises. Control participants received only standard outpatient therapy. Measures of functional mobility, balance confidence, falls efficacy, lower extremity strength, and daily physical activity were evaluated at baseline and at 16 weeks. Improvements for self-reported physical activity, mobility, balance, and knee-extensor strength were observed for the CEP group. This study demonstrated that a CEP is beneficial for community-dwelling older adults post-hip fracture.     

The family caregiving career: implications for community-based long-term care practice and policy

Informal (i.e., unpaid) long-term care for disabled older adults is often chronic, but it is only recently that research has considered the longitudinal implications of family caregiving. In particular, investigators have conceptualized caregiving as a "career," and within the caregiving career, a number of diverse trajectories and transitions can occur. Following a summary of these findings, this paper considers how longitudinal caregiving research can influence and potentially address key policy and practice concerns, especially in the delivery and support of community-based long-term care (CBLTC) services. It is suggested that with the refinement of the informal long-term care literature, existing policy and practice to support caregiving families can be similarly advanced.     

Aging, disability, and disabled older people in India

India is witnessing a demographic revolution, leading to a considerable increase in the proportion of older people in the population. Similarly, life expectancy of both the mentally and physically disabled has improved considerably. About 5% of Indian older people have problems with physical mobility. Aging has become a gender issue in India not only because more women are surviving into old age; they are also vulnerable and disadvantaged in many ways. In most cases they are the only caregivers available for the old and disabled. Older Indians are considered a high-risk group for multiple morbidity. It is estimated that nearly four million Indians suffer from mental problems. India has around 12 million people designated as "handicapped." However, little information is available about disabled people who grow older. The National Policy on Older Persons, which has been recently formulated, aims at providing an improved quality of life for millions of older Indians. However, the concerns of older disabled and of the disabled who grow old are still treated separately in both policy and practice.     

Misconceptions about strength exercise among older adults

The purposes of this study were to determine current opinions of strength exercise among older adults and whether knowledge of recommended protocols differs between strength-exercise participants and nonparticipants. One hundred twenty-nine older adults (77.5 +/- 8.6 years) responded to questions about their opinions, experiences, and knowledge of strength-exercise recommendations. Some misconceptions were identified in the sample, with 48.4% of participants responding "no" to "strength training increases muscle mass," 45% responding "no" to "increasing weight is more important than number of repetitions for building strength," and 37% responding that walking is more effective than lifting weights at building muscle strength. The number of correct responses was related to the number of years in school (semipartial r(2)= .046). More education is needed about the benefits and recommendations to ensure proper use of current strength-exercise protocols among older adults.     

Whole-body vibration training improves balance control and sit-to-stand performance among middle-aged and older adults: a pilot randomized controlled trial

Background

Aging is associated with decreased balance, which increases falling risk. The objective of the current study was to determine the feasibility and effects of whole-body vibration (WBV) training on knee extensor muscle power, limits of stability, and sit-to-stand performance among community-dwelling middle-aged and older adults in the United States.

Methods

A randomized pilot study with participant blinding was conducted. Feasibility outcomes included recruitment and compliance rate. Twenty-nine community-dwelling older adults were randomly assigned to perform body-weight exercises with either an individualized vibration frequency and amplitude, a fixed vibration frequency and amplitude, or no vibration. Isokinetic knee extensor power, limits of stability, and sit-to-stand tests were conducted before beginning the exercises (baseline) and after 8 weeks of training.

Results

With a favorable recruitment rate (58%) and compliance rates (attrition 9%; adherence 85%), the intervention was deemed feasible. The limits of stability endpoint excursion score for the individualized frequency–amplitude group was increased by 8.8 (12.9%; P = 0.025) after training, and that group’s maximum excursion score was increased by 9.2 (11.5%; P = 0.006) after training. The average weight transfer time score was significantly decreased by 0.2 s in the fixed group. The participants in the individualized group demonstrated a significant increase (3.2%) in weight rising index score after 8 weeks of WBV training.

Conclusions

WBV training is feasible for use with elderly people, and this study achieved good recruitment and compliance. The present paper suggests that 8 weeks of WBV training improves limits of stability and sit-to-stand performance. Future studies must determine whether WBV training improves other factors that affect posture control.

Trial registration

This study was registered at the Texas Woman’s University Institutional Review Board [TWU IRB 17632] on the 3rd of November 2014.

     

"Walking the Walk" of Public Service Motivation: Public Employees and Charitable Gifts of Time, Blood, and Money

Research generally indicates that public employees "talk thetalk," but do they also "walk the walk" of the public servicemotive (PSM)? Are public service employees more likely thanothers to engage in public service activities? The behavioralimplications of PSM are addressed by studying the involvementin charitable activities of public, nonprofit, and private workers.Using data from the 2002 General Social Survey, multivariatelogistic regression models are estimated to examine self-reportedgifts of time, blood, and money to charitable organizations.It is found that government employees are more likely to volunteerfor charity and to donate blood than for-profit employees are.Additionally, nonprofit workers are also more likely than theirfor-profit counterparts to volunteer. However, no differenceis found among public service and private employees in termsof individual philanthropy. These findings generally lend supportfor the hypothesis that PSM is more prominent in public servicethan in private organizations, especially as it pertains togovernment personnel.     

‘Risky’ representation: the portrayal of women with mobility impairment in twenty-first-century advertising

Representations of disability and gender in advertising have been traditionally confined by narrow ideals surrounding body image. Recently, portrayals of disabled women in advertising have substantially grown in volume and variety. This research applies a feminist disability studies critique to the exploration of women with mobility impairments as ‘risky’ in twenty-first-century advertising. Feminist disability studies recognises culture as a key site in which disabled women have been historically misrepresented. While existing research dominantly focuses on textual analyses of advertisements, this study presents empirical data collected via semi-structured interviews with disabled women. Some women believe that the link between disabled women and riskiness sustains stereotypical attitudes and suggest that women with mobility impairments are included in advertisements as a form of ‘safe quirkiness’. However, others welcome provocative portrayals of women with mobility impairment and suggest that such representations challenge presumptions of disabled women as passive. The results of this research show how disabled women use their life experiences and personal beliefs to explore advertisements that supposedly represent them.     

Learning with active rural community-dwelling older adults: comprehensive effects of intergenerational service-learning in Taiwan

This study evaluated the experiences of college students serving with active, rural community-dwelling older adults and evaluated outcomes among the students, older adults, and community leaders in rural Taiwan. Thirty-one undergraduate students assisted older adults for six weeks at three senior citizen centers as they participated in an active aging competition. The analysis of qualitative data indicated that students adapted to the communicating barriers of language and cultural variances, were aware that older adults longed for company, and impressed the active image of older adults. The results of this study indicated that service-learning with rural community-dwelling older adults simultaneously benefits students, community leaders, and older adults.     

The AKKA-board – performing mobility,disability and innovation

This study involves a mobility device with relevance for health and well-being for severely disabled persons. The purpose of this study is to examine some of the geographical, innovative and existential implications of the performance of place through mobility that the AKKA-board produces for severely disabled people. What does mobility and place mean in terms of supporting human skills that are being performed with the help of the AKKA-board? It is concluded that mobility in terms of a self-controlled movement is connected to enabling individual decision-making, independence and well-being.     

Developing programs for older adults in a faith community

I have worked in all areas of nursing, from staff and head nurse positions to faculty and administrative positions, but my work as a parish nurse, particularly with our community of older adults, is one of the most challenging and rewarding areas of nursing practice I have ever experienced. Recently, one of our independent older adult parishioners, Marge, suddenly had a marked decrease in her ability to function, which was precipitated by two trips to the hospital and surgery. She went from living independently to living in a skilled care unit, no longer able to walk or perform activities of daily living without assistance. I had known Marge for only 2 years. When she became ill, I visited her weekly during the last 4 months of her life, as she had no family in the area. During my visit one evening as I helped Marge get ready for bed, she left me with a very poignant memory. After sharing some hair-raising stories about her care at this facility, she said, "Georgine, you're my best friend. You're the only one I can tell these things to and I know you understand."     

THE NEED TO KNOW: Cultured Ignorance and Jewish Resistance in the Ghettos of Warsaw, Vilna, and Łódź

This article explores the role of knowledge in collective action with an examination of resistance efforts in the Jewish ghettos of Nazi-occupied Warsaw, Vilna, and Łódź during World War II. Because sustained collective resistance took place in Warsaw but not in the other two ghettos, a comparison of these cases is useful toward an understanding of the factors that facilitate collective action. Drawing on Schwartz's concept of "structured ignorance" and Snow and Benford's discussion of "empirical credibility," I show that resistance occurred when and where Jews were able to gain information about the Nazi regime's genocidal plans and believed that information to be credible. The cases therefore suggest that in addition to being "structured," ignorance may also be "cultured," in the sense that there may be limits to what individuals will interpret as possible and true. Warsaw Jews fought back in part because they were able to overcome both structured and cultured ignorance, while Jews in the other ghettos were not able to overcome these barriers to collective action. Suggestions for further research are outlined.