Kimberly K. Cleary

Prescription Medication Use and Health-Related Quality of Life in Rural Elderly

The purpose of this descriptive study was to examine health-related quality of life (HRQoL) and prescription medication use among older adults living in a rural region of America. Forty-four people aged 65 and older participated. Each participant completed the SF-36®, v2™ and a demographic form. Participants had significantly lower physical component summary (PCS) scores compared to national norms, confirming established evidence that physical function declines with age. Results indicate that medication use did not have an effect on perceived HRQoL although participants reported taking fewer prescription medications than the national average for the elderly.

Reliability and Internal Consistency of the Activities-Specific Balance Confidence Scale

ABSTRACT The Activities-specific Balance Confidence Scale (ABC) was developed to assess balance confidence. While several researchers have used the ABC to measure balance confidence, its psychometric properties are reported by only a few studies. The purpose of this study was to evaluate the ABCs test–retest reliability and internal consistency among a sample of community dwelling older adults. Forty-four subjects aged 65 and older who lived independently in a senior living community participated in the study. Each participant completed the ABC on two separate test days, 6 months apart. Test–retest reliability revealed an intraclass correlation coefficient of 0.879 (95% CI, 0.779–0.934). Internal consistency measured by cronbachs α was 0.973 for both baseline and six-month data. The ABC demonstrated good test–retest reliability and strong internal consistency among a sample of community dwelling older adults; however, internal consistency may be exceedingly high, indicating item redundancy.

Predicting falls in community dwelling older adults using the Activities-specific Balance Confidence Scale

OBJECTIVES Falls are a significant problem associated with aging, and can lead to serious consequences including injury and death. The purpose of this study was to determine whether balance confidence differed between future fallers and non-fallers, and whether the construct prospectively predicted falls. METHODS Forty-five community dwelling older adults aged 65 or older completed the Activities-specific Balance Confidence scale (ABC) and reported falls experienced during the next 6 months. RESULTS Eleven (24.4%) subjects were fallers, and had significantly poorer ABC scores (x=50.6%) than their non-faller counterparts (x=76.3%). The regression model was significant, where the ABC score predicted falls at 6 months. DISCUSSION Our findings suggest that balance confidence differs between fallers and non-fallers, and that ABC scores can predict future falls in community dwelling older adults. CONCLUSION Balance confidence is a fall risk predictor, and thus a critical component of fall risk assessment. Balance confidence should be measured regularly in community dwelling older adults using the ABC.

Perceptions of exercise and quality of life in older patients in the United States during the first year following coronary artery bypass surgery

Abstract Background and purpose: It is important for patients recovering from coronary artery bypass (CAB) surgery to initiate and maintain recommended exercise guidelines. The purpose of this qualitative study was to describe factors that influence adherence to exercise, and perceptions of activity limitations and health-related quality of life (QoL) in older patients recovering from CAB surgery. Subjects: Participants were 28 people aged 65 and older, prospectively recruited from a U.S. hospital following CAB surgery. Procedures: A qualitative description methodology was used to identify factors that influenced participants’ feelings about exercise and QoL. Data were collected using phone interviews 3, 6, and 12 months after surgery. Data were coded by identifying significant statements, grouping them into meaningful units or “themes”, and generating descriptions of participants’ experiences and understandings. Results: Across time points, participants’ most commonly described motivators were that it feels good to exercise, and belief that it improves physical health. The most commonly cited barriers to exercise were other time commitments, inclement weather, and pain/injury/illness related or unrelated to CAB surgery. Discussion and conclusion: Motivating themes remained consistent across the time intervals but the number of responses regarding barriers to exercise increased over time. A better understanding of the patient experience may help to promote exercise initiation and adherence following CAB surgery.

Exercise Adherence Issues, Behavior Change Readiness, and Self-Motivation in Hospitalized Patients with Coronary Heart Disease

Purpose: Exercise and increased physical activity are important lifestyle modifications for patients with coronary heart disease (CHD). The purpose of this study was to identify factors that influence patient adoption of exercise as part of a healthy lifestyle in hospitalized patients with CHD. Methods: Fifty‐one patients hospitalized for a CHD‐related diagnosis were prospectively recruited from a regional medical center. Participants completed 3 self‐report survey instruments during their inpatient hospitalization—Exercise Adherence Questionnaire, Change Readiness Assessment, and Self‐Motivation Scale for Compliance. Results: Thirty‐two men (64%) and 18 women (36%) with a mean age of 65 years (±11.5) participated in this study. Using the Exercise Adherence Questionnaire, participants identified more motivators than barriers to exercise. Based on Change Readiness Assessment responses, only one‐third of participants (33%) were exercising regularly. The mean Self‐Motivation Scale for Compliance score was below the instrument threshold score, indicating low self‐motivation and compliance, and a high likelihood of quitting exercise. Conclusion: Study findings describe current attitudes toward exercise, factors that encourage and limit exercise participation as well as likelihood of maintaining an exercise program in a group of hospitalized patients with CHD. For many patients with CHD, the acute care hospital stay may be the only opportunity to receive education about exercise, adoption of positive health behaviors, and self‐management skills. Also, the medical event and the resulting hospitalization itself can be a powerful motivator for positive health behavior changes.

Predicting falls in older adults using the four square step test

ABSTRACT The Four Square Step Test (FSST) is a performance-based balance tool involving stepping over four single-point canes placed on the floor in a cross configuration. The purpose of this study was to evaluate properties of the FSST in older adults who lived independently. Forty-five community dwelling older adults provided fall history and completed the FSST, Berg Balance Scale (BBS), Timed Up and Go (TUG), and Tinetti in random order. Future falls were recorded for 12 months following testing. The FSST accurately distinguished between non-fallers and multiple fallers, and the 15-second threshold score accurately distinguished multiple fallers from non-multiple fallers based on fall history. The FSST predicted future falls, and performance on the FSST was significantly correlated with performance on the BBS, TUG, and Tinetti. However, the test is not appropriate for older adults who use walkers. Overall, the FSST is a valid yet underutilized measure of balance performance and fall prediction tool that physical therapists should consider using in ambulatory community dwelling older adults.