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Objectives To evaluate the effects a home-based exercise program delivered to ill and mobility-limited elderly individuals on physical function, physical activity, quality of life, fall-related self-efficacy, and exercise self-efficacy. Design Randomized controlled trial ( ISRCTN Registry, Reg.-No. ISRCTN17727272). Setting Fifteen general practitioner ( GP) practices and participants' homes. Participants Chronically ill and mobility-limited individuals aged 70 and older (N = 209). Interventions An exercise therapist delivered the experimental intervention-a 12-week multidimensional home-based exercise program integrating behavioral strategies-in individual counseling sessions at the GPs' practices and over the telephone. The control intervention focused on promoting light-intensity activities of daily living. Interventions took place between February 2012 and March 2013. Measurements The primary outcome was functional lower body strength (chair-rise test). Secondary outcomes were physical function (battery of motor tests), physical activity (step count), health-related quality of life (Medical Outcomes Study 8-item Short-Form Survey), fall-related (Falls Efficacy Scale-International Version), and exercise self-efficacy (Selbstwirksamkeit zur sportlichen Aktivitaet ( SSA) scale). Postintervention differences between the groups were tested using analysis of covariance (intention to treat; adjusted for baseline value and GP practice; significance level P ≤ .05). Results Participants had a mean age ± standard deviation of 80 ± 5, 74% were female, 87% had three or more chronic diseases, and 54% used a walking aid. The difference (intention to treat; experimental minus control) between adjusted postintervention chair-rise times was −0.1 (95% confidence interval = −1.8-1.7). Differences for all secondary outcomes were also nonsignificant. Conclusion The program was ineffective in the target population. Possibilities for improving the concept will have to be evaluated. [ABSTRACT FROM AUTHOR]

Objectives To determine how nursing staff evaluate nonverbal behavior related to hand and tube feeding of residents with dementia. Design Cross-sectional survey. Setting A stratified sample of nurses and nursing assistants in residential nursing homes in a major German city. Participants Nursing staff members (N = 131) in 12 nursing homes. Measurements Nursing staff perception of nonverbal behavior of residents with dementia in response to hand and tube feeding. Results Ninety-three percent of survey participants considered the nonverbal behavior of residents with advanced dementia crucial for decisions about artificial nutrition and hydration ( ANH). The same percentage had at some point encountered residents who did not open their mouths when feeding was attempted. Fifty-three percent of the participants interpreted residents' expressions of pleasure while eating as a will to live. The most frequent interpretation of residents' aversive behavior was discomfort. When residents did not open their mouth during nurse's hand feeding, 41% of the participants inferred a will to die. Conclusion Most nurses and nursing assistants consider residents' behavior during hand or tube feeding to be important, but their interpretations are heterogeneous. Various professional caregivers assume a will to live or die. Further reflection is necessary to determine how behavioral expressions should be factored into treatment decisions. [ABSTRACT FROM AUTHOR]

Objectives To determine the efficacy of multimodal, nondrug therapy on symptoms of dementia and need for care in institutionalized individuals with degenerative dementia. Design Randomized, controlled, longitudinal trial. Data were analyzed using multiple linear regression. Setting Five German nursing homes. Participants One hundred thirty-nine nursing home residents with primary degenerative dementia ( Mini- Mental State Examination score < 24). Intervention The 6-month intervention comprised three components: motor stimulation, activities of daily living, and cognitive stimulation ( MAKS). Groups of 10 patients led by two therapists participated in the standardized intervention for 2 hours, 6 days a week. The intervention was described in detail in an intervention manual. Adherence to the manual was high. Controls received treatment as usual. Measurements Overall geriatric symptoms were recorded using the Nurses' Observation Scale for Geriatric Patients, functional independence using the Barthel Index, and care time using the Resource Utilization in Dementia- Formal Care. Results Of 646 individuals screened, 146 were eligible, and 130 were included in the intention-to-treat analysis. At 6 months, results of the per-protocol analysis (n = 119) showed improvement in overall dementia symptoms in the MAKS group and no change in the control group (adjusted mean difference ( AMD) = −6.8, 95% confidence interval ( CI) = −10.3 to −3.3; P < .001, Cohen d = 0.66). This effect was greatest on the social behavior ( AMD = −1.9, 95% CI = −2.9 to −0.8; P < .001; Cohen d = 0.54) and instrumental activity of daily living ( IADL) ( AMD = −1.4, 95% CI = −2.5 to −0.30; P = .01; Cohen d = 0.43) subscales. No effect was seen on functional independence or total care time. Conclusion This 6-month nondrug multimodal intervention improved dementia symptoms in nursing home residents, especially in social behavior and IADL capabilities. Registration Identifier: ISRCTN87391496. [ABSTRACT FROM AUTHOR]