Physical interventions for people with more advanced dementia – a scoping review

Background Dementia is a neuro-degenerative condition resulting in cognitive and physical decline over time. In the early stages of the condition, physical decline may be slow, but in the later stages, it may become more pronounced. Physical interventions may be employed to try and reduce the physical decline that people experience, yet it is unclear what interventions may be effective. The aim of this study was to explore the breadth and quantity of evidence that exists in relation to the delivery of physical interventions for people with advanced dementia. Methods We undertook a scoping review in order to map the current literature. All types of study design were included in the search in order to gain a comprehensive scope of the literature. We searched a variety of databases from inception until March 2021, focusing on physical interventions. Double screening and data extraction were employed in order to increase the reliability of the results. Results Our review found four studies which focused on physical interventions aimed at improving physical outcomes for people with more advanced dementia. The majority of studies were excluded as their interventions were not specific to people with advanced dementia. The studies that were included incorporated functional activities and, despite small sample sizes, suggested statistically significant improvements in outcomes for people with advanced dementia. Conclusion There is currently limited evidence relating to physical rehabilitation interventions for people with more advanced dementia, however, the evidence we presented suggests potential benefits for physical outcomes. Future research should focus on robust research to determine the most effective and cost-effective interventions that meet the needs of this population.

The Influence of MOQI APRNs on the COVID-19 Response in Nursing Homes

During the COVID-19 pandemic Missouri Quality Initiative APRNs worked in 16 nursing homes (NHs) providing clinical expertise and support. To understand their influence on the NH COVID-19 response, we conducted four group interviews with APRNs from 13 of the 16 NHs. Using thematic analysis, we identified similarities and differences between NH groups and then compared groups by COVID-19 infection rates. Leaders from NHs with high COVID-19 rates were unwilling to report infections and were resistant to resident/staff testing. In contrast, leaders from NHs with low COVID-19 rates were strategic about acquiring supplies, held daily huddles, and initiated CDC recommendations almost immediately. All reported residents lost weight, and experienced mood and physical decline resulting from quarantine/isolation. APRNs worked with providers to identify potentially ill residents/staff, improve isolation/quarantine procedures, manage ill residents, and supported efforts to mitigate viral spread. We will discuss implications for broader infection prevention in NHs.

Longitudinal Relations Between Views on Aging and Perceived Stress: Evidence for Mutual Associations

We investigated the reciprocal longitudinal relation between perceived stress and three established domains of views on aging (VoA): (1) subjective age; (2) attitude toward own aging [ATOA]; and (3) aging-related cognitions including social loss, physical decline, and continuous growth. We also examined the potentially moderating role of chronological age. Data of the German Ageing Survey, comprising two measurement occasions (2014 and 2017) and a sample of 4,588 individuals aged between 40 and 95 years, were analyzed. Controlling for socio-demographic and health-related indicators, cross-lagged models indicated mutual longitudinal relations between VoA and stress. Whether the pathway from stress to VoA or the opposite pathway was stronger varied depending on the VoA considered. With increasing age, most VoA domains were less strongly associated with subsequent perceived stress. Our findings suggest that less favorable VoA predict higher perceived subsequent stress, but they are also preceded and predicted by higher levels of perceived stress.

Age-Related Neuroprotection by Dietary Restriction Requires OXR1-Mediated Retromer Function

Dietary restriction (DR) is the most robust method to delay aging and the onset of neurogenerative disorders across multiple species, though the mechanisms behind this phenomenon remain unknown. To elucidate how DR mediates lifespan extension, we analyzed natural genetic variants that associate with increased longevity under DR conditions in the Drosophila Genetic Reference Panel. We found that neuronal expression of the fly homolog of human Oxidation Resistance 1 (OXR1) is necessary for DR-mediated lifespan extension. Neuronal knockdown of OXR1 also accelerated visual decline but not physical decline, arguing for a specific role of OXR1 in neuronal signaling. Further, we find that overexpression of the TLDc domain from human OXR1 is sufficient for lifespan extension in a diet-dependent manner. Studies from the Accelerating Medicines Partnership - Alzheimer's Disease network show that patients with reduced OXR1 protein levels are more prone to Alzheimer's disease diagnosis, and we find that overexpression of human OXR1 is protective in animal and cell Alzheimer's models. In seeking the mechanism by which OXR1 protects against age-related neuronal decline, we discovered that it provides a necessary function in regulating the neuronal retromer complex, which is essential for the recycling of transmembrane receptors and for maintenance of autophagy. We further discovered that OXR1 deficiency can be rescued by genetic or pharmacological enhancement of retromer function, and that this enhancement extends lifespan and healthspan. Understanding how OXR1 operates could help uncover novel mechanisms to slow neurodegeneration including Alzheimer's disease.

Physical Activity and Aging: Exploring Motivations of Masters Swimmers

Physical activity has many benefits for the optimal health of older adults (e.g., lowering risk of cardiovascular disease, depression, dementia and falls). However, less than one in four Americans meets guidelines for physical activity and evidence suggests inactivity increases with age. A growing number of unhealthy older adults will strain resources. Masters athletes are one segment of the population that some promote as exemplary because of their remarkable physical functioning. Swimming is a global, fast-growing sport in Masters athletics. This qualitative study explored the motivations and barriers of older adult (60+ years of age) members of a Masters swim club in Southern California. The researcher used purposive sampling to diversify the sample by selecting male and female participants (N=18) from multiple geographical areas. Guided by a primary research question: Why do Masters swimmers choose swim late in life, when most of their age cohort are becoming less physically active, the researcher conducted semi-structured interviews to delve into the lived experiences of the participants, solicited peer feedback and employed Interpretive Phenomenological Analysis. Four main themes emerged: Masters swimming provided an enjoyable way to slow physical decline; participants felt camaraderie; working out with a group provided challenge and achievement that reinforced their identity as swimmers; and their practice greatly reduced stress. A formidable barrier was revealed when most of the participants expressed longing and regret that they could not swim due to COVID risk and safety guidelines. These findings can be used to design community programs to promote lifelong physical activity participation.

A Randomized Placebo-Controlled Trial of Metformin for Frailty Prevention in Older Adults

Frailty is a progressive physical decline leading to higher morbidity and mortality in older adults. Previous studies have demonstrated shared mechanisms between insulin resistance, inflammation, and frailty. The purpose of this trial is to determine whether metformin prevents frailty in non-frail, community-dwelling older adults (≥65 years) with pre-diabetes, determined by 2-hour oral glucose tolerance test (OGTT). Frail individuals (Fried criteria) and those with renal impairment (glomerular filtration rate <45 mL/min) are excluded. Eligible participants are randomized to metformin or placebo and followed for two years. The primary outcome is frailty; secondary outcomes include physical function (short physical performance battery), systemic and skeletal muscle inflammation (plasma and muscle inflammatory markers), muscle insulin signaling (muscle biopsy), insulin sensitivity (insulin clamp), glucose tolerance (OGTT), and body composition (dual-energy x-ray absorptiometry) measurements. Participants are followed every 3 months for safety assessments, every 6 months for frailty assessment and OGTT, and every 12 months for muscle biopsy. Currently, 99 participants, including 53 (53.5%) male and 91 (91.9%) white, are active (54) or have completed the study (35). At baseline, mean age was 72.3 ± 5.5 years, body mass index was 30.7 ± 5.9 kg/m2, and Hemoglobin A1c was 5.73 ± 0.37%. Mean frailty score was 0.5 ± 0.6 and the proportion of non-frail and pre-frail participants were 58.6% (n = 58) and 41.5% (n = 41), respectively. Findings of this clinical trial may have future implications for the use of metformin in older adults with pre-diabetes in order to prevent the onset of frailty.

The challenges of Malay Kampung infrastructure as an Old Semarang cultural heritage area

The Malay Kampung is one of four areas of Old Semarang, which are expected to become a good heritage area. However, this area has suffered a lot of damage to the physical environment with limited infrastructure conditions. Therefore, this paper aims to explain the infrastructure challenges of Malay Kampung as a cultural heritage area. The research method used is qualitative with field observations and secondary data collection. Interviews were conducted to clarify field data and the condition of the remaining historical buildings. Based on the field results, we obtained secondary data for planning infrastructure improvements in Dadapsari Village, where Malay Kampung is included in the administration of this village. The study results show that there is still a physical decline in settlement and the environment, tidal flooding, damage to roads and drainage, the presence of inhabitable houses, and the lack of open space. The physical decline has also occurred in several old buildings that have a long history in this area which still receive less attention in this development. The Old Semarang area’s rejuvenation through infrastructure development must still be considered a cultural heritage area. Especially the redevelopment on the rehabilitation of declining cultural heritage buildings.

Associations Between Corpus Callosum Damage, Clinical Disability, and Surface-Based Homologous Inter-Hemispheric Connectivity in Multiple Sclerosis

Axonal damage in the corpus callosum is prevalent in multiple sclerosis (MS). Although callosal damage is associated with disrupted functional connectivity between hemispheres, it is unclear how this relates to cognitive and physical disability. We investigated this phenomenon using advanced measures of microstructural integrity in the corpus callosum and surface-based Homologous Inter-hemispheric Connectivity (sHIC) in the cortex. We found that sHIC was significantly decreased in primary motor, somatosensory, visual, and temporal cortical areas in a group of 36 participants with MS (29 relapsing-remitting, 4 secondary progressive MS, and 3 primary progressive MS) compared with 42 healthy controls (cluster level, p < 0.05). In participants with MS, global sHIC correlated with fractional anisotropy and restricted volume fraction in the posterior segment of the corpus callosum (r = 0.433, p = 0.013; r = 0.325, p = 0.021). Lower sHIC, particularly in somatomotor and posterior cortical areas, was associated with cognitive impairment and higher disability scores on the Expanded Disability Status Scale (EDSS). We demonstrated that higher levels of sHIC attenuated the effects of posterior callosal damage on physical disability and cognitive dysfunction, as measured by the EDSS and Brief Visuospatial Memory Test-Revised (interaction effect, p < 0.05). We also observed a positive association between global sHIC and years of education (r = 0.368, p = 0.018), supporting the phenomenon of “brain reserve” in MS. Our data suggests that preserved sHIC helps prevent cognitive and physical decline in MS.