Physical activity and functional limitations in older adults: a systematic review related to Canada's Physical Activity Guidelines Exercise for fall risk reduction in community-dwelling older adults: a systematic review. Effectiveness of exercise interventions on physical function in community-dwelling frail older people: an umbrella review of systematic reviews The prevalence of frailty syndrome in an older population from Spain. The Toledo study for healthy aging Onset of mobility disability among community-dwelling old men and women. The role of tiredness in daily activities. Living Legends: Effectiveness of a Program to Enhance Sense of Purpose and Meaning in Life Among Community-Dwelling Older Adults. Risk Factors Associated with Falls in Older Adults with Dementia: A Systematic Review. Community environmental factors are associated with disability in older adults with functional limitations: the MOST study. Maintenance Effects of a DVD-Delivered Exercise Intervention on Physical Function in Older Adults. Effects of Strength Training versus Power Training on Physical Performance in Prefrail Community-Dwelling Older Adults Leisure activities and cognitive function in elderly community-dwelling individuals in Japan: a 5-year prospective cohort study. Does monitoring change in function in community-dwelling older adults alter outcome? A randomized controlled trial Recovery from disability among community-dwelling older persons. Exercise and dietary weight loss in overweight and obese older adults with knee osteoarthritis: the Arthritis, Diet, and Activity Promotion Trial. The relationship between physical performance and cardiac function in an elderly Russian cohort. Activities of daily living function and disability in older adults in a randomized trial of the health enhancement program. Effect of strength and power training on physical function in community-dwelling older adults. Dizziness in community-dwelling older adults: a population-based study. Effects of case management in community aged care on client and carer outcomes: a systematic review of randomized trials and comparative observational studies Incidence of and predictors for chronic disability in activities of daily living among older people in Taiwan. Determinants of self-rated health in old age: A population-based, cross-sectional study using the International Classification of Functioning Effect of structured physical activity on prevention of major mobility disability in older adults: the LIFE study randomized clinical trial. The Effects of Aerobic Training and Nutrition Education on Functional Performance in Low Socioeconomic Older Adults
Background The purpose was to conduct systematic review s of the relationship between physical activity of healthy community-dwelling older ( > 65 years ) adults and outcomes of  functional limitations , disability , or loss of independence .  Methods Prospect i ve cohort studies with an outcome related to functional independence or to cognitive function  were search ed , as well as exercise training interventions that reported a functional outcome . Electronic data base search strategies were used to identify citations which were screened ( title and abstract ) for inclusion . Included articles were review ed to complete st and ardized data extraction tables , and assess study quality . An established system of assessing the level and grade of evidence for recommendations was employed . Results Sixty-six studies met inclusion criteria for the relationship between physical activity and functional independence , and 34 were included with a cognitive function outcome . Greater physical activity of an aerobic nature ( categorized by a variety of methods ) was associated with higher functional status ( expressed by a host of outcome measures ) in older age . For functional independence , moderate ( and high ) levels of physical activity appeared effective in conferring a reduced risk ( odds ratio ~0.5 ) of functional limitations or disability . Limitation in higher level performance outcomes was reduced ( odds ratio ~0.5 ) with vigorous ( or high ) activity with an apparent dose-response of moderate through to high activity . Exercise training interventions ( including aerobic and resistance ) of older adults showed improvement in physiological and functional measures , and suggestion of longer-term reduction in incidence of mobility disability . A relatively high level of physical activity was related to better cognitive function and reduced risk of developing dementia ; however , there were mixed results of the effects of exercise interventions on cognitive function indices . Conclusions There is a consistency of findings across studies and a range of outcome measures related to functional independence ; regular aerobic activity and short-term exercise programmes confer a reduced risk of functional limitations and disability in older age . Although a precise characterization of a minimal or effective physical activity dose to maintain functional independence is difficult , it appears moderate to higher levels of activity are effective and there may be a threshold of at least moderate activity for significant outcomes PURPOSE To evaluate the influence of exercise on falls and fall risk reduction  in community-dwelling older adults and to present an up date d synthesis of outcome measures for the assessment of fall risk in community-dwelling older adults . METHOD A systematic review was performed , considering English- language articles published from 2000 to 2006 and accessible through MEDLINE , CINAHL , PEDro , EMBASE , and /or AMED . Included were r and omized controlled clinical trials ( RCTs ) that used an exercise or physical activity intervention and involved participants over age 50 . Screening and method ological quality for internal validity were conducted by two independent review ers . RESULTS The search retrieved 156 abstract s ; 22 articles met the internal validity criteria . Both individualized and group exercise programmes were found to be effective in reducing falls and fall risk . The optimal type , frequency , and dose of exercise to achieve a positive effect have not been determined . A variety of outcome measures have been used to measure fall risk , especially for balance . CONCLUSIONS Falls and fall risk can be reduced with exercise interventions in the community-dwelling elderly , although the most effective exercise variables are unknown . Future studies in population s with comorbidities known to increase fall risk will help determine optimal , condition-specific fall-prevention programmes . Poor balance is a key risk factor for falls ; therefore , the best measure of this variable should be selected when evaluating patients at risk of falling Objectives : This umbrella review aim ed to determine the effectiveness of exercise interventions , alone or in combination with other interventions , in improving physical function in community-dwelling older people identified as pre-frail or frail . Introduction : Exercise is said to have a positive impact on muscle mass and strength which improves physical function and hence is beneficial for the treatment of frailty . Several systematic review s discuss the effects of exercise interventions on physical function parameters , such as strength , mobility , gait , balance and physical performance , and indicate that multi-component exercise , including resistance , aerobic , balance and flexibility training , appears to be the best way in which to improve physical function parameters in frail older people . However , there is still uncertainty as to which exercise characteristics ( type , frequency , intensity , duration and combinations ) are the most effective and sustainable over the long-term . Inclusion criteria : Participants were adults , 60 years or over , living in the community and identified as pre-frail or frail . Quantitative systematic review s , with or without meta- analysis that examined the effectiveness of exercise interventions of any form , duration , frequency and intensity , alone or in combination with other interventions design ed to alter physical function parameters in frail older people , were considered . The quantitative outcome measures were physical function , including muscular strength , gait , balance , mobility and physical performance . Methods : An iterative search strategy for ten bibliometric data bases and gray literature was developed . Critical appraisal of seven systematic review s was conducted independently by two review ers using a st and ard Joanna Briggs Institute tool . Data was extracted independently by two review ers using a st and ard Joanna Briggs Institute data extraction tool and summarized using a narrative synthesis approach . Results : Seven systematic review s were included in this umbrella review , with a total of 58 relevant r and omized controlled trials and 6927 participants . Five systematic review s examined the effects of exercise only , while two systematic review s reported on exercise in combination with a nutritional approach , including protein supplementations , as well as fruit and dairy products . The average  exercise frequency was 2–3 times per week ( mean 3.0 ± 1.5 times per week ; range 1–7 weekly ) for 10–90 minutes per session ( mean of 52.0 ± 16.5 mins ) and a total duration of 5–72 weeks with the majority lasting a minimum of 2.5 months ( mean 22.7 ± 17.7 weeks ) . Multi-component exercise interventions can currently be recommended for pre-frail and frail older adults to improve muscular strength , gait speed , balance and physical performance , including resistance , aerobic , balance and flexibility tasks . Resistance training alone also appeared to be beneficial , in particular for improving muscular strength , gait speed and physical performance . Other types of exercise were not sufficiently studied and their effectiveness is yet to be established . Conclusions : Interventions for pre-frail and frail older adults should include multi-component exercises , including in particular resistance training , as well as aerobic , balance and flexibility tasks . Future research should adopt a consistent definition of frailty and investigate the effects of other types of exercise alone or in combination with nutritional interventions so that more specific recommendations can be made Objective To assess the prevalence of the frailty syndrome and its associated variables among the older adult population in the province of Toledo ( Spain ) . Methods Data were taken from the Toledo Study for Healthy Aging , a population -based study conducted on 2,488 individuals aged 65 years and older . Study participants were selected by a two-stage r and om sampling from the municipal census of Toledo , covering both institutionalized and community dwelling persons from rural and urban setting s. Data were collected from 2006 to 2009 , and included information on social support , activities of daily living , comorbidity , physical activity , quality of life , depressive symptoms , and cognitive function . In addition , a nurse collected  anthropometric data  , conducted tests of physical performance ( walk speed , upper and lower extremities strength , and the st and - and -sit from a chair test ) and obtained a blood sample . The diagnosis of the frailty syndrome was based on the Fried criteria ( weakness , low speed , low physical activity , exhaustion , and weight loss ) . Results In total , 41.8 % ( 95 % confidence interval [ CI ] 39.4–44.2 % ) of the study participants were prefrail , and 8.4 % ( 95 % CI 7.1–9.8 % ) were frail . There were no differences in the prevalence of frailty by sex , level of education , occupation , marital status , or place of residence . The frequency of the frailty syndrome increased with age , and was higher in those with disability , depression , hip fracture and other comorbidity , such as cardiovascular disease and disorders of the central nervous system . Conclusions The prevalence of the frailty syndrome in older Spanish adults is high and similar to that reported in other population s in the Mediterranean basin BACKGROUND in the primary prevention of disability among older adults it might be useful to identify individuals at high risk for functional decline before it occurs . OBJECTIVE to examine whether  tiredness in daily activities  is an independent determinant of onset of mobility disability at 1 1/2-year follow-up among non-disabled older men and women . DESIGN a prospect i ve study with 1 1/2-year follow-up . SETTING 34 communities in four counties in Denmark . SUBJECTS 1396 older non-disabled adults ( 74 - 75 and 80 years old ) living in 17 of the participating communities . METHODS question naire surveys at baseline and at 1 1/2-year follow-up . Tiredness in daily activities  was measured by questions about tiredness in six mobility activities . Onset of mobility disability was measured as onset of need for help in one to six mobility activities . RESULTS men and women who felt tired in their daily activities at baseline had a higher risk of onset of mobility disability at 1 1/2-year follow-up , when adjusted by the covariates . In addition , low social participation , poor psychological function , and physical inactivity were independent risk factors of onset of mobility disability among men , and home help , low sense of coherence and physical inactivity were independent risk factors of onset of mobility disability among women . CONCLUSION older people who complain about tiredness are at higher risk of becoming disabled than others . This highlights the need for alertness and management of this early sign of functional decline in a preventive perspective OBJECTIVE We investigated the therapeutic benefits ( i.e. , sense of purpose and meaning in life ) of the Living Legends program , which includes life review writing and an intergenerational exchange , compared with life review writing alone , for community-dwelling older adults . METHOD This study was a r and omized controlled trial with a connected qualitative component . We analyzed quantitative data using independent- sample s t tests and written descriptions of program experiences using Collaizi 's qualitative methodology ; we then used a triangulation protocol to integrate the qualitative and quantitative data . RESULTS For participants in the writing workshop plus intergenerational exchange , sense of purpose and meaning in life increased significantly ( p<.0001 ) compared with those in the writing workshop alone . Qualitative themes revealed additional program benefits . CONCLUSION Living Legends enhanced participants ' sense of purpose and meaning in life , a factor known to prevent cognitive loss and disability , compared with life review writing alone Purpose : People with dementia fall more often than cognitively healthy older adults , but their risk factors are not well understood . A review is needed to determine a fall risk profile for this population . The objective was to critically evaluate the literature and identify the factors associated with fall risk in older adults with dementia . Methods : Articles published between January 1988 and October 2014 in EMBASE , PubMed , PsycINFO , and CINAHL were search ed . Inclusion criteria were participants aged 55 years or older with dementia or cognitive impairment , prospect i ve cohort design , detailed fall definition , falls as the primary outcome , and multi-variable regression analysis . Two authors independently review ed and extracted data on study characteristics , quality assessment , and outcomes . Adjusted risk estimates were extracted from the articles . Results : A total of 17 studies met the inclusion criteria . Risk factors were categorized into demographic , balance , gait , vision , functional status , medications , psychosocial , severity of dementia , and other . Risk factors varied with living setting and were not consistent across all studies within a setting . Conclusion : Falls in older adults with dementia are associated with multiple intrinsic and extrinsic risk factors , some shared with older adults in general and others unique to the disease . Risk factors vary between community- and institution-dwelling sample s of adults with dementia or cognitive impairment BACKGROUND There is limited evidence supporting the hypothesized environment-disability link . The objectives of this study were to ( a ) identify the prevalence of community mobility barriers and transportation facilitators and ( b ) examine whether barriers and facilitators were associated with disability among older adults with functional limitations . METHODS Four hundred and thirty-five participants aged 65 + years old with functional limitations were recruited from the Multicenter Osteoarthritis Study , a prospect i ve study of community-dwelling adults with or at risk of developing symptomatic knee osteoarthritis . Presence of community barriers and facilitators was ascertained by the Home and Community Environment survey . Two domains of disability , ( a ) daily activity limitation ( DAL ) and ( b ) daily activity frequency ( DAF ) , were assessed with the Late-Life Disability Instrument . Covariates included age , gender , education , race , comorbidity , body mass index , knee pain , and functional limitation . Multivariable logistic regression was used to examine adjusted associations of community factors with presence of DAL and DAF . RESULTS Approximately one third of the participants lived in a community with high mobility barriers and low transportation facilitators .  High mobility barriers was associated with greater odds of DAL ( odds ratio [ OR ] = 2.0 , 95 % confidence interval [ CI ] 1.2 - 3.1 ) after adjusting for covariates , and high transportation facilitators was associated with lower odds of DAL ( OR = 0.5 , 95 % CI 0.3 - 0.8 ) but not with DAF in adjusted models . CONCLUSION People with functional limitations who live in communities that were more restrictive felt more limited in doing daily activities but did not perform these daily activities any less frequently BACKGROUND Exercise training has been demonstrated to enhance physical function and to have a protective effect against  functional limitations and disability in older adults . PURPOSE The objective of this study was to determine whether the effects of a home-based , DVD-delivered exercise intervention on functional performance and limitations were maintained 6-month postintervention termination . METHODS Follow-up assessment s of functional performance and limitations were conducted in a sample of community-dwelling older adults ( N = 237 ) who participated in a 6-month r and omized controlled exercise trial . Participants were initially r and omized to a DVD-delivered exercise intervention or an attentional control condition . The Short Physical Performance Battery , measures of flexibility and strength , and functional limitations were assessed immediately before and after the intervention and then again 6 months later . Analyses of covariance were conducted to examine changes in physical function between the two conditions at the end of the intervention to 6-month follow-up . RESULTS There were statistically significant adjusted group differences in the Short Physical Performance Battery ( η(2 ) = 0.03 , p = .01 ) , upper-body strength ( η(2 ) = 0.03 , p = .005 ) , and lower-body flexibility ( η(2 ) = 0.02 , p = .05 ) , indicating that gains brought about by the intervention were maintained 6 months later . CONCLUSIONS A DVD-delivered exercise program specifically design ed to target elements of functional fitness in older adults can produce clinical ly meaningful gains in physical function that are maintained beyond intervention cessation Background : It has been unclear which training mode is most effective and feasible for improving physical performance in the risk group of prefrail community-dwelling older adults . Objective : The purpose of the present study was to compare the effects of strength training ( ST ) versus power training ( PT ) on functional performance in prefrail older adults . This study was registered at clinical trials.gov as NCT00783159 . Methods : 69 community-dwelling older adults ( > 65 years ) who were prefrail according to the definition of Fried were included in a 12-week exercise program . The participants were r and omized into an ST group , a PT group and a control group . All participants were supplemented with vitamin D3 orally before entering the intervention period . The primary outcome was the global score on the Short Physical Performance Battery ( SPPB ) . Secondary outcomes were muscle power , appendicular lean mass ( aLM ) measured by dual energy X-ray absorptiometry and self-reported functional deficits ( Short Form of the Late-Life Function and Disability Instrument , SF-LLFDI ) . Results : Regarding changes in the SPPB score during the intervention , significant heterogeneity between the groups was observed ( p = 0.023 ) . In pair-wise comparisons , participants in both training groups significantly ( PT : p = 0.012 , ST : 0.009 ) increased their SPPB score ( PT : Δmean = 0.8 , ST : Δmean = 1.0 ) compared to the control group , with no statistical difference among training groups ( p = 0.301 ) . No statistical differences were found in changes in aLM ( p = 0.769 ) , muscle power ( p = 0.308 ) and SF-LLFDI ( p = 0.623 ) between the groups . Muscle power significantly increased ( p = 0.017 ) under vitamin D3 intake . Conclusions : In prefrail community-dwelling adults , PT is not superior to ST , although both training modes result ed in significant improvements in physical performance . With regard to dropout rates , ST appears to be advantageous compared to PT . The high prevalence of vitamin D3 deficiency and the slight improvement of physical performance under vitamin D3 supplementation among study participants underline the relevance of this approach in physical exercise interventions OBJECTIVE This study aim ed to clarify the longitudinal relationship between leisure activities and cognitive decline  among Japanese community-dwelling older adults , using a 5-year prospect i ve cohort study design . METHODS A total of 567 men and women , aged 70years and over , participated in the study . The  Mini-Mental State Examination was used in baseline and follow-up surveys to assess cognitive function . The change in cognitive function from baseline to follow-up was determined , and cognitive decline over 5years was used as the outcome variable .  Leisure activities ( hobby , social activity , and physical activity )  were assessed at baseline and used as independent variables . Age , gender , number of years of education , presence of chronic diseases , instrumental activities of daily living , depressive symptoms , smoking , hearing deficits , and level of cognitive function at baseline were used as covariates . RESULTS Multivariate logistic regression analysis , adjusted for potential confounders , showed that non-participation in a hobby  was significantly and independently associated with cognitive decline ( odds ratio : 1.87 , 95 % confidence interval : 1.16 - 3.02 , p<0.01 ) . There were no significant relationships between social activity , physical activity and cognitive decline . CONCLUSIONS Our study found a longitudinal inverse relationship between hobby participation and cognitive decline among elderly Japanese community-dwelling individuals , suggesting that engaging in a hobby in later life can contribute to preserving cognitive function Objective : To determine whether information about an older person 's physical functioning provided to the patient and his or her physician delays functional decline and improves health outcomes . Design : A r and omized controlled trial was undertaken ; the assessors were not blinded to the group allocation . Setting : The study took place in a clinic within a hospital setting . Participants : Two hundred and sixty-five community-dwelling people over 65 years were recruited from family practice units . Interventions : The intervention group received assessment s of physical function with feedback to the participant and the participant 's family physician or functional assessment s alone over 18 months .  Self-report measures for health status using the Short Form-36 ( SF-36 ) and pre clinical disability were used together with performance measures which included the lower extremity performance test and muscle strength . Results : There were small , statistically significant group/time interactions which included disability scores , F=4.78 , P ≤0.05 ) , and the vitality subscale of the SF-36 , F=7.47 , P ≤0.01 ) . Conclusion : Providing information about the results of detailed assessment of physical functioning to older adults and their physicians did not show significant differences in function scores between the intervention and control groups CONTEXT Previous studies have found that a sizeable minority of newly disabled older persons recover independent function ; however , long intervals between assessment s have led to difficulty in determining the true incidence and duration of disability , and therefore in accurately characterizing the probability and course of recovery . OBJECTIVES To determine the rate of and time to recovery of independent function in community-dwelling older persons who become newly disabled in their activities of daily living ( ADLs ) , to determine the duration of recovery , and to compare the likelihood of recovery among pertinent subgroups of older persons . DESIGN , SETTING , AND PARTICIPANTS Prospect i ve cohort study , with monthly assessment s of  ADL function , for 754 initially nondisabled , community-dwelling persons aged 70 years or older , performed in a small urban area from March 1998 to May 2003 . MAIN OUTCOME MEASURES Demographic features , chronic conditions , cognitive function , and physical frailty were determined during comprehensive assessment s at 18-month intervals . Disability , defined as needing personal assistance with 1 or more key ADLs ( bathing , dressing , walking , and transferring ) , was assessed during monthly telephone interviews . RESULTS A total of 420 participants ( 56 % ) experienced disability during a median follow-up of 51 months . Of these participants , 399 ( 81 % ) recovered ( ie , regained independence in all 4 ADLs ) within 12 months of their initial disability episode , and a majority ( 57 % ) of these maintained independence for at least 6 months . Among participants who experienced 3 or more consecutive months of disability , a majority ( 60 % ) recovered , but only a third of these maintained independence for at least 6 months . Persons who were cognitively impaired , physically frail , or severely disabled ( ie , in 3 - 4 ADLs ) at onset were less likely to recover than those who were cognitively intact , nonfrail , or mildly disabled , respectively . Nonetheless , a majority of participants within each subgroup recovered . CONCLUSIONS Newly disabled older persons recover independent ADL function at rates far exceeding those that have been previously reported . Recovery from disability , however , is often short-lasting , suggesting that additional efforts are warranted to maintain independence in this high-risk group OBJECTIVE The Arthritis , Diet , and Activity Promotion Trial ( ADAPT ) was a r and omized , single-blind clinical trial lasting 18 months that was design ed to determine whether long-term exercise and dietary weight loss are more effective , either separately or in combination , than usual care in improving physical function , pain , and mobility in older overweight and obese adults with knee osteoarthritis ( OA ) . METHODS Three hundred sixteen community-dwelling overweight and obese adults ages 60 years and older , with a body mass index of > or = 28 kg/m(2 ) , knee pain , radiographic evidence of knee OA , and self-reported physical disability , were r and omized into healthy lifestyle ( control ) , diet only , exercise only , and diet plus exercise groups . The primary outcome was self-reported physical function as measured with the Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) . Secondary outcomes included weight loss , 6-minute walk distance , stair-climb time , WOMAC pain and stiffness scores , and joint space width . RESULTS Of the 316 r and omized participants , 252 ( 80 % ) completed the study .  Adherence was as follows : for healthy lifestyle , 73 % ; for diet only , 72 % ; for exercise only , 60 % ; and for diet plus exercise , 64 % . In the diet plus exercise group , significant improvements in self-reported physical function ( P < 0.05 ) , 6-minute walk distance ( P < 0.05 ) , stair-climb time ( P < 0.05 ) , and knee pain ( P < 0.05 ) relative to the healthy lifestyle group were observed . In the exercise group , a significant improvement in the 6-minute walk distance ( P < 0.05 ) was observed . The diet-only group was not significantly different from the healthy lifestyle group for any of the functional or mobility measures . The weight-loss groups lost significantly ( P < 0.05 ) more body weight ( for diet , 4.9 % ; for diet plus exercise , 5.7 % ) than did the healthy lifestyle group ( 1.2 % ) . Finally , changes in joint space width were not different between the groups . CONCLUSION The combination of modest weight loss plus moderate exercise provides better overall improvements in self-reported measures of function and pain and in performance measures of mobility in older overweight and obese adults with knee OA compared with either intervention alone This study aims to determine the cardiac dysfunction prevalence , to investigate the relationship between the Short Physical Performance Battery ( SPPB ) test and structural and functional echocardiographic parameters and to determine whether SPPB scores and cardiac dysfunction are independent mortality predictors in an elderly Russian population . A r and om sample of 284 community-dwelling adults aged 65 and older were selected from a population -based register and divided into two age groups ( 65 - 74 and ≥75 ) .  The SPPB test , echocardiography and all-cause mortality were measured . The prevalence of cardiac dysfunction was 12 % in the 65 - 74 group and 23 % in the ≥75 group . The multivariate models could explain 15 % and 23 % of the SPPB score total variance for the 65 - 74 and ≥75 age groups , respectively . In the younger age group , the mean follow-up time was 2.6±0.46 years , and the adjusted hazard ratio ( HR ) for risk of mortality from cardiac dysfunction was 4.9 . In the older age group , the mean follow-up time was 2.4±0.61 years , and both cardiac dysfunction and poor physical performance were found to be independent predictors of mortality ( adjusted HR=3.4 and adjusted HR=4.2 , respectively ) . The cardiac dysfunction prevalence in this elderly Russian population was found to be comparable to , or even lower than , reported prevalences for Western countries . Furthermore , the observed correlations between echocardiographic abnormalities and SPPB scores were limited . Cardiac dysfunction was shown to be a strong mortality predictor in both age groups , and poor physical performance was identified as an independent mortality predictor in the oldest subjects BACKGROUND Disability in basic activities of daily living ( ADLs ) implies a loss of independence and increases the risk for hospitalization , nursing home admission , and death . Little is known about ways by which ADL disability can be prevented or reversed . The authors evaluated the efficacy of the Health Enhancement Program in preventing and reducing ADL disability in community-dwelling older adults . METHODS The authors analyzed data from a 12-month , r and omized , single-blinded , controlled trial of a  disability prevention , chronic disease self-management program involving 201 adults aged 70 years and older that was conducted from February 1995 to June 1996 at a senior center in western Washington state .  Activities of daily living disability incidence , improvement , and worsening were assessed using intention-to-treat methods . RESULTS The cumulative incidence of ADL disability among those who were not ADL disabled at baseline ( n = 56 in the intervention group , n = 57 in the control group ) was modestly lower in the intervention group than in the control group at 12 months ( 14.3 % vs 21.3 % , p = .466 ) . Cumulative improvement in ADL function among those who reported any ADL disability at baseline ( n = 41 in the intervention group , n = 43 in the control group ) was greater in the intervention group at 12 months ( 80.5 % vs 46.5 % , p = .026 ) . The likelihood for ADL improvement was greater in the intervention group compared with controls at 12 months ( adjusted hazard ratio , 1.84 ; 95 % confidence interval , 1.05 to 3.22 ; p = .020 ) . Cumulative worsening of ADL function was slightly lower in the intervention group at 12 months ( 18.6 % vs 26.5 % , p = .237 ) . Intervention participants tended to be at lower risk for ADL worsening ( adjusted hazard ratio , 0.71 ; 95 % confidence interval , 0.38 to 1.30 ; p = .266 ) compared with control participants . CONCLUSION The Health Enhancement Program intervention led to improved ADL functioning  in those who were disabled initially and thereby offers a promising strategy for limiting or reversing functional decline in disabled elderly persons BACKGROUND The performance of daily tasks , such as stair climbing or lifting an object , requires both muscle strength and power . Age-associated reductions in strength and power can affect an older adult 's ability to complete daily tasks such as stair climbing and lifting a child . METHODS The purpose s of this study were to determine whether power training was more efficacious than strength training for improving whole-body physical function in older adults and to examine the relationship between changes in anaerobic power and muscle strength and changes in physical function . Thirty-nine men and women ( mean age + /- SD = 72.5 + /- 6.3 years ) with below-average leg extensor power were r and omly assigned to control ( C , n = 15 ) , strength-training ( ST , n = 13 ) or power-training ( PT , n = 11 ) groups . The ST and PT groups met 3 days per week for 16 weeks ; the C group maintained usual activity and attended three lectures during the course of the study . Primary outcome measures included the Continuous Scale Physical Functional Performance test , maximal strength , and anaerobic power . RESULTS After baseline was controlled for , the Continuous Scale Physical Functional Performance test total score was significantly greater for the PT group than for the ST ( p = .033 ) and C ( p = .016 ) groups . Maximal strength was significantly greater for the ST group than for the C group ( p = .015 ) after the intervention . There was no significant difference between groups for peak anaerobic power . CONCLUSIONS Power training was more effective than strength training for improving physical function in community-dwelling older adults UNLABELLED Dizziness is a common complaint among older adults . AIM To identify the prevalence of dizziness and its related factors in a sample of community-dwelling older adults . METHODS A prospect i ve population -based study with a representative sample of older adults aged 65 years and over . A multidimensional question naire and a battery of measures were used for assessing physical function . RESULTS The prevalence of dizziness was 45 % . Vertigo was found in 70.4 % of older adults with dizziness and 43.8 % of them referred vertigo crises along life . A significant association was found between dizziness and female gender ( p=0.004 ) , memory difficulties complaints ( p=0.015 ) , bad health perception ( p=0.001 ) , depression ( p<0.0001 ) , five or more comorbidities ( p=0.021 ) , self-reported fatigue ( p<0.0001 ) , recurrent falls ( p=0.001 ) , excessive sleepiness ( p=0.003 ) , fear of falling ( p<0.0001 ) , left leg unipedal stance ( p=0.002 ) and Short Performance Physical Battery score ( p=0.009 ) . CONCLUSION Dizziness is a common complaint among older adults and it is associated with limiting clinical conditions , such as depression , fatigue , excessive sleepiness and impaired memory . It is highlighted the association between dizziness and recurrent falls , fear of falling and lower performance in physical function tests , which can restrict independence . These data suggest the importance of a multifactorial approach to dizziness in older adults Background Case management has been applied in community aged care to meet frail older people ’s holistic needs and promote cost-effectiveness . This systematic review aims to evaluate the effects of case management in community aged care on client and carer outcomes . Methods We search ed Web of Science , Scopus , Medline , CINAHL ( EBSCO ) and PsycINFO ( CSA ) from inception to 2011 July . Inclusion criteria were : no restriction on date , English language , community-dwelling older people and /or carers , case management in community aged care , published in refereed journals , r and omized control trials ( RCTs ) or comparative observational studies , examining client or carer outcomes . Quality of studies was assessed by using such indicators as quality control , r and omization , comparability , follow-up rate , dropout , blinding assessors , and intention-to-treat analysis . Two review ers independently screened potentially relevant studies , extracted information and assessed study quality . A narrative summary of findings were presented . Results Ten RCTs and five comparative observational studies were identified . One RCT was rated high quality . Client outcomes included mortality ( 7 studies ) , physical or cognitive functioning ( 6 studies ) , medical conditions ( 2 studies ) , behavioral problems ( 2 studies ) , unmet service needs ( 3 studies ) , psychological health or well-being ( 7 studies ) , and satisfaction with care ( 4 studies ) , while carer outcomes included stress or burden ( 6 studies ) , satisfaction with care ( 2 studies ) , psychological health or well-being ( 5 studies ) , and social consequences ( such as social support and relationships with clients ) ( 2 studies ) . Five of the seven studies reported that case management in community aged care interventions significantly improved psychological health or well-being in the intervention group , while all the three studies consistently reported fewer unmet service needs among the intervention participants . In contrast , available studies reported mixed results regarding client physical or cognitive functioning and carer stress or burden . There was also limited evidence indicating significant effects of the interventions on the other client and carer outcomes as described above . Conclusions Available evidence showed that case management in community aged care can improve client psychological health or well-being and unmet service needs . Future studies should investigate what specific components of case management are crucial in improving clients and their carers ’ outcomes OBJECTIVES To estimate the incidence of chronic activities of daily living ( ADL ) disability and to analyze the sociodemographic , health status , adverse lifestyle , and leisure-time physical activity predictors for chronic ADL disability . DESIGN We recruited a cohort of community-dwelling older people in Taipei , Taiwan , who were not ADL disabled in August 1993 , and we followed them until August 1996 . SETTING S AND PARTICIPANTS The study subjects were 1321 community-dwelling people aged 65 years or older who were ADL intact at the initial interview in August 1993 . The study sample was a subset of a probability sample ( n = 1583 ) r and omly selected from household registration s in the four districts of the Taipei metropolitan area . MEASUREMENTS Baseline information regarding various factors potentially associated with the development of chronic ADL disability was assessed and collected at the beginning of the study . Study participants were assessed annually for ADL function by a structured home interview using a six-item scale . Participants who were unable to perform independently at least one of the six items -- eating , bathing , dressing , toileting ,  transfers , and walking inside the house -- for more than 3 months were considered chronically ADL disabled . Cox proportional hazard regression models were utilized to examine the independent effect of the potential predictors on risk of chronic ADL disability . RESULTS During the 3-year study period , 145 ( 11.0 % ) participants developed chronic ADL disability , 58 ( 4.4 % ) participants were lost to follow-up , and 83 ( 6.3 % ) participants died . Multiple hazard regression analysis showed that individuals aged 70 to 79 years or older than age 80 had increased risk of ADL disability ( relative risk : 2.05 ( 95 % confidence interval ( CI ) , 1.35 - 3.11 ) and 3.89 ( 95%CI , 2.33 - 6.50 ) , respectively ) compared with those participants younger than age 70 . Risk of chronic ADL disability was inversely associated with routine exercise ( RR = 0.52 ; 95 % CI , 0.39 - 0.68 ) . CONCLUSIONS Age is the most significant predictor of chronic ADL disability . Lack of routine exercise is also a significant predictor of ADL disability in older adults Background Self-rated health ( SRH ) is a widely used indicator of general health and multiple studies have supported the predictive validity of SRH in older population s concerning future health , functional decline , disability , and mortality . The aim of this study was to use the theoretical framework of the International Classification of Functioning , Disability and Health ( ICF ) to create a better underst and ing of factors associated with SRH among community-dwelling older people in urban and rural areas . Methods The study design was population -based and cross-sectional . Participants were 185 Icel and ers , r and omly selected from a national registry , community-dwelling , 65 - 88 years old , 63 % urban residents , and 52 % men . Participants were asked : " In general , would you say your health is excellent , very good , good , fair , or poor ? " Associations with SRH were analyzed with ordinal logistic regression . Explanatory variables represented aspects of body functions , activities , participation , environmental factors and personal factors components of the ICF . Results Univariate analysis revealed that SRH was significantly associated with all analyzed ICF components through 16 out of 18 explanatory variables . Multivariate analysis , however , demonstrated that SRH had an independent association with five variables representing ICF body functions , activities , and personal factors components : The likelihood of a better SRH increased with advanced lower extremity capacity ( adjusted odds ratio [ adjOR ] = 1.05 , p < 0.001 ) , upper extremity capacity ( adjOR = 1.13 , p = 0.040 ) , household physical activity ( adjOR = 1.01 , p = 0.016 ) , and older age ( adjOR = 1.09 , p = 0.006 ) ; but decreased with more depressive symptoms ( adjOR = 0.79 , p < 0.001 ) . Conclusions The results highlight a collection of ICF body functions , activities and personal factors associated with higher SRH among community-dwelling older people . Some of these , such as physical capacity , depressive symptoms , and habitual physical activity are of particular interest due to their potential for change through public health interventions . The use of ICF conceptual framework and widely accepted st and ardized assessment s should make these results comparable and relevant in an international context IMPORTANCE In older adults reduced mobility is common and is an independent risk factor for morbidity , hospitalization , disability , and mortality . Limited evidence suggests that physical activity may help prevent mobility disability ; however , there are no definitive clinical trials examining whether physical activity prevents or delays mobility disability . OBJECTIVE To test the hypothesis that a long-term structured physical activity program is more effective than a health education program ( also referred to as a successful aging program ) in reducing the risk of major mobility disability . DESIGN , SETTING , AND PARTICIPANTS The Lifestyle Interventions and Independence for Elders ( LIFE ) study was a multicenter , r and omized trial that enrolled participants between February 2010 and December 2011 , who participated for an average of 2.6 years . Follow-up ended in December 2013 . Outcome assessors were blinded to the intervention assignment . Participants were recruited from urban , suburban , and rural communities at 8 centers throughout the United States . We r and omized a volunteer sample of 1635 sedentary men and women aged 70 to 89 years who had physical limitations , defined as a score on the Short Physical Performance Battery of 9 or below , but were able to walk 400 m. INTERVENTIONS Participants were r and omized to a structured , moderate-intensity physical activity program ( n = 818 ) conducted in a center ( twice/wk ) and at home ( 3 - 4 times/wk ) that included aerobic , resistance , and flexibility training activities or to a health education program ( n = 817 ) consisting of workshops on topics relevant to older adults and upper extremity stretching exercises . MAIN OUTCOMES AND MEASURES The primary outcome was major mobility disability objective ly defined by loss of ability to walk 400 m. RESULTS Incident major mobility disability occurred in 30.1 % ( 246 participants ) of the physical activity group and 35.5 % ( 290 participants ) of the health education group ( hazard ratio [ HR ] , 0.82 [ 95 % CI , 0.69 - 0.98 ] , P = .03).Persistent mobility disability was experienced by 120 participants ( 14.7 % ) in the physical activity group and 162 participants ( 19.8 % ) in the health education group ( HR , 0.72 [ 95 % CI , 0.57 - 0.91 ] ; P = .006 ) . Serious adverse events were reported by 404 participants ( 49.4 % ) in the physical activity group and 373 participants ( 45.7 % ) in the health education group ( risk ratio , 1.08 [ 95 % CI , 0.98 - 1.20 ] ) . CONCLUSIONS AND RELEVANCE A structured , moderate-intensity physical activity program compared with a health education program reduced major mobility disability over 2.6 years among older adults at risk for disability . These findings suggest mobility benefit from such a program in vulnerable older adults . TRIAL REGISTRATION clinical trials.gov Identifier : NCT01072500 Purpose : To describe the population in terms of risk for disability and compare the effects of a walking intervention and nutrition education intervention on risk modification and functional performance in lower socioeconomic older adults using a r and omized controlled study . Methods : Twenty‐six community‐dwelling older adults aged 60 and older were r and omly assigned to a 16‐week walking exercise group or a nutrition education control group .  Peak aerobic capacity and physical function were measured at baseline and post intervention . Physical function was measured using the Medical Outcomes Study Short Form Health Survey Physical Function subscale , Short Physical Performance Battery , Physical Performance Test , and Continuous Scale Physical Functional Performance 10 item test ( CS‐PFP10 ) . Results : Eighty‐five percent of the participants were at risk for pre clinical disability of which 50 % were at risk for moderate disability . The walking exercise group significantly improved in peak aerobic capacity ( 18.9 % ) , physical function ( 25 % ) using the CS‐PFP10 compared to the control group . Conclusion : These findings highlight the importance of physical activity and indicate that walking , a simple exercise that can be done without specialized exercise leader or equipment can significantly increase peak aerobic capacity and physical function in just 4 months
Greater physical activity of an aerobic nature ( categorized by a variety of methods ) was associated with higher functional status ( expressed by a host of outcome measures ) in older age .
For functional independence , moderate ( and high ) levels of physical activity appeared effective in conferring a reduced risk ( odds ratio ~0.5 ) of functional limitations or disability .
Limitation in higher level performance outcomes was reduced ( odds ratio ~0.5 ) with vigorous ( or high ) activity with an apparent dose-response of moderate through to high activity .
Exercise training interventions ( including aerobic and resistance ) of older adults showed improvement in physiological and functional measures , and suggestion of longer-term reduction in incidence of mobility disability .
A relatively high level of physical activity was related to better cognitive function and reduced risk of developing dementia ; however , there were mixed results of the effects of exercise interventions on cognitive function indices .
Conclusions There is a consistency of findings across studies and a range of outcome measures related to functional independence ; regular aerobic activity and short-term exercise programmes confer a reduced risk of functional limitations and disability in older age .
Although a precise characterization of a minimal or effective physical activity dose to maintain functional independence is difficult , it appears moderate to higher levels of activity are effective and there may be a threshold of at least moderate activity for significant outcomes
Background The purpose was to conduct systematic review s of the relationship between physical activity of healthy community-dwelling older ( > 65 years ) adults and outcomes of  functional limitations , disability , or loss of independence .