Background Both standard impairment-based and motor learning exercise have improved walking speed. Less known is the impact of the interventions on the motor skill of walking. In older adults with walking problems, intervention effects of standard exercise with added components of motor learning exercise (standard plus) were compared to standard exercise alone on the motor skill of walking. Methods Community-dwelling older adults (>= 65 years of age) were randomized to 12-week interventions, standard plus (n = 124) or standard exercise alone (n = 125). Motor skill of walking outcomes of oxygen cost of walking, gait variability, smoothness of walking and the walk ratio were recorded at 12 weeks, and in follow up at 24 and 36 weeks. Results The older adults (n = 249) had a mean +/- SD age of 77.4 +/- 6.6 years, mean +/- SD walking speed, 1.07 +/- 0.17 m/s. No differences between groups observed in the motor skill of walking outcomes at any time point, except change in stance time variability at 24 weeks, in standard plus, mean +/- SD -0.003 +/- 0.012 compared to standard, mean +/- SD 0.006 +/- 0.071, adjusted difference +/- SE, -0.0098 +/- 0.0040, P = .0154, likely a spurious finding. Oxygen cost of walking improved after both interventions, standard plus, change in the oxygen cost, mean +/- SD, -0.052 +/- 0.060 ml/kg m at 12 weeks, -0.047 +/- 0.057 ml/kg m at 24 weeks and -0.041 +/- 0.061 ml/kg m at 36 weeks and in standard, mean +/- SD, -0.046 +/- 0.062 ml/kg m at 12 weeks, -0.039 +/- 0.066 ml/kg m at 24 weeks and -0.041 +/- 0.073 ml/kg m at 36 weeks, all P < .0001, and stance time variability improved in standard plus at 12 weeks, mean +/- SD, -0.002 +/- 0.013, maintained at 24 and 36 weeks; the change at 12 weeks nonsignificant with multiplicity correction. Conclusions There were no differences in the motor skill of walking outcomes between the intervention groups. Oxygen cost of walking improved after both the standard and the standard plus timing and coordination exercise and the improvement sustained without continued exercise for 24 weeks after intervention. ClinicalTrials.gov Identifier NCT02663778.
Background Hospitalised older adults are at increased risk of hospitalisation-associated disability.Objective to investigate the effects of an in-hospital exercise program on functional and cognitive outcomes in older adults admitted to an Acute Care for the Elderly (ACE) unit.Methods This randomised controlled trial included acutely hospitalised older adults (>= 70 years) randomised to an exercise intervention based on VIVIFRAIL program [intervention group (IG)] or usual care [control group (CG)]. Exercise intervention included resistance/power training, balance and gait exercises. Primary outcome was the Short Physical Performance Battery (SPPB). Secondary outcomes included handgrip strength, gait speed, balance, timed-up-and-go, sit-to-stand (STS) time and relative STS power, global cognitive function using Mini Mental State Examination (MMSE), executive function and depressive symptoms. Assessments were performed at ACE unit admission and discharge. Analyses followed the intention-to-treat principle using generalised estimating equations.Results Forty-seven participants (83.1 +/- 5.1 years, 33% women) were randomised into the groups and performed 4 +/- 2 exercise sessions across the hospitalisation period. Significant time & times; group interactions were found for SPPB, STS time, maximal and mean relative STS power, balance and MMSE, favouring IG compared to CG. Between-groups mean differences at discharge were observed for SPPB [3.18 points, 95% CI (1.3, 5.1)], STS time [-11.3 s, (-20.6, -1.9)], maximal relative STS power [1.45 W/Kg, (0.3, 2.5)], mean relative STS power [0.70 W/Kg, (0.2, 1.2)] and MMSE [2.16 points, (0.6, 3.7)] favouring IG compared to CG.Conclusion Multicomponent exercise may attenuate physical and cognitive declines during acute hospitalisation. These findings support the implementation of structured exercise programmes during hospitalisation. (Registration number: NCT06682598).
Background Acute hospitalization often triggers functional decline in older adults. While multicomponent exercise programs (MEP) are effective, the role of immersive Virtual Reality (VR) remains underexplored in acute geriatric wards. This study evaluated the efficacy of a VR-enhanced MEP program compared with conventional MEP and usual care (UC).Methods Randomized, three-arm, parallel clinical trial in an acute geriatric ward. Patients aged >= 75 years were randomized to receive 1) MEP, 2) MEP-VR, or 3) UC. The primary outcome was the change in functional capacity, as measured by the Short Physical Performance Battery (SPPB). Secondary outcomes included the Timed Up and Go (TUG) test, cognitive status (MMSE), Barthel Index, Quality of Life (EuroQol-5D-5L), and muscle strength.Results A total of 156 participants were enrolled (mean age, 86.4 [SD 5.2] years). Regarding the primary outcome, MEP was significantly more effective than MEP-VR. The between-group difference in SPPB was 1.04 points (95% CI: 0.33, 1.75) for MEP vs. UC and 0.13 points (95% CI: -0.64, 0.89) for MEP-VR vs. UC. Direct comparison showed MEP-VR performed lower than MEP (-0.91 points; 95% CI: -1.67, -0.16). Regarding cognitive function, between-group analysis showed superior improvements in both intervention arms versus control, with MEP-VR demonstrating a significant advantage (+1.90 points; 95% CI: 0.76, 3.04) and MEP showing an improvement of +1.23 points (95% CI: 0.18, 2.28) versus UC; direct comparison between MEP-VR and MEP yielded a non-significant difference of +0.67 points (95% CI: -0.46, 1.80). Adherence was high, with no serious adverse events related to VR.Conclusions Conventional MEP remains the most effective intervention for improving physical function. Further studies are required to confirm the comparative effectiveness of VR integration for cognitive benefits in holistic geriatric care.
Background Healthcare professionals (HCPs) with variable undergraduate geriatric education increasingly manage older adults with geriatric syndromes in ambulatory and home care settings. We aimed to identify specific unmet geriatric educational needs of the different professional groups involved in older people's outpatient care.Methods A cross-sectional structured questionnaire assessing self-perceived knowledge, interest and relevance to practice regarding 33 geriatric domains was disseminated online to interdisciplinary HCPs working in ambulatory and home care settings in the World Health Organization European Region, in the context of the PROGRAMMING COST Action 21122. A global topic score, derived from the formula (relevance + interest-knowledge) served as a surrogate of unmet educational needs, and was standardised using z-scores to enable comparisons across topics and professionals.Results In the overall sample of 2380 responders from 41 countries, perceived relevance and interest consistently exceeded self-reported knowledge across all topics. Global topic scores ranking in the top Z-score quintile, indicative of perceived unmet educational needs for most HCP groups, included comprehensive geriatric assessment, resilience and diversity, chronic pain, management of behavioral and psychiatric symptoms in dementia, depression, frailty and cognitive impairment screening. Profession-specific priorities included communication, advance healthcare directives and assessment of capacity to consent for nurses and speech-language therapists, polypharmacy and deprescribing for medical doctors and pharmacists, sarcopenia, dysphagia and nutritional assessment for dieticians and mental health problems for psychologists and social workers.Conclusions Substantial and profession-specific gaps in geriatric education exist in ambulatory and home healthcare settings, which warrant targeted interdisciplinary geriatric courses.
Background Fall-risk-increasing drugs (FRIDs) may contribute to a higher falls-risk in older people, but research examining standardised screening tools is limited. Objectives To examine FRID prevalence in community-dwelling older adults, any association with subsequent fall-related hospital admissions, and FRID prescriptions before and after admission. Design Retrospective cohort study. Subjects/setting Adults aged >= 65 years across 44 general practices in Ireland. Methods Fourteen FRIDs, defined by Screening Tool of Older Persons Prescriptions in older adults with high Fall risk (STOPPFall) criteria, were examined as time-varying exposures from 2012 to 2016. The association between FRID exposure and fall-related admissions was estimated using Cox proportional hazards models, adjusted for relevant confounders. Participants' FRID use pre- and post-fall-related admission was analysed descriptively. Findings Of the 35 942 participants, 16 780 (47%) were prescribed at least one long-term FRID at baseline, and 867 (2.4%) experienced a subsequent fall-related admission. Long-term FRID use was associated with a higher risk of fall-related admission [adjusted hazard ratio (aHR) 2.85, 95% CI 2.13-3.82, P < .001], demonstrating a stronger association with an increasing FRID burden-one FRID: aHR 2.81 (95% CI 2.07-3.82, P < .001); >= 5 FRIDs: 5.67 (95% CI 3.70-8.70, P < .001). Long-term FRID prevalence measured pre- and post-fall-related admission was unchanged (53.9%-53.2%). A total of 148 (19.5%) participants had a FRID discontinued, 86 (11.3%) were prescribed an additional FRID and 110 (14.5%) had a FRID initiated for the first time. Conclusion FRID use, defined via STOPPFall, was prevalent in older adults and associated with a substantially increased risk of injurious falls. FRID use remained unchanged following discharge. Guidelines recommend including medication review in fall-risk assessments, but further work is needed to embed this across health systems.
