A Safe Mobilisation Program to Improve Functional Mobility and Reduce Fall Risks in Cognitively Impaired Older Adults with Higher Level Gait Disorders: A Pilot Study

2021 ◽  
pp. 1-8
Author(s):  
Weihong Zhang ◽  
Lee-Fay Low ◽  
Josephine Diana Gwynn ◽  
Alexander Harry Beveridge ◽  
Elizabeth Harper ◽  
...  
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Intervention Program ◽  
Community Dwelling ◽  
Gait Disorders ◽  
Functional Mobility ◽  
Cognitively Impaired ◽  
Post Intervention ◽  
Mobility Assessment ◽  
Fall Risks

<b><i>Background:</i></b> The association between gait and cognition, and their combined impact on postural stability may underlie the increased fall risk in older adults with dementia. However, there are few interventions to improve functional mobility and reduce fall risks in people with cognitive impairment. <b><i>Objectives:</i></b> This study aims to investigate the feasibility and acceptability of a Safe Mobilisation Program for cognitively impaired older adults with higher level gait disorders. It also explores the potential effectiveness of the program on mobility and fall risks. <b><i>Methods:</i></b> Fifteen community-dwelling older adults participated in a 3-week pre-post intervention study. They were trained to take steady steps in transfers and mobilization using errorless learning and spaced retrieval teaching techniques. <b><i>Results:</i></b> The intervention program was feasible, all the participants completed the program and were able to mobilize safely. The program was acceptable and participants reported an increase in safety awareness, improvement in confidence while transferring and mobilising, and better quality of life. There was a trend of improvement in Falls Efficacy Scale-international (FES-I), 360° turn and Tinetti Performance Oriented Mobility Assessment (POMA), which may indicate improvement in balance and mobility. <b><i>Conclusion:</i></b> The Safe Mobilisation Program was feasible and acceptable in older adults with cognitive impairment and gait disorders and warrants further evaluation.

scholarly journals Cognitive Impairment, Sexual Activity and Physical Tenderness in Community-Dwelling Older Adults: A Cross-Sectional Exploration

Gerontology ◽  
2018 ◽  
Vol 64 (6) ◽  
pp. 589-602 ◽  
Author(s):  
Rosanne Freak-Poli ◽  
Silvan Licher ◽  
Joanne Ryan ◽  
M. Arfan Ikram ◽  
Henning Tiemeier
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Cognitive Functioning ◽  
Sexual Activity ◽  
Community Dwelling ◽  
Cognitively Impaired ◽  
Cross Sectional ◽  
Partner Status ◽  
Weak Evidence ◽  
Community Dwelling Older Adults

Background: The ability to engage in sexual activity and better cognitive functioning are both associated with better health. However, the association between cognitive functioning and sexual activity is understudied. Objective: To examine the association between cognitive functioning with sexual activity and physical tenderness among community-dwelling older adults. Methods: From the Rotterdam Study, cognitive impairment and sexual activity were assessed in 4,201 community-dwelling, 60+ year olds between 2008 and 2014 in the Netherlands. Mild cognitive impairment (MCI) was based upon subjective complaints related to age and education-adjusted test scores. Mini-Mental State Examination (MMSE) impairment was defined by a score of < 26. Sexual activity and physical tenderness (e.g., fondling or kissing) in the last 6 months were assessed at an interview. Analyses were stratified by gender and partner status, with prevalence rates for the “no impairment” categories weighted based on age from the cognitive impairment categories. Inter-rater reliability was examined utilising 74 cohabiting couples of opposite gender. Results: It was found that 14% were categorised as having cognitive impairment, and < 1% as dementia (excluded from subsequent analyses). There was strong evidence that the odds of engaging in physical tenderness (observed through MMSE < 26, OR 2.14, 95% CI 1.32–3.48, p = 0.002) and sexual activity (MCI, OR 2.36, 95% CI 1.35–4.12, p = 0.003) among partnered females with no impairment was twice that observed among cognitively impaired partnered females. There was weak evidence that the odds of engaging in physical tenderness (MMSE < 26, OR 1.59, 95% CI 1.04–2.42, p = 0.03) and sexual activity (MMSE < 26, OR 1.51, 95% CI 1.02–2.24, p = 0.04) among partnered males with no impairment was 50% greater than observed among cognitively impaired partnered males. The associations between cognitive functioning and physical tenderness continued to remain after adjustment for physical function, diabetes, cardiovascular disease and cancer. There was no clear evidence of a difference between amnestic and non-amnestic MCI for sexual behaviour. There was moderate to substantial agreement among the coupled adults who had 1 partner categorised with MCI. Conclusion: Having no cognitive impairment was associated with more engagement in sexual activity and physical tenderness among community-dwelling older adults. Sexuality is an important aspect of active aging and our findings illustrate a potential barrier to maintaining or instigating intimate relationships as we age. Longitudinal analyses are required to explore the direction of effect.

scholarly journals Implementation of the mHealth App for Swallowing Tongue Pressure Strengthening Exercises in Older Adults (Preprint)

2020 ◽  
Author(s):  
HyangHee Kim ◽  
Nam-Bin Cho ◽  
Kyung Min Kim ◽  
Minji Kang ◽  
Jinwon Kim ◽  
...  
Keyword(s):  
Older Adults ◽  
Mobile Health ◽  
Intervention Program ◽  
Community Dwelling ◽  
Tongue Pressure ◽  
Post Intervention ◽  
Main Trial ◽  
Home Based ◽  
Term Maintenance

BACKGROUND Tongue pressure is one of the effective indices of swallowing function, which decreases with aging and disease progression. Previous research has shown beneficial effects of swallowing exercises combined with myofunctional tongue strengthening therapy on tongue function. Tongue exercises utilizing mobile Health (mHealth) technologies may have tremendous potential in advancing healthcare in the digital age to be more efficient for people with limited resources, especially for older adults. OBJECTIVE The purpose of this study was to explore the immediate and long-term maintenance effects of an 8-week home-based mHealth app intervention program aimed at improving the swallowing tongue pressure in older adults. METHODS We developed a mobile health (mHealth) app for intervention which was utilized for 8 weeks (3 times/day, 5 days/week, a total of 120 sessions) by 11 community-dwelling older adults (10 women; mean age: 75.7 years) who complained of swallowing difficulties. The app was used for three therapy maneuvers: effortful prolonged swallowing (EPS), effortful pitch glide (EPG), and effortful tongue rotation (ETR). Pre-intervention and post-intervention isometric and swallowing tongue pressures were measured using the Iowa Oral Performance Instrument (IOPI). We also investigated the maintenance effects of the intervention on swallowing tongue pressure at 12-week post-intervention. RESULTS Eight out of 11 participants adhered to the home-based 8-week app therapy program with optimal intervention dosage. At the main trial endpoint (i.e., 8-week) of the intervention program, the participants demonstrated a significant increase in swallowing tongue pressure (median = 17.5 kPa at pre-intervention and 26.5 kPa at post-intervention; P < .05). However, long-term maintenance effects of the training program on swallowing tongue pressure at 12-week post-intervention were not observed. CONCLUSIONS Since swallowing tongue pressure is closely related with dysphagia symptoms, the combined methods of EPS, EPG, and ETR training have positively affected swallowing tongue pressure with their use as indirect and direct exercises. The mHealth app is a promising platform which can be used to deliver effective therapeutic service to vulnerable older adults. To investigate the therapeutic efficacy with a larger sample size as well as long-term effects of the intervention program, further studies are warranted. INTERNATIONAL REGISTERED REPORT RR2-10.2196/19585

The comparison of different level of cognitive impairment on falls and fall risks in community dwelling older adults

Physiotherapy ◽  
2016 ◽  
Vol 102 ◽  
pp. e171-e172 ◽  
Author(s):  
G. İyigün ◽  
F. Can ◽  
B. Kırmızıgil ◽  
E. Angın ◽  
S. Öksüz ◽  
...  
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Community Dwelling ◽  
Fall Risks ◽  
Community Dwelling Older Adults

scholarly journals Use of Technology in an Internet-Delivered Intervention for Older Adults With Mild Cognitive Impairment

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 756-756
Author(s):  
Meghan Mattos ◽  
Laura Barnes ◽  
Eric Davis ◽  
Carol Manning ◽  
Mark Quigg ◽  
...  
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Sleep Disorders ◽  
Technology Use ◽  
Large Scale ◽  
Intervention Program ◽  
Sleep Diary ◽  
Post Intervention ◽  
Access To Treatment

Abstract Internet-based interventions using technology can promote access to treatment and reduce participant burden for sleep disorders. However, preliminary studies examining technology use and compliance in older adults with mild cognitive impairment (MCI) are needed prior to undertaking large-scale interventions. Older adults with MCI were recruited from hospital-based memory and sleep disorders clinics and enrolled in a single-arm intervention pilot study. An Internet-delivered cognitive behavioral therapy for insomnia program collected daily sleep diary data and delivered the automated intervention over nine weeks. Sleep diaries and wrist-worn actigraphs collected sleep data for 14 days, pre- and post-intervention. Descriptive statistics for participant technology use are presented. We have recruited 12 subjects with MCI. Most subjects with MCI accessed the intervention program daily; however, actiwatch compliance varied. Incorporating technology for intervention delivery and data collection in this population is promising, and future work should consider using reminders with wearable technology to increase compliance.

Physical activity perceptions, experiences, and beliefs of older adults with mild cognitive impairment or Alzheimer’s disease and their care partners

2020 ◽  
Vol 45 (11) ◽  
pp. 1216-1224 ◽  
Author(s):  
Lauren E. Bechard ◽  
Dorcas Beaton ◽  
Katherine S. McGilton ◽  
Maria Carmela Tartaglia ◽  
Sandra E. Black
Keyword(s):  
Physical Activity ◽  
Alzheimer’S Disease ◽  
Older Adults ◽  
Alzheimer's Disease ◽  
Health Promotion ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Community Dwelling ◽  
Cognitively Impaired ◽  
Care Partners

Physical activity (PA) participation provides functional and social benefits for persons with mild cognitive impairment (MCI) and Alzheimer’s disease (AD), but PA participation in these populations is low. To support health promotion initiatives for cognitively impaired older adults, this study explored the perceptions, experiences, and beliefs of older adults with cognitive impairment and their caregivers concerning PA. Ten care dyads (community-dwelling adult aged ≥65 years diagnosed with MCI or mild-to-moderate AD and their care partner) participated in semi-structured interviews informed by the Theoretical Domains Framework about their PA perceptions, experiences, and beliefs. Interpretive phenomenological analysis of interview transcripts yielded 4 emergent themes: (1) PA as a meaningful activity, (2) experience versus evidence as motivating, (3) participation is possible despite dementia, and (4) care partners as enablers. Findings from this study address a research gap concerning the PA perceptions, experiences, and beliefs of cognitively impaired older adults and their care partners. Novelty Older adults with MCI/AD want to and are capable of engaging in PA. Care partners are critical supporters of PA participation in MCI/AD. Adapted health promotion strategies could enhance PA in MCI/AD.

scholarly journals Do Communication Patterns Affect the Association between Cognitive Impairment and Hearing Loss among Older Adults in Vietnam?

2021 ◽  
Vol 18 (4) ◽  
pp. 1603
Author(s):  
Tran Dai Tri Han ◽  
Keiko Nakamura ◽  
Kaoruko Seino ◽  
Vo Nu Hong Duc ◽  
Thang Van Vo
Keyword(s):  
Older Adults ◽  
Hearing Loss ◽  
Cognitive Impairment ◽  
Cognitive Function ◽  
Vision Loss ◽  
Community Dwelling ◽  
Cross Sectional ◽  
Ordinal Logistic Regression Analysis ◽  
Communication Devices ◽  
Community Dwelling Older Adults

This study examined the prevalence of cognitive impairment among older adults in central Vietnam and the roles of communication (with or without communication devices) in the association between cognitive impairment and hearing loss. This cross-sectional study was performed on 725 randomly selected community-dwelling older adults aged ≥60 years from Thua Thien Hue province, Vietnam. Participants attended a face-to-face survey. Sociodemographic characteristics, social interaction with or without communication devices, health status and cognitive function using the Mini-Mental State Examination were reported. Ordinal logistic regression analysis was performed to quantify the association between hearing loss and cognitive function by frequency of communication with and without devices. Mild and severe cognitive impairment had prevalence rates of 23.6% and 19.3%, respectively. Cognitive impairment was more prevalent among older adults with hearing-loss, vision loss and difficulties with instrumental activities of daily living (IADL). The association between hearing loss and cognitive impairment was not significant when older adults had frequent communication with others using devices. This study presented the relatively high prevalence of cognitive impairment in community-dwelling older adults in Vietnam. Frequent communication using devices attenuated the association between hearing loss and cognitive impairment.

Educational intervention to improve palliative care knowledge among informal caregivers of cognitively impaired older adults

2020 ◽  
pp. 1-9
Author(s):  
Hyunjin Noh ◽  
Lewis H. Lee ◽  
Chorong Won
Keyword(s):  
Older Adults ◽  
Palliative Care ◽  
Cognitive Impairment ◽  
Educational Intervention ◽  
Test Scores ◽  
Informal Caregivers ◽  
Cognitively Impaired ◽  
Significant Difference ◽  
Post Test ◽  
Seriously Ill

Abstract Objective Lack of palliative care knowledge among caregivers may pose an access barrier for cognitively impaired older adults, who may benefit from the specialized care. Therefore, this study aims to examine the effectiveness of an educational intervention in improving palliative care knowledge among informal caregivers of cognitively impaired older adults. Method Using a one-group, pre- and post-test intervention design, this study implemented an individual, face-to-face educational intervention with an informational brochure for 43 informal caregivers of chronically or seriously ill older adults (50+) with cognitive impairment, recruited from communities in West Alabama. Their level of knowledge about palliative care was assessed by the Palliative Care Knowledge Scale (PaCKS). The pre- and post-test scores were compared by the Wilcoxon signed-ranks test, and the racial subgroup (Whites vs. Blacks) comparison was made by the Mann–Whitney U test. Results There was a statistically significant difference between the pre- and post-test scores (z = 5.38, p < 0.001), indicating a statistically significant effect of the educational intervention in improving palliative care knowledge among participants. There was a significant difference (U = 143, p < 0.05) between Whites and Blacks in the pre-test, which, however, disappeared in the post-test (U = 173.50, p > 0.05), suggesting that the amount of increased PaCKS scores were significantly greater for Blacks (Mdn = 9.50) than for Whites (Mdn = 4.00, U = 130.50, p < 0.05). Significance of results This study demonstrated that a one-time educational intervention can improve the level of palliative care knowledge among informal caregivers of chronically or seriously ill older adults with cognitive impairment, particularly among Black caregivers. Therefore, further educational efforts can be made to promote palliative care knowledge and reduce racial disparities in palliative care knowledge and its use.

Exploring the Association between Multimorbidity and Cognitive Impairment in Older Adults Living in the Community: A Review of the Literature

2021 ◽  
pp. 108482232110304
Author(s):  
Grace F. Wittenberg ◽  
Michelle A. McKay ◽  
Melissa O’Connor
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Assessment Tool ◽  
Adult Population ◽  
Home Health ◽  
Adverse Outcomes ◽  
Community Dwelling ◽  
Cognitive Screening ◽  
Review Of The Literature ◽  
Increased Risk

Two-thirds of older adults have multimorbidity (MM), or co-occurrence of two or more medical conditions. Mild cognitive impairment (CI) is found in almost 20% of older adults and can lead to further cognitive decline and increased mortality. Older adults with MM are the primary users of home health care services and are at high risk for CI development; however, there is no validated cognitive screening tool used to assess the level of CI in home health users. Given the prevalence of MM and CI in the home health setting, we conducted a review of the literature to understand this association. Due to the absence of literature on CI in home health users, the review focused on the association of MM and CI in community-dwelling older adults. Search terms included home health, older adults, cognitive impairment, and multimorbidity and were applied to the databases PubMed, CINAHL, and PsychInfo leading to eight studies eligible for review. Results show CI is associated with MM in older adults of increasing age, among minorities, and in older adults with lower levels of education. Heart disease was the most prevalent disease associated with increased CI. Sleep disorders, hypertension, arthritis, and hyperlipidemia were also significantly associated with increased CI. The presence of MM and CI was associated with increased risk for death among older adults. Further research and attention are needed regarding the use and development of a validated cognitive assessment tool for home health users to decrease adverse outcomes in the older adult population.

scholarly journals A Modified CAIDE Risk Score as a Screening Tool for Cognitive Impairment in Older Adults

2021 ◽  
pp. 1-14
Author(s):  
Magdalena I. Tolea ◽  
Jaeyeong Heo ◽  
Stephanie Chrisphonte ◽  
James E. Galvin
Keyword(s):  
Risk Factors ◽  
Older Adults ◽  
Cognitive Impairment ◽  
Risk Score ◽  
Clinical Sample ◽  
Community Sample ◽  
Community Dwelling ◽  
Cognitive Testing ◽  
Risk Scores ◽  
Predictive Values

Background: Although an efficacious dementia-risk score system, Cardiovascular Risk Factors, Aging, and Dementia (CAIDE) was derived using midlife risk factors in a population with low educational attainment that does not reflect today’s US population, and requires laboratory biomarkers, which are not always available. Objective: Develop and validate a modified CAIDE (mCAIDE) system and test its ability to predict presence, severity, and etiology of cognitive impairment in older adults. Methods: Population consisted of 449 participants in dementia research (N = 230; community sample; 67.9±10.0 years old, 29.6%male, 13.7±4.1 years education) or receiving dementia clinical services (N = 219; clinical sample; 74.3±9.8 years old, 50.2%male, 15.5±2.6 years education). The mCAIDE, which includes self-reported and performance-based rather than blood-derived measures, was developed in the community sample and tested in the independent clinical sample. Validity against Framingham, Hachinski, and CAIDE risk scores was assessed. Results: Higher mCAIDE quartiles were associated with lower performance on global and domain-specific cognitive tests. Each one-point increase in mCAIDE increased the odds of mild cognitive impairment (MCI) by up to 65%, those of AD by 69%, and those for non-AD dementia by >  85%, with highest scores in cases with vascular etiologies. Being in the highest mCAIDE risk group improved ability to discriminate dementia from MCI and controls and MCI from controls, with a cut-off of ≥7 points offering the highest sensitivity, specificity, and positive and negative predictive values. Conclusion: mCAIDE is a robust indicator of cognitive impairment in community-dwelling seniors, which can discriminate well between dementia severity including MCI versus controls. The mCAIDE may be a valuable tool for case ascertainment in research studies, helping flag primary care patients for cognitive testing, and identify those in need of lifestyle interventions for symptomatic control.

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