Disentangling the relationship between falls, fear of falling, physical function and walking by applying a socioecological framework to the International Mobility in Aging Study

Introduction:The relationships between falls, fear of falling, poor mobility, and PA avoidance occur in a cyclic, multi-directional fashion. Aim: This study investigates the concomitant associations of fall history, fear of falling, and physical performance (SPPB) on physical activity using a cross-national sample of community-dwelling older adults from middle and high-income countries.Methods:Linear mixed-effects models looking at the influence of individual and environmental factors were used and participants were nested within each study site.Results:Estimated walking minutes was 52% lower for those with low SPPB compared to high SPPB, 20% lower for those with medium level fear of falling compared to low levels, and 50% lower for those with high level fear of falling compared to low levels.Conclusion:An individual’s fear of falling and physical performance may be important to consider when making PA recommendations to older adults regardless of sex, age, and environment

Childhood adversity and leisure time physical and sports activity in older adults: A cross-sectional analysis from the International Mobility in Aging Study

Aim: The purpose is to examine the relationship between childhood adversity and leisure time physical activity (LTPA) among community-dwelling older adults from high and middle-income sites. Methods: Cross-sectional analysis of 2012 data from older adult ages 64-75 years old from King-ston, Canada; St. Hyacinthe, Canada; Tirana, Albania; Manizales, Colombia; and Natal, Brazil. Principal exposure variables were childhood social and economic adversity. Covariates included participant age, sex, income, and educational attainment. Outcome variables were LTPA and lei-sure time sports activity (LTSA). Results: High-income sites had higher LTPA prevalence than middle-income sites. Females were less likely to engage in LTPA compared to males in Tirana (OR:0.53, 95%CI:0.30-0.94), but were more likely to engage in LTPA in Manizales (OR:2.54, 95%CI:1.54-4.18). Low education was less likely than high education to engage in LTPA in Kingston (OR:0.38, 95%CI:0.19-0.73) and Natal (OR: 0.52, 95%CI:0.28-0.97). Low income was less likely than high income to engage in LTPA in St. Hyacinthe (OR: 0.42, 95%CI:0.20-0.89) and Manizales (OR:0.33, 95%CI:0.16-0.55). In Tirana, low income was more likely than high income to engage in LTPA (OR:5.27, 95%CI:2.06-13.51). Conclusions: Childhood economic and social adversity were not significantly associated with LTPA. Sex, income, and education were associated with older adult PA engagement, however the direction of the association varied by site location. This suggests that the paradigms surrounding PA behavior may vary from city to city. Understanding the site-specific risk factors to PA engage-ment may better inform clinical recommendations and public health approaches to increase PA engagement among older adults across the globe

Trajectories of frailty with aging:Coordinated analysis of five longitudinal studies

BACKGROUND AND OBJECTIVES: There is an urgent need to better understand frailty and its predisposing factors. Although numerous cross-sectional studies have identified various risk and protective factors of frailty, there is a limited understanding of longitudinal frailty progression. Furthermore, discrepancies in the methodologies of these studies hamper comparability of results. Here, we use a coordinated analytical approach in 5 independent cohorts to evaluate longitudinal trajectories of frailty and the effect of 3 previously identified critical risk factors: sex, age, and education. RESEARCH DESIGN AND METHODS: We derived a frailty index (FI) for 5 cohorts based on the accumulation of deficits approach. Four linear and quadratic growth curve models were fit in each cohort independently. Models were adjusted for sex/gender, age, years of education, and a sex/gender-by-age interaction term. RESULTS: Models describing linear progression of frailty best fit the data. Annual increases in FI ranged from 0.002 in the Invecchiare in Chianti cohort to 0.009 in the Longitudinal Aging Study Amsterdam (LASA). Women had consistently higher levels of frailty than men in all cohorts, ranging from an increase in the mean FI in women from 0.014 in the Health and Retirement Study cohort to 0.046 in the LASA cohort. However, the associations between sex/gender and rate of frailty progression were mixed. There was significant heterogeneity in within-person trajectories of frailty about the mean curves. DISCUSSION AND IMPLICATIONS: Our findings of linear longitudinal increases in frailty highlight important avenues for future research. Specifically, we encourage further research to identify potential effect modifiers or groups that would benefit from targeted or personalized interventions

Hip fracture rehabilitation: where are we now and where are we going?

Hip fracture is a major public health problem in many developed nations. An estimated 30,000 hip fractures occur each year in Canada. To initiate adequate preventive measures, a thorough understanding of hip fracture patients' characteristics and the healthcare services they receive over the continuum of care is warranted. The global objective of this thesis is to contribute to our knowledge base concerning current and future needs, gaps, and solutions to provide optimal care for people with hip fractures.The first part describes the recovery process of patients with hip fractures and its definition. A post acute cohort was followed up to a one year after fracture and the patients' course of recovery was characterized using two methods to define recovery. This study demonstrated that the degree and time course of functional recovery after hip fracture varied on the basis of definition and the pre-fracture functional status. Despite the initial improvement, the functional status of the patients declined following cessation of rehabilitation services.Studying hip fracture patients' care and recovery at a single site over a limited time led to investigating the characteristics of the broader hip fracture population in the province of Quebec. What do we know about hip fracture trends, changes in health profile, and what might this information mean for the future? This guided the author to use an administrative database (Med-Echo) to answer these questions. The results confirmed the hypothesis that the hip fracture population is becoming frailer, which will increase the resources needed, and that the population's health profile differed on the basis of age and sex.The inside-hospital mortality rate and the proportion of patients who are discharged to rehabilitation after fracture are declining over time; consequently, increases the demand on community services. Finding the gaps and describing the needs is the first step to improve the quality of care, but this is not adequate. Therefore, the last part proposes potential solutions. A systematic review aimed at finding solutions to the previously identified gaps, specifically, the fact that hip fracture patients' functional status deteriorates following cessation of rehabilitation and that the need for community rehabilitation services will increase. Therefore, the reported effect in the literature of an extended exercise rehabilitation program was reviewed and quantified. This meta-analysis is the first to show that a clinically significant functional improvement can be gained later than is usually believed with elderly hip fracture patients. Such an improvement suggests that there is no 'plateau' for recovery. Finally, the methodology to evaluate and create a comprehensive program to serve hip fracture patients over the continuum of care is discussed and a simulated multidisciplinary program is proposed as a model.La fracture de la hanche est un problème de santé publique majeur dans de nombreux pays développés. Environ 30 000 fractures de la hanche surviennent chaque année au Canada. Afin d'initier des mesures préventives adéquates, il est nécessaire d'avoir une compréhension approfondie des caractéristiques des cas de fracture de la hanche et des services que les patients reçoivent dans le continuum des soins. L'objectif global de cette thèse est de contribuer à la base de connaissances des besoins actuels et futurs, des lacunes, et des solutions permettant d'offrir des soins optimaux aux personnes ayant souffert de fracture de la hanche. La première partie définit et décrit le processus de rétablissement des patients ayant subit une fracture de la hanche. Une cohorte post soins aiguës a été suivie pendant un an suivant la fracture et le processus de guérison du patient a été étudié en utilisant deux différentes façons de définir le rétablissement. Cette étude a démontré que le degré et le temps de récupération fonctionnelle après fracture de la hanche varient sur la base de la définition du rétablissement choisie et de l'état fonctionnel avant la fracture. Malgré l'amélioration initiale, l'état fonctionnel des patients a diminué suivant l'arrêt des soins de réadaptation. L'étude des soins et du rétablissement des patients ayant une fracture de la hanche dans un seul site pendant un temps limité a mené à examen des caractéristiques de la population souffrant d'une fracture de la hanche dans la province de Québec. Que savons-nous sur les tendances des fractures de la hanche, sur les changements dans le profil de la santé, et qu'est-ce que cette information pourrait signifier pour l'avenir? Ceci a conduit l'auteur à utiliser une base de données administrative (Med-Echo) pour répondre à ces questions. Les résultats ont confirmé l'hypothèse selon laquelle la population de patients ayant une fracture de la hanche devient de plus en plus fragile, ce qui nécessitera une augmentation des ressources. De plus, le profil de santé de cette population comparée à celle la population générale diffère sur les critères de l'âge et du sexe.Le taux de mortalité pendant l'hospitalisation suivant une fracture de hanche est en déclin ainsi que la proportion des patients envoyés en réadaptation à leur congé. Cela a comme conséquence d'augmenter de la demande de services en communauté. Rechercher les lacunes et décrire les besoins constituent une première étape vers l'amélioration de la qualité des soins, mais elle demeure insuffisante. Le but de la dernière partie est de proposer des solutions potentielles. Un examen systématique de la littérature a été mené dans le but de trouver des solutions aux lacunes identifiées précédemment, en particulier, le fait que l'état fonctionnel des patients ayant subit une fracture de la hanche se détériore après l'arrêt de la réadaptation et la nécessité d'augmenter les services de réadaptation communautaires. L'effet rapporté dans la littérature d'un programme d'exercices de réadaptation prolongée a été examiné et quantifié. Cette méta-analyse est la première à démontrer qu'une amélioration cliniquement significative du fonctionnement peut être acquise plus tard qu'on ne le croyait chez les personnes âgées ayant souffert d'une fracture de la hanche. Une telle amélioration suggère qu'il n'y a pas de «plateau» pour la récupération. Enfin, la méthodologie pour évaluer et créer un programme complet visant à servir les patients suivant une fracture de la hanche au cours du continuum des soins est discutée et un programme de simulation multidisciplinaire est proposé en tant que modèle

Effects of Aerobic Training on Brain Plasticity in Patients with Mild Cognitive Impairment: A Systematic Review of Randomized Controlled Trials

The purpose of this study was to systematically review to find if aerobic exercise compared to no exercise or any other intervention affects brain plasticity among people with mild cognitive impairment (MCI). Searches were conducted in the Scopus, SciELO, PubMed, Web of Science, Science Direct, and Google Scholar databases. The included studies were randomized control trials (RCTs) written in English comprising individuals with MCI that evaluated the effects of aerobic training on brain-derived neurotrophic factor (BDNF), brain structures, or brain activity. The quality of trials was evaluated using the PEDro scale for RCTs. Twelve studies with medium to high quality were included, of which five studies focused on brain-derived neurotrophic factor (four articles reported elevation and one article reported no changes in BDNF levels following the aerobic exercise), two studies focused on brain structures (both reported increases in hippocampus volume following the aerobic exercise), and five studies focused on brain activity (four articles reported positive changes, and one article reported no changes in brain activity following the aerobic exercise). Research regarding the effects of aerobic training on brain plasticity in people with MCI is in its infancy. Still, aerobic exercise seems to be a promising therapy in people with MCI

“I can’t imagine having to do it on your own”: a qualitative study on postoperative transitions in care from the perspectives of older adults with frailty

Abstract Background Adults aged 65 and older have surgery more often than younger people and often live with frailty. The postoperative transition in care from hospital to home after surgey is a challenging time for older adults with frailty as they often experience negative outcomes. Improving postoperative transitions in care for older adults with frailty is a priority. However, little knowledge from the perspective of older adults with frailty is available to support meaningful improvements in postoperative transitions in care. Objective To explore what is important to older adults with frailty during a postoperative transition in care. Methods This qualitative study used an interpretive description methodology. Twelve adults aged ≥ 65 years with frailty (Clinical Frailty Scale score ≥ 4) who had an inpatient elective surgery and could speak in English participated in a telephone-based, semi-structured interview. Audio files were transcribed and analyzed using thematic analysis. Results Five themes were constructed: 1) valuing going home after surgery; 2) feeling empowered through knowledge and resources; 3) focusing on medical and functional recovery; 4) informal caregivers and family members play multiple integral roles; and 5) feeling supported by healthcare providers through continuity of care. Each theme had 3 sub-themes. Conclusion Future programs should focus on supporting patients to return home by empowering patients with resources and clear communication, ensuring continuity of care, creating access to homecare and virtual support, focusing on functional and medical recovery, and recognizing the invaluable role of informal caregivers

Does Pain in Individuals with Multiple Sclerosis Affect Employment? A Systematic Review and Meta-Analysis

BACKGROUND: Individuals with multiple sclerosis (MS) experience some of the highest unemployment rates among all groups of chronic illnesses. Pain has been found to be a common reason for sick leave or early retirement in healthy populations or other groups with chronic illness; however, there is little awareness regarding the effect of pain on the work status of individuals with MS

Life-course social and economic circumstances, gender, and resilience in older adults: The longitudinal International Mobility in Aging Study (IMIAS)

Although early socioeconomic adversity is associated with poorer function and health in adulthood, those who are able to adapt positively to such risks and threats develop a resilience that may ameliorate harm. Predictors of resilience have been examined in children, however exploring the relationship between life-course events, lived environments and current resilience among older adults across countries is novel. We specifically studied how childhood social and/or economic adversity and current socioeconomic resources were associated with resilience in 2000 community dwelling older men and women in Canada, Colombia, Brazil and Albania. The longitudinal International Mobility in Aging Study (IMIAS) collected information in 2012 and 2014 on childhood adversity, current income sufficiency social support and social engagement, and resilience (Wagnild Resilience Scale RS-14). Resilience levels were moderately high, and similar among women and men. Early social adversity predicted later resilience for some, with women but not men adapting positively. In contrast there was no bouncing back from early economic adversity. Current social engagement aligned with resilience (women only) as did social support from children (for women) and friends (for men). Partner support was of no advantage to either. Among men economic circumstances were stronger correlates of resilience while for women social circumstances were primary. The impact of site on resilience suggested that cultural norms and values have an independent effect on resilience of their populations, with strong and positive social ties more typical of Latin America than Canada appearing to offset lower absolute incomes. These findings are of importance because resilience is dynamic, can be fostered across the lifespan and is generally associated with greater health. Understanding which social assets and resources can be reinforced to build individual resilience offers a means for decreasing the harms of social and economic adversity. Keywords: Aging, Resilience, Adversity, Sex differences, Social engagement, Social support, Adverse childhood experiences, Incom

Gender Roles and Physical Function in Older Adults: Cross-Sectional Analysis of the International Mobility in Aging Study (IMIAS).

OBJECTIVES:To examine the relationships between physical function and gender-stereotyped traits and whether these relationships are modified by sex or social context. METHODS:A total of 1995 community-dwelling older adults from the International Mobility in Aging Study (IMIAS) aged 65 to 74 years were recruited in Natal (Brazil), Manizales (Colombia), Tirana (Albania), Kingston (Ontario, Canada), and Saint-Hyacinthe (Quebec, Canada). We performed a cross-sectional analysis. Study outcomes were mobility disability, defined as having difficulty in walking 400 meters without assistance or climbing a flight of stairs without resting, and low physical performance, defined as a score < 8 on the Short Physical Performance Battery. The 12-item Bem Sex Role Inventory (BSRI) was used to classify participants into four gender roles (Masculine, Feminine, Androgynous, and Undifferentiated) using site-specific medians of femininity and masculinity as cut-off points. Poisson regression models were used to estimate prevalence rate ratios (PRR) of mobility disability and poor physical performance according to gender roles. RESULTS:In models adjusted for sex, marital status, education, income, and research site, when comparing to the androgynous role, we found higher prevalence of mobility disability and poor physical performance among participants endorsing the feminine role (PRR = 1.20, 95% confidence interval (CI) 1.03-1.39 and PRR = 1.37, CI 1.01-1.88, respectively) or the undifferentiated role (PRR = 1.23, 95% CI 1.07-1.42 and PRR = 1.58, CI 1.18-2.12, respectively). Participants classified as masculine did not differ from androgynous participants in prevalence rates of mobility disability or low physical performance. None of the multiplicative interactions by sex and research site were significant. CONCLUSION:Feminine and undifferentiated gender roles are independent risk factors for mobility disability and low physical performance in older adults. Longitudinal research is needed to assess the mediation pathways through which gender-stereotyped traits influence functional limitations and to investigate the longitudinal nature of these relationships

Childhood adversity and leisure time physical and sports activity in older adults: A cross-sectional analysis from the International Mobility in Aging Study

Aim: The purpose is to examine the relationship between childhood adversity and leisure time physical activity (LTPA) among community-dwelling older adults from high and middle-income sites. Methods: Cross-sectional analysis of 2012 data from older adult ages 64-75 years old from King-ston, Canada; St. Hyacinthe, Canada; Tirana, Albania; Manizales, Colombia; and Natal, Brazil. Principal exposure variables were childhood social and economic adversity. Covariates included participant age, sex, income, and educational attainment. Outcome variables were LTPA and lei-sure time sports activity (LTSA). Results: High-income sites had higher LTPA prevalence than middle-income sites. Females were less likely to engage in LTPA compared to males in Tirana (OR:0.53, 95%CI:0.30-0.94), but were more likely to engage in LTPA in Manizales (OR:2.54, 95%CI:1.54-4.18). Low education was less likely than high education to engage in LTPA in Kingston (OR:0.38, 95%CI:0.19-0.73) and Natal (OR: 0.52, 95%CI:0.28-0.97). Low income was less likely than high income to engage in LTPA in St. Hyacinthe (OR: 0.42, 95%CI:0.20-0.89) and Manizales (OR:0.33, 95%CI:0.16-0.55). In Tirana, low income was more likely than high income to engage in LTPA (OR:5.27, 95%CI:2.06-13.51). Conclusions: Childhood economic and social adversity were not significantly associated with LTPA. Sex, income, and education were associated with older adult PA engagement, however the direction of the association varied by site location. This suggests that the paradigms surrounding PA behavior may vary from city to city. Understanding the site-specific risk factors to PA engage-ment may better inform clinical recommendations and public health approaches to increase PA engagement among older adults across the globe. Conflicts of interest: None declared