Ellen Gorus

Motivators and barriers for physical activity in the oldest old: A systematic review

Worldwide, people engage insufficiently in physical activity, particularly subjects aged 80 years and over. For optimal life-style campaigns, knowledge of motivators and barriers for physical activity is mandatory. Given their specific needs, it is conceivable that these would be different for the oldest old compared to younger subjects. Pubmed, Web of Science and Psychinfo were systematically screened for articles reporting motivators and barriers for physical activity. Papers were excluded if data regarding elderly aged >79 years were absent. Forty-four relevant articles were included, involving a total of 28,583 subjects. Sixty one motivators and 59 barriers for physical activity in the elderly were identified, including those who are relevant for persons aged 80 years and over. Based on the results of our literature review, we recommend that when promoting physical activity in the oldest old, special attention is paid to the health benefits of physical activity, to the subjects fears, individual preferences and social support, and to constraints related to the physical environment. However, no studies were found exclusively describing people aged 80 years and over, and future research is necessary to differentiate the barriers or motivators that are specific for the oldest old from those of younger elderly.

Handgrip performance in relation to self-perceived fatigue, physical functioning and circulating IL-6 in elderly persons without inflammation

BackgroundLow grip strength is recognized as one of the characteristics of frailty, as are systemic inflammation and the sensation of fatigue. Contrary to maximal grip strength, the physical resistance of the muscles to fatigue is not often included in the clinical evaluation of elderly patients. The aim of this study was to investigate if the grip strength and the resistance of the handgrip muscles to fatigue are related to self-perceived fatigue, physical functioning and circulating IL-6 in independently living elderly persons.MethodsForty elderly subjects (15 female and 25 male, mean age 75 ± 5 years) were assessed for maximal grip strength, as well as for fatigue resistance and grip work (respectively time and work delivered until grip strength drops to 50% of its maximum during sustained contraction), self perceived fatigue (VAS-Fatigue, Mob-Tiredness scale and the energy & fatigue items of the WHOQOL-100), self rated physical functioning (domain of physical functioning on the MOS short-form) and circulating IL-6. Relationships between handgrip performance and the other outcome measures were assessed.ResultsIn the male participants, fatigue resistance was negatively related to actual sensation of fatigue (VAS-F, p < .05) and positively to circulating IL-6 (p < .05). When corrected for body weight, the relations of fatigue resistance with self-perceived fatigue became stronger and also apparent in the female. Grip strength and grip work were significantly related with several items of self-perceived fatigue and with physical functioning. These relations became more visible by means of higher correlation coefficients when grip strength and grip work were corrected for body weight.ConclusionWell functioning elderly subjects presenting less handmuscle fatigue resistance and weaker grip strength are more fatigued, experience more tiredness during daily activities and are more bothered by fatigue sensations. Body weight seems to play an important role in the relation of muscle performance to fatigue perception. Elderly patients complaining from fatigue should be physically assessed, both evaluating maximal grip strength and fatigue resistance, allowing the calculation of grip work, which integrates both parameters. Grip work might best reflect the functional capacity resulting from the development of a certain strength level in relation to the time it can be maintained.

Reaction Times and Performance Variability in Normal Aging, Mild Cognitive Impairment, and Alzheimer's Disease:

This study evaluated whether reaction times (RT) and performance variability are potential markers for the early detection of Alzheimers disease (AD). Cognitively healthy elderly (n = 218), persons with amnestic MCI (a-MCI) (n = 29) and patients with AD (n = 50) were examined with RT tasks with increasing complexity, subdividing RT into a decision and a movement component. Persons with cognitive deterioration demonstrated more intra-individual variability and more slowing than cognitively healthy elderly. The slowing in AD affects both the cognitive and the motor component, while performance variability mainly affects the cognitive component of the RT. Although in a-MCI not all differences reached statistical significance, primarily the cognitive component of the RT is affected in a-MCI. Intra-individual variability and RT of the complex tasks are the best predictors for a-MCI and AD status, respectively. We conclude that performance variability can be regarded as a useful preclinical marker for AD.

The advanced activities of daily living: A tool allowing the evaluation of subtle functional decline in mild cognitive impairment

ObjectivesAssessment of advanced activities of daily living (a-ADL) can be of interest in establishing the diagnosis of Alzheimer’s disease (AD) in an earlier stage, since these activities demand high cognitive functioning and are more responsive to subtle changes. In this study we tested a new a-ADL tool, developed according to the International Classification of Functioning, Disability and Health (ICF). The a-ADL tool is based on the total number of activities performed (TNA) by a person and takes each subject as his own reference. It distinguishes a total Disability Index (a-ADL-DI), a Cognitive Disability Index (a-ADL-CDI), and a Physical Disability Index (a-ADL-PDI), with lower score representing more independency. We explored whether these indices allow distinction between cognitively healthy persons, patients with Mild Cognitive Impairment (MCI) and patients with mild AD.MethodsParticipants were on average 80 years old (SD 4.6; 66–90), were community dwelling, and were diagnosed as (1) cognitively healthy subjects (n=26); (2) patients with MCI (n = 17), or (3) mild AD (n = 25), based upon extensive clinical evaluation and a set of global, cognitive, mood and functional assessments. The a-ADL-tool was not part of the clinical evaluation.ResultsThe a-ADL-CDI was significantly different between the three groups (p<.01). The a-ADL-DI was significantly different between MCI and AD (p<.001). The tool had good psychometrical properties (inter-rater reliability; agreement between patient and proxy; correlations with cognitive tests). Although the sample size was relatively small, ROC curves were computed for the a-ADL-DI and a-ADL-CDI with satisfactory and promising results.ConclusionThe a-ADLCDI and a-ADL-DI might offer a useful contribution to the identification and follow up of patients with mild cognitive disorders in an older population.

Age-related differences in pre-movement antagonist muscle co-activation and reaction-time performance.

Multiple causes contribute to the prolonged reaction-times (RT) observed in elderly persons. The involvement of antagonist muscle co-activation remains unclear. Here the Mm. Biceps and Triceps Brachii activation in 64 apparently healthy elderly (80 ± 6 years) and 60 young (26 ± 3 years) subjects were studied during a simple RT-test (moving a finger using standardized elbow-extension from one pushbutton to another following a visual stimulus). RT was divided in pre-movement-time (PMT, time for stimulus processing) and movement-time (MT, time for motor response completion). RT-performance was significantly worse in elderly compared to young; the slowing was more pronounced for MT than PMT (respectively 101 ± 10 ms and 41 ± 6 ms slower, p<0.01). Elderly subjects showed significantly higher (p<0.01) antagonist muscle co-activation during the PMT-phase, which was significantly related to worse MT and RT (p<0.01). During the MT-phase, antagonist muscle co-activation was similar for both groups. It can be concluded that increased antagonist muscle co-activation in elderly persons occurs in an early phase, already before the start of the movement. These findings provide further understanding of the underlying mechanisms of age-related slowing of human motor performance.

Diversity, dispersion and inconsistency of reaction time measures: effects of age and task complexity.

Background and aims: Performance variability of reaction time is regarded as an important parameter for cognitive functioning with aging. We investigated three types of variability, diversity (or variability between persons), dispersion (variability across trials within one task) and inconsistency (variability across testing occasions), while distinguishing between decision time and movement time and evaluating performance across comparable complexity levels. Methods: A single stratified reaction time test based on tasks with increasing complexity was used to evaluate inter- and intra-performance variability of 27 older (age 75±5 years) and 27 younger (age 29±7 years) participants, subdividing reaction time into decision and movement components. Results: There were consistent age and complexity differences for all variability types in our sample. When controlling for processing speed, which was slower in the older group, variability across age groups and task complexity tended to diminish and a more complex picture emerged. The elderly group showed a higher diversity of all reaction time measures, except for movement time, and a higher dispersion of decision time. Task complexity significantly affected the diversity of movement and overall reaction times and the dispersion of all reaction time measures, except for movement time. Conclusions: These results highlight the importance of variability in cognitive functioning; it may be an important phenomenon for study and a useful indicator for cognitive deterioration. The reaction time test we propose is easy to use and can be applied in clinical practice.

Attentional processes discriminate between patients with mild Alzheimer's disease and cognitively healthy elderly

BACKGROUND It is generally accepted that Alzheimers disease (AD) is mainly characterized by memory disorders. Although recent studies also point to an important role of attention deficits early in the disease, this notion has not yet emerged in clinical practice. Our aim was to assess whether attention, quantified by reaction times, can discriminate between patients with mild AD and controls and therefore contribute to clinical diagnosis. METHODS In a cross-sectional study, 33 patients with mild AD were matched with cognitively healthy elderly controls for age, gender, educational level and depressive mood. Selective attention (SA), alternating attention (AA) and error-rates were measured by a modified reaction time test. RESULTS Significant differences between both groups were found for all measures. Logistic regression showed that SA (corrected for individual processing speed) and error-rates could correctly classify subjects with an overall hit ratio of 81%. When attention measures were not corrected for individual processing speed, the overall hit ratio improved to 97%. CONCLUSION SA and AA deteriorate in patients with mild AD and these measures can be used to discriminate between patients and matched controls, independently of depressive mood.

Motivators and barriers for physical activity in older adults with osteoporosis

Background and Purpose:Although physical activity (PA) is an important tool to counter osteoporosis, too few older patients with osteoporosis (OPWO) engage in PA. Little is known about specific motivators for and barriers to PA in OPWO, hindering the development of targeted PA promotion campaigns for these persons. Therefore, the main objective of this study was to identify motivators for and barriers to PA specifically in OPWO. Methods:This qualitative study identified specific motivators for and barriers to PA in OPWO through 2 different methods: focus groups with professionals and in-depth interviews with OPWO. Results:The OPWO tended to give a broad interpretation of what they considered as PA (practicing sports, physical work, and performing household activities), whereas the professionals seemed to mainly focus on (therapeutic) exercise as PA. Fifteen different motivators and 18 barriers have been identified. Among others, health improvement, social contact, habit, feeling good, and receiving medical advice from a medical doctor were motivators. Pain, fear of falling, bad weather, lack of interest, and caring for an ill partner were barriers to PA. For some older respondents, osteoporosis acted as a trigger for PA, and for others it was a barrier. Conclusions:This study emphasizes the importance for health care professionals to give personalized PA advice regarding the nature and frequency of PA that is safe and beneficial for osteoporosis. It stands to reason that the information about PA needs to be clear and consistent. Furthermore, it is quintessential to mention that it can take some time to adapt to physical exercise and to experience the beneficial effects, because pain sensations during the first PA sessions can be perceived as barriers to OPWO. Misconceptions or barriers to PA should be countered by assessing motivators for and barriers to PA by the health care professional together with the older client so that barriers can be eliminated and motivators can be strengthened. Physical activity education should involve not only the OPWO but also their relatives, friends, and important peers. Different social aspects of PA and the encouragements from peers are stimulating for older adults to initiate and to continue PA. The results of our study can constitute a starting point for further research to identify the motivators for and barriers to PA with the highest impact on PA behavior in OPWO, thus enabling evidence-based PA promotion campaigns for this patient group.

The influence of galantamine on reaction time, attention processes, and performance variability in elderly Alzheimer patients

Objective: To examine the effect of galantamine in elderly patients with mild to moderate Alzheimer disease (AD) on reaction time (RT), selective (SA) and alternating attention (AA), errors, and on interindividual and intraindividual variability. Methods: Forty-one outpatients with AD were included in an open-label prospective trial and evaluated at baseline and after 8 and 22 weeks of treatment using a RT test that allows differentiation between the decision and movement time components of the total RT. The various tasks of the RT test allowed calculation of SA and AA. Standard AD evaluation tests were performed at baseline and after 22 weeks. Results: After 8 and 22 weeks of treatment, an improvement of decision time and RT at all complexity levels was noted. For movement time, improvements were less pronounced and not present at both follow-up moments or at all complexity levels. Selective attention, but not AA, improved significantly after 22 weeks. A decrease in the number of errors was noted. At several complexity levels, both at 8 and 22 weeks, the interindividual and intraindividual variability decreased. Changes in Mini Mental State Evaluation score were correlated with those in SA. Conclusions: Our study provides arguments that galantamine treatment improves various parameters of the RT, attention, and interindividual and intraindividual variability in elderly AD patients. Because the study is not a controlled trial, further investigation is needed.

Early diagnosis of mild cognitive impairment and mild dementia through basic and instrumental activities of daily living: Development of a new evaluation tool

Background Assessment of activities of daily living (ADL) is paramount to determine impairment in everyday functioning and to ensure accurate early diagnosis of neurocognitive disorders. Unfortunately, most common ADL tools are limited in their use in a diagnostic process. This study developed a new evaluation by adopting the items of the Katz Index (basic [b-] ADL) and Lawton Scale (instrumental [i-] ADL), defining them with the terminology of the International Classification of Human Functioning, Disability and Health (ICF), adding the scoring system of the ICF, and adding the possibility to identify underlying causes of limitations in ADL. Methods and findings The construct validity, interrater reliability, and discriminative validity of this new evaluation were determined. From 2015 until 2016, older persons (65–93 y) with normal cognitive ageing (healthy comparison [HC]) (n = 79), mild cognitive impairment (MCI) (n = 73), and Alzheimer disease (AD) (n = 71) underwent a diagnostic procedure for neurocognitive disorders at the geriatric day hospital of the Universitair Ziekenhuis Brussel (Brussels, Belgium). Additionally, the ICF-based evaluation for b- and i-ADL was carried out. A global disability index (DI), a cognitive DI (CDI), and a physical DI (PDI) were calculated. The i-ADL-CDI showed high accuracy and higher discriminative power than the Lawton Scale in differentiating HC and MCI (area under the curve [AUC] = 0.895, 95% CI .840–.950, p = .002), MCI and AD (AUC = 0.805, 95% CI .805–.734, p = .010), and HC and AD (AUC = 0.990, 95% CI .978–1.000, p < .001). The b-ADL-DI showed significantly better discriminative accuracy than the Katz Index in differentiating HC and AD (AUC = 0.828, 95% CI .759–.897, p = .039). This study was conducted in a clinically relevant sample. However, heterogeneity between HC, MCI, and AD and the use of different methods of reporting ADL might limit this study. Conclusions This evaluation of b- and i-ADL can contribute to the diagnostic differentiation between cognitively healthy ageing and neurocognitive disorders in older age. This evaluation provides more clarity and nuance in assessing everyday functioning by using an ICF-based terminology and scoring system. Also, the possibility to take underlying causes of limitations into account seems to be valuable since it is crucial to determine the extent to which cognitive decline is responsible for functional impairment in diagnosing neurocognitive disorders. Though further prospective validation is still required, the i-ADL-CDI might be useful in clinical practice since it identifies impairment in i-ADL exclusively because of cognitive limitations.