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ABSTRACT: BACKGROUND AND PURPOSE:: The prevalence of functional mobility limitations and falls is higher in people with dementia compared with cognitively healthy older adults, and both are associated with gait and motor impairments. The aims of this study were to examine concurrent validity of physical performance assessments and spatiotemporal gait measures in older adults with advanced dementia and to prospectively examine their relationship to functional mobility limitations and falls over a 4-month period. METHODS:: Thirty-one older adults living in dementia-specific assisted living residences participated. Correlations were examined between a modified Berg Balance Scale (mod-Berg), the Short Physical Performance Battery (SPPB), and spatiotemporal gait measures using the GAITRite Walkway system. Over 4-months, functional mobility limitations were rated, and falls were recorded by nursing supervisors. Differences in function mobility limitations and falls were examined in relation to baseline balance and gait measures. RESULTS:: Partial correlations between spatiotemporal gait measures and the mod-Berg as well as the SPPB were statistically significant (P < .05) after adjusting for age and Mini-Mental State Examination scores. Participants with low functional mobility ratings had significantly lower scores on the mod-Berg (P ≤ .001) and SPPB (P ≤ .001). They also demonstrated slower gait speed, lower cadence, higher stride time variability, and a greater percentage of gait cycle in double support (P ≤ .01). Participants with at least 1 fall, compared with those who did not fall, had lower scores on the mod-Berg (P = .02), lower cadence (P = .048), and greater stride length variability (P = .035). DISCUSSION:: The mod-Berg and SPPB were strongly correlated with reliable gait measures associated with instability and increased fall risk. The modified Berg Balance Scale demonstrates potential as a predictor of falls in older adults living in dementia-specific assisted living. CONCLUSION:: The results of this study provide support for the application of brief physical performance assessments by physical therapists to identify functional mobility limitations and fall risk in older adults with advanced dementia.
Journal of geriatric physical therapy (2001). 09/2012;
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ABSTRACT: To investigate the feasibility of implementing a Sleep Education Program (SEP) for improving sleep in adult family home (AFH) residents with dementia, and the relative efficacy of SEP compared with usual care control in a pilot randomized controlled trial.
Thirty-seven AFH staff-caregivers and 47 residents with comorbid dementia and sleep disturbances.
SEP consisted of four training sessions with staff-caregivers to develop and implement individualized resident behavioral sleep plans.
Treatment fidelity to the SEP was assessed following the National Institutes of Health (NIH) Behavior Change Consortium model utilizing trainer observations and staff-caregiver reports. Resident sleep was assessed by wrist actigraphy at baseline, 1-month posttreatment, and 6-month follow-up. Caregiver reports of resident daytime sleepiness, depression, and disruptive behaviors were also collected.
Each key area of treatment fidelity (SEP delivery, receipt, enactment) was identified, measured, and yielded significant outcomes. Staff-caregivers learned how to identify sleep scheduling, daily activity, and environmental factors that could contribute to nocturnal disturbances and developed and implemented strategies for modifying these factors. SEP decreased the frequency and disturbance level of target resident nocturnal behaviors and improved actigraphically measured sleep percent and total sleep time over the 6-month follow-up period compared with the control condition.
Results suggest behavioral interventions to improve sleep are feasible to implement in adult family homes and merit further investigation as a promising intervention for use with AFH residents with dementia.
The American journal of geriatric psychiatry: official journal of the American Association for Geriatric Psychiatry 02/2012; 20(6):494-504. · 3.35 Impact Factor
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ABSTRACT: The need for evidence-based non-pharmacological community programs to improve care of older adults with dementia is self-evident, considering the sheer numbers of affected individuals; the emotional, physical, and financial toll on affected individuals and their caregivers; the impact on our health care system; and the growing availability of evidence regarding the potential for psychosocial interventions to enhance care and decrease costs. To address this need, the Administration on Aging has begun funding translation of evidence-based programs into community settings. Two programs, Reducing Disability in Alzheimer's Disease and STAR-Community Consultants (STAR-C), were selected by the Ohio Department of Aging (in collaboration with the Alzheimer's Association Chapters in Ohio) and the Oregon Department of Health Services (in partnership with Area Agencies on Aging and the Oregon Chapter of the Alzheimer's Association) to be implemented by their staff. Both programs are designed to improve care, enhance life quality, and reduce behavioral problems of persons with dementia and have demonstrated efficacy via randomized controlled trials. This article addresses the developmental and ongoing challenges encountered in the translation of these programs to inform other community-based organizations considering the translation of evidence-based programs and to assist researchers in making their work more germane to their community colleagues.
The Gerontologist 01/2012; 52(4):452-9. · 2.48 Impact Factor
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ABSTRACT: We examined beliefs about promoting cognitive health among Filipino Americans who care for persons with dementia, their awareness of media information about cognitive health, and their suggestions for communicating such information to other caregivers. We conducted three focus groups (25 participants). The constant comparison method compared themes across focus groups. Caregivers most frequently described cognitive health benefits of social engagement and leisure; next in emphasis were benefits of healthy diets. There was less emphasis on physical activity. Participants had heard from television that avoiding smoking, alcohol, and drugs might promote cognitive health. Ways to inform others about cognitive health included information in Filipino newspapers, and handouts in Filipino languages, distributed in Filipino stores, workplaces, community organizations, and health care facilities. Findings suggest an opportunity to develop public health messages promoting cognitive health that are in-language, published in ethnic-specific media, and that are culturally appropriate for Filipino and other Asian Americans.
The International Journal of Aging and Human Development 01/2012; 75(3):273-96. · 0.62 Impact Factor
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JAMES N. LADITKA,
SARAH B. LADITKA,
RUI LIU,
ANNA E. PRICE,
BEI WU,
DANIELA B. FRIEDMAN,
SARA J. CORWIN,
JOSEPH R. SHARKEY,
WINSTON TSENG,
REBECCA HUNTER, REBECCA G. LOGSDON
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ABSTRACT: We studied concerns about cognitive health among ethnically diverse groups of older adults. The study was grounded in theories of health behaviour and the representation of health and illness. We conducted 42 focus groups (N=396, ages 50+) in four languages, with African Americans, American Indians, Chinese Americans, Latinos, Whites other than Latinos (hereafter, Whites) and Vietnamese Americans, in nine United States locations. Participants discussed concerns about keeping their memory or ability to think as they age. Audio recordings were transcribed verbatim. Constant comparison methods identified themes. In findings, all ethnic groups expressed concern and fear about memory loss, losing independence, and becoming ‘a burden’. Knowing someone with Alzheimer's disease increased concern. American Indians, Chinese Americans, Latinos and Vietnamese Americans expected memory loss. American Indians, Chinese Americans and Vietnamese Americans were concerned about stigma associated with Alzheimer's disease. Only African Americans, Chinese and Whites expressed concern about genetic risks. Only African Americans and Whites expressed concern about behaviour changes. Although we asked participants for their thoughts about their ability to think as they age, they focused almost exclusively on memory. This suggests that health education promoting cognitive health should focus on memory, but should also educate the public about the importance of maintaining all aspects of cognitive health.
Ageing and Society 09/2011; 31(07):1202 - 1228. · 1.16 Impact Factor
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ABSTRACT: To test the effects of walking, light exposure, and a combination intervention (walking, light, and sleep education) on the sleep of persons with Alzheimer's disease (AD).
Randomized, controlled trial with blinded assessors.
Independent community living.
One hundred thirty-two people with AD and their in-home caregivers.
Participants were randomly assigned to one of three active treatments (walking, light, combination treatment) or contact control and received three or six in-home visits.
Primary outcomes were participant total wake time based on wrist actigraphy and caregiver ratings of participant sleep quality on the Sleep Disorders Inventory (SDI). Secondary sleep outcomes included additional actigraphic measurements of sleep percentage, number of awakenings, and total sleep time.
Participants in walking (P=.05), light (P=.04), and combination treatment (P=.01) had significantly greater improvements in total wake time at posttest (effect size 0.51-0.63) than controls but no significant improvement on the SDI. Moderate effect size improvements in actigraphic sleep percentage were also observed in active treatment participants. There were no significant differences between the active treatment groups and no group differences for any sleep outcomes at 6 months. Participants with better adherence (4 d/wk) to walking and light exposure recommendations had significantly less total wake time (P=.006) and better sleep efficiency (P=.005) at posttest than those with poorer adherence.
Walking, light exposure, and their combination are potentially effective treatments for improving sleep in community-dwelling persons with AD, but consistent adherence to treatment recommendations is required.
Journal of the American Geriatrics Society 08/2011; 59(8):1393-402. · 3.74 Impact Factor
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ABSTRACT: To compare the efficacy of a physical activity program (Seattle Protocol for Activity (SPA)) for low-exercising older adults with that of an educational health promotion program (HP), combination treatment (SPA+HP), and routine medical care control conditions (RMC).
Single-blind, randomized controlled trial with two-by-two factorial design.
Community centers in King County, Washington, from November 2001 to September 2004.
Two hundred seventy-three community-residing, cognitively intact older adults (mean age 79.2; 62% women).
SPA (in-class exercises with assistance setting weekly home exercise goals) and HP (information about age-appropriate topics relevant to enhancing health), with randomization to four conditions: SPA only (n=69), HP only (n=73), SPA+HP (n=67), and RMC control (n=64). Active-treatment participants attended nine group classes over 3 months followed by five booster sessions over 1 year.
Self-rated health (Medical Outcomes Study 36-item Short-Form Survey) and depression (Geriatric Depression Scale). Secondary ratings of physical performance, treatment adherence, and self-rated health and affective function were also collected.
At 3 months, participants in SPA exercised more and had significantly better self-reported health, strength, and general well-being (P<.05) than participants in HP or RMC. Over 18 months, SPA participants maintained health and physical function benefits and had continued to exercise more than non-SPA participants. SPA+HP was not significantly better than SPA alone. Better adherence was associated with better outcomes.
Older adults participating in low levels of regular exercise can establish and maintain a home-based exercise program that yields immediate and long-term physical and affective benefits.
Journal of the American Geriatrics Society 06/2011; 59(7):1188-96. · 3.74 Impact Factor
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ABSTRACT: Older adults with amnestic mild cognitive impairment (aMCI) are at higher risk for developing Alzheimer disease. Physical performance decline on gait and mobility tasks in conjunction with executive dysfunction has implications for accelerated functional decline, disability, and institutionalization in sedentary older adults with aMCI.
The purpose of this study was to examine whether performance on 2 tests commonly used by physical therapists (usual gait speed and Timed "Up & Go" Test [TUG]) are associated with performance on 2 neuropsychological tests of executive function (Trail Making Test, part B [TMT-B], and Stroop-Interference, calculated from the Stroop Word Color Test) in sedentary older adults with aMCI.
The study was a cross-sectional analysis of 201 sedentary older adults with memory impairment participating in a longitudinal intervention study of cognitive function, aging, exercise, and health promotion.
Physical performance speed on gait and mobility tasks was measured via usual gait speed and the TUG (at fast pace). Executive function was measured with the TMT-B and Stroop-Interference measures.
Applying multiple linear regression, usual gait speed was associated with executive function on both the TMT-B (β=-0.215, P=.003) and Stroop-Interference (β=-0.195, P=.01) measures, indicating that slower usual gait speed was associated with lower executive function performance. Timed "Up & Go" Test scores (in logarithmic transformation) also were associated with executive function on both the TMT-B (β=0.256, P<.001) and Stroop-Interference (β=0.228, P=.002) measures, indicating that a longer time on the TUG was associated with lower executive function performance. All associations remained statistically significant after adjusting for age, sex, depressive symptoms, medical comorbidity, and body mass index.
The cross-sectional nature of this study does not allow for inferences of causation.
Physical performance speed was associated with executive function after adjusting for age, sex, and age-related factors in sedentary older adults with aMCI. Further research is needed to determine mechanisms and early intervention strategies to slow functional decline.
Physical Therapy 05/2011; 91(8):1198-207. · 3.11 Impact Factor
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ABSTRACT: This article describes results of a randomized controlled trial comparing a time-limited early-stage memory loss (ESML) support group program conducted by a local Alzheimer's Association chapter to a wait-list (WL) control condition.
One hundred and forty-two dyads were randomized in blocks to ESML (n = 96) or WL (n = 46). Mean age of participants was 74.9 years, and mean Mini-Mental State Examination was 23.4. The primary outcome was participant's quality of life; secondary outcomes included mood, family communication, and perceived stress.
On the intent-to-treat (ITT) pre-post analysis, significant differences were seen in participant quality of life (p < .001), depression (p < .01), and family communication (p < .05). Within the care partner groups, there was no significant difference between ESML and WL in the ITT analysis. A post hoc exploratory examination of changes that were associated with improved quality of life in ESML participants revealed significant reductions of depressive symptoms and behavior problems (p < .05), improved family communication (p < .05), self-efficacy (p < .01), Medical Outcomes Study short form (SF-36) role-emotional (p < .05), SF-36 social functioning (p < .05), and SF-36 mental health components (p < .01) in improvers.
These results support the efficacy of ESML support groups for individuals with dementia.
The Journals of Gerontology Series B Psychological Sciences and Social Sciences 11/2010; 65(6):691-7. · 2.62 Impact Factor
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ABSTRACT: To examine factors associated with adherence to a walking program in community-dwelling individuals with Alzheimer's disease (AD).
Data were analyzed for 66 participants with AD asked to walk 30 continuous minutes per day. Adherence data (number of days walked, minutes walked, days walked 30+ minutes) were obtained from daily logs. Predictor variables included age, spousal relationship, health limitations, depression, participant dementia severity and behavioral disturbance, and caregiver stress and dementia management style.
During week 1, participants significantly (P < .0001) increased number of days walked/week compared to baseline. However, walking frequency and duration declined over 6 months. Nonwalkers had higher behavioral disruption scores. Regression analyses indicated that participants who walked more were less depressed. Caregivers of walking participants tended to be spouses, and reported less stress.
Both participant and caregiver factors (participant behavioral disruption and depression; caregiver stress and spousal relationship) impacted whether community-dwelling individuals with AD adhered to a walking program.
American Journal of Alzheimer s Disease and Other Dementias 09/2010; 25(6):505-12. · 1.45 Impact Factor
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ABSTRACT: This study identified perceived physical activity (PA) enablers and barriers among a racially/ethnically and geographically diverse group of older adults. Data were from 42 focus groups conducted with African Americans, American Indians, Latinos, Chinese, Vietnamese, and non-Hispanic Whites (hereafter Whites). Constant-comparison methods were used to analyze the data. Common barriers were health problems, fear of falling, and inconvenience. Common enablers were positive outcome expectations, social support, and PA program access. American Indians mentioned the built environment and lack of knowledge about PA as barriers and health benefits as an enabler more than participants in other groups. Whites and American Indians emphasized the importance of PA programs specifically designed for older adults. Findings suggest several ways to promote PA among older people, including developing exercise programs designed for older adults and health messages promoting existing places and programs older adults can use to engage in PA.
Journal of aging and physical activity 04/2010; 18(2):119-40. · 2.09 Impact Factor
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ABSTRACT: Sleep problems are associated with mood and function disturbances in caregivers of persons with Alzheimer's disease (AD). However, the factors associated with the onset and maintenance of sleep disturbances in caregivers of persons with dementia are unknown, and little attention has been paid to treatments to improve sleep in caregivers. Here we review some of the evidence for the association between caregiver sleep problems, and caregiver and care-recipient demographic, health, and psychosocial variables. We present data from a longitudinal study that examined factors associated with self-reported sleep problems in dementia caregivers and care-recipients over a 5-year follow-up period, and describe the existing caregiver insomnia treatment literature. We conclude with recommendations for future research.
Sleep Medicine Clinics 12/2009; 4(4):519-526.
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The Gerontologist 06/2009; 49 Suppl 1:S108-11. · 2.48 Impact Factor
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The Gerontologist 06/2009; 49 Suppl 1:S1-2. · 2.48 Impact Factor
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ABSTRACT: For individuals with mild cognitive impairment (MCI), memory loss may prevent successful engagement in exercise, a key factor in preventing additional disability. The Resources and Activities for Life Long Independence (RALLI) program uses behavioral principles to make exercise more accessible for these individuals. Exercises are broken into small steps, sequenced, and linked with cues to help participants remember them. Memory aids, easy-to-follow instructions, and tracking forms to facilitate adherence and proper technique are provided to enhance exercise training and compensate for memory loss.
Thirty-seven individuals (M age = 81.9, SD = 5.8, range 70%-96; 78% women) participated in RALLI pilot groups held in retirement residences. Attendance was excellent, with participants attending 90% of classes.
At post-test (12 weeks), 84% of participants had exercised at least once during the prior week, compared with 62% who had exercised at least once during the week prior to baseline (p < .001), mean exercise time increased by 156 min per week (p < .0001), and SF-36 physical components scale significantly improved (p < .002). After 6 months, 76% of participants continued exercising (p < .003) and mean exercise time remained significantly improved (p < .0001).
Persons with MCI can significantly benefit from an exercise program specifically designed to address their cognitive needs. Participants' ratings indicate improvement in perceived physical health and emotional well-being as a result of the intervention. Thus, RALLI is a promising intervention to promote exercise in individuals with MCI.
The Gerontologist 06/2009; 49 Suppl 1:S94-9. · 2.48 Impact Factor
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ABSTRACT: To examine older adults' perceptions of the link between physical activity (PA) and nutrition to the maintenance of cognitive health.
Forty-two focus groups (FGs) were conducted with 396 ethnically diverse (White, African American, American Indian, Chinese, Vietnamese, and Hispanic) community-dwelling older adults. FGs were audio recorded, transcribed verbatim, and coded using a constant comparison method. Responses pertaining to PA and nutrition were analyzed.
Participants noted a positive link between both PA and dietary practices and brain health, although some participants voiced skepticism regarding diet. Walking was most frequently cited as a recommended PA, but participants did not know the recommended frequency, duration, and intensity. Limiting portion sizes; preparing foods in healthier ways; eating more fish, fruits, vegetables, low-fat foods, and chicken; and eating less red meat and chicken with the skin were associated with brain health. Multiple dietary supplements were also discussed. More racial/ethnic differences were noted for PA than for diet.
Interventions and media campaigns may benefit from explicitly linking PA and dietary habits with brain health and helping older adults understand that cardiovascular risk factors are also dementia risk factors. Emphasizing the total diet (vs. specific nutrients) and providing clear messages regarding the frequency, duration, and intensity of recommended PA would also be useful.
The Gerontologist 06/2009; 49 Suppl 1:S61-71. · 2.48 Impact Factor
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ABSTRACT: Evidence suggests that healthy lifestyles may help maintain cognitive health. The Prevention Research Centers Healthy Aging Research Network, 9 universities collaborating with their communities and the Centers for Disease Control and Prevention, is conducting a multiyear research project, begun in 2005, to understand how to translate this knowledge into public health interventions.
This article provides an overview of the study purpose, design, methods, and processes. We examined the literature on promoting cognitive health, convened a meeting of experts in cognitive health and public health interventions, identified research questions, developed a common focus group protocol and survey, established quality control and quality assurance processes, conducted focus groups, and analyzed the resulting data.
We conducted 55 focus groups with 450 participants in 2005-2007, and an additional 20 focus groups and in-depth interviews in 2007-2008. Focus groups were in English, Spanish, Mandarin, Cantonese, and Vietnamese, with African Americans, American Indians, Asian Americans, Hispanics, non-Hispanic Whites, physicians and other health practitioners, rural and urban residents, individuals caring for family or friends with cognitive impairment, and cognitively impaired individuals.
The data provide a wealth of opportunities for designing public health interventions to promote cognitive health in diverse populations.
The Gerontologist 06/2009; 49 Suppl 1:S12-7. · 2.48 Impact Factor
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Rebecca G Logsdon
The Lancet 07/2008; 372(9634):182-3. · 38.28 Impact Factor
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ABSTRACT: To describe the day-to-day variation in sleep characteristics and the concordance between nighttime sleep of persons with Alzheimer's disease (AD) and their family caregivers.
N = 44 community-dwelling older adults with probable or possible AD and their co-residing family caregivers.
Participants wore an Actillume (Ambulatory Monitoring, Inc) for one week and completed an assessment battery to evaluate patient and caregiver mood, physical function, medication use, caregiver behavior management style, and patient cognitive status.
Actigraphically derived sleep measures included bedtime, rising time, total time in bed, total sleep time, number of awakenings, total wake time, and sleep percent (efficiency). For each sleep parameter, total variance was determined for between-subject variance and within-subject variance from day-to-day. Sleep concordance was examined using multinomial logistic regression to compare trichotomous patient-caregiver combinations of good and bad sleepers. For both patients and caregivers, between-subject daily variability accounted for more of the variance in sleep than within-subject variability. Patient depression and caregiver management style were significant predictors both for concordant poor sleep (both patient and caregiver with sleep efficiency < or =85%) and patient-caregiver sleep discordance.
This study provides data that sleep disturbances for persons with AD and their family caregivers vary considerably night to night, and that poor sleep in one member of the caregiving dyad is not necessarily linked to disturbed sleep in the other. Understanding the complex interrelationship of sleep in AD patients and caregivers is an important first step towards the development of individualized and effective treatment strategies.
Sleep 05/2008; 31(5):741-8. · 5.05 Impact Factor
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ABSTRACT: To describe self-reported health status and quality of life (QOL) of ambulatory youths with cerebral palsy (CP) compared with sex- and age-matched typically developing youth (TDY).
Prospective cross-sectional cohort comparison.
Community-based.
A convenience sample of 81 youth with CP (age range, 10-13 y) with Gross Motor Function Classification System (GMFCS) levels I through III and 30 TDY participated. They were recruited from 2 regional children's hospitals and 1 regional military medical center.
Not applicable.
Participants completed the Child Health Questionnaire-Child Form (CHQ-CF87) for health status and the Youth Quality of Life for QOL.
Youth with CP reported significantly lower health status than age- and sex-matched TDY in the following CHQ-CF87 subscales: role/social behavioral physical, bodily pain, physical function, and general health (CP mean rank, 46.8-55.2; TDY mean rank, 62.2-80.9). There were significant differences across GMFCS levels. There were no significant differences in self-reported QOL.
Self-reported health status, but not QOL, appears sensitive to the functional health issues experienced by ambulatory youth with CP. Pain management and psychosocial support may be indicated for them.
Archives of physical medicine and rehabilitation 02/2008; 89(1):121-7. · 2.18 Impact Factor
