Leslie F. Taylor

Aging and Motor Learning of a Functional Motor Task

Purpose: The purpose of this study was to compare the ability of older and younger adults to learn a functional motor task following a single session of directed practice. The task under investigation was the use of a standard walker to get into the passenger side of a four-door sedan using a specific procedure. Methods: Thirty younger community-dwelling adults (aged 20–35), and thirty older community-dwelling adults (aged 61–93), with no diagnosis of dementia and no prior experience using a walker were included in the study. Subjects received individual instruction using a predetermined instruction method and practice in the specific procedure for use of a walker to get into the passenger side of a car. The single practice session lasted a maximum of twenty minutes or 5 practice trials. Performance of the motor task was scored on a specially designed form during the final trial of the training session and again 48 hours later. Results: Younger adults scored significantly higher than the older adults on the final trial of the training session (p < .001), and on the test trial 48 hours after instruction (p < .001). Decline in performance of the motor task over 48 hours was significantly greater for the older adults (p <.002). Conclusion: These findings suggest that older adults do not acquire and maintain a functional motor skill as accurately as younger adults. Motor learning in older adults may be enhanced by expanded initial instruction and by scheduling practice sessions closer to application of the skill.

Psychotropic Drug Use in a Nursing Home: A 6-Year Retrospective

The Omnibus Budget Reconciliation Act of 1987 (OBRA) was a public policy initiative intended to improve nursing home residents’quality of life by providing strict guidelines for the prescription of psychotropic drugs (PD) and physical restraints. This study documents and explains the use of PDs in one nursing home at three points in time: well before (1988), immediately before (1990), and well after (1994) OBRA implementation. In 1994, 64.5% of residents in the nursing home had prescriptions for PDs compared with 71% in 1988 and 1990, but those with a PD prescription had more than one (mean = 2.19). After OBRA implementation, antipsychotic and antidepressant use was higher than at earlier data collection points, whereas anti-anxiety medication prescription was at its lowest. In addition, diagnoses of depression and cognitive impairment had increased dramatically by 1994. Explanations for these findings are provided, including possible aging of residents, change in staffing levels, caregiver anomie, the impact of another legislative bill, and the introduction of the minimum data set.

A Comparison of Functional Outcomes Following a Physical Activity Intervention for Frail Older Adults in Personal Care Homes

Purpose: The purpose of this study was to determine the effectiveness of 2 consecutive 10‐week exercise interventions for increasing functional ability of residents living in personal care homes (PCHs). Methods: Residents in 2 intervention homes (n = 15) participated in a series of exercise classes followed by a walking program. Residents living in 2 PCHs matched for demographic and environmental variables served as controls (n = 15). Pre‐ and post‐test measures (0 weeks and 21 weeks) included the Modified Barthel Index (MBI), the Tinetti Performance‐Oriented Mobility Assessment (POMA), and the Functional Reach Test (FRT). A General Linear Model was used to analyze group (control vs. intervention) by time (0 vs. 21 weeks) interactions as well as changes over time within the intervention group (0 vs. 10 vs. 21 weeks). Results: In comparing the 2 groups at the beginning and end of the intervention, the POMA Balance Subscale showed significant improvement (p = .04) for the intervention group. Within the intervention group, scores of the MBI and POMA increased after the 10‐week exercise class series, then declined exhibiting a significant quadratic relationship (p = .03). Conclusions: It is likely that without the intervention, the gradual decline noted in the control group would have occurred in the intervention group as well. Given that older adults who live in PCHs often experience declines in their activities of daily living (ADL) and independent activities of daily living (IADL) performance, it is critical that physical activity programs be available to residents to mitigate and/or reverse these declines.

Declarative Memory and Motor Learning in the Older Adult

The degree to which declarative memory influences the ability to learn a functional motor task is relevant to clinicians working with older adults. The purpose of this study was to examine the relationship between performance on a memory assessment tool and performance of a novel motor task following a single session of directed practice. Thirty community-dwelling older adults (11 males and 19 females) were tested for declarative memory function using the Wechsler Memory Scale III. Subjects were instructed in a specific procedure for using a walker to transfer into the passenger side of an automobile, and scored on their ability to perform that same task 48 hours after instruction. Scores achieved on the memory tests were compared to scores obtained by performance of that novel motor task. The data were analyzed using correlational and multiple regression techniques, and revealed a moderate relationship between performance on some but not all of the declarative memory tests and retention of the ability to perform the motor task. Together, the measures of declarative memory explained 31% of the variance in motor learning of the functional motor task following a single session of guided practice. When examined separately, the strongest relationship between a single aspect of memory function and motor learning existed between delayed verbal recall and motor learning. Therapists are frequently involved in instructing older adults in the performance of novel motor tasks, and should be prepared to meet the challenges associated with teaching individuals who present with a wide range of memory function.