Maayan Agmon

A systematic review of interventions conducted in clinical or community settings to improve dual-task postural control in older adults

Background Injury due to falls is a major problem among older adults. Decrements in dual-task postural control performance (simultaneously performing two tasks, at least one of which requires postural control) have been associated with an increased risk of falling. Evidence-based interventions that can be used in clinical or community settings to improve dual-task postural control may help to reduce this risk. Purpose The aims of this systematic review are: 1) to identify clinical or community-based interventions that improved dual-task postural control among older adults; and 2) to identify the key elements of those interventions. Data sources Studies were obtained from a search conducted through October 2013 of the following electronic databases: PubMed, CINAHL, PsycINFO, and Web of Science. Study selection Randomized and nonrandomized controlled studies examining the effects of interventions aimed at improving dual-task postural control among community-dwelling older adults were selected. Data extraction All studies were evaluated based on methodological quality. Intervention characteristics including study purpose, study design, and sample size were identified, and effects of dual-task interventions on various postural control and cognitive outcomes were noted. Data synthesis Twenty-two studies fulfilled the selection criteria and were summarized in this review to identify characteristics of successful interventions. Limitations The ability to synthesize data was limited by the heterogeneity in participant characteristics, study designs, and outcome measures. Conclusion Dual-task postural control can be modified by specific training. There was little evidence that single-task training transferred to dual-task postural control performance. Further investigation of dual-task training using standardized outcome measurements is needed.

Increased Insomnia Symptoms Predict the Onset of Back Pain among Employed Adults

Background Back pain is among the most prevalent pain disorders causing chronic disability among adults, and insomnia is a common co-morbidity. However, whether insomnia precedes back pain or vice versa remains unclear. The current study tested the temporal association between insomnia and back pain. Methods A longitudinal design was used to investigate whether changes in insomnia over time predict the onset of back pain and vice versa. The study was conducted on a cohort of active healthy working adults (N = 2,131, 34% women) at three time points (T1, T2, and T3) over a period of 3.7 years (range = 2.2–5.12) years. Logistic regression analysis was used to test whether increased insomnia symptoms from T1 to T2 predicted the onset of new back pain. Ordinary least squares regression was used to test whether the existence of back pain at T2 predicted an increase in insomnia from T2 to T3. Results The results indicated that after controlling for socioeconomic variables, self-reported health, lifestyle behaviors, and anthropometrics, a T1–T2 increase in insomnia symptoms was associated with a 1.40-fold increased risk of back pain at T3 (OR = 1.40; 95% CI = 1.10–1.71). No support was found for reverse causation; i.e., that back pain predicts subsequent increase in insomnia. Conclusions Insomnia appears to be a risk factor in the development of back pain in healthy individuals. However, no evidence of reverse causation was found.

The Effects of EnhanceFitness (EF) Training on Dual-Task Walking in Older Adults

Decline in dual-task walking performance is associated with increased risk of falls among older adults. The objective of this study is to determine whether 18 hr of participation in EnhanceFitness (EF), an evidence-based group exercise program, improves dual-task walking performance among community-dwelling older adults. Twenty-eight healthy, community-dwelling older adults were evaluated before participating in EF and after 18 hr of participation. Gait speed was evaluated under single task and dual tasks using the TUG (Timed Up and Go) and 1-min walk tests. Dual-task costs (DTC), the relative cost of dual-task performance compared to single-task performance, were calculated for both cognitive and motor tasks. Postural control and executive functions were evaluated as well. After 18 hr of EF, dual-task walking performance improved. Single-task performance improved as well as postural control and executive function. There was no significant change in DTC across all measurements, except for the cognitive task of the TUG.

Association Between 900 Steps a Day and Functional Decline in Older Hospitalized Patients

Among patients whose refill records suggested they had 7 days’ supply or less on hand, patients in the anticipatory outreach group were more likely than controls to refill a medication within 7 days (26.9% vs 26.3%; OR, 1.03, 95% CI, 1.001.06) (Table 2). However, this effect was not consistent across medication types and was most notably observed among patients taking antiseizure medications (29.7% vs 26.1%; OR, 1.20; 95% CI, 1.02-1.41).

The Association between Hearing Loss, Postural Control, and Mobility in Older Adults: A Systematic Review

Background: Degraded hearing in older adults has been associated with reduced postural control and higher risk of falls. Both hearing loss (HL) and falls have dramatic effects on older persons’ quality of life (QoL). A large body of research explored the comorbidity between the two domains. Purpose: The aim of the current review is to describe the comorbidity between HL and objective measures of postural control, to offer potential mechanisms underlying this relationship, and to discuss the clinical implications of this comorbidity. Data Collection and Analysis: PubMed and Google Scholar were systematically searched for articles published in English up until October 15, 2015, using combinations of the following strings and search words: for hearing: Hearing loss, “Hearing loss,” hearing, presbycusis; for postural control: postural control, gait, postural balance, fall, walking; and for age: elderly, older adults. Results: Of 211 screened articles, 7 were included in the systematic review. A significant, positive association between HL and several objective measures of postural control was found in all seven studies, even after controlling for major covariates. Severity of hearing impairment was connected to higher prevalence of difficulties in walking and falls. Physiological, cognitive, and behavioral processes that may influence auditory system and postural control were suggested as potential explanations for the association between HL and postural control. Conclusions: There is evidence for the independent relationship between HL and objective measures of postural control in the elderly. However, a more comprehensive understanding of the mechanisms underlying this relationship is yet to be elucidated. Concurrent diagnosis, treatment, and rehabilitation of these two modalities may reduce falls and increase QoL in older adults.

A cross-sectional study of the association between mobility test performance and personality among older adults

BackgroundFalls among the elderly are a major public health challenge. The Timed-Up and Go (TUG) test is commonly used to identify older adults with mobility limitations. This study explored the association between TUG test results and personality among community-dwelling older adults.MethodsThis cross-sectional study included 85 older adults. Personality was evaluated with the Five Factor Model. Times to complete the TUG as a single task (TUGST) alone and also with an additional cognitive task i.e., dual-task (DT), were recorded. Ordinary least squares OLS regression models were used to examine the associations between personality factors and both single DT TUG.ResultsExtraversion was found to be inversely associated with time to complete the TUGST (β = -.26, p < .05). Conscientiousness was inversely associated with TUGDT (β = -.24, p < .01).ConclusionsFindings from this study highlight the relationship between personality and the TUG test. Specifically, older adults with high Extraversion completed the TUGST test more quickly than those who had lower measures of this trait and, people with high Conscientiousness completed the TUGDT tests more quickly. These findings may contribute to early identification of older adults at higher risk from mobility limitations and falls, and to developing personality-tailored interventions for fall prevention.

Even a small change can make a big difference: the case of in-hospital cognitive decline and new IADL dependency

BACKGROUND post-hospitalisation functional decline is a widely described phenomenon, yet factors related to new disability in instrumental activities of daily living (IADL) in previously independently functioning older adults are rarely studied. OBJECTIVE to test whether change in cognitive status from admission to discharge during short-term acute-care hospitalisation is associated with the incidence of medium-term post-hospitalisation IADL dependency. DESIGN prospective cohort study. SETTING internal medicine wards in two Israeli medical centres. SUBJECTS two hundred and seventy-two hospitalised older adults (≥70) who were independent in self-care and mobility activities at admission, at discharge and 1 month after discharge, and who were independent in IADL pre-admission. METHODS cognitive status was evaluated at admission and at discharge using Pfeiffers Short Portable Mental Status Questionnaire (SPMSQ). One-month post-discharge, IADL was assessed using Lawton and Brodys scale by telephone. RESULTS incidence of IADL dependency was 74/272 (27.2%). Controlling for length of stay, co-morbidities, re-hospitalisation and age, a one-unit decrease in SPMSQ score during hospital stay was associated with 1.57 higher odds (95% CI, 1.14-2.15) of post-hospitalisation new IADL dependency. The odds of new IADL dependency were also significantly higher in participants who were rehospitalised within the previous month (odds ratio = 2.65; 95% CI, 1.25-5.62). CONCLUSIONS decline in SPMSQ score during acute hospitalisation has a detrimental effect on functional decline after acute hospitalisation, defined by incidence IADL dependency. This finding emphasises the need to identify cognitive decline during hospitalisation to allow timely intervention to prevent post-discharge functional decline in this population.

The relationship between mentoring on healthy behaviors and well-being among Israeli youth in boarding schools: a mixed-methods study

BackgroundAlthough 10% of Israeli youth live in boarding schools, few studies, except for those focusing on mental health, have examined the well-being of this population subgroup. Thus, the aims of this study were to explore: (1) the prevalence rates of five aspects of well-being (i.e., healthy habits, avoidance of risky behaviors, peer relationships, adult relationships, and school environment) in youth residing at Israeli boarding schools; (2) the relationships between youth well-being and youth perception of their mentor; and (3) the different subgroups of youth with higher rates of risky and healthy behaviors.MethodsThis study used a mixed-methods approach including a quantitative survey of youth (n = 158) to examine the association between youth behaviors and perception of their mentor; and a qualitative study consisting of interviews (n = 15) with boarding school staff to better understand the context of these findings.ResultsGreater proportions of boarding school youth, who had positive perceptions of their mentor (the significant adult or parent surrogate), believed both that their teachers thought they were good students (p < 0.01), and that they themselves were good students (p < 0.01). This finding is supported by the qualitative interviews with mentors. Youth living in a boarding school had very similar healthy habits compared to other youth living in Israel; however, youth in the general population, compared to those in the boarding schools, were eating more sweets (OR = 1.39, 95% CI = 1.02-1.90) and engaging in higher levels of television use (OR = 2.64, 95% CI = 1.97-3.54).ConclusionsMentors, the significant adult for youth living in residential education environments, have a major influence on school performance, the major focus of their work; mentors had no impact on healthy behaviors. Overall, there were many similarities in healthy behaviors between youth at boarding schools and youth in the general population; however, the differences in healthy habits seemed related to policies governing the boarding schools as well as its structural elements.

Sleep quality is associated with walking under dual-task, but not single-task performance

OBJECTIVES The objective of this study was to assess the relationship between sleep behavior and gait performance under single-task (ST) and dual-task (DT) walking conditions in community- dwelling older adults. METHODS Walking under ST and DT conditions was evaluated in 34 community-dwelling older adults, 64.7% women, mean age 71.5 (SD±5.8). Gait-speed and gait-variability data were collected using the OPAL wearable sensors of the Mobility Lab. Sleep behavior (sleep efficiency [SE] and sleep latency [SL]) was assessed using actigraphy, over 5 consecutive nights. RESULTS Lower SE was associated with decreased gait speed and increased stride-length variability during DT (rs=0.35; p=0.04; rs=-0.36; p=0.03, respectively), whereas longer SL was associated with increased stride-length variability during DT (rs=0.38; p=.03). After controlling for age and cognition, SE accounted for 24% and 33% of the variability in stride length and stride time. No associations were found between sleep and gait measures under ST walking. CONCLUSIONS Lower SE is associated with decreased gait speed and increased gait variability under DT conditions that are indicative of an increased risk for falls in older adults. Our findings support clinical recommendations to incorporate the evaluation of sleep quality in the context of risk assessment for falls.

The effect of different types of walking on dual-task performance and task prioritization among community-dwelling older adults.

Background. The ability to safely conduct different types of walking concurrently with a cognitive task (i.e., dual task) is crucial for daily life. The contribution of different walking types to dual-task performance has not yet been determined, nor is there agreement on the strategies that older adults use to divide their attention between two tasks (task prioritization). Objectives. To compare the effect of walking in three different directions (forward, backward, and sideways) on dual-task performance and to explore the strategies of older adults to allocate their attention in response to different motor task demands. Design. A cross-sectional study. Subjects. Thirty-two (22 female) community-dwelling older adults (aged 72.7±5.7 years). Methods. Subjects randomly conducted single and dual task: walking to three directions separately, cognitive tasks separately, and combination of the two. Results. Walking forward was the least demanding task, during single (FW < BW, SW) (P < .001) and dual tasks (FW < BW < SW) (P < .001). The calculation of DTC revealed the same pattern (P < .001). DTC of the cognitive tasks was not significantly different among the three walking types. Conclusions. The decline mainly in the motor performance during dual task indicates that participants prioritized the cognitive task. These findings challenge the “posture first” paradigm for task prioritization.