Intersectional cohort change: Disparities in mobility limitations among older Singaporeans

Background: Social participation is beneficial for individuals’ health. However, people with disabilities that may lead to mobility limitations tend to experience lower levels of social participation. Information and communication technologies such as the OnRoule mobile application (app) can help promote social participation. Objectives: To obtain potential users’ perceptions on the usability and content of the OnRoule app for providing information on accessibility, as well as its potential to optimize social participation. Materials and Methods: Cross-sectional user-centered design study. Individuals with physical disabilities (n = 18) were recruited through community organizations and interviewed using a semi-structured guide. Interviews were recorded, transcribed, and analyzed using thematic analysis. Results: Three main themes were identified: (1) “user-friendliness”; (2) “balance between the amount and relevance of information”; and (3) “potential use of the app”. Discussion and Conclusion: Findings from this study indicated that the app was easy to use, had pertinent information, and enabled a positive experience of finding information. However, several areas of improvement were identified, such as the clarity of specific elements, organization and amount of information, optimization of features, and inclusiveness. Apps such as OnRoule could optimize social participation by facilitating the process of finding resources in the community and building a sense of connectedness between users.

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Physical activity coaching for adults with mobility limitations: protocol for the ComeBACK pragmatic hybrid effectiveness-implementation type 1 randomised controlled trial

BMJ Open ◽

10.1136/bmjopen-2019-034696 ◽

2020 ◽

Vol 10 (11) ◽

pp. e034696

Author(s):

Leanne Hassett ◽

Anne Tiedemann ◽

Rana S Hinman ◽

Maria Crotty ◽

Tammy Hoffmann ◽

...

Keyword(s):

Physical Activity ◽

Well Being ◽

Text Messages ◽

Waiting List ◽

Randomised Control Trial ◽

Control Group ◽

Mobility Limitations ◽

Intervention Package ◽

Motivational Resources

IntroductionMobility limitation is common and often results from neurological and musculoskeletal health conditions, ageing and/or physical inactivity. In consultation with consumers, clinicians and policymakers, we have developed two affordable and scalable intervention packages designed to enhance physical activity for adults with self-reported mobility limitations. Both are based on behaviour change theories and involve tailored advice from physiotherapists.Methods and analysisThis pragmatic hybrid effectiveness-implementation type 1 randomised control trial (n=600) will be undertaken among adults with self-reported mobility limitations. It aims to estimate the effects on physical activity of: (1) an enhanced 6-month intervention package (one face-to-face physiotherapy assessment, tailored physical activity plan, physical activity phone coaching from a physiotherapist, informational/motivational resources and activity monitors) compared with a less intensive 6-month intervention package (single session of tailored phone advice from a physiotherapist, tailored physical activity plan, unidirectional text messages, informational/motivational resources); (2) the enhanced intervention package compared with no intervention (6-month waiting list control group); and (3) the less intensive intervention package compared with no intervention (waiting list control group). The primary outcome will be average steps per day, measured with the StepWatch Activity Monitor over a 1-week period, 6 months after randomisation. Secondary outcomes include other physical activity measures, measures of health and functioning, individualised mobility goal attainment, mental well-being, quality of life, rate of falls, health utilisation and intervention evaluation. The hybrid effectiveness-implementation design (type 1) will be used to enable the collection of secondary implementation outcomes at the same time as the primary effectiveness outcome. An economic analysis will estimate the cost-effectiveness and cost-utility of the interventions compared with no intervention and to each other.Ethics and disseminationEthical approval has been obtained by Sydney Local Health District, Royal Prince Alfred Zone. Dissemination will be via publications, conferences, newsletters, talks and meetings with health managers.Trial registration numberACTRN12618001983291.

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Pharmacological Targeting of Heme Oxygenase-1 in Osteoarthritis

Antioxidants ◽

10.3390/antiox10030419 ◽

2021 ◽

Vol 10 (3) ◽

pp. 419

Author(s):

Yohei Sanada ◽

Sho Joseph Ozaki Tan ◽

Nobuo Adachi ◽

Shigeru Miyaki

Keyword(s):

Heme Oxygenase ◽

Redox Homeostasis ◽

Synovial Fibroblasts ◽

Protective Role ◽

Joint Disease ◽

Heme Oxygenase 1 ◽

Transcriptional Level ◽

Related Factor ◽

Mobility Limitations ◽

Therapeutic Implications

Osteoarthritis (OA) is a common aging-associated disease that clinically manifests as joint pain, mobility limitations, and compromised quality of life. Today, OA treatment is limited to pain management and joint arthroplasty at the later stages of disease progression. OA pathogenesis is predominantly mediated by oxidative damage to joint cartilage extracellular matrix and local cells such as chondrocytes, osteoclasts, osteoblasts, and synovial fibroblasts. Under normal conditions, cells prevent the accumulation of reactive oxygen species (ROS) under oxidatively stressful conditions through their adaptive cytoprotective mechanisms. Heme oxygenase-1 (HO-1) is an iron-dependent cytoprotective enzyme that functions as the inducible form of HO. HO-1 and its metabolites carbon monoxide and biliverdin contribute towards the maintenance of redox homeostasis. HO-1 expression is primarily regulated at the transcriptional level through transcriptional factor nuclear factor erythroid 2 (NF-E2)-related factor 2 (Nrf2), specificity protein 1 (Sp1), transcriptional repressor BTB-and-CNC homology 1 (Bach1), and epigenetic regulation. Several studies report that HO-1 expression can be regulated using various antioxidative factors and chemical compounds, suggesting therapeutic implications in OA pathogenesis as well as in the wider context of joint disease. Here, we review the protective role of HO-1 in OA with a focus on the regulatory mechanisms that mediate HO-1 activity.

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1617g Association of insomnia and fatigue due to shift work in midlife and mobility limitations over 28 years of follow-up

10.1136/oemed-2018-icohabstracts.106 ◽

2018 ◽

Author(s):

KC Prakash ◽

Subas Neupane ◽

Päivi Leino-Arjas ◽

Mikko Härmä ◽

Clas-Håkan Nygård

Keyword(s):

Shift Work ◽

Mobility Limitations

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Testosterone Attenuates Age-Related Fall in Aerobic Function in Mobility Limited Older Men With Low Testosterone

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2015-4333 ◽

2016 ◽

Vol 101 (6) ◽

pp. 2562-2569 ◽

Cited By ~ 14

Author(s):

Thomas W. Storer ◽

Shalender Bhasin ◽

Thomas G. Travison ◽

Karol Pencina ◽

Renee Miciek ◽

...

Keyword(s):

Medical Center ◽

Exercise Physiology ◽

Academic Medical Center ◽

Older Men ◽

Peak Oxygen Uptake ◽

Cycle Ergometer ◽

Aerobic Performance ◽

Mobility Limitations ◽

Age Related ◽

Ergometer Exercise

Abstract Context: Testosterone increases skeletal muscle mass and strength, but the effects of testosterone on aerobic performance in mobility-limited older men have not been evaluated. Objective: To determine the effects of testosterone supplementation on aerobic performance, assessed as peak oxygen uptake (V̇O2peak) and gas exchange lactate threshold (V̇O2θ), during symptom-limited incremental cycle ergometer exercise. Design: Subgroup analysis of the Testosterone in Older Men with Mobility Limitations Trial. Setting: Exercise physiology laboratory in an academic medical center. Participants: Sixty-four mobility-limited men 65 years or older with low total (100–350 ng/dL) or free (<50 pg/dL) testosterone. Interventions: Participants were randomized to receive 100-mg testosterone gel or placebo gel daily for 6 months. Main Outcome Measures: V̇O2peak and V̇O2θ from a symptom-limited cycle exercise test. Results: Mean (SD) baseline V̇O2peak was 20.5 (4.3) and 19.9 (4.7) mL/kg/min for testosterone and placebo, respectively. V̇O2peak increased by 0.83 (2.4) mL/kg/min in testosterone but decreased by −0.89 (2.5) mL/kg/min in placebo (P = .035); between group difference in change in V̇O2peak was significant (P = .006). This 6-month reduction in placebo was greater than the expected −0.4-mL/kg/min/y rate of decline in the general population. V̇O2θ did not change significantly in testosterone but decreased by 1.1 (1.8) mL/kg/min in placebo, P = .011 for between-group comparisons. Hemoglobin increased by 1.0 ± 3.5 and 0.1 ± 0.8 g/dL in testosterone and placebo groups, respectively. Conclusion: Testosterone supplementation in mobility-limited older men increased hemoglobin and attenuated the age-related declines in V̇O2peak and V̇O2θ. Long-term intervention studies are needed to determine the durability of this effect.

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Older Adults’ Adoption of Mobility Devices: Interplay of Predisposing Factors and Precipitating Health Events

Innovation in Aging ◽

10.1093/geroni/igaa057.1567 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 484-485

Author(s):

Farhanaz Sharmin ◽

Laura Sands

Keyword(s):

Older Adults ◽

Logistic Regression ◽

Chronic Conditions ◽

High School Education ◽

Living Alone ◽

Mobility Limitations ◽

Chi Square ◽

Health Events ◽

Mobility Devices ◽

History Of

Abstract Existing mobility limitations and chronic conditions increase likelihood of adopting mobility-related devices such as canes and walkers. Prior research has not considered how recent acute events such as falls and hospitalizations contribute to the adoption of mobility devices. We studied 4,592 older adults who responded to the 2015 and 2016 National Health and Aging Trends Study surveys, and classified adoption of mobility devices as: (i) Never users (did not use mobility devices either year) and (ii) New users (started using mobility devices in 2016). We determined through chi-square tests, that predisposing characteristics from 2015 that were significantly associated with being a New User in 2016 were: being female, aged 80+, minority race, having a high-school education or lower, living alone, being obese, and having a history of dementia, arthritis, stroke, mobility difficulties, falls, and hospitalization (all P’s<0.05). We used logistic regression to determine the contribution of recent precipitating events on the adoption of mobility devices among older adults after controlling for 2015 characteristics that were significantly associated with being a New user. Precipitating events were significantly associated with being a New user of mobility equipment. Specifically, older adults who, between the 2015 and 2016 interviews, experienced a fall (OR=1.7; 95% CI=1.1-2.9), hospitalization (OR=3.7; 95% CI=2.3-5.9) or increase in mobility difficulties (OR=3.7; 95% CI=2.3-5.9) were more likely to be New users. Study findings reveal the importance precipitating events on the adoption of mobility devices, signaling the importance of assessing for need for mobility devices after these events.

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A subjective measure of environmental facilitators and barriers to participation for people with mobility limitations

Disability and Rehabilitation ◽

10.1080/09638280701625377 ◽

2008 ◽

Vol 30 (6) ◽

pp. 434-457 ◽

Cited By ~ 77

Author(s):

David B. Gray ◽

Holly H. Hollingsworth ◽

Susan Stark ◽

Kerri A. Morgan

Keyword(s):

Subjective Measure ◽

Mobility Limitations ◽

Barriers To Participation ◽

Facilitators And Barriers

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A Longitudinal Study of Cognitive and Instrumental Activities of Daily Living Disablement Among the Oldest Mexican Americans

Journal of Aging and Health ◽

10.1177/08982643211037512 ◽

2021 ◽

pp. 089826432110375

Author(s):

Jiwon Kim ◽

Jacqueline L. Angel ◽

Sunshine M. Rote

Keyword(s):

Activities Of Daily Living ◽

Cognitive Decline ◽

Mexican Americans ◽

Daily Living ◽

Oldest Old ◽

Epidemiologic Study ◽

Mobility Limitations ◽

Limited Mobility ◽

Community Activities ◽

Instrumental Activities

Objectives Mexican Americans live longer on average than other ethnic groups, but often with protracted cognitive and physical disability. Little is known, however, about the role of cognitive decline for transitions in instrumental activities of daily living (IADL) disability and tertiary outcomes of the IADL disablement for the oldest old (after 80 years old). Methods We employ the Hispanic Established Populations for the Epidemiologic Study of the Elderly (2010–2011, 2012–2013, and 2016, N = 1,078) to investigate the longitudinal patterns of IADL decline using latent transition analysis. Results Three IADL groups were identified: independent (developing mobility limitations), emerging dependence (limited mobility and community activities), and dependent (limited mobility and household and community activities). Declines in cognitive function were a consistent predictor of greater IADL disablement, and loneliness was a particularly salient distal outcome for emerging dependence. Discussion These results highlight the social consequences of cognitive decline and dependency as well as underscore important areas of intervention at each stage of the disablement process.

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