Effectiveness and feasibility of virtual reality and gaming system use at home by older adults for enabling physical activity to improve health-related domains: a systematic review

Background
use of virtual reality and commercial gaming systems (VR/gaming) at home by older adults is receiving attention as a means of enabling physical activity.

Objective
to summarise evidence for the effectiveness and feasibility of VR/gaming system utilisation by older adults at home for enabling physical activity to improve impairments, activity limitations or participation.

Methods
a systematic review searching 12 electronic databases from 1 January 2000–10 July 2012 using key search terms. Two independent reviewers screened yield articles using pre-determined selection criteria, extracted data using customised forms and applied the Cochrane Collaboration Risk of Bias Tool and the Downs and Black Checklist to rate study quality.

Results
fourteen studies investigating the effects of VR/gaming system use by healthy older adults and people with neurological conditions on activity limitations, body functions and physical impairments and cognitive and emotional well-being met the selection criteria. Study quality ratings were low and, therefore, evidence was not strong enough to conclude that interventions were effective. Feasibility was inconsistently reported in studies. Where feasibility was discussed, strong retention (≥70%) and adherence (≥64%) was reported. Initial assistance to use the technologies, and the need for monitoring exertion, aggravation of musculoskeletal symptoms and falls risk were reported.

Conclusions
existing evidence to support the feasibility and effectiveness VR/gaming systems use by older adults at home to enable physical activity to address impairments, activity limitations and participation is weak with a high risk of bias. The findings of this review may inform future, more rigorous research.

Client self-assessment in community aged care: A comparative study involving older Australians and their case managers

Self-assessment of support needs is a relatively new and under-researched phenomenon in domiciliary aged care. This article outlines the results of a comparative study focusing on whether a self-assessment approach assists clients to identify support needs and the degree to which self-assessed needs differ from an assessment conducted by community care professionals. A total of 48 older people and their case managers completed a needs assessment tool. Twenty-two semi-structured interviews were used to ascertain older people’s views and preferences regarding the self-assessment process. The study suggests that while a co-assessment approach as outlined in this article has the potential to assist older people to gain a better understanding of their care needs as well as the assessment process and its ramifications, client self-assessment should be seen as part of a co-assessment process involving care professionals. Such a co-assessment process allows older people to gain a better understanding of their support needs and the wider community aged care context. The article suggests that a co-assessment process involving both clients and care professionals contains features that have the capacity to enhance domiciliary aged care.

Fostering resilience later in life: a narrative approach involving people facing disabling circumstances, carers and members of minority groups

Over the last two decades, the concept of resilience has become the focus of a growing body of gerontological research. However, there is a dearth of qualitative research that explores how socio-economic and socio-cultural factors shape older people's resilience. This study addresses this gap and explores the concept of resilience through the lens of 25 Australians from a variety of backgrounds, investigating the resilience strategies they employed in the face of different challenging life events. A qualitative narrative methodology involving one focus group and semi-structured interviews was employed. A stratified convenience sample of 34 people aged 60 and over participated in semi-structured interviews between 2009 and 2011. The study describes the meaning participants assigned to the term resilience, and focuses on the range of resilience responses and strategies they employed, bringing to light some key commonalities and differences. The study's findings suggest that access to economic and cultural resources and the nature of the adversity older people face can shape and limit their resilience strategies. The article outlines how the concept of resilience could be incorporated into aged care practice and argues that resilience-focused interventions that potentially broaden the resilience repertoire of older people should be explored within an aged care context.

Singing in La Voce Della Luna Italian women's choir in Melbourne, Australia

Australia is a country of ongoing migration that embraces diversity, creative expression and cultural activity. Membership of community music groups by older people can enhance life quality, and may provide a space through which cultural and linguistic identity may be shared and celebrated. This qualitative phenomenological case study explores engagement by older members of La Voce Della Luna, an Italian women’s community choir based in Melbourne, Victoria. This article presents one case study from a larger ongoing research project, Well-being and ageing: community, diversity and the arts in Victoria. In this study, data were gathered from documentary sources and by individual and focus group semi-structured interviews in 2013. Employing interpretative phenomenological analysis two significant themes emerged: Social connection and combatting isolation; and New horizons: music-making and social justice. This article describes how active music for older women provides opportunities to learn new skills, new ideas, and create for themselves a resilient community.

Exploring and expressing Italian musical heritage in Melbourne (Australia): a women’s community choir

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Australia comprises many cultures, ethnicities, and languages. Belonging to community music groups by older people can enhance quality of life, offer a sense fulfilment, and provide a space through which cultural and linguistic identity may be shared and celebrated. This qualitative case study explores engagement by older members of La Voce Della Luna, an Italian women’s community choir based in Melbourne, Victoria. Older Australians, particularly those from culturally and linguistically diverse backgrounds frequently rely on voluntary community arts organisations to enhance quality of life. Singing together can provide ways for individuals and communities to express themselves, build community identity, improve quality of life, and celebrate cultural heritage. The members of the choir know that under their inspiring conductor they would learn new songs, new languages and new ways of performing. Their music director saw that the women’s singing together opened new horizons of social engagement and new ideas such as social justice and women’s rights.
This case is from the larger ongoing joint research project (2008 ongoing), Well-being and ageing: community, diversity and the arts in Victoria. Data were gathered from documentary sources and by individual and focus group semi-structured interviews (2013) and were analysed using interpretative phenomenological analysis. Significant themes emerged: social connection and combatting isolation, the maintenance and transmission of cultural heritage, and opening horizons about music making and social justice. This paper demonstrates that active music making makes it possible for older women to learn new skills, new ideas, and create for themselves a resilient community.

Diabetes in people with an intellectual disability : a systematic review of prevalence, incidence and impact.

To establish the prevalence and incidence of Type 1 and Type 2 diabetes in people with an intellectual and developmental disability and determine their impact on health and well-being and to appraise the evidence available to inform good practice in diabetes management for people with intellectual and developmental disabilities.

In-reach nursing services improve older patient outcomes and access to emergency care

Aims: To identify the impact of in-reach services providing specialist nursing care on outcomes for older people presenting to the emergency department from residential aged care. Methods: Retrospective cohort study compared clinical outcomes of 2278 presentations from 2009 with 2051 presentations from 2011 before and after the implementation of in-reach services. Results: Median emergency department length of stay decreased by 24 minutes (7.0 vs 6.6 hours, P<0.001) and admission rates decreased by 23% (68 vs 45%, P<0.001). The proportion of people with repeat emergency department visits within six months decreased by 12% (27 vs 15%). The proportion of admitted patients who were discharged with an end of life palliative care plan increased by 13% (8 vs 21%, P=0.007). Conclusions: There was a significant reduction in the median length of stay, fewer hospital admissions and fewer repeat visits for people from residential aged care following implementation of in-reach services.

A case study about the supported participation of older men with lifelong disability at Australian community-based Men's Sheds

Background This article presents an insight into the supported participation of older men with a lifelong disability in community Men's Sheds. We draw on a subsample of men from a 3-year study that explored how older people with a lifelong disability could be supported to transition to retirement from sheltered workshops. Method Data arose from a range of sources – both quantitative and qualitative – and are structured here into a descriptive case study about how mentors at Men's Sheds provided support to older men (n = 9) with lifelong disability. Findings Older men with disability want to enjoy an active retirement similar to their peers without disability. These men can join mainstream community groups such as Men's Sheds, provided they are offered just the right amount and type of support. Conclusion Men's Sheds are largely untapped community resources where men with disability are welcome, provided that appropriate support is offered to the members of the shed.

The effects of a protein enriched diet with lean red meat combined with a multi-modal exercise program on muscle and cognitive health and function in older adults: study protocol for a randomised controlled trial

BACKGROUND: Age-related muscle wasting has been strongly implicated with falls and fractures in the elderly, but it has also been associated with cognitive decline and dementia. Progressive resistance training (PRT) and adequate dietary protein are recognised as important contributors to the maintenance of muscle health and function in older adults. However, both factors also have the potential to improve brain function and prevent cognitive decline via several pathways, including the regulation of various growth and neurotrophic factors [insulin-like growth factor-1 (IGF-1)]; brain-derived growth factor (BDNF)] and/or the modulation of systemic inflammation. The primary aim of this study is to investigate whether a modest increase in dietary protein achieved through the consumption of lean red meat three days per week, when combined with PRT, can enhance muscle mass, size and strength and cognitive function in community-dwelling older people. METHODS/DESIGN: The study design is a 48-week randomised controlled trial consisting of a 24-week intervention with a 24-week follow-up. Men and women (n=152) aged 65 years and over residing in the community will be randomly allocated to: 1) PRT and provided with 220 g (raw weight) of lean red meat to be cooked and divided into two 80 g servings on each of the three days that they complete their exercise session, or 2) control PRT in which participants will be provided with and advised to consume ≥1 serving (~1/2 cup) of rice and/or pasta or 1 medium potato on each of the three training days. The primary outcome measures will be muscle mass, size and strength and cognitive function. Secondary outcomes will include changes in: muscle function, neural health (corticospinal excitability and inhibition and voluntary activation), serum IGF-1 and BDNF, adipokines and inflammatory markers, fat mass and inter-/intra-muscular fat, blood pressure, lipids and health-related quality of life. All outcome measures will be assessed at baseline and 24 weeks, with the exception of cognitive function and the various neurobiological and inflammatory markers which will also be assessed at week 12. DISCUSSION: The findings from this study will provide important new information on whether a modest increase in dietary protein achieved through the ingestion of lean red meat can enhance the effects of PRT on muscle mass, size and strength as well as cognitive function in community-dwelling older adults. If successful, the findings will form the basis for more precise exercise and nutrition guidelines for the management and prevention of age-related changes in muscle and neural health and cognitive function in the elderly. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry: ACTRN12613001153707 . Date registered 16(th) October, 2013.

Changes in gait performance over several years are associated with recurrent falls status in community-dwelling older women at high risk of fracture

Background: gait analysis is a recommended geriatric assessment for falls risk and sarcopenia; however, previous research utilises measurements at a single time point only. It is presently unclear how changes in gait over several years influence risk of recurrent falls in older adults.Methods: we investigated 135 female volunteers (mean age ± SD: 76.7 ± 5.0 years; range: 70-92 years) at high risk of fracture. Gait parameters (speed, cadence, step length, step width, swing time and double support phase) were assessed using the GAITRite Electronic Walkway System at four annual clinics over ?3.7 ± 0.5 years. Participants reported incident falls monthly for 3.7 ± 1.2 years.Results: increasing gait speed (odds ratio: 0.96; 95% confidence interval 0.93, 0.99) and step length (0.87; 0.77, 0.98) from baseline to final follow-up was associated with reduced likelihood of being a recurrent faller over the study period. No significant associations were observed for baseline gait parameters (all P ≥ 0.05). At the second follow-up (2.8 ± 0.6 years), an increase in swing time (0.65; 0.43, 0.98) was associated with reduced likelihood, while an increase in double support phase (1.31; 1.04, 1.66) was associated with increased likelihood, for being a recurrent faller in the subsequent 1.3 years following this time point.Conclusion: changes in gait parameters over several years are significantly associated with the likelihood of being a recurrent faller among community-dwelling older women at high risk of fracture. Further research is required to develop gait monitoring guidelines and gait parameter decline cut points that may be utilised by clinicians to identify older adults at risk of incident falls and sarcopenia.

Costs and advance directives at the end of life: a case of the ‘Coaching Older Adults and Carers to have their preferences Heard (COACH)’ trial

BACKGROUND: Total costs associated with care for older people nearing the end of life and the cost variations related with end of life care decisions are not well documented in the literature. Healthcare utilisation and associated health care costs for a group of older Australians who entered Transition Care following an acute hospital admission were calculated. Costs were differentiated according to a number of health care decisions and outcomes including advance directives (ADs).

METHODS: Study participants were drawn from the Coaching Older Adults and Carers to have their preferences Heard (COACH) trial funded by the Australian National Health and Medical Research Council. Data collected included total health care costs, the type of (and when) ADs were completed and the place of death. Two-step endogenous treatment-regression models were employed to test the relationship between costs and a number of variables including completion of ADs.

RESULTS: The trial recruited 230 older adults with mean age 84 years. At the end of the trial, 53 had died and 80 had completed ADs. Total healthcare costs were higher for younger participants and those who had died. No statistically significant association was found between costs and completion of ADs.

CONCLUSION: For our frail study population, the completion of ADs did not have an effect on health care utilisation and costs. Further research is needed to substantiate these findings in larger and more diverse clinical cohorts of older people.

Respecting our elders: evaluation of an educational program for adolescent students to promote respect toward older adults

The current project explored issues related to respect for older people, and then developed, implemented, and evaluated an educational intervention program for adolescents to raise understanding and improve attitudes toward older people. In Study 1, 46 focus groups were conducted, with participants (n = 211) drawn from older people, carers of older people, and adolescents to inform on issues related to the expression of respect to older people. The emergent themes were used to inform the design of the educational program delivered to adolescents and evaluated in Study 2. A total of 118 year-9 students were allocated to an intervention or control condition. The intervention group participated in 4 educational sessions focused on developing understanding of and respect for older adults, and promoting positive interactions with older people. Participants in both conditions completed measures of knowledge and attitudes to aging to determine whether the intervention had effected change at post-program and at 6-months follow-up. Analyses indicated significant improvements in knowledge, attitudes, and social skills related to older people in the intervention group compared to the control group. The findings from these studies provide a better understanding of what constitutes respect for older people, and a method for improving this in adolescents.

Economic evaluation of a group-based exercise program for falls prevention among the older community-dwelling population

BACKGROUND: Falls among older people are of growing concern globally. Implementing cost-effective strategies for their prevention is of utmost importance given the ageing population and associated potential for increased costs of fall-related injury over the next decades. The purpose of this study was to undertake a cost-utility analysis and secondary cost-effectiveness analysis from a healthcare system perspective, of a group-based exercise program compared to routine care for falls prevention in an older community-dwelling population.

METHODS: A decision analysis using a decision tree model was based on the results of a previously published randomised controlled trial with a community-dwelling population aged over 70. Measures of falls, fall-related injuries and resource use were directly obtained from trial data and supplemented by literature-based utility measures. A sub-group analysis was performed of women only. Cost estimates are reported in 2010 British Pound Sterling (GBP).

RESULTS: The ICER of GBP£51,483 per QALY for the base case analysis was well above the accepted cost-effectiveness threshold of GBP£20,000 to £30,000 per QALY, but in a sensitivity analysis with minimised program implementation the incremental cost reached GBP£25,678 per QALY. The ICER value at 95% confidence in the base case analysis was GBP£99,664 per QALY and GBP£50,549 per QALY in the lower cost analysis. Males had a 44% lower injury rate if they fell, compared to females resulting in a more favourable ICER for the women only analysis. For women only the ICER was GBP£22,986 per QALY in the base case and was below the cost-effectiveness threshold for all other variations of program implementation. The ICER value at 95% confidence was GBP£48,212 in the women only base case analysis and GBP£23,645 in the lower cost analysis. The base case incremental cost per fall averted was GBP£652 (GBP£616 for women only). A threshold analysis indicates that this exercise program cannot realistically break even.

CONCLUSIONS: The results suggest that this exercise program is cost-effective for women only. There is no evidence to support its cost-effectiveness in a group of mixed gender unless the costs of program implementation are minimal. Conservative assumptions may have underestimated the true cost-effectiveness of the program.

Knowledge, attitudes, and self care practices associated with age related eye disease in Australia

AIM: To determine the level of correct knowledge about common eye disease and attitudes towards blindness prevention and treatment, and how these factors influence self care practices in a population based sample. METHODS: A cluster random sample of the Victorian population was interviewed. The study population comprised residents aged 40 years of age or older living in five randomly selected Melbourne metropolitan suburbs and four randomly selected rural areas of Victoria. Questions were asked to ascertain each person's knowledge of common age related eye disease--that is, cataract, age related macular degeneration (AMD), and glaucoma. A subsample of the population was also asked questions to determine their attitudes to blindness prevention and treatment. All respondents were asked the year of their last visit to an eye practitioner. RESULTS: A total of 3184 (89%) eligible residents were assessed. Sex (females), age (younger people), higher levels of education (secondary, trade, or tertiary education), recent visit to an eye practitioner (within the past 2 years) and English spoken at home appeared to be significant predictors of knowledge of common age related eye conditions. Younger people believed blindness prevention and blindness treatment were the highest priorities compared with other diseases; people who spoke English at home and people with knowledge of common age related eye disease also considered blindness treatment to be the highest priority compared with other diseases. People with a previous diagnosis of age related eye disease, older people, females, people with correct knowledge of common eye diseases, and those who spoke English at home were significantly more likely to be under eye care. No interaction was found between knowledge and positive attitudes to self care practices. CONCLUSION: These data show that there is a large gap in the public's knowledge and understanding of eye disease that will need to be understood for eye health promotion activities.