Effects of physical training on physical performance in frail elderly people

Aging is often accompanied by decreased muscle strength, aerobic capacity and balance, which can lead to impaired physical performance. Epidemiological data have demonstrated that low levels of physical activity are strongly related to functional decline. Frailty has been defined as a clinical syndrome comprised of unintentional body weight loss, self-reported exhaustion, muscle weakness, slow walking speed and a low level of physical activity in men and women over the age of 65. There is contradictory evidence regarding the effects of physical training on physical performance in frail elderly people. The primary aim of this thesis is to describe the effects of physical training on physical performance i.e. muscle strength, aerobic capacity, balance, mobility and physical activity level as well as activities of daily living (ADL) and health-related quality of life (HRQL) in frail elderly people. Another aim is to investigate reliability with test re-test in one repetition maximum (1RM) in the arm/shoulder. Ninety-six community-dwelling elderly people (58 women) were randomised to four different groups: i) physical training programme (aerobic, muscle strength, balance), ii) a nutritional intervention programme (individually targeted nutritional advice and group sessions), iii) a combination of these interventions and iv) a control group. At baseline the subjects were screened for physical performance as well as nutrition related variables. These measurements were repeated immediately after the intervention, which lasted for 12 weeks, and again six months later. During the last six months, the subjects in the training groups were encouraged to perform homebased exercises and to fill in training diaries. Two years after baseline, a third followup regarding ADL was conducted through telephone calls. The test re-test procedure with 1RM was conducted at one week-interval, comparing the reliability between test sessions, and also between subjects with or without previous muscle strength training experience. A positive effect of the physical training programme was shown on leg muscle strength and habitual physical activity level for frail elderly people. Adding a nutritional intervention did not affect the results. There were no other significant differences between groups. Subjects with improvements in muscle strength, balance and mobility had significantly higher compliance compared to non-improvers. There were moderate significant correlations between compliance of the home-based exercises and improvements in personal ADL and HRQL. There was a high correlation between the test sessions in 1RM, r=0.97 for both groups. An analysis of 95% limits of agreement for the mean difference was -4.3/+6.9 kg for the group without and -3.0/+6.4 kg for the group with previous muscle strength training experience, respectively. In conclusion, the physical training programme showed a positive effect on leg muscle strength and habitual physical activity level. An individually tailored intervention is probably necessary to achieve a positive result on physical performance such as aerobic capacity, balance and mobility in frail elderly people. 1RM seems to be a reliable and safe method for dosing the intensity and evaluating a muscle strength training programme for elderly people

Social services post-discharge and associated risk for readmission in a 2016 Swedish geriatric cohort

This study aims to describe the social services of a 2016 cohort after discharge from inpatient geriatric care, and to investigate the association between level of social services and 30-day readmissions

Downton Fall Risk Index during hospitalisation is associated with fall-related injuries after discharge : a longitudinal observational study

Questions: Among older people who are hospitalised, what is the predictive validity of the Downton Fall Risk Index (DFRI) in relation to fall-related injury after discharge? What is the predictive validity of the DFRI among males and females in this setting? Design: Prospective, longitudinal, observational study. Participants: All hospital admissions during 2012 at three geriatric clinics in the Stockholm County Council were monitored. Patients aged > 65 years who did not die during the admission and who lived in the Stockholm County Council region were included. Outcome measures: The DFRI consists of five modules: previous falls, medication, sensory deficits, mental state, and gait. Three or more points indicate an increased fall risk. Data on DFRI, health status and medications were collected prior to discharge. Data regarding fall-related injuries were collected up to 6 months after discharge. Poisson multivariate regression analyses were conducted to evaluate the association between DFRI and fall-related injuries. Results: In total, 6650 patients were analysed. The cut-off >= 3 points in the DFRI was significantly associated with fall-related injury when confounding variables were controlled for (IRR 1.94, 95% CI 1.60 to 2.38). Among individual modules, only previous falls (IRR 2.58, 95% CI 2.22 to 3.01) and unsafe gait (IRR 1.79, 95% CI 1.53 to 2.09) were associated with fall-related injuries. Stratified analyses showed a higher risk ratio for men compared to women regarding the DFRI, but the test for an interaction effect was not significant. Conclusion: The risk of post-discharge fall-related injury is increased among older hospitalised people with an increased fall risk, according to the DFRI, especially those who had previous falls or unsafe gait. Although the DFRI tool is predictive, previous falls and gait are the measures that are most worthy of focus

Physical Fitness in Older People Recently Diagnosed with Cognitive Impairment Compared to Older People Recently Discharged from Hospital

Background/Aims: There is evidence of an association between cognitive function and physical fitness. The aim of this study was to compare physical fitness in patients with cognitive impairment with a group of older people recently discharged from hospital. Methods: A cross-sectional study with 98 patients recently diagnosed with cognitive impairment and 115 patients recently discharged from hospital. Associations between the study group variable and different components in the Senior fitness test were examined, controlling for demographic factors and comorbidity. Results: The group recently diagnosed with cognitive impairment indicated poorer results on three of six physical fitness components (p Conclusion: Older adults with cognitive impairment are in need of individually tailored physical activity programs to increase the level of physical fitness

Web-based support for individuals with type 2 diabetes - a feasibility study

BackgroundSelf-care is one of the cornerstones in the treatment of type 2 diabetes. Patients with type 2 diabetes struggle to maintain acceptable levels of blood sugar, blood pressure and lipids, the fundamental for the prevention of macro- and microvascular as well as neuropathic complications. The primary aim of the study was to evaluate the feasibility and describe patients' and caregivers' experiences of using the web- and smartphone-based system Triabetes. The secondary aim was to investigate if the use of the system could improve patients' clinical outcomes.MethodsFeasibility was assessed with describing recruitment rate and the participants views of using the system. Laboratory and anthropometry data were also collected.ResultsThe study showed that recruitment of patients to participate in the intervention was limited and compliance to the study protocol was low. A majority of the patients stated that the system was easy to get an overview of and that the system motivated them and made it easier and fun to handle lifestyle habits. A secondary finding of the study was that there was a significant lowering of LDL values.Conclusions Feasibility in terms of recruitment rate was low. The participants agreed that the application overall was useful but suggested several improvements. Summarized lessons learned from this study are following: (1) we need more knowledge about what motivates a person to use a digital tool for a longer period of time; (2) the tool must be easy and less time consuming to use; (3) the technical structure needs to be improved and automatic recording of data must be improved

Arts as an ecological method to enhance quality of work experience of healthcare staff : a phenomenological-hermeneutic study

This paper explores the impact of self-chosen arts-based recreational activities, as opposed to the traditional arts therapy activities, on the well-being of healthcare providers. Three qualitative case studies of programs in which arts-based activities were used to work with healthcare providers, lasting for 10 weeks each, are phenomenological-hermeneutically evaluated using interviews and focus groups. The findings show what we refer to as an "ecological" ripple of effects: (1) the arts-based activities helped to reduce individual stress and to enhance mood over time, (2) the activities helped to transform workplace relationships within wards, and (3) the arts humanized the overall work climate in the healthcare setting. These effects go beyond those of using the art production as a strategy for stress reduction and imply potential for a more encompassing role for the arts within healthcare

Association of cardiovascular burden with mobility limitation among elderly people: a population-based study.

BACKGROUND: Cardiovascular risk factors (CRFs) such as smoking and diabetes have been associated with mobility limitations among older adults. We seek to examine to what extent individual and aggregated CRFs and cardiovascular diseases (CVDs) are associated with mobility limitation. METHODS: The study sample included 2725 participants (age ≥60 years, mean age 72.7 years, 62% women) in the Swedish National Study on Aging and Care in the Kungsholmen district of central Stockholm, Sweden, who were living either at their own home or in institutions. Data on demographic features, CRFs, and CVDs were collected through interview, clinical examination, self-reported history, laboratory tests, and inpatient register. Mobility limitation was defined as walking speed <0.8 m/s. Data were analyzed using multiple logistic models controlling for potential confounders. RESULTS: Of the 2725 participants, 581 (21.3%) had mobility limitation. The likelihood of mobility limitation increased linearly with the increasing number of CRFs (i.e., hypertension, high C-reactive protein, obesity, diabetes and smoking) (p for linear trend<0.010) and of CVDs (i.e., ischemic heart disease, atrial fibrillation, heart failure and stroke) (p for linear trend<0.001). There were statistical interactions of aggregated CRFs with age and APOE ε4 allele on mobility limitation (p interaction<0.05), such that the association of mobility limitation with aggregated CRFs was statistically evident only among people aged <80 years and among carriers of the APOE ε4 allele. CONCLUSION: Aggregations of multiple CRFs and CVDs are associated with an increased likelihood of mobility limitation among older adults; however the associations of CRFs with mobility limitation vary by age and genetic susceptibility

Is midlife occupational physical activity related to disability in old age? The SNAC-Kungsholmen study.

OBJECTIVES: Leisure-time physical activity (PA) has been established to be related to more years lived without disability. However, less is known about the relationship between occupational PA and disability in old age. The aim of the study was 1) to investigate whether midlife occupational PA is related to late-life disability, and 2) to test the hypothesis that the association differs according to the occupational categories of blue and white collar work. METHODS: The study population was derived from the Swedish National Study on Aging and Care, and consisted of a random sample of 1804 subjects aged 72 and above. The association of occupational PA during the longest held occupation with disability in old age was determined using logistic regression. RESULTS: There was no significant relationship between occupational PA and disability in personal or instrumental activities of daily living (ADL) after controlling for demographic and health-related factors. However, in stratified analyses moderate levels of occupational PA was associated with a lower odds ratio of dependency in personal ADL amongst white collar workers, compared to low level of occupational PA (OR = 0.34 95% C1 0.12-0.98). CONCLUSIONS: Moderate levels of midlife occupational PA were associated with a decreased risk of personal ADL disability in old age among white collar workers, but not among blue collar workers. Our results highlight the importance of encouraging white collar workers to engage in physical activity during or outside work hours

Education-related differences in physical performance after age 60: a cross-sectional study assessing variation by age, gender and occupation

BACKGROUND: Having a low level of education has been associated with worse physical performance. However, it is unclear whether this association varies by age, gender or the occupational categories of manual and non-manual work. This study examined whether there are education-related differences across four dimensions of physical performance by age, gender or occupational class and to what extent chronic diseases and lifestyle-related factors may explain such differences. METHODS: Participants were a random sample of 3212 people, 60 years and older, both living in their own homes and in institutions, from the Swedish National Study on Aging and Care, in Kungsholmen, Stockholm. Trained nurses assessed physical performance in grip strength, walking speed, balance and chair stands, and gathered data on education, occupation and lifestyle-related factors, such as physical exercise, body mass index, smoking and alcohol consumption. Diagnoses of chronic diseases were made by the examining physician. RESULTS: Censored normal regression analyses showed that persons with university education had better grip strength, balance, chair stand time and walking speed than people with elementary school education. The differences in balance and walking speed remained statistically significant (p < 0.05) after adjustment for chronic diseases and lifestyle. However, age-stratified analyses revealed that the differences were no longer statistically significant in advanced age (80+ years). Gender-stratified analyses revealed that women with university education had significantly better grip strength, balance and walking speed compared to women with elementary school education and men with university education had significantly better chair stands and walking speed compared to men with elementary school education in multivariate adjusted models. Further analyses stratified by gender and occupational class suggested that the education-related difference in grip strength was only evident among female manual workers, while the difference in balance and walking speed was only evident among female and male non-manual workers, respectively. CONCLUSIONS: Higher education was associated with better lower extremity performance in people aged 60 to 80, but not in advanced age (80+ years). Our results indicate that higher education is associated with better grip strength among female manual workers and with better balance and walking speed among female and male non-manual workers, respectively