R ates and factors associated with falls in older European Americans, Afro-Caribbeans, African-Americans, and Hispanics

Purpose: To evaluate rates and factors associated with older adult falls in different ethnic groups. Participants and methods: Information on demographics, medical and falls history, and pain and physical activity levels was collected from 550 community-dwelling older adults (75±9 years old, 222 European Americans, 109 Afro-Caribbeans, 106 African-Americans, and 113 Hispanics). Results: Taking medications for anxiety (risk ratio [RR] =1.4, 95% confidence interval [CI] =1.1–2.0), having incontinence (RR =1.4, 95% CI =1.1–1.8, P=0.013), back pain (RR =1.4, 95% CI =1.0–1.8), feet swelling (RR =1.3, 95% CI =1.1–1.7), and age $75 years (RR =1.3, 95$75 years were associated with falls, and Afro-Caribbeans presented lower prevalence of falls. These findings need to be taken into consideration in clinical interventions in aging. Keywords: ethnicity, falls, risks, community dwelling, older adult

Sustaining or declining physical activity: Reports from an ethnically diverse sample of older adults

Over 80% of adults in the US fail to meet the ≥150 min weekly physical activity guideline; 40% age ≥ 75 are entirely inactive. The study purpose was to understand the reasons why community-dwelling older adults (age ≥ 60) from diverse backgrounds increase, sustain, or decline in their physical activity levels over time. Sixty-two older adults were interviewed. Two-thirds of the African Americans, 57% of the Afro-Caribbeans, and 50% of the European Americans reported being less active than 2–3 years ago. Reasons for activity decline included health issues (e.g., pain, shortness of breath), lack of time, interest, or motivation. Reasons for sustaining or increasing activity levels included meeting personal goals, having a purpose for remaining active, or feeling better when active (e.g., it is important to keep moving, good for the joints, going on a cruise). Themes identified were pride in maintaining activity, goal-driven activity, pushing oneself to get past pain or fatigue, and some confusion between social and physical activity in participant reports. The results indicate widespread acceptance that activity is beneficial, but that knowledge alone was insufficient to maintain activity levels over time unless individuals had a goal or purpose (“means to an end”) and could overcome their physical and psychological barriers to physical activity

Muscular fitness and work ability among physical therapists

The Work Ability Index (WAI) is a validated and widely used tool in occupational re-search. However, normative values for physical therapists (PTs) by age and sex are lacking. Alt-hough the nature of PTs’ work is physically demanding, it is unknown whether muscular fitness is associated with their WAI. This study sought to provide reference WAI data for Spanish PTs and to evaluate the association between PTs’ muscular fitness and WAI. Data on WAI of 1005 PTs were collected using a questionnaire. A subgroup (n = 68) performed a battery of physical tests including grip strength, push-ups and back-extension endurance. Associations between muscular fitness and WAI were evaluated using logistic regression controlling for various confounders. PTs aged 50 years or older had lower WAI scores than their younger counterparts. PTs with high back-extension endurance scored 3.5 (95% CI) higher in the WAI than those with low endurance. No associations were found between grip strength or number of push-ups and WAI. Our findings seem to highlight the importance of muscular fitness in PTs, especially the back-extension endurance

PredictMed: A logistic regression–based model to predict health conditions in cerebral palsy:

Logistic regression–based predictive models are widely used in the healthcare field but just recently are used to predict comorbidities in children with cerebral palsy. This article presents a logistic regression approach to predict health conditions in children with cerebral palsy and a few examples from recent research. The model named PredictMed was trained, tested, and validated for predicting the development of scoliosis, intellectual disabilities, autistic features, and in the present study, feeding disorders needing gastrostomy. This was a multinational, cross-sectional descriptive study. Data of 130 children (aged 12–18 years) with cerebral palsy were collected between June 2005 and June 2015. The logistic regression–based model uses an algorithm implemented in R programming language. After splitting the patients in training and testing sets, logistic regressions are performed on every possible subset (tuple) of independent variables. The tuple that shows the best predictive performance in terms of accuracy, sensitivity, and specificity is chosen as a set of independent variables in another logistic regression to calculate the probability to develop the specific health condition (e.g. the need for gastrostomy). The average of accuracy, sensitivity, and specificity score was 90%. Our model represents a novelty in the field of some cerebral palsy–related health outcomes treatment, and it should significantly help doctors' decision-making process regarding patient prognosis

Can falls risk prediction tools correctly identify fall-prone elderly rehabilitation inpatients? A systematic review and meta-analysis

Background Falls of elderly people may cause permanent disability or death. Particularly susceptible are elderly patients in rehabilitation hospitals. We systematically reviewed the literature to identify falls prediction tools available for assessing elderly inpatients in rehabilitation hospitals. Methods and Findings We searched six electronic databases using comprehensive search strategies developed for each database. Estimates of sensitivity and specificity were plotted in ROC space graphs and pooled across studies. Our search identified three studies which assessed the prediction properties of falls prediction tools in a total of 754 elderly inpatients in rehabilitation hospitals. Only the STRATIFY tool was assessed in all three studies; the other identified tools (PJC-FRAT and DOWNTON) were assessed by a single study. For a STRATIFY cut-score of two, pooled sensitivity was 73% (95%CI 63 to 81%) and pooled specificity was 42% (95%CI 34 to 51%). An indirect comparison of the tools across studies indicated that the DOWNTON tool has the highest sensitivity (92%), while the PJC-FRAT offers the best balance between sensitivity and specificity (73% and 75%, respectively). All studies presented major methodological limitations. Conclusions We did not identify any tool which had an optimal balance between sensitivity and specificity, or which were clearly better than a simple clinical judgment of risk of falling. The limited number of identified studies with major methodological limitations impairs sound conclusions on the usefulness of falls risk prediction tools in geriatric rehabilitation hospitals

Sedentary behaviour among older adults residing in flat and hilly neighbourhoods and its association with frailty and chronic disease status

Background Living in hilly neighbourhoods can be associated with sedentary behaviour, but no study has compared sedentary behaviour and its associations with frailty, chronic diseases, and poor health between flat and hilly neighbourhoods among older adults. This study, therefore, compared older adults’ sedentary behaviour and its association with frailty, poor health, and chronic disease status between low and hilly neighbourhoods. Methods This study utilised a STROBE-compliant cross-sectional design with sensitivity analyses and a common methods bias assessment. The participants were 1,209 people aged 50+ years who resided in flat (Ablekuma North, n = 704) and hilly (Kwahu East, n = 505) neighbourhoods in Ghana. The data were analysed with the independent samples t-test and hierarchical linear regression. Results Older adults in the hilly neighbourhood were more sedentary than those in the flat neighbourhood. The association between sedentary behaviour and chronic disease status was significant in both neighbourhoods, but this relationship was stronger in the hilly neighbourhood. Older adults in the flat neighbourhood reported lower sedentary behaviour at higher frailty (β = -0.18; t = -3.2, p < 0.001), but those in the hilly neighbourhood reported higher sedentary behaviour at higher frailty (β = 0.16; t = 3.54, p < 0.001). Conclusions Older adults living in the hilly neighbourhood reported higher sedentary behaviour. In the hilly neighbourhood, sedentary behaviour was more strongly associated with frailty and chronic disease status. Older adults in hilly neighbourhoods may need extra support to avoid sedentary behaviour

Intergenerational differences in walking for transportation between older men and women in six countries

Background – Research on potential differences in walking between men and women have mixed and inconclusive results, and no study has examined differences in walking between men and women across multiple countries and generations (i.e., young-old, old-old, and oldest-old). This study aims to compare older men and women walking for transportation across three generations and among six countries (i.e., China, Mexico, Russia, South Africa, Ghana, and India). Methods – This study adopted the cross-sectional design that utilised data from the World Health Organization Study on AGEing and Adult Health (SAGE – wave one). The sample included 12,125 older adults aged 60-114 years from the six countries. The participants were selected with a cluster random sampling method in each country. The data was analysed using three-way Analysis of Variance (ANOVA). Results – There were significant differences in walking for transportation among countries. In only South Africa there was a significant difference in walking between men and women, as well as among the three older generations. South African men reported more walking than South African women, and younger-old South Africans reported more walking than older-old and the oldest South Africans. Conclusions – There are differences in older adult walking for transportation among countries. Differences in walking between men and women and among the three generations were only significant in South Africa

Sedentary behaviour among older adults residing in fat and hilly neighbourhoods and its association with frailty and chronic disease status

Background: Living in hilly neighbourhoods can be associated with sedentary behaviour, but no study has compared sedentary behaviour and its associations with frailty, chronic diseases, and poor health between flat and hilly neighbourhoods among older adults. This study, therefore, compared older adults' sedentary behaviour and its association with frailty, poor health, and chronic disease status between low and hilly neighbourhoods. Methods: This study utilised a STROBE-compliant cross-sectional design with sensitivity analyses and a common methods bias assessment. The participants were 1,209 people aged 50 + years who resided in flat (Ablekuma North, n = 704) and hilly (Kwahu East, n = 505) neighbourhoods in Ghana. The data were analysed with the independent samples t-test and hierarchical linear regression. Results: Older adults in the hilly neighbourhood were more sedentary than those in the flat neighbourhood. The association between sedentary behaviour and chronic disease status was significant in both neighbourhoods, but this relationship was stronger in the hilly neighbourhood. Older adults in the flat neighbourhood reported lower sedentary behaviour at higher frailty (β =-0.18; t =-3.2, p < 0.001), but those in the hilly neighbourhood reported higher sedentary behaviour at higher frailty (β = 0.16; t = 3.54, p < 0.001). Conclusions: Older adults living in the hilly neighbourhood reported higher sedentary behaviour. In the hilly neighbourhood , sedentary behaviour was more strongly associated with frailty and chronic disease status. Older adults in hilly neighbourhoods may need extra support to avoid sedentary behaviour

Prescrição de exercícios físicos para populações especiais: experiências em disciplina de tópicos especiais online para pós-graduação stricto sensu

OBJECTIVE: Contextualize and report experiences with the course “Physical exercise prescription for special populations”, delivered online to students of a stricto sensu graduate program.METHODS: The 60-hour course (4 credits) had 18 Physical Education (PE) and one Physiotherapy professionals. Six live online modules were performed for 3 hours each (immersion) with the remaining time distributed in dispersion activities (i.e., searches, readings, reports). During the teaching-learning process, approximately 10 articles were requested to be read, two assays and a final product to be produced, which should be disseminated through a knowledge translation action (social networks, UBS, academia). The program of the discipline was based on the sub-topics: 1) contextualization of special populations and the role of the PE professional; 2) training to work with special populations; 3) evidence-based physical activity; 4) exercise is medicine; 5) components for exercise prescription and; 6) connection science and practice through knowledge translation/implementation science.RESULTS: The contextualization of special populations, the education and training of PE professionals within the scope of exercise prescription for special populations with a focus on an action of knowledge translation allowed the elaboration and dissemination of physical exercise recommendations on social networks, gyms and UBS. This process provided students with active learning and experimentation on how the results of a graduate course can be immediately converted into information for society, whether for the general population or for academic training to work with special populations.CONCLUSION: It is expected that this report will provide a continued discussion about the role of PE professionals in the field of physical exercise prescription for special populations and improve science application in professional practice.OBJETIVO: Contextualizar e relatar experiências com a disciplina “Prescrição de exercícios físicos para populações especiais”, ministrada online para alunos de um programa de pós-graduação stricto sensu. MÉTODOS: A disciplina de 60h contou com 18 profissionais de Educação Física (EF) e um de Fisioterapia. Foram realizados 6 módulos ao vivo com duração de 4 horas (imersão) com o restante do tempo distribuído em atividades de dispersão (i.e., buscas, leituras, relatórios). Durante o processo de ensino-aprendizagem foi solicitada a leitura de aproximadamente 10 artigos, a realização de dois trabalhos e um produto final que deveria ser divulgado através de uma ação de knowledge translation (redes sociais, Unidades Básicas de Saúde - UBS, academias). O programa da disciplina foi ancorado nos subtópicos: 1) contextualização de populações especiais e a atuação do profissional de EF; 2) formação para atuação com populações especiais; 3) atividade física baseada em evidências; 4) exercício é remédio; 5) componentes para prescrição de exercícios e; 6) conexão ciência e prática por meio do knowledge translation/implementation science. RESULTADOS: A contextualização de populações especiais, a atuação e a formação do profissional de EF no âmbito da prescrição de exercícios para populações especiais com foco em uma ação de knowledge translation permitiram a elaboração e divulgação de recomendações de exercícios físicos em redes sociais, academias e UBS. Este processo propiciou aos alunos aprendizagem ativa e experimentação de como os resultados de uma disciplina de pós-graduação podem imediatamente ser convertidos em informação para a sociedade, seja para população geral ou para formação acadêmica para atuação com populações especiais. CONCLUSÃO: Espera-se que esse relato propicie a discussão continuada sobre a atuação do profissional de EF no campo da prescrição de exercícios físicos para populações especiais e maior aproximação de ciência na prática profissional