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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601).

Deadline for manuscript submissions: closed (31 August 2013) | Viewed by 155000

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Prof. Dr. Dawn A. Skelton

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Psychology and Allied Health Professions, School of Health and Life Sciences, Institute of Applied Health Research, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA, UK
Interests: exercise physiology; falls prevention; sedentary behaviour; physical activity; quality of life; ageing

Special Issue Information

Dear Colleagues,

The 2002 release by the World Health Organization of the Active Ageing: A Policy Framework, followed by the 2010 Global recommendations on physical activity for health have brought active ageing to the forefront of international public health awareness; this awareness was re-affirmed with the 2010 Toronto Charter for Physical Activity: A Global Call for Action which provides information for organizations and individuals interested in promoting physical activity can use this Charter to influence and unite decision makers, at national, regional and local levels, to achieve a shared goal. Inactivity in older people affects not only physical and mental health but also the individual's ability to cope with symptoms of disease, to be socially engaged and to enjoy a good quality of life. This special issue has a broad focus on active ageing, increasing physical activity but also reducing sedentary behaviour, a distinctly different risk factor for ill-health, with the ultimate goal to continue to build scientific knowledge on how we can reduce the public health burden of inactivity in older people worldwide. Both empirical and review paper submissions are welcome, on any topic relevant to health and active ageing. Papers on reducing sedentary behaviour are particularly welcome.

Dr. Dawn A. Skelton
Guest Editor

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Published Papers (14 papers)

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Research

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13093 KiB

Open AccessArticle

The Fountain of Age: A Remarkable 3D Shape that Portrays Health and Functional Differences among the European Elderly

by Stef Van Buuren and Rom Perenboom

Int. J. Environ. Res. Public Health 2014, 11(4), 4078-4090; https://doi.org/10.3390/ijerph110404078 - 14 Apr 2014

Cited by 1 | Viewed by 5131

Abstract

There are very few norms to evaluate and monitor the health and functioning of the elderly. This paper proposes a compact spatial representation of 25 health measurements of European citizens older than 50 years. Data from 44,285 unique individuals were obtained from the EU-wide Survey of Health, Ageing and Retirement in Europe(SHARE) data collected in 2004–2007 and were analyzed by homogeneity analysis, a form of non-linear principal components analysis. The resulting configuration of persons shows a remarkable three-dimensional shape that resembles a fountain. The three components explain 13.7, 5.8 and 4.6 percent of the total variation, respectively. Component 1 is driven by age and by the disabilities that come with old age. Component 2 portrays differences in health that are independent of age, with the high scores in relatively good health, given age. Component 3 distinguishes specific types of functional decline from general complaints that impact on daily life. The shape suggests that the elderly keep on maturing as they grow older, actually becoming more diverse as a group. We show how the solution may be used to develop and support profiles for the elderly. Another potential application is to track the individual development of the elderly, thereby objectifying personalized medicine. Full article

(This article belongs to the Special Issue Health Care for Old People)

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Open AccessArticle

Determinants of Sedentary Behavior, Motivation, Barriers and Strategies to Reduce Sitting Time in Older Women: A Qualitative Investigation

by Sebastien F. M. Chastin, Nicole Fitzpatrick, Michelle Andrews and Natalie DiCroce

Int. J. Environ. Res. Public Health 2014, 11(1), 773-791; https://doi.org/10.3390/ijerph110100773 - 07 Jan 2014

Cited by 104 | Viewed by 13215

Abstract

Sedentary behavior defined as time spent non-exercising seated or reclining posture has been identified has a health risk and associated with frailty and disablement for older adults. Older adults are the most sedentary segment of society. To date no study has investigated the determinants of sedentary behavior in older adults. This study reports a qualitative investigation of the determinants of sedentary behavior, strategies and motivator to reduce sitting time by structured interviews in a group of community dwelling older women (N = 11, age 65 and over). Older women expressed the view that their sedentary behavior is mostly determined by pain which acts both as an incentive to sit and a motivator to stand up, lack of energy in the afternoon, pressure from direct social circle to sit and rest, societal and environmental typecasting that older adult are meant to sit, lack of environmental facilities to allow activity pacing. This qualitative investigation highlighted some factors that older adults consider determinants of their sedentary behavior. Some are identical to those affecting physical activity (self-efficacy, functional limitations, ageist stereotyping) but some appear specific to sedentary behavior (locus of control, pain) and should be further investigated and considered during intervention design. Tailored interventions that pay attention to the pattern of sedentary behavior of individuals appear to be supported by the views of older women on their sedentary behavior. Full article

(This article belongs to the Special Issue Health Care for Old People)

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Open AccessArticle

Objective Indicators of Physical Activity and Sedentary Time and Associations with Subjective Well-Being in Adults Aged 70 and Over

by Janet Withall, Afroditi Stathi, Mark Davis, Jo Coulson, Janice L. Thompson and Kenneth R. Fox

Int. J. Environ. Res. Public Health 2014, 11(1), 643-656; https://doi.org/10.3390/ijerph110100643 - 02 Jan 2014

Cited by 57 | Viewed by 9419

Abstract

This study explored the associations of the volume and intensity of physical activity and the volume of sedentary time with subjective well-being in a diverse group of 228 older adults in the UK (111 female, mean age 78.2 years (SD 5.8)). Physical activity (PA) and sedentary behaviour were assessed by accelerometry deriving mean steps per day, mean moderate/vigorous PA minutes per hour (MVPA min·h⁻¹) and minutes of sedentary time per hour (ST min·h⁻¹). Lower limb function was assessed by the Short Physical Performance Battery. Subjective well-being was assessed using the SF-12 health status scale, the Ageing Well Profile and the Satisfaction with Life Scale. Linear regressions were used to investigate associations between the independent variables which included physical activity (steps and MVPA), sedentary time, participant characteristics (gender, age, BMI, education, number of medical conditions), and lower limb function and dependent variables which included mental and physical well-being. Steps, MVPA and lower limb function were independently and moderately positively associated with perceived physical well-being but relationships with mental well-being variables were weak. No significant associations between sedentary behaviours and well-being were observed. The association between objectively evaluated physical activity and function and subjective evaluations of physical well-being suggest that improving perceptions of physical health and function may provide an important target for physical activity programmes. This in turn may drive further activity participation. Full article

(This article belongs to the Special Issue Health Care for Old People)

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Open AccessArticle

Analysis of Newspaper Coverage of Active Aging through the Lens of the 2002 World Health Organization Active Ageing Report: A Policy Framework and the 2010 Toronto Charter for Physical Activity: A Global Call for Action

by Boushra Abdullah and Gregor Wolbring

Int. J. Environ. Res. Public Health 2013, 10(12), 6799-6819; https://doi.org/10.3390/ijerph10126799 - 05 Dec 2013

Cited by 19 | Viewed by 9749

Abstract

As populations continue to grow older, efforts to support the process of aging well are important goals. Various synonyms are used to cover aging well, such as active aging. The World Health Organization published in 2002 the report Active Ageing: A Policy Framework that according to the call for papers, has brought active ageing to the forefront of international public health awareness. The 2010 Toronto Charter for Physical Activity: A Global Call for Action was singled out in the call for papers as a key document promoting physical activity one goal of the 2002 WHO active aging policy framework. Media are to report to the public topics of importance to them. We investigated the newspaper coverage of aging well and synonymous terms such as active aging through the lens of the 2002 WHO active aging policy framework and the 2010 Toronto Charter for Physical Activity. As sources we used the following newspapers: China Daily, The Star (Malaysia), two UK newspapers (The Guardian, The Times), a database of 300 Canadian newspapers (Canadian Newsstand) and a US newspaper (The New York Times). The study generated data answering the following four research questions: (1) how often are the 2002 WHO active aging policy framework and the 2010 Toronto Charter for Physical Activity mentioned; (2) how often is the topic of active aging and terms conveying similar content (aging well, healthy aging, natural aging and successful aging) discussed; (3) which of the issues flagged as important in the 2002 WHO active aging policy framework and the 2010 Toronto Charter for Physical Activity are covered in the newspaper coverage of active aging and synonymous terms; (4) which social groups were mentioned in the newspapers covered. The study found a total absence of mentioning of the two key documents and a low level of coverage of “active aging” and terms conveying similar content. It found further a lack of engagement with the issues raised in the two key documents and a low level of mentioning of socially disadvantages groups. We posit that reading the newspapers we covered will not expose the reader to the two key documents and the issues linked to aging well including the need to increase physical activity. Full article

(This article belongs to the Special Issue Health Care for Old People)

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Open AccessArticle

Objectively Measured Activity Patterns among Adults in Residential Aged Care

by Natasha Reid, Elizabeth Eakin, Timothy Henwood, Justin W. L. Keogh, Hugh E. Senior, Paul A. Gardiner, Elisabeth Winkler and Genevieve N. Healy

Int. J. Environ. Res. Public Health 2013, 10(12), 6783-6798; https://doi.org/10.3390/ijerph10126783 - 04 Dec 2013

Cited by 65 | Viewed by 9064

Abstract

Objectives: To determine the feasibility of using the activPAL3^TM activity monitor, and, to describe the activity patterns of residential aged care residents. Design: Cross-sectional. Setting: Randomly selected aged care facilities within 100 km of the Gold Coast, Queensland, Australia. Participants: Ambulatory, older (≥60 years) residential aged care adults without cognitive impairment. Measurements: Feasibility was assessed by consent rate, sleep/wear diary completion, and through interviews with staff/participants. Activity patterns (sitting/lying, standing, and stepping) were measured via activPAL3^TM monitors worn continuously for seven days. Times spent in each activity were described and then compared across days of the week and hours of the day using linear mixed models. Results: Consent rate was 48% (n = 41). Activity patterns are described for the 31 participants (mean age 84.2 years) who provided at least one day of valid monitor data. In total, 14 (45%) completed the sleep/wear diary. Participants spent a median (interquartile range) of 12.4 (1.7) h sitting/lying (with 73% of this accumulated in unbroken bouts of ≥30 min), 1.9 (1.3) h standing, and 21.4 (36.7) min stepping during their monitored waking hours per day. Activity did not vary significantly by day of the week (p ≥ 0.05); stepping showed significant hourly variation (p = 0.018). Conclusions: Older adults in residential aged care were consistently highly sedentary. Feasibility considerations for objective activity monitoring identified for this population include poor diary completion and lost monitors. Full article

(This article belongs to the Special Issue Health Care for Old People)

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Open AccessArticle

Physical Performance and Quality of Life of Nursing-Home Residents with Mild and Moderate Dementia

by Elisabeth Wiken Telenius, Knut Engedal and Astrid Bergland

Int. J. Environ. Res. Public Health 2013, 10(12), 6672-6686; https://doi.org/10.3390/ijerph10126672 - 02 Dec 2013

Cited by 24 | Viewed by 9148

Abstract

Introduction: The aims of this study were to describe the quality of life (QoL) of nursing-home residents with dementia and their balance, mobility, muscle strength and daily life activity, as well as to examine the associations between QoL and levels of balance, mobility, muscle strength and daily life activity. Methods: The study is cross sectional, and 170 nursing-home residents with dementia were included. Tests: “The quality of life in late-stage dementia scale” (QUALID), Berg Balance Scale, comfortable walking speed, maximum walking speed, 30-s sit-to-stand, Barthel Index, Clinical Dementia Rating Scale, the Clock Drawing Test and the Mini-Mental State Examination (MMSE) were used. Results: Our study showed that nursing-home residents with dementia are a heterogeneous group regarding registrations of QUALID and physical function measures. The scores on the QUALID ranged from 11 to 41 points. Higher scores on the 30-s sit-to-stand and Berg Balance Scale were associated with a better QUALID. For comfortable, as well as maximum, walking speed there was a trend towards better QUALID results for those participants with higher walking speed. Conclusions: Good muscle strength and balance were the most important physical performance variables significantly associated with a good QUALID score. Full article

(This article belongs to the Special Issue Health Care for Old People)

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Open AccessCommunication

Indicators for Healthy Ageing — A Debate

by Judith Fuchs, Christa Scheidt-Nave, Timo Hinrichs, Andreas Mergenthaler, Janine Stein, Steffi G. Riedel-Heller and Eva Grill

Int. J. Environ. Res. Public Health 2013, 10(12), 6630-6644; https://doi.org/10.3390/ijerph10126630 - 02 Dec 2013

Cited by 50 | Viewed by 18895

Abstract

Definitions of healthy ageing include survival to a specific age, being free of chronic diseases, autonomy in activities of daily living, wellbeing, good quality of life, high social participation, only mild cognitive or functional impairment, and little or no disability. The working group Epidemiology of Ageing of the German Association of Epidemiology organized a workshop in 2012 with the aim to present different indicators used in German studies and to discuss their impact on health for an ageing middle-European population. Workshop presentations focused on prevalence of chronic diseases and multimorbidity, development of healthy life expectancy at the transition to oldest-age, physical activity, assessment of cognitive capability, and functioning and disability in old age. The communication describes the results regarding specific indicators for Germany, and hereby contributes to the further development of a set of indicators for the assessment of healthy ageing. Full article

(This article belongs to the Special Issue Health Care for Old People)

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Open AccessArticle

Recruiting Hard-to-Reach Subjects for Exercise Interventions: A Multi-Centre and Multi-Stage Approach Targeting General Practitioners and Their Community-Dwelling and Mobility-Limited Patients

by Michael Brach, Anna Moschny, Bettina Bücker, Renate Klaaßen-Mielke, Matthias Trampisch, Stefan Wilm, Petra Platen and Timo Hinrichs

Int. J. Environ. Res. Public Health 2013, 10(12), 6611-6629; https://doi.org/10.3390/ijerph10126611 - 02 Dec 2013

Cited by 11 | Viewed by 7425

Abstract

The general practitioner (GP)’s practice appears to be an ideal venue for recruiting community-dwelling older adults with limited mobility. This study (Current Controlled Trials ISRCTN17727272) aimed at evaluating the recruiting process used for a multi-centre exercise intervention (HOMEfit). Each of six steps resulted in an absolute number of patients (N1–N6). Sex and age (for N4–N6) and reasons for dropping out were assessed. Patient database screening (N1–N3) at 15 GP practices yielded N1 = 5,990 patients aged 70 and above who had visited their GP within the past 6 months, N2 = 5,467 after exclusion of institutionalised patients, N3 = 1,545 patients eligible. Using a pre-defined limitation algorithm in order to conserve the practices’ resources resulted in N4 = 1,214 patients (80.3 ± 5.6 years, 68% female), who were then officially invited to the final assessment of eligibility at the GP’s practice. N5 = 434 patients (79.5 ± 5.4 years, 69% female) attended the practice screening (n = 13 of whom had not received an official invitation). Finally, N6 = 209 (79.8 ± 5.2 years, 74% female) were randomised after they were judged eligible and had given their written informed consent to participate in the randomised controlled trial (overall recruitment rate: 4.4%). The general strategy of utilising a GP’s practice to recruit the target group proved beneficial. The data and experiences presented here can help planners of future exercise-intervention studies. Full article

(This article belongs to the Special Issue Health Care for Old People)

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Open AccessArticle

Twelve-Months Follow-up of Supervised Exercise after Percutaneous Transluminal Angioplasty for Intermittent Claudication: A Randomised Clinical Trial

by Elisabeth Bø, Jonny Hisdal, Milada Cvancarova, Einar Stranden, Jørgen J. Jørgensen, Gunnar Sandbæk, Ole J. Grøtta and Astrid Bergland

Int. J. Environ. Res. Public Health 2013, 10(11), 5998-6014; https://doi.org/10.3390/ijerph10115998 - 11 Nov 2013

Cited by 18 | Viewed by 7732

Abstract

The aim of this study was to explore the effects during 12 months follow-up of 12 weeks of supervised exercise therapy (SET) after percutaneous transluminal angioplasty (PTA) compared to PTA alone on physical function, limb hemodynamics and health-related quality of life (HRQoL) in patients with intermittent claudication. Fifty patients were randomised to an intervention or a control group. Both groups received usual post-operative care and follow-up measurements at three, six and 12 months after PTA. The intervention group performed 12 weeks of SET after PTA. The control group did not receive any additional follow-up regarding exercise. During the 12 months’ follow-up, the members of the intervention group had significantly better walking distance than the control group. The intervention group had a significantly higher HRQoL score in the physical component score of the SF-36, and the domains of physical function, bodily pain and vitality. For limb hemodynamics, there was a non-significant trend towards better results in the intervention group compared to the control group. Conclusion: SET after PTA yielded statistically significantly better results for walking distance and HRQoL in the intervention group than the control group during the 12 months of follow-up. Full article

(This article belongs to the Special Issue Health Care for Old People)

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Open AccessArticle

by Marie-Louise Bird, Jane K. Pittaway, Isobel Cuisick, Megan Rattray and Kiran D. K. Ahuja

Int. J. Environ. Res. Public Health 2013, 10(11), 5989-5997; https://doi.org/10.3390/ijerph10115989 - 11 Nov 2013

Cited by 49 | Viewed by 8000

Abstract

As the population ages, fall rates are expected to increase, leading to a rise in accidental injury and injury-related deaths, and placing an escalating burden on health care systems. Sixty-nine independent community-dwelling adults (60–85 years, 18 males) had their leg strength, physical activity levels and their annual fall rate assessed at two timepoints over three years, (summer 2010 and summer 2013) monitoring balance. Force platform measures of medio-lateral sway range increased significantly under conditions of eyes open (mean difference MD 2.5 cm; 95% CI 2.2 to 2.8 cm) and eyes closed (MD 3.2 cm; 95% CI 2.8 to 3.6 cm), respectively (all p < 0.001) indicating worsening static balance control. Dynamic balance showed similar changes (p < 0.036). Leg strength was not significantly different between visits (p > 0.26). Physical activity reduced significantly (MD −909 Cal/week; 95% CI −347 to −1,470 Cal/week; p = 0.002) during the course of the study. Participants maintained aerobic activities, however resistance and balance exercise levels decreased non-significantly. The likelihood of falling was higher at the end of the study compared to the first timepoint (odds ratio 1.93, 95% CI 0.94 to 3.94; p = 0.07). Results of this study indicate that despite maintenance of leg strength there was an increase in medio-lateral sway over a relatively short time frame, with higher than expected increases in fall rates. Full article

(This article belongs to the Special Issue Health Care for Old People)

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Open AccessArticle

Use or Non-Use of Gerontechnology—A Qualitative Study

by Ke Chen and Alan Hoi-shou Chan

Int. J. Environ. Res. Public Health 2013, 10(10), 4645-4666; https://doi.org/10.3390/ijerph10104645 - 30 Sep 2013

Cited by 103 | Viewed by 13875

Abstract

This study employed a qualitative approach to explore the attitudes and experiences of older people towards using gerontechnology, and to determine the underlying reasons that might account for their use and non-use of gerontechnology. Four focus group discussions and 26 individual interviews were undertaken. Qualitative data were analyzed using NVivo software and were categorized using coding and grounded theory techniques. The result indicated that old people in Hong Kong had an overall positive attitude toward technology. Positive attitudes were most frequently related to enhanced convenience and advanced features. Negative attitudes were most frequently associated with health risks and social problems arising from using technology (e.g., social isolation and addiction). Usage of technology is driven by outcome expectations and social influences, and supported by facilitators, whereas non-use of gerontechnology relates to the personal (e.g., health and functional capacities), technological (e.g., cost and complexity), and environmental barriers experienced. Use of gerontechnology is a synthesis of person, technology, and environment. To encourage non-users to adopt technology, there is a need to remove barriers at personal, technological, and environmental levels. Full article

(This article belongs to the Special Issue Health Care for Old People)

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Open AccessArticle

The Physical Activity Scale for the Elderly (PASE) Questionnaire; Does It Predict Physical Health?

by Samantha L. Logan, Benjamin H. Gottlieb, Scott B. Maitland, Dan Meegan and Lawrence L. Spriet

Int. J. Environ. Res. Public Health 2013, 10(9), 3967-3986; https://doi.org/10.3390/ijerph10093967 - 30 Aug 2013

Cited by 68 | Viewed by 14844

Abstract

A lack of physical activity is common in older adults. With the increasing Canadian senior population, identifying the minimum amount of physical activity required to maintain the health of older adults is essential. This study determined whether relationships existed between the Physical Activity Scale for the Elderly (PASE) questionnaire scores and health-related measurements in community-dwelling older adults who were meal delivery volunteers. Based on observed relationships between PASE scores and health parameters, the study attempted to predict an optimal PASE score that would ensure health parameters fell in desired ranges for older adults. 297 community-dwelling older adults (61.3% female) 60–88 years (72.1 ± 6.5) completed the PASE and were measured for body composition, cardiovascular and blood parameters, flexibility, and handgrip strength. Significant regression models using PASE were produced for the health-related measures, but the relationships were not meaningful due to low predictive capacity. However, correlational data suggested that a minimum PASE score of ~140 for males and ~120 for females predicted a favorable waist circumference. In conclusion, findings demonstrated that PASE scores cannot be used to predict healthy physical measures, although the relationships between PASE and WC could be used to encourage older adults to become more physically active. Full article

(This article belongs to the Special Issue Health Care for Old People)

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Review

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223 KiB

Open AccessReview

The Health Heterogeneity of and Health Care Utilization by the Elderly in Taiwan

by Li-Fan Liu

Int. J. Environ. Res. Public Health 2014, 11(2), 1384-1397; https://doi.org/10.3390/ijerph110201384 - 27 Jan 2014

Cited by 19 | Viewed by 6192

Abstract

A good understanding of the health heterogeneity of elderly people, their characteristics, patterns of health care utilization and subsequent expenditures is necessary to adequately evaluate the policy options and interventions aimed at improving quality and efficiency of care for older people. This article reviews studies that used Latent Class Analysis to identify four health profiles among elderly people in Taiwan: High Comorbidity (HC), Functional Impairment (FI), Frail (FR), and Relatively Healthy (RH). Variables associated with increased likelihood of being in the FR group were older age, female gender, and living with one’s family, and these also correlated with ethnicity and level of education. The HC group tended to use more ambulatory care services compared with those in the RH group. The HC group tended to be younger, better educated, and was more likely to live in urban areas than were people in the FI group. The FI group, apart from age and gender, was less likely be of Hakka ethnicity and more likely to live with others than were individuals in the RH group. The FI group had relatively high probabilities of needing assistance, and the FR group had higher healthcare expenditures. A person-centered approach would better satisfy current healthcare needs of elderly people and help forecast future expenditures. Full article

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Open AccessReview

Prevalence of Sedentary Behavior in Older Adults: A Systematic Review

by Juliet A. Harvey, Sebastien F. M. Chastin and Dawn A. Skelton

Int. J. Environ. Res. Public Health 2013, 10(12), 6645-6661; https://doi.org/10.3390/ijerph10126645 - 02 Dec 2013

Cited by 263 | Viewed by 21199

Abstract

Sedentary behavior is a cluster of behaviors adopted in a sitting or lying posture where little energy is being expended. Sedentary behavior is a risk factor for health independent to inactivity. Currently, there are no published systematic reviews on the prevalence of sedentary behavior objectively measured in, or subjectively reported by, older adults. The aim of this systematic review was to collect and analyze published literature relating to reported prevalence of sedentary behavior, written in English, on human adults, where subjects aged 60 years and over were represented in the study. 23 reports covered data from 18 surveys sourced from seven countries. It was noted that sedentary behavior is defined in different ways by each survey. The majority of surveys included used self-report as a measurement of sedentary behavior. Objective measurements were also captured with the use of body worn accelerometers. Whether measurements are subjective or objective, the majority of older adults are sedentary. Almost 60% of older adult’s reported sitting for more than 4 h per day, 65% sit in front of a screen for more than 3 h daily and over 55% report watching more than 2 h of TV. However, when measured objectively in a small survey, it was found that 67% of the older population were sedentary for more than 8.5 h daily. Full article

(This article belongs to the Special Issue Health Care for Old People)

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