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Background: Geriatric patients with cognitive impairment (CI) show an increased risk for a negative rehabilitation outcome and reduced functional recovery following inpatient rehabilitation. Despite this obvious demand, evidence-based training programs at the transition from rehabilitation to the home environments are lacking. The aim of this study is to evaluate the efficacy of a feasible and cost-effective home-based training program to improve motor performance and to promote physical activity, specifically-tailored for post-ward geriatric patients with CI.Methods: A sample of 101 geriatric patients with mild to moderate stage CI following ward-based rehabilitation will be recruited for a blinded, randomized controlled trial with two arms. The intervention group will conduct a 12 week home-based training, consisting of (1) Exercises to improve strength/power, and postural control; (2) Individual walking trails to enhance physical activity; (3) Implementation of patient-specific motivational strategies to promote behavioral changes. The control group will conduct 12 weeks of unspecific flexibility exercise. Both groups will complete a baseline measurement before starting the program, at the end of the intervention, and after 24 weeks for follow-up. Sensor-based as well as questionnaire-based measures will be applied to comprehensively assess intervention effects. Primary outcomes document motor performance, assessed by the Short Physical Performance Battery, and level of physical activity (PA), as assessed by duration of active episodes (i.e., sum of standing and walking). Secondary outcomes include various medical, psycho-social, various PA and motor outcomes, including sensor-based assessment as well as cost effectiveness.Discussion: Our study is among the first to provide home-based training in geriatric patients with CI at the transition from a rehabilitation unit to the home environment. The program offers several unique approaches, e.g., a comprehensive and innovative assessment strategy and the integration of individually-tailored motivational strategies. We expect the program to be safe and feasible in geriatric patients with CI with the potential to enhance the sustainability of geriatric rehabilitation programs in patients with CI.Trial Registration: International Standard Randomized Controlled Trial (# ISRCTN82378327 ). Registered: August 10, 2015. [ABSTRACT FROM AUTHOR]

Background: Studies on life-space (LS) and its determinants have previously been limited to community-dwelling subjects but are lacking in institutionalized older persons. The purpose of this study was to provide an advanced descriptive analysis of LS in nursing home residents and to identify associated factors based on an established theoretical framework, using an objective, sensor-based assessment with a high spatiotemporal resolution.Methods: Cross-sectional study in two nursing homes in Heidelberg, Germany (n = 65; mean age: 82.9 years; 2/3 female). Changes of location in the nursing home (Transits) as well as time spent away from the private room (TAFR) were assessed using a wireless sensor network. Measures of physical, psychosocial, cognitive, socio-demographic, and environmental factors were assessed via established motor performance tests, interviews, and proxy-reports.Results: LS of residents was largely restricted to the private room and the surrounding living unit (90%); 10% of daytime was spent outside the living unit and/or the facility. On average, TAFR was 5.1 h per day (±2.3; Range: 0-8); seven Transits (6.9 ± 3.2; Range: 0-18) were performed per day. Linear regression analyses revealed being male, lower gait speed, higher cognitive status, and lower apathy to be associated with more Transits; higher gait speed, lower cognitive status, and less depressive symptoms were associated with more TAFR. LS was significantly increased during institutional routines (mealtimes) as compared to the rest of the day.Conclusions: The sensor-based LS assessment provided new, objective insights into LS of institutionalized persons living in nursing homes. It revealed that residents' LS was severely limited to private rooms and adjacent living units, and that in institutional settings, daily routines such as meal times seem to be the major determinant of LS utilization. Gait speed, apathy, and depressive symptoms as well as institutional meal routines were the only modifiable predictors of Transits and/or TAFR, and thus have greatest potential to lead to an enhancement of LS when targeted with interventions.Trial Registration: Current Controlled Trials ISRCTN96090441 (retrospectively registered). [ABSTRACT FROM AUTHOR]

Background Physical activity (PA) is not only an important marker of physical impairment, but also a pathway to improve quality of life and enhance cognitive and social functioning of old individuals. Yet, making interventional use of PA training as a means for prevention and enhancement of quality of life of nursing home residents has found very limited attention worldwide so far. That said, the project 'Long-term Care in Motion' (LTCMo) as a part of the INNOVAGE consortium (funded by the European Commission) has the following aims: Overall: Install and assess a socially innovative intervention in the nursing home ecology. Concrete: (a) Conceptualization of a multidimensional intervention program (resident and staff oriented) with the potential to promote PA in nursing home residents; (b) Mixedmethods assessment of the program based on automated recording as well as questionnaire data. Methods/Design LTCMo's PA-related intervention has several components which are applied in parallel manner: (1) Residents are engaged in a physical exercise program that is based on multiple approaches: supervised group sessions, a serious games approach, and specific training in severely impaired persons; (2) Staff members will receive a competence training with a focus on PA motivation and facilitation of residents' PA engagement. Primary outcome assessment (movement-related behavior of residents) is completely conducted by means of automated data collection strategies (accelerometer-based activity recording, sensor-based life space recording). This is enriched by a broad range of secondary outcomes (e.g., cognitive performance, depression of residents; behavioral and attitudinal components of staff). Pre-, post- and 3-month follow-up assessment will take place in the target intervention setting as well as in a waiting control condition in which we will also replicate the training and its assessment in a later step. Discussion Although we are faced with methodological challenges (e.g., rather small sample size; no randomized control trial), we believe that our approach has something to offer and indeed has some unique characteristics that may have the potential to contribute to the enhancement of nursing home residents' quality of life and at the same time further PA-related research with vulnerable populations at large. [ABSTRACT FROM AUTHOR]

Background Preventing and rehabilitating gait disorders in people with dementia during early disease stage is of high importance for staying independent and ambulating safely. However, the evidence gathered in randomized controlled trials (RCTs) on the effectiveness of exercise training for improving spatio-temporal gait parameters in people with dementia is scarce. The aim of the present study was to determine whether a specific, standardized training regimen can improve gait characteristics in people with dementia. Methods Sixty-one individuals (mean age: 81.9 years) with confirmed mild to moderate stage dementia took part in a 3-month double-blinded outpatient RCT. Subjects in the intervention group (IG) received supervised, progressive resistance and functional group training for 3 months (2 times per week for two hours) specifically developed for people with dementia. Subjects in the control group (CG) conducted a low-intensity motor placebo activity program. Gait characteristics were measured before and after the intervention period using a computerized gait analysis system (GAITRite®). Results Adherence to the intervention was excellent, averaging 91.9% in the IG and 94.4% in the CG. The exercise training significantly improved gait speed (P < 0.001), cadence (P = 0.002), stride length (P = 0.008), stride time (P = 0.001), and double support (P = 0.001) in the IG compared to the CG. Effect sizes were large for all gait parameters that improved significantly (Cohen's d: 0.80-1.27). No improvements were found for step width (P = 0.999), step time variability (P = 0.425) and Walk-Ratio (P = 0.554). Interestingly, low baseline motor status, but not cognitive status, predicted positive training response (relative change in gait speed from baseline). Conclusion The intensive, dementia-adjusted training was feasible and improved clinically meaningful gait variables in people with dementia. The exercise program may represent a model for preventing and rehabilitating gait deficits in the target group. Further research is required for improving specific gait characteristics such as gait variability in people with dementia. [ABSTRACT FROM AUTHOR]

Background: The standardisation of the assessment methodology and case definition represents a major precondition for the comparison of study results and the conduction of meta-analyses. International guidelines provide recommendations for the standardisation of falls methodology; however, injurious falls have not been targeted. The aim of the present article was to review systematically the range of case definitions and methods used to measure and report on injurious falls in randomised controlled trials (RCTs) on fall prevention., Methods: An electronic literature search of selected comprehensive databases was performed to identify injurious falls definitions in published trials. Inclusion criteria were: RCTs on falls prevention published in English, study population ≥ 65 years, definition of injurious falls as a study endpoint by using the terms "injuries" and "falls"., Results: The search yielded 2089 articles, 2048 were excluded according to defined inclusion criteria. Forty-one articles were included. The systematic analysis of the methodology applied in RCTs disclosed substantial variations in the definition and methods used to measure and document injurious falls. The limited standardisation hampered comparability of study results. Our results also highlight that studies which used a similar, standardised definition of injurious falls showed comparable outcomes., Conclusions: No standard for defining, measuring, and documenting injurious falls could be identified among published RCTs. A standardised injurious falls definition enhances the comparability of study results as demonstrated by a subgroup of RCTs used a similar definition. Recommendations for standardising the methodology are given in the present review.