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Many older adults are discharged from skilled nursing facilities (SNFs) at functional levels below those needed for safe, independent home and community mobility. There is limited evidence explaining this insufficient recovery. The purpose of this secondary analysis was to determine predictors of physical function change following SNF rehabilitation. Secondary analysis of a prospective observational cohort study. Across 4 SNFs, data were collected from 698 adults admitted for physical rehabilitation following an acute hospitalization. Physical function recovery was evaluated as change from admission to discharge in Short Physical Performance Battery (SPPB) scores (N = 698) and gait speed (n = 444). Demographic and clinical characteristics collected at admission served as potential predictors of physical function change. Following imputation, a standardized model selection estimator was calculated for predictors per physical function outcome. Predictor estimates and 95% CIs were calculated for each outcome model. Higher cognitive scores [standardized β (β STD) = 0.11, 95% CI: 0.0004, 0.20] and higher activities of daily living (ADL) independence at admission (β STD = 0.22, 95% CI: 0.05, 0.34) predicted greater SPPB change; higher SPPB scores at admission (β STD = −0.26, 95% CI: −0.35, −0.14) predicted smaller SPPB change. Higher ADL independence at admission (β STD = 0.17, 95% CI: 0.01, 0.37) predicted greater gait speed change; faster gait speed at admission (β STD = −0.30, 95% CI: −0.44, −0.15) predicted smaller gait speed change. Admission cognition, ADL independence, and physical function predicted physical function change following post-hospitalization rehabilitation. Inverse findings for admission physical function and ADL independence predictors suggest independence with ADL is not necessarily aligned with mobility-related function. Findings highlight that functional recovery is multifactorial and requires comprehensive assessment throughout SNF rehabilitation. [ABSTRACT FROM AUTHOR]

The current staffing shortage across all disciplines of post-acute and long-term care (PALTC) settings is affecting the health and safety of residents, as well as the well-being of the current staff. The need to retain and recruit new talent to this challenging but fulfilling setting demands that we look to existing evidence-based strategies and identify ways to implement them quickly, effectively, and in a sustainable way. Using the 4 Ms Framework of the Age-Friendly Health System developed by the Institute for Healthcare Improvement and the John A. Hartford Foundation (What Matters, Medication, Mentation, and Mobility), we can build on successful strategies to address what matters to staff, mental health, career mobility, and the overall safety and wellness of our nation's careforce. This paper summarizes "More of a Good Thing: A Framework to Grow and Strengthen the PALTC Careforce," a series of 6 roundtable discussions held in 2022 that brought together clinicians, industry leaders, and change-makers to share strategies that have been researched and successfully implemented and discuss ways to scale and disseminate them to a broader audience. The role of PALTC leadership is highlighted, with key points from the final roundtable discussion outlined, and challenging leadership to think about what they can begin doing immediately to build trust with existing staff and lay the foundation for a stronger nursing home careforce. Next steps for "More of a Good Thing" include a survey of participants about what they have tried, what has been successful, and what barriers they face; a series of focused interviews with leaders; and potential collaboration with quality improvement organizations to help facilities build on and implement the strategies presented. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the association between combinations of sarcopenia criteria by the Asian Working Group of Sarcopenia (AWGS) 2019 guideline and incident adverse health outcomes. Longitudinal analyses of a cohort study. We conducted prospective 2-year follow-up analyses (N = 1959) among community-dwelling older adults enrolled in the nationwide Korean Frailty and Aging Cohort Study (KFACS). From the KFACS, 1959 older adults (52.8% women; mean age = 75.9 ± 3.9 years) who underwent assessments for appendicular skeletal mass using dual-energy X-ray absorptiometry, handgrip strength, usual gait speed, 5-times sit-to-stand test, and Short Physical Performance Battery (SPPB) at baseline were included. Participants with each adverse health outcome [mobility disability, falls, and instrumental activities of daily living (IADL) disabilities] at baseline were excluded for each corresponding analysis. Multivariable logistic regression was performed to examine whether sarcopenia defined by different diagnostic criteria was associated with incident adverse health outcomes after 2 years. A total of 444 participants (22.7%) were diagnosed with sarcopenia as defined by AWGS 2019. In the multivariable analysis, sarcopenia defined as both low muscle mass and low physical performance increased the risk of mobility disability (OR 2.14, 95% CI 1.35-3.38) and falls (1.74, 95% CI 1.21-2.49). Only the criterion defined as both low muscle mass and physical performance using the SPPB increased the risk of falls with fracture (2.53, 95% CI 1.01-6.35) and IADL disabilities (2.77, 95% CI 1.21-6.33). However, sarcopenia defined as both low muscle mass and low hand grip strength showed no associations with the incidence of any of the adverse health outcomes. Our study suggests that the predictive value of adverse health outcomes for community-dwelling older adults is better when diagnosed with sarcopenia based on low muscle mass and physical performance. Furthermore, using the SPPB as a diagnostic tool for low physical performance may improve the predictive validity for falls with fracture and IADL disability. Our findings may be helpful for the early detection of individuals with sarcopenia who have a higher risk of adverse health outcomes. [ABSTRACT FROM AUTHOR]

Age-Friendly Health Systems is an initiative of The John A. Hartford Foundation and the Institute for Healthcare Improvement, in partnership with the American Hospital Association and the Catholic Health Association of the United States that uses a framework to ensure high-quality, person-centered care for older adults. The framework, called the 4 Ms, includes what matters, mobility, medications, and mentation. This work outlines a practical, evidence- based approach to implementing 4 Ms care in long-term care (LTC). [ABSTRACT FROM AUTHOR]

To develop a questionnaire-based Active Mobility Index (AMI) to assess going-out behavior with physical and social activity among older adults, and to assess the criterion-related and predictive validity of the AMI. Prospective cohort study. General community setting. Participants comprised 4432 older adults [mean age: 75.9 ± 4.3 (70-96) years; 2100 men (47.4%)]. AMI assessed life-space and activities in each life-space (distance from the respondent's home: <1 km, 1-10 km, or >10 km) according to physical or social activity during the past 1 month by noting frequency, purpose, type of transportation, interaction with others, and physical activity. Baseline characteristics and outcomes were compared by AMI score quartiles (highest: Q4). To examine the criterion-related validity of AMI, depressive symptoms, frailty, and cognitive function were assessed. During follow-up, incident disability was monitored by Long Term Care Insurance certification. Lower scores (Q1-Q3 groups) were associated with more depressive symptoms, frailty, and cognitive impairment compared with the Q4 group (all P <.001). Multiple logistic regression analyses revealed significantly higher odds ratios in the Q1 group in all health adverse outcomes compared with the Q4 group [depressive symptoms, odds ratio (OR) 3.94, 95% confidence interval (CI) 2.95-5.28; frailty, OR 3.20, 95% CI 2.31-4.44; cognitive impairment, OR 1.28, 95% CI 1.04-1.57]. Cox proportional hazards modeling indicated that the Q1 group had a higher risk of incident disability compared with the group (hazard ratio 1.53, 95% CI 1.24-1.88). AMI to assess life-space with physical and social activity among older people was associated with depressive symptoms, frailty, and cognitive impairment. Lower AMI scores were associated with higher incident disability risk. Further studies are needed to elucidate whether AMI is causally associated with incident adverse health outcomes. [ABSTRACT FROM AUTHOR]

Limb contractures are associated with poor outcomes and quality of life in long-term care (LTC) residents. This study examined the rate of developing new joint contracture in the LTC residents and associated risk factors to formulate effective interventions in this critical but understudied area. This is an observational study with data obtained from the Hong Kong Longitudinal Study on LTC Residents between 2005 and 2016. Trained assessors (nurses, social workers, and therapists) used the Minimum Data Set Resident Assessment Instrument (MDS-RAI 2.0) to collect the data of the residents from 9 residential LTC facilities. Limb contractures were defined as a functional limitation in the range of motion involving the upper or lower limbs. Primary outcomes included annual prevalence of joint contractures and factors that were associated with the development of new joint contractures. We analyzed the data for 1914 older residents (674 males, mean age 83.4 years). During the first 5 years since admission, the annual prevalence of upper limb contractures increased from 29.8% to 36.5%, and lower limb contractures increased from 41.5% to 57.4%. Overall, the increment of the prevalence rate of joint contractures per year ranged from 0.7% to 3.2% for the upper limbs and 0.3% to 6.0% per year for the lower limbs. Impaired mobility, presence of neurologic diseases, and older age were the leading independent risk factors for the development of new joint contractures. Joint contractures are highly prevalent among residents admitted to the LTC facilities, and many residents develop new contractures during the first 5 years of their admission. Immobility appears to be the main modifiable risk factor. Further studies are needed to identify potential strategies to prevent new contractures in this vulnerable group. [ABSTRACT FROM AUTHOR]

To identify cognitive and health profiles of cognitively impaired older adults with the presence of prior mobility impairment, which may represent a specific pathway to the development of cognitive impairment or dementia. Retrospective longitudinal study. In adults aged ≥65 years who developed cognitive impairment or dementia, we compared cognitive and health profiles of those who did (n = 57) and did not (n = 86) experience slow gait up to 14 years before symptom onset. Measures of cognitive and biomarkers assessed longitudinally over an average of 7 years before symptom onset were compared between groups using linear mixed effects models, adjusted age, sex, race, and additionally adjusted for education for cognitive outcomes. Compared to those without prior slow gait, those with slow gait had lower Digit Symbol Substitution Test and Pegboard dominant and nondominant hand performance. The slow gait group also had greater body mass index (BMI), waist, systolic blood pressure, lower high-density lipoprotein and low-density lipoprotein, and lower lysophosphatidylcholine 18:2, a lipid associated with mitochondrial function, and showed greater increases in 2-hour glucose levels of an oral glucose tolerance test. The slow gait group was more likely to take medication for hypertension and hypercholesterolemia. During the presymptomatic stage, cognitively impaired older persons who experience prior slow gait are more likely to have deficits in psychomotor speed and manual dexterity, an unfavorable metabolic and vascular profile, and lower lipid levels related to mitochondrial function. Older persons who exhibit mobility impairment should be evaluated for metabolic and vascular dysfunction at an early stage, and successful treatment of these conditions may slow down the progression of cognitive impairment or dementia. [ABSTRACT FROM AUTHOR]

The first goal of this study was to explore associations between functional dependence levels during activities of daily living (eg, functional mobility, eating, and toileting) before COVID-19 and presence of COVID-19 symptoms (eg, fever, dehydration, lethargy, and shortness of breath) during illness. The second goal of this study was to explore associations between presence of specific COVID-19 symptoms and level of functional decline from before to after illness. Retrospective cohort study. A total of 375 residents at a single skilled nursing facility in New York City. Data were extracted from the Minimum Data Set 3.0 and chart reviews. Multiple linear regressions analyzed relationships between baseline functional dependence in eating, functional mobility, and toileting and presence of dehydration, lethargy, shortness of breath, and fever. Ordinal linear regressions analyzed associations between COVID-19 symptom presence and changes in functional dependence from before to after illness. Pre–COVID-19 eating dependence was significantly associated with dehydration during COVID-19. Dehydration during COVID-19 was significantly associated with greater functional declines in functional mobility from before to after illness. Shortness of breath was significantly associated with increased functional declines in eating and functional mobility. Patients with COVID-19 should be monitored for shortness of breath and dehydration, as these symptoms are associated with functional decline. Individuals experiencing functional decline before COVID-19 onset are especially vulnerable to these symptoms. Future research should further explore the relationship between functional status and COVID-19 symptoms. [ABSTRACT FROM AUTHOR]

Spasticity is a common movement disorder that arises from trauma or disease affecting the central nervous system. Untreated spasticity can result in limitations in completing activities of daily living, painful limb contractures, and other conditions associated with loss of mobility. In the long-term care setting, this treatable condition is prevalent, yet often unrecognized likely because of a lack of spasticity-trained practitioners. A recently published spasticity referral tool holds promise for addressing the underdiagnosis of spasticity in the long-term care population. The Minimum Data Set (MDS) would be an ideal mechanism for increasing the diagnosis and treatment of spasticity because it is a government-directed comprehensive screening tool that informs care plans for all residents residing in federally funded long-term care facilities. The MDS could easily integrate the published referral assessment to record the presence of spastic postures and muscle rigidity. We propose expanding the MDS to include 3 questions related to spasticity to improve the recognition and treatment of this prevalent and treatable condition. [ABSTRACT FROM AUTHOR]

To examine whether facility-reported staff shortages and total staff levels were independently associated with changes in nursing home (NH) outcomes in 2020. Longitudinal cohort study. A total of 8466 NHs with staffing and outcome data. This study used NH COVID-19 Public File (2020), Nursing Home Compare (2019-2020), and Payroll-Based Journal data (2019-2020). Outcome measures included the percentage of long-stay residents in a facility with declines in activities in daily living (ADLs), decreases in mobility, weight loss, and pressure ulcers in 2020 Q2, 2020 Q3, and 2020 Q4. Independent variables were whether NHs reported any shortage of aides or licensed nurses and total staff hours per resident day (HPRD). Separate 2-level (NH, state) Hierarchical Generalized Linear Mixed models examined the association of facility-reported shortages and staff hours with key NH resident outcomes, controlling for NH characteristics and COVID-19 infections. The weekly percentage of NHs reporting any staff shortage averaged 20%. Total staff HPRD increased slightly from 3.7 in 2019 to 3.8 in 2020. Health outcomes were stable during 2019 and 2020 Q1 but worsened substantially starting in 2020 Q2. For example, the percentage of residents with mobility loss increased from 16.2% in 2020 Q1 to 27.9% in 2020 Q4. Facility-reported staff shortages were associated with an increase in the proportion of residents with an ADL decline (0.54 percentage points), mobility loss (0.80 percentage points), weight loss (0.22 percentage points), and pressure ulcers (0.22 percentage points) (all P <.01). Total staff HPRD was not associated with changes in any outcomes (all P >.05). NHs reported worsened health outcomes among long-stay residents in 2020, with worse outcomes found among facilities that reported staff shortages but not among those with lower total staff levels. Facility-reported shortages provide important quality information during the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

To examine the association between the baseline number of chronic diseases and multimorbidity with regard to the incidence of all and injurious falls over 3 years among European community-dwelling older adults. Observational analysis of DO-HEALTH, a double-blind, randomized controlled trial. Multicenter trial with 7 European centers: Zurich, Basel, Geneva (Switzerland), Berlin (Germany), Innsbruck (Austria), Toulouse (France), and Coimbra (Portugal), including 2157 community-dwelling adults aged 70 years and older without any major health events in the 5 years prior to enrollment, sufficient mobility, and good cognitive status. The main outcomes were the number of all falls and injurious falls experienced over 3 years. The number of chronic diseases and multimorbidity, defined as the presence of 3 or more chronic diseases at baseline, were assessed with the Self-Administered Comorbidity Questionnaire by Sangha et al. Among the 2155 participants included in the analyses (mean age: 74.9 years, 62% were women, 52% were physically active more than 3 times a week), 569 (26.4%) had multimorbidity at baseline. Overall, each 1-unit increase in the baseline number of chronic diseases was linearly associated with a 7% increased incidence rate of all falls [adjusted incidence rate ratio (aIRR) 1.07, 95% CI 1.03-1.12, P <.001] and a 6% increased incidence rate of injurious falls (aIRR 1.06, 95% CI 1.02-1.11, P =.003). Baseline multimorbidity was associated with a 21% increased incidence rate of all falls (aIRR 1.21, 95% CI 1.07-1.37, P =.002) and a 17% increased incidence rate of injurious falls (aIRR 1.17, 95% CI 1.03-1.32, P =.02). Baseline number of prevalent chronic diseases and multimorbidity in generally healthy and active community-dwelling older adults were associated with increased incidence rates of all and injurious falls over 3 years. These findings support that multimorbidity may need consideration as a risk factor for falls, even in generally healthy and active older adults. [ABSTRACT FROM AUTHOR]

To examine the distribution of admission and discharge functional abilities among Medicare fee-for-service beneficiaries with a skilled nursing facility (SNF) stay. Further, to assess the validity of the standardized discharge self-care and mobility data by examining their association to community discharge. Observational study of SNF Medicare fee-for-service residents' self-care and mobility scores at admission and discharge. Medicare beneficiaries with Medicare Part A SNF stays in 2017 from 15,127 Medicare-certified SNFs. We calculated self-care and mobility score frequencies and percentages at admission and discharge to describe the functional abilities of SNF residents; we examined discharge scores by percentage discharge to the community to evaluate item construct validity. Between admission and discharge, SNF resident scores showed overall improvements in function for all self-care and most mobility activities. For example, between admission and discharge the percentage of residents independent with toileting hygiene and sit to lying increased from 3.7% and 8.2%, to 25.3% and 32.7%, respectively. For all but 2 data elements, residents with lower functional abilities had a lower percentage of being discharged into the community, and the percentage of residents discharged into the community increased as residents performed functional activities of self-care and mobility at higher score ratings. There was a consistent monotonic relationship between residents' discharge self-care and mobility scores and community discharge rates for all but 2 data elements. Our study found measurable improvements for each self-care and mobility function item for SNF Medicare Part A resident stays in 2017. The results also demonstrated a positive association between higher discharge self-care and mobility scores and higher discharge to community rates. These findings support the validity of the data elements in measuring functional abilities among SNF Medicare Part A residents. [ABSTRACT FROM AUTHOR]

To compare the Fried criteria for frailty diagnosis with the Frailty Screening Index (FSI) and the fatigue, resistance, ambulation, illness, and loss of weight (FRAIL) scale in older patients with cardiovascular disease (CVD). We conducted a retrospective 1-year follow-up cohort study of adult inpatients who participated in a cardiac rehabilitation program between June 2016 and September 2018. We included 1472 Japanese patients age 65 years and older with CVD. After excluding 765 patients with incomplete frailty measurements, 707 patients were included in the analysis. Frailty and physical function were measured before hospital discharge according to each of the 3 definitions. Outcomes were all-cause mortality and physical dysfunction. The prevalence of frailty according to the Fried criteria, the FRAIL scale, and the FSI was 213 (30.1%), 181 (25.6%), and 186 (26.3%), respectively. The FSI and the FRAIL scale showed moderate agreement with the Fried criteria [vs FSI: K = 0.52, 95% confidence interval (CI): 0.45–0.59; vs FRAIL scale: K = 0.45, 95% CI: 0.37–0.52; all P <.001]. We found a significant correlation between all-cause mortality and frailty assessed by all of the definitions, even after multivariate adjustment [FSI: hazard ratio (HR): 2.43, 95% CI: 1.30–4.58, P =.006; FRAIL scale: HR: 2.32, 95% CI: 1.21–4.45, P =.011; Fried criteria: HR: 1.99, 95% CI: 1.04–3.82, P =.038). However, the prediction accuracy of the FRAIL scale was higher than that of the FSI and comparable to that of the Fried criteria for physical dysfunction. The FSI and the FRAIL scale showed moderate agreement with the Fried criteria regarding frailty diagnostic performance and had comparable prognostic value. However, only the FRAIL scale was as accurate as the Fried criteria in screening for physical dysfunction. [ABSTRACT FROM AUTHOR]

This study explored the association between cognitive impairment at admission with self-care and mobility gain rate (amount of change per week) during a post-acute care stay (admission to discharge) for older adults with stroke. Retrospective cohort study. Four inpatient rehabilitation and 6 skilled nursing facilities. A total of 100 adults with primary diagnosis of stroke; mean age 79 years (SD 7.7); 67% women. Retrospective cohort study. We evaluated the extent to which cognitive impairment at admission explained variation in weekly gain rate separately for self-care and mobility. Additional covariates were occupational and physical therapy minutes per day, self-care and mobility function at admission, age, and number of comorbidities. Participants were classified as having severe (n = 16), moderate (n = 39), or mild (n = 45) cognitive impairment at admission. Occupational therapy minutes per day (β = 0.04; P <.01) and Functional Independence Measure (FIM) self-care function at admission (β = 0.48; P <.01) were both significantly associated with self-care gain rate (Adjusted R 2 = 0.18); cognitive impairment group, age, and number of comorbidities were not significant. Only FIM mobility function at admission (β = 0.29; P <.001) was significantly associated with mobility gain rate (Adjusted R 2 = 0.18); cognitive impairment group, physical therapy minutes, age, and number of comorbidities were not significant. These results provide preliminary evidence that patients with stroke who have severe cognitive impairment may benefit from intensive therapy services as well as less severely impaired patients, particularly occupational therapy for improvement in self-care function. [ABSTRACT FROM AUTHOR]

Some epidemiological studies of older American adults have reported a relationship between life-space mobility (LSM) and mortality. However, these studies did not show a dose-response relationship and did not include individuals from other countries. Therefore, we evaluated the dose-response relationship between LSM and mortality in older adults. Prospective cohort study. We used the data of 10,014 older Japanese adults (aged ≥65 years) who provided valid responses to the Life-Space Assessment (LSA) in the Kyoto-Kameoka study in Japan. LSM was evaluated using the self-administered LSA consisting of 5 items regarding life-space from person's bedroom to outside town. The LSM score was calculated by multiplying life-space level by frequency score by independence score, yielding a possible range of 0 (constricted life-space) to 120 (broad life-space). These scores were categorized into quartiles (Qs). Mortality data were collected from July 30, 2011 to November 30, 2016. A multivariate Cox proportional hazards model that included baseline covariates were used to evaluate the relationship between LSM score and mortality risk. A total of 1030 deaths were recorded during the median follow-up period of 5.3 years. We found a negative association between LSM score and overall mortality even after adjusting for confounders [Q1: reference; Q2: hazard ratio (HR) 0.81, 95% CI 0.69-0.95; Q3: HR 0.70, 95% CI 0.59-0.85; Q4: HR 0.68, 95% CI 0.55-0.84, P for trend <.001]. Similar results were observed for the spline model; up to a score of 60 points, LSM showed a strong dose-dependent negative association with mortality, but no significant differences were observed thereafter (L-shaped relationship). Our findings demonstrate an L-shaped relationship between LSM and mortality. This study will be useful in establishing target values for expanding the range of mobility among withdrawn older adults with a constricted life-space. [ABSTRACT FROM AUTHOR]

Life-space mobility is a measure of the extent and frequency of mobility in older adults reflecting not only physical function, but also cognitive, psychosocial, and environmental factors. This study aimed to (1) develop life-space mobility profiles for nursing home residents; (2) examine independent factors associated with these profiles; and (3) identify health outcomes [ie, mortality, quality of life (QoL) and falls] associated with the life-space mobility profiles at 1 year. Prospective cohort study. Twelve nursing homes including 556 residents, mean age 87.73 ± 7.25 years, 73.0% female. Life-space mobility was measured using the Nursing Home Life-Space Diameter (NHLSD). Mortality and falls were extracted from residents' records. QoL was measured using the QoL in Alzheimer Disease (QoL-AD) scale. NHLSD scores ranged from 0 to 50 with a mean score of 27.86 ± 10.12. Resident life-space mobility was mainly centered around their room (94.8%, n = 527) and wing (86.4%, n = 485). One-half of the residents left their wing daily (51.0%, n = 284), and over one-quarter (26.4%, n = 147) ventured outside their nursing home at least weekly. Significant associations (P <.05) with high life-space mobility, identified through multivariable analyses, included lower age [odds ratio (OR) 0.70, 95% confidence interval (CI) 0.51, 0.96]; lower frailty levels (OR 0.67, 95% CI 0.50, 0.86); lower sarcopenia risk (OR 0.72, 95% CI 0.65, 0.79); and a better nutritional status (OR 1.16, 95% CI 1.05, 1.29). High life-space mobility was a predictor (P <.05) of lower mortality, lower falls rate, and higher QoL at 1 year when compared with moderate or low mobility. Given the independent association between high life-space mobility and lower frailty status, lower sarcopenia risk, and a better nutritional status, physical activity and nutritional interventions may be beneficial in leading to improved life-space use. This requires further investigation. Improved life-space mobility can lead to improved health outcomes, such as lower mortality, lower falls rate, and improved QoL. [ABSTRACT FROM AUTHOR]

Slowness, generally assessed by walking speed (WS), is an estimator of frailty and its outcomes. Because of potential difficulties in assessing WS, the Moberg picking-up test (MPUT) might be an alternative. This study investigated the capacity of slowness measurements (WS and MPUT) to predict nonfatal adverse consequences of frailty: primarily, decline in basic activities of daily living (BADL); and secondarily, decline in instrumental activities of daily living (IADL), fall, hospitalization, and incident disease. Observational (prospective longitudinal study). This study used data from the population-based Lausanne cohort 65+. At baseline, 1887 individuals (aged 72-77 years) completed both WS (time to walk 20 m at usual pace) and MPUT (time to pick up 12 objects) assessments. All outcomes, assessed at 1- and 4-year follow-ups, were entered in separate logistic regression models with adjustment for age, sex, and respective values at baseline. The prediction of all outcomes by either WS or MPUT was assessed using area under the receiver operating characteristic curve and compared by χ2 tests. There were positive associations between slowness either assessed by WS [relative risk (RR) = 2.48; P <.001] or MPUT (RR = 1.91; P <.001) and decline in BADL at 1-year follow-up. These associations remained significant at 4-year follow-up for both WS (RR = 2.28; P <.001) and MPUT (RR = 1.95; P <.001). There was no significant difference between predictive values of slow WS and MPUT for decline in BADL at 1-year (P =.328) and 4-year follow-ups (P =.413). The prediction was not significantly different for secondary outcomes, except for decline in IADL for which the prediction was slightly better for WS. MPUT may be an alternative measurement of slowness with predictive value of functional decline. No significant difference in predictive capabilities of MPUT and WS for specific adverse consequences of frailty is promising in favor of using MPUT for measuring slowness. [ABSTRACT FROM AUTHOR]

Slow gait speed and sit-to-stand performance are associated with adverse clinical outcomes in older adults. Identifying older adults with functional performance "below norms" is the first step toward prevention. We aimed to (1) examine the associations of age, body height, and gender with gait speed and sit-to-stand performance and (2) develop subgroup-specific reference ranges in older adults with no self-reported mobility limitations. Cross-sectional study. This study analyzed data from 775 community-dwelling older adults who reported no difficulty walking 100 m, climbing stairs, and rising from the chair. Gait speed and sit-to-stand performance were measured by the 10-m gait speed test and 5-times sit-to-stand test, respectively. Bayesian linear regression was used to derive 95% reference ranges for gait speed and sit-to-stand performance, defined by different levels of age, body height, and gender. Overall, 95% reference range was 0.89-1.79 m/s for habitual gait speed and 7.4-27.9 stands/30 s for sit-to-stand pace. Age had the highest posterior probability (>99%) of a meaningful association with both functional outcomes. Additionally, height was strongly associated with gait speed: a 10-cm increase in height was associated with 0.07 m/s (95% credible interval, 0.05-0.10) faster gait speed. For sit-to-stand test, the lower 95% reference range limits tended to be similar across gender and gender-specific height subgroups, owing to the associations of faster sit-to-stand pace with shorter height and male gender. Because extensive tables of reference ranges are impractical, a web-based application (https://sghpt.shinyapps.io/ippts/) is created to provide subgroup-specific reference ranges. In a large sample of mobile-intact older adults, reference ranges for gait speed and sit-to-stand performance differed meaningfully by age. Furthermore, gait speed was stature dependent. Although requiring validation, our findings may be used to define subgroup-specific "below-range" values and to complement existing universal clinical cut points for gait speed and sit-to-stand performance. [ABSTRACT FROM AUTHOR]

The aim is to inspect the effects of exercise and nutritional intervention on prefrail older adults' physical function. Systematic review and meta-analysis registered with PROSPERO (registration number: CRD42021261197). Randomized controlled trials involving prefrail older adults who received exercise and/or nutritional interventions. Ovid MEDLINE, EMBASE, Cochrane Central Registry of Controlled Trials (CENTRAL), Web of Science, Clinical Trials, and PubMed were searched from inception to September 1, 2021. Primary outcomes were physical function, including physical performance, mobility, and grip strength. The short physical performance battery score and chair sit-to-stand test were used to assess the physical performance. Timed up and go and gait speed were applied to assess the mobility. Secondary outcomes were frailty status, weight, body mass index, Barthel index, and quality of life (Euro quality of life 5 dimension index values). We included 16 randomized controlled trials comprising 1199 prefrail older adults (intervention group, n = 593; control group, n = 606). Exercise and nutritional interventions significantly improved the short physical performance battery score [n = 5, mean difference 0.81, 95% confidence interval (CI) 0.21‒1.42, I2 = 62%], handgrip strength (n = 7, mean difference 1.52, 95% CI 0.70‒2.34, I2 = 6%), and gait speed (n = 4, standard weighted mean difference −1.06, 95% CI -1.87 to −0.25, I2 = 89%). There were no significant differences among the chair sit-to-stand test, timed up and go, weight, body mass index, and Barthel index. Our systematic review and meta-analysis shows that the receipt of exercise and nutritional intervention significantly improved physical function in prefrail older adults. [ABSTRACT FROM AUTHOR]

We examined whether the comorbidity burden of patients with hip fracture was associated with quality of in-hospital care reflected by fulfillment of process performance measures. Population-based cohort study using prospectively collected data from the Danish Multidisciplinary Hip Fracture Registry (DMHFR). Patients aged 65 years or older with an incident hip fracture from 2014 to 2018 registered in the DMHFR (n = 31,443). Comorbidity was measured using the Charlson Comorbidity Index based on hospital diagnoses. Quality of in-hospital care was defined as fulfillment of eligible process performance measures, including preoperative optimization, early surgery, early mobilization, pain assessment, basic mobility, nutritional risk, need for anti-osteoporotic medication, fall prevention, and a post-discharge rehabilitation program, reflecting guideline-recommended in-hospital care. The outcomes were (1) an all-or-none composite measure defined as fulfillment of all relevant process performance measures, and (2) fulfillment of the individual process performance measures. Using binary regression, we calculated relative risk (RR) for the association between comorbidity level and outcomes. The overall proportion of patients with hip fracture who fulfilled the all-or-none measure was 31%. Among patients with no comorbidity, 34% fulfilled the all-or-none measure versus 29% among patients with high comorbidity (Charlson ≥ 3). This corresponds to a 15% lower chance (RR = 0.85, 95% confidence interval 0.81–0.89). Increasing comorbidity was also associated with lower fulfillment of the individual process performance measures. The largest difference was seen for preoperative optimization, early surgery, and early mobilization, where patients with high comorbidity had 6% to 11% lower chance of fulfillment of these process performance measures compared with patients without comorbidity. Increasing level of comorbidity was associated with lower quality of in-hospital care among patients with hip fracture. Our results highlight the need for tailored clinical initiatives to ensure that comorbid patients also benefit from the positive progress in hip fracture care in recent years. [ABSTRACT FROM AUTHOR]

The objective of the present systematic review was to investigate the effects of organizational capacity building interventions on the environment, nursing staff capacity, and mobility of residents in nursing facilities. Systematic review. Nursing facilities, staff, and residents. We conducted a systematic review according to the methods of the Cochrane Collaboration. The systematic review was prospectively registered in the PROSPERO database of systematic reviews (registration number CRD42020202996). We searched for studies in MEDLINE (via PubMed), CINAHL (via EBSCO), the Physiotherapy Evidence Database (PEDro), and the Cochrane Library (07/20). A narrative synthesis was conducted because of the high heterogeneity of the included studies. We identified 6747 records and included 14 studies in our review. We clustered the 14 interventions into 3 different categories (environmental modification, nursing staff capacity, and multifactorial interventions). Three studies assessed outcomes at the nursing staff level, and all studies reported outcomes at the resident level. We found highly heterogeneous and inconsistent effects of organizational capacity building on increasing nursing staff capacity and/or resident mobility. The findings emphasize the need for further research focusing on an international understanding and definition of organizational capacity building. Additionally, research and intervention development for organizational capacity building interventions to promote resident mobility are needed while applying the framework of the Medical Research Council. Furthermore, studies should assess outcomes regarding the environment and nursing staff to better understand if and how environmental structures and nursing staff capacity effect resident mobility. [ABSTRACT FROM AUTHOR]

To examine the association between cocalibrated functional scores across post-acute care settings and the subsequent risk of hospital readmission. Retrospective cohort study. We analyzed 781,021 fee-for-service Medicare beneficiaries discharged to either inpatient rehabilitation facilities (IRFs), skilled nursing facilities (SNFs), or home health agencies (HHA) after an acute hospital stay for stroke (N = 143,277), lower extremity joint replacements (512,577), and hip/femur fracture (125,167) between January 1, 2013, and August 31, 2014. Functional items from IRF-PAI, MDS, and OASIS were categorized into self-care and mobility domains. We cocalibrated admission functional scores across post-acute settings and divided scores into 4 functional levels using quartiles (Q1-Q4, with Q4 representing the most independent function). The primary outcomes were 30-day and 90-day hospital readmissions (yes/no) after an initial post-acute stay. Patients who were more dependent in self-care and mobility at the initial post-acute setting were significantly more likely to experience hospital readmission [eg, hazard ratios of 30-day readmission in stroke: 1.54 (95% confidence interval [CI] 1.47-1.61), 1.18 (95% CI 1.14-1.23), and 1.12 (95% CI 1.08-1.16) for Q1, Q2 and Q3, compared to Q4]. We found similar results for risk of 90-day hospital readmission across impairment conditions. Patients who were more functionally dependent at the initial post-acute setting had a higher risk to readmit to the hospitals after discharging from the post-acute setting for 30 and 90 days, compared with patients who were more functionally independent. This finding is consistent across impairment conditions and post-acute settings. Future research should determine effective strategies of maintaining and facilitating functional performance across post-acute settings to optimize long-term patient outcomes. [ABSTRACT FROM AUTHOR]

Mobility interventions have been shown to mitigate functional decline in various clinical populations; however, the effects of mobility programs in older hospitalized patients are unclear. The objective of this study was to determine the effects of unstructured mobility programs on physical activity, physical function, length of stay (LOS), and quality of life (QOL) in older (≥60 years) general medicine inpatients. In this systematic review and meta-analysis, we systematically searched MEDLINE, Embase, CINAHL, and AMED databases from inception to March 2020, plus hand screening references of relevant studies. We included randomized controlled trials (RCTs) and quasi-experimental studies assessing the effects of mobility programs compared to usual care in older adults admitted to general medicine units. Teams of 2 reviewers independently extracted data, assessed risk of bias, and evaluated quality of evidence. Where study population, intervention, and outcomes were similar, results from RCTs were combined by meta-analysis. Three RCTs and 10 quasi-experimental studies met eligibility criteria. Interventions mainly included ambulation and staff, patient, or caregiver education. Meta-analyses showed that mobility interventions had a moderate effect on physical activity [step count standardized mean difference 0.60, 95% confidence interval (CI) 0.23-0.97] and a nonsignificant effect on LOS (mean difference –0.36, 95% CI –1.92 to 1.21), both favoring mobility. Narrative synthesis showed consistent evidence for improvement in physical function, potential decrease in LOS, and no increase in adverse events with mobility interventions. Unstructured mobility interventions in general medicine units may improve older hospitalized patients' physical activity and physical function; however, the quality of evidence was low. More RCTs are needed to evaluate the effectiveness of mobility interventions, particularly on LOS and QOL. [ABSTRACT FROM AUTHOR]

A priority health outcome for patients, families, and the Centers for Medicare & Medicaid Services (CMS) is a patient's ability to return home and remain in the community without adverse events following discharge from post-acute care services. Successful discharge to community (DTC) is defined as being discharged to the community and not experiencing a readmission or death within 30 days of discharge. The objective of this study was to determine the association between patient factors and successful DTC after home health for individuals with Alzheimer's disease and related dementias (ADRD). This retrospective study derived data from 100% national CMS data files from October 1, 2016, through September 30, 2017. Criteria from the Home Health Quality Reporting program were used to identify a cohort of 790,439 Medicare home health beneficiaries, 143,164 (18.0%) with ADRD. Successful DTC rates with associated 95% confidence intervals (CIs) were calculated for each patient characteristic. Multilevel logistic regression was used to estimate the relative risk (RR) of successful DTC after home health, by ADRD diagnosis, mobility, self-care, caregiver support, and medication management, adjusted for patient demographics and clinical characteristics. Overall, 79.4% of beneficiaries had a successful DTC. Beneficiaries with ADRD had a significantly lower odds of successful DTC than those without ADRD (RR=0.947, 95% CI=0.944-0.950). This association remained significant after adjustment for caregiver support, assistance with medications, independence in mobility, and level of self-care. Greater need for caregiver support, greater need for assistance with medications, greater dependence in mobility, and greater self-care dependence were all associated with decreased risk of successful DTC. Older adults with ADRD receiving home health had decreased RR of successful DTC. To have a successful DTC, older adults with ADRD need sufficient support from caregivers and independence in functioning. [ABSTRACT FROM AUTHOR]

Physical activity in people with dementia (PwD) may enhance physical and mental functioning. Exergaming, which combines physical exercise with cognitive stimulation in a gaming environment, was developed to overcome barriers in performing physical activities. We evaluated the effects of exergaming in day care centers (DCCs) for PwD and informal caregivers (ICs). A randomized controlled trial among 23 DCCs across the Netherlands randomized to exergaming (interactive cycling during 6 months) or a care-as-usual control group. A total of 112 (73 exergaming, 39 control) community-dwelling dyads (PwD, IC), with the PwD visiting a DCC at least twice per week. All outcomes were assessed using structured questionnaires during interviews with PwD and ICs at baseline (T0), 3 months (T1), and 6 months (T2). Primary outcomes: physical activity and mobility of the PwD. Secondary outcomes: physical, cognitive, emotional and social functioning, and quality of life for PwD. For ICs: experienced burden, quality of life, and positive care experiences. Mixed-model analyses showed no statistically significant effects on primary outcomes. There were statistically significant positive effects on PwD's secondary outcomes at T2 on cognition [Mini-Mental State Examination (MMSE): r = 2.30, 95% confidence interval (CI): 0.65, 3.96, P =.007; and Trail Making Test part A (TMT-A): r = −28.98, 95% CI: −54.89, −3.08, P =.029], social functioning (Behavior Observation Scale for Intramural Psychogeriatrics subscale 1 (GIP): r = −1.86, 95% CI: −3.56, −0.17, P =.031), and positive post-test effects in ICs on distress caused by the PwD's neuropsychiatric symptoms (NPI-Q total distress: r = −3.30, 95% CI: −6.57, −0.03, P =.048) and on sense of competence (SSCQ: r = 2.78, 95% CI: 0.85, 4.71, P =.005). Exergaming appeared not effective on the primary outcomes. Despite the study being underpowered, we found positive effects on secondary outcomes for PwD and ICs, and no negative effects. We therefore recommend further study, dissemination, and implementation. [ABSTRACT FROM AUTHOR]