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Background: Nursing home eligible participants in the Program of All‐inclusive Care for the Elderly (PACE) are at high risk for falls. Physical function is a modifiable predictor of falls and an important target for prevention. We engaged a PACE site to explore feasibility of implementing progressive intensive rehabilitation to improve physical function and preliminary patient‐level improvements. Methods: The research involved a mixed‐methods, pre–post implementation study with longitudinal patient follow‐up at one Denver PACE site. Older adults at risk for institutionalization (N = 28) took part in Screening and high‐intensity interventions to Improve Falls risk and Transform expectations in age and aging (SHIFT) rehabilitation program over six weeks. Outcomes included the short physical performance battery (SPPB); 4‐meter gait speed at baseline, discharge, and 6 and 12 months postdischarge from SHIFT. A focus group with staff explored facilitators and barriers to program implementation in the PACE setting and with complex patients and perceived effectiveness. Results: The rehabilitation team demonstrated high treatment fidelity to SHIFT (>80%). No treatment‐specific adverse events were reported. SPPB scores and gait speeds improved significantly over time (p < 0.005). The average SPPB score at evaluation was 4.6 ± 0.24 compared to 7.7 ± 0.38 points at discharge. The average gait speed at evaluation was 0.58 ± 0.03 meters/second (m/s) compared to 0.79 ± 0.04 m/s at discharge. Common barriers to program completion included changes in health status and environmental factors (e.g., transportation). Conclusions: Rehabilitation therapists incorporated a high‐intensity resistance training program into routine care of complex older adults in PACE and improved pre–post physical function to levels above independence thresholds (SPPB ≥6; gait speed ≥0.65 m/s). Our pilot implementation study informed refinement of eligibility criteria, number of visits, and strategies to address long‐term adherence to enhance scalability and optimize impact. [ABSTRACT FROM AUTHOR]

OBJECTIVES: We aimed to describe a new multidisciplinary team fall prevention intervention for older adults who seek care in the emergency department (ED) after having a fall, assess its feasibility and acceptability, and review lessons learned during its initiation. DESIGN: Single‐blind randomized controlled pilot study. SETTING: Two urban academic EDs PARTICIPANTS: Adults 65 years old or older (n = 110) who presented to the ED within 7 days of a fall. INTERVENTION: Participants were randomized to a usual care (UC) and an intervention (INT) arm. Participants in the INT arm received a brief medication therapy management session delivered by a pharmacist and a fall risk assessment and plan by a physical therapist (PT). INT participants received referrals to outpatient services (eg, home safety evaluation, outpatient PT). MEASUREMENTS: We used participant, caregiver, and clinician surveys, as well as electronic health record review, to assess the feasibility and acceptability of the intervention. RESULTS: Of the 110 participants, the median participant age was 81 years old, 67% were female, 94% were white, and 16.3% had cognitive impairment. Of the 55 in the INT arm, all but one participant received the pharmacy consult (98.2%); the PT consult was delivered to 83.6%. Median consult time was 20 minutes for pharmacy and 20 minutes for PT. ED length of stay was not increased in the INT arm: UC 5.25 hours vs INT 5.0 hours (P <.94). After receiving the Geriatric Acute and Post‐acute Fall Prevention Intervention (GAPcare), 100% of participants and 97.6% of clinicians recommended the pharmacy consult, and 95% of participants and 95.8% of clinicians recommended the PT consult. CONCLUSION: These findings support the feasibility and acceptability of the GAPcare model in the ED. A future larger randomized controlled trial is planned to determine whether GAPcare can reduce recurrent falls and healthcare visits in older adults. J Am Geriatr Soc 68:198–206, 2019 [ABSTRACT FROM AUTHOR]

The American Geriatrics Society and British Geriatrics Society recommend that all adults older than 65 years be screened annually for a history of falls or balance impairment. The U.S. Preventive Services Task Force and American Academy of Family Physicians recommend exercise or physical therapy and vitamin D supplementation to prevent falls in community-dwelling older adults who are at increased risk of falls. Although the U.S. Preventive Services Task Force and American Academy of Family Physicians do not recommend routine multifactorial intervention to prevent falls in all community-dwelling older adults, they state that it may be appropriate in individual cases. The Centers for Disease Control and Prevention developed an algorithm to aid in the implementation of the American Geriatrics Society/British Geriatrics Society guideline. The algorithm suggests assessment and multifactorial intervention for those who have had two or more falls or one fall-related injury. Multifactorial interventions should include exercise, particularly balance, strength, and gait training; vitamin D supplementation with or without calcium; management of medications, especially psychoactive medications; home environment modification; and management of postural hypotension, vision problems, foot problems, and footwear. These interventions effectively decrease falls in the community, hospital, and nursing home settings. Fall prevention is reimbursed as part of the Medicare Annual Wellness Visit. [ABSTRACT FROM AUTHOR]

With gigabit networking becoming economically feasible and widely installed at homes, there are new opportunities to revisit in-home, personalized telehealth services. In this paper, we describe a novel telehealth eldercare service that we developed viz., “PhysicalTherapy-as-a-Service” (PTaaS) that connects a remote physical therapist at a clinic to a senior at home. The service leverages a high-speed, low-latency network connection through an interactive interface built on top of Microsoft Kinect motion sensing capabilities. The interface that is built using user-centered design principles for wellness coaching exercises is essentially a ‘Synchronous Big Data’ application due to its: (i) high data-in-motion velocity (i.e., peak data rate is ≈ 400 Mbps), (ii) considerable variety (i.e., measurements include 3D sensing, network health, user opinion surveys and video clips of RGB, skeletal and depth data), and (iii) large volume (i.e., several GB of measurement data for a simple exercise activity). The successful PTaaS delivery through this interface is dependent on the veracity analytics needed for correlation of the real-time Big Data streams within a session, in order to assess exercise balance of the senior without any bias due to network quality effects. Our experiments with PTaaS in an actual testbed involving senior homes in Kansas City with Google Fiber connections and our university clinic demonstrate the network configuration and time synchronization related challenges in order to perform online analytics. Our findings provide insights on how to: (a) enable suitable resource calibration and perform network troubleshooting for high user experience for both the therapist and the senior, and (b) realize a Big Data architecture for PTaaS and other similar personalized healthcare services to be remotely delivered at a large-scale in a reliable, secure and cost-effective manner. [ABSTRACT FROM AUTHOR]

Background/Goal. Attitudes towards older persons are particularly important for healthcare students and practitioners. The aim of our work is to analyse the attitudes of social gerontology and physiotherapy students towards elderly persons. Method. A structured questionnaire using the Kogan Attitudes towards Older People scale (KAOP) was used to collect data. Statistical methods were applied to evaluate the data: reliability test, t-test for independent samples and bivariate correlational analysis. Results. Social gerontology and physiotherapy students accept the elderly with awareness and respect. Few age-related prejudices and stereotypes were found among them, and they do not problematise the elderly. Social gerontology students have more positive attitudes towards the elderly than physiotherapy students do. Male students and students who live in the same household with elderly persons are more appreciative towards them, but they have more prejudices; the same applies to a lesser extent to students who do not live in the same household with an elderly person. Conclusion. Although minor deviations from a positive attitude were found, probably resulting from different experiences with elderly people, the results of this study raise hopes that respectful relations and cooperation across age groups will continue. [ABSTRACT FROM AUTHOR]

Background: Functional decline of hospitalized older adults is common and triggers health care expenditures. Physical therapy can retard the functional decline that occurs during hospitalization. This study aims to examine whether shared situational awareness (SSA) intervention may enhance the benefits of physical therapy for hospitalized older persons with a common diagnosis, heart failure. Method: An SSA intervention that involved daily multidisciplinary meetings was applied to the care of functionally declining older adults admitted to the medicine floor for heart failure. Covariates were matched between the intervention group (n=473) and control group (n=475). Both intervention and control groups received physical therapy for ≥0.5 hours per day. The following three outcomes were compared between groups: 1) disability, 2) transition to skilled nursing facility (SNF, post-acute care setting), and 3) 30-day readmission rate. Results: Disability was lower in the intervention group (28%) than in the control group (37%) (relative risk [RR] =0.74; 95% confidence interval [CI], 0.35-0.97; P=0.026), and transition to SNF was lower in the intervention group (22%) than in the control group (30%) (RR =0.77; 95% CI, 0.39-0.98; P=0.032). The 30-day readmission rate did not significantly differ between the two groups. Conclusion: SSA intervention enhanced the benefits of physical therapy for functionally declining older adults. When applied to older adults with heart failure in the form of daily mul- tidisciplinary meetings, SSA intervention improved functional outcomes and reduced transfer to SNFs after hospitalization. [ABSTRACT FROM AUTHOR]

IMPORTANCE Mobility limitations are common in older adults, affecting the physical, psychological, and social aspects of an older adult's life. OBJECTIVE To identify mobility risk factors, screening tools, medical management, need for physical therapy, and efficacy of exercise interventions for older primary care patients with limited mobility. EVIDENCE ACQUISITION Search of PubMed and PEDro from January 1985 to March 31, 2013, using the search terms mobility limitation, walking difficulty, and ambulatory difficulty to identify English-language, peer-reviewed systematic reviews, meta-analyses, and Cochrane reviews assessing mobility limitation and interventions in community-dwelling older adults. Articles not appearing in the search referenced by reviewed articles were also evaluated. FINDINGS The most common risk factors for mobility impairment are older age, low physical activity, obesity, strength or balance impairment, and chronic diseases such as diabetes or arthritis. Several tools are available to assess mobility in the ambulatory setting. Referral to physical therapy is appropriate, because physical therapists can assess mobility limitations and devise curative or function-enhancing interventions. Relatively few studies support therapeutic exercise to improve mobility limitation. Strong evidence supports resistance and balance exercises for improving mobility-limiting physical weakness and balance disorders. Assessing a patient's physical environment and the patient's ability to adapt to it using mobility devices is critical. CONCLUSIONS AND RELEVANCE Identification of older adults at risk for mobility limitation can be accomplished through routine screening in the ambulatory setting. Addressing functional deficits and environmental barriers with exercise and mobility devices can lead to improved function, safety, and quality of life for patients with mobility limitations. [ABSTRACT FROM AUTHOR]

Background: Impaired balance and mobility are common among rehabilitation inpatients. Poor balance and mobility lead to an increased risk of falling. Specific balance exercise has been shown to improve balance and reduce falls within the community setting. However few studies have measured the effects of balance exercises on balance within the inpatient setting. The aim of this randomised controlled trial is to investigate whether the addition of circuit classes targeting balance to usual therapy lead to greater improvements in balance among rehabilitation inpatients than usual therapy alone. Methods/Design: A single centre, randomised controlled trial with concealed allocation, assessor blinding and intention-to-treat analysis. One hundred and sixty two patients admitted to the general rehabilitation ward at Bankstown-Lidcombe Hospital will be recruited. Eligible participants will have no medical contraindications to exercise and will be able to: fully weight bear; stand unaided independently for at least 30 seconds; and participate in group therapy sessions with minimal supervision. Participants will be randomly allocated to an intervention group or usual-care control group. Both groups will receive standard rehabilitation intervention that includes physiotherapy mobility training and exercise for at least two hours on each week day. The intervention group will also receive six 1-hour circuit classes of supervised balance exercises designed to maximise the ability to make postural adjustments in standing, stepping and walking. The primary outcome is balance. Balance will be assessed by measuring the total time the participant can stand unsupported in five different positions; feet apart, feet together, semi-tandem, tandem and single-leg-stance. Secondary outcomes include mobility, self reported physical functioning, falls and hospital readmissions. Performance on the outcome measures will be assessed before randomisation and at two-weeks and three-months after randomisation by physiotherapists unaware of intervention group allocation. Discussion: This study will determine the impact of additional balance circuit classes on balance among rehabilitation inpatients. The results will provide essential information to guide evidence-based physiotherapy at the study site as well as across other rehabilitation inpatient settings. [ABSTRACT FROM AUTHOR]

Aging can be understood as a set of structural and functional changes in the body that accumulate gradually and may degrade performance of the elderly in their basic activities of life. Pilates sets up the attempted control of the muscles involved in the movements of a more conscious way possible. The aim of this study was to review the literature regarding the Pilates physical therapy rehabilitation in the elderly. Bibliographic study on electronic databases LILACS, MEDLINE, PUBMED SCIELO and through the keywords: "elderly", "pilates", where he sought periodicals published in Portuguese and English, between the years 2008 to 2013. We analyzed 68 articles found, of which, 3 fulfilled the inclusion criteria. All studies suggest the improvement of the elderly in their functional performance, balance and quality of life to the practice of the Pilates method, especially when compared to other traditional methods of treatment. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 87-year-old female patient who resides in an assisted apartment and has history of numerous illnesses like moderate osteoarthritis, Alzheimer's dementia and congestive heart failure in the U.S. She has been in physical therapy due to decline of functional mobility as per the report of her daughter. Moreover, therapists stated that the patient had limited learning success and safe transfer training.

Normal aging processes result in losses of functional flexibility and muscular strength, which increase seniors' fall risk and dependence on others. A relatively new intervention to reduce and/or reverse the adverse effects of aging is whole-body vibration (WBV) exercise. The purpose of this article is to review the established effects of WBV exercise exclusively with the aging population. A systematic search utilizing PubMed and Sport Discus databases uncovered journal articles specific to seniors and whole-body vibration. An extensive hand search supplemented the database results to find other relevant articles. Twenty-seven articles were obtained; all articles have been published in the past 8 years, reflecting the recent and growing interest in this area. Researchers have determined that WBV training can reduce fall risk and improve postural control in seniors. It has also been determined that WBV training can be as effective as conventional resistance training to improve seniors' lower body strength. However, little is known about the effect of WBV exercise on flexibility and upper body strength in the aging population. More research is required to establish how effective WBV training is on these specific components and how it may affect seniors' quality of life. [ABSTRACT FROM AUTHOR]

Objective: To study the effects of treatment with atypical antipsychotic drugs on brain levels of glutamate plus glutamine in early-stage first-episode schizophrenia. Participants: Sixteen patients (eight males, eight females; aged 30 ± 11 years) completed the study. Methods: We used administered 6 months of atypical antipsychotic drugs and used proton magnetic resonance spectroscopy to evaluate the results. Results: We found that the administration of atypical antipsychotic drugs for 6 months decreased the glutamate plus glutamine/creatine ratio in the frontal lobe. These results suggest that the administration of atypical antipsychotic drugs for at least 6 months decreased glutamatergic neurotransmissions in the frontal lobe in early-stage first-episode schizophrenia, but there was no difference in frontal-lobe levels between patients and control subjects before administration. Conclusion: Taking these findings into account, the glutamatergic and GABAergic neurons are implicated in early-stage first-episode schizophrenia, but in complex ways. [ABSTRACT FROM AUTHOR]

Background: This randomized controlled pilot study aimed to explore whether a cognitive-motor exercise program that combines traditional physical exercise with dance video gaming can improve the voluntary stepping responses of older adults under attention demanding dual task conditions. Methods: Elderly subjects received twice weekly cognitive-motor exercise that included progressive strength and balance training supplemented by dance video gaming for 12 weeks (intervention group). The control group received no specific intervention. Voluntary step execution under single and dual task conditions was recorded at baseline and post intervention (Week 12). Results: After intervention between-group comparison revealed significant differences for initiation time of forward steps under dual task conditions (U = 9, P = 0.034, r = 0.55) and backward steps under dual task conditions (U = 10, P = 0.045, r = 0.52) in favor of the intervention group, showing altered stepping levels in the intervention group compared to the control group. Conclusion: A cognitive-motor intervention based on strength and balance exercises with additional dance video gaming is able to improve voluntary step execution under both single and dual task conditions in older adults [ABSTRACT FROM AUTHOR]

Objective: To review scientific literature pertaining to aquatic physical therapy in the elderly and institutionalized population. Methods: A qualitative systematic review of electronic databases MEDLINE and LILACS, with the topic index terms: "hydrotherapy", "homes for the aged or residential facilities", and aged. In light of the lack of studies carried out on the institutionalized population, we opted for reviewing literature on the effectiveness of this modality of physical therapy treatment on the non-institutionalized elderly population in order to produce knowledge that can be critically analyzed according to its potential applicability for the institutionalized population. The methodological quality of the studies was assessed using the Delphi listing. Results: Of the 27 studies analyzed by their abstracts, 10 studies were excluded since they did not correspond to the eligibility criteria. We analyzed the subject characteristics of each study, as well as the quality of the methods (good methodological quality in 47% of the studies), the result measurements considered, the intervention strategies, the sites where they took place, and the professionals involved (76% by physical therapists). Conclusion: Although a large part of the studies demonstrated good results with aquatic physical therapy practice, none of them had been applied on long-stay institution for the elderly. Therefore, more studies are needed in this area for a model of assistance to long-stay institution for the elderly to be proposed [ABSTRACT FROM AUTHOR]

Gait and balance disorders are common in older adults and are a major cause of falls in this population. They are associated with increased morbidity and mortality, as well as reduced level of function. Common causes include arthritis and orthostatic hypotension; however, most gait and balance disorders involve multiple contributing factors. Most changes in gait are related to underlying medical conditions and should not be considered an inevitable consequence of aging. Physicians caring for older patients should ask at least annually about falls, and should ask about or examine for difficulties with gait and balance at least once. For older adults who report a fall, physicians should ask about difficulties with gait and balance, and should observe for any gait or balance dysfunctions. The Timed Up and Go test is a fast and reliable diagnostic tool. Persons who have difficulty or demonstrate unsteadiness performing the Timed Up and Go test require further assessment, usually with a physical therapist, to help elucidate gait impairments and related functional limitations. The most effective strategy for falls prevention involves a multifactorial evaluation followed by targeted interventions for identified contributing factors. Evidence on the effectiveness of interventions for gait and balance disorders is limited because of the lack of standardized outcome measures determining gait and balance abilities. However, effective options for patients with gait and balance disorders include exercise and physical therapy. [ABSTRACT FROM AUTHOR]

Although mycoplasmas are generally considered to be harmless commensals, some mycoplasma species are able to cause infections in pediatric, geriatric, or immunocompromised patients. Thus, accidental contamination of biologics with mycoplasmas represents a potential risk for the health of individuals who receive cell-derived biological and pharmaceutical products. To assess the efficiency of inactivation of mycoplasmas by the agents used in the manufacture of egg-derived influenza vaccines, we carried out a series of experiments aimed at monitoring the viability of mycoplasmas spiked into both chicken allantoic fluid and protein-rich microbiological media and then treated with beta-propiolactone, formalin, cetyltrimethylammonium bromide, Triton X-100, and sodium deoxycholate, which are agents that are commonly used for virus inactivation and disruption of viral particles during influenza vaccine production. Twenty-two mycoplasma species (with one to four strains of each species) were exposed to these inactivating agents at different concentrations. The most efficient inactivation of the mycoplasmas evaluated was observed with either 0.5% Triton X-100 or 0.5% sodium deoxycholate. Cetyltrimethylammonium bromide at concentrations of ≥0.08% was also able to rapidly inactivate (in less than 30 min) all mycoplasmas tested. In contrast, negligible reductions in mycoplasma titers were observed with 0.0125 to 0.025% formaldehyde. However, increasing the concentration of formaldehyde to 0.1 to 0.2% improved the mycoplasmacidal effect. Incubation of mycoplasmas with 0.1% beta-propiolactone for 1 to 24 h had a marked mycoplasmacidal effect. A comparison of the mycoplasma inactivation profiles showed that strains of selected species (Mycoplasma synoviae, Mycoplasma gallisepticum, Mycoplasma orale, Mycoplasma pneumoniae, and Acholeplasma laidlawii) represent a set of strains that can be utilized to validate the effectiveness of mycoplasma clearance obtained by inactivation and viral purification processes used for the manufacture of an inactivated egg-based vaccine. [ABSTRACT FROM AUTHOR]

The purposes of the current study were to determine geriatric clients' recognition of 32 popular songs and songs from musicals by asking whether they: (a) had heard the songs before; (b) could "name the tune" of each song; and (c) list the decade that each song was composed. Additionally, comparisons were made between the geriatric clients' recognition of these songs and by music therapy students' recognition of the same, songs, based on data from an earlier study (Van Weelden, Juchniewicz, & Cevasco, 2008). Results found 90% or more of the geriatric clients had heard 28 of the 32 songs, 80% or more of the graduate students had heard 20 songs, and 80% of the under- graduates had heard 18 songs. The geriatric clients correctly identified 3 songs with 80% or more accuracy, which the graduate students also correctly identified, while the undergraduates identified 2 of the 3 same songs. Geriatric clients identified the decades of 3 songs with 50% or greater accuracy. Neither the undergraduate nor graduate students identified any songs by the correct decade with over 50% accuracy. Further results are discussed. [ABSTRACT FROM AUTHOR]

The article looks at a study on the utilization and efficacy of physical therapy in home-based rehabilitation care under the prospective payment system. The average number and duration of physical therapy visits for test subjects is considered. Results indicate that homebound patients may benefit from physical therapy aimed at improving functional abilities.

Objective: To evaluate effects of early intensive physiotherapy during acute illness on post hospitalization activity daily living autonomy (ADL). Design: Prospective randomized controlled trial of intensive physiotherapy rehabilitation on day 1 to 2 after admission until clinical stability or usual care. Setting: acute care geriatric medicine ward. Patients: A total of 76 acutely ill patients, acutely bedridden or with reduced mobility but who were autonomous for mobility within the previous 3 months. Patients in palliative care or with limiting mobility pathology were excluded. Mean age was 85.4 (SD 6.6) years. Measurements: At admission, at clinical stability and one month later: anthropometry, energy and protein intakes, hand grip strength, ADL scores, and baseline inflammatory parameters. An exploratory principal axis analysis was performed on the baseline characteristics and general linear models were used to explore the course of ADL and nutritional variables. Results: A 4-factor solution was found explaining 71.7 % of variance with a factor “nutrition”, a factor “function” (18.8 % of variance) for ADL, handgrip strength, bedridden state, energy and protein intakes, serum albumin and C-reactive protein concentrations; a factor “strength” and a fourth factor . During follow-up, dietary intakes, handgrip strength, and ADL scores improved but no changes occurred for anthropometric variables. Intervention was associated only with an increase in protein intake. Better improvement in ADL was found in intervention group when model was adjusted on “function” factor items. Conclusion: Physical intervention programs should be proposed according to nutritional intakes with the aim of preventing illness induced disability. [ABSTRACT FROM AUTHOR]

Approximately 30% of elderly community dwellers fall each year. A large number of exercise-based interventions have been designed to reduce fall incidence, the movement therapy of Tai Chi being used increasingly. The aim of this systematic review was to examine the current literature surrounding the effectiveness of Tai Chi in reducing the incidence of and fear of falling in older people. A computerised literature search of Medline, AMED, CINAHL, the Cochrane Central Register of Controlled Trials, PubMed, PEDro and Scirus was performed. Only randomised controlled trials, with a study population aged over 60 years, investigating Tai Chi as an intervention to reduce incidence of falls and/or fear of falling were included. The methodological quality of the included trials was rated using the Delphi List. Owing to clinical heterogeneity, the data were qualitatively analysed using a 'best-evidence synthesis'. Seven randomised controlled trials involving a total of 1146 people met the inclusion criteria. The duration, frequency and intensity of the Tai Chi interventions showed great variation. The trials included were of high methodological quality. There is strong evidence to support the effectiveness of Tai Chi in reducing fear of falling, and weak evidence supporting its effectiveness in reducing the incidence of falls in older adults. Future research should focus on targeting defined clinical subpopulations with high-quality, well-designed randomised controlled trials of sufficient size and with long-term follow-up, to provide further evidence supporting the use of Tai Chi to reduce the incidence and fear of falling in older people. [ABSTRACT FROM AUTHOR]

There is little knowledge about the ways geriatric physiotherapy is being carried out in practice and about the situational construction of formal policies for promoting physical activity. This article examines how professional physiotherapists and frail community-dwelling older adults as their clients use talk and action to construct a group exercise session in an inpatient rehabilitation setting in Finland. The analysis of 7 group exercise sessions with a total of 52 clients and 9 professional physiotherapists revealed 3 different practitioner approaches, which served different functions in older adults' empowerment and lifestyle activity change. The highly structured approach favored taciturn physical performances completed independently and successfully by frail older adults. The guided exercise approach with individualized guidance encouraged occasional coconstruction of shared understanding of learning the exercises. The circuit training approach facilitated occasional self-regulation by the clients. The results of this study indicate that a combination of different approaches is required to address the multifaceted needs of heterogeneous frail older adults. [ABSTRACT FROM AUTHOR]

Background and Purpose During the aging process, older adults may experience a loss of strength and power, which then may lead to functional limitations and disability. The purpose of this study was to examine how impairments in lower-extremity strength and power are related to functional limitations and disability in community-dwelling older adults. Subjects Thirty older adults (age[X̅± SD], 77.3 ± 7.0 years; 25 women and 5 men) with mild to moderate functional limitations participated in this study. Methods Lower-extremity strength, peak power, power at a low relative intensity, and power at a high relative intensity were measured with a pneumatic resistance leg press. Functional limitations and disability were assessed with the Short Physical Performance Battery (SPPB), the Six-Minute Walk Test (SMWT), and the Late Life Function and Disability Instrument (LLFDI). Results All measures of strength and power were related to functional limitations. Peak power demonstrated the strongest relationships with SMWT, the SPPB gait speed subscale, and the LLFDI functional limitation component. Power at a high relative intensity demonstrated the strongest relationships to the SPPB total score and the SPPB sit-to-stand subscale score. All measures of strength and power were indirectly related to the LLFDI disability component. Discussion and Conclusion Older adults should focus on increasing and maintaining lower-extremity strength and power across a range of intensities in order to decrease functional limitations and disability. [ABSTRACT FROM AUTHOR]

The article analyzes randomized controlled trials on the effects of motor intervention in older patients with dementia. It cites the importance of physiotherapy, occupational therapy and physical education in promoting patient benefits concerning psychosocial function, physical health and function, affective status and caregiver's distress. It attributes patient's improvement to frequency and intensity of treatment, among others. It concludes that motor intervention is beneficial to patients.

Background and Purpose Previous studies of Timed "Up & Go" Test (TUG) scores as a predictor of falls were based primarily on retrospective data, and no prospective studies of the TUG for predicting falls in people with hip fracture are available. The purpose of this study was to determine whether TUG scores obtained upon discharge from an acute orthopedic hip fracture unit can predict falls in people with hip fracture during a 6-month follow-up period. Subjects The subjects included in this study were 79 consecutive elderly people who had hip fractures and were able to perform the TUG when discharged directly to their own homes or to assisted living facilities from a specialized acute orthopedic hip fracture unit, with 59 (75%) being able to participate in the follow-up interview. Methods In this prospective study, all subjects were contacted for a 6-month follow-up interview about falls since discharge from the hospital. The score on the TUG performed at discharge (median of 10 days after surgery) was compared with the New Mobility Score, which describes functional level before the fracture and mental status on admission, sex, type of fracture, residence, and walking aids before and after the fracture. All subjects followed a well-defined care plan with multimodal fast-track rehabilitation including an intensive physical therapy program comprising 2 daily sessions; discharge was in accordance with standardized criteria. Analyses and correlations of all variables were examined for prediction of falls, and sensitivity, specificity, predictive values, and likelihood ratios were calculated. Falls were classified as "none" or as "1 or more." Results Among the 59 subjects in the follow-up group, 19 subjects (32%) experienced 1 or more falls in the period since discharge; 4 of these falls resulted in new hip fractures. The TUG performed at discharge with a cutoff point of 24 seconds was the only parameter that significantly predicted falls during the 6-month follow-up period, with a negative likelihood ratio of 0.1 to be a faller as a nonfaller. Discussion and Conclusion The results suggest that the TUG is a sensitive measure for identifying people with hip fracture at risk for new falls, and it should be part of future outcome measures to decide for whom preventive measures against falls should be instituted. [ABSTRACT FROM AUTHOR]

Physical activity can have a positive impact on cognition and well-being in older people. This article reviews and evaluates the effects of planned physical activity programmes on mood, sleep and functional ability in people with dementia. A total of 27 studies between 1974 and 2005 were found. Of these, four included participants living at home, two involved participants who were living either at home or in care homes and 21 included participants living solely in care homes. Since psychosocial intervention can reduce family caregiver burden, the break down of home-care and associated rates of institutionalization, the indirect effects of these physical activity programmes on the family caregiver are also explored. The scope for developing physical activity programmes for people with dementia in primary care using families and volunteers is discussed. [ABSTRACT FROM AUTHOR]

Objective: To compare intensive with non-intensive home-based rehabilitation provision following stroke or hip fracture in old age (65 years+). Design: Parallel single-blind randomized control trial. Setting: Domiciliary provided multidisciplinary rehabilitation. Subjects: One hundred and sixty patients aged 65 or over recently discharged from hospital after suffering a stroke or hip fracture. Intervention: Patients assigned to receive six or more face-to-face contacts or three or less face-to-face contacts from members of a multidisciplinary rehabilitation team. Main measures: Patients assessed using the Barthel Index, Therapy Outcome Measure, Euroqol 5D (EQ-5D), Hospital Anxiety and Depression Scale (HADS) and Frenchay Activities Index (FAI) at three months. All follow-up assessments were conducted blind to allocation. Results: Subgroup analysis was conducted on the basis of incident condition (stroke or hip fracture). Significant differences were detected for the stroke subgroup at three months [Therapy Outcome Measure Handicap (median difference 0.5 (P < 0.05)) and EQ-5D (median difference 0.17 (P < 0.05))] and in change at three months [Therapy Outcome Measure (mean difference 0.52 (SD 0.85) 95% CI (0.16, 0.88)) and EQ-5D (mean difference 0.15 (SD 0.25) 95% CI (0.05, 0.26))]. No significant differences were detected between the two arms of the study for the hip fracture subgroup. Conclusion: Following stroke older people who receive a more intensive community-based multidisciplinary rehabilitation service may experience short-term benefit in relation to social participation and some aspects of health-related quality of life. A more intensive service after discharge from hospital following a hip fracture is unlikely to result in similar patient benefit. [ABSTRACT FROM AUTHOR]

Background and Purpose. The University of Alabama at Birmingham (UAB) Study of Aging Life-Space Assessment (LSA) is a relatively new instrument to measure mobility. The purpose of this report is to describe the relationships between LSA and traditional measures of physical function, sociodemographic characteristics, depression, and cognitive status. Subjects. Subjects were a stratified random sample of 998 Medicare beneficiaries aged ≥65 years. The sample was 50% African American, 50% male, and 50% from rural (versus urban) counties. Methods. In-home interviews were conducted. Mobility was measured using the LSA, which documents where and how often subjects travel and any assistance needed during the 4 weeks prior to the assessment. Basic activities of daily living (ADL) and instrumental activities of daily living (IADL), cognitive status, income level, presence of depressive symptoms, and transportation resources were determined. The Short Physical Performance Battery (SPPB) was used to assess physical performance. Results. Simple bivariate correlations indicated a significant relationship between LSA and all variables except residence (rural versus urban). In a regression model, physical function (ADL, IADL) and physical performance (SPPB) accounted for 45.5% of the variance in LSA scores. An additional 12.7% of the variance was explained by sociodemographic variables, and less than 1% was explained by cognition and depressive symptoms. Discussion and Conclusion. The LSA can be used to document patients' mobility within their home and community. The LSA scores are associated with a person's physical capacity and other factors that may limit mobility. These scores can be used in combination with other tests and measures to generate clinical hypotheses to explain mobility deficits and to plan appropriate interventions to address these deficits. [ABSTRACT FROM AUTHOR]

The Guide to Physical Therapy Practice integrates the patient/client management and disablement models in the required process that a physical therapist follows at the first visit with the patient before providing therapeutic intervention. This case report illustrates the integration of the guide in the physical therapy management of a geriatric patient with chronic obstructive pulmonary disease. [ABSTRACT FROM AUTHOR]

The practice of geriatric physical therapy continues to evolve and be influenced by numerous external forces. Greater emphasis than ever before is now placed on the role of physical therapists as patient educators. The purpose of this article is to present the Social Cognitive Theory for the education of older adult clients. This theory examines factors such as the interrelationships of behavior, personal beliefs, cognitive factors, and the environment. An overview of the Social Cognitive Theory, its relevant concepts as they apply to the physical therapy management of an older adult client, and application to a case study are provided. [ABSTRACT FROM AUTHOR]

During recent years, numerous studies have found an association between minor depressive symptoms and physical functioning for older adults recuperating from illness or injury Whereas earlier research has focused on the effects of minor depression during rehabilitation in acute or long-term settings, this study examined 209 patients receiving subacute physical therapy. The dependent measures were total score changes on the Functional Independence Measure (FIM) obtained at admission, discharge, and 3-month follow-up. The independent measure was minor depressive symptoms, as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, obtained within 5 days of admission. A binary logistic regression analysis was conducted with dichotomized FIM scores and the presence/absence of minor depressive symnptoms. The results indicated a statistically significant relationship between FIM score change and minor depression from admission to discharge, but not from discharge to follow-up. [ABSTRACT FROM AUTHOR]

The article discusses a controversial decision to strike certain rehabilitation benefits for the elderly from the catalogue in order to finance young people's medical care and otherwise to ration elder care. A major question involves whether the decision violates the principle of "maximal" treatment for the individual patients. General grounds for rationing medical care are discussed and rejected.

The effect of increasing the level of physiotherapy services in elderly care was studied using an intervention and a control unit. The units had 20 and 2 hours of physiotherapy services per week, respectively. Physiotherapy and occupational therapy records were reviewed before and during the project. Physiotherapists also kept extended documentation over an 11-month period. Data analyses employed the chi-square test and content analysis. There was a significant increase in the number of patients receiving physiotherapy and occupational therapy within both units. No significant differences between the units were found for the number of patients receiving physiotherapy. The number of patients receiving occupational therapy differed significantly between units before as well as during the intervention. Primarily care assistants and auxiliary nurses initiated contact with the physiotherapists mainly for patient-orientated errands. Fifty per cent of the instructions given by the physiotherapist at the 20-hour unit related to movement-orientated activities of daily living. At the 2-hour unit, the majority of instructions (52%) were programme-orientated. [ABSTRACT FROM AUTHOR]

Purpose : To test General Motor Function assessment scale (GMF) for concurrent validity, to analyse the distribution of scores and its clinical sensitivity in a setting of geriatric rehabilitation. Method : A descriptive and comparative study involving comparisons between GMF and Katz Index of ADL, analyses of GMF scores concerning distribution and comparisons between three geriatric care levels and between assessments pre- and post-intervention. One group of 20 in-patients and one group of 154 patients in three different care forms - institutional care, home rehabilitation and day care were included. Non parametric statistics were utilized, including a method which can separately measure the level of change for the group and for the individuals in that group. Results : High correlation with r s = 0.80 ( p < 0.001) between the subscale Dependence and the Katz Index of ADL verified that this part of the GMF measures variables related to ability in ADL. No floor effects in any of the subscales of the GMF were shown. The GMF was found to be sufficiently sensitive to demonstrate change from pre- and post-intervention assessments. Conclusion : This study indicates that GMF could be useful as a satisfactorily valid and sensitive tool for physiotherapists' standardized assessments in geriatric practice. [ABSTRACT FROM AUTHOR]

Objective: To assess the sensitivity of the Elderly Mobility Scale (EMS) to detect improvements in mobility after physiotherapy in comparison with the Barthel Index (BI) and Functional Ambulation Category (FAC) in routine clinical day hospital practice. Subjects: Eighty-three patients who completed a course of physiotherapy were studied. Methods: Each was assessed by an independent physiotherapist before and after a programme of physiotherapy, using the EMS, BI and FAC. Results: The mean age was 79 years (SD 7.7). Fifty-three out of 83 (64%) patients were female and 92% were community dwelling. The median number of physiotherapy sessions undergone by each patient was 9 (range 3–51). All three scales detected an improvement in mobility with physiotherapy (p < 0.001). However, using the EMS, 68 out of 82 (83%) patients had a detectable improvement in mobility compared with only 34 out of 80 (42%) using the BI and 28 out of 81 (35%) using the FAC. Using a matched-pairs comparison, the EMS was significantly more likely to detect an improvement in mobility following physiotherapy within the study group than the BI (p < 0.001) or the FAC (p < 0.001). Conclusion: Although all three scales detected improvements in mobility, the EMS detected mobility improvements in a significantly greater number of patients. [ABSTRACT FROM AUTHOR]

Presents information on a study which examined the physical therapy treatment for urinary incontinence in older adults. Barriers to treatment of urinary incontinence; Medical evaluations for patients with urinary incontinence; Subjective and objective component of physical therapy evaluation; Treatment techniques; Conclusions.