Effectiveness of Nurse Practitioners in nursing homes: a systematic review Executive functions are associated with gait and balance in community-living elderly people. Effectiveness of exercise interventions on physical function in community-dwelling frail older people: an umbrella review of systematic reviews Incidence and predictors of falls in the chinese elderly. Are exergames promoting mobility an attractive alternative to conventional self-regulated exercises for elderly people in a rehabilitation setting? Study protocol of a randomized controlled trial Properties of the ‘Timed Up and Go’ Test: More than Meets the Eye Fall prevention in the young old using an exoskeleton human body posturizer: a randomized controlled trial Specific effects of balance and gait exercises on physical function among the frail elderly Lower limb power rehabilitation (LLPR) using interactive video game for improvement of balance function in older people. The design of the Dutch EASYcare study: a randomised controlled trial on the effectiveness of a problem-based community intervention model for frail elderly people [NCT00105378] Physical training in institutionalized elderly people with multiple diagnoses--a controlled pilot study.
Background There are 1.5 million people living in nursing homes in the United States1 . The number of people admitted to nursing homes has increased since 1994 , and it is expected that the number of people aged 65 and older living in nursing homes will double by the year 20202 . Nursing home patients are sicker than they have been in the past 10 years , and the frail , sick patients are more likely to be hospitalized3 . Unnecessary hospitalization of nursing home patients is a costly and critical problem in our healthcare system3 . Hospitalization can cause irreversible decline in function for the elderly patient and can " expose residents to iatrogenic disease and delirium"4 . It has been cl aim ed that nurse practitioners ( NPs ) can play a valuable role in caring for the long term care patient , reducing unnecessary hospital admissions , and supporting the physician 's practice . A NP on site in the nursing home can provide quick assessment and treatment when a patient has a change of condition . The NP can intervene and treat the patient as needed , instead of transferring the patient to the hospital for assessment . Objectives The objective of this systematic review was to evaluate the effectiveness of having a NP in the nursing home and whether this lead to a decrease in the rate of patient hospitalizations . Inclusion Criteria Types of Participants This systematic review considered studies that include long term care nursing home residents . Types of Interventions The review considered studies that evaluate utilization of a NP ( in collaboration with a physician ) as a primary care provider for long term care nursing home patients . Types of Outcomes This review considered studies that include the following outcome measures : incidence of hospitalization , types of hospitalization and duration of hospitalization of nursing home patients . Types of Studies R and omized controlled trials ( RCTs ) were not identified in the search . Therefore , other research design s , such as non‐r and omized controlled trials and before and after studies , were included . Search Strategy Major data bases were search ed for English articles written from 1983 to December 2008 . Method ological Quality Seven papers were selected for retrieval , and were assessed by two independent review ers for method ological validity prior to inclusion in the review using st and ardized critical appraisal instruments from the Joanna Briggs Institute Meta Analysis of Statistics Assessment and Review Instrument ( JBI‐MAStARI ) ( Appendix I ) . Data Collection / Extraction Quantitative data was extracted from papers included in the review using the st and ardized data extraction tool from JBI‐MAStARI ( Appendix II ) . Data Synthesis Statistical pooling was not possible and the findings are presented in narrative form . Results The review consisted of 12,681 patients in 238 nursing homes . All of the seven included articles found a decrease in hospitalization rates when NPs were utilized as a part of the medical team . Five of the 7 studies found a decrease in ER transfers with the NP group . Garrard , Kane , et al17 did not measure ER transfers and Kane , Garrard et al24 found no difference in rate of ER use . Three studies also measured length of hospitalization , and all 3 found that the patients with NPs had shorter lengths of stay . Conclusions This review has demonstrated that nurse practitioners can reduce hospitalization and ER transfers of nursing home patients . Implication s for Research It is recommended that more studies be initiated using only Master 's prepared advanced practice nurses . Implication s for Practice It is recommended that NPs be utilized as primary care providers in nursing homes . Physicians should be encouraged to employ NPs to improve patient outcomes and to assist with patient loads BACKGROUND Cognition influences gait and balance in elderly people . Executive functions seem to play a key role in this mechanism . Previous studies used only a single test to probe executive functions , and outcome measures were restricted to gait variables . We extend this prior work by examining the association between two different executive functions and measures of both gait and balance , with and without two different cognitive dual tasks . METHODS This is a cross-sectional study with r and omly selected community-living elderly people . Executive functions were tested with the Trail Making Test Parts A and B and the Stroop Color Word Test ; memory with Cambridge Neuropsychological Test Automated Battery ( CANTAB ) subtests . Patients walked without and with two dual tasks ( subtracting serial sevens and animal naming ) . Main outcomes focused on gait ( velocity , stride length , and stride time variability ) , measured on an electronic walkway , and balance , measured as trunk movements during walking . Associations were assessed with multiple regression models . RESULTS One hundred elderly people , with a mean age 80.6 years ( range 75 - 93 years ) participated . Both dual tasks decreased gait velocity and increased variability and trunk sway . Executive functions were associated with only stride length variability and mediolateral trunk sway during performance of animal naming as the dual task . Memory was not associated with the gait and balance variables . CONCLUSIONS In community-living elderly people , executive functions are associated with gait and balance impairment during a challenging dual-task condition that also depends on executive integrity . Next steps will be to explore the value of executive functions in defining fall-risk profiles and in fall-prevention interventions for frail patients 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 INTRODUCTION This is the first prospect i ve longitudinal study carried out in a Chinese elderly population with the objective of identifying the incidence and predictors of falls . MATERIAL S AND METHODS This is a population -based cohort study in Hong Kong with 1517 ambulatory elderly Chinese recruited using a multi-stage sampling method . Baseline data on demographic , comorbid diseases , drugs , Activities of Daily Living ( ADL ) [ Barthel Index and Lawton 's Instrumental Activities of Daily Living ( IADL ) ] , Geriatric Depression Scale ( GDS-15 ) , cognitive assessment by the Abbreviated Mental Test ( AMT ) , fear of falling , self-perceived mobility problem , h and grip strength , lower limb power , balance and gait tests were performed . Every subject was followed up for 1 year . RESULTS Four hundred and one falls occurred in 294 fallers ( 19.3 % ) over 1 year of follow-up . The prevalence of falls and recurrent falls were 19.3 % and 4.75 % , respectively . The incidences of falls ( i.e. , the fall events ) were 220 , 324 and 270 per 1000 person-years for men , women and both gender , respectively . The independent predictors of falls were previous history of falls , advancing age , Parkinson 's disease , knee extension power and gait speed . The independent predictors of recurrent falls were previous history of falls , self-perceived mobility problem , the knee extension strength and the Total Mobility Score of the Tinetti Balance and Gait Evaluation . CONCLUSIONS The incidence of falls in the Chinese elderly was 270 per 1000 person-years . History of falls , old age , Parkinson 's disease , decreased lower limb power and impairment in balance and gait function were important independent predictors of falls or recurrent falls in the Chinese elderly . Effective fall prevention programmes targeted at improving these risk factors for falls should be developed for the Chinese elderly in Hong Kong and Asia Background Maintaining mobility in elderly persons has become a primary goal within healthcare services . In older adults , exercise programs significantly reduce the risk of falling and death . Long-lasting and high-intensive multi-component exercises are most effective . In a rehabilitation setting , self-regulated exercises are conventionally taught by physiotherapists , using h and outs . However , the adherence of elderly persons to executing these self-administered programs varies considerably . They are often considered tedious and boring , and thus prematurely stopped . The primary aim of this clinical trial is to determine whether elderly persons in a rehabilitation setting show higher adherence to self-regulated training when using exergames than when performing conventional exercises . The second objective is to explore which mode of exercise leads to greater improvement in balance performance . Methods / Design The study consists of a single blind , stratified , r and omized control trial with two parallel groups . Once included , study participants will be stratified according to their balance and computer skills and r and omly allocated to self-regulated training with conventional exercise programs or with exergames played with the Windows Kinect ® sensor and FitBit ® pedometer . In both groups , self-administered exercise programs will be taught by experienced physiotherapists and performed at the patient ’s own discretion during the ten days of intervention . The primary outcome is the performed daily training volume , collected by the participants in a logbook . Secondary outcomes are objective and subjective balance skills measured by an activity tracker and the Fall Efficacy Scale self-administered question naire . Both assessment s will be performed at pre- and post-intervention . Discussion According to the available literature , this study is the first to compare conventional self-regulated exercises with exergames among older patients in a rehabilitation setting . Results of this study will contribute to our underst and ing of its motivational potential on exercise adherence in elderly persons and provide more insight into the potential effectiveness of exergames promoting mobility . Trial registration The present clinical study has been registered on Clinical Trials.gov under the identifier number : NCT02077049 . The detailed trial protocol can be accessed online on : NCT02077049 Background : The  ‘ timed up and go ’ test ( TUG ) is a simple , quick and widely used clinical performance-based measure of lower extremity function , mobility and fall risk . We speculated that its properties may be different from other performance-based tests and assessed whether cognitive function may contribute to the differences among these tests in a cohort of healthy older adults . Objective : To evaluate psychometric properties of the TUG in healthy older adults in comparison to the Berg balance test ( BBT ) and the Dynamic Gait Index ( DGI ) . Methods : The  TUG , DGI and BBT  were assessed in 265 healthy older adults ( 76.4 ± 4.3 years ; 58.3 % women ) who participated in a 3-year prospect i ve study . The  Mini-Mental State Examination , digit span and verbal fluency measured cognitive function . The one- sample Kolmogorov-Smirnov test evaluated deviations from a normal distribution and Pearson ’s correlation coefficients quantified associations . Results : The mean scores of the BBT , DGI and TUG were : 54.0 ± 2.4 , 22.8 ± 1.5 , 9.5 ± 1.7 s , respectively . The BBT and the DGI were not normally distributed ( p < 0.001 ) , but the TUG was ( p = 0.713 ) . The TUG times were mildly associated ( p < 0.01 ) with digit span and verbal fluency and were related to future falls , while the BBT and the DGI were not . Conclusions : The TUG appears to be an appropriate tool for clinical assessment of functional mobility even in healthy older adults . It does not suffer from ceiling effect limitations , is normally distributed and is apparently related to executive function . The BBT and the DGI do not share these beneficial properties . Perhaps the transferring and turning components of the TUG help to convert this relatively simple motor task into a more complex measure that also depends on cognitive re sources Abstract Background Fall risk in elderly has been related with physical decline , low quality of life and reduced survival . Aim To evaluate the impact of exoskeleton human body posturizer ( HBP ) on the fall risk in the elderly . Methods 150 subjects ( mean age 64.85 ; 79 M/71 F ) with mild fall risk were r and omized into two groups : 75 for group treated with human body posturizer ( HBP group ) and 75 for physical training without HBP group ( exercise group ) . The effects of interventions were assessed by differences in tests related to balance and falls .  Medically eligible patients were screened with Tinetti balance and Gait evaluation scale , short physical performance battery and numeric pain rating scale to determine fall risk in elderly people . Results In the HBP group there was a significant improvement in short physical performance battery , Tinetti scale and Pain Numeric rating scale with a significant reduction in fall risk ( p < 0.05 ) . In the exercise group we observed only minimal variations in the test scores . Discussion The results at the sixth and twelfth months show a twofold positive effect in the HBP group reducing fall risk and improving quality of life by reducing pain . Conclusion The use of exoskeleton human body posturizer seems to be a new significant device for prevention of fall in elderly patients . Further research should be carried out to obtain more evidence on effects of robotic technology for fall prevention in the elderly Objective : To evaluate the specific effects of balance and gait exercises among frail elderly individuals . Design : A r and omized three-group parallel controlled study . Setting : Geriatric health services facility in Japan . Subjects : Thirty-four frail elderly subjects attending the care facility were r and omized into a control group , an exercise group with emphasis on balance or an exercise group with emphasis on gait re-education . Interventions : The two exercise groups received balance or gait exercise for 40 minutes , 2–3 times weekly , for 12 weeks . Main outcome measures : One Leg St and ing Test , Functional Reach Test , Manual Perturbation Test , Functional Balance Scale , Performance-Oriented Mobility Assessment , Timed ‘ Up and Go ’ Test and Stair Climbing/Descending Test . These assessment s were performed before and after 12-week intervention . Results : Comparison of the performance before and after intervention demonstrated significant improvement in One Leg St and ing Test , Functional Reach Test and Functional Balance Scale in the balance exercise group , and Functional Balance Scale , Timed ‘ Up and Go ’ Test and Stair Descending Test showed improvement in the gait exercise group . All test items showed no significant differences in the control groups . Among the three groups , the balance exercise group showed more significant improvement in Functional Balance Scale , and the gait exercise group showed more significant improvement in Performance-Oriented Mobility Assessment than the control group . The balance exercise group showed greater improvement in performance in Functional Reach Test than the gait exercise group . Conclusions : Balance exercises led to improvements in static balance function , and gait exercises result ed in improvements to dynamic balance and gait functions in the very frail elderly Declined balance functions have adverse effects on elderly population .  Lower limbs muscle power training is currently an emerging concept in rehabilitation on individuals with decreased balance and mobility . In this prospect i ve , controlled study , we used a human-computer interactive video-game-based rehabilitation device ( LLPR ) for training of lower limb muscle power in the elderly . Forty ( aged > 65 years ) individuals were recruited from the community . Twenty participants in the exercise group received 30-min training , twice a week , using the LLPR system . The LLPR system allows participants to perform fast speed sit-to-st and ( STS ) movements . Twenty age-matched participants in the control group performed slow speed STS movements , as well as strengthening and balance exercises , with the same frequency and duration . The results were compared after 12 sessions ( 6 weeks ) of training . The mechanical and time parameters during STS movement were measured using the LLPR system . Modified falls efficacy scale ( MFES ) , Tinetti Performance-Oriented Mobility Assessment ( POMA ) , function reach test , five times sit to st and ( FTSS ) and Timed Up and Go ( TUG ) were administered to participants as clinical assessment s. Results showed that in the exercise group , all the mechanical and time parameters showed significant improvement . In control group , only the maximal vertical ground reaction force ( MVGRF ) improved significantly . For clinical assessment s ( balance , mobility , and self-confidence ) , exercise group showed significantly better scores . The STS movements in video-game-based training mimic real life situations which may help to transfer the training effects into daily activities . The effectiveness of lower limb muscle training is worthy of further investigation Background Because of their complex clinical presentations and needs frail elderly people require another approach than people who age without many complications . Several inpatient geriatric health services have proven effectiveness in frail persons . However , the wish to live independently and policies that promote independent living as an answer to population aging call for community intervention models for frail elderly people . Maybe models such as preventive home visits , comprehensive geriatric assessment , and intermediate care qualify , but their efficacy is controversial , especially in frail elderly persons living in the community . With the Dutch EASYcare Study Geriatric Intervention Programme ( DGIP ) we developed a model to study effectiveness of problem based community intervention models in frail elderly people . Methods / Design DGIP is a community intervention model for frail elderly persons where the GP refers elderly patients with a problem in cognition , mood , behaviour , mobility , and nutrition . A geriatric specialist nurse applies a guideline -based intervention with a limited number of follow up visits . The intervention starts with the application of the EASYcare instrument for geriatric screening . The EASYcare  instrument  assesses ( instrumental ) activities of daily life , cognition , mood , and includes a goal setting item . During the intervention the nurse regularly consults the referring GP and a geriatrician . Effects on functional performance ( Groningen Activity Restriction Scale ) , health related quality of life ( MOS-20 ) , and carer burden ( Zarit Burden Interview ) are studied in an observer blinded r and omised controlled trial . 151 participants were r and omised over two treatment arms – DGIP and regular care – using pseudo cluster r and omisation . We are currently performing the follow up visits . These visits are planned three and six months after inclusion . Process measures and cost measures will be recorded . Intention to treat analyses will focus on post intervention differences between treatment groups . Discussion The design of a trial evaluating the effects of a community intervention model for frail elderly people was presented . The problem-based participant selection procedure satisfied ; few patients that the GP referred did not meet our eligibility criteria . The use of st and ard terminology makes detailed insight into the contents of our intervention possible using terminology others can underst and well Reduction in muscle mass and physical function depends on a variety of interacting factors : age , physical activity level , nutritional state and the type and impact of disease . The aim of this study was to investigate the effect of an individualized moderate intensity physical training program on muscle strength , balance , mobility , ambulation and activities of daily living ( ADL ) in institutionalized elderly people aged 65 and over with multiple diagnoses . Baseline assessment s consisted of strength , balance , mobility/ambulation , and ADL .  Twenty-one subjects were included in the intervention program . A control group ( 21 subjects ) was first matched in pairs according to gender , age , ADL and mobility , and then by balance , ambulation and strength . The intervention program was individualized and included strength , mobility , balance and endurance training . Follow-up measures were conducted directly after the intervention and 10 weeks later . After drop-out , 20 subjects in the intervention group and 15 subjects in the control group remained for analyses . Balance and mobility improved significantly in the intervention group while declining in the control group . This pilot study indicates that a physical training program may improve functional capacity for institutionalized elderly persons with multiple diagnoses
The analysis of our outcomes illustrates the similarities and differences between the identified tests
Assessment s of gait , balance , and transfer in elderly people play a valuable role in maintaining healthy aging and preventing a decline in mobility .
Several evaluation tools have been proposed ; however , clinicians should select the most accurate ones wisely , based on numerous criteria .
This systematic review aims to identify all applicable elderly mobility assessment tests and show their measurement properties with as much detail as possible .