Role Models of Aging among Older Men: Strategies for Facilitating Change and Implications for Health Promotion.

Understanding later-life role model choice and motivations, particularly for older men in sport, exercise, and health contexts, is complex and heterogenous, making it difficult for health and exercise promotion initiatives. This qualitative study examined: (1) whether older men have aging role models, and if so, their characteristics; and (2) older men's reasons for role model choice, or lack thereof, and how role models can influence meaningful change in perceptions and practices associated with aging, sport, exercise, and health. Through in-depth interviews and photo-elicitation with 19 Canadian men aged 75 years and over, thematic analysis determined two key themes: Role model choice, and Processes of role models facilitating change. Four key strategies for role models facilitating change in older men were determined: elite (biomedical) transcendence; valued exemplary endeavours; alliance connections; and disconnect and caveats. Ultimately, while promoting the biomedical achievements of role models may resonate with many older men, when applied too closely in sport or exercise contexts (e.g., using Masters athletes as role models), there is potential for unrealistic standards and overmedicalization that could miss uncovering the latent importance that older men place on the diverse experiences and perspectives of aging that go beyond traditional masculine ideals.

Getting the best GRIP on blood pressure control: Investigating a cost-effective isometric handgrip alternative.

OBJECTIVES: The World Health Organization emphasises the need for cost-effective alternative methods to lower blood pressure (BP). Endorsed nationally in HTN guidelines, isometric handgrip (IHG) training is an alternative method of BP control. The purpose of this study was to compare the BP, heart rate (HR) and rates of perceived exertion (RPE) responses between a bout of IHG training performed using the traditional computerized device and a more affordable, inflatable stress ball. METHODS: Twenty healthy adults performed one bout (4, 2-min isometric contractions, with 1-min rests between each contraction at 30% maximal voluntary contraction) of IHG training using the traditional computerized device, and one bout with the inflatable stress ball. BP, HR, and RPE were recorded. RESULTS: No statistically significant differences between devices were observed with HR, BP, and RPE (p < 0.05). However, average RPE for both devices ranged between 5 and 6 indicating that participants were rating 30% of their MVC, consistent with previous work. DISCUSSION: The similar cardiovascular and psychophysical responses provide support for the potential use of this low individual- and provider-burden, cost-efficient IHG device, and lay the foundation for a future training study to test the hypothesis of benefit.

Seven A's of Active Aging: Older Men's Suggestions for Physical Activity Programs.

In an attempt to offset the widespread anticipated impact of aging populations, active aging programs have become nearly ubiquitous in Western society. Nonetheless, older adults tend to remain relatively inactive. The perspectives of older adults constitute a key resource to help guide active aging efforts. Moreover, gender-sensitized and ecological approaches to physical activity programming may contribute markedly to the efficacy and inclusiveness of such initiatives. Considering the paucity of research regarding older men's suggestions for physical activity programs, this study involved semistructured interviews to ascertain the perceptions among 19 older men (aged 75-90 years). Through a thematic analysis, seven key attributes emerged that participants believed physical activity programs should possess: affordable, available, accessible, adapted, alternative, accompanied, and awareness. The complexities and implications pertaining to these attributes are discussed in the context of ecological theory and ideals of masculinity.

Factors Influencing Outcomes of Older Adults After Undergoing Rehabilitation for Hip Fracture.

OBJECTIVES: To determine the contribution of cognitive impairment, prefracture functional impairment, and treatment as predictors of functional status and mobility 6 months after discharge from rehabilitation for older adults with hip fracture. DESIGN: Longitudinal. SETTING: Inpatient rehabilitation units of two community hospitals. PARTICIPANTS: Adults with hip fractures aged 65 and older who were discharged from a rehabilitation unit and had been living in the community before the fracture (N = 133). MEASUREMENTS: Mini-Mental State Examination (MMSE) score at discharge from rehabilitation was used to identify the presence and severity of cognitive impairment. Outcomes were measured using questions from two subscales of the Functional Independence Measure (Self-Care Function and Functional Mobility) and the New Mobility Scale (NMS). Measurements were made at discharge from a rehabilitation setting and 3 and 6 months after discharge. RESULTS: Prefracture functional impairment was associated with worse outcomes throughout the 6 months after discharge and with lower rates of improvement, or in some cases decline, after discharge. Cognitive impairment was associated with worse outcomes throughout the 6 months after discharge but was only weakly associated with lower rates of improvement or decline. The Patient Centered Rehabilitation Model of care targeting persons with cognitive impairment (PCRM-CI) intervention group had higher NMS scores after discharge than a usual care group. CONCLUSION: Although cognitive impairment and prefracture functional impairment contribute to poor outcomes, prefracture functional impairment was more strongly associated with poor outcomes than cognitive impairment. There is evidence to show that individuals with cognitive impairment are able to regain their mobility, which suggests a need for postdischarge targeted interventions that include a focus on activities of daily living for older adults with cognitive impairment and functional impairment to stabilize gains from inpatient rehabilitation.

3D peak and cumulative low back and shoulder loads and postures during greenhouse pepper harvesting using a video-based approach.

BACKGROUND: In agricultural field work many tasks have been cited as high priority risk factors for the development of work-related musculoskeletal disorders (WRMDs). Although video-based biomechanical approaches have been effective in documenting the physical demands and risks associated with various occupational and non-occupational tasks, to date, this method has yet to be used to document jobs such as crop harvesting in a greenhouse environment. OBJECTIVE: To document and assess the postural characteristics and 3D peak and cumulative low back and shoulder loads associated with greenhouse pepper harvesting using a video-based posture sampling approach. METHODS: Nine male (28.2 (4.1) years) pepper harvesters from a greenhouse in Southwestern Ontario, Canada were videotaped during a normal shift. 3DMatch was used to document working trunk and shoulder postures, from which 3D peak and cumulative forces and moments were quantified. RESULTS: On average, workers spent the majority of their time in neutral trunk postures (lateral bend: 99.1%; axial twist: 59.9%; flexion: 89.8%). Consistent results were found for the left and right shoulder, with the arms held in a neutral flexion posture 50% of the time or more. Four participants experienced peak L4/L5 compression forces (between 4116.3 N and 5937.0 N) which exceeded the NIOSH Action Limit (3400 N) during the cart pushing/pulling task, but remained below the threshold during picking. Mean cumulative L4/L5 extension and shoulder flexion moments ranged in magnitude from 18.5 Nm to 28.2 Nm, and between 19.4 Nm and 23.2 Nm, respectively, across all tasks. CONCLUSIONS: The postural characteristics and biomechanical loads associated with greenhouse pepper harvesting were quantified with a video-based biomechanical approach. Further investigations of the physical risk factors for low back and shoulder musculoskeletal disorders is warranted in pepper harvesting, given the postures and loads documented in this study.

Community-Based Hip Fracture Rehabilitation Interventions for Older Adults With Cognitive Impairment: A Systematic Review.

BACKGROUND: A hip fracture in older adulthood can result in function and mobility decline. The consequences are debilitating and place a great burden on patients, caregivers, and the health care system. Although inpatient rehabilitation programs have proven effective, the best practices for community-based rehabilitation required to maintain the gains in function and mobility post hospital discharge are currently unknown. OBJECTIVE: The aim of this systematic review is to identify and evaluate the evidence on the effectiveness of community-based rehabilitation post hospital discharge interventions for older adults with cognitive impairment (CI) following a hip fracture, and to identify the physical recovery outcomes and measures used in previous studies. METHODS: The methods outlined in the Cochrane Handbook for Systematic Reviews of Intervention were followed and findings were reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The search strategy included a combination of text words and subject headings relating to the concepts of CI, dementia, delirium, cognitive reserve, and hip fractures. For a study to be included in the review, it had to involve participants with CI who underwent hip fracture surgery, and consisted of an outpatient intervention that occurred in the participant's home or community. Peer-reviewed journal articles were identified by searching various databases. Two independent reviewers screened the titles and abstracts to determine which articles comprising of a rehabilitation intervention within a community setting prior to being included for a full article review. A data extraction form and an evidence and quality checklist were used during the full article data analysis and synthesis. A meta-analysis was not conducted due to heterogeneity of measures and outcomes. RESULTS: The original search resulted in over 3000 articles. Of those, three studies satisfied the necessary criteria to be included in the systematic review. All studies included inpatient and outpatient physiotherapy, with some including a cognitive component, family education, and a discharge assessment. CONCLUSIONS: The findings from this review suggest that community-based rehabilitation post hospital discharge interventions show promising results towards improving various physical function outcomes, mobility, and activities of daily living for older adults with CI following a hip fracture. This review also demonstrates and discusses the current lack of outpatient rehabilitation interventions targeted towards older adults with CI post-hip fracture. Additionally, several substantive gaps that require attention to move this field forward are highlighted.

Manual patient transfers used most often by student and staff nurses are consistent with their perceptions of transfer training, and performance confidence.

BACKGROUND: A disconnect in manual patient transfer (MPT) training practices for nurses, between what is taught and used in academic and clinical settings, could have implications for injury. OBJECTIVE: This study aimed to determine: 1. what MPTs student and staff nurses use in clinical settings, and 2. if the MPTs used most often were also the ones they perceived that they received training for and had the most confidence performing. METHODS: Survey responses from student nurses (n=163) (mid-sized university) and staff nurses (n=33) (local hospital) regarding 19 MPTs were analyzed to determine which transfers were perceived to be used most often, and which ones they had received training for and had the greatest confidence performing. RESULTS: The MPTs nurses perceived using most often were the same transfers they had the greatest confidence performing and for which they perceived receiving training. However, these MPTs were not taught at the university at the time of this investigation. CONCLUSION: Reducing the disconnect between manual patient transfer training obtained in the academic and clinical environments will hopefully reduce the risk of injury for nurses and improve the quality of care for patients.

Community-based rehabilitation post hospital discharge interventions for older adults with cognitive impairment following a hip fracture: a systematic review protocol.

BACKGROUND: Hip fractures among older adults remain a public concern. Consequences of a hip fracture include the subsequent decline in function and mobility for the older adult, and an increased burden placed upon their caregivers and the health care system. The consequences may be more challenging if an older adult also has a compromised cognitive reserve. Although rehabilitation programs have proven effective, the best practices and resources required to maintain the gains in function and mobility, to negate diminution of effect, and to enable this patient population to continue living at home are currently unknown. OBJECTIVE: The objective of this study is to develop a systematic review protocol focused on identifying the evidence and evaluating the effectiveness of post discharge rehabilitation programs for older adults with a cognitive impairment following a hip fracture. METHODS: The search strategy will include a combination of text words and subject headings relating to the concepts of cognitive impairment, dementia, delirium, cognitive reserve, and hip fractures. Searching various databases will identify peer-reviewed journal articles. There will be two independent reviewers who will screen the titles and abstracts to determine which articles comprise a rehabilitation intervention within a community setting prior to being included for a full article review. A data extraction form and an evidence and quality checklist will be used during the full article data analysis and synthesis. It is expected that there will be a paucity of studies that focus on post discharge rehabilitation interventions for older adults with cognitive impairment following a hip fracture, and few studies that use the same or similar outcome measures. However, if possible, a meta-analysis will be conducted on studies that used similar outcome methods. RESULTS: This review will synthesize knowledge focusing on activities to maintain and restore function in older adult patients with cognitive impairment once they have completed their active rehabilitation program and return home. A synthesis of the findings will be conducted to determine which components of the interventions identified were the most advantageous to the patient population. The results will be used to develop a multi-faceted post discharge rehabilitation intervention aimed at enabling older adults to return and remain living at home after a hip fracture. CONCLUSIONS: The aim of this systematic review is to generate results that can be used to create interventions that focus on the care necessary to enable older adults to remain living at home post discharge from acute or inpatient rehabilitation care for a hip fracture. With the support and contributions by our associated knowledge users, this systematic review will be used to help inform procedures and policies to facilitate the necessary care and resources required by our patient population.

Analyzing what nurses do during work in a hospital setting: a feasibility study using video.

OBJECTIVE: Patient transfers have been implicated as a contributing factor in the high work-related musculoskeletal disorder (MSD) rate in nursing. However, documenting how much time is spent doing such tasks, compared to other less biomechanically stressful tasks in the workplace, has been limited, and not performed to date using a video-based approach. Therefore, the purpose of this study was to determine the feasibility of documenting all job-related nursing tasks performed during a typical shift in a hospital setting using video. PARTICIPANTS: Ten female nurses from an acute care hospital who worked in different units and during all three shifts. METHODS: Nurses working in different units of the hospital were videotaped performing their normal job-related tasks for a 2 hour period. Video records were subsequently analyzed to identify and categorize all tasks performed by each nurse. RESULTS: Overall, nurses spent less than 7% of their time during patient moving and transfer activities. One third of their time was spent walking, standing and sitting, 19.8% charting, 14.7% in patient care, 13.9% preparing medicines, 9.5% in housekeeping, and about 3% in self-care. CONCLUSIONS: This study showed that video-based methods are feasible for documenting what nurses do in the workplace. It also highlighted the diversity and non-repetitive nature of the workplace tasks nurses perform and suggests that ergonomic assessments of the cumulative effects of work on nurses in the field should focus on more than just patient handling activities.

The influence of training on decision times and errors associated with classifying trunk postures using video-based posture assessment methods.

The purpose of this study was to examine the influence of training on the decision times and errors associated with video-based trunk posture classifications. Altogether, 30 amateur and 30 knowledge-based participants completed a three-phase study (pre-training, training, post-training) that required them to classify static trunk postures in images on a computer screen into a posture category that represented the angle of the trunk depicted. Trunk postures were presented in both flexion/extension and lateral bend views and at several distances from the boundaries of the posture categories. Both decision time and errors decreased as distance from the boundaries increased. On average, amateur analysts experienced a larger decrease in decision time per posture classification than knowledge-based analysts (amateur: 0.79 s, knowledge-based: 0.60 s; p <0.05) suggesting that training can have beneficial effects on classification performance. The implications are that the analysis time associated with video-based posture assessment methods can be reduced with appropriate training, making this type of approach feasible for larger-scale field studies. Statement of Relevance:Understanding the role that training can play in reducing errors associated with the use of video-based posture assessment methods may result in more efficient use of these tools by ergonomic practitioners. Reducing decision time and misclassification errors will provide a more efficient, accurate and representative assessment of injury risk.

Nurse perceptions of manual patient transfer training: implications for injury.

OBJECTIVE: The purpose of this study was to evaluate the perceptions of student and staff nurses regarding training they received and their confidence in performing a variety of common manual patient transfers (MPTs), given that inadequate training may have implications for injury risk. PARTICIPANTS: Student nurses (n=163) from a mid-sized university and staff nurses (n=33) from a small rural hospital in the university's region. METHODS: Participants were surveyed to determine which of 19 MPTs they perceived having received training for and had greatest confidence performing. RESULTS: The staff nurses perceived being trained on four MPTs; the same four they indicated they had the greatest confidence performing. However, nursing students were not trained on these MPTs at the local university, indicating an apparent disconnect in training practices between the academic institution and the workplace. CONCLUSIONS: It is suggested that a participatory ergonomics training approach may help to provide student nurses more opportunity to practice MPTs and help all nurses reduce work-related musculoskeletal injury risk and increase job satisfaction. Increased training time may also allow student nurses to gain greater mastery and confidence of skills prior to full-time employment.

Determining the optimal size for posture categories used in video-based posture assessment methods.

Currently, there are no standards for the development of posture classification systems used in observation-based ergonomic posture assessment methods. This study was conducted to determine if an optimal posture category size for different body segments and posture views could be established by examining the trade-off between magnitude of error and the number of posture category misclassification errors made. Three groups (trunk flexion/extension and lateral bend; shoulder flexion/extension and adduction/abduction; elbow flexion/extension) of 30 participants each selected postures they perceived to correctly represent the video image shown on a computer screen. For each view, 10 images were presented for five different posture category sizes, three times each. The optimal posture category sizes established were 30 degrees for trunk, shoulder and elbow flexion/extension, 30 degrees for shoulder adduction/abduction and 15 degrees for trunk lateral bend, suggesting that posture category size should be based on the body segment and view of the image being assessed. Across all conditions, the posture category sizes were comparable to those used in published ergonomic tools.