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This chapter reviews a three-arm clinical trial, which compared the LiFE (Lifestyle-integrated Functional Exercise) program to structured strength and balance exercise and gentle flexibility exercise. Older adults, aged 70 years and above, who had a history of falls were recruited from the community and randomly assigned to one of the three exercise programs. Older adults in the LiFE program successfully integrated strength and balance exercises into their everyday activities. Significant improvements in favor of the LiFE condition were observed for fall rates, static balance, ankle strength, function, and participation. The study shows that the LiFE program is an effective alternative fall prevention program compared to traditional structured strength and balance exercise.

Study Design This is a cross-sectional observational study. Background Reference equations for describing hand-grip strength across the age span were derived from the 2011 NIH Toolbox norming study. Purpose The purpose of this study was to cross-validate reference equations by evaluating its predicting power on a separate, independent data set from the 2011-2014 National Health and Nutrition Examination Survey (NHANES) study Methods Observed hand-grip strength data from 13,676 noninstitutionalized participants were obtained from the NHANES study. Best values (best from 3 trials) and the mean values (averaged from 3 trials) were determined for each hand. Using the age (yr), height (m), and weight (kg), we computed predicted grip strength values for dominant and nondominant hands using the reference equations. For validation, three predictability measures: the correlation coefficient, residuals, and accuracy, were used along with the Bland-Altman plot. Results The predicted values highly correlated with observed values (r = 0.90, ICC = 0.89). In predicting best values, means (SD) of residuals were 1.41 (5.57) and 1.03 (5.44) kg for dominant and nondominant hands, respectively. In predicting mean values, means (SD) of residuals were −0.23 (5.42) and −0.54 (5.31) kg for dominant and nondominant hands, respectively. Root mean square error ranged from 4.10 (female's nondominant mean values) to 6.74 (male's dominant best values). About 5.56% fell outside of the 95% confidence interval of the prediction. Conclusions We acknowledged that the two studies' hand-grip protocols (NIH Toolbox, NHANES) were different. Results provided the preliminary predicting performance of the reference equations derived from the NIH Toolbox study.

Translating and implementing research exercise programs that fit into the context of community service provisions could become part of the effort to reduce late-life disability. The purpose of this study was to examine the feasibility of a staff-led 3-Step Workout for Life program by applying a logic model in a local senior living community. The academic investigator and community fitness staff worked together to modify and implement the program protocol following the logic model. The community staff recruited residents and delivered the program. Residents were eligible if they were sedentary, showed muscle weakness, and experienced difficulty in performing activities of daily living. Feasibility was evaluated with program completion and attendance rates, adverse events, physical performance, and activities of daily living. Seventeen residents (mean age = 80 years) enrolled and 13 completed the program with an average attendance rate of 95%. No severe adverse events were reported. After program completion, participants' muscle strength and gross motor coordination of the upper extremity, as well as performance and satisfaction of activities of daily living were improved. This study supported the feasibility of the staff-led 3-Step Workout for Life program to promote independence for residents at risk of late-life disability in a senior living community.

Occupational therapy practitioners are essential members of the home health rehabilitation team to support patients transitioning from acute care to home. However, home health occupational therapy services have been underutilized, in part, due to limited understanding of services that the profession provides. Improving this understanding is necessary to help patients receive timely services. The purpose of the study was to describe the current practice patterns in home health occupational therapy. Fifty home health occupational therapy practitioners from 27 states completed an electronic survey between May and June 2021. The survey consisted of questions about assessment and treatment, communication with physical therapy colleagues, and the impact of the Patient-Driven Grouping Model and the coronavirus disease 2019 pandemic on service delivery. Results showed that occupational therapy assessments focused on personal care activities, mobility and balance, and cognition. The treatment content usually included training in activities of daily living, functional mobility, the application of compensatory strategies (e.g., home adaptations), and fall prevention strategies. Most respondents communicated with their physical therapy colleagues at least once a week on topics related to scheduling, changes in a patient’s condition, and falls and safety concerns. Seventy percent of respondents experienced a reduction of home visits during the recent Medicare payment reform and the pandemic. These practitioners felt that some patients might be discharged prematurely because of this reduction. The survey results highlight the pertinence of occupational therapy services to support patients’ independence and safety at home and the need to increase these services for home health patients.

Sensory processing is defined as the ability to respond to sensory information from the environment and to act accordingly to the situational demands. Sensory processing is associated with anxiety in middle-aged adults, specifically in those with sensory over-responsiveness and under-responsiveness. It remains unclear how age-related change in sensory processing is correlated with mental health. The purpose of this study is to examine the correlations between sensory processing patterns, depression, and perceived-stress in older adults. Respondents were recruited from community networks serving older adults. They were asked to complete an electronic survey, including the Adult Sensory Processing Scale (ASPS), the Perceived Stress Scale, and the Center of Epidemiologic Depression Scale-Revised. ASPS has 11 factors related to over-responsive, under-responsive, and sensory seeking in visual, auditory, tactile, vestibular and proprioceptive input.Of 148 older adults (Mean age = 72 years) completed the survey, 30% perceived moderate to high levels of stress, and 18% had depressive symptoms. The total score of the ASPS Scale is positively correlated with perceived stress (r=0.26; p=.001) and depression (r=0.27; p=.001). Specifically, those who were over-responsive to auditory and vestibular input, and under-responsive to proprioception had higher stress levels and greater depression.Sensory decline or impairment in older adults may alter older adults’ ability to process sensory information. As sensory processing has significant impact on anxiety and perceived stress in older adults, it should be considered in evaluation and intervention, particularly on audition, vestibular and proprioception. Including sensory-based approach may help better manage their mental health.

Importance: Rural homebound older adults are a vulnerable population at risk for depression, loneliness, and limited participation, but studies that examine these factors in this population are scarce. Objective: To describe the degree of depression, loneliness, and activity engagement among rural homebound older adults and determine differences in loneliness and activity engagement between those with and those without self-reported depression. Design: Cross-sectional survey. Setting: Two rural counties in south central Indiana. Participants: Homebound adults ages 60 yr and older who received nutritional or companionship services from a local Area Agency on Aging. Outcomes and Measures: Depression was measured with an item on the self-report questionnaire and the Geriatric Depression Scale–15. Loneliness was measured with an item on the self-report questionnaire and the UCLA Loneliness Scale. Activity engagement was measured with the Engagement in Meaningful Activities Survey and the Meaningful Activity Participation Assessment. Results: Ninety-one participants returned surveys, of which 78 were analyzed. Regarding depression, 40% of participants reported having it, but results for the Geriatric Depression Scale–15 showed that 63% were in the indicative or suggestive range for depression. Participants in general reported moderate loneliness and low to moderate engagement in meaningful activities. Those with self-reported depression had significantly higher loneliness and lower activity engagement, particularly in self-care, leisure, and socializing activities. Conclusions and Relevance: A high proportion of this sample of rural homebound older adults had depression. Those who did tended to have a higher degree of loneliness and lower engagement in meaningful activities. What This Article Adds: Depression was associated with greater loneliness and lower activity engagement in rural homebound older adults. Occupational therapy practitioners serving rural homebound older adults with depression should consider providing interventions to address loneliness and facilitate activity engagement.

Background and Objectives The prevalence of cognitive impairment and sensory loss in hearing or vision increases with age. Based on the Information Processing Model, cognitive impairment coupled with sensory loss may exacerbate disability in late life. Yet this issue has not been systematically studied. The purpose of this scoping review was to examine the literature that studied the relationship between cognitive impairment, sensory loss, and activities of daily living in older adults. Research Design and Methods Two reviewers independently screened 1,410 studies identified from 5 electronic databases (Medline, EMBASE, PsycINFO, CINHAL, and Web of Science). The search was completed in June 2020. A study was eligible if it included measurements of cognitive function, vision or hearing, and activities of daily living. Additionally, the data analyses must address how cognitive impairment and sensory loss are related to the performance of activities of daily living. Results The final review included 15 studies. Findings show an additive effect of cognitive impairment and sensory loss on the activities of daily living. Cognitive impairment or vision loss independently relates to the decline in activities of daily living. Hearing loss relates to the decline only when the loss is severe, or if the daily task is hearing - specific. Discussion and Implications Older adults with coexisting sensory loss and cognitive impairment have the highest risk or prevalence of disability, comparing to cognitive impairment or sensory loss alone. This finding highlights the importance of developing interventions to reduce the risk of disability for older adults experiencing multiple impairments.

Importance: The prevalence of low vision increases with age. Low vision has detrimental effects on older adults’ independence. Objective: To identify the effectiveness of interventions within the scope of occupational therapy practice to maintain, restore, and improve performance in daily activities for older adults with low vision. Data Sources: Literature published between 2010 and 2017 was searched in CINAHL, Cochrane Databases, MEDLINE, OTseeker, and PsycINFO. Study Selection and Data Collection: The authors screened and appraised studies following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. Studies were eligible if the participants’ mean age was 55 yr or older, the level of evidence was Level III or higher, the intervention was within the scope of occupational therapy practice, and the outcome measures assessed the performance of daily activities. Findings: Fourteen studies met the review criteria. Three intervention themes were identified: low vision rehabilitation services (n = 6), self-management approach (n = 6), and tango (n = 2). Moderate evidence was found for low vision rehabilitation services. Low evidence was found for using the self-management approach or adding the self-management approach to existing low vision rehabilitation services. Low evidence was found for tango. Conclusion and Relevance: This systematic review supports the use of low vision rehabilitation services as an effective approach. Occupational therapy practitioners are encouraged to be part of multidisciplinary teams that offer comprehensive low vision evaluations and multicomponent services. What This Article Adds: Low vision rehabilitation that offers multidisciplinary services, including occupational therapy, is effective in promoting independence among older adults with low vision.

Islene Araujo de Carvalho and coauthors discuss the WHO guidelines on integrated care for older people.

Older adults with reduced physical capacity are at greater risk of progression to care dependency. Progressive resistance strength exercise and multimodal exercise have been studied to restore reduced physical capacity. To summarize the best evidence of the two exercise regimes, this meta-analysis study appraised randomized-controlled trials from published systematic reviews. Medline, Embase, and the Cochrane Database of Systematic Review and Cochrane Central Register of Controlled Clinical Trials were searched for relevant systematic reviews. Two reviewers independently screened the relevant systematic reviews to identify eligible trials, assessed trial methodological quality, and extracted data. RevMan 5.3 software was used to analyze data on muscle strength, physical functioning, activities of daily living, and falls. Twenty-three eligible trials were identified from 22 systematic reviews. The mean age of the trial participants was 75 years or older. Almost all multimodal exercise trials included muscle strengthening exercise and balance exercise. Progressive resistance exercise is effective in improving muscle strength of the lower extremity and static standing balance. Multimodal exercise is effective in improving muscle strength of the lower extremity, dynamic standing balance, gait speed, and chair stand. In addition, multimodal exercise is effective in reducing falls. Neither type of exercise was effective in improving activities of daily living. For older adults with reduced physical capacity, multimodal exercise appears to have a broad effect on improving muscle strength, balance, and physical functioning of the lower extremity, and reducing falls relative to progressive resistance exercise alone.

Study Design This is a cross-sectional, observational study. Introduction The disability of the arm, shoulder and hand (DASH) questionnaire is an upper-extremity specific outcome measure commonly used in routine clinical care and clinical trials. Purpose of the Study Our purposes were to: (1) examine the psychometric properties of the DASH questionnaire using factor analysis, one- and two-parameter item response theory models, and (2) develop a functional staging map illustrating the relationships between the item difficulty hierarchy of the DASH items and the patient's DASH total score. Methods Data from 2724 patients with orthopedic shoulder impairments seeking outpatient physical therapy in 79 clinics in the US were analyzed. Results Factor analysis supported a general factor, explaining 62.2% of the total variance. The coverage of DASH items was suitable for patients with shoulder impairments with no ceiling or floor effect. Endorsed items representing the most difficult items were related to feeling less capable, executing recreational activities with force or impact, and performing recreational activities in which you move your arm freely. Items with higher discriminating abilities were those related to do heavy household chores, garden/yard work, and change a light bulb overhead. With a separation index equaled to 4.94, the DASH can differentiate persons into at least 6 statistically distinct person strata. None of the DASH items exhibited differential item functioning by gender or symptom acuity, except two items by age group. Discussion Besides a total (summed) final score obtained from a specific measure, the keyform and functional staging plots/maps can be used to assist clinicians in clinical interpretation of the scores. Conclusions Results supported the clinical usage of the DASH questionnaire in patients with orthopedic shoulder impairments seeking outpatient rehabilitation.

Hand function is critical for independence in activities of daily living for older adults. The purpose of this study was to examine how grip strength, arm curl strength, and manual dexterous coordination contributed to time-based versus self-report assessment of hand function in community-dwelling older adults. Adults aged ≥60 years without low vision or neurological disorders were recruited. Purdue Pegboard Test, Jamar hand dynamometer, 30-second arm curl test, Jebsen-Taylor Hand Function Test, and the Late-Life Function and Disability Instrument were administered to assess manual dexterous coordination, grip strength, arm curl strength, time-based hand function, and self-report of hand function, respectively. Eighty-four adults (mean age = 72 years) completed the study. Hierarchical multiple regressions show that older adults with better arm curl strength (β = −.25, p

The purpose of this feasibility study was to evaluate the 3-Step Workout for Life program, a 10-week exercise program that included moderate-intensity muscle strength training followed by task-oriented training. Fourteen participants completed the program (mean age = 73 years; SD = 6.83). The Box and Block test (Z = −2.24, p = .03) and the 30-s chair stand test (Z = − 2.21, p = .03) indicate improved physical functioning of the upper and lower extremities. More importantly, results of the function component from the Late-Life Function and Disability Instrument (Z = –2.04, p = .04) and motor skills scale from the Assessment of Motor and Process Skills (Z = −2.97, p = .003) indicate subjective and objective improvements on performing activities of daily living. Supplementing moderate-intensity muscle strength exercise with task-oriented training components is feasible. Preliminary data support the effectiveness of 3-Step Workout for Life in reducing late-life disability.

Date Presented 03/26/20 The study examined Medicare quality-measure data to determine the amount of rehabilitation services needed (e.g., therapy intensity and the length of stay) to maximize the improvement in self-care skills for older adults with an orthopedic hip condition in skilled-nursing facilities. Findings of the study can serve as a reference for OTs to plan intervention and justify the resources necessary to increase clients’ independence. Primary Author and Speaker: Chiung-ju (CJ) Liu Additional Authors and Speakers: Christine Kroll Contributing Authors: Courtney Hayden, Craig Wright, Erin Ingram, Lauren Barr, Niki Pierson, Ashley Suda

Objective: The aim of the study is to assess the relationship between body mass index (BMI) class and Medicare claims among young-old (65-69), old (70-74), and old-old (75+) adults over a 10-year period. Method: We assessed costs by BMI class and age group among 9,300 respondents to the 1998 Health and Retirement Study (HRS) with linked 1998-2008 Medicare claims data. BMI was classified as normal (18.5-24.9), overweight (25-29.9), mild obesity (30-34.9), or severe obesity (35 or above). Results: Annualized total Medicare claims adjusted for age, gender, ethnicity, education, and smoking history were 109% greater for severely obese young-old adults in comparison with normal weight young-old adults (US$9,751 vs. US$4,663). Total annualized claim differences between the normal weight and severely obese in the old and old-old groups were not statistically significant. Discussion: Excess Medicare expenditures related to obesity may be concentrated among severely obese young-old adults. Preventing severe obesity among middle and older aged adults may have large cost implications for society.

Background Resistance exercise is effective to increase muscle strength for older adults; however, its effect on the outcome of activities of daily living is often limited. The purpose of this study was to examine whether 3-Step Workout for Life (which combines resistance exercise, functional exercise, and activities of daily living exercise) would be more beneficial than resistance exercise alone. Methods A single-blind randomized controlled trial was conducted. Fifty-two inactive, community-dwelling older adults (mean age =73 years) with muscle weakness and difficulty in activities of daily living were randomized to receive 3-Step Workout for Life or resistance exercise only. Participants in the 3-Step Workout for Life Group performed functional movements and selected activities of daily living at home in addition to resistance exercise. Participants in the Resistance Exercise Only Group performed resistance exercise only. Both groups were comparable in exercise intensity (moderate), duration (50–60 minutes each time for 10 weeks), and frequency (three times a week). Assessment of Motor and Process Skills, a standard performance test on activities of daily living, was administered at baseline, postintervention, and 6 months after intervention completion. Results At postintervention, the 3-Step Workout for Life Group showed improvement on the outcome measure (mean change from baseline =0.29, P=0.02), but the improvement was not greater than the Resistance Exercise Only Group (group mean difference =0.24, P=0.13). However, the Resistance Exercise Only Group showed a significant decline (mean change from baseline =−0.25, P=0.01) 6 months after the intervention completion. Meanwhile, the superior effect of 3-Step Workout for Life was observed (group mean difference =0.37, P

Muscle strength is essential but insufficient to reduce ADL disability in older adults. A parallel-group randomized controlled trial was conducted to compare whether adding functional and task-oriented training to resistance exercise would generate a greater improvement on ADL performance relative to resistance exercise alone. Fifty-two older adults who showed muscle weakness, lived a sedentary life style, and had ADL difficulty were recruited from local subsidized housing properties. They received 10 weeks of resistance exercise or the 3-Step Workout for Life, which included practicing functional movements and ADL tasks at home in addition to resistance exercise. The Box and Blocks test, Timed Up and Go, and Assessment of Motor and Process Skills were used to measure physical function and ADL performance. At six-month follow-up, all three outcomes in the 3-Step Workout for Life group were not different from the baseline while the resistance exercise only group showed a significant decline (mean change in the Box and Blocks = -4.05, p = 0.02; mean change in the Timed Up and Go = 1.84, p = 0.01; mean change in the Assessment of Motor and Process Skills = -0.25, p = 0.01). More importantly, the 3-Step Workout for Life group showed a greater improvement in ADL performance when compared to the resistance exercise only group (group mean difference = 0.37, p

The challenge of using exergames to promote physical activity among cancer survivors lies in the selection of the exergames that match their fitness level. There is a need for a standardized grading scheme by which to judge an exergame’s capacity to address specific physical fitness attributes with different levels of physical engagement. The study aimed to develop an Exergame Grading Scheme and preliminarily evaluate its psychometric properties. Fourteen (14) items were created from the human movement and exergame literature. The content validity index (CVI) was rated by content experts with two consecutive rounds (N=5 and N=3 independently). The interrater reliability (IRR) was determined by two raters who used the Exergame Grading Scheme to determine the grading score of the five exergames performed by two cancer survivors (N=10). Each item had a score of 1 for item-level CVI and 1 for k. For IRR, 9 items had rho values of 1, 1 item had 0.93, and 4 items had between 0.80 and 0.89. This valid and reliable Exergame Grading Scheme makes it possible to develop a personalized physical activity program using any type of exergame or fitness mobile application in rehabilitation practice to meet the needs of cancer survivors.

Aims: To describe and determine factors predicting utilization of occupational and physical therapy (PT) services in postacute rehabilitation systems over a 1-year period in Medicare beneficiaries. Methods: Data from 1,667 respondents in the 2006 Health and Retirement Study and linked Medicare claims were analyzed. Results: The average length of inpatient rehabilitation stay ranged between 11 and 17 days. Therapeutic procedures were the most commonly claimed Current Procedural Terminology (CPT) codes in outpatient rehabilitation. Very-high level was the mostly claimed resource utilization group (RUG) in skilled nursing facilities. Additionally, the average number of therapy home visit ranged between 31 and 34. Logistic regression analysis showed that greater age and more comorbidities were associated with using therapy services from two or more postacute care (PAC) systems. Conclusion: The study results increase the understanding of the utilization of rehabilitation therapy services across PAC sys...

Date Presented 4/20/2018 A discord between the Canadian Occupational Performance Measure and the Assessment of Motor and Process Skills suggests that a discrepancy exists between older adults’ subjective perception and occupational therapists’ objective evaluation of occupational performance early in the disablement process. Primary Author and Speaker: Chiung-ju Liu Additional Authors and Speakers: Hilary Harris, Alyssa Davis, Louella Schoenfeld, Taylor Romero

Among matrix metalloproteinases (MMPs), MMP-9 has been observed in patients with brain inflammatory diseases and may contribute to the pathology of brain diseases. Thrombin has been known as a regulator of MMP-9 expression and cells migration. However, the mechanisms underlying thrombin-induced MMP-9 expression in rat brain astrocytes (RBA-1 cells) were not completely understood. Here, we demonstrated that thrombin induced the expression of pro-form MMP-9 in RBA-1 cells and cells migration which were attenuated by pretreatment with the inhibitor of receptor tyrosine kinase (Genistein), c-Src (PP1), Jak2 (AG490), PDGFR (AG1296), PI3K (LY294002), Akt (SH-5), PKCs (Ro318220), PKCδ (Rottlerin), or NF-κB (Bay11-7082) and transfection with siRNA of c-Src, PDGFR, Akt, PKCδ, ATF2, p65, IKKα, or IKKβ. In addition, thrombin-stimulated c-Src, Jak2, or PDGFR phosphorylation was inhibited by a thrombin inhibitor (PPACK), PP1, AG490, or AG1296. Thrombin further stimulated c-Src and PDGFR complex formation in RBA-1 cells. Thrombin also stimulated Akt and PKCδ phosphorylation and PKCδ translocation which were reduced by PPACK, PP1, AG490, AG1296, or LY294002. We further observed that thrombin markedly stimulated ATF2 or IκBα phosphorylation and NF-κB p65 translocation which were inhibited by Rottlerin or LY294002. Finally, thrombin stimulated in vivo binding of p65 to the MMP-9 promoter, which was reduced by pretreatment with Rottlerin or LY294002. These results concluded that in RBA-1 cells, thrombin activated a c-Src/Jak2/PDGFR/PI3K/Akt/PKCδ pathway, which in turn triggered ATF2 and NF-κB activation and ultimately induced MMP-9 expression associated with cell migration.

The purpose of this study is to understand current practice of patient education by occupational therapy practitioners who work with the geriatric population. A 30-item survey was sent to 97 practitioners in the Indianapolis area. Seventy-eight (80.4%) returned the survey. Respondents reported that activities of daily living and safety were two topics taught most frequently. Verbal instructions and demonstrations were two main strategies of patient education. Clients’ cognitive function was the biggest factor considered when providing written information. Most respondents used written materials developed by their facilities. Over half of the respondents perceived that clients sometimes had difficulty understanding educational content. Time constraints and limited resources of educational materials were two main barriers to patient education. The majority of practitioners reported that they needed education materials that cover the topic of safety. Further research on developing effective and effic...

Matrix metalloproteinase-9 (MMP-9) plays a crucial role in pathological processes of brain inflammation, injury, and neurodegeneration. Thrombin has been known as a regulator of MMP-9 expression and cells migration. However, the mechanisms underlying thrombin-induced MMP-9 expression in rat brain astrocytes (RBA-1 cells) remain unclear. Here, we demonstrated that thrombin induced the expression of pro-form MMP-9 and migration of RBA-1 cells, which were inhibited by pretreatment with the inhibitor of Gq-coupled receptor (GPAnt2A), Gi/o-coupled receptor (GPAnt2), PC-PLC (D609), PI-PLC (U73122), Ca2+-ATPase (thapsigargin, TG), calmodulin (CaMI), CaMKII (KN62), PKC (Go6976 or GF109203X), MEK1/2 (PD98059), p38 MAPK (SB202190), JNK1/2 (SP600125), or AP-1 (Tanshinone IIA) or the intracellular calcium chelator (BAPTA/AM) and transfection with siRNA of PKCα, Erk2, JNK1, p38 MAPK, c-Jun, or c-Fos. In addition, thrombin-induced elevation of intracellular Ca2+ concentration was attenuated by PPACK (a thrombin inhibitor). Thrombin further induced CaMKII phosphorylation and PKCα translocation, which were inhibited by U73122, D609, KN62, TG, or BAPTA/AM. Thrombin also induced PKCα-dependent p42/p44 MAPK and JNK1/2, but not p38 MAPK activation. Finally, we showed that thrombin enhanced c-Fos expression and c-Jun phosphorylation. c-Fos mRNA levels induced by thrombin were reduced by PD98059, SP600125, and Go6976, but not SB202190. Thrombin stimulated in vivo binding of c-Fos to the MMP-9 promoter, which was reduced by pretreatment with SP600125 or PD98059, but not SB202190. These results concluded that thrombin activated a PLC/Ca2+/CaMKII/PKCα/p42/p44 MAPK and JNK1/2 pathway, which in turn triggered AP-1 activation and ultimately induced MMP-9 expression in RBA-1 cells.

Increasing readability of written cancer prevention information is a fundamental step to increasing awareness and knowledge of cancer screening. Instead of readability formulas, the present study focused on text cohesion, which is the degree to which the text content ties together. The purpose of this study was to examine the effect of text cohesion on reading times, comprehension, and retention of colorectal cancer prevention information. English-speaking adults (50 years of age or older) were recruited from local communities. Participants were randomly assigned to read colorectal cancer prevention subtopics presented at 2 levels of text cohesion: from higher cohesion to lower cohesion, or vice versa. Reading times, word recognition, text comprehension, and recall were assessed after reading. Two weeks later, text comprehension and recall were reassessed. Forty-two adults completed the study, but five were lost to follow up. Higher text cohesion showed a significant effect on reading times and text comprehension but not on word recognition and recall. The effect of text cohesion was not found on text comprehension and recall after 2 weeks. Increasing text cohesion facilitates reading speed and comprehension of colorectal cancer prevention information. Further research on the effect of text cohesion is warranted.

In this paper, we give both lower and upper bound estimates of the Bergman kernel for a degeneration of Riemann surfaces with constant curvature −1. As a result, we give a geometric proof of the Riemann–Rock theorem for a singular Riemann surface.

Age-related decline in muscle strength affects both upper and lower extremities. This decline is associated with late-life onset of physical disability. Although progressive resistance strength training (PRT) has shown promising results in lower-extremity-related physical function, such as walking speed, little is known about the effect on upper-extremity-related physical function. This study reviewed 28 randomized controlled trials published before 2008. Outcomes of upper-extremity muscle strength, hand-grip strength, eye–hand coordination, and physical function were appraised. It is hard to conclude whether or not upper-extremity PRT is beneficial for upper-extremity-related physical function in older adults because the specific effect of upper extremities was often unmeasured, poorly measured with timed tests, or buried in mixed results of upper and lower extremities. Additional research that focuses on examining the effect of upper-extremity PRT is recommended to support the need for a compreh...

OBJECTIVE. This systematic review aimed to synthesize the effects of interventions within the scope of occupational therapy to improve performance of activities of daily living (ADLs) in community-dwelling older adults. METHOD. Searches were conducted in CINAHL, the Cochrane Database of Systematic Reviews, MEDLINE, PsycINFO, and OTseeker. Empirical studies published between 1995 and 2015 were individually screened and appraised by two reviewers. RESULTS. Forty-three studies met the review inclusion and exclusion criteria. Physical exercise was the most common intervention approach. Physical exercise interventions for frail older adults showed a moderate benefit, but no benefits were found for older adults without noticeable difficulty in ADLs. For older adults with difficulty in ADLs, there was a high benefit of using home-based intervention. CONCLUSION. The findings of this systematic review highlight the importance of addressing older adults’ living environment in intervention to promote independence in ADLs.

The decline of muscle strength is associated with physical disability in late adulthood. Progressive resistance strength training has been demonstrated to be an effective intervention to increase muscle strength, however, its effect on reducing physical disability in older adults is unclear. The purpose of this study is to examine the effect of progressive resistance strength training on physical disability via meta-analysis.Two reviewers independently searched for qualified trials, assessed trial quality and extracted data. Trial inclusion criteria are: (1) Randomised controlled trials, (2) Mean age of participant sample is ≥ 60 years, (3) Progressive resistance strength training as the primary intervention and (4) the trial included outcome measures of physical disability (i.e. physical function domain of the Short-Form 36).Thirty-three trials were analysed. Although the effect size is small, the intervention groups showed reduced physical disability when compared to the control groups (SMD = 0.14, 95% CI = 0.05 to 0.22).Progressive resistance strength training appears to be an effective intervention to reduce physical disability in older adults. To maximise the effect, we suggest therapists use responsive outcome measures and multi-component intervention approach.

In this paper, the Bando-Futaki invariants on hypersurfaces are derived in terms of the degree of the defining polynomials, the dimension of the underlying projective space, and the given holomorphic vector field. In addition, the holomorphic invariant introduced by Tian and Chen (Ricci Flow on K\"ahler-Einstein surfaces) is proven to be the Futaki invariant on compact K\"ahler manifolds with positive first Chern class., Comment: 44 pages

Objective To examine whether explanatory illustrations can improve older adults’ comprehension of written health information. Methods Six short health-related texts were selected from websites and pamphlets. Young and older adults were randomly assigned to read health-related texts alone or texts accompanied by explanatory illustrations. Eye movements were recorded while reading. Word recognition, text comprehension, and comprehension of the illustrations were assessed after reading. Results Older adults performed as well as or better than young adults on the word recognition and text comprehension measures. However, older adults performed less well than young adults on the illustration comprehension measures. Analysis of readers’ eye movements showed that older adults spent more time reading illustration-related phrases and fixating on the illustrations than did young adults, yet had poorer comprehension of the illustrations. Conclusion Older adults might not benefit from text illustrations because illustrations can be difficult to integrate with the text. Practice implications Health practitioners should not assume that illustrations will increase older adults’ comprehension of health information.

We used eye-tracking technology to examine young and older adults’ performance in the reading with distraction paradigm. One-, 2- and 4-word distracters that formed meaningful phrases were used. There were marked age differences in fixation patterns. Young adults’ fixations to the distracters and targets increased with distracter length, suggesting that they were attempting to integrate the distracters with the sentence and had more and more difficulty doing so as the distracters increased in length. Young adults did have better comprehension of the sentences than older adults and also better recognition memory for target words and distracters.

The eye movements of young and older adults were tracked as they read sentences varying in syntactic complexity. In Experiment 1, cleft object and object relative clause sentences were more difficult to process than cleft subject and subject relative clause sentences; however, older adults made many more regressions, resulting in increased regression path fixation times and total fixation times, than young adults while processing cleft object and object relative clause sentences. In Experiment 2, older adults experience more difficulty than young adults while reading cleft and relative clause sentences with temporary syntactic ambiguities created by deleting the “that” complementizers. Regression analyses indicated that readers with smaller working memories need more regressions and longer fixation times to process cleft object and object relative clause sentences. These results suggest that age-associated declines in working memory do affect syntactic processing.

OBJECTIVE. The purpose of this study was to examine the relationship between visual inattention and daily life performance in people with Alzheimer’s disease. METHODS. Twenty persons with Alzheimer’s disease (Mini Mental Status Exam [MMSE] > 20) and 21 community dwelling persons (MMSE >26) voluntarily participated in this study. One line bisection test and two cancellation tests were used for testing attention abilities. The Functional Spatial Abilities Questionnaire (FSAQ), the Disability Assessment for Dementia (DAD), and the behavioral subtests of the Behavioral Inattention Test (BIT) were used to assess daily functioning. The presence of visuospatial neglect in people with Alzheimer’s disease was determined by comparing performance on the three attention tests with the control group. RESULTS. People with Alzheimer’s disease who omitted more targets on the symbol cancellation test showed more deficits on the behavioral subtests of the BIT (p = .02). They also used less systematic searching strategies (p = .001), spent more time looking for targets (p = .001), and made more commission errors (p = .007) than controls on the cancellation test. However, those with Alzheimer’s disease who had visuospatial neglect did not differ from those without neglect on the FSAQ, DAD, and most of the BIT behavioral subtests. CONCLUSION. People with Alzheimer’s disease have visual inattention problems; however, visuospatial neglect did not interfere with their performance in daily activities as measured in this study. Further research focusing on the relationship between visual attention and daily life function as the disease progresses is suggested.

The impact of age-related vision loss on older adults’ independence at home is profound. The purpose of this systematic review was to identify the effectiveness of interventions within the scope of occupational therapy practice to maintain, restore, and improve performance in daily activities at home for older adults with low vision. We searched and screened abstracts from multiple electronic databases and identified 17 studies that fulfilled our inclusion and exclusion criteria. Three themes in intervention approaches emerged: multicomponent intervention, single-component intervention, and multidisciplinary intervention. Strong evidence of effectiveness was found in studies that applied a multicomponent approach; these interventions involved teaching knowledge and skills that older adults with low vision need to help overcome the disablement process. Evidence also suggests that multiple sessions of training with low vision devices and special viewing skills to compensate for vision loss are necessary to have a positive effect on daily activities. Finally, multidisciplinary intervention that focused on personal goals yielded greater positive outcomes than interventions that were not personalized.

Matrix metalloproteinase-9 (MMP-9) plays a crucial role in pathological processes of brain inflammation, injury, and neurodegeneration. Thrombin has been known as a regulator of MMP-9 expression and cells migration. However, the mechanisms underlying thrombin-induced MMP-9 expression in rat brain astrocytes (RBA-1 cells) remain unclear. Here, we demonstrated that thrombin induced the expression of pro-form MMP-9 and migration of RBA-1 cells, which were inhibited by pretreatment with the inhibitor of Gq-coupled receptor (GPAnt2A), Gi/o-coupled receptor (GPAnt2), PC-PLC (D609), PI-PLC (U73122), Ca(2+)-ATPase (thapsigargin, TG), calmodulin (CaMI), CaMKII (KN62), PKC (Gö6976 or GF109203X), MEK1/2 (PD98059), p38 MAPK (SB202190), JNK1/2 (SP600125), or AP-1 (Tanshinone IIA) or the intracellular calcium chelator (BAPTA/AM) and transfection with siRNA of PKCα, Erk2, JNK1, p38 MAPK, c-Jun, or c-Fos. In addition, thrombin-induced elevation of intracellular Ca(2+) concentration was attenuated by PPACK (a thrombin inhibitor). Thrombin further induced CaMKII phosphorylation and PKCα translocation, which were inhibited by U73122, D609, KN62, TG, or BAPTA/AM. Thrombin also induced PKCα-dependent p42/p44 MAPK and JNK1/2, but not p38 MAPK activation. Finally, we showed that thrombin enhanced c-Fos expression and c-Jun phosphorylation. c-Fos mRNA levels induced by thrombin were reduced by PD98059, SP600125, and Gö6976, but not SB202190. Thrombin stimulated in vivo binding of c-Fos to the MMP-9 promoter, which was reduced by pretreatment with SP600125 or PD98059, but not SB202190. These results concluded that thrombin activated a PLC/Ca(2+)/CaMKII/PKCα/p42/p44 MAPK and JNK1/2 pathway, which in turn triggered AP-1 activation and ultimately induced MMP-9 expression in RBA-1 cells.

Date Presented 4/7/2016 What is the correlation between muscle strength of the upper extremity and hand function in older adults? Our study shows that arm-curl strength, rather than grip strength, is correlated with hand function. An arm-curl strength test may be used to predict hand function performance in older clients. Primary Author and Speaker: Chiung-ju Liu Additional Authors and Speakers: Aaron Frederick, Elaine Fess, Kristen Utley, Jessica Bertram, Deana Schuman

We give a purely complex geometric proof of the existence of the Bergman kernel expansion. Our method provides a sharper estimate, and in the case that the metrics are real analytic, we prove that the remainder decays faster than any polynomial., Revised version of the previous version