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Purpose: The purpose of this quality improvement project was to examine the feasibility of rapidly converting a Tai Chi program for older Veterans from face‐to‐face to virtual classes. Methods: Eighteen Veterans attending our face‐to‐face Tai Chi course were invited to transition to virtual classes. Feasibility was defined as the ability of program staff and participants to successfully connect and complete the initial and subsequent classes by VA Video Connect (VVC) with little to no technical difficulties, participant ability to participate in the course without safety concerns, and favorable feedback from participants and program staff. Results: Nine of 18 Veterans agreed to transition to the virtual program and attended a median (interquartile range) of 11 (4–15) classes; they were younger (62.7 + 11.5 vs. 70.5 + 7.0 years, p <.05) and more likely to have the knowledge and equipment needed to participate (78% vs. 0%, p <.01) than nonparticipants. Tai Chi instructors and participating Veterans reported being able to connect to and complete the classes virtually with only minimal technical problems. No adverse events were reported. Feedback from the instructors and Veterans was positive and included comments on ease of use and enjoyability. Conclusion: Results suggest that virtual Tai Chi classes via VVC are feasible for some older Veterans. [ABSTRACT FROM AUTHOR]

Background. Although weight change in older persons has proven prognostic significance, it is not known whether monthly weights obtained by the clinical staff in long-term care institutions are reliable enough to be useful in identifying at-risk residents. The objective of this study was to determine whether an association exists between mortality risk and the intraresident variation in weight in long-term care institutions. Methods. For this study, 900 nursing home residents with a recently identified nutritional problem from 96 long-term care facilities in 8 states were randomly selected. At study entry, nutritional, health status, and demographic data were extracted from the nursing home chart or the Minimum Data Set. Weights obtained by the nursing home staff were recorded at baseline and during each of the subsequent 6 months. Cox proportional hazards regression analysis was used to assess relationships between weight parameters and mortality risk during the 7 months of observation. Results. During the study, 435 (48%) participants had at least 1 monthly weight that differed from the previous month's weight by [greater than or equal to]5%; 163 (18%) participants had this magnitude of a 1-month weight change more than once. By controlling for the linear trend (i.e., slope) of each residents' weight change between the first to the as weight the average month-to-month residual variability in the resident's weights was calculated. This residual variability or 'average random fluctuation' in weight from 1 month to the next was [greater than or equal to]2% in 229 (25%) participants and [greater than or equal to]3% in 82 (9%) participants. Despite the large random fluctuation in the residents' weights weight loss was au important prognostic indicator. Those who lost [greater than or equal to]5% in any month had a 10-fold increased risk for death compared with those who gained weight (adjusted relative risk, 10.6; 95% confidence interval, 3.2 to 35.5). The average random fluctuation in weight was associated with an increased risk for death only at the upper 10th percentile for the population. Conclusions. Many nutritionally compromised elderly nursing home residents experience significant bidirectional fluctuations in their weight from month to month. How much of this variability is due to measurement error is not known. However, a weight loss of [greater than or equal to]5% in any month has important prognostic implications.

Background. The importance of undernutrition as a determinant of postdischarge mortality among hospitalized elderly people remains controversial. The purpose of this study was to investigate this issue. Methods. The study included 660 elderly patients (85% white, 98% men, average age 73 [+ or -] 6 years) discharged from a university-affiliated Department of Veterans Affairs Hospital, who were followed for 1 year. Associations between patient characteristics at hospital discharge and mortality were identified utilizing Cox Proportional Hazards Regression analysis. Results. In the year following hospital discharge, 85 subjects (13%) died. After adjusting for illness severity (Acute Physiology and Chronic Health Evaluation II score) and functional status (Katz Index of Activities of Daily Living score), a body mass index (BMI) [less than or equal to] 20 kg/[m.sup.2] was strongly associated with mortality (adjusted relative risk, [95% confidence interval] 1.83 [1.17-2.85]), as was more than 10% weight loss in the prior year (2.31 [1.35-3.94]), and weight as percent of usual weight (WPU) [less than or equal to] 85% (1.78 [1.14-2.77]). Albumin [less than or equal to] 30 g/l was only weakly associated with mortality (1.10 [0.67-1.81]). When all of the putative nutrition variables were included in a multivariable analysis with the two control variables, only BMI followed by WPU [less than or equal to] 85% entered the model. Utilizing this model, the predicted probabilities of death at 1 year were calculated for the study subjects and for a hypothetical group of patients who were identical to the study subjects except they were assigned a BMI of 28 kg/[m.sup.2] and their WPU was 100%. Compared to 24% of the actual subjects, only 7% of the hypothetical well-nourished patients would have been classified as being at high risk for mortality (a 71% relative reduction). Conclusions. Older patients who have evidence of chronic body mass depletion are at significantly increased risk of mortality within the year following hospital discharge.

Purpose: To evaluate the effectiveness of an evidence‐based 12‐week Tai Chi course designed to improve balance and physical function in a population of older veterans. Methods: Community dwelling veterans of all ages with gait and balance problems were invited to participate in the Tai Chi program. Participants completed the Berg Balance Scale (BBS), the Timed Up and Go (TUG) test, and the Falls Efficacy Scale‐International (FES‐I) at baseline and again at the end of the program. Descriptive statistics were used to summarize study participants' characteristics. The change from baseline to the end of the 12‐week program was calculated for each of the three primary outcome variables (BBS, TUG, FES‐I). Results: Twenty‐two veterans, aged 58 years and above, with perceived gait and/or balance issues were enrolled in the program with completion by 11 veterans. Veterans who completed their final assessments showed the BBS, improved significantly (p = 0.004) from baseline to the 12‐week assessment. The TUG scores improved by a median of 1.3 s (p = 0.022). There was not a significant change in the FES‐I. Conclusions: Preliminary findings provide evidence of the effectiveness of a 12‐week Tai Chi program to improve functional outcomes for older veterans with mild to moderate gait and balance problems. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this nurse‐led project was to increase the number of interprofessional Tai Chi instructors for veterans through a 5‐week (32 hours) training of trainers (ToT) course led by a Tai Chi master trainer. Methods: This project was designed to evaluate the effectiveness of using the ToT model to increase the availability of Tai Chi to veterans. To understand how well the ToT course met learners' needs, a two‐phase course evaluation was conducted. Results: Fifteen interprofessional employees enrolled in and completed the course. Most learners were white (67%) females (67%) with a median age of 50 years. All agreed that the training provided the skills, materials, and confidence to lead Tai Chi classes. Most (93%) indicated experiencing positive health benefits from the training and none experienced any negative effects. The 3‐month follow‐up evaluation indicated that 10 (67%) were teaching veterans in individual or group classes with two others assisting. Twelve instructors taught more than 150 veterans. Conclusions: Overall, learners evaluated this ToT course positively and indicated their needs were met and felt prepared to teach Tai Chi despite being inexperienced. The course was a success with 80% of new instructors teaching or coteaching Tai Chi to veterans. [ABSTRACT FROM AUTHOR]

Objective: Apathy is a common behavioral problem in Alzheimer's disease. Apathy has profound consequences, such as functional impairment, higher service utilization, higher caregiver burden, and increased mortality. The authors' objective was to study the effects of methylphenidate on apathy in Alzheimer's disease.Method: A 12-week, prospective, double-blind, randomized, placebo-controlled trial (methylphenidate versus placebo) was conducted in community-dwelling veterans (N=60) with mild Alzheimer's disease. The primary outcome for apathy (Apathy Evaluation Scale-Clinician) and secondary outcomes for cognition (Mini-Mental State Examination, Modified Mini-Mental State Examination), functional status (activities of daily living, instrumental activities of daily living), improvement and severity (Clinical Global Impressions Scale [CGI]), caregiver burden (Zarit Burden Scale), and depression (Cornell Scale for Depression in Dementia) were measured at baseline and at 4, 8, and 12 weeks.Results: Participants were all men (77 years old, SD=8). After adjusting for baseline, the methylphenidate group had significantly greater improvement in apathy than the placebo group at 4 weeks, 8 weeks, and 12 weeks. At 12 weeks, there was also greater improvement in cognition, functional status, caregiver burden, CGI scores, and depression in the methylphenidate group compared with the placebo group.Conclusions: Methylphenidate improved apathy in a group of community-dwelling veterans with mild Alzheimer's disease. Methylphenidate also improved cognition, functional status, caregiver burden, CGI scores, and depression. [ABSTRACT FROM AUTHOR]

Background/objective: Balance problems are common in older adults with Alzheimer's disease (AD). The objective was to study the effects of a Wii-Fit interactive video-game-led physical exercise program to a walking program on measures of balance in older adults with mild AD.Methods: A prospective randomized controlled parallel-group trial (Wii-Fit versus walking) was conducted in thirty community-dwelling older adults (73±6.2 years) with mild AD. Home-based exercises were performed under caregiver supervision for 8 weeks. Primary (Berg Balance Scale, BBS) and secondary outcomes (fear of falls and quality of life) were measured at baseline, 8 weeks (end of intervention), and 16 weeks (8-weeks post-intervention).Results: At 8 weeks, there was a significantly greater improvement (average inter-group difference [95% CI]) in the Wii-Fit group compared to the walking group in BBS (4.8 [3.3-6.2], p < 0.001), after adjusting for baseline. This improvement was sustained at 16 weeks (3.5 [2.0-5.0], p < 0.001). Analyses of the secondary outcome measures indicated that there was a significantly greater improvement in the Wii-Fit group compared to walking group in Activity-specific Balance Confidence scale (6.5 [3.6-9.4], p < 0.001) and Falls Efficacy Scale (-4.8 [-7.6 to -2.0], p = 0.002) at 8 weeks. However, this effect was not sustained at 16 weeks. Quality of life improved in both groups at 8 weeks; however, there were no inter-group differences (p = 0.445).Conclusion: Home-based, caregiver-supervised Wii-Fit exercises improve balance and may reduce fear of falling in community-dwelling older adults with mild AD. [ABSTRACT FROM AUTHOR]

Background/Objectives. Balance problems are well-established modifiable risk factors for falls, which are common in older adults. The objective of this study was to establish the efficacy of a Wii-Fit interactive video-game-led physical exercise program to improve balance in older Veterans. Methods. A prospective randomized controlled parallel-group trial was conducted at Veterans Affairs Medical Center. Thirty community dwelling Veterans aged 68 (±6.7) years were randomized to either the exercise or control groups. The exercise group performed Wii-Fit program while the control group performed a computer-based cognitive program for 45 minutes, three days per week for 8-weeks. The primary (Berg Balance Scale (BBS)) and secondary outcomes (fear of falling, physical activity enjoyment, and quality of life) were measured at baseline, 4 weeks, and 8 weeks. Results. Of 30 randomized subjects, 27 completed all aspects of the study protocol. There were no study-related adverse events. Intent-to-treat analysis showed a significantly greater improvement in BBS in the exercise group (6.0; 95% CI, 5.1–6.9) compared to the control group (0.5; 95% CI, −0.3–1.3) at 8 weeks (average intergroup difference (95% CI), 5.5 (4.3–6.7), p < 0.001) after adjusting for baseline. Conclusion. This study establishes that the Wii-Fit exercise program is efficacious in improving balance in community dwelling older Veterans. This trial is registered with ClinicalTrials.gov Identifier NCT02190045. [ABSTRACT FROM AUTHOR]

The purpose of this study was to evaluate a multi-component method for capturing nutrient intake, which used observation, photography, and an innovative computer program. To assess reliability and accuracy, multiple responsible employees (REs) independently conducted nutrient intake assessments on simulated meals; each RE's results relating to energy intake were compared to those from the other REs and to those obtained by pre- and post-meal weighing of the food items. System efficiency was assessed by having REs perform independent assessments on the same set of simulated meals using either the new or traditional hospital method for which the REs had to document each food item served and then find the items in a computer database--steps that were automated in the new method. Interrater reliability for energy intake estimated on clinic wards was excellent (intraclass correlation coefficient = 0.975, 95% CI 0.958 to 0.992) and there was a high level of agreement between the REs' estimates and the true values determined by food weighing; per the method of Bland and Altman the mean difference between the two types of estimates was 0.3 kcal (95% CI, [ABSTRACT FROM AUTHOR]

Obtaining a detailed assessment of a hospitalized patient's nutrient intake is often critically important to ensuring the patient's successful recovery. However, this process is often laborious and prone to error. Inaccurate nutrient intake assessments result in the inability of the healthcare team to recognize patients with developing nutritional deficits that contribute to delayed recovery and prolonged lengths of stay. This paper describes an innovative, easy to use system designed to increase the precision of calorie count reports by using a combination of photography, direct observation, and a specially developed computer program. Although the system was designed specifically for use in a Department of Veterans Affairs Hospital, it has the potential to be adapted for use in other hospital environments. [ABSTRACT FROM AUTHOR]

Background: Immune function may influence the ability of older adults to maintain or improve muscle mass, strength, and function during aging. Thus, nutritional supplementation that supports the immune system could complement resistance exercise as an intervention for age-associated muscle loss. The current study will determine the relationship between immune function and exercise training outcomes for older adults who consume a nutritional supplement or placebo during resistance training and post-training follow-up. The supplement was chosen due to evidence suggesting its ingredients [arginine (Arg), glutamine (Gln), and β-hydroxy β-methylbutyrate (HMB)] can improve immune function, promote muscle growth, and counteract muscle loss. Methods/design: Veterans (age 60 to 80 yrs, N = 50) of the United States military will participate in a randomized double-blind placebo-controlled trial of consumption of a nutritional supplement or placebo during completion of three study objectives: 1) determine if 2 weeks of supplementation improve immune function measured as the response to vaccination and systemic and cellular responses to acute resistance exercise; 2) determine if supplementation during 36 sessions of resistance training boosts gains in muscle size, strength, and function; and 3) determine if continued supplementation for 26 weeks post-training promotes retention of training-induced gains in muscle size, strength, and function. Analyses of the results for these objectives will determine the relationship between immune function and the training outcomes. Participants will undergo nine blood draws and five muscle (vastus lateralis) biopsies so that the effects of the supplement on immune function and the systemic and cellular responses to exercise can be measured. Discussion: Exercise has known effects on immune function. However, the study will attempt to modulate immune function using a nutritional supplement and determine the effects on training outcomes. The study will also examine post-training benefit retention, an important issue for older adults, usually omitted from exercise studies. The study will potentially advance our understanding of the mechanisms of muscle gain and loss in older adults, but more importantly, a nutritional intervention will be evaluated as a complement to exercise for supporting muscle health during aging. [ABSTRACT FROM AUTHOR]

Objectives. To determine the effects on balance and gait of a Wii-Fit program compared to a walking program in subjects with mild Alzheimer's dementia (AD). Methods. A prospective randomized (1 : 1) pilot study with two intervention arms was conducted in an assisted living facility with twenty-two mild AD subjects. In both groups the intervention occurred under supervision for 30 minutes daily, five times a week for eight weeks. Repeated measures ANOVA and paired t-tests were used to analyze changes. Results. Both groups showed improvement in Berg Balance Scale (BBS), Tinetti Test (TT) and Timed Up and Go (TUG) over 8 weeks. However, there was no statistically significant difference between the groups over time. Intragroup analysis in the Wii-Fit group showed significant improvement on BBS (P = 0.003), and TT (P = 0.013). The walking group showed a trend towards improvement on BBS (P = 0.06) and TUG (P = 0.07) and significant improvement in TT (P = 0.006). Conclusion. This pilot study demonstrates the safety and efficacy of Wii-Fit in an assisted living facility in subjects with mild AD. Use of Wii-Fit resulted in significant improvements in balance and gait comparable to those in the robust monitored walking program. These results need to be confirmed in a larger, methodologically sound study. [ABSTRACT FROM AUTHOR]

The article presents a study on the hospital rehabilitation of older adults with primary or comorbid debility. The study aims to determine the functional outcomes and discharge setting of older patients, who are 65 years old and above, receiving inpatient rehability. Results showed that patients with primary diagnosis of debility (PDD) were unlikely to be discharged home and more likely to be discharged to a hospital. It is suggested that the functional recovery of older patients with primary or comorbid debility is significantly the same.

Investigates undernutrition and risk of mortality in elderly patients within a year of hospital discharge. Assessment criteria used in older hospitalized patients for being undernourished at the time of their hospital discharge; Characteristics the patients; Weight loss indicators which are evaluated to determine whether the amount and duration of weight loss are related to one-year mortality risk.

Our work identifies subjects based on their height and the distance between their joints. Using a depth sensing camera, we obtained the position of a person's joints in 3D space relative to each other. The distances between adjacent joints and height of a subject's head are used to create a vector of eight features for an individual to use for identification. Using modified KNN, full and partial feature sets were used to identify subjects. Additionally, our classifier can be utilized to assess ambulation (such as walking's velocity and distance) of subject, when identified.

Background/objective: Balance problems are common in older adults with Alzheimer's disease (AD). The objective was to study the effects of a Wii-Fit interactive video-game-led physical exercise program to a walking program on measures of balance in older adults with mild AD., Methods: A prospective randomized controlled parallel-group trial (Wii-Fit versus walking) was conducted in thirty community-dwelling older adults (73±6.2 years) with mild AD. Home-based exercises were performed under caregiver supervision for 8 weeks. Primary (Berg Balance Scale, BBS) and secondary outcomes (fear of falls and quality of life) were measured at baseline, 8 weeks (end of intervention), and 16 weeks (8-weeks post-intervention)., Results: At 8 weeks, there was a significantly greater improvement (average inter-group difference [95% CI]) in the Wii-Fit group compared to the walking group in BBS (4.8 [3.3-6.2], p < 0.001), after adjusting for baseline. This improvement was sustained at 16 weeks (3.5 [2.0-5.0], p < 0.001). Analyses of the secondary outcome measures indicated that there was a significantly greater improvement in the Wii-Fit group compared to walking group in Activity-specific Balance Confidence scale (6.5 [3.6-9.4], p < 0.001) and Falls Efficacy Scale (-4.8 [-7.6 to -2.0], p = 0.002) at 8 weeks. However, this effect was not sustained at 16 weeks. Quality of life improved in both groups at 8 weeks; however, there were no inter-group differences (p = 0.445)., Conclusion: Home-based, caregiver-supervised Wii-Fit exercises improve balance and may reduce fear of falling in community-dwelling older adults with mild AD.

The purpose of this study was to evaluate a multi-component method for capturing nutrient intake, which used observation, photography, and an innovative computer program. To assess reliability and accuracy, multiple responsible employees (REs) independently conducted nutrient intake assessments on simulated meals; each RE's results relating to energy intake were compared to those from the other REs and to those obtained by pre- and post-meal weighing of the food items. System efficiency was assessed by having REs perform independent assessments on the same set of simulated meals using either the new or traditional hospital method for which the REs had to document each food item served and then find the items in a computer database-steps that were automated in the new method. Interrater reliability for energy intake estimated on clinic wards was excellent (intraclass correlation coefficient = 0.975, 95% CI 0.958 to 0.992) and there was a high level of agreement between the REs' estimates and the true values determined by food weighing; per the method of Bland and Altman the mean difference between the two types of estimates was 0.3 kcal (95% CI, -8.1 to 8.7 kcal) with limits of agreement of -79.5 kcal to 80.1 kcal. Compared to the traditional method, energy intake assessments could be completed using the multi-component method in less than a third of the time. These results indicate the multi-component method is an accurate, reliable, and efficient method of obtaining energy intake assessments for hospitalized patients., Competing Interests: The funding sponsors had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, and in the decision to publish the results.

Obtaining a detailed assessment of a hospitalized patient's nutrient intake is often critically important to ensuring the patient's successful recovery. However, this process is often laborious and prone to error. Inaccurate nutrient intake assessments result in the inability of the healthcare team to recognize patients with developing nutritional deficits that contribute to delayed recovery and prolonged lengths of stay. This paper describes an innovative, easy to use system designed to increase the precision of calorie count reports by using a combination of photography, direct observation, and a specially developed computer program. Although the system was designed specifically for use in a Department of Veterans Affairs Hospital, it has the potential to be adapted for use in other hospital environments.

Objectives: Assess whether postoperative nightly enteral nutrition support improves outcomes of elderly patients with an acute hip fracture, Design: Randomized controlled trial., Setting: A University and a Department of Veteran's Affairs Hospital, Subjects: Adults >64 years of age who underwent surgical repair of an acute hip fracture., Interventions: Subjects randomized to the control (Ctrl) group received standard care while the treatment (Tx) group received standard care plus up to 1,375 Kcal [5,755 kJ/d] of nasoenteral tube feedings each night. When tube feedings had to be discontinued, Tx subjects were asked to drink an equivalent amount of the nutritional supplement each night., Measures of Outcome: Rate of postoperative complications and 6-month postoperative survival., Results: Fifty-seven patients were randomized to the Tx (n = 27, mean age 75.9 +/- 7.4 yrs) or Ctrl groups (age 81.7 +/- 7.7 yrs). All subjects had reduced volitional nutrient intakes after surgery. During the first week subsequent to surgery, there was no difference between the treatment and control groups in the amount of nutrients that they volitionally consumed during the day. However, the treatment subjects had a greater total daily nutrient intake (Median 5,866 (IQR 5,024 to 7,335) kJ/d vs. 3,965 (IQR 2,968 to 4,664) kJ/d, p < 0.001). However, by the second postoperative week this difference was no longer statistically significant. Intolerance to the tube feedings developed commonly. There was no difference between the groups in the rate of postoperative life-threatening complications or mortality within six months subsequent to surgery., Conclusions: This study failed to confirm findings from a prior study of improved postoperative survival with nutrition support. However, it was conducted on multiple hospital wards which may have contributed to the higher rate of tube-related problems and less nutrient delivery signifying the need for further study.