Association between muscle power impairment and WHODAS 2.0 in older adults with physical disability in Taiwan

Abstract

Purpose: To explore the association between muscle power impairment and each World Health Organization Disability Assessment Schedule second edition (WHODAS 2.0) domain score among subjects with physical disability. Methods: Subjects (≥60 years) with physical disability related to neurological diseases, including 730 subjects with brain disease (BD) and 126 subjects with non-BD, were enrolled from a data bank of persons with disabilities from 1 July 2011 to 29 February 2012. Standardized WHODAS 2.0 scores ranging from 0 (least difficulty) to 100 (greatest difficulty) points were calculated for each domain. Results: More than 50% of subjects with physical disability had the greatest difficulty in household activities and mobility. Muscle power impairment (adjusted odds ratios range among domains, 2.75–376.42, p?<?0.001), age (1.38–4.81, p?<?0.05), and speech impairment (1.94–5.80, p?<?0.05) were associated with BD subjects experiencing the greatest difficulty in most WHODAS 2.0 domains. But a few associated factors were identified for the non-BD group in the study. Conclusions: Although the patterns of difficulty in most daily activities were similar between the BD and non-BD groups, factors associated with the difficulties differed between those two groups. Muscle power impairment, age and speech impairment were important factors associated with difficulties in subjects with BD-related physical disability.

• Implications for Rehabilitation

• Older adults with physical disability often experience difficulties in household activities and mobility.

• Muscle power impairment is associated with difficulties in daily life in subjects with physical disability related to brain disease.

• Those subjects with brain disease who had older age, a greater degree of muscle power impairment, and the presence of speech impairment were at higher risk of experiencing difficulties in most daily activities.

     

Framing disability among young adults with disabilities and non-disabled young adults: an exploratory study

Abstract

Purpose: To explore how young adults frame disability and to compare the meanings of disability between persons with and without disabilities. Method: Snow ball sampling was used to recruit the participants. The sample comprised of 14 young adults from Upstate New York area; nine were non-disabled, five had a physical disability. Data were collected by semi-structured interviews. Qualitative content analysis was used to analyze the data. Results: Five themes emerged from the analysis: disability as a deviation from “the norm”, disability as inability, disability as something one needs to overcome, the role of the environment in disability, and disability as a negative phenomenon. The findings suggest that persons with disabilities hold somewhat different meanings of disability compared with non-disabled persons. Conclusions: While the biomedical frame of disability was somewhat challenged, disability is mainly understood via a biomedical lens. Disability should be framed as form of human diversity, not as a mark of Cain.

• Implications for Rehabilitation

• The ways through which disability is framed-as a medical issue or a social one-influences social attitudes and behaviors toward persons with disabilities as well as the shaping of disability policies and services. These, in turn, effect the well-being and impact the lives of persons with disabilities.

• In a relatively small sample which comprised of young adults with disabilities and non-disabled young adults, this study shows that while medical definitions of disability are somewhat contested, the medical definition of disability seems to prevail.

     

Probit vs. semi-nonparametric estimation: examining the role of disability on institutional entry for older adults

Purpose: The purpose of this study was to showcase an advanced methodological approach to model disability and institutional entry. Both of these are important areas to investigate given the on-going aging of the United States population. By 2020, approximately 15% of the population will be 65 years and older. Many of these older adults will experience disability and require formal care.

Methods: A probit analysis was employed to determine which disabilities were associated with admission into an institution (i.e. long-term care). Since this framework imposes strong distributional assumptions, misspecification leads to inconsistent estimators. To overcome such a short-coming, this analysis extended the probit framework by employing an advanced semi-nonparamertic maximum likelihood estimation utilizing Hermite polynomial expansions.

Results: Specification tests show semi-nonparametric estimation is preferred over probit. In terms of the estimates, semi-nonparametric ratios equal 42 for cognitive difficulty, 64 for independent living, and 111 for self-care disability while probit yields much smaller estimates of 19, 30, and 44, respectively.

Conclusions: Public health professionals can use these results to better understand why certain interventions have not shown promise. Equally important, healthcare workers can use this research to evaluate which type of treatment plans may delay institutionalization and improve the quality of life for older adults.

• Implications for rehabilitation

• With on-going global aging, understanding the association between disability and institutional entry is important in devising successful rehabilitation interventions.

• Semi-nonparametric is preferred to probit and shows ambulatory and cognitive impairments present high risk for institutional entry (long-term care).

• Informal caregiving and home-based care require further examination as forms of rehabilitation/therapy for certain types of disabilities.

     

Everyday technology use among older deaf adults

Purpose: Technology holds great potential to support Deaf individuals as they age into older adulthood. However, it is unclear to what extent Deaf seniors are using technology in everyday life or whether they experience challenges in using technology. The current study explored technology use among older Deaf adults with regard to attitudes, adoption style, and frequency of use for a wide range of technologies, including assistive technologies (ATs) for persons with hearing loss and general, everyday technologies.

Materials and methods: We developed a questionnaire that assessed older Deaf adults’ use of and experiences with technology. The questionnaire was made available in online and paper versions. Participants (N?=?109) were recruited from national conferences and organizations for the Deaf.

Results: Overall, we found that the older Deaf adults were technology adopters and regularly use and feel comfortable with a variety of devices. However, we also identified a number of technologies that are not being used by this population, including an AT that appears to have become obsolete and technologies that use sound-based alerts.

Conclusions: Insights on how older Deaf adults are embracing technology and which devices they are actually using can help policy makers, technology developers, and a range of aging services professionals, better meet the needs of this understudied population.

• Implications for Rehabilitation:

• Older Deaf adults use a variety of assistive and everyday technologies and must be considered as consumers and included in the design process.

• Older Deaf adults are generally positive in their attitudes towards technologies but they are infrequent users of potentially beneficial health technologies, highlighting opportunities for future research and development.

• Assistive technology for the Deaf (TTY/TTD) appears to have become obsolete with advances in modern communication technologies, which has implications for policy decisions.

     

Functioning and primary healthcare utilization in older adults: a 1-year follow-up study

Background/Purpose: Older adults are high users of healthcare services, mainly due to health conditions and their impact on daily activities, challenging the ability of health systems to provide timely and high-quality care. Conceivably, using disability-related variables to predict future healthcare utilization could contribute to reduce both older adults’ disability and healthcare costs. This study aimed to explore the association between aspects of disability and older adults’ primary healthcare utilization and hospitalization over a period of 1 year. Methods: Older adults (n = 129) were assessed for self-reported disability, lower limb performance, pain intensity and number of painful body sites, depressive symptoms, and self-reported physical activity. Data on primary healthcare utilization and hospitalization were collected for the period of 1 year through registries and phone interviews. Results: Regression analysis, adjusted for potential confounders, showed that self-reported disability and pain intensity were significantly associated with total primary healthcare utilization and together with a confounding variable (number of chronic conditions) explained 16% of its variance (p < 0.05). Increased physical activity was significantly associated with a decreased likelihood of being admitted to hospital (95% CI for exponentiation (B) = 0.27–0.81). Discussion: Data suggest that decreasing self-reported disability and increasing physical activity may decrease primary healthcare utilization and hospitalization, respectively.     

The effect of motivational interviewing on physical activity level among older adults: a systematic review and meta-analysis

Abstract

Aim: To determine the reported effect of randomized controlled trials (RCTs) using Motivational Interviewing (MI) to advance physical activity among older adults.

Methods: We searched for RCTs in MEDLINE, EMBASE, CINAHL, AgeLine, PsycINFO and Cochrane Library from inception until March, 2019. Identified trials that used MI for improving physical activity in community-dwelling older adults (≥65?years).

Results: From 5616 citations identified from the search, we included three trials (four publications). There was no evidence of a significant difference between the effect of MI and usual care on physical activity in older adults (Standard Mean Difference (SMD) -0.02, 95% Confidence Interval (CI) 0.05 to 0.46, I² 16%; 3 trials; 84 participants).

Conclusion: There is insufficient evidence to support the effect of MI on improving physical activity among older adults. There is a need for more high quality trials to show that MI is beneficial in older adults who are physically inactive.     

Effects of a biopsychosocial-spiritual group therapy on quality of life among institutionalized older adults with disabilities: A randomized controlled trial

The traditional biomedical care approach has been unsatisfactory to meet the complex needs of seniors with long-term multimorbidity and irreversible disability, particularly for those living in residential LTC facilities. This study aimed to develop and evaluate the effectiveness of an 8-week biopsychosocial-spiritual (BPS-S) group intervention with the attempt to enhance quality of life (QoL) and meaning in life among senior residents with disability. This single-blind randomized controlled trail was conducted in eight residential LTC facilities. The primary outcome, ‘participants' overall and subdomain QoL’, and the secondary outcome, ‘meaning in life’, were repeatedly assessed, including four time points: before, mid- and post-intervention, and at a 1-month follow-up. A generalized linear mixed model (GLMM) was used to assess between-group differences over time. The post-intervention differences indicated significant higher improvement on senior residents' overall and all 4 domains of QoL, as well as their meaning in life, between the baseline and both times of post-intervention and 1-month follow-up. On the other hand, participants' family QoL have improved immediately in the midst of intervention. This study provides preliminary evidence to support the feasibility and effectiveness of an 8-week BPS-S group therapy. We recommend the BPS-S be integrated into routine institutional care activities to help maximize senior residents' own capacity for self-healing, achieve a state of harmonious balance between body, mind, social and spiritual relationships; and in turn, enhance holistic health of this group.     

中老年人的复原力与成功老化

介绍了复原力、成功老化的概念以及复原力与成功老化的关系。提出在中老年人群中复原力正向性影响成功老化;成功老化可增强复原力。建议在中老年人群中进行更多的研究,以验证复原力与成功老化的关系。     

Influence of the placebo effect on oxidative stress in healthy older adults of Mexico City

Background:  The placebo effect has been widely recognized in the randomized clinical trials; nevertheless, this effect has not been evaluated in terms of antioxidant therapy on oxidative stress (OxS).
Objective:  The objective of this study was to determine the influence of the placebo effect on OxS in healthy older adults of Mexico City.
Methods:  We carried out a double-blind controlled clinical assay with the participation of 75 healthy older adults residents for the past 10 years of Mexico City; randomly distributed into three groups of 25 subjects each after previous informed consent; control group not received any treatment, placebo group received a placebo with a pharmaceutical presentation similar to that of the treatment, whereas treatment group were administered 1000 mg of ascorbic acid and 400 IU of alpha-tocopherol. All subjects ingested the treatment daily according to study group for 12 months. We measured before and after 12 months of treatment, lipoperoxides levels (LPO), erythrocyte superoxide dismutase, glutathione peroxidase and total plasma antioxidant status with Randox Laboratories Ltd kits. The concentration of ascorbic acid and alpha-tocopherol were measured using high-performance liquid chromatography.
Results:  The placebo group subjects showed a statistically significant decrease in LPO concentration, in the same way as the treatment group subjects ( P  < 0·01), both in comparison with a control group.
Conclusion:  Our findings suggest that the placebo has a significant effect on OxS.     

Short stick exercises for fall prevention among older adults: a cluster randomized trial

Abstract

Purpose: To investigate the effects of short stick exercise (SSEs) on fall prevention and improvement of physical function in older adults. Methods: A cluster randomized trial was conducted in five residential care facilities. The intervention group (n?=?51) practiced SSEs for six months, followed by routine care for six more months. The control group (n?=?54) received ordinary care for 12 months. The primary outcome measure was the number of fallers, taking into account the time to first fall using the Kaplan–Meier method. The secondary outcome measures were physical and mental functions. Results: The number of fallers was significantly lower in the intervention group (n?=?6) than in the control group (n?=?16) during the 12 months. The adjusted hazard ratio for a first fall in the intervention group compared with the control group was 0.15 (CI, 0.03 to 0.74, p?=?0.02). The fall-free period was significantly longer in the intervention group than in controls (mean?±?SD, 10.1?±?3.0 versus 9.0?±?4.1 months, p?=?0.027). The functional reach and sit and reach tests were significantly improved at three and six months. Conclusion: The SSEs appeared effective for fall prevention and improvement of physical function in older adults.

• Implications for Rehabilitation

• The newly developed short stick exercises appear an effective means of reducing falls among older adults in residential care facilities.

• The short stick exercises seem to have an immediate effect on improving physical functions.

• Effects gained by performing the short stick exercises, such as static balance, flexibility and agility may last for six months.

• The short stick exercises were found to be easy for older adults to practice continuously in residential care facilities.