scholarly journals Gait changes over time in hospitalized older adults with advanced dementia: Predictors of mobility change

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0259975
Author(s):  
Sina Mehdizadeh ◽  
Mohammadreza Faieghi ◽  
Andrea Sabo ◽  
Hoda Nabavi ◽  
Avril Mansfield ◽  
...  
Keyword(s):  
Older Adults ◽  
Range Of Motion ◽  
Neuropsychiatric Symptoms ◽  
Step Length ◽  
Time Variability ◽  
Mixed Effect ◽  
Gait Stability ◽  
Rehabilitation Outcomes ◽  
People With Dementia ◽  
Over Time

People with dementia are at risk of mobility decline. In this study, we measured changes in quantitative gait measures over a maximum 10-week period during the course of a psychogeriatric admission in older adults with dementia, with the aims to describe mobility changes over the duration of the admission, and to determine which factors were associated with this change. Fifty-four individuals admitted to a specialized dementia inpatient unit participated in this study. A vision-based markerless motion capture system was used to record participants’ natural gait. Mixed effect models were developed with gait measures as the dependent variables and clinical and demographic variables as predictors. We found that gait stability, step time, and step length decreased, and step time variability and step length variability increased over 10 weeks. Gait stability of men decreased more than that of women, associated with an increased sacrum mediolateral range of motion over time. In addition, the sacrum mediolateral range of motion decreased in those with mild neuropsychiatric symptoms over 10 weeks, but increased in those with more severe neuropsychiatric symptoms. Our study provides evidence of worsening of gait mechanics and control over the course of a hospitalization in older adults with dementia. Quantitative gait monitoring in hospital environments may provide opportunities to intervene to prevent adverse events, decelerate mobility decline, and monitor rehabilitation outcomes.

Physical Activity and its Influencing Factors in Community-Dwelling Older Adults With Dementia: A Path Analysis

2021 ◽  
pp. 105477382110339
Author(s):  
Bei Li ◽  
Xiuxiu Huang ◽  
Chenchen Meng ◽  
Qiaoqin Wan ◽  
Yongan Sun
Keyword(s):  
Physical Activity ◽  
Older Adults ◽  
Path Analysis ◽  
Neuropsychiatric Symptoms ◽  
Community Dwelling ◽  
Cross Sectional ◽  
People With Dementia ◽  
The Status ◽  
Path Analysis Approach ◽  
Community Dwelling Older Adults

Dementia is prevalent in worldwide, and increases the care burden and potential costs. Physical activity (PA) has been increasingly shown to be beneficial for them. This was a cross-sectional observational study aiming to investigate the status of PA among community-dwelling older adults with dementia in Beijing or Hangzhou, China, and verify the relationships between neuropsychiatric symptoms, activities of daily living (ADL), caregivers’ fear of patients’ falling and their PA using a path analysis approach. The level of PA among 216 included people with dementia was low. PA was related to the neuropsychiatric symptoms, with ADL and caregivers’ fear of patients’ falling have mediation roles. The findings indicated that person-centered strategies related to the management of these symptoms might be helpful to improve ADL, relieve caregivers’ concerns about them falling and consequently foster positive participation in PA.

scholarly journals DOES ONSET OF CHRONIC CONDITIONS MODERATE THE IMPACT OF RELATIONAL LIFE EVENTS ON DEPRESSED MOOD?

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S260-S260
Author(s):  
Aaron M Ogletree ◽  
Rosemary Blieszner ◽  
Rachel Pruchno ◽  
Jyoti Savla ◽  
Laura P Sands
Keyword(s):  
Mental Health ◽  
Older Adults ◽  
Depressive Symptoms ◽  
Life Events ◽  
Chronic Conditions ◽  
Chronic Condition ◽  
Process Model ◽  
Mixed Effect ◽  
The Impact ◽  
Over Time

Abstract More than 62% of adults aged 65+ have more than one chronic condition; this number increases to more than 82% for those 85+. Older adults simultaneously experience changes in their relationships due to negative relational life events, including illness, injury, or death of a loved one. Stressors occurring in tandem can overload psychological resources and increase risk for poor mental health. Informed by the stress process model, we assessed the influence of relational life events on depressive symptoms over time and evaluated the moderating effects of chronic condition onset. Self-reports of four stressful life events, five chronic conditions, and depressive symptoms as measured by the CES-D came from 2,948 older adults participating in the ORANJ BOWL panel. Using longitudinal multilevel mixed effect modeling, we examined trajectories of depressive symptoms across three waves. While depressive symptoms increased over time, they were greater for people who experienced more relational life events and the onset of more chronic conditions. Participants who reported experiencing all four relational life events but no chronic conditions had an average CES-D score of 5.28 (p<.0001); average CES-D score increased to 12.72 (p<.0001) for those who reported four life events and the onset of four or more new chronic conditions during the study period. In summary, chronic condition onset moderated the relationship between life events and depressive symptoms. Findings highlight the need for practitioner awareness of increased mental health risks for people experiencing stressors in multiple domains of life.

The Nursing Home Older Adult Gut Microbiome Composition Shows Time-dependent Dysbiosis and is Influenced by Medication Exposures, Age, Environment, and Frailty

2021 ◽  
Author(s):  
John P Haran ◽  
Abigail Zeamer ◽  
Doyle V Ward ◽  
Protiva Dutta ◽  
Vanni Bucci ◽  
...  
Keyword(s):  
Older Adults ◽  
Gut Microbiota ◽  
Older Adult ◽  
Gut Microbiome ◽  
Assessment Tool ◽  
Mini Nutritional Assessment ◽  
Metagenomic Sequencing ◽  
Mixed Effect ◽  
Stool Samples ◽  
Over Time

Abstract Older adults in nursing homes (NHs) have increased frailty, medication, and antimicrobial exposures, all factors that are known to affect the composition of gut microbiota. Our objective was to define which factors have the greatest association with the NH resident gut microbiota, explore patterns of dysbiosis and compositional changes in gut microbiota over time in this environment. We collected serial stool samples from NH residents. Residents were assessed using the Mini Nutritional Assessment tool and Clinical Frailty Scale. Bacterial composition of resident stool samples was determined by metagenomic sequencing. We used mixed-effect random forest modeling to identify clinical covariates that associate with microbiota. We enrolled and followed 166 residents from 5 NHs collecting 512 stool samples and following 15 residents for > 1 year. Medications, particularly psychoactive and anti-hypertensive medications, had the greatest effect on the microbiota. Age and frailty also contributed, and were associated with increased and decreased diversity, respectively. The microbiota of residents who had lived in the NH for > 1 year were enriched in inflammatory and pathogenic species and reduced in anti-inflammatory and symbiotic species. We observed intra-individual stability of the microbiome among older adults who had lived in the NH already for >1 year followed with sample collections 1 year apart. Older adult NH gut microbiome is heavily influenced by medications, age, and frailty. This microbiome is influenced by length of NH residence with dysbiosis becoming evident at 12 months, however after this point there is demonstrated relative stability over time.

scholarly journals The Effect of Diabetes on the Cognitive Trajectory of Older Adults in Mexico and the United States

2020 ◽  
Author(s):  
Jaqueline C Avila ◽  
Silvia Mejia-Arangom ◽  
Daniel Jupiter ◽  
Brian Downer ◽  
Rebeca Wong
Keyword(s):  
United States ◽  
Older Adults ◽  
Linear Models ◽  
The United States ◽  
Mixed Effect ◽  
Cognitive Domains ◽  
Aging Study ◽  
Nationally Representative ◽  
The Impact ◽  
Over Time

Abstract Objectives To study the impact of diabetes on the long-term cognitive trajectories of older adults in 2 countries with different socioeconomic and health settings, and to determine whether this relationship differs by cognitive domains. This study uses Mexico and the United States to confirm if patterns hold in both populations, as these countries have similar diabetes prevalence but different socioeconomic conditions and diabetes-related mortality. Methods Two nationally representative cohorts of adults aged 50 years or older are used: the Mexican Health and Aging Study for Mexico and the Health and Retirement Study for the United States, with sample sizes of 18,810 and 26,244 individuals, respectively, followed up for a period of 14 years. The outcome is cognition measured as a total composite score and by domain (memory and nonmemory). Mixed-effect linear models are used to test the effect of diabetes on cognition at 65 years old and over time in each country. Results Diabetes is associated with lower cognition and nonmemory scores at baseline and over time in both countries. In Mexico, diabetes only predicts lower memory scores over time, whereas in the United States it only predicts lower memory scores at baseline. Women have higher total cognition and memory scores than men in both studies. The magnitude of the effect of diabetes on cognition is similar in both countries. Discussion Despite the overall lower cognition in Mexico and different socioeconomic characteristics, the impact of diabetes on cognitive decline and the main risk and protective factors for poor cognition are similar in both countries.

scholarly journals Exploring life-space in the nursing home. An observational longitudinal study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Karen Sverdrup ◽  
Sverre Bergh ◽  
Geir Selbæk ◽  
Jūratė Šaltytė Benth ◽  
Bettina Husebø ◽  
...  
Keyword(s):  
Nursing Home ◽  
Physical Performance ◽  
Neuropsychiatric Symptoms ◽  
Central Element ◽  
Life Space ◽  
People With Dementia ◽  
Medical Health ◽  
Group 2 ◽  
The Impact ◽  
Over Time

Abstract Background Traditional performance-based measurements of mobility fail to recognize the interaction between the individual and their environment. Life-space (LS) forms a central element in the broader context of mobility and has received growing attention in gerontology. Still, knowledge on LS in the nursing home (NH) remains sparse. The aim of this study was to identify LS trajectories in people with dementia from time of NH admission, and explore characteristics associated with LS over time. Methods In total, 583 people with dementia were included at NH admission and assessed biannually for 3 years. LS was assessed using the Nursing Home Life-Space Diameter. Association with individual (age, sex, general medical health, number of medications, pain, physical performance, dementia severity, and neuropsychiatric symptoms) and environmental (staff-to-resident ratio, unit size, and quality of the physical environment) characterises was assessed. We used a growth mixture model to identify LS trajectories and linear mixed model was used to explore characteristics associated with LS over time. Results We identified four groups of residents with distinct LS trajectories, labelled Group 1 (n = 19, 3.5%), Group 2 (n = 390, 72.1%), Group 3 (n = 56, 10.4%), Group 4 (n = 76, 14.0%). Being younger, having good compared to poor general medical health, less severe dementia, more agitation, less apathy, better physical performance and living in a smaller unit were associated with a wider LS throughout the study period. Conclusion From NH admission most NH residents’ LS trajectory remained stable (Group 2), and their daily lives unfolded within their unit. Better physical performance and less apathy emerged as potentially modifiable characteristics associated with wider LS over time. Future studies are encouraged to determine whether LS trajectories in NH residents are modifiable, and we suggest that future research further explore the impact of environmental characteristics.

Changes in step time variability, not changes in step length and width, are associated with lower-trunk sway during dual-task gait in older adults

2019 ◽  
Vol 66 ◽  
pp. 157-163 ◽  
Author(s):  
Tsuyoshi Asai ◽  
Kensuke Oshima ◽  
Yoshihiro Fukumoto ◽  
Hiroki Kubo ◽  
Shota Koyama ◽  
...  
Keyword(s):  
Older Adults ◽  
Dual Task ◽  
Step Length ◽  
Time Variability ◽  
Lower Trunk ◽  
Trunk Sway

scholarly journals User-Driven Living Lab for Assistive Technology to Support People With Dementia Living at Home: Protocol for Developing Co-Creation–Based Innovations (Preprint)

2018 ◽  
Author(s):  
Robin CP van den Kieboom ◽  
Inge MB Bongers ◽  
Ruth E Mark ◽  
Liselore JAE Snaphaan
Keyword(s):  
Neuropsychiatric Symptoms ◽  
Informal Caregivers ◽  
Monthly Basis ◽  
Outcome Measurements ◽  
The North ◽  
People With Dementia ◽  
Living Lab ◽  
First Results ◽  
Over Time ◽  
At Home

BACKGROUND Owing to no cure for dementia currently, there is an urgent need to look for alternative ways to support these people and their informal caregivers. Carefully designed interventions can answer the unmet needs of both people with dementia and their informal caregivers in the community. However, existing products, systems, and services are often too complex or unsuitable. OBJECTIVE This study aims to identify, longitudinally, the changing needs (as dementia progresses) of people with dementia living at home and their informal caregivers. By developing co-creation-based innovations, these changing needs will hopefully be met. METHODS A user-driven Living Lab design is used to structurally explore the needs over time of people with dementia (and their informal caregivers) living in the community in the North Brabant region of the Netherlands. In addition, co-creation-based innovations will be developed, tested, and evaluated by these people and their caregivers at home. All participants will complete complaints-oriented questionnaires at 3 time-points—at the baseline, 1 year, and 2 years after they start participating. Home interviews are scheduled to explore if and how these complaints translate into participants’ specific needs or wishes. Focus groups meet on a monthly basis to further identify the needs of people with dementia and their informal caregivers and provide feedback to the stakeholders. In the context field, participants have an opportunity to actually test the products at home and provide feedback. Quantitative outcome measurements include neuropsychiatric symptoms, cognitive decline, independence in activities of daily living, safety, and caregiver burden. Qualitative outcome measurements include feedback to the stakeholders regarding the needs of people with dementia and their informal caregivers and how these needs change over time, as well as user experiences about the specific innovations. RESULTS Participant recruitment will start in September 2018 and is ongoing. The first results of data analyses are expected in the spring of 2019. CONCLUSIONS The overall aim of Innovate Dementia 2.0 is to facilitate person-centered innovations developed for people with dementia and their informal caregivers at all stages as dementia progresses. This should lead to newly designed concepts and innovations, which are better able to answer the needs of people with dementia and their caregivers in the community. INTERNATIONAL REGISTERED REPOR PRR1-10.2196/10952

scholarly journals Smart Restored by Learning Exercise Alleviates the Deterioration of Cognitive Function in Older Adults with Dementia—A Quasi-Experimental Research

2019 ◽  
Vol 16 (7) ◽  
pp. 1270 ◽  
Author(s):  
Tseng ◽  
Lee ◽  
Hsieh ◽  
Lee
Keyword(s):  
Older Adults ◽  
Cognitive Function ◽  
Frontal Lobe ◽  
Neuropsychiatric Symptoms ◽  
Routine Care ◽  
Control Group ◽  
Time Interaction ◽  
People With Dementia ◽  
Quasi Experimental ◽  
And Control

Maintaining cognitive function is essential for older adults with dementia. The purpose of this study was to investigate the effectiveness of Smart Restored by Learning Exercise (SRLE) on cognitive functions, neuropsychiatric symptoms, and frontal lobe functions in elderly people with dementia. A total of 68 older adults with dementia participated in this study. A quasi-experimental design was used, and convenience sampling and assignment approaches were adopted to select the participants for experimental and control groups. The experimental group engaged in SRLE for 6 months. The control group received routine care without SRLE. The participants’ cognitive function, neuropsychiatric symptoms, and frontal lobe function at baseline were evaluated using the Mini-Mental State Examination (MMSE), Neuropsychiatry Inventory (NPI), and Frontal Assessment Battery (FAB), respectively, in month 3 and month 6. The Group by Time interaction was statistically significant for MMSE and FAB scores, which indicated the different group effects between months 3 and 6. The results also showed that the improvement of MMSE, NPI, and FAB scores in the SRLE group were significantly better than the control group (t = −5.99~4.90, p < 0.001) at both months 3 and 6. In conclusion, long-term facilities may provide residents with SRLE every day to prevent a decline in the residents’ levels of cognitive function.

Vision-Based Assessment of Gait Features Associated With Falls in People With Dementia

2019 ◽  
Vol 75 (6) ◽  
pp. 1148-1153 ◽  
Author(s):  
Sina Mehdizadeh ◽  
Elham Dolatabadi ◽  
Kimberley-Dale Ng ◽  
Avril Mansfield ◽  
Alastair Flint ◽  
...  
Keyword(s):  
Baseline Period ◽  
Demographic Variables ◽  
Lateral Margin ◽  
Time Variability ◽  
Period Range ◽  
Gait Stability ◽  
Margin Of Stability ◽  
People With Dementia ◽  
Gait Features ◽  
Important Marker

Abstract Background Gait impairments contribute to falls in people with dementia. In this study, we used a vision-based system to record episodes of walking over a 2-week period as participants moved naturally around their environment, and from these calculated spatiotemporal, stability, symmetry, and acceleration gait features. The aim of this study was to determine whether features of gait extracted from a vision-based system are associated with falls, and which of these features are most strongly associated with falling. Methods Fifty-two people with dementia admitted to a specialized dementia unit participated in this study. Thirty different features describing baseline gait were extracted from Kinect recordings of natural gait over a 2-week period. Baseline clinical and demographic measures were collected, and falls were tracked throughout the participants’ admission. Results A total of 1,744 gait episodes were recorded (mean 33.5 ± 23.0 per participant) over a 2-week baseline period. There were a total of 78 falls during the study period (range 0–10). In single variable analyses, the estimated lateral margin of stability, step width, and step time variability were significantly associated with the number of falls during admission. In a multivariate model controlling for clinical and demographic variables, the estimated lateral margin of stability (p = .01) was remained associated with number of falls. Conclusions Information about gait can be extracted from vision-based recordings of natural walking. In particular, the lateral margin of stability, a measure of lateral gait stability, is an important marker of short-term falls risk.

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