The im.pact of the 2020 COVID-19 pandemic and the associated public health measures enacted by governments globally bad a significant impact on all aspects of human life including economic activity and mobility. One of the main public health measures designed to reduce the transmission of the SAR-Co V-2 vims have been the implementation ofvarious levels of lockdowns that limited mobility and resulted in almost half of the world's population UD.der som.e form of confinement. Many govemm.ents, including in Australia, UK, and Norway, enacted flexible forms oflockdowns that allowed daily outdoor exercise, while adhering to safe physical distancing, in recognition of the role of physical activity in reducing the mental and physical consequences of confinement. Australia saw first strict lockdown restrictions over March/April 2020 with progressive easing of restrictions during May and Ju.ne 2020. Emerging evidence from these countries has indicated that physical activity, particularly cycling, increased over the lockdown period and the following months as some restrictions were eased. However, many have wamed of a decline in physical activity with serious health consequences among older adults who were at a high.er risk: of m.orbidity and fatality associated with COVID-19 and were m.ore likely tobe confined to their homes for longer periods compared to younger age groups. The aim ofthis stu.dy was to investigate the impact ofCOVID-19 pandemic on cycling activity among older adults aged 50 years and over in New South Wales (NSW), Australia during the early months of the COVID-19 pandemic.

The number of older adults is estimated to double from 52 million to 95 million by 2060. Approximately 80-85% of older adults are diagnosed with a chronic health condition. Many of these chronic health conditions are influenced by diet and exercise, suggesting improved diet and eating behaviors could improve health-related outcomes. One factor that might improve dietary habits in older adults is food-related inhibitory control. We tested whether food-related inhibitory control, using behavioral (response time, error rate) and scalp-recorded event-related potential (ERP; N2 and P3 components) measures of food-related inhibitory control differed between younger and older adults over age 55. Fifty-nine older adults (31 females [52.5%], Mage=64, SDage=7.5) and 114 younger adults (82 females [71.9%], Mage=20.8) completed two go/no-go tasks, one inhibiting to high-calorie stimuli and one inhibiting to low-calorie stimuli, while electroencephalogram (EEG) data were recorded. Older adults had slower overall response times than younger adults, but this was not specific to either food task. There was not a significant difference for accuracy between younger and older adults, but both groups' accuracy and response times were significantly improved during the high-calorie task than the low-calorie task. For both the N2 and P3 ERP components, younger adults had greater amplitude than older adults, but this effect was not food-specific, reflecting overall generalized lower inhibitory processing in older adults. Of note, P3 amplitude for the younger adults demonstrated a specific food-related effect (greater P3 amplitude for high-calorie no-go) that was not present for older adults. Findings support previous research demonstrating age related differences in inhibitory control though those differences may not be specific to inhibiting to high-calorie foods.

I takt med att befolkningen blir äldre ökar även andelen äldre individer med skörhet. Med stigande ålder ökar även förekomsten av hjärtsjukdom och multisjuklighet. Sköra äldre med hjärtsjukdom, med eller utan multisjuklighet, läggs ofta in för vård i den akuta hjärtsjukvården. De har ofta komplexa och omfattande omvårdnadsbehov som är svåra att tillgodose i den akuta hjärtsjukvården. Om skörheten inte tas i beaktande riskerar den sköra äldre patienten att utsättas för onödigt lidande och försämrad livskvalitet. Syftet med litteraturöversikten var att beskriva faktorer som påverkar livskvaliteten under och efter vård av akut hjärtsjukdom hos sköra äldre. Metoden för genomförandet var en allmän litteraturöversikt med integrerad dataanalys. Ett systematiskt arbetssätt har tillämpats under metodförfarandet. Analysen av inkluderade artiklar resulterade i tre kategorier och fyra underkategorier som beskriver vilka faktorer som påverkar livskvaliteten hos sköra äldre under och efter vård av akut hjärtsjukdom. Inkluderingen föregicks av en noggrann urvalsprocess och vetenskaplig kvalitetsgranskning. Resultatet visade att faktorer som multisjuklighet och behandling, biologiska aspekter och sociodemografi samt funktionsförmåga påverkade livskvaliteten hos de sköra äldre. De faktorer som hade störst inverkan på livskvaliteten var multisjuklighet, medicinska och kirurgiska interventioner samt ingrepp, ålder och fysisk funktionsförmåga. Slutsatsen är att de faktorer som påverkar livskvaliteten hos sköra äldre under och efter vård för akut hjärtsjukdom i stor utsträckning har ett samband med graden av skörhet. Skörheten påverkar utfall av behandling, försämrar den fysiska funktionsförmågan samt ger en hög biologisk ålder vilket kan leda till försämrad livskvalitet. Utifrån skörhetsgrad kan vård och omvårdnad anpassas till den enskilde individens förutsättningar och behov vilket möjliggör ett personcentrerat helhetsperspektiv. Specialistsjuksköterskan i hjärtsjukvård kan spela en viktig roll vid initiering av och utförande av skörhetsbedömningar. / As the population ages, the proportion of older individuals with frailty increases. With advancing age, the prevalence of heart disease and multimorbidity also increases. Frail older adults with heart disease, with or without multimorbidity, are often admitted for care in acute cardiac care. They often have complex and extensive care needs that are difficult to meet in acute cardiac care. Inadequate consideration of frailty can result in unnecessary suffering and diminished quality of life. The aim of this literature review was to describe factors that affect quality of life during and after care for acute cardiac disease in frail older adults.  The method was a general literature review with an integrated data analysis. A systematic approach was applied during the method procedure. The analysis of the included articles resulted in three categories and four subcategories that describe the factors that affects the quality of life. Inclusion was preceded by a careful selection process and scientific quality review. The results showed that the factors multimorbidity and treatment, biological aspects and sociodemographic, and functional ability influenced the quality of life of frail, older adults. The factors with the greatest impact on quality of life were multimorbidity, medical and surgical interventions and procedures, age, and physical functional ability. The conclusion is that the factors that affect the quality of life in frail older adults during and after care for acute cardiac disease are largely related to the degree of frailty. Frailty affects treatment outcomes, impairs physical functional, and results in a high biological age, which can lead to reduced quality of life. Based on the identified degree of frailty, care and nursing can be adapted to the individual's conditions and needs, enabling a person-centred approach. The cardiac specialist nurse plays an important role in initiating and performing frailty assessments.

This qualitative study uses interviews to examine factors explaining why 20 elderly individuals from a variety of occupations and still living in the community independently did or did not exercise. Within the limits of this qualitative study, the reasons elderly participants gave for avoiding exercise included fear of injury, joint pain, poor health, complications from various degenerative diseases, and a lack of enjoyment of exercise. The reasons for exercising included necessity due to post-heart attack motivation, work-site exercise program or equipment availability, opportunity to habituate work-related tasks, spouse support, history of exercise experience, ability to exercise without injury, enjoyment of family outings, and an appreciation of the enjoyment of exercise.

Frailty is a well-established indicator of late-life decline and is accompanied by higher rates of comorbidity and disability. Meanwhile, an estimated 41% of adults over the age of 65 report consuming alcohol – an identified health risk and protective factor depending on dosage. Given that the demographic group of older Americans is projected to double by the year 2050, identification of frailty risk and protective factors is imperative. The goals of this thesis are to: (1) identify how varying levels of alcohol consumption relate to frailty, and (2) elucidate a possible mechanism that accounts for the relationship between alcohol consumption and frailty. A sample of stroke-free participants over the age of 65 was identified from the Health and Retirement Study. Study 1 utilized stepwise logistic regression models to identify predictors of prevalent frailty at baseline (2000), and of incident frailty 4, 8, and 12 years later. For both males and females, significant predictors of frailty at all years included age, depressive symptomatology, and medical burden score. In addition, BMI was a significant predictor of frailty for females at all years. With respect to alcohol use, results revealed that drinking 1-7 drinks per week had a protective effect for females at baseline (OR=0.50) and 12 years later (OR=0.75); however, no such protective effects were found for males. Given that extant research has identified CRP as a mediator between the relationship of moderate alcohol use and cardiovascular health benefits, Study 2 used a cross-sectional sample from the 2008 wave to examine the potential mediating role of CRP between moderate alcohol use and reduced frailty risk. Results from structural equation modeling support the hypothesized model that moderate alcohol is associated with less frailty, and that this relationship is partially mediated by CRP levels. Overall findings suggest that moderate alcohol use confers health benefits for females by reducing frailty risk and that CRP is one mechanism by which alcohol use may confer protective effects for frailty. These results provide a starting place in an effort to better understand the protective effects of moderate alcohol use and can assist in improving prevention and treatment efforts for older adults by preventing or prolonging the onset of age-related diseases. Future research should further examine the relationship between alcohol use and frailty and determine if CRP mediates the relationship between moderate alcohol use and other beneficial health outcomes.

Over 5 million older adults with diabetes are hospitalized each year. Though typically not the index condition that leads to hospitalization, diabetes control often decompensates during the course of an admission and necessitates changes in home self-management plans. The specific transitional care needs of older adults with diabetes have been largely unstudied. Transition theory provided the guiding framework for this research and proposes that each transition is a complex process created by the continuous interaction of personal, community, and societal-level conditions that facilitate or inhibit the health of a transition. Hospitalization has been described as a series of three successive, interrelated transitions. The aims of this study were to determine whether personal and community transition conditions impacted the early and intermediate post-discharge outcomes in a sample of older adults with diabetes. A simultaneous quantitative/qualitative mixed method design was used to identify factors that impacted the home recovery transition experiences in a sample of 96 older adults with a mean age of 75 years. A supplementary content analysis of free-response data gathered during administration of the Post-Discharge Coping Difficulty Scale (PDCDS) clarified difficulties encountered by elders and caregivers during in the first 30 days following discharge. Four overarching themes emerged: "the daily stuff is difficult"; "engineering care at home is difficult"; "life is stressful" and "difficulty managing complex health problems". Difficulties managing a complex medication regimen, regulating blood glucose, and managing a non-diabetes chronic health problem such as hypertension and chronic lung disease were subthemes that emerged during qualitative data analyses. These subthemes were transposed into discrete nominal level variables and served as additional indicators of post-discharge coping difficulty in the descriptive correlational core component of the research project. Participants in this study who experienced an event of recidivism had lower pre-discharge assessments of readiness on the Readiness for Hospital Discharge Scale (RHDS) (t = 2.274, df = 48, p =.028). Higher PDCDS scores were observed in patients who experienced an event of recidivism within 30 days of discharge (t = -3.363, df=24.7, p = .003) and also in respondents who described difficulties with managing medications, controlling diabetes, and managing a chronic illness. Binary logistic regression was used to identify factors that may predict recidivism risk. No condition-specific predictor variables were identified. A statistically significant three-variable model (X2 = 26.737, df = 3, p < .001) revealed that PDCDS scores at 7 days (Wald X2 =3.671, df = 1, p =.050), PDCDS scores at 30 days (Wald X2 = 6.723, df = 1, p =.010), and difficulty managing a chronic health condition (Wald X2 = 8.200, df = 1, p =.004) were predictive of an event of recidivism within 30 days of discharge. Difficulty managing a chronic health problem other than diabetes was particularly predictive of recidivism. The nurse's skill in delivering discharge education was a factor in limiting early postdischarge difficulties. Elders with residual information needs on the day of discharge as measured by scores the Quality of Discharge Teaching Scale (QDTS) reported a lower readiness for discharge (r = -.314, p = .003) and experienced greater difficulties with early post-discharge coping (r =. 288, p = .023). Greater satisfaction with the post-discharge transition was noted in participants with higher QDTS scores (r = .444, p < .001). Outcomes of the hospital-to-home transition experience were impacted by a variety of personal, hospital, and community factors. Findings of this study suggest that there is a need to better understand the sequential nature of the home recovery transition and the fluid needs of older adults during this high-risk phase of care. The environments in which older adults receive post-discharge care are complex and need to be thoroughly considered when planning the postdischarge transition. Metrics of institutional performance of transitional care practices need to extend beyond events to recidivism and include evaluations of post-discharge coping and transition satisfaction. The nurse as the primary provider of discharge education has the potential to significantly promote positive transition outcomes for older adults and their family care providers.

Muscle function is determined by structure and morphology at the architectural level. In response to resistance training, older adults have demonstrated that the neuromuscular system has a substantial adaptability, which may compensate for muscle size and quality and lead to improved functional capacities and higher quality of life. PURPOSE: The purpose of this study was to examine the effect of six weeks of progressive resistance exercise on muscle morphology and architecture in healthy older adults. METHODS: Twenty- five healthy men and women were randomly assigned to either six weeks of progressive resistance training (RT) (n=13; age = 71.08 ± 6.75, BMI = 28.5 ± 5.22) or to serve as a control (CON) (n = 12; age = 70.17 ± 5.58, BMI = 27.52 ± 5.6). Fat mass (FM), lean mass (LM), and lean thigh mass (LTM) were evaluated using dual x-ray absorptiometry. Lower body strength was estimated by predicting maximal knee extensor strength (1RM). Muscle quality (MQ) was evaluated as strength per unit mass (kg/kg). Cross-sectional area (CSA), muscle thickness (MT), fascicle length (Lf), pennation angle (cosΘ), and echo intensity (EI) of the rectus femoris (RF) and vastus lateralis (VL) were collected using B-mode ultrasound and extended field of view (FOV) ultrasound. EI was quantified using grayscale analysis software. Strength per unit of echo intensity (REI) was determined by dividing 1RM by EI of the thigh. Physiological cross-sectional area (PCSA) was calculated as the ratio of (CSA x cosΘ) / (EI x Lf). A 2x2 (group [exercise vs. control] x time [pre vs. post]) repeated measures ANOVA was used to identify group differences and group x time interactions and stepwise regression was performed to assess variables related to strength. RESULTS: 1RM increased by 31.9% (p ≤ 0.01) in the RT group and was significantly correlated to PCSA of the thigh (r = .579; p = .003) at baseline. MQ increased 31.4% (p ≤ 0.01) in the RT group consistent iv with an REI increase of 33.3% (p ≤ 0.01). There were no significant changes in LTM in either group. VL CSA increased 7.4%, (p ≤ 0.05) and demonstrated a significant interaction (p ≤ 0.05) in the RT group. There were no significant changes in the CON group for 1RM, MQ, REI or VL CSA. PCSA demonstrated a significant (p ≤ 0.05) group x time interaction but did not significantly change in either group. EI did not significantly change in the RT or CON groups. CONCLUSION: Calculated PCSA of the thigh assessed by ultrasound was related to the force producing capacity of muscle and demonstrated a significant interaction following resistance training. Short term resistance exercise training was effective in increasing 1RM, muscle quality as relative strength, muscle quality as relative echo intensity, and muscle morphology, but not EI. In addition, ultrasonography appears to be a safe, feasible, informative and sensitive clinical technique to aid in our understanding of muscle strength, function, and quality.

BACKGROUND: The amount and intensity of people's activities are related to latent chronic diseases and the aging process. Accurate information about people's patterns of activity in their natural environments would go a long way toward understanding the relationship between types/levels of activity and health. Unlike the commercially available activity monitors, an algorithm developed at Boston University utilizes frequency (cycles/second) to identify overground gait and pedaling. These studies evaluate the validity of this system in a real-life environment and then investigate people's locomotive behavior across weekdays of the same week. METHODS: Wearing the monitoring system developed at BU on their right ankles, 16 older adults performed a battery of functional locomotive activities continuously in a residential setting, while being video recorded for reference. For the validity algorithm output regarding gait and pedaling variables was statistically compared to the video analysis of the same using the intraclass correlation coefficient (ICC). To investigate the consistency of locomotor behavior across weekdays of the same week, 227 older adults wore the monitoring system under study on their right ankles continuously for a week. Daily gait and pedaling values were correlated across weekdays of the same week also using ICCs. An investigation into the differences in gait variability for the average of 3 weekdays according to the subgroups; age, gender, and BMI was conducted on this sample using the Wilcoxon Signed Ranks test. RESULTS: Three of the four gait validity ICCs were significant (p ≤ 0.019) ranging from 0.267 to 0.778. All pedaling validity variables had ICCs ≥ 0.993 The locomotive consistency study found all 6 daily gait variables significantly (p < 0.001) correlated across 3 weekdays, ranging from 0.534 to 0.914. Three of four ICCs for pedaling consistency variables were significant (p ≤ 0.029) ranging from 0.277 to 0.838. CONCLUSIONS: This study's validity results support this monitoring system's gait and pedaling identification approach. There is also evidence to suggest how the system could improve its real-life locomotive detection validity and potentially diversify its applications. Additionally, based on this dissertation's results, some of people's daily locomotive behaviors remain relatively constant over weekdays during the same week.

BACKGROUND: Knee osteoarthritis is a chronic disease that frequently results in pain, activity limitations and difficulties performing social and community activities. Despite the growing prevalence of arthritis and associated participation restrictions, few studies have measured the long-term impact of the environment and psychological factors on participation restriction in this population. METHODS: Participants from the Multicenter Osteoarthritis Study (MOST) self-reported participation at baseline, 30, 60, and 84 months using the Instrumental Role subscale of the Late Life Disability Index. For study 1, participants’ environmental features were assessed at baseline from the Home and Community Environment questionnaire administered in the MOST-Knee Pain & Disability study, an ancillary study of MOST. The relative risk of participation restriction at 60 months due to community mobility barriers and transportation facilitators was calculated using binomial regression, adjusting for covariates. For study 2, baseline levels of positive and negative affect were assessed with the Center for Epidemiological Studies Depression Scale. The relative risk of incident participation restriction over 84 months due to 1) low positive affect (vs. high positive affect), 2) high negative affect (vs. low negative affect), and 3) combinations of low/high positive and negative affect (vs. high positive affect/low negative affect) were calculated in separate analyses using binomial regression, adjusting for covariates. RESULTS: In study 1, 69 (27%) of the 322 participants developed participation restriction by 60 months. Participants reporting high community mobility barriers at baseline had 1.8 times the risk [95% CI: 1.24, 2.73] of participation restriction at 60 months, after adjusting for covariates, whereas the risk due to high transportation facilitators was not significant. In study 2, 470 participants (26%) had incident participation restriction over 7 years. The adjusted relative risks of incident participation restriction over 7 years across the three analyses were: 1) low positive affect (vs. high positive affect): RR: 1.2 [95% CI: 1.0, 1.4], 2) high negative affect (vs. low negative affect): RR: 1.5 [95% CI: 1.3, 1.7], 3) low positive affect and high negative affect (vs. high positive and low negative affect): RR: 1.8 [95% CI: 1.4, 2.1]. CONCLUSIONS: These studies highlight that people with knee osteoarthritis who have certain contextual features, such as environmental barriers or low positive and high negative affect, are at increased risk of participation restriction over time. / 2018-07-07T00:00:00Z

Research acknowledges that older adults residing in long-term care facilities are at risk for social isolation, depression, and functional decline (Mezuk et al., 2014; Ouyang et al., 2015). The health risks associated with long-term care facilities may lead to poor health outcomes and poor quality of life. However, current evidence-based literature demonstrates ways in which to counteract the health risks associated with long-term care facilities through a holistic approach addressing the social, emotional, and physical health of an individual as they relate to quality of life. The aim of this doctoral project is to create an evidence-based and theory-driven program that supports older adults in long-term care facilities. The project explores the various factors impacting quality of life and provides recommendations and a potential solution to improving overall quality of life of older adults in long-term care facilities. E.D.U.C.A.T.E is a 7-step web-based resource for occupational therapy practitioners that utilizes a health and wellness approach and empowerment principles to improve quality of life of older adults residing in long-term care facilities. The objectives of E.D.U.C.A.T.E. are to foster occupational therapy practitioners employing a health and wellness approach to practice, increase older adults’ participation in meaningful occupations and social engagements, and increase older adults’ feelings of self-efficacy through an empowerment approach. By following the 7-step resource, occupational therapy practitioners may promote overall quality of life of older adults by addressing the social, emotional, and physical components impacting health outcomes. In order for this program to be implemented, additional information is included related to program evaluation, funding plans, and dissemination plans.