Search

Background: An analysis of practice is conducted by the American Board of Physical Therapy Specialties (ABPTS) every 10 years to revalidate, update, and revise the description of specialty practice (DSP) for each specialty. The Geriatric Specialty Council recently conducted an analysis of practice and revised its content consistent with established procedures by the ABPTS. Purpose: The purpose of this article is threefold: first, to describe the process of the most recent practice analysis; second, to report revisions to the description of specialty practice based on the analysis of practice; and third, to identify elements of practice that define current specialist practice in geriatric physical therapy. Methods: A 10-member committee of subject matter experts (SM Es) and a psychometric consultant developed a survey instrument addressing geriatric physical therapy specialty practice areas. The survey was initially pilot-tested and subsequently administered online to a sample of 801 board-certified geriatric clinical specialists. The consultant facilitated the consensus process to determine decision rules in selecting the final competencies describing current geriatric physical therapy specialty practice. Results: A total of 372 respondents fully or partially completed the survey, resulting in a response rate of 46.4%. Based on a priori decision rules regarding survey data, consensus of the group of SMEs, and input from the ABPTS, the DSP for geriatric physical therapy specialty practice was revised. Revisions (elimination [-] of prior items and addition [+] of new items) were made in Section 1: Knowledge Areas (-8 and +6), in Section 2: Professional Roles, Responsibilities, and Values (-14 and +4), and Section 3: Practice Expectations (-53 and +28). Conclusion: The revised DSP will be used as the basis for the development of the examination blueprint for the specialist examination in geriatric physical therapy and the curricula for residency programs in geriatric physical therapy. [ABSTRACT FROM AUTHOR]

Background: Aging presents both challenges and opportunities. It will increase demand for health care to restore function or enhance residual functional capability and improving the quality of life in older people. The objective of the present investigation was to offer perspectives into the worldwide research production concerning the geriatric rehabilitation. Methods: A bibliometric analysis was conducted utilizing the Scopus database covering the period of 1948 through 2022. Several methods and instruments were employed to scrutinize and illustrate the data. Results: The search strategy found 6630 articles. The United States was the most active country with the highest number of coauthors. VA Medical Center was the most active organization with Becker the most active author in Geriatric Rehabilitation research with 40 articles from Germany, followed by Hauer and Trabucchi with 39 and 37 articles, respectively. The most frequent words in this field were "rehabilitation, elderly, geriatrics, stroke, hip fracture, aged, dementia and activities of daily living." The most influential articles were specified. In terms of journals, BMC Geriatrics was the most active, while the most cited article was "Gait Variability and Fall Risk in Community-Living Older Adults: A 1-Year Prospective Study" by Hausdorff in 2001. Conclusions: Geriatric rehabilitation has received special attention in the last decade. Current studies highlight the importance and understanding of the unique needs of older adults. The core for this area that includes impairment related to physical, cognitive, and functional needs is considered. Hence, health care practitioners and scholars must prioritize geriatric rehabilitation as a specialty and comprehend the optimal strategy for supporting elderly individuals to maintain their independence as much as feasible. [ABSTRACT FROM AUTHOR]

Background: Medicare recipients historically have been discharged from rehabilitation when progress plateaus. This improvement standard continues to shape episodic practice of physical therapy (PT). The Jimmo v Sebelius decision of 2013 has the potential to open physical therapist practice with the adoption of community-based maintenance PT into everyday practice. Conclusion: Prevention and maintenance of function are supported by the American Physical Therapy Association. Evidence suggests that intervention over time combats frailty, reduces fall risk, improves functional outcomes, and prevents movement disability. Community-based maintenance PT as a method of moving from the episodic restorative model to a continuous paradigm of restoration, prevention, and maintenance is proposed. [ABSTRACT FROM AUTHOR]

Objectives To examine racial differences in the use of rehabilitation services and functional improvement during receipt of services. Design Secondary analysis of the 2016 National Health and Aging Trends Study ( NHATS). Setting Standardized in-person home interviews. Participants Community-dwelling Medicare enrollees (N = 6,309), 1,276 of whom reported receiving rehabilitation services in the previous 12 months. Measurements Self-reported use of rehabilitation services, setting (inpatient, outpatient, home based), reason for use, and perceptions of change in functioning after receiving services. Results Controlling for sex, dual eligibility for Medicaid, age, number of chronic conditions, functional mobility at the prior round, income, and geographic region, the odds of receiving rehabilitation services in any setting was 1.38 times as great in whites as in blacks (95% confidence interval = 1.09-1.75). Of those receiving therapy, whites were more likely to receive home-based and inpatient rehabilitation services, but there were no racial differences in improvement in function. Conclusion Strategies are needed to identify possible barriers to use of rehabilitation services for vulnerable groups of aging individuals who need rehabilitation services, particularly older blacks. [ABSTRACT FROM AUTHOR]

Objective: This study analyzes the links between planning, the built environment, and availability of health-related community services across U.S. urban and rural communities. Method: We analyze the first national survey of health-related community services for seniors (2010 Maturing of America), covering 1,459 U.S. cities and counties. We tested the influence of morbidity (diabetes and obesity), city management, socioeconomic characteristics, planning and the built environment, metro status, and government finance. Results: Community health-related services are more common in places that plan for and involve seniors in planning processes. Places with higher need and government capacity also show higher levels. Service levels in rural communities are not lower after controlling for other population characteristics. Morbidity measures (diabetes and obesity) do not explain differences in service availability. Discussion: Policies promoting planning for aging and elder involvement in the planning process have the greatest impact on the level of community health-related services for seniors. [ABSTRACT FROM AUTHOR]

Background. Mexican Americans comprise the most rapidly growing segment of the older US population and are reported to have poorer functional health than European Americans, but few studies have examined factors contributing to ethnic differences in walking speed between Mexican Americans and European Americans. Objective. The purpose of this study was to examine factors that contribute to walking speed and observed ethnic differences in walking speed in older Mexican Americans and European Americans using the disablement process model (DPM) as a guide. Design. This was an observational, cross-sectional study. M.U. Quiben, PT, PhD, DPT, MS, GCS, NCS, Department of Physical Therapy, University of North Texas Health Science Center, 3500 Camp Bowie Blvd, MET-555, Ft Worth, TX 76107 (USA). Address all correspondence to Dr Quiben at: Myla.Quiben@unthsc. edu. H.P. Hazuda, PhD, Department of Medicine, Division of Nephrology, University of Texas Health Science Center at San Antonio, San Antonio, Texas. Methods. Participants were 703 Mexican American and European American older adults (aged 65 years and older) who completed the baseline examination of the San Antonio Longitudinal Study of Aging (SALSA). Hierarchical regression models were performed to identify the contribution of contextual, lifestyle/anthropometric, disease, and impairment variables to walking speed and to ethnic differences in walking speed. Results. The ethic difference in unadjusted mean walking speed (Mexican Americans =1.17 m/s, European Americans =1.29 m/s) was fully explained by adjustment for contextual (ie, age, sex, education, income) and lifestyle/anthropometric (ie, body mass index, height, physical activity) variables; adjusted mean walking speed in both ethnic groups was 1.23 m/s. Contextual variables explained 20.3% of the variance in walking speed, and lifestyle/anthropometric variables explained an additional 8.4%. Diseases (ie, diabetes, stroke, chronic obstructive pulmonary disease) explained an additional 1.9% of the variance in walking speed; impairments (ie, FEV1, upper leg pain, and lower extremity strength and range of motion) contributed an additional 5.5%. Thus, both nonmodifiable (ie, contextual, height) and modifiable (ie, impairments, body mass index, physical activity) factors contributed to walking speed in older Mexican Americans and European Americans. Limitations. The study was conducted in a single geographic area and included only Mexican American Hispanic individuals. Conclusions. Walking speed in older Mexican Americans and European Americans is influenced by modifiable and nonmodifiable factors, underscoring the importance of the DPM framework, which incorporates both factors into the physical therapist patient/client management process. [ABSTRACT FROM AUTHOR]

OBJECTIVE. Reduced physical fitness secondary to heart failure (HF) may contribute to poor driving; reduced physical fitness is a known correlate of cognitive impairment and has been associated with decreased independence in driving. No study has examined the associations among physical fitness, cognition, and driving performance in people with HF. METHOD. Eighteen people with HF completed a physical fitness assessment, a cognitive test battery, and a validated driving simulator scenario. RESULTS. Partial correlations showed that poorer physical fitness was correlated with more collisions and stop signs missed and lower scores on a composite score of attention, executive function, and psychomotor speed. Cognitive dysfunction predicted reduced driving simulation performance. CONCLUSION. Reduced physical fitness in participants with HF was associated with worse simulated driving, possibly because of cognitive dysfunction. Larger studies using on-road testing are needed to con- firm our findings and identify clinical interventions to maximize safe driving. [ABSTRACT FROM AUTHOR]

Elderly and aging manual wheelchair users have an increased risk for accelerated loss of function and mobility that greatly limits independence and affects quality of life. This review addresses important issues for preserving function and mobility among elderly and aging individuals who use a manual wheelchair by presenting the current available evidence and recommendations. These include recommendations for maximizing function by decreasing pain, improving the ability to self-propel, and prolonging mobility and endurance through ergonomics, individualized wheelchair selection and configuration, and adaptations for increasing the capacity to handle the daily mobility demands through training, strengthening, and exercise. Each recommendation is supported by current research in each relevant area. [ABSTRACT FROM AUTHOR]

Fractures of the proximal femur, commonly referred to as hip fractures, are a significant cause of mortality and disability among older individuals. Surgical repair can involve open reduction with internal fixation with various implants or removal and replacement of the femoral head through hip arthroplasty. For the purposes of this article, focus will be placed on hip fractures treated with open reduction and internal fixation and on discussing recovery across the health care continuum from acute care to rehabilitation facilities to community-based rehabilitation, the major goals of rehabilitation, evidence-based rehabilitation interventions, and examples of standardized measures that may be useful during the rehabilitation process. [ABSTRACT FROM AUTHOR]

The impact of peripheral arterial disease on women is only now being recognized as a significant issue. In this review, we examine the epidemiologic, clinical, and intervention differences that exist between men and women who have this disease. The conclusions are incontrovertible; women are as much at risk for peripheral arterial disease as men, but an insufficient amount of research has been conducted on risk factors, diagnostics, and interventions for women. Recommendations related to women's health and peripheral arterial disease are provided for rehabilitation professionals. [ABSTRACT FROM AUTHOR]

The purpose of this review was to illustrate the role of nutrition in the prevention and management of peripheral arterial disease (PAD), which is one of the leading causes of disability in the United States. Declining physical function and loss of independence in the later years, which are potential consequences of this condition, highlight the importance of preventing or containing this disease. The risk factors for PAD are similar to those of coronary heart disease. The primary objective is to reduce the risk of cardiovascular morbidity and mortality. Optimal PAD management is best achieved by a combination of pharmacological intervention, lifestyle changes, and, when necessary, angioplasty or surgery. Addressing diet and eating is a critical component of a successful therapeutic approach. Improved nutrition is associated with a reduced prevalence of this disease. This article focuses on the role of nutrition as a component of lifestyle modification in the overall management of PAD. [ABSTRACT FROM AUTHOR]

Peripheral arterial disease is a significant public health issue in the United States, especially for older adults, African Americans, smokers, and those with a history of coronary artery disease, diabetes, elevated C-reactive protein levels, hypercholesterolemia, hypertension, and overweight and obesity. Approximately half of the 8 million to 12 million individuals in the United States with peripheral arterial disease are asymptomatic and undiagnosed, but they are at a significant risk for amputation, death, and stroke. This commentary describes peripheral arterial disease as a public health issue, discusses the cost associated with the disease, makes a case for screening individuals at risk, identifies the benefits of screening, and challenges the reader to be active in performing ankle-brachial index screenings on individuals at risk for the disease. [ABSTRACT FROM AUTHOR]

Older adults with low health literacy are living to advanced ages, often with multiple chronic conditions. This review focuses on eHealth literacy, which is defined as "the ability to seek, find, understand, and appraise health information from electronic sources and apply the knowledge gained to addressing or solving a health problem." Sixteen articles spanning a 10-year period were reviewed and examined for study design, intervention, and outcomes. Systemic changes in our societies are needed to decrease problems associated with low eHealth literacy. Fundamental training in computer literacy and health literacy is also needed. Integrating eHealth with adequate health literacy is key to people's ability to maintain their health, foster behavioral change, and utilize medical services effectively. [ABSTRACT FROM AUTHOR]

Much of health literacy is predicated on being able to read and understand health information and instructions given during the patient-provider encounter. Older adults with low vision face barriers to attaining health literacy because they have difficulty reading and interacting with health providers. Health care professionals can facilitate health literacy by understanding how vision impairment potentially limits health literacy in older adults. The article describes simple strategies both to increase the visibility and readability of printed health information and to improve the quality of the encounter between the health care provider and the patient, using suggestions from persons with vision impairment. [ABSTRACT FROM AUTHOR]

The purposes of the present study were to determine whether exercise is associated with functional disability in a dose-dependent manner and to identify a threshold for exercise benefit. The original data were collected using a national telephone survey technique. The current investigation was restricted to persons in the sample at baseline who were aged 60 or older. Functional disability, the primary dependent variable, was the summation of subject responses to five questions pertaining to functional limitation. Exercise was the independent variable in each of the three categories: strenuous exercise, moderate exercise, and walking. Age was used as a covariate in all statistical models. Descriptive data revealed a favorable linear relationship between exercise and functional disability. Tests of statistical significance partially supported a dose-dependent relationship between exercise and functional protection. Some exercise was better than none at all and high frequency exercise was better than some exercise with respect to functional impairment. However, a lower threshold for exercise effectiveness with respect to functional disability was not discovered. [ABSTRACT FROM AUTHOR]

A documentation system of ADL was designed and integrated into the electronic records for reporting Skilled Nursing Facility (SNF) inpatient rehabilitation outcomes to share with the stakeholders and agencies. A Webinar was developed for training in the administration of the Modified Barthel Index (MBI). This pilot study evaluated SNF rehabilitation efficiency and effectiveness from the changes in the MBI scores using a pilot sample of 234 patients with a diagnosis of complex medical-surgical conditions. The participants' mean age was 77.54 ± 13.08 years. The mean length of inpatients' stay was 27.2 ± 20.3 days. Eighty-nine percent of patients were discharged home. Rehabilitation efficiency was 0.91 point improvement in the MBI score per day. Rehabilitation effectiveness was 53.8%. For the future, this data entry system for the MBI would now be utilized across 23 states and 700 sites and outcomes evaluated on 22,000 inpatients to establish benchmarks of expected functional outcomes for various diagnostic groups. [ABSTRACT FROM AUTHOR]

The article reports on research which was conducted to investigate implementation challenges and outcome predictors for elder community-based disability prevention programs. Researchers evaluated longitudinal data on 719 clients and primary data from interviews to replicate a research trial and compared their results with original trial data. They found that replication functional outcome changes were lower and structures and processes were less intense than in the original research trial.

An interdisciplinary team has been developing and examining effects of Project B-Active (Be Active in the Community To Increase Vitality and Enjoyment) in response to the National Prevention Strategy which focuses on a weUness and prevention model and the NIH GO4Life campaign (NCCAM, 2011). The purpose of B-Active is to promote adherence to enjoyable physical activity for older adults who have a fear of falling. Adherence to enjoyable physical activity is important since it is associated with positive outcomes including increased fitness, strength, balance, flexibility, and self-efficacy. The project brings together expertise in: (a) therapeutic recreation associated with developing and evaluating leisure education interventions designed to be enjoyable and empowering, (b) human development associated with designing and evaluating group interventions for older adults using social facilitation strategies, and (c) kinesiology. All contributors of this collaboration are members of a Perm State Center for Healthy Aging. This paper highlights an evolving collaboration that has resulted in an innovative program associated with therapeutic recreation. Details about the program are provided. [ABSTRACT FROM AUTHOR]

The article focuses on the use of Hatha yoga to support bone health and minimize the risk of fracture in the geriatric population. It states that yoga likely improve bone health of the geriatric population based on various mechanisms such as enhancing balance and fear or falling, functioning development, and bone density improvement. It also presents a table comparing the American College of Sport Medicine (ACSM) guidelines for exercise in older adults and yoga practice to promote bone health.

The article explores the characteristics of older people at the intersection of driving with a disabling condition in the U.S. It stresses that the exploration on the conditions that older people are facing illustrates an example of dynamic intersection on the challenges associated with older people and transportation. Furthermore, the article explores on the training and education as a possible method of helping people extend life expectancy.

An introduction to the journal is presented in which the author discusses articles within the issue which focus on seating and wheeled mobility (SWM) for the elderly and individuals with mobility impairments, the challenges of evolving health care system and evidence for SWM technologies and services.

An introduction to topics discussed within the issue is presented, including an article on the unique risk of peripheral arterial disease (PAD) in women, an article on exercise interventions for those with PAD and an article on cause of arterial wounds of the lower extremities resulting from PAD.

An introduction is presented in which the authors discuss various reports within the issue on topics including cognitive training interventions in older adults, predictors of instrumental activities of daily living (IADL) performance, and relationship of demographic factors and health conditions.

The article evaluates the effect of depressive symptomatology on memory scores of elderly using data from the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) memory training and control conditions in the U.S. It mentions the faster decline in memory performance of those elderly with elevated depressive symptoms than those with fewer depressive symptoms. It also emphasizes the potential of training conditions in improving memory.

Objective: This article investigated how a multicomponent memory intervention affected memory for prose. We compared verbatim and paraphrased recall for short stories immediately and 1, 2, 3, and 5 years post-intervention in the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) sample. Method: We studied 1,912 ACTIVE participants aged 65 to 91. Participants were randomized into one of three training arms (Memory, Reasoning, Speed of Processing) or a no-contact Control group; about half of the trained participants received additional booster training 1 and 3 years post-intervention. Results: Memory-trained participants showed higher verbatim recall than non-memory-trained participants. Booster-memory training led to higher verbatim recall. Memory training effects were evident immediately following training and not after 1 year following training. Discussion: Results suggest that multifactorial memory training can improve verbatim recall for prose, but the effect does not last without continued intervention. [ABSTRACT FROM AUTHOR]

Objective: To examine basic and everyday cognitive predictors of older adults’ self-reported instrumental activities of daily living (IADL). Method: Basic and everyday cognitive predictors of self-reported IADL were examined in a sample of healthy, community-dwelling older adults (n = 698) assessed over 5 years of measurement. Results: Multilevel longitudinal analyses revealed linear and quadratic change trends for self-reported IADL function, with steeper declines at higher ages. Within-person, when participants exhibited lower cognitive performance, they also reported more IADL impairment. Everyday cognition remained a significant unique predictor of self-reported IADL after controlling for attrition, resampling effects, temporal gradients, and baseline levels and changes in demographic, sensory, functional, and basic cognitive measures. Discussion: By itself, everyday cognition appears to be an important predictor of self-reported IADL, and maintains a unique predictive contribution after many covariates are controlled. Future research should consider the inclusion of everyday cognitive measures in functional assessment batteries. [ABSTRACT FROM AUTHOR]