Older adults' neuromuscular adaptations to resistence training and effects on challenging gait tasks

Community locomotion is threatened when older individuals are required to negotiate obstacles, which place considerable stress on the musculoskeletal system. The vulnerability of older adults during challenging locomotor tasks is further compromised by age-related strength decline and muscle atrophy. The first study in this investigation determined the relationship between the major muscle groups of the lower body and challenging locomotor tasks commonly found in the community environment of older adults. Twenty-nine females and sixteen males aged between 62 and 88 years old (68.2 ±6.5) were tested for the maximal voluntary contraction (MVC) strength of the knee extensors and 1-RM for the hip extensors, flexors, adductors, abductors, knee extensors and flexors and ankle plantar flexors. Temporal measurements of an obstacle course comprising four gait tasks set at three challenging levels were taken. The relationship between strength and the obstacle course dependent measures was explored using linear regression models. Significant associations (p≤0.05) between all the strength measures and the gait performances were found. The correlation values between strength and obstructed gait (r = 0.356-0.554) and the percentage of the variance explained by strength (R2 = 13%-31%), increased as a function of the challenging levels, especially for the stepping over and on and off conditions. While the difficulty of community older adults to negotiate obstacles cannot be attributed to a single causal pathway, the findings of the first study showed that strength is a critical requirement. That the magnitude of the association increased as a function of the challenging levels, suggests that interventions aimed at improving strength would potentially be effective in helping community older adults to negotiate environmental gait challenges. In view of the findings of the first study, a second investigation determined the effectiveness of a progressive resistance-training program on obstructed gait tasks measured under specific laboratory conditions and on an obstacle course mimicking a number of environmental challenges. The time courses of strength gains and neuromuscular mechanisms underpinning the exercise-induced strength improvements in community-dwelling older adults were also investigated. The obstructed gait conditions included stepping over an obstacle, on and off a raised surface, across an obstacle and foot targeting. Forty-three community-living adults with a mean age of 68 years (control =14 and experimental=29) completed a 24-week progressive resistance training program designed to improve strength and induce hypertrophy in the major muscles of the lower body. Specific laboratory gait kinetics and kinematics and temporal measures taken on the obstacle course were measured. Lean tissue mass and muscle activation of the lower body muscle groups were assessed. The MVC strength of the knee extensors and 1-RM of the hip extension, hip flexion, knee extension, knee flexion and ankle plantar flexion were measured. A 25% increase on the MVC of the knee extensors (p≤0.05) was reported in the training group. Gains ranging between 197% and 285% were recorded for the 1-RM exercises in the trained subjects with significant improvements found throughout the study (p≤0.05). The exercise-induced strength gains were mediated by hypertrophic and neural factors as shown by 8.7% and 27.7% increases (p≤0.05) in lean tissue mass and integrated electromyographic activity, respectively. Strength gains were accompanied by increases in crossing velocity, stride length and reductions in stride duration, stance and swing time for all gait tasks except for the foot targeting condition. Specific kinematic variables associated with safe obstacle traverse such as vertical obstacle heel clearance, limb flexion, horizontal foot placements prior to and at post obstacle crossing and landing velocities resulted in an improved crossing strategy in the experimental subjects. Significant increases in the vertical and anterior-posterior ground reaction forces accompanied the changes in the gait variables. While further long-term prospective studies of falls rates would be needed to confirm the benefits of lower limb enhanced strength, the findings of the present study provide conclusive evidence of significant improvements to gait efficiency associated with a systematic resistance-training program. It appears, however, that enhanced lower body strength has limited effects on gait tasks involving a dynamic balance component. In addition, due to the larger strength-induced increases in voluntary activation of the leg muscle compared to relatively smaller gains in lean tissue mass, neural adaptations appear to play a greater contributing role in explaining strength gains during the current resistance training protocol.

Quality of life assessment in the community-dwelling elderly : validation of the Assessment of Quality of Life (AQoL) instrument and comparison with the SF-36

Measurement of Health-Related Quality of Life (HRQoL) of the elderly requires instruments with demonstrated sensitivity, reliability, and validity, particularly with the increasing proportion of older people entering the health care system. This article reports the psychometric properties of the 12-item Assessment of Quality of Life (AQoL) instrument in chronically ill community-dwelling elderly people with an 18-month follow-up. Comparator instruments included the SF-36 and the OARS. Construct validity of the AQoL was strong when examined via factor analysis and convergent and divergent validity against other scales. Receiver Operator Characteristic (ROC) curve analyses and relative efficiency estimates indicated the AQoL is sensitive, responsive, and had the strongest predicative validity for nursing home entry. It was also sensitive to economic prediction over the follow-up. Given these robust psychometric properties and the brevity of the scale, AQoL appears to be a suitable instrument for epidemiologic studies where HRQoL and utility data are required from elderly populations.

Effect of exercise and protein on skeletal muscle inflammatory mediators

Intense exercise results in muscular inflammation. Molecular techniques were used to identify novel inflammatory proteins in human muscle. Males and females displayed different levels of exercise-induced inflammatory proteins. Interestingly, dairy protein supplements reduced these inflammatory proteins post-exercise. Increased dietary red meat consumption, with training, had no impact on muscle inflammation, although strength gain was improved.

Fall risk management intervention : a feasibility and validation study

A fall risk management intervention was undertaken by staff caring for older people in nursing homes. Its acceptability and usefulness was tested. 'High risk times' and 'at risk' individuals were found, thereby identfying times when staff should be vigilant, and specific residents to be targeted with fall prevention strategies.

Improving health with nutritional interventions in residential aged care

In a group of Australian aged care residents, dietary energy and nutrient intakes were generally inadequate, despite sufficient energy being served. Six months of multivitamin supplementation improved nutritional status and bone quality; and six months of fortified milk consumption improved serum 25(OH)D and folate levels, and increased vitamin D and folate intakes.

Hypertrophic signalling in human skeletal muscle

Ý-lactoglobulin enriched whey protein isolate, but not carbohydrate, increased growth signalling in human skeletal muscle when consumed in conjunction with resistance exercise. Ageing did not impair the anabolic signalling response; however this response was attenuated after training. These findings help identify strategies to prevent, or delay the onset of sarcopenia.

Reducing adverse events in older Australians taking newly released drugs

The number of older Australians with one or multiple chronic diseases is increasing. This thesis presents a model to assist in identifying current older patients with multiple illnesses and taking multiple medications who are at risk of experiencing an adverse drug reaction if they are prescribed a newly released drug.

Community nutrition : providing for older citizens

Diet quality is a contributing factor to the health of the increasing number of aged. A fortnightly small group meal program focusing on social interaction was trialled. It was concluded that the program had strong support from participants and that there is scope for expansions of existing food service programs to include alternative styles of presentations; and that the principle of the Community Meals Program should be continued and endorsed.

Prescription medication hoarding and borrowing or sharing behaviours in older residents in the Illawarra, New South Wales, Australia

Aim: To examine prescription medication hoarding and borrowing or sharing (PMHBS) behaviours in older people, particularly which medications are subject to these behaviours and the circumstances that enable these behaviours.

Methods: A mixed methods triangulation design, using consecutive qualitative (focus groups) and quantitative (survey) methodologies in a convenience sample of people older than 65 years, living independently in the Illawarra region (New South Wales).

Results: Focus group participants (n= 28) acknowledged PMHBS behaviours were widespread; however, very few survey respondents (n= 226) admitted to engaging in these behaviours. Main findings in the study were enablers for these behaviours: the prescription medication is considered the same as that prescribed previously; and self-medicating for pain relief.

Conclusions: The prevalence of PMHBS behaviours in this study was low, although it was acknowledged such behaviours occurred in the wider community. Sharing strong pain medication and the same prescription medication appeared to be acceptable in this population.

Where will we live when we get older?

Ageing populations, although exhibiting marked differences across countries and cultures, are a global phenomenon. Old-age dependency ratios in most developed countries are projected to double by the year 2050. In Australia there will be a strain on economic growth as a large part of the population moves from pre-retirement to post-retirement age over the next 25 years. A disproportionate amount of this strain will be concentrated in aged-care housing or retirement accommodation. Current evidence suggests that existing housing stock for older people is inadequate. As the Australian population ages, the maintenance and long-term performance of retirement housing is a key concern of government and housing providers. This study looked at four aged-care or retirement providers across Australia and examined the performance of the current housing stock managed by these providers. The interviews revealed that housing design decisions in retirement stock, although critically important to the changing needs of occupants and the adequate supply of suitable housing, are often ill-considered. The findings critically question the idea of simply building ‘more of the same’ to relieve demand. This study has major implications for the future of Australian retirement housing, especially as the population ages dramatically.

Ways in which 'community' benefits frail older women's well-being : '... we are much happier when we feel we belong'

Aim: This paper aims to explore frail older women’s lived experiences of ‘community’ and which aspects of ‘community’ they perceive as beneficial to their well-being.

Method: This qualitative project used a mixed methodological approach which integrated aspects of descriptive phenomenology and grounded theory. Ten frail, older women residing in South East Melbourne, Australia participated in in-depth interviews.

Results: This research obtained a rich and detailed account of the aspects of ‘community’ identified by participants as enhancing their well-being. These included: social contact, community dynamics, feelings of support and positive orientation.

Conclusion: This paper has increased our understanding of the factors supporting well-being of frail older women. Service providers should actively consider how they can strengthen these factors to improve social connectedness for frail older women by the use of volunteers, developing social networks and increasing availability and quality of community-based activities.

An evaluation of a national program to implement the cornell scale for depression in dementia into routine practice in aged care facilities

Background: Screening tools have been recommended for use in aged care to improve the detection and treatment of depression. This study aimed to evaluate the impact of a program for the routine implementation of the Cornell Scale for Depression in Dementia in Australian facilities, to determine whether use of the instrument by nurses led to further monitoring of depressive symptoms, medical referral, and changes in treatments prescribed for depression.
Methods: A file review was completed for 412 participants out of a total of 867 older people (47.5%) who resided in ten aged care facilities. The review examined Cornell Scale assessment data, medication charts, medical history, nursing progress notes, and resident care plans. Nursing staff who administered the Cornell Scale to each participant were also interviewed, and ten facilitymanagers took part in an interview to determine barriers to the effective implementation of the instrument.
Results: The Cornell Scale had been administered to 46.8% of the sample in the previous 12 months, with 25% of these participants scoring 9–13 and 27% scoring 14 and above. Less than one third of the residents with high scores were monitored by the staff following the assessment. Only 18% of residents with high scores were referred for further assessment of depression, while 10% received a treatment change.
Conclusions: The absence of a protocol for responding to high Cornell Scale scores limited the potential of this program to result in widespread improved treatment of depressed older people. The use of the Cornell Scale by aged care nurses with limited training raised concern.

A study of older Australians’ volunteering and quality of life : empirical evidence and policy implications

Older Australians are confronted by dramatic changes in their physical, social, financial, and psychological well-being. There are social costs to these changes related to their productivity and increased costs associated with caring for older Australians. Greater community engagement through voluntary work practice may minimize these costs, as well as positively influence volunteers' subjective quality of life (QOL). This study investigates the motivations for older Australians to engage in formal voluntary work. It seeks to identify whether the motivational factors to volunteer are associated with individuals' subjective QOL. The results indicate a positive relationship between older people's motivations to volunteer and their subjective QOL. This association is strengthened by respondents' community orientation, positive perception of voluntary work, positive personal attitudes toward volunteering, and their self-esteem. The role of policy makers in motivating larger participation by the older groups is discussed.

Self-reported medication side effects in an older cohort living independently in the community - the Melbourne Longitudinal Study on Health Ageing (MELSHA) : cross-sectional analysis of prevalence and risk factors

Background Medication side effects are an important cause of morbidity, mortality and costs in older people. The aim of our study was to examine prevalence and risk factors for self-reported medication side effects in an older cohort living independently in the community.

Methods The Melbourne Longitudinal Study on Healthy Ageing (MELSHA), collected information on those aged 65 years or older living independently in the community and commenced in 1994. Data on medication side effects was collected from the baseline cohort (n = 1000) in face-to-face baseline interviews in 1994 and analysed as cross-sectional data. Risk factors examined were: socio-demographics, health status and medical conditions; medication use and health service factors. Analysis included univariate logistic regression to estimate unadjusted risk and multivariate logistic regression analysis to assess confounding and estimate adjusted risk.

Results Self-reported medication side effects were reported by approximately 6.7% (67/1000) of the entire baseline MELSHA cohort, and by 8.5% (65/761) of those on medication. Identified risk factors were increased education level, co-morbidities and health service factors including recency of visiting the pharmacist, attending younger doctors, and their doctor's awareness of their medications. The greatest increase in risk for medication side effects was associated with liver problems and their doctor's awareness of their medications. Aging and gender were not risk factors.

Conclusion Prevalence of self-reported medication side effects was comparable with that reported in adults attending General Practices in a primary care setting in Australia. The prevalence and identified risk factors provide further insight and opportunity to develop strategies to address the problem of medication side effects in older people living independently in the community setting.

A framework to understand depression among older persons

Aims and objectives.  To develop an explanatory framework to understand depression among community-dwelling Chinese older persons in Macau.

Background.  Depression has been described as the most common psychological problem among Chinese older persons. Dominant psychosocial theories are derived from research conducted mainly in western societies and similar research in Chinese populations is scant.

Design.  Mixed methods.

Methods.  Qualitative and quantitative methods (mixed methods) were employed to collect data from 31 participants between 2007–2009 in Macau.

Results.  Four categories of factors related to depression emerged: (1) negative thinking, (2) physical limitations and complaints, (3) present living conditions and social support and (4) past experiences. Each category interacts with the others and, consequently, one category both affects and is affected by others. The categories captured participants’ life-long hardship and bio-psycho-social-cultural disability that lay at the root of their negative thinking. The consequences and impacts of their negative thinking appear to feed and sustain depression.

Conclusion.  The framework offers a deeper understanding of the nature and meaning of the experiences of depressed older persons in a Chinese context.

Relevance to clinical practice.  The findings have several implications for clinical practice. First, the cultural context of Chinese older persons should be emphasised in nursing practice. Second, the root of depression among Chinese older persons is seen to lie in their social, family, cultural and day to day living issues. Finally, this study illustrates the potential for incorporating psychosocial nursing interventions as a therapeutic approach on its own or as an adjunct to other therapy.