Projet pilote "Pas de retraite pour ma santé" : évaluation de l'effet sur les participants

"Pas de retraite pour ma santé" est un projet de promotion du mouvement et de l'alimentation favorables à la santé dédié spécifiquement aux seniors. Ce projet mené par les Ligues de la Santé du Canton de Vaud est le fruit d'une collaboration entre le programme cantonal « Ça marche ! », Pro Senectute Vaud, le Service de gériatrie du CHUV et le Service de l'éducation physique et du sport. Le projet s'inscrit dans la politique « Vieillissement et Santé » du canton de Vaud. Il bénéficie également d'un soutien financier de Promotion Santé Suisse. Le projet « Pas de retraite pour ma santé » a été développé avec les objectifs suivants : - susciter une prise de conscience quant à l'importance de bouger plus et manger mieux - (re)donner goût au mouvement aux seniors par les rencontres actives - améliorer leurs capacités physiques globales - favoriser l'intégration sociale et sportive des participants au sein d'un groupe et de la commun

Activité physique et vieillissement : il n'est jamais trop tard!

Cet article propose une démarche pratique permettant à partir d'une évaluation initiale de leur niveau d'activité physique d'informer, de conseiller et de convaincre les personnes âgées sédentaires qui nous consultent des bénéfices à retirer d'une activité physique adaptée pour le maintien de leur indépendance, de leur autonomie et de leur qualité de vie

Physical Behavior in Older Persons during Daily Life: Insights from Instrumented Shoes.

Activity level and gait parameters during daily life are important indicators for clinicians because they can provide critical insights into modifications of mobility and function over time. Wearable activity monitoring has been gaining momentum in daily life health assessment. Consequently, this study seeks to validate an algorithm for the classification of daily life activities and to provide a detailed gait analysis in older adults. A system consisting of an inertial sensor combined with a pressure sensing insole has been developed. Using an algorithm that we previously validated during a semi structured protocol, activities in 10 healthy elderly participants were recorded and compared to a wearable reference system over a 4 h recording period at home. Detailed gait parameters were calculated from inertial sensors. Dynamics of physical behavior were characterized using barcodes that express the measure of behavioral complexity. Activity classification based on the algorithm led to a 93% accuracy in classifying basic activities of daily life, i.e., sitting, standing, and walking. Gait analysis emphasizes the importance of metrics such as foot clearance in daily life assessment. Results also underline that measures of physical behavior and gait performance are complementary, especially since gait parameters were not correlated to complexity. Participants gave positive feedback regarding the use of the instrumented shoes. These results extend previous observations in showing the concurrent validity of the instrumented shoes compared to a body-worn reference system for daily-life physical behavior monitoring in older adults

Bewegung im Alter : Dafür ist es nie zu spät!

Fallvignette : Herr Blanc ist ein 78-jähriger Patient mit Hypertonie, Prostatabeschwerden (ohne Inkontinenz), chronischen Lumbalgien und Arthrose im rechten Knie. Er wird zu seinem halbjährlichen Kontrolltermin vorstellig. Der Patient führt von sich aus an Beschwerden lediglich eine leichte Verstärkung der chronischen Lumbalgien an und dass er sich in den letzten Monaten ein wenig erschöpfter und lustloser fühlt. Er erklärt dies mit dem trüben, kalten Wetter («was für ein verregneter Sommer!»), wodurch er nicht so oft wie gewünscht aus dem Haus kam. Bei diesem Patienten von eher guter Gesundheit könnte die Sprechstunde hier bereits enden, nachdem man ihm vielleicht noch einige Ratschläge gegeben hat, wie er (angesichts seiner Erschöpfung) ein wenig ausspannen kann, und sein Paracetamol-Rezept erneuert wurde. Die Sprechstunde könnte (sollte!) jedoch auch eine Gelegenheit sein, um bei diesem älteren Patienten eine gesundheitliche Situation mit hohem Risiko für funktionellen Abbau zu erkennen und ihn zu motivieren, sich wieder mehr zu bewegen. Dieser Artikel mit praktischem Ansatz soll dazu anregen, wenig aktive ältere Patienten, die sich in unserer Praxis vorstellen, nach einer initialen Erfassung ihres Bewegungsverhaltens zu informieren, zu beraten und sie von den Vorteilen zu überzeugen, die angemessene Bewegung zur Aufrechterhaltung von Selbständigkeit, Autonomie und Lebensqualität leisten kann

Relative and absolute reliability of the clinical version of the Narrow Path Walking Test (NPWT) under single and dual task conditions.

Decline in gait stability has been associated with increased fall risk in older adults. Reliable and clinically feasible methods of gait instability assessment are needed. This study evaluated the relative and absolute reliability and concurrent validity of the testing procedure of the clinical version of the Narrow Path Walking Test (NPWT) under single task (ST) and dual task (DT) conditions. Thirty independent community-dwelling older adults (65-87 years) were tested twice. Participants were instructed to walk within the 6-m narrow path without stepping out. Trial time, number of steps, trial velocity, number of step errors, and number of cognitive task errors were determined. Intraclass correlation coefficients (ICCs) were calculated as indices of agreement, and a graphic approach called "mountain plot" was applied to help interpret the direction and magnitude of disagreements between testing procedures. Smallest detectable change and smallest real difference (SRD) were computed to determine clinically relevant improvement at group and individual levels, respectively. Concurrent validity was assessed using Performance Oriented Mobility Assessment Tool (POMA) and the Short Physical Performance Battery (SPPB). Test-retest agreement (ICC1,2) varied from 0.77 to 0.92 in ST and from 0.78 to 0.92 in DT conditions, with no apparent systematic differences between testing procedures demonstrated by the mountain plot graphs. Smallest detectable change and smallest real change were small for motor task performance and larger for cognitive errors. Significant correlations were observed for trial velocity and trial time with POMA and SPPB. The present results indicate that the NPWT testing procedure is highly reliable and reproducible

Fallers in postacute rehabilitation have worse functional recovery and increased health services use.

OBJECTIVES: To determine characteristics associated with single and multiple fallers during postacute rehabilitation and to investigate the relationship among falls, rehabilitation outcomes, and health services use. DESIGN: Retrospective cohort study. SETTING: Geriatric postacute rehabilitation hospital. PARTICIPANTS: Patients (n = 4026) consecutively admitted over a 5-year period (2003-2007). MEASUREMENTS: All falls during hospitalization were prospectively recorded. Collected patients' characteristics included health, functional, cognitive, and affective status data. Length of stay and discharge destination were retrieved from the administrative database. RESULTS: During rehabilitation stay, 11.4% (458/4026) of patients fell once and an additional 6.3% (253/4026) fell several times. Compared with nonfallers, fallers were older and more frequently men. They were globally frailer, with lower Barthel score and more comorbidities, cognitive impairment, and depressive symptoms. In multivariate analyses, compared with 1-time fallers, multiple fallers were more likely to have lower Barthel score (adjOR: 2.45, 95% CI: 1.48-4.07; P = .001), cognitive impairment (adjOR: 1.43, 95% CI: 1.04-1.96; P = .026), and to have been admitted from a medicine ward (adjOR: 1.55, 95% CI: 1.03-2.32; P = .035). Odds of poor functional recovery and institutionalization at discharge, as well as length of stay, increased incrementally from nonfallers to 1-time and to multiple fallers. CONCLUSION: In these patients admitted to postacute rehabilitation, the proportion of fallers and multiple fallers was high. Multiple fallers were particularly at risk of poor functional recovery and increased health services use. Specific fall prevention programs targeting high-risk patients with cognitive impairment and low functional status should be developed in further studies

Instrumented shoes for activity classification in the elderly.

Quantifying daily physical activity in older adults can provide relevant monitoring and diagnostic information about risk of fall and frailty. In this study, we introduce instrumented shoes capable of recording movement and foot loading data unobtrusively throughout the day. Recorded data were used to devise an activity classification algorithm. Ten elderly persons wore the instrumented shoe system consisting of insoles inside the shoes and inertial measurement units on the shoes, and performed a series of activities of daily life as part of a semi-structured protocol. We hypothesized that foot loading, orientation, and elevation can be used to classify postural transitions, locomotion, and walking type. Additional sensors worn at the right thigh and the trunk were used as reference, along with an event marker. An activity classification algorithm was built based on a decision tree that incorporates rules inspired from movement biomechanics. The algorithm revealed excellent performance with respect to the reference system with an overall accuracy of 97% across all activities. The algorithm was also capable of recognizing all postural transitions and locomotion periods with elevation changes. Furthermore, the algorithm proved to be robust against small changes of tuning parameters. This instrumented shoe system is suitable for daily activity monitoring in elderly persons and can additionally provide gait parameters, which, combined with activity parameters, can supply useful clinical information regarding the mobility of elderly persons

Predictors of functional recovery in patients admitted to geriatric postacute rehabilitation.

OBJECTIVE: To examine characteristics associated with functional recovery in older patients undergoing postacute rehabilitation. DESIGN: Observational study. SETTING: Postacute rehabilitation facility. PARTICIPANTS: Patients (N=2754) aged ≥65 years admitted over a 4-year period. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Functional status was assessed at admission and again at discharge. Functional recovery was defined as achieving at least 30% improvement on the Barthel Index score from admission compared with the maximum possible room for improvement. RESULTS: Patients who achieved functional recovery (70.3%) were younger and were more likely to be women, live alone, and be without any formal home care before admission, and they had fewer chronic diseases (all P<.01). They also had better cognitive status and a higher Barthel Index score both at admission (mean ± SD, 63.3±18.0 vs 59.6±24.7) and at discharge (mean ± SD, 86.8±10.4 vs 62.2±22.9) (all P<.001). In multivariate analysis, patients <75 years of age (adjusted odds ratio [OR]=1.51; 95% confidence interval [CI], 1.16-1.98; P=.003), women (adjusted OR=1.24; 95% CI, 1.01-1.52; P=.045), patients living alone (adjusted OR=1.61; 95% CI, 1.31-1.98; P<.001), and patients without in-home help prior to admission (adjusted OR=1.39; 95% CI, 1.15-1.69; P=.001) remained at increased odds of functional recovery. In addition, compared with those with moderate-to-severe cognitive impairment (Mini-Mental State Examination score <18), patients with mild-to-moderate impairment (Mini-Mental State Examination score 19-23) and those cognitively intact also had increased odds of functional recovery (adjusted OR=1.56; 95% CI, 1.13-2.15; P=.007; adjusted OR=2.21; 95% CI, 1.67-2.93; P<.001, respectively). CONCLUSIONS: Apart from sociodemographic characteristics, cognition is the strongest factor that identifies older patients more likely to improve during postacute rehabilitation. Further study needs to determine how to best adapt rehabilitation processes to better meet the specific needs of this population and optimize their outcome

Instrumented shoes for activity classification in the elderly

Quantifying daily physical activity in older adults can provide relevant monitoring and diagnostic information about risk of fall and frailty. In this study, we introduce instrumented shoes capable of recording movement and foot loading data unobtrusively throughout the day. Recorded data were used to devise an activity classification algorithm. Ten elderly persons wore the instrumented shoe system consisting of insoles inside the shoes and inertial measurement units on the shoes, and performed a series of activities of daily life as part of a semi-structured protocol. We hypothesized that foot loading, orientation, and elevation can be used to classify postural transitions, locomotion, and walking type. Additional sensors worn at the right thigh and the trunk were used as reference, along with an event marker. An activity classification algorithm was built based on a decision tree that incorporates rules inspired from movement biomechanics. The algorithm revealed excellent performance with respect to the reference system with an overall accuracy of 97% across all activities. The algorithm was also capable of recognizing all postural transitions and locomotion periods with elevation changes. Furthermore, the algorithm proved to be robust against small changes of tuning parameters. This instrumented shoe system is suitable for daily activity monitoring in elderly persons and can additionally provide gait parameters, which, combined with activity parameters, can supply useful clinical information regarding the mobility of elderly persons. (C) 2015 Elsevier B.V. All rights reserved