[Treatment of dementia patients in a geriatric day clinic : Improvement of behavioral abnormalities and distress of caring relatives]. / Therapie mit Demenzkranken in einer geriatrischen Tagesklinik : Verbesserung von Verhaltensauffälligkeiten und Belastungserleben der Angehörigen.

BACKGROUND AND OBJECTIVE: The aim of the study was to evaluate a specific treatment concept for patients suffering from dementia in a geriatric day clinic with respect to improvement of dementia-related behavioral abnormalities and effects on distress of the caring relatives. MATERIAL AND METHODS: Designed as a naturalistic study with a sample of 34 dementia patients (average age 83 years, 62% female, 82% mild dementia, 18% moderate dementia) surveyed at three time points, the dementia-related behavioral symptoms and the relatives' distress were measured using the neuropsychiatric inventory. A waiting time before treatment was implemented as a control condition. RESULTS: Compared with waiting time, a significant improvement of dementia-related behavioral abnormalities was found after treatment, especially in patients suffering from moderate dementia. The distress of caring relatives was clearly reduced. CONCLUSION: The interprofessional treatment of patients with dementia using a specific program in a geriatric day clinic leads to a clear improvement in behavioral symptoms and positively influences the distress of caring relatives.

Instrumented gait analysis: a measure of gait improvement by a wheeled walker in hospitalized geriatric patients.

BACKGROUND: In an increasing aging society, reduced mobility is one of the most important factors limiting activities of daily living and overall quality of life. The ability to walk independently contributes to the mobility, but is increasingly restricted by numerous diseases that impair gait and balance. The aim of this cross-sectional observation study was to examine whether spatio-temporal gait parameters derived from mobile instrumented gait analysis can be used to measure the gait stabilizing effects of a wheeled walker (WW) and whether these gait parameters may serve as surrogate marker in hospitalized patients with multifactorial gait and balance impairment. METHODS: One hundred six patients (ages 68-95) wearing inertial sensor equipped shoes passed an instrumented walkway with and without gait support from a WW. The walkway assessed the risk of falling associated gait parameters velocity, swing time, stride length, stride time- and double support time variability. Inertial sensor-equipped shoes measured heel strike and toe off angles, and foot clearance. RESULTS: The use of a WW improved the risk of spatio-temporal parameters velocity, swing time, stride length and the sagittal plane associated parameters heel strike and toe off angles in all patients. First-time users (FTUs) showed similar gait parameter improvement patterns as frequent WW users (FUs). However, FUs with higher levels of gait impairment improved more in velocity, stride length and toe off angle compared to the FTUs. CONCLUSION: The impact of a WW can be quantified objectively by instrumented gait assessment. Thus, objective gait parameters may serve as surrogate markers for the use of walking aids in patients with gait and balance impairments.

[Subjective time left in life and precautionary relocation planning in the last half of life]. / Subjektive Restlebenszeit und vorsorgende Umzugsplanung in der zweiten Lebenshälfte.

BACKGROUND: Many people wish to remain in current residence for as long as possible. Nonetheless, they do think about their residential future. For older people the question of where to live must be considered with respect to age-related changes and continuity. So far only little research has been focused on the influence of the subjective perception of remaining lifetime until death on plans for the future, for example regarding relocation. OBJECTIVE: This study investigated the influence of the subjective perception of time left to live on relocation planning and its timing in the further course of life. MATERIAL AND METHODS: The data were obtained from a paper-pencil questionnaire including 2156 persons aged 50 years and older (average age 65.5 years, SD = 9.7 years, range 50-94 years, 51.1 % female) who were asked about their wishes and plans for the future, particularly about their relocation considerations and the subjective perception of remaining time until death. RESULTS: Approximately 39 % of the subjects considered relocation in the further course of life. Besides social demographics, current housing and the state of health, the subjective time left in life had a significant influence on the consideration of relocation and its timing in the further course of life. Persons who perceived their time horizon as limited considered relocation later in life (temporizing relocation planning) than persons who perceived themselves to have more time left in life. Their temporal occurrence of precautionary relocation planning is embedded earlier in the course of life. CONCLUSION: Thoughts about the residential future of older people should be considered not only in connection with the content of these wishes but also related to the future time perspective and the timing in the further course of life. This can be of assistance in consultation and decision-making situations.

Reliability analysis of time series force plate data of community dwelling older adults.

Frequency-based analysis of body sway has been used to distinguish between healthy young, healthy elderly adults and elderly adults with Huntingtons disease. Our aim was to assess the reliability of spectral-based outcomes of the centre of pressure (CoP) kinematics in order to determine if these outcomes could be tested for their capability to distinguish between elderly fallers and non-fallers in a future study. We have studied balance for 30 community dwelling healthy older adults 60 years or older. Four test conditions were used. Three successive trials were performed for each condition. CoP kinematics were estimated with a force platform with three strain gauges set in a triangular position. The frequency content of these signals was estimated. Intrasession correlation coefficients (ICC's) were then calculated for all test conditions. The reliability of the selected parameters varied between low and high (ICC 0.652-0.939). The ICC's for the narrow stance tests were higher compared to tests with normal standing conditions (0.771-0.94) to (0.652-0.865). The highest value was obtained in the high frequency band (0.939). These measures should be viewed with caution when screening geriatric patients because their reliability cannot always be assumed.

Intrasession reliability of force platform parameters in community-dwelling older adults.

OBJECTIVE: To investigate the intrasession reliability of center of pressure (COP) parameters calculated from force platform measurements. DESIGN: A cross-sectional study. SETTING: Gait and balance laboratory. PARTICIPANTS: Community-dwelling healthy older adults (N=63) above the age of 62 years (mean age, 78.74 y). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: COP was estimated from a force platform, and the following parameters were calculated: (1) the total length of the COP displacement, (2) area of sway, (3) length of the COP displacement in the sagittal plane, and (4) length of the COP displacement in the frontal plane. Intraclass correlation coefficients (ICCs) were calculated by using 3 successive trials with 4 different test conditions. The test conditions were (1) normative standing with eyes open, (2) normative standing with eyes closed, (3) narrow stance with eyes open, and (4) narrow stance with eyes closed. RESULTS: The ICCs for the tests with eyes closed (.710-.946) were higher than those for tests with eyes open (.841-.945). The highest value was obtained for the vector sum of the COP during anteroposterior movement in narrow stance with eyes closed (.946). The value .710 was the lowest of all parameters and was an outlier for the narrow stance with eyes closed test, which was otherwise very reliable. CONCLUSIONS: Eight of 16 calculated ICCs showed excellent reliability (>.90). They can be recommended for further use in clinical trials. Tests with closed eyes were more reliable than tests with eyes open. We recommend using eyes closed test conditions when assessing static balance control. For these tests, all the calculated ICCs were over .90, except for measurements of sway area.

Autovaloración de calidad de vida / Self-assessment of quality

Objetivo: describir la autovaloración de calidad de viday del envejecimiento de tres grupos: adultos portadoresy no portadores de la mutación E280A en el gen de laPresenilina 1 para Enfermedad de Alzheimer FamiliarPrecoz, y adultos mayores, en Antioquia-Colombia,estudio realizado entre enero de 2005 y junio de 2007.Metodología: estudio descriptivo transversal dondeparticiparon 162 personas asintomáticas en riesgo dedesarrollar Enfermedad de Alzheimer como consecuenciagenética o del proceso de envejecimiento, quienesse subdividieron en tres grupos: 27 portadores, 39 noportadores y 96 adultos mayores. Investigación realizadaen el Grupo de Neurociencias de la Universidadde Antioquia (Medellín) y en el Centro GerontológicoAtardecer (Envigado). Se analizaron las característicassociodemográficas, y se aplicaron pruebas para laautovaloración de la calidad de vida global del envejecimiento:World Health Organization Quality of Life y laNürnberg -Self-Evaluation-List respectivamente. Análisisestadístico: Se describieron los grupos y se compararonfrente a las variables de estudio utilizando el análisis devarianza no paramétrico de Kruskall Wallis y la prueba Ude Mann-Whitney. Resultados: las calificaciones mediasde los instrumentos para la autovaloración de calidad devida y global del envejecimiento en los tres grupos departicipantes, fueron superiores a 50 puntos e inferioresa 55 puntos respectivamente. Conclusiones: los adultosmayores se autovaloran con menor calidad de vidaque los portadores y los no portadores, especialmenteen el área de salud física, al igual que en la percepcióndel envejecimiento, a pesar de las condiciones de losportadores, aunque, en general, todos los grupos laspuntuaron bien.

Differential effects of single versus combined cognitive and physical training with older adults: the SimA study in a 5-year perspective.

The present study evaluates the effect of cognitive training, of psychoeducational training and of physical training on cognitive functioning, physical functioning, physical health, independent living and well-being in older people. Also the combination of physical training with cognitive training or psychoeducational training, respectively, was evaluated. In contrast to most training studies with older people, training effects were evaluated in a longitudinal perspective over 5 years to analyse long-term-results of cognitive and physical activity on older adults. Training effects were evaluated compared to a no-treatment-control group. Subjects were 375 community residents aged 75-93 years. Up to 5 years after baseline examination, significant training effects were observed in the group exposed to the combined cognitive and physical training. The physical and cognitive status in the participants of this group could be preserved on a higher level compared to baseline, and the participants displayed fewer depressive symptoms than the no-treatment-control group. The results are discussed in the light of recent research regarding the effects of mental and physical activity on brain function in older adults.