Physical Activity and Activities of Daily Living in Older Adult Patients With Heart Failure Admitted for Subacute Musculoskeletal Disease

Objective@#To examine activities of daily living (ADL) and physical activity in older adults with heart failure admitted to a rehabilitation ward for subacute musculoskeletal disease. @*Methods@#This study included patients with musculoskeletal disease (aged ≥75 years) who were admitted to the rehabilitation ward. Data on age, ADL, and time for physical activity (metabolic equivalents [METs]) were collected. Patients were divided into groups with or without heart failure, and the differences were compared using Mann–Whitney U-test. @*Results@#This study included 84 musculoskeletal patients, including 25 with heart failure. The heart-failure group had similar levels of ADL independence compared to the without-heart-failure group (p=0.28) but had shorter duration of continuous and sustained physical activities and less total time (p<0.01) of light-intensity physical activity or higher. @*Conclusion@#Older adults with subacute musculoskeletal disease with heart failure do not necessarily require a large amount of physical activity to maintain ADL at the time of discharge. But very low physical activity may increase the risk for developing hospitalization-associated disability. Physical activity in older adults with subacute musculoskeletal disease with heart failure should be monitored separately from ADL.

The effects of off–campus classes for students in a school of health sciences / 医学教育

In Japan, community–based education remains uncommon in undergraduate programs for students in schools of health sciences. The purpose of this study was to examine how students are affected by their participation in off–campus classes, which are considered as a main course of community–based education at the School of Health Sciences, Gunma University.<br>1)Reports submitted by students after participating in off–campus classes were broken down into sentences (with care being taken that each sentence made sense). The extracted sentences were carefully consolidated by means of the Kawakita Jiro method (affinity diagram).<br>2)A total of 972 sentences were extracted and were categorized into 3 categories: "enjoy going out to the community," "increased activity through experiences," "awareness of what one wants to be and one's insufficient abilities." Five middle–sized categories and 10 small categories were obtained.<br>3)Experiences in off–campus classes are expected to increase the activity of students and to have synergic effects with on–campus classes.<br>4)Community–based education might be effectively included in undergraduate programs for students in schools of health sciences.

PHYSICAL FUNCTION SCREENING OF INSTITUTIONALIZED ELDERLY WOMEN TO PREDICT THEIR RISK OF FALLING / 体力科学

This study examined the relationship between multiple physical function and falls among institutionalized elderly women, and screening methods designed to effectively identify elderly with a high risk of falling. The subjects comprised 44 elderly women aged 82±6 years residing in a nursing home. Multiple physical assessments were tested using the following measures; muscle strength(quadriceps strength and grip strength), balance test(functional reach and one-legged stance test), flexibility test(sit and reach test), agility test(stepping test), and physical performance test(TUG and chair stand test). Based on the experience of fall-related accidents within the past two years, we categorized the subjects into two groups (non-fall group and fall group). Of these measures, quadriceps strength, grip strength, functional reach, stepping test in a standing position, and chair stand test were significant factors discriminating whether the subject had a history of falls. Logistic regression analysis demonstrated that quadriceps strength, functional reach, stepping test in a standing position, and chair stand test were important predictors of falls in an institutionalized elderly population. The results of this study suggest that 0.84 Nm/kg for quadriceps strength, 26 cm for functional reach, 17 steps for stepping test, and 14 sec for chair stand test, were useful indicators for screening institutionalized elderly for risk of falling. Particularly, the stepping test was most effective in screening the elderly to assess their fall risk.