Stability of physical assessment of older drivers over 1 year. Physical activity and functional limitations in older adults: a systematic review related to Canada's Physical Activity Guidelines Examination of cognitive and instrumental functional performance as indicators for driving cessation risk across 3 years. Longitudinal predictors of driving cessation among older adults from the ACTIVE clinical trial. White Matter Integrity Declined Over 6-Months, but Dance Intervention Improved Integrity of the Fornix of Older Adults The Lifestyle Interventions and Independence for Elders Pilot (LIFE-P): 2-year follow-up. The Effects of Aerobic Training and Nutrition Education on Functional Performance in Low Socioeconomic Older Adults Ten years down the road: predictors of driving cessation. Reducing Sedentary Behavior Versus Increasing Moderate-to-Vigorous Intensity Physical Activity in Older Adults Effects of a weight loss plus exercise program on physical function in overweight, older women: a randomized controlled trial Determining the validity of the AMA guide: A historical cohort analysis of the assessment of driving related skills and crash rate among older drivers. A Randomized Trial of a Physical Conditioning Program to Enhance the Driving Performance of Older Persons Angiotensin-converting enzyme inhibitor use by older adults is associated with greater functional responses to exercise. Driving status and three-year mortality among community-dwelling older adults. Maintenance Effects of a DVD-Delivered Exercise Intervention on Physical Function in Older Adults. Improvement in usual gait speed predicts better survival in older adults. Functional benefits of tai chi training in senior housing facilities. Improving Physical Activity and Function in Overweight and Obese Older Adults with Osteoarthritis of the Knee: A Feasibility Study Predicting road test performance in drivers with dementia. Progressive multi-component home-based physical therapy for deconditioned older adults following acute hospitalization: a pilot randomized controlled trial Should physical activity programs be tailored when older adults have compromised function? A multidomain approach for predicting older driver safety under in-traffic road conditions. Moving to maintain function in knee osteoarthritis: evidence from the osteoarthritis initiative. Changes in cognitive function in a randomized trial of physical activity: results of the lifestyle interventions and independence for elders pilot study. Community-based intervention to improve dietary habits and promote physical activity among older adults: a cluster randomized trial Predicting driving cessation over 5 years in older adults: psychological well-being and cognitive competence are stronger predictors than physical health. Improvement in balance, strength, and flexibility after 12 weeks of Tai chi exercise in ethnic Chinese adults with cardiovascular disease risk factors. Mobility Is a Key Predictor of Change in Well-Being Among Older Adults Who Experience Falls: Evidence From the Vancouver Falls Prevention Clinic Cohort.
Older adults represent the fastest-growing population of drivers with a valid driver 's licence . Also common in this age group are multiple chronic medical conditions that may have an effect on physical function and driving ability . Determining the reliability of physical measures used to assess older drivers ' functional ability is important to identifying those who are safe to continue driving . Most previous reliability studies of clinical physical measures of health used test-retest intervals shorter than those between patient visits with a clinician . In the present study we examined a more clinical ly representative interval of 1 year to determine the stability of commonly used physical measures collected during the C and rive II prospect i ve cohort study of older drivers .  Reliability statistics indicate that the  sequential finger-thumb opposition , rapid pace walk  and the  Pelli-Robson contrast sensitivity tests  have adequate stability over 1 year . Poor stability was observed for the one-legged stance and Snellen visual acuity test . Several assessment s with nominal data ( Marottoli method [ functional neck range of motion ] , whispered voice test , range of motion and strength testing ) lacked sufficient variability to conduct reliability analyses ; however , a lack of variability between test days suggests consistency over a 1-year time frame . Our results provide evidence that specific physical measures are stable in monitoring functional ability over the course of a year 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 The purpose of this study was to prospect ively examine the role of cognitive and instrumental functional performance in driving cessation while simultaneously accounting for any contributions of demographics , vision , physical performance , and health among a sample of older adults without dementia . DESIGN AND METHODS Included in the analyses were 1,838 participants from the Advanced Cognitive Training for Independent and Vital Elderly ( ACTIVE ) study who were drivers at baseline and completed the third-year assessment . Participants completed baseline assessment s of sociodemographic characteristics , health , sensory function , physical function , cognitive abilities , instrumental functional performance , and depressive symptoms . Driving status was again ascertained 3 years later . RESULTS We used Cox proportional hazard analyses to examine prospect i ve predictors of driving cessation over a 3-year period . The final model indicated four significant risk factors for driving cessation : older age ( hazard ratio [ HR ] = 1.06 , p = .009 ) , poorer balance as measured by the Turn 360 degrees test ( HR = 1.17 , p = .002 ) , slower cognitive speed of processing as measured by the Useful Field of View test ( HR = 1.37 , p = .004 ) , and poorer instrumental functional performance as assessed by the Everyday Problems Test ( HR = 1.59 , p < .001 ) . IMPLICATION S Although vision , health , and physical abilities are commonly considered when determining driving capacity , cognitive speed of processing and instrumental functional performance may be better indicators of subsequent likelihood of driving cessation across 3 years among older adults . Poor health and vision may only impact driving cessation to the extent that cognitive speed of processing and instrumental functioning are affected We examined the physical , visual , health , and cognitive abilities of 1,656 older adults as prospect i ve predictors of self-reported driving cessation over a 5-year period . We examined the time to driving cessation across 5 years after we controlled for days driven per week at baseline and any cognitive intervention participation . Older age , congestive heart failure , and poorer physical performance ( according to the Turn 360 Test ) were statistically significant risk factors for driving cessation . Slower speed of processing ( according to the Digit Symbol Substitution and Useful Field of View tests ) was a significant risk factor even after we took baseline driving , age , health , vision , and physical performance into consideration . Implication s are that assessment s of cognitive speed of processing can provide valuable information about the subsequent risk of driving cessation Degeneration of cerebral white matter ( WM ) , or structural disconnection , is one of the major neural mechanisms driving age-related decline in cognitive functions , such as processing speed . Past cross-sectional studies have demonstrated beneficial effects of greater cardiorespiratory fitness , physical activity , cognitive training , social engagement , and nutrition on cognitive functioning and brain health in aging . Here , we collected diffusion magnetic resonance ( MRI ) imaging data from 174 older ( age 60–79 ) adults to study the effects of 6-months lifestyle interventions on WM integrity . Healthy but low-active participants were r and omized into Dance , Walking , Walking + Nutrition , and Active Control ( stretching and toning ) intervention groups ( NCT01472744 on Clinical Trials.gov ) . Only in the fornix there was a time × intervention group interaction of change in WM integrity : integrity declined over 6 months in all groups but increased in the Dance group . Integrity in the fornix at baseline was associated with better processing speed , however , change in fornix integrity did not correlate with change in processing speed . Next , we observed a decline in WM integrity across the majority of brain regions in all participants , regardless of the intervention group . This suggests that the aging of the brain is detectable on the scale of 6-months , which highlights the urgency of finding effective interventions to slow down this process . Magnitude of WM decline increased with age and decline in prefrontal WM was of lesser magnitude in older adults spending less time sedentary and more engaging in moderate-to-vigorous physical activity . In addition , our findings support the anterior-to-posterior gradient of greater-to-lesser decline , but only in the in the corpus callosum . Together , our findings suggest that combining physical , cognitive , and social engagement ( dance ) may help maintain or improve WM health and more physically active lifestyle is associated with slower WM decline . This study emphasizes the importance of a physically active and socially engaging lifestyle among aging adults BACKGROUND It is well recognized that physical activity ( PA ) is important for older adults ; yet , clinicians remain pessimistic about the ability of older adults with compromised function to adhere to long-term treatment and to maintain behavior change once treatment has been terminated . METHODS We examined the functional status of older adults at a field center ( Wake Forest University ) 2 years after completing 12 months of treatment in the Lifestyle Interventions and Independence for Elders Pilot study . At baseline , participants were r and omized to either a PA or a successful aging ( SA ) control group .  Outcome measures included an interview assessment of PA , the Short Physical Performance Battery ( SPPB ) , and performance on a 400-m self-paced walking test . RESULTS Two years after the formal intervention had ended , participants who were originally in the PA group continued to engage in more minutes of moderate PA and tended to have better SPPB and walking speed than those in the SA group ( effect sizes [ ES ] : SPPB = 0.40 , walking speed = 0.37 ) . Seven ( 12.7 % ) participants in the PA group failed the 400-m walk at the 36-month follow-up assessment , whereas this number was 11 ( 21.6 % ) in the SA group . CONCLUSION Older adults who have compromised physical function are able to sustain some of the benefits derived from participating in structured PA 2 years after supervised treatment has been terminated 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 PURPOSE Recent prospect i ve studies have found that cognition is a more salient predictor of driving cessation than physical performance or demographic factors among community-dwelling older adults . However , these studies have been limited to 5 years of follow-up . The current study used data from the Maryl and Older Drivers Project to examine predictors of  driving cessation in older adults over a 10-year period . DESIGN AND METHODS Participants ( N = 1,248 ) completed baseline and 5-year assessment s of physical and cognitive abilities .  Driving status was ascertained at baseline and annually thereafter . RESULTS Cox proportional hazard models were used to examine the risk of driving cessation as a function of demographic , physical , and cognitive predictors . The final model indicated three significant predictors of driving cessation , older age at baseline ( hazard ratio [ HR ] = 1.12 , p < .001 ) , days driven per week ( HR = 0.83 , p = .05 ) , and slower speed of processing as measured by the Useful Field of View Test ( HR = 1.76 , p < .01 ) . IMPLICATION S These results underscore the importance of cognitive speed of processing to the maintenance of driving . Brief cognitive assessment can be conducted in the field to potentially identify older adults at increased risk for driving cessation . Further research is needed to determine the costs and potential benefits of such screening Objective : To compare the effects of behavioral interventions targeting decreased sedentary behavior versus increased moderate-to-vigorous intensity physical activity ( MVPA ) in older adults . Method : Inactive older adults ( N = 38 , 68 ± 7 years old , 71 % female ) were r and omized to 12-week interventions targeting decreased sedentary behavior ( Sit Less ) or increased MVPA ( Get Active ) . The SenseWear armb and was used to objective ly assess activity in real time . Assessment s included a blinded armb and , the Community Health Activites Model Program for Senior ( CHAMPS ) question naire , 400-meter walk , and the Short Physical Performance Battery ( SPPB ) . Results : Objective ly measured MVPA increased in Get Active ( 75 ± 22 min/week , p < .001 ) ; self-reported MVPA increased in both groups ( p < .05 ) . Sedentary behavior did not change in either group ( all p > .05 ) . Only the Sit Less group improved the SPPB score ( 0.5 ± 0.3 , p = .046 ) . Discussion : Targeting reduced sedentary behavior had a greater effect on physical function among inactive but high functioning older adults over 12 weeks . Future studies of longer duration and combining increased MVPA with reduced sedentary behavior are needed Background : Obesity and a sedentary lifestyle are associated with physical impairments and biologic changes in older adults . Weight loss combined with exercise may reduce inflammation and improve physical functioning in overweight , sedentary , older adults . This study tested whether a weight loss program combined with moderate exercise could improve physical function in obese , older adult women . Methods : Participants ( N = 34 ) were generally healthy , obese , older adult women ( age range 55–79 years ) with mild to moderate physical impairments ( ie , functional limitations ) . Participants were r and omly assigned to one of two groups for 24 weeks : ( i ) weight loss plus exercise ( WL+E ; n = 17 ; mean age = 63.7 years [ 4.5 ] ) or ( ii ) educational control ( n = 17 ; mean age = 63.7 [ 6.7 ] ) . In the WL+E group , participants attended a group-based weight management session plus three supervised exercise sessions within their community each week . During exercise sessions , participants engaged in brisk walking and lower-body resistance training of moderate intensity . Participants in the educational control group attended monthly health education lectures on topics relevant to older adults . Outcomes were : ( i ) body weight , ( ii ) walking speed ( assessed by 400-meter walk test ) , ( iii ) the Short Physical Performance Battery ( SPPB ) , and ( iv ) knee extension isokinetic strength . Results : Participants r and omized to the WL+E group lost significantly more weight than participants in the educational control group ( 5.95 [ 0.992 ] vs 0.23 [ 0.99 ] kg ; P < 0.01 ) . Additionally , the walking speed of participants in the WL+E group significantly increased compared with that of the control group ( reduction in time on the 400-meter walk test = 44 seconds ; P < 0.05 ) . Scores on the SPPB improved in both the intervention and educational control groups from pre- to post-test ( P < 0.05 ) , with significant differences between groups ( P = 0.02 ) . Knee extension strength was maintained in both groups . Conclusion : Our findings suggest that a lifestyle-based weight loss program consisting of moderate caloric restriction plus moderate exercise can produce significant weight loss and improve physical function while maintaining muscle strength in obese , older adult women with mild to moderate physical impairments BACKGROUND Chronic health conditions associated with ageing can lead to changes in driving ability . The Canadian Driving Research Initiative for Vehicular Safety in the Elderly ( C and rive II ) is a 5-year prospect i ve study funded by the Canadian Institutes of Health Research aim ing to develop an in-office screening tool that will help clinicians identify potentially at-risk older drivers . Currently , no tools exist to directly predict the risk of motor vehicle collision ( MVC ) in this population . The American Medical Association ( AMA ) , in collaboration with the National Highway Traffic Safety Association , has design ed an opinion-based guide for assessing medical fitness to drive in older adults and recommends that physicians use the Assessment of Driving Related Skills ( ADReS ) as a test battery to measure vision , cognition and motor/somatosensory functions related to driving . The ADReS consists of the  Snellen visual acuity test , visual fields by confrontation test , Trail Making Test part B , clock drawing test , Rapid Pace Walk  , and  manual tests of range of motion and motor strength .  We used baseline data from the C and rive/Ozc and rive common cohort of older drivers to evaluate the validity of the ADReS subtests . We hypothesized that participants who crashed in the 2 years before the baseline assessment would have poorer scores on the ADReS subtests than participants who had not crashed . METHODS In the C and rive/Ozc and rive study , 1230 participants aged 70 years or older were recruited from 7 Canadian cities , 1 Australian city and 1 New Zeal and city , all of whom completed a comprehensive clinical assessment at study entry . The assessment included all tests selected as part of the ADReS. For this historical cohort study , data on all crashes ( at-fault and non-at-fault ) that occurred within 2 years preceding the baseline assessment were obtained from the respective licensing jurisdictions . Those who crashed were compared to those who had not crashed on their ADReS subtest scores using Pearson 's chi-squared test and Student 's t-test . RESULTS Sixty-three of the 1230 participants ( 5.1 % ) were involved in an MVC within the 2 years preceding the baseline assessment . Contrary to our hypothesis , there were no statistically significant associations between abnormal performance on the tests constituting the  ADReS  and history of crash in the previous 2 years ( p>0.01 ) . DISCUSSION We found that a history of crash in the previous 2 years was not associated with abnormalities on the subtests comprising the ADReS. This suggests the need for prospect i ve analyses of risk factors over time to establish sensitive , valid predictors of crash that can be incorporated in clinical practice guidelines Background As the number of older drivers increases , concern has been raised about the potential safety implication s. Flexibility , coordination , and speed of movement have been associated with older drivers ’ on road performance . Objective To determine whether a multicomponent physical conditioning program targeted to axial and extremity flexibility , coordination , and speed of movement could improve driving performance among older drivers . Design R and omized controlled trial with blinded assignment and end point assessment . Participants r and omized to intervention underwent graduated exercises ; controls received home , environment safety modules . Participants Drivers , 178 , age ≥ 70 years with physical , but without substantial visual ( acuity 20/40 or better ) or cognitive ( Mini Mental State Examination score ≥24 ) impairments were recruited from clinics and community sources . Measurements On-road driving performance assessed by experienced evaluators in dual-brake equipped vehicle in urban , residential , and highway traffic . Performance rated three ways : ( 1 ) 36-item scale evaluating driving maneuvers and traffic situations ; ( 2 ) evaluator ’s overall rating ; and ( 3 ) critical errors committed . Driving performance reassessed at 3 months by evaluator blinded to treatment group . Results Least squares mean change in road test scores at 3 months compared to baseline was 2.43 points higher in intervention than control participants ( P = .03 ) . Intervention drivers committed 37 % fewer critical errors ( P = .08 ) ; there were no significant differences in evaluator ’s overall ratings ( P = .29 ) . No injuries were reported , and complaints of pain were rare . Conclusions This safe , well-tolerated intervention maintained driving performance , while controls declined during the study period . Having interventions that can maintain or enhance driving performance may allow clinician – patient discussion s about driving to adopt a more positive tone , rather than focusing on driving limitation or cessation OBJECTIVES To assess the association between angiotensin converting enzyme inhibitors ( ACEis ) and improvements in the physical function of older adults in response to chronic exercise training . DESIGN Secondary analysis of the Lifestyle Interventions and Independence for Elders Pilot ( LIFE-P ) study , a multisite r and omized clinical trial to evaluate the effects of chronic exercise on the physical function of older adults at risk for mobility disability . SETTING Four academic research centers within the United States . PARTICIPANTS Four hundred twenty-four individuals aged 70 to 89 with mild to moderate functional impairments categorized for this analysis as ACEi users , users of other antihypertensive drugs , or antihypertensive nonusers . INTERVENTION A 12-month intervention of structured physical activity ( PA ) or health education promoting successful aging ( SA ) . MEASUREMENTS Change in walking speed during a 400-m test and performance on a battery of short- duration mobility tasks ( Short Physical Performance Battery ( SPPB ) ) . RESULTS Physical activity significantly improved the adjusted walking speed of ACEi users ( P < .001 ) but did not of nonusers . PA improved the adjusted SPPB score of ACEi users ( P < .001 ) and of persons who used other antihypertensive drugs ( P = .005 ) but not of antihypertensive nonusers ( P = .91).The percentage of ACEi users deriving clinical ly significant benefit from exercise training for walking speed ( 30 % ) and SPPB score ( 48 % ) was dramatically higher than for nonusers ( 14 % and 12 % , respectively ) . CONCLUSION For older adults at risk for disability , exercise-derived improvements in physical function were greater for ACEi users than users of other antihypertensive drugs and antihypertensive nonusers BACKGROUND Driving cessation can lead to myriad negative consequences for older adults . The purpose of these analyses was to examine driving status as a predictor of mortality among community-dwelling older adults . METHODS This prospect i ve cohort study included 660 community-dwelling adults ranging in age between 63 and 97 years . Between 2000 and 2004 , participants completed performance-based assessment s of vision , cognition , and physical abilities and indexes of health , depression , self-efficacy , and driving habits . Follow-up telephone interviews were completed approximately 3 years later . RESULTS Among community-dwelling older adults , older age , health , poor near visual acuity , depressive symptoms , compromised cognitive status , and being a nondriver are associated with increased risk for a 3-year mortality . Nondrivers were four to six times more likely to die than drivers during the subsequent 3-year period . CONCLUSIONS The ability to drive represents both a sign of cherished independence and underlying health and well-being for older adults . Retaining this ability is an important health concern in the United States 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 OBJECTIVES To estimate the relationship between 1-year improvement in measures of health and physical function and 8-year survival . DESIGN Prospect i ve cohort study . SETTING Medicare health maintenance organization and Veterans Affairs primary care programs . PARTICIPANTS Persons aged 65 and older ( N=439 ) . MEASUREMENTS Six measures of health and function assessed at baseline and quarterly over 1 year . Participants were classified as improved at 1 year , transiently improved , or never improved for each measure using a priori definitions of meaningful change : gait speed ( usual walking pace over 4 m ) , 0.1 m/s ; Short Physical Performance Battery , 1 point ; Medical Outcomes Study 36-item Short Form Health Survey physical function , 10 points ; EuroQol , 0.1 point ; National Health Interview activity of daily living scale , 2 points ; and global health change , two levels or reaching the ceiling . Mortality was ascertained from the National Death Index . Covariates included demographics , comorbidity , cognitive function , and hospitalization . RESULTS Of the six measures , only improved gait speed was associated with survival . Mortality after 8 years was 31.6 % , 41.2 % , and 49.3 % for those with improved , transiently improved , and never improved gait speed , respectively . The survival benefit for improvement at 1 year persisted after adjustment for covariates ( hazard ratio=0.42 , 95 % confidence interval=0.29 - 0.61 , P<.001 ) and was consistent across subgroups based on age , sex , ethnicity , initial gait speed , healthcare system , and hospitalization . CONCLUSION Improvement in usual gait speed predicts a substantial reduction in mortality . Because gait speed is easily measured , clinical ly interpretable , and potentially modifiable , it may be a useful " vital sign " for older adults . Further research is needed to determine whether interventions to improve gait speed affect survival OBJECTIVES To determine the effects of tai chi training on functional performance and walking with and without the addition of the performance of a cognitive task , in older adults living in supportive housing facilities . DESIGN Secondary data analysis comparing a single-blind , r and omized controlled trial of tai chi training with an attention-matched educational control intervention with crossover to tai chi . SETTING Two supportive housing facilities . PARTICIPANTS Sixty-six men and women living in supportive housing facilities entered the study , and 57 aged 87±7 completed all study procedures . INTERVENTION Interventions consisted of two 1-hour-long instructor-led group sessions per week for 12 weeks . Tai chi training consisted of movements based upon the Yang-style short form . Educational sessions consisted of lectures and discussion s of age-related health topics . MEASUREMENTS Subjects were tested for physical function ( Short Physical Performance Battery , SPPB ) , balance ( Berg Balance Scale , BBS ) , mobility ( timed up- and -go , TUG ) , and walking speed under normal and cognitive dual-task conditions . RESULTS The tai chi group exhibited greater improvement in SPPB scores ( baseline 8.1±2.9 , follow-up 9.0±2.6 ) than controls ( baseline 8.2±2.6 , follow-up 8.2±2.6 ) ( P=.005 ) . Tai chi also increased normal and dual-task walking speed ( P<.001 ) yet did not affect BBS ( P=.02 ) or TUG ( P=.02 ) after accounting for multiple comparisons . The dual-task cost ( percentage change ) to walking speed was unaffected . After the crossover tai chi intervention , the control group improved performance in the SPPB , BBS , and TUG , and increased walking speed under normal and dual-task conditions ( P=.008 ) . CONCLUSION Tai chi training may be a safe and effective therapy to help improve physical function and dual-task walking in very old adults living in supportive housing facilities & NA ; Osteoarthritis of the knee , a prevalent condition in older adults , can impact physical function and ability to perform physical activity . This r and omized controlled trial examined the effects of a 6‐month self‐efficacy‐based , individually delivered , lower‐extremity exercise and fitness walking intervention with 6‐month follow‐up on physical activity and function . The 26 subjects were mostly older ( M = 63.2 years , SD = 9.8 ) , White ( 83 % ) , obese ( BMI M = 33.3 , SD = 6.0 ) women ( 96 % ) . Physical activity was measured by diaries . Physical function was measured by the 6‐minute walk , Short Physical Performance Battery ( SPPB ) , and WOMAC Physical Function subscale . Exercise self‐efficacy was assessed by a question naire . Results showed significant increases in self‐reported performance of lower‐extremity exercise and participation in fitness walking , distance in the 6‐minute walk , and SPPB scores from baseline to 6‐month follow‐up with a trend for improvement in self‐efficacy . Results suggest that the intervention was feasible , acceptable , and improved physical activity and function OBJECTIVES To develop a cognitive and functional screening battery for the on-road performance of older drivers with dementia . DESIGN Prospect i ve observational study . SETTING On-road driving evaluation clinic at an academic rehabilitation center . PARTICIPANTS Ninety-nine older people with dementia ( 63 % male , mean age 74.2 ± 9 ) , referred by community physicians to an occupational therapy driving clinic . MEASUREMENTS The outcome variable was pass or fail on the modified Washington University Road Test . Predictor measures were tests of visual , motor , and cognitive functioning , selected for their empirical or conceptual relationship to the complex task of driving safely . RESULTS Sixty-five ( 65 % ) participants failed the on-road driving test . The best predictive model , with an overall accuracy of up to 85 % when participants were blinded , included the Eight-item Informant Interview to Differentiate Aging and Dementia , Clock Drawing Test score , and time to complete the Snellgrove Maze Test or Trail Making Test Part A. Visual and motor functioning were not associated with road test failure . CONCLUSION A screening battery that could be performed in less than 10 minutes predicted with good accuracy failure rate for the on-road driving test in this sample of older drivers with dementia . A probability of failure calculator is provided from a logistic regression model that may be useful for clinicians in their decision to refer impaired older adults for further testing . More studies are needed in larger community-based sample s , along with discussion s with patients , families , and clinicians , with regard to acceptable levels of test uncertainty Objective : To determine whether a progressive multicomponent physical therapy intervention in the home setting can improve functional mobility for deconditioned older adults following acute hospitalization . Design : R and omized controlled trial . Setting : Patient homes in the Denver , CO , metropolitan area . Participants : A total of 22 homebound older adults age 65 and older ( mean ± SD ; 85.4 ±7.83 ) ; 12 were r and omized to intervention group and 10 to the control group . Intervention : The progressive multicomponent intervention consisted of home-based progressive strength , mobility and activities of daily living training . The control group consisted of usual care rehabilitation . Measurements : A 4-meter walking speed , modified Physical Performance Test , Short Physical Performance Battery , 6-minute walk test . Results : At the 60-day time point , the progressive multicomponent intervention group had significantly greater improvements in walking speed ( mean change : 0.36 m/s vs. 0.14 m/s , p = 0.04 ) , modified physical performance test ( mean change : 6.18 vs. 0.98 , p = 0.02 ) and Short Physical Performance Battery scores ( mean change : 2.94 vs. 0.38 , p = 0.02 ) compared with the usual care group . The progressive multicomponent intervention group also had a trend towards significant improvement in the 6-minute walk test at 60 days ( mean change : 119.65 m vs. 19.28 m ; p = 0.07 ) . No adverse events associated with intervention were recorded . Conclusions : The progressive multicomponent intervention  improved patient functional mobility following acute hospitalization more than usual care . Results from this study support the safety and feasibility of conducting a larger r and omized controlled trial of progressive multicomponent intervention in this population . A more definitive study would require 150 patients to verify these conclusions given the effect sizes observed The purpose of this study was to determine whether a walking program supplemented by tasks design ed to challenge balance and mobility ( WALK+ ) could improve physical function more than a traditional walking program ( WALK ) in older adults at risk for mobility disability . 31 community-dwelling older adults ( M + /- SD age = 76 + /- 5 yr ; Short Physical Performance Battery [ SPPB ] score = 8.4 + /- 1.7 ) were r and omized to treatment . Both interventions were 18 sessions ( 1 hr , 3x/wk ) and progressive in intensity and duration . Physical function was assessed using the SPPB and the 400-m-walk time . A subset of participants in the WALK group who had relatively lower baseline function showed only small improvement in their SPPB scores after the intervention ( 0.3 + /- 0.5 ) , whereas a subset of participants in the WALK+ group with low baseline function showed substantial improvement in their SPPB scores ( 2.2 + /- 0.7 ) . These preliminary data underscore the potential importance of tailoring interventions for older adults based on baseline levels of physical function OBJECTIVES To identify a battery of tests that predicts safe and unsafe performance on an on-road assessment of driving . DESIGN Prospect i ve cohort study . SETTING University laboratory assessment and an on-road driving test . PARTICIPANTS Two hundred seventy community-living adults aged 70 to 88 recruited through the electoral roll . MEASUREMENTS Performance on a battery of multidisciplinary tests and on a st and ardized measure of on-road driving performance . RESULTS A combination of three tests from the vision , cognitive , and motor domains , including motion sensitivity , color choice reaction time , postural sway on a compliant foam rubber surface , and a self-reported measure of driving exposure , was able to classify participants into safe and unsafe driver groups with sensitivity of 91 % and specificity of 70 % . CONCLUSION In a sample of licensed older drivers , a short battery of tests and a self-reported measure of driving exposure were able to accurately predict driving safety OBJECTIVES To investigate the association between baseline physical activity and 1-year functional performance in adults with knee osteoarthritis ( OA ) . DESIGN Prospect i ve cohort study of knee OA development and progression with 1-year follow-up . SETTING Community . PARTICIPANTS Osteoarthritis Initiative public data on adults with knee OA ( n=2274 ; age , 45 - 79y ) who participated in functional performance assessment s ( timed 20-m walk and chair st and test ) at baseline and 1-year follow-up . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURE A good 1-year performance outcome ( separately defined for walk time and chair st and measures ) was improvement from baseline quintile or maintenance in the best quintile . RESULTS Almost 2 in 5 persons with radiographic knee OA improved or maintained high performance at 1 year .  Physical activity  measured by the  Physical Activity Scale for the Elderly  ( PASE ) was significantly associated with good walk rate and chair st and outcomes ( odds ratio per 40 units PASE [ 95 % confidence interval]=1.13 [ 1.13 , 1.17 ] and 1.10 [ 1.05 , 1.15 ] , respectively ) , as were participation in sports/recreational activities ( 1.45 [ 1.23 , 1.71 ] and 1.29 [ 1.09 , 1.51 ] , respectively ) and lifestyle activities ( 1.11 [ 1.06 , 1.16 ] and 1.09 [ 1.04 , 1.14 ] , respectively ) . An independent protective relationship for these physical activity measures approached significance after adjusting for sociodemographic and health factors . Older adults reported the least baseline physical activity and least frequent good 1-year outcomes . CONCLUSIONS These findings support public health recommendations to be physically active in order to preserve function for persons with knee OA .  Physical activity messages should specifically target older adults whose low activity levels may jeopardize their ability to maintain functional performance BACKGROUND Cognitive impairment is an important contributor to disability . Limited clinical trial evidence exists regarding the impact of physical exercise on cognitive function ( CF ) . We report results of a pilot study to provide estimates of the relative impact of physical activity ( PA ) on 1-year changes in cognitive outcomes and to characterize relationships between changes in mobility disability and changes in cognition in older adults at increased risk for disability . METHODS Sedentary persons ( 102 ) at increased risk for disability ( aged 70 - 89 years ) were r and omized to moderate-intensity PA or health education .  Participants were administered the  Digit Symbol Substitution Test ( DSST ) , Rey Auditory Verbal Learning Test ( RAVLT ) , modified Stroop test , and Modified Mini-Mental State Examination  at baseline and 1 year . RESULTS Group differences were not significant but improvements in cognitive scores were associated with improvements in physical function . Specifically , the DSST significantly correlated with change in the Short Physical Performance Battery score ( r = .38 , p = .0002 ) , in chair st and score ( r = .26 , p = .012 ) , in balance score ( r = .21 , p = .046 ) , and in 400-m gait speed ( r = .15 , p = .147 ) . Change recall on the RAVLT and in the Stroop test was also positively correlated with changes in chair st and and balance , respectively . CONCLUSIONS These results provide further support for the benefits of exercise on CF in older adults . An adequately powered clinical trial of PA involving older adults at increased risk for cognitive disability is needed to exp and the indications for prescribing exercise for prevention of decline in brain function Background The fastest growing age group globally is older adults , and preventing the need for long-term nursing care in this group is important for social and financial reasons . A population approach to diet and physical activity through the use of social services can play an important role in prevention . This study examined the effectiveness of a social health program for community-dwelling older adults aim ed at introducing and promoting physical activity in the home at each individual ’s pace , helping participants maintain good dietary habits by keeping self-check sheets , and determining whether long-st and ing unhealthy or less-than-ideal physical and dietary habits can be changed . Method This cluster r and omized trial conducted at 6 community centers in an urban community involved 92 community-dwelling older adults aged 65–90 years . The intervention group ( 3 community centers ; n = 57 ) participated in the social health program “ Sumida TAKE10 ! ” which is an educational program incorporating the “ TAKE10 ! ® for Older Adults ” program , once every 2 weeks for 3 months . The control group ( 3 community centers ; n=35 ) was subsequently provided with the same program as a crossover intervention group . The main outcome measures were changes in food intake frequency , food frequency score ( FFS ) , dietary variety score ( DVS ) , and frequency of walking and exercise . The secondary outcome measures were changes in self-rated health , appetite , and the Tokyo Metropolitan Institute of Gerontology ( TMIG ) Index of Competence score . Results Compared to baseline , post-intervention food intake frequency for 6 of 10 food groups ( meat , fish/shellfish , eggs , potatoes , fruits , and seaweed ) , FFS , and DVS were significantly increased in the intervention group , and interaction effects of FFS and DVS were seen between the two groups . No significant differences were observed between baseline and post-intervention in the control group . Frequency of walking and exercise remained unchanged in both groups , and no significant difference in improvement rate was seen between the groups . Self-rated health was significantly increased in the intervention group . Appetite and TMIG Index of Competence score were unchanged in both groups . Conclusions The social health program result ed in improved dietary habits , as measured by food intake frequency , FFS , and DVS , and may improve self-rated health among community-dwelling older adults . Trial registration OBJECTIVES To examine psychological , medical , and sensorimotor risk factors that predict driving cessation in older adults . DESIGN Prospect i ve cohort study including five waves of data collected in 1992 , 1993 , 1994 , 1995 , and 1997 . SETTING The Australian Longitudinal Study of Aging . PARTICIPANTS One thous and four hundred sixty-six men and women aged 70 and older drawn from the electoral roll and including 753 drivers at baseline . MEASUREMENTS Interviews , including assessment s of self-rated health ( indicating general well-being ) ; medical conditions ; driving status ; and clinical assessment s of vision , hearing , cognitive function , and grip strength  , were conducted in 1992 ( baseline ) and 1994 . Information on current driving status was obtained at baseline and four subsequent waves ( 1993 , 1994 , 1995 , and 1997 ) . Drivers and nondrivers were compared at baseline . Risk factors for driving cessation were identified using logistic regression . RESULTS Drivers were younger and more likely to be male and had better self-rated health , vision , hearing , and cognitive performance than nondrivers at baseline . Seventeen percent of drivers in the study had vision of 6/18 or worse , and 7.3 % were classified as possibly cognitively impaired . In those identified as drivers at baseline , subsequent cessation was associated with increasing age , low grip strength , poorer cognitive performance , and poorer self-rated health . CONCLUSION Self-rated health and cognitive function were more important than medical conditions or sensory function for predicting driving cessation CONTEXT Declines in physical performance are associated with aging and chronic health conditions . Appropriate physical activity interventions can reverse functional limitations and help maintain independent living . Tai chi is a popular form of exercise in China among older adults . OBJECTIVE To determine whether tai chi improves balance , muscular strength and endurance , and flexibility over time . DESIGN Repeated measures intervention ; data collected at baseline , 6 weeks , and 12 weeks . SETTING Community center in the San Francisco Bay Area . PARTICIPANTS Thirty-nine Chinese adults with at least 1 cardiovascular disease ( CVD ) risk factor . INTERVENTIONS A 60-minute tai chi exercise class 3 times per week for 12 weeks . MAIN OUTCOME MEASURES A battery of physical fitness measures specifically developed for older adults assessed balance , muscular strength and endurance , and flexibility . RESULTS Subjects were 65.7 ( + /- 8.3 ) years old , Cantonese-speaking ( 97 % ) immigrants , with 12 years or less of formal education ( 87 % ) and very low income ( 67 % ) . Reported CVD risk factors were hypertension ( 92 % ) , hypercholesteremia ( 49 % ) , diabetes ( 21 % ) , and 1 current smoker . Subjects were below the 50th percentile of fitness at baseline compared to age- and gender-specific normative US data . Statistically significant improvements were observed in all balance , muscular strength and endurance , and flexibility measures after 6 weeks , and they increased further after 12 weeks . CONCLUSIONS Tai chi is a potent intervention that improved balance , upper- and lower-body muscular strength and endurance , and upper- and lower-body flexibility in these older Chinese adults . These findings provide important information for future community-based tai chi exercise programs and support current public health initiatives to reduce disability from chronic health conditions and enhance physical function in older adults OBJECTIVE To determine the factors that predict change in well-being over time in older men and women presenting to the falls prevention clinic . DESIGN Prospect i ve cohort study . SETTING Falls prevention clinic . PARTICIPANTS Community-dwelling older adults who were referred to the clinic after sustaining a fall ( between N=244 and N=255 , depending on the analysis ) . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES The ICEpop CAPability measure for Older people , a measure of well-being or quality of life , was administered at baseline , 6 months , and 12 months . We constructed linear mixed models to determine whether baseline predictor variables were related to baseline well-being and /or changes in well-being over time . In addition , we included interactions with sex to investigate the difference between men and women . Baseline predictors included 2 measures of mobility -- Short Performance Physical Battery and timed Up and Go test-- and a measure of global cognitive function -- Montreal Cognitive Assessment .  RESULTS All 3 predictors were associated with well-being at baseline ( P<.05 ) . Furthermore , both the Short Performance Physical Battery and the timed Up and Go test interacted with sex ( P<.05 ) to predict changes in well-being over time . Follow-up analyses suggested that better mobility was protective against decline in well-being in men but was generally unrelated to changes in well-being in women . CONCLUSIONS We found that 2 valid and reliable measures of mobility interacted with sex to predict changes in well-being over time . This is a critical research area to develop in order to appropriately tailor future intervention strategies targeting well-being in older fallers , a population at high risk of functional decline
Conclusions The Timed Up- and -Go test measure appears not to be a useful measure of physical functioning for the driving outcomes included here .
The Rapid Pace Walk may be useful in studies of driving ability and exposure .
Background Improving physical functioning may be a future intervention to keep older adults driving safely longer as it can help maintain both physical and cognitive health longer .
This systematic review assesses the evidence on the association between three physical functioning measures : the Short Physical Performance Battery , the Timed Up- and -Go test , and the Rapid Pace Walk with driving outcomes in older adults .