Gait Problems Are Common

To study gait disorders in community-residing older adults and their association with death and institutionalization, the Einstein Aging Study in New York recruited 488 adults ages 70 to 99. At entry and during annual visits over five years, subjects received clinical evaluations to determine the presence of gait abnormalities. Prevalence and incidence of gait disorders were based on clinical evaluations. Prevalence of abnormal gait was 35 percent for neurological and non- neurological reasons. Men had a higher incidence of neurological gait abnormalities, whereas women had a higher incidence of non-neurological gaits. Abnormal gaits were associated with greater risk of institutionalization and death, with risk of both strongly related to severity of impairment.

Easing Arthritis

"Those with regular physical activity are less likely to develop problems with walking, climbing stairs, and other daily activities."Among older Americans, osteoarthritis is one of the major causes of functional decline. In a study that followed more than 3,500 people with osteoarthritis, researchers found that those who were getting regular physical activity at the study's start were less likely than their sedentary peers to develop problems with walking, climbing stairs, and other daily activities. Moreover, exercisers were more likely than inactive adults to show improvements in any mobility problems they had at the outset. Study participants who got some exercise - but less than 30 minutes per day of moderate activity or less than 20 minutes of vigorous exercise - were still less likely than inactive arthritis sufferers to show functional decline over time.

Slowing Down Peripheral Artery Disease

Peripheral artery disease (PAD), which often causes leg pain because of impaired blood flow in the arteries, affects about one in five people over age 70. The disease also brings a six to seven times higher risk of heart attack or stroke. Although treadmill walking can help PAD's symptoms, a new study by Northwestern University researchers sheds light on walking for those who do not participate in a supervised exercise program. A total of 417 participants with PAD reported how much they walked each week over 36 months. They were classified according to the number of times they reportedly walked for exercise each week. Results showed that self-directed walking exercise performed at least three times weekly is associated with significantly less functional decline during the subsequent year. The researchers also found that a small proportion of African-American participants walked for exercise three or more times per week. The prevalence of PAD is higher in African-Americans than in whites.

Motor Complaints May Presage Parkinson's Disease

New research indicated that subjective complaints of stiffness, tremors, and imbalance often precede Parkinson's disease (PD). The findings came from a population-based cohort study of 6,038 subjects who were free from dementia and Parkinsonian signs at baseline physical examination. The subjects were at least 55 years of age and lived in a district of Rotterdam, the Netherlands. After initial evaluation in the early 1990s, the subjects were assessed twice more for PD during that decade. The average follow-up period was 5.8 years. The report indicated that during follow-up, 56 people developed PD, and most had at least one prior motor complaint. Subjects complaining of stiffness, tremors, or imbalance at baseline were at least twice more likely to develop PD during follow-up than their peers who didn't have these complaints. The results suggested that a questionnaire on subjective complaints might be useful when screening for PD.

The Neglected Outdoors

Journal of Housing for the Elderly (Oct-Dec. 2005)

Most information about outdoor amenities in nursing homes and the use of outdoor space by residents has been anecdotal. Using data collected from a study on quality of life, researchers Lois Cutler and Rosalie Kane described the availability of outdoor amenities in 40 nursing homes and residents' perception of their use of that space. Data were collected from 1,988 residents in 131 nursing units in 40 nursing homes on a broad array of topics, including how often residents get outdoors and if that amount of time was as much as they wanted, too much, or not enough. Staff members also were questioned on how often residents participated in planned outdoor activities. Descriptive statistics showed great variation in outdoor amenities and access to those amenities. The majority of 131 units had no items featured on an outdoor amenities index. Of the residents physically able to go outdoors, 32 percent did so less than once a month.

Inadequate Oral Care

"Adherence to standards was low; teeth were brushed and mouths were rinsed with water in 16 percent of observations." This study observed the daily oral care provided by 47 certified nursing assistants (CNAs) for 67 nursing home residents who required assistance with oral care. The study was conducted in five communities using real-time observations of CNAs providing morning care to residents. Oral care standards, developed and validated by a panel of experts, were used to evaluate the care. CNAs were blinded to the study's specific focus on oral care. Adherence to standards was low; teeth were brushed and mouths were rinsed with water in 16 percent of observations. Standards that were never met included brushing teeth for at least two minutes, flossing, oral assessment, rinsing with mouthwash, and wearing clean gloves during care. Most residents who received assistance were resistive to the CNAs' approaches. Actual oral care provided to residents contrasted sharply with CNAs' self-reported practices in the literature and suggests that residents who need assistance receive inadequate oral health care.

Documentary Set to Premiere on PBS

Shot on location in a Milwaukee, Wisconsin, Almost Home is about a year in the life of people who live and work in a nursing home. It is about one community trying to make a difference, bucking the institutional trappings of traditional nursing homes in favor of a place where people could imagine themselves feeling truly "at home." It tells real stories of older couples bonded and divided by disability, and children torn between caring for their aging parents and their own families. It is also about care workers doing unsavory work for poverty wages and a visionary nursing home director committed to culture change. This new documentary will air for the first time on PBS, February 21 at 10 p.m. ET (check local listings). A companion website including a discussion guide is available at http://www.almosthomedoc.org/.

Aging Well in Utah

Many older adults can and do maintain good health into their later years, according to the results of the Cache County Memory Study, which involved nearly all of the adults in a Utah county who were 65 years of age or older at the 1995 start of the study. Most of the participants rated their overall health as "excellent" or "good." Nearly 90 percent or more in every age subgroup lived at home and more than 90 percent were free of depressive symptoms. While about half of the oldest participants had vision or hearing problems, more than 60 percent of 75-84-year olds reported having good or excellent vision and hearing. Still, more than two-thirds of women ages 85 years or older and more than three-quarters of men of similar ages were independent in all activities of daily living. Factors most associated with perceptions of being in good or excellent health were vision, hearing, and mood - all of which, the researchers noted, "are potentially modifiable."

Chronic Disability May Be Overestimated

In a study that involved 552 participants ages 70 or older, Yale University researchers found that the rate of chronic disability in older Americans has been overestimated substantially by about 40 percent. Participants were classified as having chronic disability based on the presence of disability during consecutive monthly interviews immediately before or after the fourth comprehensive assessment. A total of 16.1 to 17.2 percent met criteria for chronic disability, leading to a national estimate ranging from 4.9 to 5.3 million chronically disabled older Americans. This projection is about 2 million fewer chronically disabled older Americans in 1999, relative to the published estimate of 7 million.

Young Adult Caregivers: A First Look at an Unstudied Population

In this review, the prevalence, characteristics, and responsibilities of young adults ages 18 to 25 years who are caregivers for ill, elderly, or disabled family members or friends were examined using two national studies from 1998 and 2004. Young adult caregivers make up between 12 percent and 18 percent of the total number of adult caregivers. More than half are male, and the average age is 21. Most young adults care for a female relative, most often a grandmother. Young adult caregivers identified a variety of unmet needs, including obtaining medical help, information, and help making end-of-life decisions. Concerted efforts are essential to ensure that young adults who become caregivers are not deterred from pursuing educational and career goals.

Caring for Terminally Ill Relatives with Cancer

Family caregivers for cancer patients experience high levels of stress, burden, and diminished quality of life (QOL). The purpose of this study was to determine whether hospice plus a coping skill training intervention improved family caregivers' QOL, burden, coping, and mastery, compared with hospice plus emotional support, and usual hospice care. More than 300 patient/caregiver dyads were randomly divided into three groups, including a control group who received standard hospice care; a group who received standard hospice care plus three supportive visits; and a group who received standard care plus three visits to teach a coping skills intervention. At the 30-day follow-up, the coping skills intervention led to significantly greater improvement in caregiver QOL, burden of patient symptoms, and caregiving burden than did the other two conditions. Skill training for caregivers is promising even in end-of-life care and for families already receiving benefits of hospice care.

Behavioral Therapy Aids Sleep

Therapies focused on changing sleep habits may be good alternatives to sleeping pills for older adults with insomnia. This review of 23 clinical trials found that behavioral therapies aimed at changing people's habits and attitudes regarding sleep were generally effective in helping older adults get a better night's sleep. Three broad types of behavioral therapy were studied; one was cognitive-behavioral therapy, which aims to change insomniacs' thoughts and feelings regarding sleep and to teach them practical ways to surmount their sleep problems, such as getting into bed only when they're drowsy and getting up and reading a book when they fail to fall asleep in 20 minutes. Some studies investigated relaxation-based therapies, while others tested behavioral-only approaches. Of the 23 clinical trials included in the study, only eight focused on adults older than 55 years of age. The review found that all three forms of therapy were similarly effective at improving older adults' sleep. The prevalence of insomnia among older adults is approximately 30 percent.

Team Management of Depression

"A team-care model is effective and more cost-effective than standard treatment options."Approximately five to 10 percent of older adults seen in primary care suffer from clinical depression. Depression in late life is associated with higher health care expenses, mostly due to increased medical visits and treatment. This study showed that a team-care model is effective and more cost-effective than standard treatment options. Participants included 1,801 patients ages 60 years or older with major depression, minor depression, or both. About half had usual care and 906 were assigned to a treatment group who had a care manager, either a nurse or psychologist supervised by a physician. The care managers helped educate patients about depression; tracked depressive symptoms and side effects; helped make changes in treatment when necessary; and offered a brief course of psychotherapy. People in the treatment program experienced 107 more depression-free days over 24 months. The cost of using the treatment model was about $580 per year for each patient, which was offset by cost-savings in the year following the program.

Register Now for the NCOA and ASA Joint Conference

The 2006 Joint Conference of the National Conference on the Aging and the American Society on Aging will take place March 16-19 in Anaheim, California (adjacent to Disneyland). The conference is themed Invest in Aging: Strengthening Families, Communities and Ourselves. More than 4,000 professionals, including researchers, practitioners, educators, business people and policymakers, will meet to discuss the physical, emotional, social, economic, and spiritual aspects of aging. Hundreds of workshops, plenary sessions, daylong special programs, and pre-conference intensives will cover critical topics on aging. For information, registration, and session descriptions, visit www.agingconference.org.

The Business Case for Older Workers

Competition for talent among U.S. companies is likely to increase significantly as the Baby Boomer generation approaches traditional retirement age. Many companies potentially face critical losses of experienced talent in key roles ranging from leadership to sales to certain technical and professional disciplines and many skilled trades. Fortunately, workers who are 50+ represent a viable solution to these challenges. This AARP study examines the recruitment and retention of workers ages 50+ from a business-case perspective. In addition, it highlights the need for employers to consider costs with a broader lens and demonstrates that 50+-year-old workers represent a solid and sound investment proposition. To read the 28-page report, go to http://www.aarp.org/research/work/employment/workers_fifty_plus.html.

Talking With Your Doctor: A Guide for Older People

The U.S. government's National Institute on Aging has issued a new and revised edition of Talking with Your Doctor: A Guide for Older People, a guide intended to help patients better work with their physician to receive good, effective health care. It offers tips on finding a doctor; preparing for an appointment; giving and getting information during an appointment; making decisions; discussing sensitive subjects; involving family and friends; and more. Free copies of the 48-page guide are available at www.niapublications.org/pubs/talking/index.asp.

Understanding Aging: The Social Worker's Role

This free, two-hour Web-based course highlights the essential information that social workers and other health professionals need to know about aging. The first lesson covers the basics of aging, with applications from direct and systems-based practices. The next lesson focuses on the values, ethics, and theoretical perspectives necessary for practicing across the aging continuum. The third lesson will broaden the understanding of the diversity of roles in working with older adults. The final lesson provides a list of resources for social workers and their clients to find information addressing various needs along the aging continuum. To enroll in this course or other free Continuing Education Unit courses, visit http://www.naswwebed.org.