Introdução: A expectativa de vida dos brasileiros cresce a cada ano; com isso, os idosos vivem mais, e fatores como, Hipertensão Arterial Sistêmica, Diabetes mellitus e o próprio processo de envelhecimento os tornam suscetíveis à doença renal crônica (DRC). Com a DRC, esses idosos têm maiores chances de desenvolverem a fragilidade e terem consequências desfavoráveis na Qualidade de Vida (QV). Objetivo geral: Analisar a relação entre as variáveis independentes (fragilidade, características sociodemográficas e clínicas) e a variável desfecho (QV) de idosos com DRC em tratamento conservador, hemodiálise (HD) e diálise peritoneal (DP). Material e método: Trata-se de uma pesquisa quantitativa, descritiva e transversal. Participaram idosos com 60 anos ou mais, com DRC em tratamento conservador, HD ou DP, que estavam, no mínimo, há seis meses em tratamento e em acompanhamento em um hospital público de Ribeirão Preto-SP. A coleta de dados ocorreu de outubro/14 a março/15, utilizando-se os seguintes instrumentos: de caracterização sociodemográfica, econômica e clínica adaptado; para avaliar a fragilidade, a Edmonton Frail Scale (EFS); para avaliar a QV, o WHOQOL-BREF e WHOQOL-OLD; para avaliar a cognição, o Mini-Exame do Estado Mental (MEEM). Foram realizadas análises estatísticas descritivas, teste de correlação de Spearman e análise de variância multivariada (MANOVA) para as variáveis de interesse. O nível de significância adotado foi de 5%. O projeto foi aprovado por um Comitê de Ética em Pesquisa com seres humanos com CAAE número 34923214.0.0000.5393; seguiu-se as recomendações da Resolução CNS 466/2012. Resultados: Participaram 77 idosos, sendo 35 em tratamento conservador, 14 em DP e 28 em HD. A maioria era homem (41; 53,2%) e tinha companheiro(a) (51; 66,2%). A média dos escores de fragilidade entre os tratamentos foi: tratamento conservador (7,71±3,10); DP (6,79±2,72) e HD (7,36±2,92). No WHOQOL-BREF, os domínios relações sociais e físico obtiveram maior e menor escores médios, respectivamente, (68,93±17,48) e (55,44±14,11). O WHOQOL-OLD apresentou a maior média na faceta Intimidade (68,67±16,45) e menor média na faceta Morte e morrer (37,66±22,76). Foram encontradas correlações inversas entre a idade e o escore do MEEM (p=0,001) e entre anos de estudo e fragilidade (p=0,016); por outro lado, houve correlações positivas entre os escores do MEEM e anos de estudo (p<0,001), entre número de complicações da DRC e fragilidade (p<0,001) e número de comorbidades e fragilidade (p<0,001). Em relação à QV, houve correlação positiva entre o escore global do WHOQOL-BREF e o escore da faceta global do WHOQOL-OLD, bem como correlação inversa entre os escores globais desses instrumentos com os escores de fragilidade (p<0,00; p=0,023). Na MANOVA, o tipo de tratamento e o número de complicações não influenciaram a QV, porém a fragilidade apresentou relação com o constructo, sendo que, para o aumento de um ponto na escala da fragilidade, a QV apresentou redução média de 1,38 no escore global do WHOQOL-BREF e 0,82 no escore global do WHOQOL-OLD, considerando pertencer ao mesmo tipo de tratamento. Conclusão: os pacientes com DRC apresentaram piores escores médios de QV mediante a maiores escores de fragilidade, independentemente do tipo de tratamento e considerando-se a mesma média de complicações / Introduction: The life expectancy of Brazilians grows every year; with this, the elderly live longer, and factors such as systemic hypertension, diabetes mellitus and aging process itself makes them susceptible to chronic kidney disease (CKD). With the CKD, these seniors are more likely to develop the frailty and have adverse effects on quality of life (QOL). General Objective: To analyze the relationship between the independent variables (frailty, sociodemographic and clinical characteristics) and the outcome variable (QOL) of elderly patients with CKD in conservative treatment, hemodialysis (HD) and peritoneal dialysis (PD). Methods: This is a quantitative, descriptive and cross-sectional survey. Participated elderly aged 60 or more with CKD in conservative treatment, HD or PD, who were at least six months in treatment and follow-up at a public hospital in Ribeirão Preto-SP. Data collection took place from October/14 to March/15, using the following instruments: of sociodemographic characterization, economic and clinical adapted; to evaluate the frailty of Edmonton Frail Scale (EFS); to evaluate QOL, the WHOQOL-BREF and WHOQOL-OLD; to evaluate cognition, the Mini-Mental State Examination (MMSE). Descriptive statistical analyzes, Spearman correlation test and multivariate analysis of variance (MANOVA) for the variables of interest were performed. The significance level adopted was 5%. The project was approved by the Research Ethics Committee with humans with CAAE number 34923214.0.0000.5393; the recommendations of Resolution CNS 466/2012 were followed. Results: 77 elderly participated, 35 in conservative treatment, 14 PD and 28 on HD. Most were male (41; 53.2%) and had a partner (51; 66.2%). The average of frailty scores between treatments was: conservative treatment (7.71 ± 3.10); PD (6.79 ± 2.72) and HD (7.36 ± 2.92). In the WHOQOL-BREF, social relations and physical domains obtained highest and lowest mean scores, respectively (68.93 ± 17.48) and (55.44 ± 14.11). The WHOQOL-OLD had the highest average in the intimacy facet (68.67 ± 16.45) and the lowest average in death and dying facet (37.66 ± 22.76). Inverse correlations were found between age and MMSE score (p = 0.001) and between years of study and frailty (p = 0.016); By contrast, there was positive correlation between the MMSE scores and years of education (p <0.001), between the CKD number of complications and fragility (p <0.001) and number of comorbidities and fragility (p <0.001). Regarding the QOL, there was a positive correlation between the total score of the WHOQOL-BREF and the score of the global facet of the WHOQOL-OLD, and inverse correlation between the global scores of these instruments with the frailty scores (p <0.00; p = 0.023). In MANOVA, the type of treatment and the number of complications did not influence QOL, but the frailty was correlated with the construct, and, for an increase of one point on the scale of frailty, QOL showed a mean reduction of 1.38 in overall score of WHOQOL-BREF and 0.82 in the global score of the WHOQOL-OLD, considering that they belong to the same type of treatment. Conclusion: Patients with CKD presented worse average scores of QOL by greater frailty scores, regardless of the type of treatment and considering the same average complications

El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado. / OBJECTIVE: To assess the relationship between physical performance (PP) and muscle strength (MS) in elderly subjects with and without diabetes in a public hospital of Lima, Peru. SUBJECTS AND METHOD: A cross-sectional analysis of subjects aged 60 years or older with and without diabetes. MS was measured with a handheld dynamometer, and PP with the «timed get-up-and-go» test. Nutritional status was determined using body mass index, body fat percentage measured with a handheld fat loss monitor and protein intake based on the 24-hour recall. Age, sex, and history of hospitalization and supplementation were also recorded. The association was assessed using adjusted prevalence ratios. RESULTS: Overall, 139 patients with diabetes (26.6% with low PP and 13.7% with decreased MS) and 382 subjects without diabetes (36.6% with low PP and 23.0% with decreased MS) were evaluated. No association was found between T2DM and MS (aPR: 0.99; 95% CI: 0.67-1.57) or PP (aPR: 1.13; 95% CI: 0.84-1.52). Protein and supplement consumption was also unrelated (P>.05); however, history of hospitalization, age, sex, nutritional status, and body fat percentage were related (P>.05). CONCLUSIONS: No association was found between T2DM, MS, and PP. However, low PP was associated to female sex and overweight/obesity, and decreased MS was associated to high body fat percentage and underweight. Moreover, MS and PP were related to older age and history of hospitalization. / Revisión por pares

Orientadores: Maria Elena Guariento, André Fattori / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-09-11T21:20:20Z (GMT). No. of bitstreams: 1 Moretto_MariaClara_M.pdf: 1783926 bytes, checksum: 2c067621bb35bbbfed02cdf9ebd7e96b (MD5) Previous issue date: 2012 / Resumo: Objetivos: Investigar associações entre estado nutricional, adiposidade abdominal e risco cardiovascular com fragilidade em idosos de 65 anos e mais, recrutados na comunidade. Métodos: Dados de 3.075 idosos de seis cidades brasileiras coletados do banco eletrônico do FIBRA (Estudo sobre Fragilidade em Idosos Brasileiros). As variáveis utilizadas foram: faixa etária, gênero, índice de massa corporal (IMC), circunferência de cintura (CC), relação cintura-quadril (RCQ), critérios de fragilidade (perda ponderal não intencional, fadiga, baixa força de preensão manual, lentidão da marcha e baixo gasto calórico em atividade física) e níveis de fragilidade, conforme o fenótipo biológico. Resultados: A amostra geral foi composta predominantemente por mulheres (67,35%) e a idade média foi de 72,84 ± 5,91 anos. As frequências de baixo peso e obesidade foram de 18,18% e 24,14%, respectivamente. A maioria apresentou risco cardiovascular moderado ou elevado, medido pela RCQ e pela CC (65,12% e 72,81% respectivamente). A fragilidade foi significativamente mais frequente (p < 0,001) a partir dos 75 anos e associou-se com o baixo peso (OR = 1,49; IC: 1,22-1,82) e com elevado risco cardiovascular, medido pela RCQ (OR = 1,25; IC: 1,05-1,49). A obesidade associou-se significativamente aos critérios de fragilidade em fadiga (p < 0,001) e lentidão da marcha (p = 0,032). Conclusão: A fragilidade apresentou relação com idades mais avançadas, desnutrição e elevada adiposidade abdominal. Destaca-se a importância da avaliação nutricional dos idosos, para a identificação de estados nutricionais inadequados, associados à elevada morbidade, incapacidade funcional e mortalidade / Abstract: Objective: To investigate association between nutritional status, abdominal adiposity and cardiovascular risk with frailty in community-dwelling elderly aged 65 years and over. Methods: Data from 3075 elderly were collected from the electronic database of FIBRA (Frailty of Brazilian Elderly Study). The variables used were: age, gender, body mass index (BMI), waist circumference (WC), waist-hip ratio (WHR), frailty criteria (unintentional weight loss, exhaustion, low grip strength, slowness and low energy expenditure) and frailty levels, according to the biological phenotype. Results: The overall sample was composed predominantly by women (67.35%) and the mean age was 72.84 ± 5.91 years. The percentages of underweight and obesity were respectively 18.18% and 24.14%. Most of the sample showed moderate or high cardiovascular risk, measured by WHR and WC (65.12% and 72.81%, respectively). Frailty increased significantly (p < 0.001) after 75 years and was associated with underweight (OR = 1.49; CI: 1.22-1.82) and with high cardiovascular risk, measured by WHR (OR = 1.25; CI: 1.05-1.49). Obesity was significantly associated with exhaustion (p < 0.001) and slowness (p = 0.032). Conclusion: Frailty was associated with advanced ages, malnutrition and abdominal fat. Nutritional assessment of elderly in clinical practice is recommended for the identification of nutritional status associated with morbidity, disability and mortality / Mestrado / Gerontologia / Mestra em Gerontologia

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No. of bitstreams: 1 Dissertação - Bianca Ladislau Abecassis.pdf: 2268449 bytes, checksum: 34d5216434f218ef401cf5a960610dcd (MD5) Previous issue date: 2011-10-13 / Outras / The growing population of elderly is a worldwide phenomenon, in which many are also older, due to advances in medical technology that enable man to live longer but not a guarantee of quality of life for everyone, because many older, having to struggle with poor with his family to survive. With the increase in life expectancy, older age, those over 80 years, begin to demand for care by performing basic activities of daily living, the incidence of chronic diseases, making them dependent. The family have been going through a remarkable transformation, from the inclusion of women in the labor market, among other factors, causing a reduction in their size, number of emerging models of family and specific demands. The majority of Brazilian families are responsible for the care of their elders, but without any guidance and training, few can still hire a professional caregiver support and formal care. From this perspective, as to the overall goal, we sought to analyze the working conditions of caregivers of frail elders in Manaus. The specific goals: identify who are the caregivers and the frail elderly; describe the activities performed by caregivers in households consider whether working conditions affect their health, causing interference in the practice of caring. The methodology was quanti nature and the case study method. The techniques: documentary research, interviews and use the recorder. Of the total of 248 caregivers identified 08 graduates in 2008, these 05 agreed to participate. The inclusion criteria were consent to participate in the interview as a volunteer, 2) be caring for frail elderly independent of the type of health problem, 3) work at home. As for the exclusion criteria: 1) refused to participate in the interview 2) work in health units, long-term institution or family caregiver. Script was applied semi-structured interview with 05 caregivers and 01 questionnaire to municipal management policy for the elderly, totaling 06 subjects, that after collecting the data we analyze the speeches. Results: The formal caregivers are only women in the group envelhecentes that serve the elderly of middle and upper classes who lived in the north, considered the exploitation of precarious workers activities not covered by its function, with no recognition and appreciation of family, low wages, for not being officially recognized as professionals. The activities are to support the basic activities of daily living autonomy and independence for the elderly. Due to the intense day of work with formal employment contract or not, and no family support to these caregivers, are overloaded, accumulate stress, taking care to leave for work for fear of losing their jobs and the link with the elderly, also by requiring health care and assistance. The role of formal caregiver needs to be recognized as a profession, for the family, the state and society can monitor these services, to provide a skilled care for the elderly at home, significantly reducing gender discrimination, as well as providing better. / O crescimento da população de idosos é um fenômeno mundial, em que muitos também estão envelhecendo, devido aos avanços da tecnologia médica que permitem o homem viver mais, mas não é garantia de qualidade de vida para todos, pois muitos envelhecem pobres tendo que lutar junto com a sua família para sobreviver. Com o aumento na expectativa de vida, os idosos de idade avançada, os acima de 80 anos, passam a demandar por cuidados para realização das atividades básicas de vida diária, pela incidência de doenças crônicas, tornando-se dependentes. A família vêm passando por notáveis transformações, a partir da inserção da mulher no mercado de trabalho, entre outros fatores, ocasionando a redução do seu tamanho, surgindo vários modelos de família e com demandas específicas. A maioria das famílias brasileiras é responsável pelos cuidados dos seus idosos, mas sem nenhuma orientação e treinamento, poucos ainda podem contratar um profissional o cuidador formal para prestar apoio e cuidados. Nessa perspectiva, quanto ao objetivo geral, buscou-se analisar em que condições trabalham os cuidadores de idosos fragilizados nos domicílios em Manaus. Quanto aos objetivos específicos: identificar quem são os cuidadores formais e os idosos fragilizados; descrever as atividades desenvolvidas pelos cuidadores; analisar se a atuação profissional dos cuidadores nos domicílios estão de acordo com o que aprenderam no curso de formação. A metodologia foi de natureza quantiqualitativa e o método utilizado foi o estudo de caso, em que realizamos a análise das falas e dos depoimentos, numa perspectiva crítica da realidade possibilitado através do contato direto com as trabalhadoras. Do total de 248 cuidadores formados em 2008 identificamos 08, destes 05 aceitaram participar. Os critérios de inclusão foram: aceitar participar da entrevista como voluntária; 2) estar cuidando de idosos fragilizados independente do tipo de agravo de saúde; 3) atuar em domicílio. Quanto ao critério de exclusão: 1) não aceitar participar da entrevista 2) atuar em unidades de saúde, instituição de longa permanência ou ser cuidador familiar 3) Falecimento do idoso. Aplicou-se roteiro de entrevista semi-estruturada às 05 cuidadoras e 01 questionário à gestora municipal da política do idoso, totalizando 06 sujeitos, que após a coleta dos dados analisamos as falas. Resultados: As cuidadoras formais são exclusivamente mulheres do grupo envelhecentes, que atendem idosos de classes média e alta, residentes na zona Norte, consideradas trabalhadoras precarizadas pela exploração de atividades não contempladas a sua função, com não reconhecimento e valorização da família, mal remuneradas, por ainda não serem oficialmente reconhecidas como profissionais. As atividades desenvolvidas são para dar apoio às atividades básica de vida diária para autonomia e independência da pessoa idosa. Devido à intensa jornada de trabalho com contrato de trabalho formal ou não, e ausência de apoio da família a esses cuidadores, ficam sobrecarregadas, acumulam estresse, deixam de se cuidar em função do trabalho por medo de perder o emprego e o vínculo com o idoso, demandando também por cuidados de saúde e assistência. A função de cuidador formal precisa ser reconhecida como profissão, para que a família, o Estado e a sociedade possam fiscalizar esses serviços, para propiciar um atendimento qualificado aos idosos em domicílio, reduzindo significativamente a discriminação de gênero, bem como proporcionar melhor remuneração.

INTRODUÇÃO: Recentemente, videogames interativos (VI) estão sendo utilizados como intervenção cognitiva-motora que associa estímulos motores e cognitivos. Vários estudos mostraram que os VI podem promover melhorias no controle postural, marcha, cognição e independência funcional em idosos e pacientes com doença neurológica. No entanto, ainda não há evidências sobre os efeitos dos VI em idosos frágeis. O objetivo deste estudo foi avaliar a aplicabilidade, a segurança, a aceitabilidade do treinamento com Nintendo Wii Fit Plus® (NWFP) e os resultados funcionais (controle postural, marcha, cognição, humor e medo de cair) em idosos frágeis e pré-frágeis. MÉTODOS: Foi realizado um ensaio clínico randomizado controlado, grupo paralelo, para avaliação da aplicabilidade. Idosos frágeis e pré-frágeis foram atribuídos aleatoriamente ao grupo experimental (GE, n = 15) ou grupo controle (GC, n=15). Os participantes do GE realizaram 14 sessões de treinamento, com duração de 50 minutos cada, duas vezes por semana. Em cada sessão de treinamento, os participantes jogaram cinco dos 10 jogos selecionados, duas tentativas em cada jogo. Os participantes do GC receberam recomendações gerais sobre a importância da atividade física. Todos os participantes foram avaliados por um fisioterapeuta cego em três momentos: antes e depois da intervenção e 30 dias após o término da intervenção (follow-up). Avaliamos a aplicabilidade (pontuação dos participantes nos jogos), aceitabilidade (questionário de satisfação dos jogos), segurança (eventos adversos durante as sessões de treinamento) e desfechos funcionais: (1) controle postural (Mini-BESTest); (2) marcha (Functional Gait Assessment, FGA); (3) cognição (Montreal Cognitive Assessment, MoCA); (4) humor (GDS-15); e (5) medo de cair (FES-I). RESULTADOS: Os participantes do GE melhoraram suas pontuações em todos os 10 jogos, relataram que entenderam os jogos e gostaram de praticá-lo, houve poucos eventos adversos durante o período do estudo. Houve melhora significativa no Mini-BESTest e no FGA no GE quando comparado ao GC (p < 0,05). CONCLUSÃO: O treinamento com NWFP foi aplicável, aceitável e seguro para idosos frágeis e promoveu melhora no controle postural e na marcha. Não houve efeitos sobre a cognição, humor ou medo de cair / BACKGROUND: Recently, interactive video games (IVG) have been used as a cognitive-motor intervention that associates exercises and cognitive stimulation. Several studies have shown that IVG can promote improvement in postural control, gait, cognition, and functional independence in elderly people and patients with neurological disease. However, there is a lack of evidence about the effects of IVG on frail and pre frail elderly. The aim of this study was to evaluate the feasibility, safety, and acceptability of playing Nintendo Wii Fit PlusTM (NWFP) interactive video games, and the functional outcomes (postural control, gait, cognition, mood, and fear of falling) in frail and pre frail older adults. Methods: This study is a randomised controlled, parallel group, feasibility trial. Participants were frail and pre frail older adults randomly assigned to the experimental group (EG, n=15) or control group (CG, n=15). Participants of the EG performed 14 training sessions, lasting 50 minutes each, twice a week. In each training session, participants played five of 10 selected games, with two attempts at each game. Participants of the CG received general advice regarding the importance of physical activity. All participants were assessed by a blinded physical therapist at three moments: before and after intervention, and 30 days after the end of the intervention (follow-up). We assessed the feasibility (score of participants in the games), acceptability (game satisfaction questionnaire), safety (adverse events during training sessions), and functional outcomes: (1) postural control (Mini-BESTest); (2) gait (Functional Gait Assessment); (3) cognition (Montreal Cognitive Assessment); (4) mood (GDS-15); and (5) fear of falling (FES-I). Results: Participants in the EG improved their scores in all of the 10 games, reported to understand and enjoy the tasks of the games, and presented few adverse events during the practice. There was a significant improvement in the Mini-BESTest and Functional Gait Assessment in the EG when compared to the CG (p < 0.05). Conclusion: NWFP was feasible, acceptable, and safe for frail older adults and promoted improvement in postural control and gait. There were no effects on cognition, mood, or fear of falling

Graduation date: 2004

<p>The international concern about human rights, gender equality, domestic violence and the increase in the aging populations has brought elder abuse into the public focus. Elder abuse is a complex, multi-faceted health, social, criminal justice, international public health and human rights issue. The widely divergent and varying definitions is a controversial problem to understanding elder abuse. The elderly have been excluded from national gender-based programs on domestic violence and the abuse of women and children. In South Africa victims of elder abuse are often physically and or cognitively unable to speak for themselves which necessitates that the public be empowered and trained to become advocates for the aged. Lachs &amp / Pillemer ( 2004 : 1265 ) states that &ldquo / the physical and psychological impairement of elder persons could be predisposing factors for elder abuse &ldquo / . Statistical evidence on the incidence and prevalence rates of elder abuse is lacking as elderly persons are reluctant to identify care givers for fear of abandonment, retaliation and being left destitute ( Lachs &amp / Pillemer, 2004 : 1265 ). Despite the Bill of Rights as set out in the South African Constitution and the Older Persons Act, No. 13 of 2006 which was developed to deal with the empowerment and protection of elder persons and promote and maintain their status, rights, safety, security and well being the abuse of elder person continues to occur ( Older Persons Act, No. 13 of 2006 ). This qualitative research study is allied with the phenomenological approach in an attempt to understand elder person&rsquo / s perception, viewpoints and perspectives from their lived experiences and personal lives. Three (3) focus group discussions and eighteen (18) one-on-one interviews were conducted with elder persons living in the suburbs of Cape Town. Data from participants were audio-taped, transcribed verbatim before an inductive analysis lead to the emergence of broad themes and patterns. The main findings of the research study concluded that elderly persons were informed but not empowered about financial, emotional and verbal abuse. The abuse of the elder person in old age homes also featured prominently. The findings of the research study can be used to provide education and empower elder persons and the general public on specific aspects related to elder abuse which are : Financial, Emotional, Verbal and the abuse by staff at old age homes. These findings could be utilized by health and social welfare advocates and organisations who offer community educational and development programs to advocate against elder abuse.</p>

The main purposes of this thesis were to evaluate a high-intensity functional weight-bearing exercise pro­gramme, regarding its applicability (attendance, achieved intensity, adverse events) as well as its effect on physical functions and activities of daily living (ADL) among older people living in residential care facilities, with a special focus on people with dementia. Furthermore, a main purpose was to systematically review the applicability and effects of physical exercise on physical functions, cognitive functions, and ADL among people with dementia. A high-intensity functional weight-bearing exercise programme that includes lower-limb strength and balance exercises in standing and walking, was evaluated in a randomised controlled trial among 191 older people, dependent in ADL, living in residential care facilities, and with a Mini-Mental State Examination (MMSE) score of ten or more. One hundred (52.4%) of the participants had dementia. Participants were randomised to an exercise programme or a control activity, consisting of 29 supervised sessions over 3 months, as well as to an intake of a protein-enriched energy supplement or a placebo drink immediately after each session. The effect on physical functions was evaluated using the Berg Balance Scale, usual and maximum gait speed, and one-repetition maximum in a leg press machine measuring lower-limb strength. The effect on ADL was evaluated using the Barthel Index. These outcome measures were followed up at 3 and 6 months by blinded assessors and analysed using the intention-to-treat principle. The evaluation of the applicability of the high-intensity functional weight-bearing exercise programme showed that there was a high rate of attendance, a relatively high achieved intensity in the exercises, and all except two adverse events were assessed as minor or temporary and none led to manifest injury or disease. No statistically significant differences were observed in applicability when comparing participants with dementia and participants without dementia. In addition, the applicability of the programme was not associated with the participants’ cognitive function. Significant long-term effects of the exercise programme were seen regarding functional balance, gait ability and lower-limb strength in comparison with the control activity. The intake of the protein-enriched energy supplement did not increase the effect of the training. Age, sex, depression, dementia disorder, nutritional status, and level of functional balance capacity did not influence the effect on functional balance of the high-intensity functional weight-bearing exercise programme. There were no significant differences between the groups regarding overall ADL performance. Analyses for each item revealed that a significantly smaller proportion of participants in the exercise group had deteriorated regarding indoor mobility at 3 and 6 months. For people with dementia, there was a significant difference in overall ADL performance in favour of the exercise group at 3 months, but not at 6 months. In a systematic review, randomised controlled trials, evaluating the effects of physical exercise among people with dementia, were identified according to pre-defined inclusion criteria. Two reviewers independently extracted predetermined data and assessed methodological quality. Ten studies were included in the review and the majority of the participants were older people with Alzheimer’s disease living in residential care facilities. Four studies reached “moderate” methodological quality and six “low”. The results showed that among older people with Alzheimer’s disease in residential care facilities, combined functional weight-bearing exercise over 12 months at an intended moderate intensity seems applicable for use regarding attendance and adverse events and there is some evidence that the exercise improves walking performance and reduces ADL decline. Furthermore, there is some evidence that walking exercise over 16 weeks performed individually, where the participant walks as far as possible during the session, reduces decline in walking performance, but adverse events need to be evaluated. In conclusion, among older people who are dependent in ADL, living in residential care facilities, and have an MMSE score of 10 or more, a high-intensity functional weight-bearing exercise programme is applicable for use and has positive long-term effects on functional balance, gait ability, and lower-limb strength and seems to reduce ADL decline related to indoor mobility. An intake of a protein-enriched energy supplement immediately after the exercise does not appear to increase the effect of the training. In people with dementia, the exercise programme may prevent decline in overall ADL performance, but continuous training may be needed to maintain that effect. The positive results regarding applicability and effects of combined functional weight-bearing exercise among people with dementia is confirmed when the scientific literature is systematically reviewed. It seems to be important that exercise interventions among people with dementia last for at least a few months and that the exercises are task-specific and intended to challenge the individual’s physical capacity. Whether physical exercise can improve cognitive functions among people with dementia remains unclear. There is a need for more exercise studies of high methodological quality among people with dementia disorders.

published_or_final_version / Gerontology / Master / Master of Social Sciences

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