Falling Head Over Heels: Investigating the higher-level cognitive and electrophysiological processes underlying gait control and falls in older adults and stroke survivors

Falls are a common problem for Ireland’s older adults and stroke survivors, which have severe consequences for the individual and high care costs for the state. Current clinical interventions that focus solely on musculoskeletal function are not evidenced to be consistently effective in the long term, or in those older adults without muscle and bone impairments (Cadore, Rodríguez-Mañas, Sinclair, & Izquierdo, 2013; Teasell, McRae, Foley, & Bhardwaj, 2002). The role of cognition in gait control and falls has become increasingly apparent, with higher-level executive functions exhibiting a clear relationship with falls and cognitive decline with ageing (Morris, Lord, Bunce, Burn, & Rochester, 2016). This research aims to address a gap in the literature by identifying the specific higher-level executive processes that play a role in gait control, and examining if these processes are impaired in older adults and stroke survivors with a high risk of falling. Behavioural and electrophysiological measures were used to examine walking gait in both single- and dual-task conditions, as well as cognitive performances and the associated event-related potentials in healthy young and older adult “fallers” and “non-fallers”, and also in a sample of stroke survivors. The results suggest that executive top-down processes (working memory in particular), play a role in gait control during dual-task walking generally, and that executive processes are relied upon more in older age. This work suggests that there may also be neural markers of “successful” ageing that differentiate fallers from non-fallers, and that there can be substantial recovery of both cognition and gait post-stroke. These findings support the resource capacity and compensatory theories of neurocognitive ageing, and suggest that executive neuropsychological tasks could be developed to offer alternative cognitive/neural fall screening assessments and rehabilitation programmes for stroke patients and the wider older adult population

Falling Head Over Heels: Investigating the higher-level cognitive and electrophysiological processes underlying gait control and falls in older adults and stroke survivors

Falls are a common problem for Ireland’s older adults and stroke survivors, which have severe consequences for the individual and high care costs for the state. Current clinical interventions that focus solely on musculoskeletal function are not evidenced to be consistently effective in the long term, or in those older adults without muscle and bone impairments (Cadore, Rodríguez-Mañas, Sinclair, & Izquierdo, 2013; Teasell, McRae, Foley, & Bhardwaj, 2002). The role of cognition in gait control and falls has become increasingly apparent, with higher-level executive functions exhibiting a clear relationship with falls and cognitive decline with ageing (Morris, Lord, Bunce, Burn, & Rochester, 2016). This research aims to address a gap in the literature by identifying the specific higher-level executive processes that play a role in gait control, and examining if these processes are impaired in older adults and stroke survivors with a high risk of falling. Behavioural and electrophysiological measures were used to examine walking gait in both single- and dual-task conditions, as well as cognitive performances and the associated event-related potentials in healthy young and older adult “fallers” and “non-fallers”, and also in a sample of stroke survivors. The results suggest that executive top-down processes (working memory in particular), play a role in gait control during dual-task walking generally, and that executive processes are relied upon more in older age. This work suggests that there may also be neural markers of “successful” ageing that differentiate fallers from non-fallers, and that there can be substantial recovery of both cognition and gait post-stroke. These findings support the resource capacity and compensatory theories of neurocognitive ageing, and suggest that executive neuropsychological tasks could be developed to offer alternative cognitive/neural fall screening assessments and rehabilitation programmes for stroke patients and the wider older adult population

What are the views of hospital-based generalist palliative care professionals on what facilitates or hinders collaboration with in-patient specialist palliative care teams?:a systematically constructed narrative synthesis

Background: Hospital-based specialist palliative care services are common, yet existing evidence of inpatient generalist providers’ perceptions of collaborating with hospital-based specialist palliative care teams has never been systematically assessed. Aim: To assess the existing evidence of inpatient generalist palliative care providers’ perceptions of what facilitates or hinders collaboration with hospital-based specialist palliative care teams. Design: Narrative literature synthesis with systematically constructed search. Data sources: PsycINFO, PubMed, Web of Science, Cumulative Index of Nursing and Allied Health Literature and ProQuest Social Services databases were searched up to December 2014. Individual journal, citation and reference searching were also conducted. Papers with the views of generalist inpatient professional caregivers who utilised hospital-based specialist palliative care team services were included in the narrative synthesis. Hawker’s criteria were used to assess the quality of the included studies. Results: Studies included (n = 23) represented a variety of inpatient generalist palliative care professionals’ experiences of collaborating with specialist palliative care. Effective collaboration is experienced by many generalist professionals. Five themes were identified as improving or decreasing effective collaboration: model of care (integrated vs linear), professional onus, expertise and trust, skill building versus deskilling and specialist palliative care operations. Collaboration is fostered when specialist palliative care teams practice proactive communication, role negotiation and shared problem-solving and recognise generalists’ expertise. Conclusion: Fuller integration of specialist palliative care services, timely sharing of information and mutual respect increase generalists’ perceptions of effective collaboration. Further research is needed regarding the experiences of non-physician and non-nursing professionals as their views were either not included or not explicitly reported

How do grandparents experience the death of a grandchild following a life limiting condition?

Introduction: Traditionally, bereavement support for families extends to parents and siblings of children who have died following a life limiting condition (LLC). Few research studies have focused on the needs of bereaved grandparents, who are playing an increased role on the care of children with LLCs and their families. This study aimed to explore how grandparents experience the death of a grandchild from a LLC. Methods: A purposive sample of seven participants, who identified themselves as fulfilling a grandparenting role, participated in a semi-structured, in depth face-to-face interview. Transcribed data was analysed using interpretive phenomenological analysis. Ethical approval: Ethical approval was sought and granted by Lancaster University in October 2013. NHS NRES approval was not required as the participants were not the primary carers of NHS patients. Results: Emerging themes indicated a number of contextual factors that affect the experience of bereaved grandparents, including intergenerational bonds, identity and perceived changes in role following the death of their grandchild. Bearing witness to the suffering of their child (the deceased child's parent) and an inability to 'make things better' was a recurrent stressor. The essence of grandparents' experiences was interpreted as being driven by and focused on fulfilling a parenting role. Conclusion and implications: The study identified that the primary motivation of grandparental support stems from their role as a parent, and not as a grandparent. The findings from this study should assist the development of practice to better understand, and therefore support, grandparents of children with a LSC, in addition to bereavement support

Reflecting on Climate Change Education Priorities in Secondary Schools in England: Moving beyond Learning about Climate Change to the Emotions of Living with Climate Change

Schools in England remain a valued and important site of climate change education for secondary school pupils (aged 11–18 years). Drawing on focus group data (n = 85) from young people based in eight schools in England, we explored the language pupils used about climate change. We found that young people’s responses to climate change were predominantly focused on content knowledge about climate change, including the concept of global warming and a range of negative impacts, such as biodiversity and habitat loss and extreme and unpredictable weather. In addition, the young people expressed emotions in relation to climate change that were primarily negative and were focused on fear of the future and fear of frustrated youth action. We highlight that school-based climate change education requires support and resources from policy-makers so that young people do not solely learn about climate change, but rather, they are able to live with the emotions of a future shaped by the impacts of climate change. We highlight the need for teacher professional development which enables them to respond to the emotions young people experience in the context of climate change education

Dual-task and electrophysiological markers of executive cognitive processing in older adult gait and fall-risk

The role of cognition is becoming increasingly central to our understanding of the complexity of walking gait. In particular, higher-level executive functions are suggested to play a key role in gait and fall-risk, but the specific underlying neurocognitive processes remain unclear. Here, we report two experiments which investigated the cognitive and neural processes underlying older adult gait and falls. Experiment 1 employed a dual-task (DT) paradigm in young and older adults, to assess the relative effects of higher-level executive function tasks (n-Back, Serial Subtraction and visuo-spatial Clock task) in comparison to non-executive distracter tasks (motor response task and alphabet recitation) on gait. All DTs elicited changes in gait for both young and older adults, relative to baseline walking. Significantly greater DT costs were observed for the executive tasks in the older adult group. Experiment 2 compared normal walking gait, seated cognitive performances and concurrent event-related brain potentials (ERPs) in healthy young and older adults, to older adult fallers. No significant differences in cognitive performances were found between fallers and non-fallers. However, an initial late-positivity, considered a potential early P3a, was evident on the Stroop task for older non-fallers, which was notably absent in older fallers. We argue that executive control functions play a prominent role in walking and gait, but the use of neurocognitive processes as a predictor of fall-risk needs further investigation

Communicative constructions of person-centred and non-person-centred caring in nurse-led consultations

Purpose Nursing is theorised to be a component of person-centred care. Communicative constructions of person-centred caring are a topic that needs to be studied in consultations. The study aimed to explore how person-centred caring and non-person- centred caring are verbally constructed in consultations between patients and nurse. Method This study was qualitative using audio-recorded observations from consultations with advanced nurse practitioners in nurse-led chemotherapy clinics from four hospitals in the UK through purposive sampling. Discourse analysis was used to identify communicative patterns in 45 non-participant observations of nurse consultations. Results The dominant discourse was a non-person-centred oriented discourse framed by the biomedical model. It was also possible to identify fragments of an alternative discourse—a person-oriented discourse localising health problems within the patient's personal and sociocultural context. Conclusions The prominent use of a non-person-oriented discourse focusing on the medical/technical aspects of a patient's assessment/evaluation in consultations may make it difficult for patients to raise questions and concerns from their daily lives during consultations. However, fragments of a person-oriented discourse show that it is possible for nurses to allow a person-centred approach to the consultation. The pedagogical implications have to do with raising nurses' awareness of the role of evaluative language in enhancing person-centred communication with patients in clinical interactions

Executive Function Capacities, Negative Driving Behavior and Crashes in Young Drivers

Motor vehicle crashes remain a leading cause of injury and death in adolescents, with teen drivers three times more likely to be in a fatal crash when compared to adults. One potential contributing risk factor is the ongoing development of executive functioning with maturation of the frontal lobe through adolescence and into early adulthood. Atypical development resulting in poor or impaired executive functioning (as in Attention-Deficit/Hyperactivity Disorder) has been associated with risky driving and crash outcomes. However, executive function broadly encompasses a number of capacities and domains (e.g., working memory, inhibition, set-shifting). In this review, we examine the role of various executive function sub-processes in adolescent driver behavior and crash rates. We summarize the state of methods for measuring executive control and driving outcomes and highlight the great heterogeneity in tools with seemingly contradictory findings. Lastly, we offer some suggestions for improved methods and practical ways to compensate for the effects of poor executive function (such as in-vehicle assisted driving devices). Given the key role that executive function plays in safe driving, this review points to an urgent need for systematic research to inform development of more effective training and interventions for safe driving among adolescents

Peer support for people with advanced cancer:a systematically constructed scoping review of quantitative and qualitative evidence

Purpose of review The number of people living with advanced cancer is increasing, and appropriate support to this population is essential. Peer support is increasingly advocated as a component of care, but little is known about how to provide this in the context of advanced cancer. This review describes the experience and impact of different forms of peer support for people with advanced cancer. Recent findings Data from 22 articles were reviewed, primarily descriptive studies. They describe three forms of peer support (one-to-one, group, and online), reaching primarily those who are women, middle-aged, and well educated. Only two studies focused on support to people with advanced cancer, but those with advanced cancer were frequent users of all forms of peer support. Benefits of peer support were described, but no data were presented to allow a determination of the best form of support for people with advanced cancer. Summary Practitioners can be assured that peer support is likely to be beneficial and provide care that complements that of clinicians. However, there is a need for a comprehensive programme of high-quality evaluative research of peer support for people with advanced cancer. © 2018 Wolters Kluwer Health, Inc. All rights reserved