Exercise programs are often recommended for preventing or delaying late-life disability. Programs that incorporate functional training, which uses movements similar to performing activities of daily living, may be suitable for such recommendation. The purpose of this systematic review was to examine the effects of functional training on muscle strength, physical functioning, and activities of daily living in older adults. Studies in three electronic databases (MEDLINE, CINAHL, and SPORTDiscus) were searched, screened, and appraised. Thirteen studies were included in the review. These studies vary greatly in participant recruitment criteria, functional training content, and selection of comparison groups. Mobility exercises were the most common element in functional training across studies. Results show beneficial effects on muscle strength, balance, mobility, and activities of daily living, particularly when the training content was specific to that outcome. Functional training may be used to improve functional performance in older adults.

Islene Araujo de Carvalho and coauthors discuss the WHO guidelines on integrated care for older people.

This study examined how Flesch Reading Ease and text cohesion affect older adults' comprehension of common health texts. All older adults benefited when high Flesh Reading Ease was combined with high cohesion. Older adults with small working memories had more difficulty understanding texts high in Flesch Reading Ease. Additionally, older adults with low verbal ability or older than 77 years of age had difficulty understanding texts high in text cohesion but low in Flesch Reading Ease. These results imply that writers must increase Flesch Reading Ease without disrupting text cohesion to ensure comprehension of health-related texts.Understanding health-related written materials, such as medication leaflets or health education brochures, is critical for older adults. Unfortunately, older adults often have difficulty comprehending written health information (Benson & Forman, 2002;Gazmararian et al., 1999;Williams et al., 1995). Comprehension problems are associated with poor health status and more hospital admissions (Baker et al., 2002;Baker, Parker, Williams, & Clark, 1998;Baker, Parker, Williams, Clark, & Nurss 1997;Schillinger et al., 2002). This issue has become a concern to the health care system because of the consequences of high health costs (Marwick, 1997). Improving comprehension by increasing the readability of health-related written materials is commonly suggested (Adams, Smith, Metts, & Ross, 1979;Cotugna, Vickery, & Carpenter-Haefele, 2005;Eaton & Holloway, 1980;Johnson & Stern, 2004;Singh, 2003). Readability is typically assessed in terms of grade level and recommendations are often specified relative to an eighth grade reading standard. However, this approach may be limited by the formulas used to assess readability.Readability formulas are generally a function of word length and sentence length, such as the Flesch Reading Ease index (Flesch, 1948). The number of syllables per word and the number of words per sentence capture only the shallow features of a text and do not directly reflect content and organization. Comprehension is a complex mental process that involves not only decoding words and sentences but also making connections of ideas and deriving meaning from a written text. Readability formulas may not, therefore, measure actual determinates of reading difficulty. Kintsch and Vipond (1979) suggested that researchers must look for other predictor variables to supplement readability formulas in order to determine the real readability of a text. One such variable may be text cohesion. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author ManuscriptText comprehension involves three hierarchical levels of processing and representation. The basic level is the surface form which represents the exact words and syntactic structures of the text. The second level is that of propositional abstraction which represents the idea units of the text in a textbase; propositions consist of predicates, corresponding to verbs, states, or properties, and arguments, corresponding to nouns. The t...

The purpose of this feasibility study was to evaluate the 3-Step Workout for Life program, a 10-week exercise program that included moderate-intensity muscle strength training followed by task-oriented training. Fourteen participants completed the program (mean age = 73 years; SD = 6.83). The Box and Block test (Z = −2.24, p = .03) and the 30-s chair stand test (Z = − 2.21, p = .03) indicate improved physical functioning of the upper and lower extremities. More importantly, results of the function component from the Late-Life Function and Disability Instrument (Z = –2.04, p = .04) and motor skills scale from the Assessment of Motor and Process Skills (Z = −2.97, p = .003) indicate subjective and objective improvements on performing activities of daily living. Supplementing moderate-intensity muscle strength exercise with task-oriented training components is feasible. Preliminary data support the effectiveness of 3-Step Workout for Life in reducing late-life disability.

Objective The aim of the study is to assess the relationship between body mass index (BMI) class and Medicare claims among young-old (65–69), old (70–74), and old-old (75+) adults over a 10-year period. Method We assessed costs by BMI class and age group among 9,300 respondents to the 1998 Health and Retirement Study (HRS) with linked 1998–2008 Medicare claims data. BMI was classified as normal (18.5–24.9), overweight (25–29.9), mild obesity (30–34.9), or severe obesity (35 or above). Results Annualized total Medicare claims adjusted for age, gender, ethnicity, education, and smoking history were 109% greater for severely obese young-old adults in comparison with normal weight young-old adults (US$9,751 vs. US$4,663). Total annualized claim differences between the normal weight and severely obese in the old and old-old groups were not statistically significant. Discussion Excess Medicare expenditures related to obesity may be concentrated among severely obese young-old adults. Preventing severe obesity among middle and older aged adults may have large cost implications for society.

No abstract

BackgroundResistance exercise is effective to increase muscle strength for older adults; however, its effect on the outcome of activities of daily living is often limited. The purpose of this study was to examine whether 3-Step Workout for Life (which combines resistance exercise, functional exercise, and activities of daily living exercise) would be more beneficial than resistance exercise alone.MethodsA single-blind randomized controlled trial was conducted. Fifty-two inactive, community-dwelling older adults (mean age =73 years) with muscle weakness and difficulty in activities of daily living were randomized to receive 3-Step Workout for Life or resistance exercise only. Participants in the 3-Step Workout for Life Group performed functional movements and selected activities of daily living at home in addition to resistance exercise. Participants in the Resistance Exercise Only Group performed resistance exercise only. Both groups were comparable in exercise intensity (moderate), duration (50–60 minutes each time for 10 weeks), and frequency (three times a week). Assessment of Motor and Process Skills, a standard performance test on activities of daily living, was administered at baseline, postintervention, and 6 months after intervention completion.ResultsAt postintervention, the 3-Step Workout for Life Group showed improvement on the outcome measure (mean change from baseline =0.29, P=0.02), but the improvement was not greater than the Resistance Exercise Only Group (group mean difference =0.24, P=0.13). However, the Resistance Exercise Only Group showed a significant decline (mean change from baseline =−0.25, P=0.01) 6 months after the intervention completion. Meanwhile, the superior effect of 3-Step Workout for Life was observed (group mean difference =0.37, P<0.01).ConclusionCompared to resistance exercise alone, 3-Step Workout for Life improves the performance of activities of daily living and attenuates the disablement process in older adults.

No abstract