A informação háptica fornecida pelo toque leve (TL) e pelas âncoras reduz a oscilação postural durante a postura em pé. No entanto, não está claro se esse benefício permaneceria na presença de tarefas cognitivas em adultos jovens e em idosos com e sem histórico de quedas. Assim, os objetivos foram: 1) investigar os efeitos das âncoras e de tarefas cognitivas visuais e auditivas no controle postural em adultos jovens em uma tarefa postural desafiadora (Estudo 1); 2) investigar o efeito das dicas hápticas fornecidas pelo TL e pelas âncoras durante a realização de uma tarefa cognitiva visual idosos com e sem histórico de quedas quando na postura em pé (Estudo 2). Sessenta e quatro indivíduos foram distribuídos em três grupos: adultos jovens (n=20), idosos caidores (n=22) e idosos não caidores (n=22). Para os adultos jovens (Estudo 1), a tarefa consistiu em permanecer em pé em uma trave de equilíbrio com pés distantes na largura dos ombros sem e com o uso das âncoras, sem e com tarefas cognitivas (teste visual de Stroop adaptado e tarefa auditiva de monitoramento de dígitos). Para os idosos (Estudo 2), a tarefa consistiu em permanecer na postura ereta com os pés unidos desempenhando seis condições experimentais combinando dicas hápticas (sem contato, TL e âncoras) e na presença ou ausência da tarefa cognitiva visual (teste visual de Stroop adaptado). Os resultados do estudo 1 mostraram que para os adultos jovens os benefícios do uso das âncoras não foram influenciados pelas tarefas cognitivas. Mesmo em superfície desafiadora, a oscilação postural foi reduzida para facilitar a execução das tarefas cognitivas. Os resultados do estudo 2 revelaram que os idosos com e sem histórico de quedas se beneficiaram igualmente da adição de dicas hápticas. A presença da tarefa cognitiva-visual reduziu a oscilação postural em ambos os grupos. De maneira geral, tanto o TL quanto as âncoras foram eficazes na redução da oscilação postural em adultos jovens e idosos com e sem histórico de quedas, sugerindo que a informação háptica foi capaz de beneficiar o controle postural mesmo em condições de tarefas cognitivas, demonstrando que jovens e idosos, particularmente aqueles com histórico de quedas, foram capazes de modular funcionalmente o controle postural de forma a facilitar a execução das tarefas cognitivas. / Haptic information provided by the light touch (LT) and the anchors reduce the postural sway during upright standing. It is unclear whether this benefit would remain in the presence of cognitive tasks in young and older adults with and without a history of falls. Thus, the aims were: 1) to investigate the effects of the anchors and the visual and auditory cognitive tasks on postural control in young adults in a challenging balancing task (Study 1); 2) to investigate the effect of haptic input provided by LT and anchors while performing a cognitive-visual task in older adults with and without a history of falls when standing upright (Study 2). Sixtyfour individuals were divided into three groups: young adults (n=20), faller older adults (n=22) and non-faller older adults (n=22). For the young adults (Study 1), the task consisted in standing upright on a balance beam with feet apart at shoulders width while performing 6 experimental conditions combining the anchors (with or without) and the cognitive tasks (none, the adapted visual Stroop test and the auditory digit monitoring task). For the older adults (Study 2), the task consisted in standing upright with feet together while performing six experimental conditions combining haptic cues (none, LT, and anchors) and the presence/absence of the cognitive-visual task (the adapted visual Stroop test). The results of the study 1 showed that the cognitive tasks did not affect the benefits of the anchors for the young adults. Even on a challenging surface, the postural sway reduced to facilitate the execution of the cognitive tasks. The results of the study 2 revealed that the older adults benefited similarly from the haptic cues, independently their history of falls. The presence of the cognitive-visual task reduced the postural sway in both groups. In general, both LT and anchors were effective to reduce postural sway in young and older (fallers and non-fallers) adults, suggesting that the haptic information was able to benefit the postural control even with cognitive tasks, demonstrating that young and older adults, particularly those with a history of falls, were able to functionally modulate their postural control to facilitate the execution of the cognitive tasks.

Introduction: Medication adherence is vital to ensuring optimal patient outcomes, particularly amongst older adults prescribed polypharmacy. However, complex interventions aimed at improving adherence have shown only limited effectiveness. To maximise effectiveness, the Medical Research Council (MRC) supports the use of both evidence and theory in developing interventions. Feasibility and pilot testing is then recommended to optimise interventions in advance of definitive trials. The aim of this research was to develop a novel complex intervention (using evidence and theory) to improve adherence in older adults (prescribed polypharmacy) and to test the feasibility of delivering this in community pharmacies. Methods: The presented research models the MRC complex intervention framework and focuses on development and feasibility testing phases. Firstly, a systematic review was conducted to address an identified evidence gap in relation to theory-based adherence interventions previously delivered to older adults prescribed polypharmacy. Qualitative research was then conducted to explore older patients’ adherence behaviour and identify determinants (barriers, facilitators) to target for change. Using the Theoretical Domains Framework (TDF) as a lens, key domains were selected for targeting and mapped to behaviour change techniques (BCTs) using established methods. These BCTs formed the basis of a complex intervention that was delivered to older patients by community pharmacists (CPs) as part of a small-scale feasibility study. In addition to exploring older patients’ adherence behaviours, further research focused on CPs’ clinical behaviour in relation to providing medication adherence support (MAS). The qualitative TDF-based methods used in the patient study were extended and a mixed methods (qualitative, quantitative) approach was used to identify determinants influencing CPs’ behaviour. Key target domains were identified and mapped to BCTs that could be directed at CPs (e.g. in a training package) to improve future implementation of the patient intervention. Results: The systematic review found that adherence interventions delivered to older patients prescribed polypharmacy were rarely based on theory, supporting the need for further research. The qualitative research conducted with older patients identified eight key domains (e.g. ‘Beliefs about consequences’, Memory, attention and decision process’) that could be targeted and these domains were mapped to 11 BCTs (e.g. ‘Prompts/cues’, ‘Self-monitoring’) which formed the basis of a complex intervention. The feasibility study demonstrated that the intervention was highly acceptable to both patients and CPs but some modifications were suggested. It also highlighted the need for additional research that focuses on CPs’ behaviour (i.e. MAS provision). Findings from the mixed methods study on CPs’ behaviour led to the identification of seven key domains that could be targeted for change (e.g. ‘Skills’, ‘Motivation and goals’). Eighteen BCTs were then selected for inclusion in a training package (e.g. ‘Demonstration of the behaviour’) or for delivery alongside the patient intervention in future research (e.g. ‘Rewards/incentives’) to improve implementation. Discussion/Conclusion: The MRC framework served as a useful guide for developing a complex intervention to improve adherence in older patients prescribed polypharmacy. This systematic theory-based approach that involved explicitly linking theoretical domains to intervention components (BCTs) will aid future replication and understanding of how the intervention aims to bring about behaviour change. Aside from targeting patients’ adherence behaviours, this research emphasised the importance of exploring the behaviours of intervention providers (i.e. CPs) to enhance implementation. Future research will involve pilot testing a refined version of the patient intervention and CP training package to establish if a definitive trial of effectiveness (e.g. randomised controlled trial) is warranted.

Purpose: To determine whether symptoms of dizziness and fall rates change due to routine cataract surgery and to determine the influence of visual and refractive factors on these common problems in older adults. Methods: Self-reported dizziness and falls were determined in 287 subjects (mean age of 76.5±6.3 years, 55% females) before and after routine cataract surgery for the first (81, 28%), second (109, 38%) and both eyes (97, 34%). Six-month falls rates were determined using self-reported retrospective data. Dizziness was determined using the short-form of the Dizziness Handicap Inventory. Results: The number of patients with dizziness reduced significantly after cataract surgery (52% vs. 38%; χ2 = 19.14 , p < 0.001), but the reduction in number of patients who fell in the 6-months post surgery was not significant (23% vs. 20%; χ2= 0.87, p=0.35). Multivariate logistic regression analyses found significant links between post-operative falls and change in spectacle type (increased risk if switched into multifocal spectacles). Post-operative dizziness was associated with changes in best eye visual acuity and changes in oblique astigmatic correction. Conclusions: Dizziness is significantly reduced by cataract surgery and this is linked with improvements in best eye visual acuity, although changes in oblique astigmatic correction increased dizziness. The lack of improvement in falls rate may be associated with switching into multifocal spectacle wear after surgery.

Objetivo: verificar associação independente entre subnutrição e óbito em idosos brasileiros domiciliados. Métodos: pesquisa epidemiológica, observacional, longitudinal, retrospectiva e analítica, baseada no Estudo SABE: Saúde, Bem-estar e Envelhecimento, realizado nos anos 2000 e 2006, no município de São Paulo. Foram estudados 1170 idosos ( 60 anos), de ambos os sexos, residentes habituais em domicílios particulares da área urbana do município de São Paulo. As variáveis analisadas foram: óbito, subnutrição, sexo, renda, força muscular reduzida, fratura de quadril, hábito de fumar, câncer, depressão, diabete melito, doença coronariana, doença pulmonar crônica, doença vascular cerebral e hipertensão, sendo a maioria relatada pelos idosos ou por seus proxis, com exceção do óbito (averiguado pelo Sistema de Informações sobre Mortalidade de São Paulo), da subnutrição (Miniavaliação Nutricional®), da depressão (Escala de depressão geriátrica) e da força muscular reduzida (força de preensão manual). Realizou-se, segundo grupos etários (60-74 anos e 75 anos), análise multivariada hierarquizada por regressão logística, baseada em modelo teórico proposto, selecionando as variáveis cujo p foi < 0,05. Resultados: constataram-se 332 óbitos, com maior proporção no grupo 75 anos (41,8%) que 60-74 anos (18,3%) (p < 0,001). A subnutrição foi identificada em 2,4% dos idosos e, assim como para óbito, verificou-se maior proporção no grupo 75 anos (2,5% e 2,4%, respectivamente). Em idosos de 60-74 anos, 6,7% daqueles que morreram eram subnutridos e, no grupo etário 75 anos, 3,9%. Tanto em idosos de 60-64 anos (OR = 6,17; IC = 5,89-6,47), como 75 anos (OR = 2,82; IC = 2,57- 3,10), a subnutrição foi fator de risco independente para óbito (p < 0,05). Exceto fratura de quadril e doença vascular cerebral, em ambos grupos etários, e hipertensão, em idosos de 60-74 anos, todas as outras variáveis também explicaram o óbito, porém, com menor efeito. Conclusão: a subnutrição representou fator de risco 6 independente e mais fortemente associado ao óbito em idosos brasileiros domiciliados dentre as variáveis consideradas, com efeito mais pronunciado no grupo de 60-74 anos. / Objective: to verify the independent association between undernutrition and death in older Brazilian adults community-dwelling setting. Methods: epidemiological, observational, longitudinal, retrospective and analytical study based in Health, Wellbeing and Aging survey realized in the years 2000 and 2006. This study included 1170 older adults ( 60 years) both gender that living in private households in São Paulo urban area. The variables analyzed were: death, undernutrition, sex, income, low muscle strength, hip fracture, smoker, cancer, depression, diabetes, coronary heart disease, chronic lung disease, cerebral vascular disease and hypertension being the majority self reported by older adults, except death (investigated in the Mortality Information System of the São Paulo city), undernutrition (Mini-nutritional Assessment®), depression (Geriatric Depression Scale) and muscle strength (handgrip). Hierarchical multivariate analysis by logistic regression was performed according to age groups (60-74 years and 75 years) based on a proposed theoretical model. The p-values < 0.05 were considered significant. Results: were identified 332 death being the highest proportion in the age group 75 years (41.8%) that 60-74 years (18.3%) (p < 0.001). Undernutrition was identified in 2.4% of older adults and as well as for death, there was a higher proportion in the group 75 years (2.6 and 2.4, respectively). In the older adults from 60-74 years, 6.7% died and were undernutrition and the older adults 75 years, 3.9%. Undernutrition was independent risk factor for death (p<0.05) both in the age group 60-74 years (OR = 6.17; CI = 5.89-6.47) and in the age group 75 years (OR = 2.82; CI = 2.57-3.10). Except hip fracture and cerebral vascular disease in both age groups and hypertension in age group from 60-74 years, the other variables also explained the death in older adults, however, the effect of these variables was lower. Conclusion: undernutrition represented the independent and the most strongly risk factor to death in older 8 Brazilian adults in the community-dwelling setting among the variables considered in this study with effect more pronounced in older adults from 60-74 years.

O objetivo deste estudo foi avaliar o efeito do treinamento de força muscular dos membros inferiores na estabilidade postural de mulheres idosas. As participantes (n =21) eram saudáveis, com idade entre 60 e 75 anos (M = 64,4 anos), e foram designadas a um grupo de treinamento (TF) ou a um grupo controle (CO). Esses grupos foram comparados em estabilidade postural e força antes e após um programa de treinamento de força para o grupo TF. A estabilidade postural foi avaliada em posturas eretas estáticas com apoio unipodal e bipodal, e em situações em que a estabilidade postural bipodal foi perturbada de forma previsível ou imprevisível. A perturbação previsível foi produzida por um movimento voluntário, por meio da elevação rápida com as mãos, de cargas conhecidas: 1 Kg, 3 Kg ou 5 Kg. A perturbação imprevisível foi produzida pela alteração inesperada da carga de 3 Kg para a carga de 1 Kg ou de 5 Kg antes de sua elevação. Os resultados indicaram aumento da força muscular após o treinamento de força. Quanto à estabilidade postural, nãob foram observadas diferenças significativas entre os grupos após o treinamento para as tarefas de apoio bipodal e apoio unipodal. A estabilidade postural foi afetada principalmente, quando uma carga mais leve foi elevada na situação imprevisível, gerando maior deslocamento anterior e posterior do CP. Entretanto, não houve efeito do treinamento de força no deslocamento do CP. Após o treinamento de força, o grupo TF apresentou uma redução do tempo de deslocamento posterior do CP e uma redução na variabilidade de amplitude do CP após ajustes compensatórios. Estes resultados sugerem que o treinamento de força não afeta o equilíbrio de idosos em situações estáticas ou componentes de ajustes iniciais com a perturbação da postura, mas houve um efeito positivo nos componentes tardios de ajustes após a perturbação / The goal of this study was to investigate the effect of strength training of the lower limbs on postural stability of older women. Participants (n =21) were healthy, with ages ranging between 60 and 75 years (M=64.4 years); they were assigned to two groups: strength training (ST) and control (CO). These groups were compared for postural stability and muscular strength before and after a strength training program for the ST group. Postural stability was evaluated in uni and bipodal static stance, and in situations of predictable and unpredictable perturbation of balance. The predictable disturbance was produced through the action of lifting a known load (1 kg, 3 kg or 5 kg) with the hands. The unpredictable disturbance was produced by an unexpected alteration of the load of 3 kg to 1 kg or 5 kg right before lifting the load up. The results indicated increased muscle strength after strength training. Regarding postural stability, no significant difference was detected between groups for uni/bipodal static postures. Postural stability was most affected when a lighter weight was lifted in the unpredictable situation, leading to greater anterior and posterior center of pressure (CP) displacement. Strength training, however, had no effect on the initial CP displacement. After training, the ST group showed shorter time of posterior CP displacement and lower variability of CP range after compensatory adjustments. These results suggest that strength training for elderly individuals does not affect stability in static postures or the early component of adjustments to balance perturbation, but it has a positive effect on the late component of adjustments to balance perturbation

Sexual expression is a natural act that occurs across the life course, unrestricted by age or physical location. Regardless if a person is 75 and residing in an assisted living facility, sex is a facet of life. Although sexual activity may slow as individuals age, interest in sex does not (Langer, 2009). Older adults maintain healthy sexual desires, yet face unique challenges when it comes to sexual expression and sexual health, which can be further complicated within the margins of a community living facility (i.e., assisted living, residential care, and nursing homes). Aside from the physiological changes that occur in mid-to-late life (e.g., menopause, erectile dysfunction), the older adult population faces growing rates of sexually transmitted infections (Centers for Disease Control and Prevention, 2017), particularly in community living facilities (Warso, 2015). Sexual assault and abuse is another issue facing community living facilities, as well as ambiguous or nonexistent policies that support and protect the rights of older persons to express themselves in a sexual manner (Connoll et al, 2012). Mystification surrounding sex in later life further compounds these issues. Moreover, a plethora of misinformation underscores societal taboos and myths surrounding sexuality and its prevalence in later life, the physical and cognitive changes that occur in later life, and the attitudes and biases (of care workers and residents) involving sexual expression of older adults residing in community living facilities. A current review of the research points to more education needed that incorporates a lifespan approach and attends to older adults in community living facilities (Langer, 2009; Villar, Fabà, Serrat, & Celdrán, 2015). Creating an environment that supports open discussion of safer sex practices, as well as encouragement (and normalization) of healthy sexual expression, can lead to an improvement in the overall wellbeing of residents living at these facilities (Syme, 2017). The current project takes a look at the preliminary stages of developing a sexual health forum for seniors residing in an assisted living facility in northern Louisiana. This project was undertaken by an undergraduate sexual health research team comprised of students majoring in Family and Child Studies or Psychology, and/or minoring in Gerontology. The presentation will detail strategies for creating a forum for seniors, highlighting successes and challenges in navigating limited research on sexuality in late life and program development targeting older adults, as well as community standards surrounding sexual health and expression. Additionally, this presentation will offer reflexive activities for educators and practitioners addressing sexual health in aging populations, particularly in residential community living facilities.

No description available.

Study Objectives: Nocturnal awakenings may constitute a unique risk for falls among older adults. We describe differences in gait and balance between presleep and midsleep testing, and whether changes in the lighting environment during the midsleep testing further affect gait and balance. Methods: Twenty-one healthy, late middle-aged and older (64.7 ± 8.0 y) adults participated in this repeated-measures design consisting of four overnight laboratory stays. Each night, participants completed baseline visual acuity, gait, and balance testing. After a 2-h sleep opportunity, they were awakened for 13 min into one of four lighting conditions: very dim white light (< 0.5 lux); dim white light (∼28.0 lux); dim orange light (∼28.0 lux); and white room-level light (∼200 lux). During this awakening, participants completed the same sequence of testing as at baseline. Results: Low-contrast visual acuity significantly decreased with decreasing illuminance conditions (F(3,45) = 98.26, p < 0.001). Our a priori hypothesis was confirmed in that variation in stride velocity and center of pressure path length were significantly worse during the mid-sleep awakening compared to presleep baseline. Lighting conditions during the awakening, however, did not influence these parameters. In exploratory analyses, we found that over one-third of the tested gait and balance parameters were significantly worse at the midsleep awakening as compared to baseline (p < 0.05), and nearly one-quarter had medium to large effect sizes (Cohen d ≥ 0.5; r ≥ 0.3). Conclusions: Balance and gait are impaired during midsleep awakenings among healthy, late middle-aged and older adults. This impairment is not ameliorated by exposure to room lighting, when compared to dim lights.

We examined the potential contribution of sleep quality to the relation between mindfulness and subjective vitality, a marker of physical and psychological energy. Seven components of the Pittsburgh Sleep Quality Index were investigated as potential mediators of the association between dispositional mindfulness and subjective vitality in our sample of 219 older adults. Mindfulness, sleep quality, and subjective vitality were significantly and positively associated with each other. Sleep quality partially mediated the relation between mindfulness and subjective vitality, with two components responsible for this effect: habitual sleep efficiency and sleep-related problems experienced during the daytime. Implications of the association between mindfulness and subjective vitality in older adults via sleep quality are addressed, including the potential for interventions to improve sleep quality and well-being among older adults by inclusion of mindfulness training.

We examined associations between trait hope and preparation for future care needs (PFCN) among 66 older adult primary care patients in western New York. Participants completed a questionnaire assessing PFCN (awareness, information gathering, decision-making, concrete planning, and avoidance), and the Adult Trait Hope Scale. In multivariate regressions, lower hope, particularly less agency, was associated with more awareness of needing care, whereas higher hopefulness, particularly pathways thinking, was associated with increased decision-making and concrete planning. Greater hopefulness appears to be linked to goal-directed planning behaviors, although those with lower hope may actually be more aware of the need for planning. Evidence-based programming that encourages learned hopefulness may contribute to enhanced health planning and decision-making among older adult primary care patients.