According to traditional conceptualizations of the relationship between fear of falling and falls in older adults, fear of falling is considered to be predictive of falls because it leads to activity avoidance which, in turn, leads to de-conditioning that increases fall risk. The recent literature has begun to challenge such conceptualizations. Specifically, it has been argued that fear of falling and anxiety, in and of themselves, have a direct negative effect on balance. In this study we manipulated anxiety level by asking older research participants to walk either on the floor (low anxiety condition) or an elevated platform (high anxiety condition). Half the time participants carried a tray (dual tasking) and half the time they did not. Manipulation checks (involving heart rate, galvanic skin response, and self-reported anxiety measurement) confirmed that the experimental manipulation was successful in affecting anxiety level. The results demonstrate that the experimental manipulation (platform vs. floor) affected balance parameters and dual tasking performance with the platform condition resulting in a less stable gait. In addition, increased task demand (i.e., dual tasking) also had a negative effect on balance performance. Finally, the results demonstrate that the paper and pencil measures of fear can also predict balance performance (although the variance accounted for is small) even after controlling for medical risk factors for falling. Implications for models of fear of falling are discussed.

Contrary to previous research, the present study found that the interactive PE program was effective in changing pain beliefs and improving knowledge. Continuing PE in LTC has the potential to address knowledge gaps among front-line LTC providers.

Person-centred approaches in long-term care focus on providing holistic care to residents in order to improve quality of life, enhance resident wellbeing and autonomy, and mitigate behavioural and/or other symptoms. The results of research on person-centred approaches to care are mixed, with very few high-quality empirical studies examining resident outcomes specifically. The purpose of this investigation was to examine a person-centred care programme implemented in three Canadian long-term care facilities to determine its effect on resident outcomes, approach to care and maintenance of the programme three years after implementation. Using the Resident Assessment Instrument Minimum Data Set (RAI-MDS) scale scores and quality indicators, we retrospectively examined resident outcomes before, after and six months following the initiation of the programme using three additional facilities as control. We did not find any effects on resident outcomes. Focus group interviews with facility staff revealed no systematic differences between the programme and control facilities in their approach to care. All facilities supported aspects of a person-centred philosophy. Focus group interview data from the programme facilities indicated partial maintenance in two facilities and more complete maintenance in one facility. Although staff members supported the programme, implementation and maintenance proved difficult and effectiveness on resident outcomes was not indicated in this research. Additional controlled studies are needed.

Our findings suggest that interventions to improve LTC staff resilience would be important to pursue and that consideration should be given to resilience in optimizing the match between potential staff members and LTC positions.

Objective To investigate the relationship of emotion regulation strategies (i.e., emotional suppression and reappraisal) with pain catastrophizing, fear of pain, pain intensity, worry, and depression as function of age in samples of older and younger adults. Design Cross-sectional design using validated questionnaires. Setting Participants resided in the community. They completed validated measures using online questionnaires. Subjects Two-hundred fifty-seven older adults and 254 younger adults with chronic pain participated. Methods Participants completed validated questionnaires of emotion regulation strategies, pain-related functioning and mental health. Results Emotion regulation varied as a function of age and gender. Among our chronic pain sample, older adult males reported lower use of reappraisal and suppression than younger adult males, while older adult females reported higher use of reappraisal than younger adult females. Emotional suppression was positively related to pain catastrophizing, pain intensity, worry, and depression. Reappraisal was negatively related to depression and worry. Interestingly, age showed a positive relationship with fear of pain, pain catastrophizing, worry, depression, and pain intensity, while gender was related to fear of pain and worry. Finally, emotional reappraisal partially mediated the relationship between the affective dimensions of pain intensity and pain catastrophizing among older adults. Conclusions Our results indicate that reappraisal strategies are important for older and younger adults with chronic pain, pointing to the necessity of considering these strategies when working clinically with such populations. However, given our findings as well as those in the literature, gender should also be considered.

KeynoTe sPeaKer: Mary ellen Jeans lecTure undersTanding huMan Pain PercePTion and analgesia Through advanced neuroiMaging invited speaker: irene Tracey nuffield Professor anaesthetic science & director, oxford centre for fMri of Brain, nuffield department of clinical neurosciences, (head, nuffield division anaesthetics), oxford university, england, uK The ability to experience pain is old and shared across species. It confers an evolutionary advantage and provides a warning of harm or impending threat. As far back as Hippocrates, it was understood that the brain was key to a person experiencing pain. Fortunately, these days we now have many techniques available to explore the human central nervous system in vivo from a functional, structural and chemical perspective in both patients and healthy subjects. Relating specific neurophysiologic measures to perceptual or non-perceptual changes induced by peripheral or central sensitisation, behavioural, psychological or pharmacological mechanisms and identifying their site of action within the CNS has both value and has been a major goal for scientists, clinicians and the pharmaceutical industry. Identifying non-invasively where functional and structural plasticity, sensitisation and other amplification or attenuation processes occur along the pain neuraxis for an individual and relating these neural mechanisms to specific pain experiences, measures of pain relief, persistence of pain states, degree of injury and the subject's underlying genetics, has neuroscientific relevance and potential diagnostic value. Learning Objectives: 1. Better knowledge of the range of physiological measures available using advanced neuroimaging that give novel insights into central pain mechanisms 2. To understand the importance of the descending pain modulatory system in acute and chronic pain 3. To learn how current theories regarding how the brain generates perception can inform the pain field.

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