Gait speed characteristics and Its spatiotemporal determinants in nursing home residents: A cross-sectional study

Fien, S ORCiD: 0000-0003-0181-5458BACKGROUND AND PURPOSE: Low and slowing gait speeds among nursing home residents are linked to a higher risk of disability, cognitive impairment, falls, and mortality. A better understanding of the spatiotemporal parameters of gait that influence declining mobility could lead to effective rehabilitation and preventative intervention. The aims of this study were to objectively quantify the spatiotemporal characteristics of gait in the nursing home setting and define the relationship between these parameters and gait speed. METHODS: One hundred nursing home residents were enrolled into the study and completed 3 habitual gait speed trials over a distance of 3.66 m. Trials were performed using an instrumented gait analysis. The manner in which the spatiotemporal parameters predicted gait speed was examined by univariate and multivariable regression modeling. RESULTS: The nursing home residents had a habitual mean (SD) gait speed of 0.63 (0.19) m/s, a stride length of 0.83 (0.15) m, a support base of 0.15 (0.06) m, and step time of 0.66 (0.12) seconds. Multivariable linear regression revealed stride length, support base, and step time predicted gait speed (R = 0.89, P < .05). Step time had the greatest influence on gait speed, with each 0.1-second decrease in step time resulting in a 0.09 m/s (95% confidence interval, 0.08-0.10) increase in habitual gait speed. CONCLUSIONS: This study revealed step time, stride length, and support base are the strongest predictors of gait speed among nursing home residents. Future research should concentrate on developing and evaluating intervention programs that were specifically designed to focus on the strong predictors of gait speed in nursing home residents. We would also suggest that routine assessments of gait speed, and if possible their spatiotemporal characteristics, be done on all nursing home residents in an attempt to identify residents with low or slowing gait speed

Exploring the feasibility, sustainability and the benefits of the GrACE + GAIT exercise programme in the residential aged care setting

Fien, S ORCiD: 0000-0003-0181-5458Background: The feasibility and benefits of a 24-week targeted progressive supervised resistance and weight-bearing exercise programme (Group Aged Care Exercise + GAIT (GrACE + GAIT)) in the residential aged care (RAC) setting was investigated as very little peer-reviewed research has been conducted in relation to exercise programmes of this duration in this cohort. Methods: A quasi-experimental study design consisting of two groups (control and exercise) explored a 24-week targeted progressive supervised resistance and weight-bearing exercise programme (GrACE + GAIT) in two RAC facilities in Northern New South Wales, Australia. A total of 42 adults consented to participate from a total of 68 eligible residents (61.7%). The primary outcome measures were feasibility and sustainability of the exercise programme via intervention uptake, session adherence, attrition, acceptability and adverse events. Secondary measures included gait speed and the spatio-temporal parameters of gait, handgrip muscle strength and sit to stand performance. Results: Twenty-three residents participated in the exercise intervention (mean (SD) 85.4 (8.1) years, 15 females) and 19 in the control group (87.4 (6.6) years 13 females). Exercise adherence was 79.3%, with 65% of exercise participants attending ≥70% of the sessions; 100% of those originally enrolled completed the programme and strongly agreed with the programme acceptability. Zero exercise-related adverse events were reported. ANCOVA results indicated that post-intervention gait speed significantly increased (p < 0.001) with an 18.8% increase in gait speed (m/s). Discussion: The GrACE + GAIT programme was shown to be feasible and significantly improve adults living in RAC facilities gait speed, handgrip strength and sit to stand performance. These results suggest that the GrACE + GAIT programme is suitable for use in the RAC sector and that it has the potential to reduce disability and improve function and quality of life of the residents

Prevalence, predictors and benefits of resistance training for improving gait speed in aged care

Fien, S ORCiD: 0000-0003-0181-5458Background: Low gait speed is a significant risk factor for many age‐related adverse effects. Relatively little is known about the prevalence and predictors of low gait speed in residential aged care (RAC) and if this can be improved by exercise. Methods: The gait speed of 102 adults residing in 11 RAC facilities in South East Queensland was collected via stopwatch. Another 100 RAC adults had their gait spatiotemporal characteristics analysed by the Gaitmat II pressure mat system in an attempt to better characterise the gait and understand which spatio‐temporal gait parameters predict gait speed. A feasibility trial was also conducted to examine the feasibility and benefits of resistance and balance training to improve gait in RAC. Results: Sarcopenic gait speed prevalence was ˜97% in RAC across the two initial studies. Multivariable linear regression involving all independent secondary spatio‐temporal outcomes identified the following factors (stride length, support base and step time) that predicted walking speed (r2 = 0.89). Stride length was the strongest predictor with each 0.1 m increase in stride length resulting in an average 0.09 (95% CI 0.06–0.13) m/s faster preferred gait speed. Resistance and balance training was found to be highly feasible, and resulted in significant increases in the gait speed of RAC residents. Conclusion: Sarcopenic gait speed is endemic in the RAC setting, with short stride length, wide support base and a long step time predictive of slow gait speed. Resistance and balance training proved feasible and significantly improved gait speed in the RAC setting. Further improvements in gait speed may be obtained by matching the exercise prescription to the strongest predictors of gait speed

Challenges and facilitators in delivering optimal care at the End of Life for older patients: a scoping review on the clinicians’ perspective

The concepts and elements determining quality of care at the End of Life may vary across professional groups but there is consensus that high-quality care at the End of Life is beneficial for the patient, families, health systems and society at large. This scoping review aimed to elucidate gaps in the delivery of this specific type of care in older people from the clinicians’ perspective, and to identify potential solutions to both improve this care and promote work satisfaction by the involved clinicians. Twelve studies published since 2010 with data from 18 countries identified four major gaps: (1) Core clinical competencies; (2) Shared decision-making; (3) Health care system, environmental context, and resources; and (4) Organisational leadership, culture and legislation. Multiple suggestions for staff communications training, multidisciplinary mentoring, and advance care planning alignment with patient wishes were identified. However, a clear picture arose of consistently unmet needs that have been previously highlighted in research for more than a decade. This indicates poor uptake of previous recommendations and highlights the difficulties in changing the service culture to ensure provision of optimal services at the End of Life. Future investigations on the reasons for poor uptake and identification of effective approaches to execute the agreed recommendations are warranted

Impact of COVID-19 social distancing on the quality of dying: A call for discretionary application of rules

During the COVID-19 pandemic the media and the regulators have given limited attention to the impact of social distancing rules on the quality of living and dying, not only for COVID-19 patients, but for anyone who has reached the end of life from natural causes in hospitals and residential aged care facilities (RACFs). Fear for the safety of other patients, visitors, and healthcare clinicians during the pandemic (Gordon et al., 2020), triggered unprecedented isolation practices including limiting staff numbers attending to patients, transitioning to virtual rounds (Arora, Chivu, Schram, & Meltzer, 2020), restricting hours and duration of visiting, isolating patients in ICU at end of life, and enacting policies on numbers of bedside family/caregivers who can accompany terminal patients (Wakam, Montgomery, Biesterveld, & Brown, 2020). In some institutions, nursing staff, and social workers on shift are taking the place of families, providing a compassionate presence to dying patients: others are dying unaccompanied. Unfortunately, these extraordinary circumstances place an immediate and ongoing emotional burden on clinicians and families alike. While it is true that people will eventually adapt and that those of us who lived through the pandemic will recover from the shock and unexpected changes to our lifestyle and clinical practice, many who lost loved ones without a proper farewell due to draconian health service rules will experience prolonged, complicated grief responses, post-traumatic stress (Selman et al., 2020) and separation distress (Gesi et al., 2020). Meanwhile the strict rules have caused clinicians job dissatisfaction, and moral distress (Canadian Medical Association, 2020). The quality of dying has been negatively impacted. The ethical dilemma for clinicians is reconciling the need for compliance with internal policies and the competing need for holistic management of the individual

Clinical importance of assessing walking speed in older adults in general practice

No abstract available

Pumping iron in residential aged adults: why isn't this more commonly available?

No abstract available

Feasibility and benefits of group-based exercise in residential aged care adults: a pilot study for the GrACE programme

The objective of the study was to examine the feasibility and benefits of a group resistance training exercise programme for improving muscle function in institutionalised older adults. A feasibility and acceptability study was designed for a residential aged care (RAC) facility, based on the Gold Coast, Australia. Thirty-seven adults, mean age 86.8 ± 6.1 years (30 females) living in a RAC facility. Participants were allocated into an exercise (n = 20) or control (n = 17) group. The exercise group, the Group Aged Care Exercise (GrACE) programme, performed 12 weeks of twice weekly resistance exercises. Feasibility was measured via recruitment rate, measurement (physiological and surveys) completion rate, loss-to-follow-up, exercise session adherence, adverse events, and ratings of burden and acceptability. Muscle function was assessed using gait speed, sit-to-stand and handgrip strength assessments. All intervention participants completed pre- and post-assessments, and the exercise intervention, with 85% (n = 17) of the group attending ≥ 18 of the 24 sessions and 15% (n = 3) attending all sessions. Acceptability was 100% with exercise participants, and staffwho had been involved with the programme strongly agreed that the participants "Benefited from the programme." There were no adverse events reported by any participants during the exercise sessions. When compared to the control group, the exercise group experienced significant improvements in gait speed (F(4.078) = 8.265, p = 0.007), sit to stand performance (F(3.24) = 11.033, p = 0.002) and handgrip strength (F(3.697) = 26.359, p < 0.001). Resistance training via the GrACE programme is feasible, safe and significantly improves gait speed, sit-to-stand performance and handgrip strength in RAC adults

Clinical importance of assessing walking speed in older adults in general practice

7 ABSTRAKT Univerzita Karlova v Praze, Farmaceutická fakulta v Hradci Králové Katedra biologických a lékařských věd Školitel: PhDr. Zděnka Kudláčková, Ph.D. Kandidát: Mirka Dohnalová Název diplomové práce: Etiopatogeneze selhání ledvin Úvod: Selhání ledvin je stav, který doprovází řadu civilizačních nemocí. Nejčastěji vzniká na podkladě špatně kompenzovaného diabetu mellitu, hypertenze, obezity nebo vlivem nežádoucích účinků některých léků a toxinů. Důležitým opatřením při léčbě renální insuficience je včasná a správně vedená léčba, která přispívá ke snížení rizika možných komplikací. Cíl práce: Cílem práce bylo zhodnotit vliv jednotlivých rizikových faktorů na funkci ledvin. Metody: Data jsme zjišťovali pomocí dotazníkové metody a sběru ze zdravotnické databáze. Závěr: Podle našich výsledků je nejrizikovější skupinou skupina pacientů s vysokým krevním tlakem, zvýšenou hladinou cholesterolu a diabetem mellitem. U těchto pacientů jsme zjistili na základě našich šetření riziko ledvinového selhání. Mezi další příčiny tohoto onemocnění patří také nezdravý životní styl, omezená pohybová aktivita a kouření. Klíčová slova: příčiny, selhání ledvin,8 ABSTRACT Charles University in Prague, Faculty of Pharmacy in Hradec Králové Department of Biological and Medical Studies Supervisor: PhDr. Zděnka Kudláčková, Ph.D. Candidate: Mirka Dohnalová Title of Diploma thesis: Etiopathogensis of Kidney Failure Introduction: A kidney failure is a state that accompanies a number civilization illnesses. This illness arises mostly from badly compensated diabetes mellitus, hypertension, obesity or from the influence of unwanted effects caused by some medicaments and toxins. An important precaution in the treatment of renal insufficiency is well-timed and proper treatment. It contributes to reduce other possible complications. The aim of the thesis: The aim of the thesis was to evaluate effects of individual risk factors on the function of the kidneys. This result has been given by health database. Methods: We collected information using a questionnaire method and collected from a medical database. Conclusion: According to our results, the most risky group is the group of patients with high blood pressure, high cholesterol and diabetes. These patients have a higher risk of renal failure. Other causes of this disease include unhealthy lifestyle, limited physical activity and smoking. Key words: causes, kidney failureKatedra biologických a lékařských vědDepartment of Biological and Medical SciencesFarmaceutická fakulta v Hradci KrálovéFaculty of Pharmacy in Hradec Králov