摘要:

OBJECTIVE:To determine the effects of 12 weeks of progressive resistance strength training on the isometric strength, explosive power, and selected functional abilities of healthy women aged 75 and over.DESIGN:Subjects were matched for age and habitual physical activity and then randomly assigned into either a control or an exercise group.SETTING:The Muscle Function Laboratory, Royal Free Hospital School of Medicine, London.PARTICIPANTS:Fifty‐two healthy women were recruited through local and national newspapers. Five dropped out before and seven (4 exercisers and 3 controls) during the study. Pre‐ and posttraining measurements were obtained from 20 exercisers (median age 79.5, range 76 to 93 years) and 20 controls (median age 79.5, range 75 to 90 years).INTERVENTIONS:Training comprised one supervised session (1 hour) at the Medical School and two unsupervised home sessions (supported by an exercise tape and booklet) per week for 12 weeks. The training stimulus was three sets of four to eight repetitions of each exercise, using rice bags (1–1.5 kg) or elastic tubing for resistance. The exercises were intended specifically to strengthen the muscles considered relevant for the functional tasks, but were not to mimic the functional measurements. No intervention was prescribed for the controls.MEASUREMENTS:Pre‐ and posttraining measurements were made for isometric knee extensor strength (IKES), isometric elbow flexor strength (IEFS), handgrip strength (HGS), leg extensor power (LEP), and anthropometric indices (Body impedance analysis, arm muscle circumference, and body weight). Functional ability tests were chair rise, kneel rise, rise from lying on the floor, 118‐m self‐paced corridor walk, stair climbing, functional reach, stepping up, stepping down, and lifting weights onto a shelf. Pre‐ and posttraining comparisons were made using analysis of variance or analysis of covariance (using weight as a covariate) for normally distributed continuous data and one‐sided Fishers exact test (2times2 table) for discontinuous data.RESULTS:Improvements in IKES (mean change 27%,P= .03), IEFS (22%,P= .05), HGS (4%,P= .05), LEP/kg (18%,P= .05) were associated with training, but the improvement in LEP (18%,P= .11) did not reach statistical significance. There was an association between training and a reduction in normal pace kneel rise time (median change 21%,P= .02) and a small improvement in step up height (median 5%,P= .005). The other functional tests did not improve.CONCLUSIONS:Progressive resistance exercise can produce substantial increases in muscle strength and in power standardized for body weight in healthy, very old women. However, isolated increases in strength and LEP/kg may confer only limited functional benefit in healthy, independent,

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1995.tb07004.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

OBJECTIVE:To determine whether patients with dementia have reduced bone mass, altered vitamin D, or parathyroid hormone status.DESIGN:Survey.SETTING:University hospital outpatient department.PARTICIPANTS:Twenty women with DSM‐III‐R mild dementia living in the community were compared with 40 cognitively normal community‐dwelling women, matched for age, who had been recruited as part of studies in elderly twins.MEASUREMENTS:Bone density at the lumbar spine and neck of femur by dual‐energy X‐ray absorptiometry, intact serum PTH, and 25‐hydroxyvitamin D levels.MAIN RESULTS:There was no significant difference in bone density between the subjects with mild dementia and the age‐ and sex‐matched controls. The intact PTH (mean ± SD) in the demented subjects was 4.9 ± 2.1 pmol/L compared with 2.9 ± 1.7 pmol/L in the twin controls (P<.01). The mean 25‐hydroxyvitamin D in the demented subjects was 61 ± 33 nmol/L, whereas it was 90 ± 38 nmol/L in the twin controls (P<.01).CONCLUSIONS:We conclude that there were no significant differences in the bone density of community‐dwelling women with mild dementia compared with normals. However, there were significant differences in parathyroid hormone and vitamin D levels between the two groups, suggesting that there is a high prevalence of subclinical hypovitaminosis D in demente

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1995.tb07005.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

OBJECTIVES:To determine the extent to which selected variables within demographic, psychometric, and memory domains can predict functional abilities in dementia.DESIGN:Hierarchical regression analyses were employed to predict functional abilities, while controlling for disease severity, using the Mini‐Mental State Exam (MMSE).SETTING AND PARTICIPANTS:A total of 2368 inhabitants of Kungsholmen parish in Stockholm, Sweden, aged 75 years of age or older. Eighty‐one subjects with confirmed dementia (MMSE,M= 17.9; SD = 5.26) were selected from the study population. The mean age was 84.5 years (SD = 5.58), and 72% were female.MEASUREMENTS:Participants received a battery of standardized neuropsychological instruments and selected experimental tasks that measured visuospatial ability as well as primary and episodic memory. Self‐care was assessed using the Katz index of activities of daily living (ADL); instrumental activities of daily living (IADL) were assessed through the primary caregiver, who responded to questions related to functional competence of the participant.RESULTS:Hierarchical regression procedures revealed that disease severity was the strongest predictor of ADL and IADL performance. Controlling for disease severity, a measure of visuoperception (Poppelreuter's figures) also made a significant contribution to the explanatory variance in both ADL and IADL function. Beyond disease seve—ity and visuoperception, years of schooling and disease duration were marginally predictive of IADL performance.CONCLUSION:It is possible to predict functional abilities in dementia on the basis of individual difference variables. Multiple variables were initially correlated with ADL and IADL performance; however, after controlling for disease severity, visuoperception was the only predictor of ADL scores. In addition to visuoperception, IADL scores were also marginally predicted by education and disease duration. These findings highlight the importance of peripheral sensory processes in adaptive function in dementia. They also suggest that although many variables may be correlated with functional ability, their explanatory role, particularly with regard to self‐care skills, is diminished in the presence of th

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1995.tb07006.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

OBJECTIVES:To determine if two physical activity programs of varying intensity would result in improved sleep among incontinent and physically restrained nursing home residents.DESIGN:Controlled trials of two physical activity programs.SETTING:Seven community nursing homes in the Los Angeles area.PARTICIPANTS:Residents were included if they had urinary incontinence or were physically restrained. Sixty‐five subjects were studied. Mean age was 84.8 years, 85% were female, mean length of residency in the nursing home was 19.9 months, and mean Mean Mini‐Mental State Exam score was 13.1.INTERVENTION:The first physical activity program involved sit‐to‐stand repetitions and/or transferring and walking or wheelchair propulsion. These activities were performed every 2 hours during the daytime, 5 days per week for 9 weeks. The second, less frequent physical activity program involved rowing in a wheelchair‐accessible rowing machine plus walking or wheelchair propulsion once per day three times per week for 9 weeks.MEASUREMENTS:The physical function measures reported here include mobility endurance (maximum time walking or wheeling) and physical activity as measured by motion sensors (Caltrac). Nighttime sleep was estimated by wrist activity monitors. Nighttime sleep measures included total time asleep, percent sleep, average duration of sleep, and peak duration of sleep. Daytime sleep was measured by timed behavioral observations of sleep versus wakefulness performed every 15 minutes during the day.RESULTS:Nighttime sleep was markedly disrupted in both groups at baseline. Across all subjects at baseline, the average total sleep time was 6.2 hours and the percent sleep was 72.0%, but the average duration of sleep episodes was only 21.2 minutes and the peak duration of sleep episode averaged only 83.8 minutes. During the daytime, subjects were observed asleep during 14.5% of observations. Although there was improvement in mobility endurance in the intervention subjects compared with controls (MANOVA F = 4.36,P= .042), there were no differences in the night and day sleep measures at follow‐up testing. Even among a subgroup of intervention subjects who showed a 30% or greater improvement in mobility endurance, sleep did not improve at follow‐up compared with baseline.CONCLUSION:This study supports our previous findings of marked sleep disruption in impaired nursing home residents. In addition, despite documented improvements in physical function with activity, we did not find improvements in sleep in the intervention versus control groups. These results suggest that increasing daytime physical activity alone is not adequate to improve sleep in impaired NH residents. Future efforts to improve sleep in this population should take into account the multifactorial nature of sleep disruption, including individual health problems that effect sleep and the disruptive nature of the nighttime N

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1995.tb07007.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

OBJECTIVE:To compare the health status of newly admitted lower socioeconomic status (SES) southern black (n = 81) and white (n = 53) nursing home residents.DESIGN:The study data were part of a larger prospective study on the health of newly admitted nursing home residents.SETTING:A 575‐bed, government‐funded nursing home providing care for indigent residents in a large southern city.PARTICIPANTS:Newly admitted black and white nursing home residents aged 60 and older.MEASUREMENTS:Mental status was measured using the Short Portable Mental Status Questionnaire, activities of daily living by Scaled Outcome Criteria, and medical status by medical diagnoses and medications.MAIN RESULTS:Blacks entering the nursing home were more cognitively and functionally impaired and had 3.7 years less education than white residents, but average age was not significantly different for black and white residents.CONCLUSIONS:Many common health status measures showed no significant black‐white differences for institutionalized older adults when region and SES were constants. However, mental status, self‐care activities, and marital status were significantly different. These findings indicate a possible impact of lifelong poverty or low educational attainment on the increased disability of indigent black older adults. Black residents in our study had less spousal support to remain in the co

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1995.tb07008.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

OBJECTIVES:Knowledge of male sexual function is somewhat limited because of a lack of current population‐based data. This study provides information on sexual function and satisfaction in a population‐based sample of men.METHODS:Men aged 40 to 79 years (n = 2115) were selected randomly from the Olmsted County population for the baseline component of a prospective cohort study (the Olmsted County Study of Urinary Symptoms and Health Status Among Men) during 1989–1990. The men completed a self‐administered questionnaire that included questions about sexual concerns, performance, satisfaction, drive, and erectile dysfunction.RESULTS:For all five sexual parameters queried, the prevalence of problems and dysfunction increased with age. A comparison of men aged 70 to 79 years with men aged 40 to 49 years suggested that older men were more worried about sexual function (46.6% vs 24.9%), had worsened performance compared with a year ago (30.1% vs 10.4%), expressed extreme dissatisfaction with sexual performance (10.7% vs 1.7%), had absent sexual drive (25.9% vs 0.6%), and reported complete erectile dysfunction when sexually stimulated (27.4% vs 0.3%). Logistic regression analyses suggested that sexual dissatisfaction was significantly associated with erectile dysfunction, decreased libido, and the interaction between erectile dysfunction and libido, but not age.CONCLUSIONS:These population‐based cross‐sectional data corroborate the previously reported age‐related decrease in sexual function. The age‐related increase in dissatisfaction could, however, be accounted for primarily by the age‐related increase in erectile dysfunction, decreased libido, and the interaction between erectile dysfunction and

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1995.tb07009.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

OBJECTIVE:More than half of nursing home residents suffer from urinary incontinence. These residents typically have long stays and, because of comorbid cognitive and physical impairments, have little hope of living again in a noninstitutional environment The value of interventions to change functional status of this chronically institutionalized population is often questioned. This paper explores this value issue in the context of two incontinence management interventions that have been shown to improve functional status: (1) Functional Incidental Training (FIT), and (2) Prompted Voiding (PV). The relative value of the different interventions for the nursing home population was estimated using paired preferences.DESIGN:The cost of two interventions (FIT and PV) that target incontinent nursing home residents was related to the value of these interventions as perceived by consumers of nursing home services. Both interventions decrease incontinence frequency, and one intervention also improves mobility endurance.PARTICIPANTS:Ninety incontinent nursing home residents received the intervention; 37 older nondemented board and care residents and 31 family members of the nursing home residents provided estimates of the intervention's value.MEASUREMENT:The staff‐time allocations involved in implementing both interventions were documented in more than 85 resident care episodes. These time data were converted to labor cost based on the cost of nursing aides who would actually implement the intervention. The value of each intervention was assessed by asking consumers to make choices between the intervention and its associated outcomes (such as increased dryness) and other nursing home services of known cost (e.g., moving to a private room).RESULTS:Both interventions had labor costs that were greater than “usual care” costs. The additional cost was estimated to be $4.31 per resident per day for PV and $6.42 per resident per day for FIT if these programs were implemented from 7 AM to 7 AM. Consumer preference data indicated that consumers preferred the FIT and PV outcomes to more expensive alternative services, calculated to cost $10.00 per day, often marketed to consumers,CONCLUSION:Consumers may prefer the FIT and PV interventions relative to the typical services often marketed to the nursing home consumer. The analysis completed in this paper suggests that both interventions have value for frail residents likely to live out their lives in a nursing

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1995.tb07010.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

OBJECTIVE:Nurses commonly observe more depression than is diagnosed and treated in nursing homes. Accordingly, we aimed to describe the clinical features of untreated nursing home residents whom nurses identify as depressed and to compare nurse ratings of depressed nursing home residents with ratings from direct interviews and patient self‐reports.DESIGN:Cross‐sectional survey followed by semi‐structured diagnostic interviews of depressed patients and their nurses.SETTING:A large academic, multi‐level, long‐term care facility.PARTICIPANTS:Thirty‐seven patients aged 74–99 (mean age 88.4) whom nurses identified as having daily symptoms of depression. Subjects had Mini‐Mental State Exam (MMSE) scores>10 (mean score 21.2), were not acutely or terminally ill, and were able to participate in an interview.MEASUREMENTS:DSM‐III‐R mood diagnoses and separate ratings of interviews with nurses and patients using the Cornell Scale for Depression.RESULTS:Nurses observed daily symptoms of depression in 110 of 495 (22%) long‐term care residents on units not reserved for advanced dementia. Of these 110 patients, 58 (53%) were not receiving antidepressants. Of 37 patients eligible for interviews, nine met criteria for major depression, 20 met criteria for another non‐major depression diagnosis, and eight did not have a diagnosable mood disorder. Cornell scale ratings derived exclusively from interviews of nurses were similar across the three diagnostic groups (12.5, 9.9, and 9.5, respectively;P= .31; mean 10.5), whereas Cornell scale ratings from patient interviews differed among groups (15.9, 6.9, and 4.1, respectively;P<.001; mean 8.4). Correlation between nurse Cornell ratings and patient Cornell ratings was poor (r= .27), especially for patients with non‐major forms of depression (r= ‐.20). MMSE and Cumulative Illness Rating Scale (CIRS‐G) scores were similar in the three groups.CONCLUSIONS:Nurses frequently observed symptoms of depression in a long‐term care setting, and many symptomatic patients were not being treated with antidepressants. In these patients, nurse‐derived symptom ratings did not vary across DSM‐III‐R diagnostic categories and correlated poorly with ratings from direct patient interviews. These findings suggest that nurse caregivers may contribute important diagnostic information about non‐major depression and raise questions about the application of standard diagnostic categories to l

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1995.tb07011.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

OBJECTIVE:To determine if nutritional parameters and discharge setting are associated with mortality in older male veterans on a Geriatric rehabilitation unit (GRU).DESIGN:Two‐year follow‐up of sequential admissions to the GRU who had laboratory studies completed on admission to the acute hospital and on transfer to and discharge from the GRU.SETTING:University‐affiliated VA medical center.PATIENTS:Eighty‐three consecutive older male veterans admitted to the GRU.MEASUREMENT:Mortality during a period of 2 years post‐discharge.MAIN RESULTS:In a univariate analysis, predictors of mortality were serum albumin level ≤ 3.5g/dL on admission to the GRU (P= .01), moderate or severe Nutritional Status Score (P= .03), discharge to a place other than home (P= .01), and use of antibiotics while on the GRU (P= .05). Discharge albumin remained the single significant predictor of mortality in a multivariate analysis (P= .005).CONCLUSIONS:Serum albumin is the strongest predictor of 2‐year post‐hospitalization mortality of older patients cared for on a GRU. Other predictors were presence of infection, Nutritional Status Score of moderate or severe compromise, and discharge to a place

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1995.tb07012.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

OBJECTIVE:To compare the reliability of instruments used in clinical trials involving cognitively impaired older adults when the instruments are administered in‐home rather than in‐clinic and to compare withdrawal rates is these two groups.DESIGN:This study was part of a larger n‐of‐1 clinical trial to investigate the efficacy and safety of a MAO/A inhibitor (Brofaromine) in patients with Alzheimer's disease. Participants were initially assessed at the clinic (baseline) and then randomly allocated to in‐home or in‐clinic assessments for the remainder of the trial. The baseline and second assessment (performed before initiation of the treatment) were used for the reliability analysis. Withdrawal rates were examined over the course of the 6‐month trial.SETTING:Assessments took place at a geriatric clinic in an urban university teaching hospital and at residences of some of the patients.PARTICIPANTS:Forty‐six Alzheimer's disease patients participated in the study, of which, 22 were randomized to in‐home assessments and 24 to in‐clinic assessments.MEASUREMENTS:Test‐retest reliability was measured for all five instruments used in the study and was based on the first two assessments. Sample size requirements, based on within‐group variance, were calculated. Withdrawal rates were obtained for the total duration of the trial.RESULTS:Test‐retest reliability of the instruments, as determined by intraclass correlations, was good in both groups but favored in‐clinic for all but one instrument (range: 0.47–0.90 for in‐home vs 0.57–0.92 for in‐clinic). Sample size requirements based on reliability assessment data were found to be larger for some instruments when administered in‐home. Only four in‐home patients withdrew before completion of the study, compared with eight in‐clinic patients.CONCLUSION:The results suggest the in‐home assessments in cognitively impaired older adults may result in lower withdrawal rates but may necessitate larger sample siz

ISSN:0002-8614    

DOI:10.1111/j.1532-5415.1995.tb07013.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY