Predictors of Engagement in Home Activities Among Community-Dwelling Older Adults

Aims: This analysis aims to identify what older adults self-report about engagement in home activities (EHA), if there is a difference between perceived and observed activity performance in the home, and what predicts EHA. Methods: Baseline data were analyzed from a randomized controlled trial of an occupational therapy fall prevention intervention with older adults age 65 and older with a fall within 6 months. A multiple linear regression model was used to compare perceived and observed activity performance. Results: Ninety-two participants (mean age 77.7 ± 7.4) were included. EHA can be predicted (F(6, 85) = 13.86, p < 0.001, R = 0.70, R² = 0.50) by perceived activity performance (p = 0.02), fear of falling (FOF) (p < 0.001), and depression (p = 0.05). Conclusions: Perceived activity performance predicts EHA but observed activity performance does not, indicating clinicians should consider older adults' perceptions. Self-efficacy and awareness may be reasons for differences between perceived and observed activity performance in the home. FOF and depression are also predictors of EHA.     

Factors influencing the adaptation to skilled nursing facilities among older Korean adults

This study was conducted to identify the factors that influence the level of adaptation of older Korean adults to skilled nursing facilities. The subjects were 500 adults aged 65 or older who were living in six different skilled nursing facilities in Seoul and Gyeong‐gi‐do, South Korea. The measures were a demographic form, Health Self‐Rating Scale, Activities of Daily Living Scale, Self‐Efficacy Instrument, Korean Simple Depression Scale, Quality of the Facility Scale and Facility Adaptation Scale. The analyses showed that the prediction model was significant (F = 128.624, P < 0.001). The value of the adjusted R² was 0.435, which corresponds to the explanatory power of 43.5%. The factor that was found to have the greatest influence on the adaptation of older Korean adults to skilled nursing facilities was activities of daily living (β = ?0.564), followed by self‐efficacy (β = 0.321), quality of the facility (β = 0.164), depression (β = 0.133), decision to enter a skilled nursing facility (β = 0.122), perceived health status (β = 0.064) and age (β = ?0.010). This cross‐sectional study provides preliminary evidence that the level of adaptation of older Korean adults to skilled nursing facilities is related to their activities of daily living, self‐efficacy, depression, decision to enter a skilled nursing facility, perceived health status and age, and to the quality of the facility.     

Factors impacting the household and recreation participation of older adults living in the community

Abstract

Purpose: To identify demographic, physical and psychosocial determinants associated with participation in daily activities of community-dwelling older adults. Methods: A cross-sectional design of older adults (≥70 years) from Victoria, Australia, residing in their homes was drawn from a convenience sample. The outcomes were recent participation in household and recreational activities as measured by the Phone-FITT. Explanatory variables included demographics, physical and mental health functioning (Short Form-12 version 2, Geriatric Depression Scale 15). Associations were analyzed through linear regression. Results: There were 244 participants (60% female), with a mean age of 77.5 years (SD 5.7). Higher levels of depression and fewer falls (during the previous year) were independently associated with restrictions in household participation (p?<?0.001, p?<?0.001). For recreational participation, higher levels of depression were associated with restricted participation (p?<?0.001). Conclusion: Screening for depression should be a key component of health assessments with older adults. Untreated depression may lead to lower participation rates in daily activities potentially resulting in social isolation. Fewer falls and restricted household participation were associated, but no association was observed between falls and recreational participation. Further studies are required to explore this association in more detail.

• Implications for Rehabilitation

• Depression is significantly correlated with the level of participation in daily activities for older adults.

• Health professionals need to screen for depression when working with older adults.

     

Fear of falling does not alter the kinematics of recovery from an induced trip: a preliminary study

Marone JR, Rosenblatt NJ, Troy KL, Grabiner MD. Fear of falling does not alter the kinematics of recovery from an induced trip: a preliminary study.

Objective

To provide preliminary information about the relationships between self-reported fear of falling (FOF) in healthy community-dwelling women, number of falls, and recovery kinematics in response to a laboratory-induced trip.

Design

Cohort study.

Setting

Clinical research laboratory.

Participants

A subset of community-dwelling older women (N=33) recruited from studies of laboratory-induced trips and fall prevention.

Intervention

A laboratory-induced trip.

Main Outcome Measures

Number of fallers in the FOF group versus the control group. Recovery kinematics of FOF group falls versus control group falls, and FOF group recoveries versus control group recoveries were compared. Degree of FOF was assessed by using the Activities-Specific Balance Confidence (ABC) Scale.

Results

Falls occurred in 6 of 14 (43%) FOF and 4 of 16 (25%) control subjects (P=.26). The kinematics of FOF group falls were similar to those of control group falls. At completion of the initial recovery step, the FOF group showed significantly greater trunk extension velocity than controls (−82.1°/s±−66.1°/s vs −25.0°/s±−53.0°/s, respectively; P=.05). All other variables were not significantly different. ABC Scale scores of FOF subjects did not differ significantly between fallers and those who recovered (mean, 75.2±5.6, 71.1±11.8, respectively; P=.84).

Conclusion

Healthy community-dwelling older adults would benefit from fall prevention regardless of the presence of self-reported FOF.     

Comparison of the effects of virtual reality-based balance exercises and conventional exercises on balance and fall risk in older adults living in nursing homes in Turkey

Objectives: There is limited information on effective balance training techniques including virtual reality (VR)-based balance exercises in residential settings and no studies have been designed to compare the effects of VR-based balance exercises with conventional balance exercises in older adults living in nursing homes in Turkey. The objective of our study was to investigate the effects of VR-based balance exercises on balance and fall risk in comparison to conventional balance exercises in older adults living in nursing homes. Methods: A total sample of 18 subjects (65–82 years of age) with fall history who were randomly assigned to either the VR group (Group 1, n = 7) or the conventional exercise group (Group 2, n = 11) completed the exercise training. Results: In both groups, Berg balance score (BBS), timed up & go duration, and left leg stance and tandem stance duration with eyes closed significantly improved with time (p < 0.05), but changes were similar in both groups (p > 0.05) after training, indicating that neither the exercise method was superior. Conclusion: Similar improvements were found in balance and fall risk with VR-based balance training and conventional balance training in older adults living in the nursing home. Both exercise trainings can be preferable by health care professionals considering fall prevention. Appropriate patient selection is essential.     

Is there a relationship between pain and psychological concerns related to falling in community dwelling older adults? A systematic review

Abstract

Purpose: To systematically review and synthesise the research evidence linking pain to psychological concerns about falling in community dwelling older adults. Methods: A systematic review was conducted in accordance with the preferred reporting items of systematic reviews and meta-analysis statement (PRISMA). Major electronic databases were searched from inception until June 2013. Two authors independently conducted the searches, extracted data and completed methodological quality assessments. Articles were included if they measured one of the psychological concerns related to falling in a sample of community dwelling older adults with pain, or explored the association between the two. Results: Of a potential 892 articles, 12 met the eligibility criteria (n?=?3398). The methodological quality of the included studies was variable and none of the included studies primary aim was to investigate the relationship between pain and psychological concerns related to falls. Two studies found significant differences in psychological concerns related to falls in older adults with pain and a control group. Nine out of 10 studies reported a significant correlation between pain and psychological concerns related to falls in their sample. Conclusion: This review provides provisional evidence that pain is associated with fear of falling (FOF), avoidance of activities due to FOF and falls efficacy in community dwelling older adults.

• Implications for Rehabilitation

• Pain is a common and pervasive problem in community dwelling older adults and can affect an individual’s mobility, levels of physical activity and increase their falls risk.

• Psychological concerns related to falls, such as fear of falling (FOF), falls efficacy and balance confidence are also common and troublesome issues in older adults, yet the association with pain has not been investigated with a systematic review.

• This review provides provisional evidence that pain may increase older adult’s risk of developing FOF, avoiding activities due to a FOF and impact their falls efficacy.

• In recognition of the findings of this review, clinicians working with older adults with pain should consider assessing psychological concerns related to falls and if necessary intervene if they identify an individual at risk.

     

Linking chronic stress to insomnia symptoms in older adults: The role of stress co-occurrence during the pandemic

Studies examining the associations of chronic stressors with sleep health in older adults have shown conflicting results. While the COVID-19 pandemic increased perceived stress at the population level, less is known about chronic stressors experienced by older adults in the context of the COVID-19 pandemic and its impact on sleep health in an aging population. This study aims to examine the association of older adults' chronic stress with insomnia symptoms during the first year of the COVID-19 pandemic. A cross-sectional analysis was performed using early-release COVID-19 data from the Health and Retirement Study. Data on chronic stressors and insomnia symptoms in older adults (N = 2021; mean age = 68.8) were examined. Co-occurrence network analysis, latent class analysis, Rao–Scott χ² tests, and multivariable logistic regression were used to characterize the co-occurrence of chronic stressors and associations with insomnia symptoms. The most common co-occurring chronic stressors during the first year of the COVID-19 pandemic were self-health issues, family-health issues, and financial stress. Older adults experiencing frequent stress co-occurrence had 91% higher odds of difficulty initiating sleep (p < 0.001), 40% higher odds of frequent nocturnal awakening (p = 0.028), and 83% higher odds of nonrestorative sleep (p < 0.001). However, adjustment for health risk factors and COVID-19 concerns attenuated the effects, leaving strongest association for difficulty initiating sleep (odds ratio = 1.51, p = 0.010). Frequent stress co-occurrence plays an important role linking chronic stress to insomnia symptoms in an aging population. Ongoing research is needed to examine the lingering effects of frequent stress co-occurrence on older adults' sleep health in the post COVID-19 era.     

Using the Transtheoretical Model of Change to Implement Home Safety Modifications with Community-Dwelling Older Adults: An Exploratory Study

Objective: This exploratory study examined the viability of applying Prochaska's Transtheoretical Model (TTM) to community-living older adults making home safety changes over time.

Method: The Readiness for Change (RFC) interview and the Westmead Home Safety Assessment were administered to 20 community-dwelling older adults. Eight to twelve weeks later, a follow-up home visit was made to determine how many home safety modifications had been implemented.

Results: Participants in the action-related stages (i.e., action and maintenance stages) implemented significantly more home modifications than participants in the non-action stages (i.e., precontemplation, contemplation, and preparation stages, F(1, 18) = 7.7; p ≤ 0.01.

Conclusion: The readiness for change model was a useful approach to apply when working with older adults to implement home safety changes over time.     

Reablement in a community setting

Abstract

Purpose: When older adults experience a decrease in functional independence including decreased ability to perform activities of daily living (ADL) tasks, rehabilitation services are required. The aim of this pilot study was to evaluate if a home-based reablement program influenced the ADL ability of older adults. Methods: Ninety-one older adults (80?±?9 years) were allocated to a 12-weeks home-based reablement program consisting of ADL task performance training by a home carer supervised by an occupational therapist. ADL ability was measured at baseline, at 12 weeks and at follow-up (range: 310–592?d) using the ADL-Interview (ADL-I). Results: Overall, ADL ability improved significantly over time (p?=?0.041). Post-hoc t-tests indicated that the improvements occurred between baseline and end of intervention (p?=?0.042) and were maintained at follow-up 10 months after intervention (p?=?0.674). There were no effects related to age (p?=?0.787) or to whether the older adult had received help previously (p?=?0.120). Conclusion: A 12-weeks home-based reablement program was found to improve ADL ability among older adults regardless of whether they previously received help. This implies that receiving home care services should not be considered a barrier to participation in a reablement program.

• Implications for Rehabilitation

• Older adults, motivated for obtaining independence within performance of ADL tasks, will potentially benefit from participation in the reablement program.

• Older adults, already receiving home care services, will also have the potential to benefit from participation in the reablement program.

     

Health-related and subjective quality of life of older adults with visual impairment

Purpose.?To document health-related quality of life (HRQOL) and subjective quality of life (SQOL) and explore their correlates in older adults seeking services for visual impairment (VI).

Method.?A convenience sample of 64 participants (79.3?±?5.9 years) with VI was interviewed at home. HRQOL was measured with the Visual Function Questionnaire-25 and SQOL with the Quality of Life Index. The potential correlates were as follows: personal factors (sociodemographic characteristics, co-morbidity, depressive symptoms, activity level), environmental factors (technical aids, social support) and participation in daily activities and social roles (level and satisfaction).

Results.?Compared to normative data from previous studies of older adults, the participants had lower HRQOL but similar SQOL. Greater level of participation in social roles, higher perceived activity level, use of a writing aid and greater satisfaction with participation in social roles together explained better HRQOL (R²?=?0.66). Fewer depressive symptoms, greater satisfaction with participation in social roles and with social support and fewer co-morbidities together explained better SQOL (R²?=?0.70).

Conclusions.?HRQOL of older adults with VI is mainly explained by level of participation correlates, while their SQOL is mainly explained by depressive symptoms and satisfaction variables. The results also underscore the importance of social roles for HRQOL and SQOL of this population.     

Is fall self-efficacy an independent predictor of recurrent fall events in older adults? Evidence from a 1-year prospective study

Falls, which are prevalent among older adults, may not only cause severe physical injuries, but also lead to low fall self-efficacy (FSE). Low FSE is associated with restricted activity, which putatively increases risk of future falls. However, emerging studies have failed to confirm this association. Furthermore, the interplay between age, gender, and fall history with falls has not been adequately addressed in adults aged 70 years or older. The aims of this secondary analysis were to: (1) prospectively explore the association of FSE and fall events considering age, gender, and fall history, and (2) examine the characteristics of fall events and fall-related outcomes. Forty-seven community-dwelling adults over 70 years of age were followed for about 12 months. During the follow-up, 22 participants with low FSE experienced 119 fall events whereas 25 participants with high FSE reported 106 fall events. Among fallers, 72.3% (n = 34) experienced recurrent fall events. About 15.0% (n = 34) of 225 fall events resulted in injuries and 4.0% of injuries required medical care. FSE was a statistically significant predictor of future fall events (incident rate ratio = 0.96, p = .013) regardless of age, gender, and fall history. Participants with low FSE were more likely than those with high FSE to fall more frequently without noticeable prodromal symptoms and apparent reasons. These findings suggest that FSE is an important protective factor against future fall events. However, interpretation of these results requires caution given the small sample size and effect size.     

Help at Home and Perceived Health Status: Gender Differences in a Community-Dwelling Population

ABSTRACT

Understanding the factors that impact perceived health status of older adults will help to identify the factors associated with aging well and to develop occupational and physical therapy interventions. Objectives: The purpose of the study was to examine the relationship between life circumstances related to living with a helper and perceived health status. Methods: Questionnaire responses from a sample (n = 243) of community-dwelling older adults (ages 60–90+) were analyzed for relationships between demographic information, living with a helper, and SF-36 scores. Results: In a sample with high socioeconomic status, there were no differences between men and women in reported health status, but women were significantly less likely to have a helper at home. Ceiling effects were noted in several subscales of the SF-36. Discussion: Consideration must be given to gender differences in help at home during therapy, and when recommending outside services to help with daily living tasks.     

Daily life consequences of hearing loss in the elderly

Purpose.?To assess the daily life consequences of hearing loss in older adults and to explore the influences of hearing loss, subjective assessment of health and general life satisfaction, gender, age and marital status.

Method.?Eighty-four participants, each older than 65 years, were consecutively recruited from a hospital waiting list for outpatient hearing aid fitting. All participants were assessed by pure-tone audiometry. Daily life consequences of hearing loss were measured using the Hearing Disability and Handicap Scale, which assesses perceived activity limitation and participation restriction. Another questionnaire was used to measure self-assessed health and life satisfaction.

Results.?Adjusted linear regression analysis showed that activity limitation was significantly associated with increased hearing loss (p == 0.028) and decreased health (p == 0.009), and participation restriction with lower estimated life satisfaction (p ≤ 0.001). Gender, age and marital status were not determinant factors for perceived activity limitation or participation restriction.

Conclusions.?Daily life consequences of hearing loss, health conditions and general life satisfaction are closely related. These findings indicate that health factors and psychosocial aspects should be emphasised as a natural part of audiological rehabilitation.     

Participation frequency and perceived participation restrictions at older age: applying the International Classification of Functioning,Disability and Health (ICF) framework

Purpose.?To identify variables from different components of International Classification of Functioning, Disability and Health (ICF) associated with older people's participation frequency and perceived participation restrictions.

Method.?Participants (N == 186) were community-living, 65–88 years old and 52%% men. The dependent variables, participation frequency (linear regression) and perceived participation restrictions (logistic regression), were measured using The Late-Life Function and Disability Instrument. Independent variables were selected from various ICF components.

Results.?Higher participation frequency was associated with living in urban rather than rural community (β == 2.8, p < 0.001), physically active lifestyle (β == 4.6, p < 0.001) and higher cognitive function (β == 0.3, p == 0.009). Lower participation frequency was associated with being older (β == ?0.2, p == 0.002) and depressive symptoms (β == ?0.2, p == 0.029). Older adults living in urban areas, having more advanced lower extremities capacity, or that were employed had higher odds of less perceived participation restrictions (adjusted odds ratio [[OR]] == 5.5, p == 0.001; OR == 1.09, p < 0.001; OR == 3.7, p == 0.011; respectively). In contrast, the odds of less perceived participation restriction decreased as depressive symptoms increased (OR == 0.8, p == 0.011).

Conclusions.?Our results highlight the importance of capturing and understanding both frequency and restriction aspects of older persons' participation. ICF may be a helpful reference to map factors associated with participation and to study further potentially modifiable influencing factors such as depressive symptoms and advanced lower extremity capacity.     

Investigating Older Adults’ Expressed Needs Regarding Falls Prevention

Abstract

Aims: The purpose of this study was to explore perceptions regarding falls prevention programs for community-dwelling older adults offered in a specific geographic area. Method: The investigators conducted focus groups with 44 community-dwelling older adults in four locations. Focus group discussions were transcribed, coded, and analyzed by all investigators. Results: Themes included what people want, why people fall, what people do, impact of falls, and barriers to falls prevention participation. Older adults wanted falls prevention programs to include socialization among peers, various types of education, balance training, convenience in times and locations where falls prevention programs are offered, affordability, and independence and autonomy for decision-making. Participants believed they fell due to inattention and the aging process, and they made lifestyle changes and tried to recognize their own ability accordingly. Older adults believed the impact of falls on lifestyle was far-reaching and drastic. The main barrier to falls prevention participation was motivation, mitigated by other priorities. The Person-Environment-Occupation (PEO) Model provided a framework for considering occupational impact when addressing older adults’ concerns regarding falls. Conclusions: Occupational therapists can be key contributors to falls prevention programing by developing programs that focus on current perceptions and barriers in programing and the expressed wants and needs of community-dwelling older adults.     

What Is the Relation Between Fear of Falling and Physical Activity in Older Adults?

Objective

To describe the association between fear of falling (FOF) and total daily activity in older adults.

Design

Cross-sectional observational study.

Setting

Ambulatory clinical research training center.

Participants

Community-dwelling older adults aged ≥64 years (N=78), who were independent in ambulation with or without an assistive device.

Interventions

Not applicable.

Main Outcome Measures

FOF was defined by self-reported fear ratings using the Survey of Activities and Fear of Falling in the Elderly and self-reported fear status determined by response to the following question: Are you afraid of falling? Physical function was assessed using the Late Life Function and Disability Instrument. Physical activity was recorded using an accelerometer worn on the waist for 7 consecutive days, and mean daily counts of activity per minute were averaged over the 7-day period.

Results

Fear ratings were related to total daily activity (r=−.26, P=.02). The relation was not as strong as the relation of function and physical activity (r=.45, P<.001). When stratified by exercise status or functional status, fear was no longer related to total daily activity. Physical function explained 19% of the variance in physical activity, whereas the addition of fear status did not add to the explained variance in physical activity.

Conclusions

FOF is related to total daily physical activity; however, FOF was not independently associated with physical activity when accounting for physical function. Some FOF may be reported as a limitation in function.     

Development and Validation of the Comprehensive Falls Risk Screening Instrument

ABSTRACT

Annually, one in three older adults experiences a fall. Falls can lead to death, disability, and/or decreased health-related quality of life (HRQL). Objectives: To validate the Comprehensive Falls Risk Screening Instrument (CFRSI). Methods: Data were collected on 286 older adults (M age in years = 74.2 ± 10.0). The CFRSI total falls risk score was compared to subscale scores, the Physical Activity Scale for the Elderly (PASE), the Functional Status Index (FSI), and HRQL (SF-36, PCS, and Mental Component Summary (MCS)) scores. Results: The total CFRSI falls risk score was associated with all subscales (r = 0.25, p < 0.01 to r = 0.69, p < 0.01), PASE (r = ?0.30, p < 0.01), FSI (r = 0.30, p < 0.01), and SF-36 PCS and MCS scores (r = ?0.44, p < 0.01 to r = ?0.24, p = 0.03, respectively). Fallers (n = 90) had a higher total falls risk score (M = 41.03 ± 9.38) than nonfallers (n = 188, M = 34.06 ± 10.05, t [276] = 5.53, p < 0.001). The most important predictor of falling status was only the history risk score (r = 0.96). Strong association of variables supports the construct validation of the CFRSI. The CFRSI is a valid comprehensive measure of falls risk that allows for identification of older adults who are at risk for falls and the specific areas that should be targeted for falls prevention.     

Performance-oriented mobility assessment (POMA) balance score indicates need for assistive device

Purpose.?To determine (1) if older adults using an assistive device (AD) score lower on the Performance-Oriented Mobility Assessment (POMA) balance subscale (B-subscale) than individuals not using an AD; and (2) if a cut-score of 12 would indicate the need to use an AD.

Methods.?Elderly persons (n = 82, mean age = 82.1 years) were surveyed about AD use, health status, activity level and fall history. A one-time assessment of balance was conducted using the B-subscale. The ‘arising task’ was repeated to evaluate performance on the sit-to-stand task without using hands.

Results.?A significant difference in B-subscale scores was observed between the two groups (AD; no AD), (P < 0.001). AD use was associated with lower activity level and health status. A cut-score of 12 points indicated device use (P = 0.000). The repeated ‘arising task’ demonstrated that 76.8% performed the task without using hands for support.

Conclusion.?Older adults using an AD will score lower on the B-subscale and report lower activity level and health status. A score of less than 12 on the B-subscale is indicative of AD need. Older adults who use an AD and self-report a falls history will score lower on the B-subscale than individuals using an AD and no reported history of falls.     

The Effects of Footwear on Postural Sway: A Pilot Study

Abstract

Aims: This pilot study provides a methodology to measure differences in velocity of postural sway of older adults while barefoot, with non-slip socks, and in athletic shoes during a simulated fall. Methods: Postural sway was measured during a simulated fall on 14 ambulatory adults over 50?years of age using computerized posturography. Hierarchical linear modeling statistics determined the difference in velocity of sway wearing different types of randomly applied footwear with p?≤?.05. Results: Velocity of sway while wearing socks was significantly lower compared to barefoot (p?=?0.0132). Velocity of sway while being barefoot compared to wearing shoes did not significantly differ (p?=?0.1460). Velocity of sway while wearing socks is significantly lower compared to wearing shoes (p?=?0.0001). Conclusions: This pilot study indicates postural sway is lowest during a simulated fall while wearing non-slip socks.     

Effectiveness and Acceptability within a Skilled Nursing Facility Setting

ABSTRACT

Aims: The program evaluated the effectiveness and acceptability of the Stepping On protocol (Clemson L, Swann M, Mahoney J. (2011). Stepping On: Building confidence and reducing falls in older adults (3rd ed.). Cedar Falls, IA: Freiberg Press Inc.) in reducing fall risk in older adults when delivered in a skilled nursing facility (SNF). Method: Stepping On was delivered by an occupational therapist to participants (n = 11) over 7 weeks followed by a 3-month session (Clemson et al., 2011). Results: Through comparison of pre and post data (n = 7) and 3-month outcomes (n = 4), trends revealed an overall increase in the use of protective behaviors and self-perceived physical health. Trends showed sustained outcomes at all measures, with exception of a decline in fall efficacy. The program was well received by participants and staff at the SNF with high satisfaction rates. Conclusion: Stepping On has the potential to be an effective fall prevention program for older adults with trends towards fall prevention while providing needed support to current and past SNF residents, and community members.