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Background: Post-intensive care syndrome (PICS) is characterized by all three adverse survivorship dimensions: physical function, cognitive function and mental health status. Aim: This review aimed to describe the quality of life (QoL) of Intensive Care Unit (ICU) survivors with PICS after discharge and of their relatives with Family Post-intensive care syndrome (PICS-F) and to report anxiety, depression and Posttraumatic Stress Disorders (PTSD) in studies investigating PICS. Study Design: A systematic review was carried out. We searched PubMed, Scopus, Web of Science and the Cumulative Index to Nursing and Allied Health Literature. This review was registered in the PROSPERO database (CRD42022382123). Results: We included 19 studies of PICS and PICS-F in this systematic review. Fourteen observational studies report the effects of PICS on depression, 12 studies on anxiety and nine on post-traumatic stress disorder and 10 on QoL. Mobility, personal care, usual activities and pain/discomfort in QoL were the domains most affected by PICS. A significant association was demonstrated between a high level of ICU survivors' anxiety and high levels of ICU relatives' burden. Strain-related symptoms and sleep disorders were problems encountered by ICU relatives with PICS-F. Conclusion: PICS and PICS-F were widespread experiences among ICU survivors and their ICU relatives, respectively. The results of this review showed the adverse effects of PICS and PICS-F on QoL. Relevance to Clinical Practice: PICS and PICS-F strongly impact the rehabilitation process and are measured in terms of health costs, financial stress and potentially preventable readmission. [ABSTRACT FROM AUTHOR]

Background: FUNDES‐Child‐SE is a proxy rating questionnaire for measuring participation and independence in children with disabilities in a Swedish context. It includes the components of frequency of attendance, engagement and independence. The original, Taiwanese FUNDES‐Child 7.0, has previously been found to have a four‐factor structure for frequency of participation and a two‐factor structure for independence. The aim of this study was to test the factor structure in FUNDES‐Child‐SE. The factor structure is an important part of construct validity. Methods: Caregivers of 163 children with disabilities aged 6–18 years participated in this cross‐sectional study. Exploratory factor analysis was used to find the factor structure for Engagement. Confirmatory factor analysis was used to test the factor structure for all three components. Results: The proposed factor structure for frequency of participation (daily living participation frequency, mobility participation frequency, learning participation frequency and community participation frequency) and independence (daily living independence and social participation independence) fit with data from FUNDES‐Child‐SE after excluding three to five items and adding two to five covariances of residuals. In the engagement component, two factors, named engagement in informal activities and engagement in formal activities, were found. After excluding one item and adding 10 covariances of residuals, the factor structure had an acceptable fit to data. Conclusions: Differences in components' factor structure indicate that attendance and engagement are separate aspects of participation. Before using numeric scores from FUNDES‐Child‐SE in clinical settings, responsiveness and interpretability should be evaluated. [ABSTRACT FROM AUTHOR]

Peripheral nerve injuries are common injuries that often have a drastic effect on patient's activities of daily living and physical function. While techniques for the surgical repair of these injuries have improved over time, rehabilitation methods following these repairs have been non‐standardized and under researched. Electronic searches were conducted in Ovid/Medline and SCOPUS to identify articles that discuss rehabilitation and exercise following peripheral nerve injury in animal models and its effects on peripheral nerve regeneration and recovery of function. Thirty‐eight articles met inclusion criteria; all were prospective studies in animal models. This systematic review suggests that exercise is a useful tool in returning autonomy to the individual and has beneficial effects in the recovery from peripheral nerve injury. It is beneficial to use rehabilitation exercises following the repair of peripheral nerve injuries to promote regeneration, and timing of that exercise may be just as important as the exercise prescribed. However, further studies with standardized models and outcome measures need to be conducted before translation to clinical trials. [ABSTRACT FROM AUTHOR]

Background: Older adults with multimorbidity are under‐represented in clinical drug trials. Their inclusion will not increase unless they are willing and able to participate. Data on motivators and barriers to participation in trials of new medications of older adults with multimorbidity are needed. Methods: Cross‐sectional internet and telephone survey of a nationally representative sample of adults ≥65 years with ≥3 chronic conditions (NORC University of Chicago Amerispeak Panel) conducted from March–April, 2023 to determine motivators and barriers to drug trial participation, described graphically and using statistics. Results: Surveyed 1318 (1142 Internet, 176 phone) with mean age 72.3 ± 6.3 (SD), 52% women; race: 83% White, 10% Black or African American, 5% Hispanic or Latino, 1.1% Asian; 4.4 ± 1.9 chronic conditions (of 16 queried), taking 7.5 ± 3.3 medications. Barriers included fear of side effects (48%), taking too many medications (44%), placebo (44%), mobility (33%), bathroom needs (25%), hearing (19%), eyesight (15%), video visits (33%; higher in women, Black or African‐American respondents, and those ≥80 years). Sixty‐five percent would join all in‐person trials, 49% would join all‐video trials. Travel >1 h was difficult for 66%, most difficult for women. Trust was a concern in 25% of Black respondents. Caregiving responsibilities or lack of time were not obstacles. Participants were most likely to consider a drug trial for a problem they have (63%) versus prevention (44%) and if invited by a physician (80%) or University healthcare system (58%). Getting better care was ranked very important (79%) followed by helping others (57%). Conclusions: Major concerns of older patients with multimorbidity about participation in drug trials are potential side effects, taking too many medicines, and video visits. Physicians have the greatest influence on decisions and in‐person visits are preferred. Proposed changes in trial design to increase enrollment of under‐represented older adults may not align with patient‐reported preferences. [ABSTRACT FROM AUTHOR]

Objective: The aim of our study was to evaluate the physical performance, balance, gait and activities of daily living (ADL) of older individuals with long COVID syndrome (LCS). Methods: A total of 124 individuals (49% women) with a mean age of 71.8 ± 5.8 years were included in the study. Participants were divided into two groups, older individuals with LCS in the LCS group and older individuals who were not diagnosed with COVID‐19 in the CON (control) group. Physical performance of participants was evaluated with the Alusti Test, balance and gait assessment was evaluated with the Tinetti Balance and Gait Assessment (TBGA), and ADL were evaluated with the Barthel Index (BI). Results: In the evaluations between groups, the mean score of active muscular mobility of right and left upper extremities, transfer supine position to sitting, trunk in sitting position and standing, which are among the subparameters of the Alusti Test, were statistically significantly lower in LCS compared to CON (p <.05). TBGA total score and gait section mean score of TBGA were statistically significantly lower in LCS than in CON (p <.05). There was no significant difference between the groups in the balance section of the TBGA and the mean BI scores (p >.05). Conclusions: It was concluded that physical performance parameters related to active muscular mobility of the upper extremity, transfer supine position to sitting, trunk in sitting position and walking in LCS were negatively affected by the disease, but this did not affect the level of balance and independence in ADL. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to determine dose parameters for resistance exercise associated with improvements in pain and physical function in knee and hip osteoarthritis (OA) and whether these improvements were related to adherence. Methods: We searched six databases, from inception to January 28, 2023, for randomized controlled trials comparing land‐based, resistance exercise–only interventions with no intervention, or any other intervention. There were four subgroups of intervention duration: 0 to <3 months, 3 to 6 months, >6 to <12 months, ≥12 months. The between‐group effect was calculated for immediate postintervention pain and physical function (activities of daily living [ADL] and sports/recreation [SPORT]). Results: For both knee and hip, data from 280 studies showed moderate benefit for pain, physical function ADL, and physical function SPORT in favor of interventions 3 to 6 months. For the knee, there was also a moderate benefit for physical function ADL in favor of interventions >6 to <12 months. From 151 knee and hip studies that provided total exercise volume data (frequency, time, duration), there was no association between volume with the effect size for pain and physical function. A total of 74 studies (69 knee, 5 hip) reported usable adherence data. There was no association between adherence with the effect size for pain and physical function. Conclusion: In knee and hip OA, resistance exercise interventions 3 to 6 months (and for the knee >6 to <12 months) duration improve pain and physical function. Improvements do not depend on exercise volume or adherence, suggesting exercise does not require rigid adherence to a specific dose. [ABSTRACT FROM AUTHOR]

Background: Around 15% of the global population live with some form of disabilities and experience worse health outcomes, less participation in the community and are part of fewer activities outside the home. Outdoor mobility interventions aim to improve the ability to move, travel and orient outside the home and could influence the number of activities outside the home, participation and quality of life. However, outdoor mobility interventions may also lead to harm like falls or injuries or have unforeseen effects which could lead to mortality or hospitalization. Objectives: To assess the efficacy of interventions aiming to improve outdoor mobility for adults living with disabilities and to explore if the efficacy varies between different conditions and different intervention components. Search Methods: Standard, extensive Campbell search methods were used, including a total of 12 databases searched during January 2023, including trial registries. Selection Criteria: Only randomized controlled trials were included, focusing on people living with disabilities, comparing interventions to improve outdoor mobility to control interventions as well as comparing different types of interventions to improve outdoor mobility. Data Collection and Analysis: Standard methodological procedures expected by Campbell were used. The following important outcomes were 1. Activity outside the home; 2. Engagement in everyday life activities; 3. Participation; 4. Health‐related Quality of Life; 5. Major harms; 6. Minor harms. The impact of the interventions was evaluated in the shorter (≤6 months) and longer term (≥7 months) after starting the intervention. Results are presented using risk ratios (RR), risk difference (RD), and standardized mean differences (SMD), with the associated confidence intervals (CI). The risk of bias 2‐tool and the GRADE‐framework were used to assess the certainty of the evidence. Main Results: The screening comprised of 12.894 studies and included 22 studies involving 2.675 people living with disabilities and identified 12 ongoing studies. All reported outcomes except one (reported in one study, some concerns of bias) had overall high risk of bias. Thirteen studies were conducted in participants with disabilities due to stroke, five studies with older adults living with disabilities, two studies with wheelchair users, one study in participants with disabilities after a hip fracture, and one study in participants with cognitive impairments. Skill training interventions versus control interventions (16 studies) The evidence is very uncertain about the benefits and harms of skill training interventions versus control interventions not aimed to improve outdoor mobility among all people living with disabilities both in the shorter term (≤6 months) and longer term (≥7 months) for Activity outside the home; Participation; Health‐related Quality of Life; Major harms; and Minor harms, based on very low certainty evidence. Skill training interventions may improve engagement in everyday life activities among people with disabilities in the shorter term (RR: 1.46; 95% CI: 1.16 to 1.84; I2 = 7%; RD: 0.15; 95% CI: −0.02 to 0.32; I2 = 71%; 692 participants; three studies; low certainty evidence), but the evidence is very uncertain in the longer term, based on very low certainty evidence. Subgroup analysis of skill training interventions among people living with disabilities due to cognitive impairments suggests that such interventions may improve activity outside the home in the shorter term (SMD: 0.44; 95% CI: 0.07 to 0.81; I2 = NA; 118 participants; one study; low certainty evidence). Subgroup analysis of skill training interventions among people living with cognitive impairments suggests that such interventions may improve health‐related quality of life in the shorter term (SMD: 0.49; 95% CI: 0.12 to 0.88; I2 = NA; 118 participants; one study; low certainty evidence). Physical training interventions versus control interventions (five studies) The evidence is very uncertain about the benefits and harms of physical training interventions versus control interventions not aimed to improve outdoor mobility in the shorter term (≤6 months) and longer term (≥7 months) for: Engagement in everyday life activities; Participation; Health‐related Quality of Life; Major harms; and Minor harms, based on very low certainty evidence. Physical training interventions may improve activity outside the home in the shorter (SMD: 0.35; 95% CI: 0.08 to 0.61; I2 = NA; 228 participants; one study; low certainty evidence) and longer term (≥7 months) (SMD: 0.27; 95% CI: 0.00 to 0.54; I2 = NA; 216 participants; one study; low certainty evidence). Comparison of different outdoor mobility interventions (one study) The evidence is very uncertain about the benefits and harms of outdoor mobility interventions of different lengths in the shorter term (≤6 months) and longer term (≥7 months) for Activity outside the home; Engagement in everyday life activities; Participation; Health‐related Quality of Life; Major harms; and Minor harms, based on very low certainty evidence. No studies explored the efficacy of other types of interventions. Authors' Conclusions: Twenty‐two studies of interventions to improve outdoor mobility for people living with disabilities were identified, but the evidence still remains uncertain about most benefits and harms of these interventions, both in the short‐ and long term. This is primarily related to risk of bias, small underpowered studies and limited reporting of important outcomes for people living with disabilities. For people with disabilities, skill training interventions may improve engagement in everyday life in the short term, and improve activity outside the home and health‐related quality of life for people with cognitive impairments in the short term. Still, this is based on low certainty evidence from few studies and should be interpreted with caution. One study with low certainty evidence suggests that physical training interventions may improve activity outside the home in the short term. In addition, the effect sizes across all outcomes were considered small or trivial, and could be of limited relevance to people living with disabilities. The evidence is currently uncertain if there are interventions that can improve outdoor mobility for people with disabilities, and can improve other important outcomes, while avoiding harms. To guide decisions about the use of interventions to improve outdoor mobility, future studies should use more rigorous design and report important outcomes for people with disabilities to reduce the current uncertainty. [ABSTRACT FROM AUTHOR]

Background: Static and dynamic balance skills can be related to the activities of daily living (ADL) in children with non‐syndromic intellectual disabilities, and the type of balance skills affecting ADL can differ depending on the domain of ADL (self‐care, mobility, and social function). Methods: The ADL capabilities of 66 children with intellectual disabilities were assessed using the Pediatric Evaluation of Disability Inventory (PEDI) and were examined in relation to static and dynamic balance skills. Results: Significant positive correlations were found between the one‐leg standing and PEDI (r =.841 for self‐care, r =.700 for mobility, and r =.760 for social function). Our analysis showed that static balance skills affected self‐care, dynamic balance skills affected mobility, and intelligence quotient affected social function. Conclusions: Improving balance skills is important for enhancing ADL capabilities, and the type of balance skills that need enhancement vary based on the domain of ADL. [ABSTRACT FROM AUTHOR]

Objective: To determine the impact of occupational therapy (OT) on the self‐management of function, pain, fatigue, and lived experience for people living with rheumatoid arthritis (RA). Methods: Five databases and gray literature were searched up to June 30, 2022. Three reviewers screened titles and abstracts, with two independently extracting and assessing full texts using the Cochrane risk of bias (quantitative) and Critical Appraisal Skills Programme (qualitative) tools to assess study quality. Studies were categorized into four intervention types. Grading of Recommendations, Assessment, Development and Evaluations (GRADE) (quantitative) and GRADE‐ Confidence in Evidence from Reviews of Qualitative research (qualitative) were used to assess the quality of evidence for each intervention type. Results: Of 39 eligible papers, 29 were quantitative (n = 2,029), 4 qualitative (n = 50), and 6 mixed methods (n = 896). Good evidence supports patient education and behavior change programs for improving pain and function, particularly group sessions of joint protection education, but these do not translate to long‐term improvements for RA (>24 months). Comprehensive OT had mixed evidence (limited to home OT and an arthritis gloves program), whereas limited evidence was available for qualitative insights, splints and assistive devices, and self‐management for fatigue. Conclusion: Although patient education is promising for self‐managing RA, no strong evidence was found to support OT programs for self‐managing fatigue or patient experience and long‐term effectiveness. More research is required on lived experience, and the long‐term efficacy of self‐management approaches incorporating OT, particularly timing programs to meet the individual's conditional needs (i.e., early or established RA) to build on the few studies to date. [ABSTRACT FROM AUTHOR]

Background: Translating knowledge to improve paediatric rehabilitation has become a research area of interest. This study describes the development and evaluation of an online conference that brought together perspectives of individuals with cerebral palsy (CP), families, health care professionals, and researchers to discuss the daily living of individuals with CP. Methods: We anchored the development and implementation of the online conference in the action cycle of the Knowledge to Action Framework. To develop the meeting, we included representatives from each stakeholder group in the programme committee. The conference programme was designed having the lifespan perspective of individuals with CP, from birth to adulthood, as its central core, with themes related to daily living (e.g., self‐care, mobility, and continuing education). Participants' satisfaction with the conference was assessed using an anonymized online survey sent to all participants. Results: The conference had 1656 attendees, of whom 675 answered the online satisfaction survey. Most participants rated the structure of the conference (i.e., quality of the technical support, audio and video, and online platform) and discussed topics (i.e., relevance, content, discussion, speakers, and available time) positively. Conclusion: Collaborative conferences that include stakeholders throughout the planning and implementation are a viable, effective knowledge translation strategy that allows for sharing experiences and disseminating knowledge among families and individuals with CP, health care professionals, and researchers. [ABSTRACT FROM AUTHOR]

Objectives: Oral health problems are common and are associated with various geriatric conditions in older adults. The importance of oral health has not been fully highlighted in the assessment and management of patients with heart failure. Here, we investigated the association between oral health status and the decline in physical function during hospitalization in elderly patients with acute heart failure. Materials and Methods: We evaluated oral health using the revised oral assessment guide in 77 patients aged 65 years or older who were admitted to hospital for acute heart failure. Oral health problems were defined as a revised oral assessment guide score ≥9. Results: Oral health problems were identified in 66.2% of the patients. Patients with oral health problems had high prevalence of decreased physical function, undernutrition, and cognitive impairment. A reduction in the Barthel Index, as an indicator of activities of daily living during hospitalization, was significant in the enrolled patients. The Barthel Index decreased more in patients with oral health problems than those with normal oral health. Furthermore, the revised oral assessment guide score on admission was found to be the only independent predictor of changes in the Barthel Index during hospitalization in the multivariate analyses. Conclusions: Oral assessment using the revised oral assessment guide during hospitalization could provide useful information for the management of elderly heart failure patients. [ABSTRACT FROM AUTHOR]

Age‐related alterations in physiology lead to declines in physical function that are associated with numerous adverse outcomes among older adults. Utilizing a hybrid design, we aimed to understand whether both long‐term and short‐term Tai Chi (TC) training are associated with age‐related decline in physical function in healthy older adults. We first conducted cross‐sectional comparisons among TC‐naïve older adults (n = 60, 64.2 ± 7.7 years), TC‐expert older adults (n = 27, 62.8 ± 7.6 years, 24.5 ± 12 years experience), and TC‐naïve younger adults (n = 15, 28.7 ± 3.2 years) to inform long‐term effects of TC training on physical function, including single leg stance time with eyes closed, grip strength, Timed Up and Go, maximum walking speed, functional reach, and vertical jump for lower‐extremity power. There were significant differences among the three groups on all the six tests. For most functional tests, TC‐experts performed better than age‐matched TC‐naïve controls and were statistically indistinguishable from young healthy adult controls. Long‐term TC training was associated with higher levels of physical function in older adults, suggesting a potential preventative healthy aging effect. In the randomized longitudinal trial, TC‐naïve subjects were randomized (n = 31 to Tai Chi group, n = 29 to usual care control group) to evaluate the short‐term effects of TC over 6 months on all outcomes. TC's short‐term impacts on physical function were small and not statistically significant. The impact of short‐term training in healthy adults is less clear. Both potential longer‐term preventive effects and shorter‐term restorative effects warrant further research with rigorous, adequately powered controlled clinical trials. [ABSTRACT FROM AUTHOR]

Issues Addressed: To (i) determine the prevalence of health risk factors (physical activity, diet, alcohol, smoking, blood pressure medication use and mental health) in community‐dwelling stroke survivors; and (ii) examine how these health risk factors cluster, and identify associations with physical functioning, independent living, or sociodemographic factors. Methods: A secondary analysis of data obtained during a national randomised controlled trial. Participants had experienced stroke and completed a baseline telephone survey on demographic and stroke characteristics, health risk factors, physical functioning and independence in activities of daily living. A latent class analysis was performed to determine health risk profiles. Univariate logistic regressions were performed to identify if participant characteristics were associated with resulting classes. Results: Data analysed from 399 participants. Two classes of health risk factors were identified: Low Mood, Food & Moves Risk (16% of participants) and Alcohol Use Risk (84% of participants). The Low Mood, Food & Moves Risk group had poorer diet quality, lower physical activity levels and higher levels of depression and anxiety. Lower levels of independence and physical functioning were predictor variables for this group. In contrast, the Alcohol Use Risk group had better physical activity and diet scores, significantly lower probability of depression and anxiety, but a higher probability of risky drinking. Conclusions: We identified two distinct health risk factor groups in our population. So What?: Future interventions may benefit from targeting the specific needs and requirements of people who have experienced stroke based on their distinct risk group. Alcohol consumption in poststroke populations requires further attention. [ABSTRACT FROM AUTHOR]

Background: According to a biopsychosocial approach to health and disability, participation at home and functional skills are important components of the functioning. Therefore, knowledge about interactions between these components allows for targeting specific interventions. Objective: This study investigated whether participation opportunities (frequency and involvement) for children/adolescents with Down syndrome (DS) in a realistic environment at their own home are associated with the functional skills related to the domains of Daily Activities, Mobility, Social/Cognitive and Responsibility. Methods: This was an observational study. Forty‐eight children/adolescents with DS participated (mean age: 10.73 ± 3.43; n = 27 females). Participants were evaluated using the Participation and Environment Measure for Children and Youth (PEM‐CY) home environment setting (raw frequency and engagement scores) and Pediatric Evaluation of Disability Inventory speedy version (PEDI‐CAT‐SV) (continuous score). Results: Significant and positive correlations were found between the frequency of participation at home with Daily Activities (ro = 0.320), Social/Cognitive (ro = 0.423) and Responsibility (ro = 0.455). For involvement, significant and positive correlations were found with Daily Activities (ro = 0.297), Social/Cognitive (ro = 0.380) and Responsibility (ro = 0.380). For the PEDI‐CAT‐SV Mobility, no significant correlation was found. Conclusions: Higher frequency and involvement of participation at home are associated with greater functional skills assessed, except for Mobility. This study provided pioneering insights about the relationships between the level of home participation and functional skills in DS, generating evidence that could guide approaches to participation‐focused intervention. [ABSTRACT FROM AUTHOR]

Background: The increasing prevalence of obesity is a global issue with the World Health Organization estimating that more than 650 million adults are impacted by obesity. Those living with obesity are impacted by both physical and psychological issues. The physical consequences of living with obesity can lead to decreased mobility and reduced occupational participation. The aim of this research is to understand how the use of a powered mobility device influences occupational participation and quality of life from the perspective of people with obesity. Method: Semi‐structured qualitative interviews (n = 7) were undertaken with a phenomenological approach to gain an understanding of the lived experience of using a powered mobility device. Results: Thematic analysis occurred resulting in inter‐connected themes that describe the positive experiences associated with using a powered mobility device: (1) autonomous mobility; (2) enhanced occupational participation; and (3) improved self‐efficacy creates increased confidence in relation to participation. In addition, two themes emerged that were barriers to usage of powered mobility devices: (4) physical environmental barriers and (5) difficulty transporting the powered mobility device. Conclusion: For those with obesity, a powered mobility device provided autonomous mobility allowing them to engage in an increased range of activities. This was hampered by physical environmental barriers and difficulties transporting the powered mobility device. Further research is required to verify the results of this study with a wider population and to explore the benefits and barriers to use of a powered mobility device in the home and community. [ABSTRACT FROM AUTHOR]

Aim: Life-space mobility (LSM) restriction is a serious issue among older adults using home-visit rehabilitation (HR). This study evaluated physical function, transportation, and other factors not comprehensively tested in previous studies and examined factors associated with the restriction of LSM among older adults using HR. Methods: This cross-sectional multi-center study recruited 88 HR users (49 men, 39 women, mean age 79.0 [-7.8] years) living in urban and rural areas from August to October 2020. We administered the Life-Space Assessment (LSA), the Self-Efficacy Scale on Going out among community-dwelling Elderly (SEGE), grip strength, a 30-s chair stand test, Bedside Mobility Scale, Functional Independence Measure, Frenchay Activities Index (FAI), Ikigai-9, and Home and Community Environment (HACE) test. Participants were divided into two groups based on the cut-off value of the LSA scores. In the logistic regression analysis, the dependent variable was LSA scores =30, and the independent variables were measured based on objective evaluation items and adjusted for confounding factors (age, sex, and frequency of use of day-care services). Results: Restriction of LSM was significantly associated with FAI (odds ratio [OR] = 0.817, 95% confidence interval [CI] = 0.706-0.945), HACE facilitators (OR = 1.558, 95% CI = 1.168-2.079), and living alone (OR = 12.822, 95% CI = 1.202-136.716). Conclusion: Restriction of LSM is associated with environmental factors, such as assistive devices and household composition, and ability to engage in instrumental activities of daily living. Our findings indicate a great need for focusing on these factors among home-care older adults receiving HR. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to identify nursing interventions and activities for patients with multiple traumas who have variations in physical mobility. Methods: We used integrative literature review following Whittemore and Knafl method and the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses' guidelines and adopting the Oxford Center for Evidence‐Based Classification Medicine – Levels of Evidence. The data collection was carried out between October and December 2019 and updated in May 2022, in the following databases: Virtual Health Library, Cochrane Library, Excerpta Medica dataBASE, Medical Literature Analysis and Retrieval System Online, PubMed®, SciVerse Scopus, The Cumulative Index to Nursing and Allied Health Literature, and Web of Science. Findings: There were 103 articles to be fully read and evaluated. From these, 34 publications were selected. Most nursing interventions and activities identified were placed in the NIC class Activity and Exercise Management in the Physiological: Basic domain, which has interventions to organize or to assist with physical activity, energy conservation, and expenditure; followed by Elimination Management (interventions to establish and maintain regular bowel and urinary elimination patterns and manage complications due to altered patterns); Immobility Management (interventions to manage restricted body movement and the sequelae); Nutrition Support (interventions to modify or maintain nutritional status); Physical Comfort Promotion (interventions to promote comfort using physical techniques); and Self‐Care Facilitation (interventions to provide or assist with routine activities of daily living). Conclusions: The interventions and nursing activities found in this research were not only related to the change in mobility in victims of multiple traumas but also aimed to prevent the consequences of immobility and to take care of already established conditions. Implications for the nursing practice: This research enables the taxonomy's development and the validation of interventions for selected groups of patients. This allows the contribution to the development of the NIC—an important resource to improve nursing practice in teaching, research, and care. [ABSTRACT FROM AUTHOR]

Background: Orthopedists and other clinicians assess recovery potential of hip fracture patients at 2 months post‐fracture for care planning. It is unclear if examining physical performance (e.g., balance, gait speed, chair stand) during this follow‐up visit can identify individuals at a risk of poor functional recovery, especially mobility, beyond available information from medical records and self‐report. Methods: Data came from 162 patients with hip fracture enrolled in the Baltimore Hip Studies‐7th cohort. Predictors of mobility status (ability to walk 1 block at 12 months post‐fracture) were the Short Physical Performance Battery (SPPB) comprising balance, walking and chair rise tasks at 2 months; baseline medical chart information (sex, age, American Society of Anesthesiologist physical status rating, type of fracture and surgery, and comorbidities); and self‐reported information about the physical function (ability to walk 10 feet and 1 block at pre‐fracture and at 2 months post‐fracture). Prediction models of 12‐month mobility status were built using two methods: (1) logistic regression with least absolute shrinkage and selection operator (LASSO) regularization, and (2) classification and regression trees (CART). Area under ROC curves (AUROC) assessed discrimination. Results: The participants had a median age of 82 years, and 49.3% (n = 80) were men. Two‐month SPPB and gait speed were selected as predictors of 12‐month mobility by both methods. Compared with an analytic model with medical chart and self‐reported information, the model that additionally included physical performance measures had significantly better discrimination for 12‐month mobility (AUROC 0.82 vs. 0.88, p = 0.004). Conclusion: Assessing SPPB and gait speed at 2 months after a hip fracture in addition to information from medical records and self‐report significantly improves prediction of 12‐month mobility. This finding has important implications in providing tailored clinical care to patients at a greater risk of being functionally dependent who would not otherwise be identified using regularly measured clinical markers. [ABSTRACT FROM AUTHOR]

Background and Purpose: Patients with Duchenne muscular dystrophy (DMD) change their movement patterns to compensate for muscle weakness. The Duchenne Video Assessment (DVA) measures ease of movement through evaluation of compensatory movements. The DVA directs caregivers to video record patients performing home‐based movement tasks using a mobile application, and DVA‐certified physical therapists evaluate the videos using scorecards with prespecified compensatory movement criteria. Two qualitative interview studies were conducted to select movement tasks for the DVA that are relevant to patients with DMD and able to reflect changes in function. Methods: Qualitative interviews with eligible physical therapists were conducted remotely. Physical therapists were asked to spontaneously suggest movement tasks prior to evaluating specific movement tasks selected a priori. Analysts conducted a content analysis to investigate whether movement tasks selected a priori were confirmed as relevant to the population of interest and able to show changes in function. Results: The studies included five physical therapists to select tasks for ambulatory patients with DMD and six for non‐ambulatory patients. For an ambulatory population, all five experts confirmed Climb Five Stairs, Run, Stand Up from Sitting, Sit Up from Supine, and Jump Forward, and four (80%) confirmed Walk as relevant and able to show functional changes. For a non‐ambulatory population, all six experts confirmed Eat 10 Bites, Roll Over in Bed, Shift Weight in Bed, Take T‐Shirt Off, Put T‐Shirt On, Put Arms on Armrest, and Reach Across Table to Grab Cell Phone, and five (83%) confirmed Raise Hands Above Head as relevant and able to show functional changes. Discussion: Physical therapists confirmed the DVA movement tasks as relevant to patients with DMD and able to reflect changes in function. The use of the DVA in clinical trials provides an opportunity to collect data not seen in clinic and reduce travel burden for families. [ABSTRACT FROM AUTHOR]

The article explores the efficacy of a combination of functional exercise training and promyogenic therapy for the prevention and treatment of mobility-disability in older adults. It describes the characteristics of traditional progressive resistance exercise training and functional exercise training. It highlights pharmacological function-promoting promyogenic therapies such as testosterone, nonsteroidal selective androgen receptor modulators, and growth hormone secretagogues.

Aim: To assess the feasibility and applicability of a standardized programme to facilitate family participation in essential care activities in the intensive care unit. Design: Pilot study with a cross‐sectional survey design. Methods: A standardized programme to facilitate family participation in essential nursing care activities was implemented in intensive care units of three hospitals in the Netherlands from November 2018 until March 2019. The feasibility and applicability of the programme were assessed with surveys of the patients, relatives and healthcare providers. Results: Three intensive care units successfully implemented the standardized programme. Three patients, ten relatives and 37 healthcare providers responded to the surveys. Patients appreciated family participation and recognized that their relatives liked to participate. Relatives appreciated being able to do something for the patient (80%) and to participate in essential care activities (60%). The majority of relatives (60%) felt they had sufficient knowledge and skills to participate and did not feel obliged nor uncomfortable. Healthcare providers felt they were trained adequately and motivated to apply family participation; application was perceived as easy, clear and relatively effortless according to the majority. According to 68% of the healthcare providers, most relatives were perceived to be capable of learning to participate in essential care activities. Some healthcare providers felt uncertain about the patient's wishes regarding family participation, with some indicating the behaviours of relatives and patients discouraged them from offering family participation. Use of a standardized programme to facilitate family participation in essential care activities in the intensive care unit seems feasible and applicable as determined by relatives and healthcare providers. [ABSTRACT FROM AUTHOR]

Introduction: The World Haemophilia Federation advises regular musculoskeletal assessment covering all International Classification of Functioning and Health (ICF) domains, including limitations in activities and participation in persons with haemophilia (PWH). This enables clinicians to detect changes early and enable adjustments in personalized healthcare when needed. However, data on the course of physical functioning and occurrence of decline is lacking. The aim of this study is to describe changes in perceived limitations in activities of PWH and to identify factors associated with a change. Methods: Data were collected from medical health records of regular check‐up visits of adults with moderate and severe haemophilia in two time periods. Perceived limitations in activities was measured with the Haemophilia Activities List (HAL). Association between variables (e.g., age, body mass index, bleeding rate and synovitis) and change in perceived limitations was assessed using a generalized linear model. Results: A total of 104 PWH were included. At T0, the median HAL sum score was 79.5 (IQR 62.1–93.6) and at T1 the median HAL sum score was 74.2 (IQR 57.5–88.3). A functional decline was found in 35.6% of PWH, 55.8% remained stable and 8.7% improved. Among other variables, a BMI > 30 kg/m2 appeared to be an important factor that negatively influenced the change in perceived functioning in adult PWH. With the included factors we could only explain a small part of this decline (R2adj:.12). Conclusion: The majority of PWH remained stable in their perceived functional ability over mid‐long term (median 3.5 years). However, about a third showed a clinical relevant decline in their functional ability. [ABSTRACT FROM AUTHOR]

Background: The prevalence of obesity has risen in recent decades and reached epidemic proportions worldwide. The proportion of those living with obesity is also increasing in nursing homes. This could impact the nursing care required, equipment and facilities provided, and morbidity in these settings. Limited evidence exists on clinical consequences of obesity in nursing home residents and their care. Objective: Therefore, the aim was to examine the rate and associated factors of obesity (BMI ≥30; class I (BMI 30.0–34.9 kg/m2), class II (BMI 35.0–39.9 kg/m2), and class III (BMI >40.0 kg/m2)) amongst older nursing home residents in European countries. Methods: We analysed data from 21,836 people who reside in nursing homes in Austria, the Netherlands, and the United Kingdom. They participated in the "International Prevalence Measurement of Care Quality", a cross sectional study between 2016 and 2019, where trained nurses interviewed the residents, reviewed care records, and conducted clinical examinations. A tested and standardised questionnaire comprised questions on demographic data, measured BMI, medical diagnosis according to ICD‐10, and care dependency. Descriptive and logistic regression analyses were performed. Results: Obesity rates were highest in Austria (17.1%) and lowest in the UK (13.0%) (p =.006). Residents with obesity were younger and less likely to be care dependent or living with dementia and had more often diabetes mellitus, endocrine, metabolic, and skin diseases compared to residents without obesity (p <.05). Most obese residents had obesity class I. Therefore, two subgroups were built (class I vs. class II + III). Residents with obesity class II + III were more frequently care dependent for mobility, getting dressed and undressed, and personal hygiene compared to residents with class I (p <.05). Conclusions: This study identified several factors that are associated with obesity amongst older nursing home residents in selected European countries. Implications for practice: The division into obesity classes is important for planning targeted care according to the individual needs of nursing home residents. [ABSTRACT FROM AUTHOR]

Background: Life‐space mobility represents the distance, frequency, and independence of mobility, ranging from one's bedroom to beyond their town. Older men with lower urinary tract symptoms (LUTS) may limit their life‐space to stay close to a bathroom. However, it's unknown whether LUTS severity or urinary bother are associated with risk of life‐space mobility restriction. Methods: We analyzed data from 3025 community‐dwelling men age ≥71 years without life‐space mobility restriction at analytic baseline (Year 7) of the Osteoporotic Fractures in Men (MrOS) study. The American Urologic Association Symptom Index (AUASI) was assessed at baseline and includes one question assessing urinary bother ("If you were to spend the rest of your life with your urinary condition just the way it is now, how would you feel about that?"; score 0–1,2,3,4–6) and seven items to classify LUTS severity as none/mild (score 0–7), moderate (8–19), or severe (20–35). The University of Alabama Life‐space Assessment was used to define life‐space mobility restriction (≤60) at baseline and follow‐up (Year 9). We used log‐binomial regression with robust variance estimators to model adjusted risk ratios (ARR) for LUTS severity and urinary bother with incident life‐space mobility restriction, controlling for age, site, health‐related factors, and comorbidities. We then mutually adjusted for urinary bother and LUTS severity. Results: Overall, the 2‐year risk of life‐space mobility restrictions was 9.9%. Compared to men without urinary bother (scores 0–1), the risk of life‐space mobility restriction was significantly higher among men with bother scores of 4–6 (ARR = 2.20, 95% CI: 1.52, 3.19), independent of LUTS severity and confounders. Conversely, LUTS severity was not independently associated with the risk of life‐space mobility restriction. Conclusions: Urinary bother, but not LUTS severity, is independently associated with incident life‐space mobility restriction among older men. To maintain life‐space mobility in older men with LUTS, future studies should identify shared mechanisms and interventions that minimize urinary bother. [ABSTRACT FROM AUTHOR]

Aim: Analysis of the concepts and development of a conceptual definition of being wheelchair‐bound and being bedridden. Design: Concept analysis. Methods: Walker and Avant´s concept analysis method was used. A thematic analysis guided the determination of the attributes, antecedents and consequences. Results: Being wheelchair‐bound and being bedridden are defined as permanent states in which people are bound to an object. Being passively bound to a wheelchair and being bedridden both mean an increasing restriction of the life‐space. Being passive wheelchair‐bound often represents a preliminary stage to being bedridden. Both concepts have six attributes: in need of help, powerlessness, life‐space confinement, mobility limitation, endurance and weakness. They differ in the main feature maintaining an independent sitting position. Physical immobility and physiological instability are antecedents with the following influencing factors: illness, complexity, burden, endogenous/exogenous booster. The consequences are the progression of inactivity and all related physical and psycho‐social problems. [ABSTRACT FROM AUTHOR]

Introduction: There are an increasing number of individuals with long‐term symptoms of coronavirus‐19 disease (COVID‐19); however, the prognosis for recovery of physical function and fatigue after COVID‐19 is uncertain. Objective: To report the changes in functional recovery between 1 and 6 months after hospitalization of adults hospitalized for COVID‐19 and explore the baseline factors associated with physical function recovery. Design: A prospective cohort study. Setting: Tertiary care hospital. Participants: U.S. adult COVID‐19 survivors. Intervention: N/A. Main Outcome Measures: Telephone interviews assessed three outcome domains: basic and instrumental activities of daily living (ADLs) performance, fatigue, and general physical function (Health Assessment Questionnaire [HAQ]). Results: The age of participants (n = 92) ranged from 22 to 95 years (54.3 ± 17.2). Across outcome domains, a majority (63%–67%) of participants developed new ADL impairment, fatigue, or worsening HAQ severity by 1 month. Of those, 50%–79% partially or fully recovered by 6 months, but 21%–50% did not recover at least partially. Fifteen to 30% developed new impairment between 1 and 6 months. For those without any improvement in ADL impairments at 6 months, lower socioeconomic status was significantly more common (p =.01) and age ≥ 65 (p =.06), trending toward being more common. Conclusion: In this cohort, a substantial proportion of the participants who developed new ADL impairment, worsening fatigue, or HAQ severity after hospitalization for COVID‐19 did not recover at least partially by 6 months after discharge. Evaluating functional status 1 month after discharge may be important in understanding functional prognosis and recovery after hospitalization for COVID‐19. [ABSTRACT FROM AUTHOR]

Objective: Patient‐provider discussions about functioning are often outside the scope of usual care for systemic lupus erythematosus (SLE), and tools to facilitate such discussions are lacking. The present study was undertaken to assess the comprehension, utility, and acceptability of a novel, individualized functioning report, the purpose of which is to facilitate patient–provider communication about functioning, in a predominantly Black SLE patient population. Methods: Individualized reports (including sections with pictorial representations of participants' measured activities of daily living, falls, physical performance, perceived physical functioning, and community mobility from a previous pilot study visit) and surveys were emailed or mailed to 59 SLE patients. Ease of interpretation was dichotomized ("very easy" versus all other responses). Utility and acceptability were assessed by items relating to usefulness for care planning and comfort with discussing the report. Results: Among 47 (79.7%) SLE patients who completed the survey (78.7% Black, 91.5% female, mean age 49.6 years), the reported ease of interpretation ranged from 70.2% to 85.1% across the report sections. Ease of interpretation was lower among those who were older, Black, and female and who had lower cognitive scores (P > 0.05 for all). Most reported that physical functioning domains of the report were useful for treatment or other care planning (70.2–80.5%) and that they felt comfortable discussing the report with a health care provider (93.2–100%). Conclusion: We found that a novel functioning report for SLE patients was associated with high comprehension, utility, and acceptability. Future studies can help determine how an individualized functioning report could improve patient–provider communication in the clinic setting. [ABSTRACT FROM AUTHOR]

Background: Many clinical and financial decisions for older adults depend on the future risk of disability and mortality. Prognostic tools for long‐term disability risk in a general population are lacking. We aimed to create a comprehensive prognostic tool that predicts the risk of mortality, of activities of daily living (ADL) disability, and walking disability simultaneously using the same set of variables. Methods: We conducted a longitudinal analysis of the nationally‐representative Health and Retirement Study (HRS). We included community‐dwelling adults aged ≥70 years who completed a core interview in the 2000 wave of HRS, with follow‐up through 2018. We evaluated 40 predictors encompassing demographics, diseases, physical functioning, and instrumental ADLs. We applied novel methods to optimize three models simultaneously while prioritizing variables that take less time to ascertain during backward stepwise elimination. The death prediction model used Cox regression and both the models for walking disability and for ADL disability used Fine and Gray competing‐risk regression. We examined calibration plots and generated optimism‐corrected statistics of discrimination using bootstrapping. To simulate unavailable patient data, we also evaluated models excluding one or two variables from the final model. Results: In 6646 HRS participants, 2662 developed walking disability, 3570 developed ADL disability, and 5689 died during a median follow‐up of 9.5 years. The final prognostic tool had 16 variables. The optimism‐corrected integrated area under the curve (iAUC) was 0.799 for mortality, 0.685 for walking disability, and 0.703 for ADL disability. At each percentile of predicted mortality risk, there was a substantial spread in the predicted risks of walking disability and ADL disability. Discrimination and calibration remained good even when missing one or two predictors from the model. This model is now available on ePrognosis (https://eprognosis.ucsf.edu/alexlee.php) Conclusions: Given the variability in disability risk for people with similar mortality risks, using individualized risks of disabilities may inform clinical and financial decisions for older adults. [ABSTRACT FROM AUTHOR]

Introduction: With improved HIV treatment availability in sub‐Saharan Africa, the population of older people with HIV (PWH) is growing. In this qualitative study, we intended to understand (1) the lived experiences of ageing people in rural Uganda, with and without HIV, (2) their fears and health priorities as they grow older. Methods: We conducted 36 semi‐structured interviews with individuals with and without HIV in Mbarara, Uganda from October 2019 to February 2020. Interview guide topics included priorities in older age, physical functioning in daily activities, social functioning, HIV‐related stigma and the impact of multimorbidity on health and independence. Interviews were conducted in Runyankole, transcribed, translated and inductively coded thematically by two researchers with tests for inter‐coder reliability. Results: The respondents were purposively sampled to be evenly divided by sex and HIV serostatus. The median age of respondents was 57 (49–73). Two‐thirds were married or cohabitating, 94% had biological children and 75% cited farming as their primary livelihood. Overall, PWH considered themselves as healthy or healthier than people without HIV (PWOH). PWH rarely considered their HIV status a barrier to a healthy life, but some reported a constant sense of anxiety as it relates to their long‐term health. Irrespective of HIV status, nearly all respondents noted concerns about memory loss, physical pain, reductions in energy and the effect of these changes on their ability to complete physical tasks like small‐scale farming, and activities of daily living important to the quality of life, such as participating in community groups. Increasing reliance on others for social, physical and financial support was also a common theme. The most prevalent health concern among participants involved the threat of non‐communicable diseases and perceptions that physical functioning may diminish. Conclusions: In rural Uganda, we found that PWH consider themselves to be healthy and do not anticipate a different ageing experience from PWOH. Common priorities shared by both groups included the desire for physical and financial independence, health maintenance and social support for daily functioning and social needs. Entities supporting geriatric care in Uganda would benefit from attention to concerns about functional limitations and reported needs as people age with and without HIV. [ABSTRACT FROM AUTHOR]

Background: There is a dearth of studies examining the associations of objectively measured dual sensory impairment (DSI) with incident mobility and activities of daily life (ADL) difficulty longitudinally. Methods: Cox proportional hazards models were used to examine the associations of DSI and single sensory impairment (hearing, vision) with incident mobility difficulty (many problems or inability to walk ¼ mile and/or climb 10 steps) and ADL difficulty up to six years of follow‐up among 2020 participants of the Health, Aging, and Body Composition Study, a cohort of older adults aged 70–79 years from Pittsburgh, PA and Memphis, TN. Vision impairment (VI) was defined as impaired visual acuity (20/50 or worse on Bailey‐Lovie distance test) and contrast sensitivity (<1.3 log units on Pelli‐Robson test), and hearing impairment (HI) was defined as pure‐tone average in better‐hearing ear >25 decibels. Models were adjusted by age, race, sex, education, diabetes, depressive symptoms, hypertension, gait speed from 20‐meter walk, global cognition score, prevalent cardiovascular disease, and body mass index. Results: There were 23% with DSI (n = 459). DSI was associated with increased risk of both incident report of mobility (hazard ratio [HR] = 2.25, 95% confidence interval [CI]: 1.47, 3.43), and ADL difficulty (HR = 2.26, 95% CI: 1.50, 3.40). Neither VI nor HI alone was associated with risk of either outcome. Conclusions: DSI is associated with increased risk of incident mobility and ADL difficulty. Rehabilitation and adaptive environmental changes for individuals living with DSI may be important to maximize mobility and daily function. [ABSTRACT FROM AUTHOR]

The incidence of aortic stenosis (AS) increases with age and is a serious problem in an aging society. In recent years, transcatheter aortic valve implantation (TAVI) has been performed widely; however, older patients may be ineligible for TAVI or surgical treatment because of medical ineligibility. Symptom‐based rehabilitation is required for these patients to maintain and improve their physical function and ability to perform activities of daily living. No studies have examined exercise safety for older patients with severe AS who are ineligible for TAVI or surgery. We summarized the safety of exercise for older patients with severe AS, collecting 7 studies on maximal exercise stress tests and 16 studies on preoperative physical examinations. From this review, it may be unlikely that exercise under appropriate management can cause hemodynamic changes, leading to death. However, there were no studies on exercise intervention for older patients with AS who are chosen for conservative management. The optimal exercise intensity for symptomatic older patients with AS undergoing conservative management and the effects of continuous exercise intervention require future study. [ABSTRACT FROM AUTHOR]

Background: Lower urinary tract symptoms (LUTS) are associated with frailty phenotype, a risk factor for functional decline. Our objective was to determine the association between baseline LUTS and 2‐year risk of new functional limitation among older men. Methods: We analyzed data from the Osteoporotic Fractures in Men (MrOS) study with baseline at Year 7 and follow‐up through Year 9. Participants included 2716 community‐dwelling men age ≥ 71 years without any baseline self‐reported functional limitation. LUTS severity (American Urologic Association Symptom Index) was classified as none/mild (score 0–7), moderate (8–19), and severe (20–35). At baseline and follow‐up, men reported their ability to complete several mobility, activities of daily living (ADLs), and cognition‐dependent tasks. Risk was estimated for 3 incident functional limitation outcomes: (1) mobility (any difficulty walking 2–3 blocks or climbing 10 steps), (2) ADL (any difficulty bathing, showering, or transferring), and (3) cognition‐dependent (any difficulty managing money or medications). We used Poisson regression with a robust variance estimator to model adjusted risk ratios (ARR) and 95% CIs controlling for age, site, and comorbidities; other demographic/lifestyle factors did not meet criteria for inclusion. Results: Overall, the 2‐year risk was 15% for mobility, 10% for ADLs, and 4% for cognition‐dependent task limitations. Compared to none/mild LUTS, risk of incident mobility limitations was increased for moderate (ARR = 1.35, 95% CI: 1.12, 1.63) and severe LUTS (ARR = 1.98, 95% CI: 1.48, 2.64). Men were also at higher risk for incident ADL limitations if they reported moderate (ARR = 1.32, 95% CI: 1.05, 1.67) and severe LUTS (ARR = 1.62, 95% CI: 1.07,2.43). Results were somewhat attenuated after adjusting for the frailty phenotype but remained statistically significant. LUTS were not associated with incident cognition‐dependent task limitations. Conclusions: LUTS severity is associated with incident mobility and ADL limitations among older men. Increased clinical attention to risk of functional limitations among older men with LUTS is likely warranted. [ABSTRACT FROM AUTHOR]

A correction to the article "Changes in Older Adults' Life Space During Lung Cancer Treatment: A Mixed Methods Cohort Study" that was published in a 2022 issue is presented.

Objectives: To identify published evidence on person-centered outcome measures (PCOMs) used in dementia care and to explore how PCOMs facilitate shared decisionmaking and improve outcomes of care. To build a logic model based on the findings, depicting linkages with PCOMimpact mechanisms and care outcomes. Design: Mixed-methods systematic review. We searched PsycINFO, MEDLINE, CINAHL, and ASSIA from databases and included studies reporting experiences and/or impact of PCOM use among people with dementia, family carers, and/or practitioners. Groen Van de Ven's model of collaborative deliberation informed the elements of shared decision-making in dementia care in the abstraction, analysis, and interpretation of data. Data were narratively synthesized to develop the logic model. Setting: Studies were conducted in long-term care, mixed settings, emergency department, general primary care, and geriatric clinics. Participants: A total of 1064 participants were included in the review. Results: Ten studies were included. PCOMs can facilitate shared decision-making through "knowing the person," "identifying problems, priorities for care and treatment and goal setting," "evaluating decisions", and "implementation considerations for PCOM use." Weak evidence on the impact of PCOMs to improve communication between individuals and practitioners, physical function, and activities of daily living. Conclusions: PCOMs can enable shared decision-making and impact outcomes through facilitating collaborative working between the person's network of family and practitioners to identify and manage symptoms and concerns. The constructed logic model demonstrates the key mechanisms to discuss priorities for care and treatment, and to evaluate decisions and outcomes. A future area of research is training for family carers to use PCOMs with practitioners. [ABSTRACT FROM AUTHOR]

Aim: Chronic kidney disease (CKD) is an important public health problem. Recently, CKD has been found to be associated with poor physical functioning in community‐dwelling elderly individuals. However, the physical functioning of non‐dialysis (ND) patients with advanced CKD treated by nephrologists is unknown. Methods: Patients with ND‐CKD stage G3b‐5 who participated in a nationwide Reach‐J CKD cohort study were included in this study. Physical functioning and physical activity were assessed by the Katz Index, Lawton‐Body instrumental activities of daily living (IADL) scale, and Rapid Assessment of Physical Activity questionnaire of the international CKD Outcomes and Practice Patterns Study (CKDopps) questionnaires. Dichotomies between good and poor physical functioning and physical activity scores were explored. Results: Among 1628 patients, 84.3% had good physical functioning. Poor physical functioning was more common with older age (p <.001), higher CKD stage (p <.05), and comorbid conditions such as diabetes (p <.001), cardiovascular disease (p <.05), cerebrovascular disease (p <.001), and cancer (non‐skin) (p <.05). Forty percent of the patients were inactive. Physical inactivity was more common with older age (p <.001) and higher CKD stage (p <.001). Conclusion: A minority, but sizeable proportion of patients with advanced CKD treated by nephrologists in Japan have some disability in ADLs/IADLs. Nephrologists need to routinely assess the physical functioning and physical activity of patients with advanced CKD to provide individualized guidance and comprehensive support to these patients for their daily life. SUMMARY AT A GLANCE: Among non‐dialysis stage G3b‐5 subjects, poor physical functioning was more common with older age, higher CKD stage, and comorbid conditions such as diabetes, cardiovascular disease, cerebrovascular disease, and cancer (non‐skin). The study stressed the need for nephrologists to routinely assess the physical functioning and physical activity of patients with advanced CKD to provide individualized guidance and comprehensive support for their daily life. [ABSTRACT FROM AUTHOR]

Objective: Lifespace, the physical area in which someone conducts life activities, indicates lived community mobility. This study explored the feasibility of technology‐based lifespace measurement for older people with dementia and mild cognitive impairment (MCI), including the generation of a range of lifespace metrics, and investigation of relationships with health and mobility status. Methods: An exploratory study was conducted within a longitudinal observational study. Eighteen older adults (mean age 86.7 years (SD: 3.2); 8 men; 15 MCI), participated. Lifespace metrics were generated from geolocation data (GPS and Bluetooth beacon) collected through a smartphone application for one week (2015–2016). Cognitive and mobility‐related outcomes were compared from study data sets at baseline (2005–2007) and 6‐year follow‐up (2011–2014). Results: Lifespace data could be collected from all participants, and metrics were generated including percentage of time at home, maximum distance from home, episodes of travel in a week, days in a week participants left home, lifespace area (daily, weekly and total), indoor lifespace (regions in the home/hour), and a developed lifespace score that combined time, frequency of travel, distance and area. Results indicated a large range of lifespace areas (0.1 – 97.88 km2; median 6.77 km2) with similar patterns across lifespace metrics. Significant relationships were found between lifespace metrics and concurrent driving status and anteceding scores on the sit‐to‐stand test (at baseline and follow‐up). Conclusions: Further longitudinal exploration of lifespace is required to develop an understanding of the nature of lifespace of older community‐dwelling people, and its relationship with health, mobility and well‐being outcomes. [ABSTRACT FROM AUTHOR]

Background: Understanding the physical and mental changes in community‐dwelling elderly people is very important during the coronavirus disease 2019 (COVID‐19) pandemic when considering preventive measures. The purpose of this study was to clarify the changes of physical function and anxiety for activities of daily living in community‐dwelling older adults, focusing on locomotor function during the COVID‐19 pandemic. Methods: The study participants were 127 older people who participated in successive surveys, in the summers of 2019 and again in 2020, after the state of emergency. The Locomo 25 questionnaire, Geriatric Depression Scale‐15 (GDS‐15) questionnaire, medical history, and number of people living together were self‐reported. The Locomo 25 covers six aspects of physical pain, movement‐related difficulty, usual care, daily activity, social activities, and anxiety. Results: The paired samples t‐test revealed that Locomo 25 total scores in 2020 were significantly higher than those in 2019. The GDS‐15 score showed no significant difference. The comparison of scores for each item of the Locomo 25 revealed significantly higher scores in 2020 on Q21 ('difficult to perform sports activity', P = 0.0021), Q22 ('restricted from meeting own friends', P < 0.001), Q23 ('restricted from joining social activities', P < 0.001), Q24 ('anxious about falling in own house', P = 0.0023), and Q25 ('anxious about being unable to walk in the future', P = 0.0016). Conclusions: About 2 months after declaration of the first state of emergency due to the COVID‐19 pandemic in Japan, social activity was severely restricted. Older adults showed almost no changes in body pain and locomotive disabilities, but increases in their anxieties about walking ability and falling were remarkable. [ABSTRACT FROM AUTHOR]

The article quantifies the extent that functional limitations are captured in a national pool of structured electronic health record (EHR) data. Topics discussed include lack of standardization in EHR documentation of function, reasons why structured EHR data are poor source of information, and possible solutions to improve EHR data on functional limitations.

Aging is often associated with a decline in physical function that eventually leads to loss of autonomy in activities of daily living (ADL). Walking is a very common ADL, important for main determinants of quality of life in older age, and it requires the integration of many physiological systems. Gait speed has been described as the 'sixth vital sign' because it is a core indicator of health and function in aging and disease. We reviewed original studies up to June 2020 that assessed frailty in both longitudinal and cross‐sectional observational studies, paying particular attention to how gait is measured in older population and how the gait parameter adopted may influence the estimated frailty models and the health‐related outcomes of the various studies (i.e. clinical, cognitive, physical, and nutritional outcomes). Eighty‐five studies met the search strategy and were included in the present systematic review. According to the frailty tools, more than 60% of the studies used the physical phenotype model proposed by Fried and colleagues, while one‐third referred to multi‐domain indexes or models and only 5% referred to other single‐domain frailty models (social or cognitive). The great heterogeneity observed in gait measurements and protocols limited the possibility to directly compare the results of the studies and it could represent an important issue causing variability in the different outcome measures in both clinical‐and population‐based settings. Gait appeared to be an indicator of health and function also in frail older adults, and different gait parameters appeared to predict adverse health‐related outcomes in clinical, cognitive, and physical domains and, to a lesser extent, in nutritional domain. Gait has the potential to elucidate the common basic mechanisms of cognitive and motor decline. Advances in technology may extend the validity of gait in different clinical settings also in frail older adults, and technology‐based assessment should be encouraged. Combining various gait parameters may enhance frailty prediction and classification of different frailty phenotypes. [ABSTRACT FROM AUTHOR]

Objective: To elucidate basic activities of daily living (BADL) changes, and the causes, in older adults with long‐term care needs. Methods: This retrospective study utilised long‐term care insurance (LTCI) certification survey data from 2010 to 2017 in City A. Results: In decreasing likelihood of requiring assistance, BADL items were grooming, bathing, getting dressed/undressed, mobility, toilet hygiene, functional mobility and self‐feeding. Cox proportional hazard regression indicated that age correlated with need for assistance for all BADL items. Male sex corresponded to needing assistance with BADL items other than grooming and functional mobility. Shared living corresponded to needing assistance with BADL items other than grooming and bathing. Visual acuity corresponded to needing assistance with grooming. Conclusion: The most significant result was using survival curves to visualise the changes in BADL items of older adults with LTCI. These findings could help develop rehabilitation programs to prevent the need for BADL assistance in older adults. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To evaluate the effects of a home‐based disability prevention program on life‐space and falls efficacy among low‐income older adults. DESIGN: Single‐blind two‐arm randomized controlled trial. SETTING: Participants' homes. PARTICIPANTS: Participants were low‐income cognitively intact older adults (≥65 years old) with restricted daily activities. Our analytic sample for life‐space (n = 194) and falls efficacy (n = 233) varied as the life‐space measure was introduced 4 months after the trial began. INTERVENTION: Up to six 1‐hour home visits with an occupational therapist; up to four 1‐hour home visits with a registered nurse; and up to $1,300 worth of home repairs, modifications, and assistive devices with a handyman, during a course of 4 months. MEASUREMENTS: Life‐space was measured by the Homebound Mobility Assessment; falls efficacy was measured using the 10‐item Tinetti Falls Efficacy Scale at baseline and 5 months. RESULTS: Participants were on average 75 years old, predominantly Black (86%) and female (85%–86%). Compared with participants in the control group, participants receiving the intervention were more likely to have improved versus decreased life‐space in areas of bathroom (adjusted odds ratio (OR) = 3.95; 95% confidence interval (CI) = 1.20–12.97), front or back porch, patio, or deck (adjusted OR = 2.67; 95% CI = 1.05–6.79), stairs (adjusted OR = 4.09; 95% CI = 1.34–12.48), leaving the house for any reason other than for health care (adjusted OR = 2.40; 95% CI = 1.01–5.73), and overall life‐space (adjusted OR = 2.15; 95% CI = 1.10–4.19). Participants who received the intervention also had an 11% improvement in falls efficacy in performing daily activities (exponentiated coefficient = 1.12; 95% CI = 1.04–1.21). CONCLUSION: Life‐space and falls efficacy were improved through a multicomponent, person‐directed, home‐based disability prevention intervention. Findings suggest that this intervention should be translated into different settings to promote independent aging. [ABSTRACT FROM AUTHOR]

Background and objective: Given that most dementia care is provided at home by family caregivers, caregivers' health and outdoor activities may influence persons with dementia (PWDs)' mobility. At the same time, PWDs' functional deterioration and mobility changes might affect mobility behaviours in their caregivers. The aims of this pilot study were to examine the relationship of PWD's life‐space mobility (LSM) with their caregiver's LSM and to investigate the role of caregiver and PWD characteristics in determining the level of LSM in both PWDs and caregivers. Design and method: A cross‐sectional survey was conducted with 26 caregivers providing dementia care at home. Caregivers were used as proxy for assessing sociodemographic, clinical and physical function in PWDs. Caregivers' sociodemographic characteristics, LSM, social support, depressive symptoms, caregiving burden and preparedness for caregiving were measured. Results: The level of LSM in caregivers was correlated with the PWD's LSM level. Caregivers who perceived high levels of social support and readiness for caregiving tended to report high levels of LSM. PWDs' age and independence in instrumental activities of daily living were correlated with caregivers' LSM. Conclusions: The study findings suggest that the caregiver's LSM influenced and was affected by the PWD's LSM. This underscores the need for additional research that examines the role of caregivers' psychosocial and physical health on PWDs' mobility and the context of dementia care and its influences on how dementia care dyads decide and participate in mobility behaviours. Implications for practice: The findings of this pilot study will be helpful in identifying a target for interventions designed to delay the onset of mobility disability and maintain and improve social participation in PWDs. To minimise the effects of mobility limitations in PWDs, it is critical to examine their mobility issues from multilevel perspectives, including their caregiver's LSM levels and characteristics that have implications for both research and clinical practice. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to examine the frailty transition patterns of older adults recruited from both community and residential care settings within a 5‐year period, and to identify the physical and psychosocial factors associated with the transitions. Design: This study is a secondary data analysis of a longitudinal study for tracking the change of health status of older adults 60 years of age or older. Participants who had undergone at least two assessments during 2013–2017 were selected for analysis. Guided by the Gobben's Frailty Model, biopsychosocial predictors were comprehensively identified from the literature, and their relationship to frailty state transition was explored. Methods: We compared the baseline characteristics of participants at the frail, pre‐frail, and robust states (categorized using the Fried Frailty Index). A generalized estimating equation was used to identify factors associated with an improvement or a deterioration in frailty. The probability of transitions between frailty states was calculated. Findings: Among the 306 participants, 19% (n = 59) improved and 30% (n = 92) declined in frailty within the project period. Sleep difficulties (odds ratio [OR] = 1.76; 95% confidence interval [CI]: 1.07–2.90; p =.027), better cognitive status (OR = 0.80–0.84; 95% CI: 0.66–0.98 and 0.73–2.73; p =.031 and.018), good nutritional status (OR = 0.74; 95% CI: 0.59–0.91; p =.005), slow mobility (OR = 1.03–1.13; 95% CI: 1.00–1.05 and 1.03–1.25; p =.047 and.014), hearing impairment (OR = 2.83; 95% CI: 1.00–8.01; p =.05), better quality of health—physical domain (OR = 0.95; 95% CI: 0.92–0.99; p =.006), and better functional ability (OR = 0.85–0.97; 95% CI: 0.79–0.92 and 0.96–0.99; p <.001 and p =.003) were significant associated factors in the worsening group. More physical activity (OR = 1.01; 95% CI: 1.00–1.01 and 1.01–1.02; p =.026 and p <.001), hearing impairment (OR = 0.26; 95% CI: 0.08–0.86; p =.028), and slow mobility (OR = 0.93; 95% CI: 0.87–1.00; p =.037) were significant associated factors in the improvement group. Conclusions: Frailty is a crucial global public health issue. This study provides evidence for nurses to holistically consider the associated factors and to design effective interventions to combat frailty in our ageing society. Clinical Relevance: Frailty is a transient state that can be reversed. Professional nurses working in both community and residential care settings should be able to identify older adults at risk and improve their health conditions appropriately. [ABSTRACT FROM AUTHOR]