Physical activity combined with resistance training reduces symptoms of frailty in older adults: A randomized controlled trial

IntroductionIncreased physical activity (PA) is a crucial factor in the prevention of physical deterioration, and resistance training (RT) is also a common and effective intervention for older adults. However, the effects of PA as an adjunct to RT on frailty status remains unclear; therefore, we clarified the effect of a PA intervention with feedback, as an adjunct to resistance strength training, on the physical and mental outcomes of frail older adults.Materials and methodsWe employed a randomized controlled trial. Community-dwelling frail older adults in Japan were recruited to participate. Forty-one participants (mean age 81.5) were randomly assigned to engage in a resistance training with PA (RPA group) or RT group for six months. Frailty status and frailty scores, which were measured according to the Cardiovascular Health Study criteria—muscle strength, mobility, instrumental activities of daily living, and health-related quality of life—were assessed.ResultsParticipants in the RPA group exhibited a significant increase in light-intensity PA, the number of steps taken daily (p < 0.05), and lower-limb muscle strength (p < 0.05) and a significant decrease in frailty scores. However, pre- and postintervention frailty status, instrumental activities of daily living, and health-related quality of life did not differ significantly.ConclusionsImplementation of a PA intervention as an adjunct to RT is feasible, as it reduced frailty scores and increased lower-limb muscle strength and mobility in older adults with frailty symptoms.     

Instrumental activities of daily living: a stepping-stone towards Alzheimer's disease diagnosis in subjects with mild cognitive impairment?

This paper challenges the requirements of normal activities of daily living/instrumental activities of daily living (ADL/IADL) functioning in mild cognitive impairment and stresses the need for further research and assessment refinement. Although people who develop dementia seem to experience subtle changes in complex IADLs long before the disease onset, studies that compare cognitively mildly impaired subjects with demented and nondemented subjects present no clear consensus regarding differentiation according to IADL ability. The traditional ADL/IADL assessment instruments and techniques seem to present a major problem when the purpose is to predict or differentiate between diagnoses. It is therefore argued that the diagnosis of MCI should include rather than exclude observed or experienced changes in complex everyday life activities.     

Factors related to disability: Evidence from the “Treviso Longeva (TRELONG) Study”

Prolongation of life is an important public health goal as long as there is an emphasis on the quality of life (QoL) and independent living. Diminishing abilities to ambulate and participate in activities of daily living point to a serious decline in functional health, increasing the risk of institutionalization and death. In our work we found a pattern of factors associated with disability, especially cognitive impairment, as well as stroke, physical activity and performance, reading, and the nutritional biomarkers, blood albumin and high-density lipoprotein cholesterol (HDL-C). The attention to this cluster of markers, suggesting multidimensional prevention, may have unexpected good effects against disability.     

Urinary incontinence in a community sample of older adults: prevalence and impact on quality of life

Purpose.?To measure the prevalence of urinary incontinence (UI) in a community-dwelling sample and the impact of self-reported UI on well-being and activity in older men and women.

Method.?Participants were older adults aged ≥65 years. Measures included the frequency of urgency incontinence, depression, positive and negative affect and social activity, independence in activities of daily living (IADL) and self-rated health. The data were collected by face to face interview (1994) and computer assisted telephone interviews (1996).

Results.?Of the 796 participants, 28%% experienced urgency incontinence and 21%% reported stress incontinence occasionally or often, with higher rates among women. The threshold for the impact on depression, negative affect and IADL was with occasional occurrence of urinary urgency incontinence. For positive affect and self-rated health, the threshold was experiencing urinary urgency incontinence often. The presence of urinary stress incontinence was associated with depression, IADL dependence, self-rated health and positive affect. Overall, women with incontinence had higher negative affect scores, but men with stress incontinence had higher scores than those without.

Conclusions.?The impact of incontinence highlights the need for more effective management of the condition. The threshold for the effects of urinary urgency incontinence on mental health and functionality is lower than for the effects on general health. There is a need to consider how older people judge the impact of UI in the design of targeted health promotion programmes.     

Hilfe- und Pflegebedürftigkeit im Alter in den neuen Bundesländern: Ergebnisse aus der Leipziger Langzeitstudie in der Altenbevölkerung (LEILA75+)

In a representative sample of the Leipzig population age 75 and older 61.8% of the participants showed relevant deficits in their capacity of independent living as assessed by a combined ADL/IADL scale. According to a staging model of care as promoted by Schneekloth and coworkers, 17% of the sample was in need of care. Especially, mobility-related instrumental activities of daily living (IADL) such as shopping, cleaning and visiting are affected, but also basic activities (ADL) such as climbing stairs, walking or taking a shower/bath. Each of these activities created problems for more than 45% of the participants. Between 18 and 33% of the sample even regarded it as impossible to carry out these activities. Expectedly, the percentages of assistance needed with ADLs/IADLs appeared to be strongly age-related with exponential increases beyond the age of 85. Beyond effects of sampling and life expectancy, significantly more women suffered from decreases in their capacity of independent living. Community-dwelling elderly on average had a 10% higher rate of problems with ADLs/IADLs as compared to German reference data from the studies on "Chances and Limits of Independent Living in Old Age"; the rate of institutionalized participants, who regarded it impossible to carry out these activities, was even higher by about 30%. As discussed by Schneekloth et al., data from the LEILA study support the hypothesized pattern that ecological disadvantages under both community-dwelling as well as insitutionalized living conditions lead to higher percentages of elderly in the former East German states who are in need of care. As a consequence and although more disabled, elderly seem to stay longer under community-dwelling living conditions and move even more disabled into an institutionalized form of living.     

Stroke and activity limitation in Chinese adults 65 Years or older

BackgroundDifferences in activity limitations between stroke survivors and people with other chronic conditions and how their levels of activity limitation vary by sociodemographic characteristics have not been well quantified.ObjectiveTo quantify activity limitations experienced by Chinese older adult stroke survivors and explore stroke effects in specific subgroups.MethodsWe used Chinese Longitudinal Healthy Longevity Survey 2017–2018 data (N = 11,743) to produce population-weighted estimates of activity limitations using the Activities of Daily Living (ADL) and the Instrumental ADL (IADL) scales for older adults (age 65 and older) stroke survivors compared to those with non-stroke chronic conditions and those without chronic conditions. Multinomial logistic regressions were run with outcomes “no activity limitation,” “IADL only limitation,” and “ADL limitation.”ResultsThe weighted marginal prevalence of ADL limitation was higher in the stroke group (14.8%) than in those with non-stroke chronic condition (4.8%) or no chronic conditions (3.6%) (p < 0.01). The corresponding prevalence of IADL limitation for the three groups was 36.0%, 31.4%, and 22.2%, respectively (p < 0.01). Stroke survivors aged ≥ 80 years had a higher prevalence of ADL/IADL limitation than those aged 65–79 years (p < 0.01). Formal education was associated with a lower prevalence of ADL/IADL limitation in each chronic condition group (p < 0.01).ConclusionsPrevalence and severity of activity limitation among Chinese older adult stroke survivors were several times higher than those without chronic conditions and those with non-stroke chronic conditions. Stroke survivors, particularly those aged ≥80 years and those without formal education, might be predisposed to more severe activity limitation and require more support to compensate.     

Hematologic improvement and response in elderly AML/RAEB patients treated with valproic acid and low-dose Ara-C

The histone deacetylase inhibitor (HDACi) valproic acid (VPA) has been shown to be active on acute myeloid leukemia (AML) and refractory anemia with excess of blasts (RAEB). Thirty-one elderly AML/RAEB patients (AML n = 25; RAEB n = 6) with a high rate of comorbidity were entered in a phase II study with low-dose cytarabine (Ara-C) and VPA. Fitness was evaluated by means of the Comprehensive Geriatric Assessment (CGA), including the Cumulative Illness Rating Scale (CIRS) score, the self-sufficiency scores of Activity of Daily Living (ADL) and Instrumental Activity of Daily Living (IADL). Eight patients obtained a lasting complete remission and 3 other patients obtained hematologic improvement for a total response rate of 35%. Five of 11 responding patients were relapsed or resistant after a previous treatment with Ara-C. Seven of 11 responding patients were assessed as frail at enrolment and/or had IADL impairment. Grades 3 and 4 toxicities were mainly hematological. Low-dose Ara-C and VPA is a relatively non-toxic combination with good therapeutic activity in elderly patients with AML/RAEB. This therapeutic approach represents an alternative treatment for patients who cannot undergo standard induction therapy.