Characteristics of community-based exercise programs for community-dwelling older adults in rural/regional areas: a scoping review.
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SUBMITTER: Fien S
PROVIDER: S-EPMC8852913 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:BACKGROUND:Concern has been expressed that preventive measures in older people might increase frailty by increasing survival without improving health. We investigated the impact of exercise on the probabilities of health improvement, deterioration and death in community-dwelling older people. METHODS AND PRINCIPAL FINDINGS:In the Canadian Study of Health and Aging, health status was measured by a frailty index based on the number of health deficits. Exercise was classified as either high or low/no exercise, using a validated, self-administered questionnaire. Health status and survival were re-assessed at 5 years. Of 6297 eligible participants, 5555 had complete data. Across all grades of frailty, death rates for both men and women aged over 75 who exercised were similar to their peers aged 65 to 75 who did not exercise. In addition, while all those who exercised had a greater chance of improving their health status, the greatest benefits were in those who were more frail (e.g. improvement or stability was observed in 34% of high exercisers versus 26% of low/no exercisers for those with 2 deficits compared with 40% of high exercisers versus 22% of low/no exercisers for those with 9 deficits at baseline). CONCLUSIONS:In community-dwelling older people, exercise attenuated the impact of age on mortality across all grades of frailty. Exercise conferred its greatest benefits to improvements in health status in those who were more frail at baseline. The net effect of exercise should therefore be to improve health status at the population level.
| S-EPMC2702830 | biostudies-literature
Project description:IntroductionFall rates and fall-related injuries among community-dwelling older adults (≥65 years) are expected to increase rapidly, due to the aging population worldwide. Fall prevention programs (FPPs), consisting of strength and balance exercises, have been proven effective in reducing fall rates among older adults. However, these FPPs have not reached their full potential as most programs are under-enrolled. Therefore, this study aims to identify promising strategies that promote participation in FPPs among community-dwelling older adults.MethodsThis is an exploratory qualitative study. Previously, barriers and facilitators for participation in FPPs by older adults had been identified. Next, six strategies had been designed using the Intervention Mapping approach: (1) reframing; (2) informing about benefits; (3) raising awareness of risks; (4) involving social environment; (5) offering tailored intervention; (6) arranging practicalities. Strategies were validated during semi-structured interviews with community-dwelling older adults (n = 12) at risk of falling. Interviews were audio-recorded, transcribed, and analyzed following a qualitative thematic methodology, with a hybrid approach.ResultsAll strategies were considered important by at least some of the respondents. However, two strategies stood out: (1) reframing 'aging' and 'fall prevention': respondents preferred to be approached differently, taking a 'life course' perspective about falls, and avoiding confronting words; and (2) 'informing about benefits' (e.g., 'living independently for longer'); which was mentioned to improve the understanding of the relevance of participating in FPPs. Other strategies were considered important to take into account too, but opinions varied more strongly.DiscussionThis study provides insight into potential strategies to stimulate older adults to participate in FPPs. Results suggest that reframing 'aging' and 'fall prevention' may facilitate the dialogue about fall prevention, by communicating differently about the topic, for example 'staying fit and healthy', while focusing on the benefits of participating in FPPs. Gaining insight into the strategies' effectiveness and working mechanisms is an area for future research. This could lead to practical recommendations and help professionals to enhance older adults' participation in FPPs. Currently, the strategies are further developed to be applied and evaluated for effectiveness in multiple field labs in a central Dutch region (Utrecht).
| S-EPMC10359893 | biostudies-literature
Project description:Malnutrition is a frequent condition in elderly people, especially in nursing homes and geriatric wards. Its frequency is less well known among elderly living at home. The objective of this study was to describe the nutritional status evaluated by the Mini Nutritional Assessment (MNA) of elderly community-dwellers living in rural and urban areas in France and to investigate its associated factors.Subjects aged 65 years and over from the Approche Multidisciplinaire Intégrée (AMI) cohort (692 subjects living in a rural area) and the Three-City (3C) cohort (8,691 subjects living in three large urban zones) were included. A proxy version of the MNA was reconstructed using available data from the AMI cohort. Sensitivity and specificity were used to evaluate the agreement between the proxy version and the standard version in AMI. The proxy MNA was computed in both cohorts to evaluate the frequency of poor nutritional status. Factors associated with this state were investigated in each cohort separately.In the rural sample, 38.0% were females and the mean age was 75.5 years. In the urban sample, 60.3% were females and the mean age was 74.1 years. Among subjects in living in the rural sample, 7.4% were in poor nutritional status while the proportion was 18.5% in the urban sample. Female gender, older age, being widowed, a low educational level, low income, low body mass index, being demented, having a depressive symptomatology, a loss of autonomy and an intake of more than 3 drugs appeared to be independently associated with poor nutritional status.Poor nutritional status was commonly observed among elderly people living at home in both rural and urban areas. The associated factors should be further considered for targeting particularly vulnerable individuals.
| S-EPMC4136808 | biostudies-other
Project description:BackgroundDemographic transition in Nepal, like in many developing countries, has resulted in a burgeoning elderly population whose health status is not currently monitored. One pillar of health is adequate nutrition. Yet, little is known about the nutritional health status of the elderly in Nepal. The financial, material, and personnel limitations in Nepal's health delivery services necessitate health screening instruments that require minimal clinical staff and resources. To our knowledge, no such nutritional assessment tool has been validated in Nepal. Therefore, our aims are two-fold: To assess the nutritional status of the elderly population in one typical Nepali village, Okharpauwa, in Nuwakot District, Nepal; and concurrently, to validate the Mini Nutritional Assessment (MNA) tool.MethodsA cross-sectional field study was conducted with a sample of 242 elderly people in Okharpauwa, Nepal to obtain prevalence of malnutrition. Differences in demographic and lifestyle factors between these who were malnourished, those at risk of malnourishment, and those who had adequate nutritional status were analyzed. The MNA tool was evaluated using receiver operating characteristic (ROC) curve analysis; sensitivity, specificity, and diagnostic accuracy were calculated.Results111 males and 131 females, with a mean age of 69.8±7.4 years, participated in this study. The mean BMI of the participants was 21.4±3.9 kg/m2; the mean MNA score was 19.3±4.2. BMI was significantly correlated with the total MNA score (r = 0.58; p<0.001). The diagnostic accuracy, sensitivity and specificity of MNA were 81%, 86% and 67% respectively. Of the 242 elderly sampled, 24% were malnourished and 65% were at risk of malnutrition. Malnutrition was more prevalent among females (29%) than males (18%), and most prevalent among the marginalized Dalit ethnic group (40%). Elderly persons who were married and literate had better nutritional health than their counterparts.ConclusionsThe MNA appears to be a valid and sensitive tool for rapid nutritional screening of the elderly in Nepal. The prevalence of malnutrition was high among Nepalese elderly in the Okharpauwa VDC, which requires urgent health monitoring and management attention.
| S-EPMC5308814 | biostudies-literature
Project description:Psychological sense of community (PSOC) is an important construct for health and well-being outcomes for community-dwelling older adults. Drawing on the Ecological Theory of Aging and the Age-Friendly Cities (AFC) framework, this scoping review explored how PSOC has been used in research with community-dwelling older adults. This study examined antecedents, correlates, and outcomes of PSOC, with a focus on relevance to theory and practice. Databases were searched between 1986 and 2021 for peer-reviewed journal articles. Searches identified 582 unique articles, and 28 were included in the final sample. Three primary themes emerged in the synthesis: relevance to the AFC framework, PSOC as a predictor of health and well-being outcomes, and the role of PSOC in relocation. Findings from this review show that PSOC serves as a mechanism that links the social and physical AFC environments with health and well-being outcomes. This review also presents mechanisms for how features of the environment relate to PSOC. These findings demonstrate the role of PSOC as a resource to improve person-environment fit. Results from this review can be used to guide future research and inform theory, policy, and practice.
| S-EPMC9317274 | biostudies-literature
Project description:OBJECTIVES:To understand patterns of marijuana use in community-dwelling older adults in Colorado. DESIGN:Anonymous survey. SETTING:Two academic geriatric primary care clinics. PARTICIPANTS:English-speaking individuals. MEASUREMENTS:We assessed self-reported characteristics and patterns of marijuana use and effect on targeted symptoms. Survey analysis focused on current users, defined as individuals who had used marijuana in the past 3 years. RESULTS:Three hundred forty-five individuals completed the survey (55% response rate); 113 (32%) had used marijuana in the past, of whom 55 (16%) had used since legalization. More than half of current users were aged 75 and older, and one-quarter were aged 85 and older. Most current users were white women. Of current users, 44% used marijuana products at least weekly for common conditions including chronic pain, depression, anxiety, and insomnia, and most found marijuana helpful for these conditions. Most respondents reported obtaining marijuana recreationally (67%) without a prescription. Nine respondents reported negative side effects attributable to marijuana use. CONCLUSION:To our knowledge, this is the first study to characterize marijuana use of older adults in a state in which it is legal for medical and recreational use. Marijuana was used for several common geriatric conditions, and respondents reported few side effects. The small number of survey respondents, the lack of generalizability in states where marijuana sales are illegal, and participation bias were the main study limitations. Further research is needed to better understand useful or harmful effects in this population. J Am Geriatr Soc 66:2167-2171, 2018.
| S-EPMC6476562 | biostudies-literature
Project description:BackgroundAlthough many physical activity (PA) programs have been implemented and tested for effectiveness, high participation levels are needed in order to achieve public health impact. This study aimed to determine participation levels of PA programs aimed to improve PA among community-dwelling older adults.MethodsWe searched five databases up until March 2013 (PubMed, PubMed publisher, Cochrane Library, EMBASE, and Web of Science) to identify English-written studies investigating the effect of PA programs on at least one component of PA (e.g. frequency, duration) among community-dwelling populations (i.e. not in a primary care setting and/or assisted living or nursing home) of persons aged 55 years and older. Proportions of participants starting and completing the PA programs (initial and sustained participation, respectively) were determined.ResultsThe search strategy yielded 11,994 records of which 16 studies were included reporting on 17 PA programs. The number of participants enrolled in the PA programs ranged between 24 and 582 persons. For 12 PA programs it was not possible to calculate initial participation because the number of older adults invited to participate was unknown due to convenience sampling. Of the five remaining programs, mean initial participation level was 9.2% (±5.7%). Mean sustained participation level of all 17 programs was 79.8% (±13.2%).ConclusionsUnderstanding how to optimize initial participation of older adults in PA programs deserves more attention in order to improve the population impact of PA programs for community-dwelling older adults.
| S-EPMC4301079 | biostudies-literature
Project description:Fear of injury is reported as a barrier to exercise by older adults. However, the literature is limited in describing exercise injuries in older adults.This study prospectively evaluated the 12-month incidence of exercise-related injuries to community-dwelling older adults (n=167 respondents; 63 men, 104 women; mean age 69±5 year).A questionnaire developed for use in older adults was administered to document self-reported injuries. Linear regression analysis was conducted to identify covariates related to injury outcomes.23 people (14%) reported injuries. 41% of injuries were to the lower extremities, where the most common type was overuse muscle strains (32%, n=7). Overexertion was the most common cause of injury (n=9) and walking accounted for half of the activities during which injury occurred. 70% of injuries required medical treatment. 44% were not able to continue exercising after injury and return-to-activity time varied from 1 to 182 days. Sex, age and exercise volume were not significantly associated with injury occurrence.These results showed similar, or lower, exercise-related injury rates as compared with previous reports on younger and middle-aged adults; however, the definition of, and criteria for, 'injury' reporting varies in the literature. This study indicates that older adults taking up exercise are not at increased risk of injury versus younger age groups.
| S-EPMC3686222 | biostudies-other
Project description:BackgroundMultiple neuroimaging and clinical biomarkers have been identified to predict cognitive decline and clinical progression to mild cognitive impairment (MCI) or dementia. However, early biomarkers associated with transition to and reversion from cognitive impairment (cognitive migration) require further understanding. We investigated the impacts of baseline neuroimaging and clinical biomarkers on cognitive migration in a community-dwelling older cohort.MethodsWe studied 391 participants from the Wake Forest Alzheimer's Disease Research Center Clinical Core cohort who underwent neuropsychological assessment and magnetic resonance imaging (MRI). At baseline, each participant was categorized to a functional/cognitive state using global Clinical Dementia Rating (CDR) score: CDR = 0 indicates normal cognitive function; CDR = 0.5 is minimal cognitive impairment. The primary outcome was cognitive migration status determined by CDR change between baseline and follow-up (mean difference = 13.9 months): CDR-0 Stables (no migration; maintained CDR = 0), CDR-0.5 Stables (no migration; maintained CDR = 0.5), Migrants- (negative migration; CDR 0 to CDR 0.5), and Reverters+ (positive migration; CDR 0.5 to CDR 0). Baseline T1-weighted MRI was analyzed for gray matter (GM) volume using voxel-based morphometry (VBM). For VBM, we used a two-sample t-test controlling for age, sex, education years and intracranial volume for group comparisons: CDR-0 Stables vs CDR-0.5 Stables, CDR-0 Stables vs Migrants-, CDR-0.5 Stables vs Reverters+ and Migrants- vs Reverters+ (thresholded at k = 30 voxels, p <.01 uncorrected). Oral Glucose Tolerance Testing (OGTT-2h) assessed blood glucose 120-minute post challenge. Multinomial logistic regression estimated average predicted probabilities of cognitive migration status using OGTT-2h and age range (55-65, 65-75 and 75+) as predictors.ResultsVBM analyses revealed lower GM volume in inferior and middle temporal gyri, hippocampus, parahippocampal gyrus, and superior and inferior frontal regions in Migrants- and CDR-0.5 Stables. Predicted probabilities indicated that individuals aged 55-65 with normal OGTT-2h levels were more likely to have better cognitive migration status (e.g., CDR-0 Stables or Reverters+) than those aged 75+ with high OGTT-2h.ConclusionsLower GM volumes and high OGTT-2h glucose levels may predict worse cognitive migration status in early stages of disease. The opposite is true for better cognitive migration. Validating these biomarkers may guide clinical diagnosis and treatments.
| S-EPMC9668626 | biostudies-literature
Project description:ObjectivesThe aim of this study was to evaluate the associations of frailty with perceived neighborhood walkability and environmental pollution among community-dwelling older adults in rural areas.MethodsThe participants were 808 community-dwelling men and women aged 65 years and older in 2 rural towns. Comprehensive information, including demographics, socioeconomic status, grip strength, polypharmacy, perceived neighborhood environment (specifically, walkability and environmental pollution), and frailty, was collected from participants using face-to-face interviews conducted between June and August 2018. Perceived neighborhood walkability was measured using 20 items that were selected and revised from the Neighborhood Environment Walkability Scale, the Neighborhood Walkability Checklist from the National Heart Foundation of Australia, and the Physical Activity Neighborhood Environment Survey. The Kaigo-Yobo Checklist was used to assess participants' frailty.ResultsThe overall prevalence of frailty in this community-dwelling population was 35.5%. Sex, age, cohabitation status, educational attainment, employment status, grip strength, and polypharmacy were significantly associated with frailty. In the logistic regression analysis, frailty was associated with low perceived neighborhood walkability (adjusted odds ratio [aOR], 0.881; 95% confidence interval [CI], 0.833 to 0.932; p<0.001) and severe perceived neighborhood environmental pollution (aOR, 1.052; 95% CI, 1.017 to 1.087; p=0.003) after adjusting for sex, age, cohabitation status, educational attainment, employment status, monthly income, grip strength, and polypharmacy.ConclusionsMore studies are warranted to establish causal relationships between walkability and environmental pollution and frailty.
| S-EPMC6893222 | biostudies-literature