Neurocognitive effects of multivitamin supplementation on the steady state visually evoked potential (SSVEP) measure of brain activity in elderly women

OBJECTIVE: Growing evidence suggests that dietary supplementation with selected micronutrients and nutraceuticals may have the potential to improve cognition in older adults. Fewer studies have investigated the effects of these substances on brain activity. METHODS: This study was a randomised, double-blind, placebo-controlled trial, conducted to explore the effects of 16 weeks supplementation with a combined multivitamin, mineral and herbal formula on the steady state visually evoked potential (SSVEP) measure of brain electrical activity. Participants were elderly women aged between 64 and 79 years, with subjective memory complaints. Baseline and post-treatment SSVEP data was obtained for 22 participants in the multivitamin group and 19 in the placebo group. A spatial working memory delayed response task (DRT) was performed during the recording of the SSVEP. RESULTS: The results revealed that when compared to placebo, multivitamin supplementation delayed SSVEP latency during retrieval, interpreted as an increase in inhibitory neural processes. Behavioural performance on the DRT was not improved by the multivitamin, however improved performance accuracy was associated with increased midline central SSVEP latency. There were no multivitamin-related effects on SSVEP amplitude. CONCLUSION: These findings indicate that in the elderly, multivitamin supplementation may enhance neural efficiency during memory retrieval.

Use of the Screening tool of older person's prescriptions (STOPP) in older people admitted to an Australian hospital

Aims: To determine the prevalence of potentially inappropriate medications (PIMs) in older people aged 65years and over who were admitted to hospital, and to examine the medications and medication classes that comprised these PIMs with use of the Screening Tool of Older Person's Prescriptions. Method: Using a retrospective clinical audit design, the medical records of 100 older patients were randomly selected and examined for the prevalence and characteristics of PIMs. The audit was undertaken of patients admitted over a 12-month period to an Australian public teaching hospital. Results: In total, 92 individual occurrences of PIMs were detected, and 54 patients had at least one PIM. The most common type of PIM experienced related to prescribed medications that adversely affected individuals who were prone to falls. Conclusion: Many older patients experienced a PIM during their hospital admission, where the risk of an adverse event could outweigh the clinical benefit.

Development of mental health first aid guidelines on how a member of the public can support a person affected by a traumatic event: a Delphi study

BACKGROUND: People who experience traumatic events have an increased risk of developing a range of mental disorders. Appropriate early support from a member of the public, whether a friend, family member, co-worker or volunteer, may help to prevent the onset of a mental disorder or may minimise its severity. However, few people have the knowledge and skills required to assist. Simple guidelines may help members of the public to offer appropriate support when it is needed.

METHODS: Guidelines were developed using the Delphi method to reach consensus in a panel of experts. Experts recruited to the panels included 37 professionals writing, planning or working clinically in the trauma area, and 17 consumer or carer advocates who had been affected by traumatic events. As input for the panels to consider, statements about how to assist someone who has experienced a traumatic event were sourced through a systematic search of both professional and lay literature. These statements were used to develop separate questionnaires about possible ways to assist adults and to assist children, and panel members answered either one questionnaire or both, depending on experience and expertise. The guidelines were written using the items most consistently endorsed by the panels across the three Delphi rounds.

RESULTS: There were 180 items relating to helping adults, of which 65 were accepted, and 155 items relating to helping children, of which 71 were accepted. These statements were used to develop the two sets of guidelines appended to this paper.

CONCLUSIONS: There are a number of actions which may be useful for members of the public when they encounter someone who has experienced a traumatic event, and it is possible that these actions may help prevent the development of some mental health problems in the future. Positive social support, a strong theme in these guidelines, has some evidence for effectiveness in developing mental health problems in people who have experienced traumatic events, but the degree to which it helps has not yet been adequately demonstrated. An evaluation of the effectiveness of these guidelines would be useful in determining their value. These guidelines may be useful to organisations who wish to develop or revise curricula of mental health first aid and trauma intervention training programs and policies. They may also be useful for members of the public who want immediate information about how to assist someone who has experienced a potentially traumatic event.

Expert in my pocket: creating first person POV videos to enhance mobile learning

Worldwide, there has been a rapid increase in both the use of mobile technologies as a conduit for student learning and the use of wearable cameras to record sporting and recreational activities. The Expert in My Pocket project (EiMP) has combined these two technologies to produce a repository of freely available short videos and supporting materials to enhance student development of psychomotor clinical skills. The videos are presented from a first person point of view (1PPOV) with expert health professionals ‘thinking aloud’ as they demonstrate selected skills. Research indicates that students and educators overwhelmingly support the concept of EiMP videos and more importantly value the 1PPOV as an authentic view. This paper demonstrates the techniques and equipment employed to produce these videos, which consisted of a chest or head mounted GoPro camera operated via an iPad. Additionally, the paper explains another innovative feature, Quick Response (QR) Codes, that when linked to the videos placed on equipment assists with “just in time” mobile learning.

Perspective taking and empathy: does having similar past experience to another person make it easier to take their perspective?

This study tested the hypothesis that it is easier to take the perspective of another person when one has similar past experience. Volunteer participants (N = 154) were asked to take the perspective of a protagonistin one of four problematic interpersonal situations and then to rate the ease with which they felt able to perspective take and the extent of their personal past experience of similar situations. Similar past experiencepredicted ease of perspective taking, with the relationship influenced by reflection on past experience. Ease of perspective taking mediated the relationship between similar past experience and participant perceptionsof their accuracy in understanding the other person, but ease was not associated with emotional arousal. The findings have potential therapeutic applications for attempts to increase empathy and understanding in people for whom perspective taking may be difficult.

Neuromuscular mechanics and hopping training in elderly

Purpose: The present study examined the effects of repetitive hopping training on muscle activation profiles and fascicle–tendon interaction in the elderly. Methods: 20 physically active elderly men were randomly assigned for training (TG) and control groups (CG). TG performed supervised bilateral short contact hopping training with progressively increasing training volume. Measurements were performed before the training period (BEF) as well as after 2 weeks (2 W) and 11 weeks (11 W) of training. During measurements, the gastrocnemius medialis–muscle (GaM) fascicle and its outer Achilles tendon length changes during hopping were examined by ultrasonography together with electromyographic (EMG) activities of calf muscles, kinematics, and kinetics. Results: At 2 W, the ankle joint stiffness was increased by 21.0 ± 19.3 % and contact time decreased by 9.4 ± 7.8 % in TG. Thereafter, from 2–11 W the jumping height increased 56.2 ± 18.1 % in TG. Simultaneously, tendon forces increased 24.3 ± 19.0 % but tendon stiffness did not change. GaM fascicles shifted to shorter operating lengths after training without any changes in their length modifications during the contact phase of hopping. Normalized EMG amplitudes during hopping did not change with training. Conclusions: The present study shows that 11 W of hopping training improves the performance of physically active elderly men. This improvement is achieved with shorter GaM operating lengths and, therefore, increased fascicle stiffness and improved tendon utilization after training. Based on these results, hopping training could be recommended for healthy fit elderly to retain and improve rapid force production capacity.

Reliability, validity, and responsiveness of the Western Ontario and McMaster Universities osteoarthritis index for elderly patients with a femoral neck fracture

Background: The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) has been extensively evaluated in groups of patients with osteoarthritis, yet not in patients with a femoral neck fracture. This study aimed to determine the reliability, construct validity, and responsiveness of the WOMAC compared with the Short Form-12 (SF-12) and the EuroQol 5D (EQ-5D) questionnaires for the assessment of elderly patients with a femoral neck fracture.

Methods: Reliability was tested by assessing the Cronbach alpha. Construct validity was determined with the Pearson correlation coefficient. Change scores were calculated from ten weeks to twelve months of follow-up. Standardized response means and floor and ceiling effects were determined. Analyses were performed to compare the results for patients less than eighty years old with those for patients eighty years of age or older.

Results: The mean WOMAC total score was 89 points before the fracture in the younger patients and increased from 70 points at ten weeks to 81 points at two years postoperatively. In the older age group, these scores were 86, 75, and 78 points. The mean WOMAC pain scores before the fracture and at ten weeks and two years postoperatively were 92, 76, and 87 points, respectively, in the younger age group and 92, 84, and 93 points in the older age group. Function scores were 89, 68, and 79 points for the younger age group and 84, 71, and 73 points for the older age group. The Cronbach alpha for pain, stiffness, function, and the total scale ranged from 0.83 to 0.98 for the younger age group and from 0.79 to 0.97 for the older age group. Construct validity was good, with 82% and 79% of predefined hypotheses confirmed in the younger and older age groups, respectively. Responsiveness was moderate. No floor effects were found. Moderate to large ceiling effects were found for pain and stiffness scales at ten weeks and twelve months in younger patients (18% to 36%) and in the older age group (38% to 53%).

Conclusions: The WOMAC showed good reliability, construct validity, and responsiveness in both age groups of elderly patients with a femoral neck fracture who had been physically and mentally fit before the fracture. The instrument is suitable for use in future clinical studies in these populations.

Translating person-centered care into practice: a comparative analysis of motivational interviewing, illness-integration support, and guided self-determination

OBJECTIVE: Person-centred care [PCC] can engage people in living well with a chronic condition. However, translating PCC into practice is challenging. We aimed to compare the translational potentials of three approaches: motivational interviewing [MI], illness integration support [IIS] and guided self-determination [GSD]. METHODS: Comparative analysis included eight components: (1) philosophical origin; (2) development in original clinical setting; (3) theoretical underpinnings; (4) overarching goal and supportive processes; (5) general principles, strategies or tools for engaging peoples; (6) health care professionals' background and training; (7) fidelity assessment; (8) reported effects. RESULTS: Although all approaches promoted autonomous motivation, they differed in other ways. Their original settings explain why IIS and GSD strive for life-illness integration, whereas MI focuses on managing ambivalence. IIS and GSD were based on grounded theories, and MI was intuitively developed. All apply processes and strategies to advance professionals' communication skills and engagement; GSD includes context-specific reflection sheets. All offer training programs; MI and GSD include fidelity tools. CONCLUSION: Each approach has a primary application: MI, when ambivalence threatens positive change; IIS, when integrating newly diagnosed chronic conditions; and GSD, when problem solving is difficult, or deadlocked. PRACTICE IMPLICATIONS: Professionals must critically consider the context in their choice of approach.

Prevalence of disability in Australian elderly: impact of trends in obesity and diabetes

OBJECTIVE: We aimed to estimate the impact of past and future changes in obesity and diabetes prevalence in mid-life on disability prevalence for adult Australians. METHODS: We analysed data from the Australian Diabetes, Obesity and Lifestyle study (AusDiab) including participants aged 45-64years, disability-free at baseline (1999/2000) with disability information at follow-up (2011/12) (n=2107). We used coefficients from multinomial logistic regression to predict 10-year probabilities of disability and death from baseline predictors (age, sex, obesity, smoking, diabetes and hypertension). We estimated the prevalence of disability attributable to past (1980) and expected future (2025) changes in obesity and diabetes prevalence using the life table approach. RESULTS: We estimated that the prevalence of disability for those aged between 55 and 74years would have been 1697 cases per 100,000 persons less in 2010 (10.3% less) if the rates of obesity and diabetes observed in 2000 had been as low as the levels observed in 1980. However, if instead the prevalence of obesity and diabetes had been as high as the levels expected in 2025, then the prevalence of disability would have been an additional 2173 per 100,000 persons (an additional 13.2%). CONCLUSIONS: We demonstrate, for the first time, a substantial potential impact of obesity and diabetes trends on disability amongst those aged 55-74years. In Australian adults by 2025 we estimate that around 26% of disability cases would have been avoidable if there had been no change in obesity and diabetes prevalence since 1980. A similar impact is likely around the world in developed countries.

Role of dietary pattern analysis in determining cognitive status in elderly Australian adults

Principal Component Analysis (PCA) was used to determine the association between dietary patterns and cognitive function and to examine how classification systems based on food groups and food items affect levels of association between diet and cognitive function. The present study focuses on the older segment of the Australian Diabetes, Obesity and Lifestyle Study (AusDiab) sample (age 60+) that completed the food frequency questionnaire at Wave 1 (1999/2000) and the mini-mental state examination and tests of memory, verbal ability and processing speed at Wave 3 (2012). Three methods were used in order to classify these foods before applying PCA. In the first instance, the 101 individual food items asked about in the questionnaire were used (no categorisation). In the second and third instances, foods were combined and reduced to 32 and 20 food groups, respectively, based on nutrient content and culinary usage—a method employed in several other published studies for PCA. Logistic regression analysis and generalized linear modelling was used to analyse the relationship between PCA-derived dietary patterns and cognitive outcome. Broader food group classifications resulted in a greater proportion of food use variance in the sample being explained (use of 101 individual foods explained 23.22% of total food use, while use of 32 and 20 food groups explained 29.74% and 30.74% of total variance in food use in the sample, respectively). Three dietary patterns were found to be associated with decreased odds of cognitive impairment (CI). Dietary patterns derived from 101 individual food items showed that for every one unit increase in ((Fruit and Vegetable Pattern: p = 0.030, OR 1.061, confidence interval: 1.006–1.118); (Fish, Legumes and Vegetable Pattern: p = 0.040, OR 1.032, confidence interval: 1.001–1.064); (Dairy, Cereal and Eggs Pattern: p = 0.003, OR 1.020, confidence interval: 1.007–1.033)), the odds of cognitive impairment decreased. Different results were observed when the effect of dietary patterns on memory, processing speed and vocabulary were examined. Complex patterns of associations between dietary factors and cognition were evident, with the most consistent finding being the protective effects of high vegetable and plant-based food item consumption and negative effects of ‘Western’ patterns on cognition. Further long-term studies and investigation of the best methods for dietary measurement are needed to better understand diet-disease relationships in this age group.