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The prescribed amount of physical activity in randomized clinical trials in older adults
- Authors:
- KRUGER Judy, BUCHNER David M., PROHASKA Thomas R.
- Journal article citation:
- Gerontologist, 49(S1), June 2009, pp.S100-S107.
- Publisher:
- Oxford University Press
This article describes the amount of physical activity prescribed between 1980 and 2005 to sedentary older adults enrolled in randomized controlled trials (RCTs) using MEDLINE, Health and Psychological Instruments, EBM Reviews, CINAHL, ERIC, PsychInfo, and Social Science Abstracts with the key words "exercise," "physical activity," and "older adult." More than 13,502 research abstracts were reviewed, and 160 RCTs 12 weeks or more in duration with documented outcomes of physical activity were synthesized. The average prescribed dose of aerobic activity provided by interventions for older adults was less than the recommended amount of 150 min or more per week of moderate-intensity physical activity. In interpreting the results of RCTs, there is an insufficient body of evidence on the relationship between physical activity and cognitive health. However, studies indicated that moderate-intensity physical activity had a positive effect on cognitive health. Given the broad consensus of a dose–response relationship between aerobic activity and a variety of health outcomes, the RCT literature appears to have underestimated the benefit of physical activity for previously sedentary older adults because the prescribed dosages are not consistent with those recommended.
Modality of physical exercise and cognitive function in Hong Kong older Chinese community
- Authors:
- LAM Linda C. W., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 24(1), January 2009, pp.48-53.
- Publisher:
- Wiley
This study reports on the association between modality of Physical Exercise and cognitive function in 782 older Chinese adults assessed in the second phase of a population survey for dementia in Hong Kong. Profiles of physical exercise was measured by a questionnaire (no exercise, stretching, aerobic and mind-body exercise). Cognitive Assessments included the CMMSE, ADAS-Cog, and Category Verbal Fluency Test (CVFT). The aerobic and mind body exercise groups with longer exercise habits had higher scores in most cognitive tests. Beneficial effects were more significant in the young old group from 65- 75 years. It is concluded that possible age related specific effects of aerobic and mind body exercise on cognitive reserve are worthy of further exploration.
Making physical activity accessible to older adults with memory loss: a feasibility study
- Authors:
- LOGSDON Rebecca G., et al
- Journal article citation:
- Gerontologist, 49(S1), June 2009, pp.S94-S99.
- Publisher:
- Oxford University Press
The Resources and Activities for Life Long Independence (RALLI) program in the US uses behavioural principles to make exercise more accessible for older people with memory loss. Exercises are broken into small steps, sequenced, and linked with cues to help participants remember them. Memory aids, easy-to-follow instructions, and tracking forms to facilitate adherence and proper technique are provided to enhance exercise training and compensate for memory loss. Thirty-seven individuals participated in RALLI pilot groups held in retirement residences. Attendance was excellent, with participants attending 90% of classes. At post-test (12 weeks), 84% of participants had exercised at least once during the prior week, compared with 62% who had exercised at least once during the week prior to baseline, mean exercise time increased by 156 min per week, and SF-36 physical components scale significantly improved. After 6 months, 76% of participants continued exercising and mean exercise time remained significantly improved. Persons with MCI can significantly benefit from an exercise program specifically designed to address their cognitive needs. Participants’ ratings indicate improvement in perceived physical health and emotional well-being as a result of the intervention. Thus, RALLI is a promising intervention to promote exercise in individuals with MCI.
Gender differences in views about cognitive health and healthy lifestyle behaviors among rural older adults
- Authors:
- WU Bie, et al
- Journal article citation:
- Gerontologist, 49(S1), June 2009, pp.S72-S78.
- Publisher:
- Oxford University Press
Gender differences in views about cognitive health and behaviours are examined, focusing on older adults living in rural areas. Six focus groups in rural West Virginia were conducted. Participants included 37 women and 30 men, aged 55 years and older. Men and women held similar views of cognitive decline, as well as largely similar views about causes of Alzheimer's disease (AD). However, women were more concerned about developing AD than were men. Gender differences were also noted with respect to healthy lifestyle beliefs, including diet, leisure-time physical activity, and strategies to maintain cognitive health. Findings illustrate the importance of considering gender with respect to health beliefs, health behaviours, and health promotion, and emphasize the need to develop interventions designed for specific populations.
Predictors of rapid cognitive decline among demented subjects aged 75 or more: (Sujet Agé Fragile - Evaluation et Suivi Cohort - SAFES)
- Authors:
- VIATONOU Saturnin, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 24(7), July 2009, pp.709-715.
- Publisher:
- Wiley
This study aimed to identify factors predictive of rapid cognitive decline (RCD) among elderly subjects aged 75 or over suffering from dementia. The analysis concerned 250 patients drawn from the Sujet Agé Fragile - Evaluation et Suivi (SAFES) cohort, presenting a dementia syndrome at inclusion and followed-up for at least 1 year. RCD was defined as the loss of at least 3 points on the Mini-Mental State Examination (MMSE) in the follow-up period of 12 months. All patients underwent a standardised geriatric evaluation. Logistic regression was used to identify factors predictive of RCD. In the study sample, 84 patients (33.6%) presented RCD. The factors identified in multivariate analysis as predictive of RCD were: high level of education, risk of depression, and the initial MMSE score. Among subjects with a main caregiver (n = 177), the predictive factors were malnutrition or risk thereof, risk of a fall, caregiver burden and initial MMSE score. The authors conclude that as soon as dementia is diagnosed in elderly subjects, information should be collected about the subject's socioeconomic status, nutritional status, risk of falling, mood state, and caregiver burden. This would enable the provision of appropriate therapeutic care, and make it possible to adapt follow-up in case of a risk of accelerated cognitive deterioration.
Intellectual activity and likelihood of subsequently improving or maintaining instrumental activities of daily living functioning in community-dwelling older Japanese: a longitudinal study
- Authors:
- FUJIWARA Yoshinori, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 24(6), June 2009, pp.547-555.
- Publisher:
- Wiley
This study aimed to test the a priori hypothesis that increase or maintenance of the level of cognitive activity would be independently associated with a subsequent beneficial impact (i.e. improvement or maintenance) on instrumental activity of daily living (IADL) functioning. An observational study was carried out using 4-year longitudinal data from 1477 community-dwelling Japanese who were 66 years and older and living in Yoita town, a rural community located in the northwest along the Sea of Japan. Baseline assessment occurred in November 2000. Intellectual Activity and IADL were evaluated using the Tokyo Metropolitan Institute of Gerontology (TMIG) Index of Competence. Results showed that an Increase or maintenance of exposure to intellectual activities over a period of 2 years was associated with increased likelihood of better IADL functioning trajectory (i.e. improvement or stability) over the subsequent 2 years, even after adjustment for major confounders. The authors conclude that this study documented a longitudinal, independent association of exposure to intellectual activities with better IADL functioning over time. These findings provide preliminary support for promotion of exposure to intellectual activities among older adults as an opportunity to prevent disability in the older segment of the population. Assessment of public health programs targeting such an opportunity is warranted.
The mental health needs of people living in extra care housing
- Authors:
- BROOKER Dawn J., ARGYLE Elaine, CLANCY David
- Journal article citation:
- Journal of Care Services Management, 3(3), April 2009, pp.295-309.
- Publisher:
- Taylor and Francis
Extra care housing is promoted as the best way of providing long-term support for older people. What happens to people if they develop dementia or other mental health problems in these settings is less clear. While promising ‘a home for life’, the reality is that many have to move on to more dependent care facilities if they experience significant problems. This paper reports data from 268 residents in ten extra care housing schemes who were judged by staff teams as being at risk from exclusion because of mental health problems. The sample included three large village schemes (greater than 170 residents) that had opened in the last five years as well as three medium schemes (60–80 residents) and four smaller schemes (under 50 residents). The overall incidence of dementia and depression was difficult to ascertain from records and from staff reports. Formal diagnosis varied substantially across schemes and staff estimates of diagnosis were also variable. Formal assessment of those residents that staff identified as being most at risk, however, showed that they had similar profiles on the Mini Mental State Examination, Geriatric Depression Scale, Bristol Activities of Daily Living Schedule and Barthel Inventory, regardless of the size of scheme they lived in. Those in larger village schemes were more likely to share their apartment with a spouse but the majority of people identified as being most vulnerable lived alone. These findings suggest that there is a need to take a proactive approach to people's mental health in extra care housing in order to be serious about maintaining a good quality of life for all within housing schemes.
Cognitive status and the psychological well-being of long-term care residents over time
- Authors:
- O'ROURKE Norm, et al
- Journal article citation:
- Aging and Mental Health, 13(2), March 2009, pp.280-287.
- Publisher:
- Taylor and Francis
The majority of research within long-term care (LTC) has emphasized the physical health of residents, has been cross-sectional in design and has focused almost exclusively on residents with dementia. Few longitudinal studies have followed participants over intervals longer than 1 year. In contrast, the current study set out to examine the experience of LTC residents with and without significant cognitive loss over a 2-year period comparing the psychological well-being of groups over time. Significant Group Time interaction effects were observed between residents with and without significant cognitive loss in life satisfaction and depressive symptomatology. Results of this study underscore the need for longitudinal measurement in LTC research, the use of multivariate statistical procedures and the need to identify and meet the distinct needs of residents with and without significant cognitive loss.
What cognitive functions are associated with passive suicidal ideation? Findings from a national sample of community dwelling Israelis
- Authors:
- AYALON Liat, LITWIN Howard
- Journal article citation:
- International Journal of Geriatric Psychiatry, 24(5), May 2009, pp.472-478.
- Publisher:
- Wiley
This study aimed to identify the specific cognitive domains associated with passive suicidal ideation (e.g. thoughts of being better off dead). A cross sectional, national based study of 1,712 individuals over the age of 50. Outcome measure, passive suicidal ideation, was evaluated by the question, in the past month, have you felt that you would rather be dead?, taken from the Euro-D. Cognitive domains assessed were time orientation, verbal learning, verbal recall, word fluency, and arithmetic. After adjusting for demographic and clinical information, those reporting passive suicidal ideation were significantly more likely to have impaired performance on the time orientation task. None of the other cognitive domains were associated with passive suicidal ideation. Clinicians working with older adults need to be aware not only of demographic and clinical information, but also of cognitive functioning and more specifically, time orientation, as a potential determinant of passive suicidal ideation. Possibly, cognitive domains that are less affected by education and prior learning (e.g. time orientation) have a unique association with passive suicidal ideation.
Anxiety symptoms in mild cognitive impairment
- Authors:
- ROZZINI Luca, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 24(3), March 2009, pp.300-305.
- Publisher:
- Wiley
This study aimed to validate the Italian version of Geriatric Anxiety Inventory (GAI), an instrument that measures dimensional anxiety in elderly people, and assess whether MCI subjects with anxiety symptoms show different neuropsychological profiles in comparison with MCI without anxiety symptoms. Fifty-seven outpatients with MCI were consecutively recruited. All patients were assessed using a complete neuropsychological battery to detect the cognitive impairment, and the GAI for the presence of anxiety symptoms. Anxiety + patients (GAI 10) show more behavioral and psychological disturbances than patients with Anxiety- (GAI < 10); in particular they had more agitation, anxiety, depression and more sleep disorders. Moreover, Anxiety + patients are more compromised on instrumental daily functions and on executive functions evaluated with Trail Making B test (TMB). Linear Regression analysis was completed to estimate the coefficients of the linear equation, involving neuropsychological, psychobehavioural and functional characteristics: the executive functions (TMB) are the only variable independently related to the presence of anxiety disturbances. It is concluded that executive functions are independently related to anxiety disorders in MCI patients. It is hypothesized that the strict interaction between anxiety symptoms and executive functions could depend on specific pathological features at the level of caudate nucleus characterizing early phases of dementia.