Bruna R. Gouveia

An evaluation of a nurse-led rehabilitation programme (the ProBalance Programme) to improve balance and reduce fall risk of community-dwelling older people: a randomised controlled trial

OBJECTIVE This study aims to assess the effect of a nurse-led rehabilitation programme (the ProBalance Programme) on balance and fall risk of community-dwelling older people from Madeira Island, Portugal. DESIGN Single-blind, randomised controlled trial. SETTING University laboratory. PARTICIPANTS Community-dwelling older people, aged 65-85, with balance impairments. Participants were randomly allocated to an intervention group (IG; n=27) or a wait-list control group (CG; n=25). INTERVENTION A rehabilitation nursing programme included gait, balance, functional training, strengthening, flexibility, and 3D training. One trained rehabilitation nurse administered the group-based intervention over a period of 12 weeks (90min sessions, 2 days per week). A wait-list control group was instructed to maintain their usual activities during the same time period. OUTCOME Balance was assessed using the Fullerton Advanced Balance (FAB) scale. The time points for assessment were at zero (pre-test), 12 (post-test), and 24 weeks (follow up). RESULTS Changes in the mean (SD) FAB scale scores immediately following the 12-week intervention were 5.15 (2.81) for the IG and -1.45 (2.80) for the CG. At follow-up, the mean (SD) change scores were -1.88 (1.84) and 0.75 (2.99) for the IG and CG, respectively. The results of a mixed between-within subjects analysis of variance, controlling for physical activity levels at baseline, revealed a significant interaction between group and time (F (2, 42)=27.89, p<0.001, Partial Eta Squared=0.57) and a main effect for time (F (2, 43)=3.76, p=0.03, Partial Eta Squared=0.15), with both groups showing changes in the mean FAB scale scores across the three time periods. A significant main effect comparing the two groups (F (1, 43)=21.90, p<0.001, Partial Eta Squared=0.34) confirmed a clear positive effect of the intervention when compared to the control. CONCLUSION This study demonstrated that the rehabilitation nursing programme was effective in improving balance and reducing fall risk in a group of older people with balance impairment, immediately after the intervention. A decline in balance was observed for the IG after a period of no intervention. CLINICAL TRIAL REGISTRATION NUMBER ACTRN12612000301864.

High-Density Lipoprotein Cholesterol Level Relates to Working Memory, Immediate and Delayed Cued Recall in Brazilian Older Adults: The Role of Cognitive Reserve

Aims: The present study set out to investigate the relation of the high-density lipoprotein cholesterol (HDL-C) level to cognitive performance and its interplay with key markers of cognitive reserve in a large sample of older adults. Methods: We assessed tests of working memory, immediate and delayed cued recall in 701 older adults from Amazonas, Brazil. The HDL-C level was derived from fasting blood samples. In addition, we interviewed individuals on their education, past occupation, and cognitive leisure activity. Results: A critically low HDL-C level (<40 mg/dL) was significantly related to lower performance in working memory, immediate and delayed cued recall. Moderation analyses suggested that the relations of the HDL-C level to working memory and delayed cued recall were negligible in individuals with longer education, a higher cognitive level of the job, and greater engagement in cognitive leisure activity. Conclusion: Cognitive reserve accumulated during the life course may reduce the detrimental influences of a critically low HDL-C level on cognitive functioning in old age.

The Relation of Hypertension to Performance in Immediate and Delayed Cued Recall and Working Memory in Old Age: The Role of Cognitive Reserve:

Objective: We investigated the relation of hypertension to cognitive performance and its interplay with key markers of cognitive reserve in a large sample of older adults. Method: We assessed tests of immediate and delayed cued recall and working memory in 701 older adults. We measured systolic blood pressure and interviewed individuals on their education, past occupation, and cognitive leisure activity. Results: Hypertension (≥140 mmHg) was related to lower performance in all three cognitive measures. Moderation analyses suggested that these relations were reduced in individuals with greater engaging in cognitive leisure activity. Hierarchical regression analyses showed that hypertension was not related to any of the three investigated cognitive performance measures when education, cognitive level of job, and cognitive leisure activity were simultaneously taken into account. Discussion: The detrimental influences of hypertension on cognitive functioning in old age may be reduced in individuals with greater cognitive reserve accumulated during the life course.

Multivariate analysis of lifestyle, constitutive and body composition factors influencing bone health in community-dwelling older adults from Madeira, Portugal.

This study describes the association between habitual physical activity (PA), other lifestyle/constitutive factors, body composition, and bone health/strength in a large sample of older adults from Madeira, Portugal. This cross-sectional study included 401 males and 401 females aged 60-79 years old. Femoral strength index (FSI) and bone mineral density (BMD) of the whole body, lumbar spine (LS), femoral neck (FN), and total lean tissue mass (TLTM) and total fat mass (TFM) were determined by dual-energy X-ray absorptiometry-DXA. PA was assessed during face-to-face interviews using the Baecke questionnaire and for a sub-sample by Tritrac accelerometer. Demographic and health history information were obtained by telephone interview through questionnaire. The relationship between habitual PA variables and bone health/strength indicators (whole body BMD, FNBMD, LSBMD, and FSI) investigated using Pearson product-moment correlation coefficient was similar for females (0.098≤r≤0.189) and males (0.104≤r≤0.105). Results from standard multiple regression analysis indicated that the primary and most significant predictors for FNBMD in both sexes were age, TLTM, and TFM. For LSBMD, the most significant predictor was TFM in men and TFM, age, and TLTM in females. Our regression model explained 8.3-14.2% and 14.8-29.6% of the total variance in LSBMD and FNBMD for males and females, respectively. This study suggests that habitual PA is minimally but positively associated with BMD and FSI among older adult males and females and that body composition factors like TLTM and TFM are the strongest determinants of BMD and FSI in this population.

The Cognitive Telephone Screening Instrument (COGTEL): A Brief, Reliable, and Valid Tool for Capturing Interindividual Differences in Cognitive Functioning in Epidemiological and Aging Studies

Aims: The present study set out to evaluate the psychometric properties of the Cognitive Telephone Screening Instrument (COGTEL) in 2 different samples of older adults. Methods: We assessed COGTEL in 116 older adults, with retest after 7 days to evaluate the test-retest reliability. Moreover, we assessed COGTEL in 868 older adults to evaluate convergent validity to the Mini-Mental State Examination (MMSE). Results: Test-retest reliability of the COGTEL total score was good at 0.85 (p < 0.001). Latent variable analyses revealed that COGTEL and MMSE correlated by 0.93 (p < 0.001), indicating convergent validity of the COGTEL. Conclusion: The present analyses suggest COGTEL as a brief, reliable, and valid instrument for capturing interindividual differences in cognitive functioning in epidemiological and aging studies, with the advantage of covering more cognitive domains than traditional screening tools such as the MMSE, as well as differentiating between individual performance levels, in healthy older adults.

The Ethics and the Meaning of Life among College Students

The concern of the ethics and the meaning of life in young adults became universal and are present in all contexts of human life. Such universality is due to the development of modern rationality, to establish a relationship between the intrinsic theoretical dimensions (scientific) and practical dimensions (ethical), originated that are present in the own array of knowledge. This descriptive cross-sectional study, aims to identify the values of the ethical dimension and meaning of life defended by the college students of the Universities of Madeira, Portugal and Fortaleza, Brazil. The sample consists of 605 University students (Madeira = 225 and Fortaleza = 380), with an average age of 21 years and a standard deviation of 2. We used the questionnaire on values (adapted from the European Values Survey). Most of the young people referred to have a religion (60% wood and 78.4% stronghold), being the most Catholic, however, present in your frequency disinterest and, yet, in Brazil there is a greater diversity of religions. Supporting the intervention of religious institutions in situations of everyday life is accepted mostly by Brazilians, with the exception of politics (35.5%). On the other hand, the university students of the University of Madeira understand that Religious Institutions should only give their opinion on racial discrimination (76.6%). Believe in God (90.8% and 55.1% Stronghold) and Soul (80.3% and 66.4% Stronghold) are beliefs more referred to by college students. These results are intended to contribute in the field of research on ethical values and meaning of life in young people. This study contributes to future comparative research among university students and to developing strategic programs in education and health, increasing the success and excellence in the formation of a full citizenship, preventing the fanaticisms and the social discrimination that today devastate the collective globally.

The relation of education, occupation, and cognitive activity to cognitive status in old age: the role of physical frailty

BACKGROUND It remains unclear so far whether the role of cognitive reserve may differ between physically frail compared to less frail individuals. Therefore, the present study set out to investigate the relation of key markers of cognitive reserve to cognitive status in old age and its interplay with physical frailty in a large sample of older adults. METHODS We assessed Mini-Mental State Examination (MMSE) in 701 older adults. We measured grip strength as indicator of physical frailty and interviewed individuals on their education, past occupation, and cognitive leisure activity. RESULTS Greater grip strength, longer education, higher cognitive level of job, and greater engaging in cognitive leisure activity were significantly related to higher MMSE scores. Moderation analyses showed that the relations of education, cognitive level of job, and cognitive leisure activity to MMSE scores were significantly larger in individuals with lower, compared to those with greater grip strength. CONCLUSIONS Cognitive status in old age may more strongly depend on cognitive reserve accumulated during the life course in physically frail (compared to less frail) older adults. These findings may be explained by cross-domain compensation effects in vulnerable individuals.

The Role of Leisure Activities in Mediating the Relationship between Physical Health and Well-Being: Differential Patterns in Old and Very Old Age.

Background: Recently, Paggi et al. [Gerontology 2016;62:450-458] for the very first time showed in a cross-sectional sample of 259 adults aged 18-81 years that the relation of physical health to psychological well-being was mediated via frequency of leisure activity participation. Objective: To extend this framework, we followed theories on successful aging and vulnerability to propose to add a differential perspective predicting that certain individuals may be more vulnerable than others and therefore may show differences in the mediation pattern. Specifically, we examined whether mediation patterns were differential in certain populations, such as in old-old (compared to young-old) adults and in individuals who carried out a low (compared to those with a high) number of activities. Methods: We analyzed data from 3,080 individuals on physical health (number of chronic diseases, subjective health status, and subjective evaluation of change in health over the last 10 years), frequency of participation in 18 leisure activities, and physical and psychological well-being using moderated mediation models with a path model approach that allowed the simultaneous estimation of all model paths, including their significance. Results: We found that the relation of physical health to physical and psychological well-being was mediated via frequency of activity participation. For physical (but not for psychological) well-being, this mediation was more pronounced in old-old (compared to young-old) adults and in individuals who carried out a low (compared to those with a high) number of activities. These moderated mediations were attributable to differential relations of physical health to frequency of activity participation and to differential relations of frequency of activity participation to physical well-being between the investigated moderator levels. Conclusion: Present data suggest that participation in leisure activities may play a key role in mediating the relationship between physical health and well-being, particularly in very old age. Findings are discussed with respect to theories of successful aging and differences between physical and psychological well-being.

The relationship of physical activity to high-density lipoprotein cholesterol level in a sample of community-dwelling older adults from Amazonas, Brazil

OBJECTIVES (1) To study the relation of physical activity (PA) to high-density lipoprotein cholesterol (HDL-C) and (2) to investigate if the strength of these associations holds after adjustments for sex, age, and other key correlates. METHODS This study included 550 older adults from Amazonas. HDL-C was derived from fasting blood samples. PA at sport and leisure, smoking, alcohol consumption, and socioeconomic status (SES) were interviewed. Waist circumference (WACI) was assessed. RESULTS HDL-C was positively related to PA sport, PA leisure, and SES (0.22≤r≤0.34; p≤0.001) and negatively related to smoking and WACI (r≤-0.10; p<0.05). Controlling for sex and age did not affect these relationships. Hierarchical multiple regression analyses showed that the relation of HDL-C to PA sport and leisure remained significant when controlling for all other investigated correlates (0.14≤β≤0.24; p≤0.001). DISCUSSION In order to prevent low HDL-C in older adults, promoting PA seems to be an important additional component besides common recommendations concerning weight reduction.

European Academy of Nursing Science 2016 Summer Conference

Background Nurses have a twofold role in healthcare. On one hand, they provide care to patients who are not able to take care of themselves. On the other hand nurses play a vital role as guardians of patient safety. It is mainly on the second role of nurses that the EU funded RN4CAST project is focusing. Materials and methods Data from more than 33,000 nurses and 11,000 patients in 500 hospitals from 12 European countries were collected from 2009 until 2011. It is one of the largest databases in the world on nurses staffing and its impact on patient safety. Results One of the main results [1] is that an increase in a nurses’ workload by one patient increases the likelihood of an inpatient dying within 30 days of admission by 7%. And every 10% increase in bachelor’s degree nurses is associated with a decrease in this likelihood by 7%. Relating this finding to the human error theory of James Reason, there seem to be a knowledge problem in early detecting of risks and adverse events. Secondly there are some slips and lapses in execution because of a too high workload. As an example, one out of four nurses say that they didn’t have the time to perform proper patient surveillance [2]. Again, this is explained by nurse staffing, education, working environment and non-nursing tasks to be performed. Discussion and conclusions In the follow-up of the report of the Institute of Medicine on “to err is human” [3], the crucial role of nurses in patient safety is highly underestimated [4]. This is mainly because the evidence is recent and mainly based on observational data. But the evidence is growing and consistent and strong evaluated against the Bradford-Hill criteria of causation (1965), showing that mechanisms are well understood, can be replicated across populations and settings and are time and dose-response related. Based on the available evidence, we see that some countries are adapting already their legislation to provide safe nurse staffing ratios to create a safe environment for their patients.