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Background:To meet the complex needs of adults with dementia, a team-based, individualizedrehabilitation approach may be required. This randomized controlled pilot trial evaluatedthe feasibility of a person-centred multidimensional interdisciplinary rehabilitationprogram for older adults with dementia, in terms of follow-up and response rates, andpotential short- and long-term effects in adults with dementia on social participation,loneliness, and mental health.

Methods: Participants (mean age (SD) 78.7 (±6.6) years), were randomized to an interventiongroup (n = 31) or usual care (n = 30). The rehabilitation program consisted of a20-week rehabilitation period and two follow-ups after 5 and 14 months. An interdisciplinaryteam performed assessments and interventions based on the individual’sgoals. Assessors blinded to group allocation performed structured assessments atbaseline and after 5, 12, 24, and 36 months.

Results: Initially, response rates in participants with dementia were high for all assessmentsin the areas of social participation, loneliness, and mental health. Response ratesafter 12 months decreased, particularly for cognitively demanding questions withmultiple-choice options in the area of social participation. Overall, there were few statistically significant differences between the groups in the outcomes over 36 months, but some of the findings seemed potentially clinically meaningful in favor of the intervention group: increased frequency of active recreation and organized social activities outside the home, as reported by both participants with dementia and caregivers or staff; as well as experienced more frequent visits to family and friends; and short-term reduction in depressive symptoms.

Conclusions: Assessments made of loneliness and mental health in this study over three years seemed feasible. It seemed cognitively demanding for participants with dementia to answer questions regarding social participation over time; therefore it seemed worthwhile to also ask informal caregivers or staff to avoid data loss. The positive findings noted during assessments and potential effects indicate that it is relevant to proceed further to an adequately powered RCT and conducted in additional geographical regions.

Objective: What are the core capabilities physiotherapists need to deliver quality care when working with people with dementia and their families/caregivers?

Design: A three-round modified e-Delphi study. Participants: Panel members were physiotherapists experienced in working with people with dementia and/or educating and/or researching in the dementia field.

Methods: A steering group (16 international physiotherapists and a consumer) developed a draft framework including 129 core capabilities across 5 domains for panel members to rate their appropriateness for inclusion as a core capability to provide high quality care to people with dementia and their caregivers/families. The RAND/UCLA method was used to assess consensus.

Results: Thirty-five physiotherapists from 11 countries participated in Round 1, 31 (89%) in Round 2 and 28 (80% of Round 1) in Round 3. All core capabilities were rated appropriate for inclusion in each round. Panel members recommended wording refinements across the rounds and suggested 51 core capabilities for consideration. Three rounds were needed to reach consensus, resulting in 137 core capabilities rated appropriate for inclusion across 5 domains: 1) Knowledge and understanding, n = 36; 2) Assessment, n = 39; 3) Management, interventions and prevention n = 40; 4) Communication, therapeutic relationship and person-centred care, n = 17; and 5) Physiotherapists self-management and improvement, n = 5. Conclusions: This e-Delphi study outlines the core capabilities physiotherapists need to provide high quality care to people with dementia and their families/caregivers. These core capabilities can be used by physiotherapists to help identify knowledge/skill gaps, as well as by educators to improve their training of undergraduate and postgraduate students, and clinicians.

Contribution of Paper:

• This e-Delphi study has developed, through expert consensus, the first comprehensive physiotherapy specific core capability framework for providing high-quality care to people with dementia and their families/caregivers.

• The core capability framework can be used by physiotherapists to identify knowledge and/or skill gaps, and by physiotherapy educators to assist with entry-level and post-graduate curriculum development and student/workforce training.

• As physiotherapists play a vital role in working with people with dementia and their caregivers/families, and competencies lie at the heart of effective quality care and service delivery, the newly developed core capability framework serves as basis for broader consultation and input.

Objectives: Fear of falling (FoF) is a common problem among older adults. It can lead to reduced quality of life and less physical activity, which increases fall risk. Earlier work has shown that FoF can be a manifestation of executive dysfunction in adults over 50 years, but studies on people over age 75 years are lacking. Executive functions (EFs) are cognitive functions associated with the frontal lobes and the prefrontal cortex. The aim of this study was to assess associations of EFs and FoF among people aged 80 years or older.

Methods: This cross-sectional study was based on data from the Northern Sweden Silver-MONICA study and included 434 participants aged 80 years or older. EFs were assessed with the Frontal Assessment Battery (FAB) and FoF with the Falls Self-Efficacy Scale–International (FES-I). Multivariable linear regression analysis was used to examine associations among EF, FoF, and a comprehensive set of adjustment factors. Pearson correlation analysis was used to evaluate associations of FES-I and the subitems of the FAB.

Results: EFs as measured by FAB were inversely associated with FoF (β = -0.23; 95% confidence interval, -0.42 to -0.03; p = 0.021), even after comprehensive adjustments. The FAB subitems measuring lexical fluency, inhibitory control, sustained attention, self-organization, motor programming, and planning also were inversely associated with FoF.

Conclusions: Lower EF is associated with higher FoF among people aged 80 years or older. This information is important for treating and preventing FoF in this population.

Background: To reduce the risk of falls, tailored interventions including exercise that simultaneously challenges cognition (motor–cognitive) are recommended. However, considerable variation in motor–cognitive approaches exist, and its use in clinical practice is less widespread. This study aimed to explore older peoples’ and physiotherapists’ perspectives on motor–cognitive exercise and their suggestions for programme development during co-creation.

Method: Community-dwelling women (n = 8) and men (n = 9), aged (mean ± SD) 74 ± 5.6 years, and 4 physiotherapists working in geriatric rehabilitation were included. Data were collected through nine workshops. The discussions were audio-recorded and analysed employing a qualitative content analysis approach. This study aligns with the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist.

Results: The analysis resulted in four themes and nine categories. The themes were: discovering the motor–cognitive concept through engagement in activity, balancing safety and challenge, navigating the complexity of individualisation, and managing motivation and compliance. The context was initially difficult to grasp. Performing practical activities led to understanding, and motor–cognitive exercises were experienced as enjoyable yet challenging to perform. Balancing safety while providing exercises that were challenging enough to make the programme effective was perceived as challenging by both older participants and physiotherapists. Regular individual follow-up during the exercise programme was considered important for promoting progression and compliance. Leader-led, group-based exercises later incorporated into daily life routines were suggested to support motivation and promote safety.

Conclusion: Incorporating motor–cognitive exercise in fall prevention exercises programmes for older people at risk of falls, may enhance enjoyment and motivation but requires consideration for safe and effective delivery. The co-creative design in this context is rare and the results may be useful for further research and for the development of fall prevention interventions.

Background: There is a growing interest in eHealth solutions to enhance access to and use of pulmonary rehabilitation for people with chronic obstructive pulmonary disease (COPD).

Objective: This study aims to evaluate the feasibility of a novel eHealth tool (Me&COPD) to support pulmonary rehabilitation concerning usability, exercise adherence, intensity, progression, and adverse events. Moreover, this study aims to evaluate clinical outcome measures to prepare for a future larger trial.

Methods: A multicenter, parallel-group randomized controlled pilot and feasibility trial was conducted in 6 primary health care centers. People with mild to severe COPD were recruited by physiotherapists at the included health care centers and randomized either to the intervention group with access to Me&COPD for 3 months or to the control group receiving usual care. The Me&COPD tool comprised audio-visual and written self-management strategies, including an individually tailored home-based exercise program and interaction with a physiotherapist. The exercise program was prescribed in a face-to-face meeting with a physiotherapist, and thereafter it was regularly reviewed and adjusted through the eHealth tool. The primary outcome, usability, was self-assessed at intervention completion in the intervention group and among participating physiotherapists (n=7) using the Swedish version of the Mobile Health App Usability Questionnaire (S-MAUQ). In addition, use data on exercise adherence, intensity, and progression and adverse events were exported from the eHealth tool. Clinical outcomes, assessed by blinded assessors at baseline and 3 months in the intervention and control groups, included exercise capacity, balance, physical activity level, COPD-related symptoms, and health-related quality of life. Descriptive statistics were used for analysis.

Results: In total, 22 participants (women: n=12, 55%), aged 72.3 (SD 8.4) years on average, were included in the intervention (n=15) and control (n=7) groups. The mean overall S-MAUQ scores out of 7 (highest possible usability) were 4.4 (SD 1.5) for participants and 4.5 (SD 1.2) for physiotherapists. Among the subscales, the highest score was assigned to usefulness among participants (S-MAUQ: mean 4.9, SD 1.3) and physiotherapists (S-MAUQ: mean 5.1, SD 1.7). No severe adverse events were registered, although exercise adherence, intensity, and progression evaluation were limited by incomplete exercise session registration. The test procedures and the clinical outcome measures used were found to be feasible for the participants and the assessors.

Conclusions: The novel eHealth tool, Me&COPD, seemed feasible in terms of safety and had acceptable usability among people with COPD and participating physiotherapists. Usability may be improved by better organization of the information and simplification of the exercise diary to enable collection of data on exercise adherence, intensity, and progression through the eHealth tool. The test procedures seemed feasible, although the recruitment process needs further consideration. The effectiveness of the intervention remains to be evaluated in a future larger trial.

Background: Co-creation methods ensure that interventions are tailored to the target group by incorporating their unique insights and preferences, strengthen innovation, and facilitate implementation. Although co-creation research is becoming more common, most research exploring co-creation focuses on the researchers' perspectives rather than the experiences of the target population. By exploring these experiences, researchers can better understand the preferences for, and facilitators/barriers to, engagement and participation to inform future co-creation studies. This study aimed to explore older persons' experiences and insights into participating in co-creation of an intervention to prevent falls.

Methods: Qualitative interviews were conducted with 13 community-dwelling older persons (aged 66–83 years) after their participation in a co-creation study developing an intervention for fall prevention. Data were analyzed using qualitative content analysis.

Results: Three themes emerged from the analysis: Diversity of co-creators enriches understanding and creativity, Interactive activities promote learning, and Supportive environments enhance collaboration. These themes describe how participating in workshops with others deepened and broadened participants' knowledge and understanding of the subject and enabled them to contribute their experiences and perspectives. Discussing and testing exercises gave participants new insights into their physical abilities and the importance of exercise and a better understanding of the concept of motor-cognitive exercises and their role in everyday life. A respectful atmosphere where everyone shared responsibility for creating a supportive environment so all participants could express their thoughts was perceived as important by the participants.

Conclusions: The results underscore the potential for co-creation to enhance participants' knowledge and understanding of the topic, as well as their own capacity. For researchers, it is important to consider how to foster an inclusive and supportive environment, thereby boosting participation, engagement and collaboration.

Objectives: To investigate the association between gait speed and depressive disorders among very old adults (≥85 years).

Method: This study utilized the GERDA-database, which encompasses a representative sample of those aged 85, 90, and 95+ years residing in northern Sweden and western Finland. From four data collections between 2000 and 2017, this study included 1794 participants. Self-paced gait speed was measured over 2.4-m and depressive disorders was evaluated by a specialist in geriatric medicine according to the DSM-IV-TR criteria. T-tests and multivariable logistic regressions were used to explore differences and associations between gait speed and depressive disorders.

Results: Gait speed was independently associated with depressive disorders among very old adults (p <.001). The results showed significantly different mean gait speeds (m/s) between individuals with/without a depressive disorder (0.34 ± 0.24/0.52 ± 0.26, p <.001), between individuals with a depressive disorder with/without antidepressant treatment (0.35 ± 0.24/0.44 ± 0.24, p <.001) and between non-responders/responders to antidepressants (0.36 ± 0.21/0.42 ± 0.22, p =.020).

Conclusion: This is the first study focusing on very old adults that has shown an independent association between gait speed and depressive disorders. Responders to antidepressant medication had a higher mean gait speed than non-responders, which may imply shifts in function upon successful treatment.

Background: A team-based, individualised rehabilitation approach may be required to meet the complex needs of people with dementia. This randomised controlled pilot trial evaluated the feasibility of a person-centred multidimensional interdisciplinary rehabilitation programme for community-dwelling older people with dementia and their informal primary caregivers.

Methods: Participants with dementia were randomised to an intervention group (n = 31, mean age (SD) 78.4 (6.0) years) or usual care (n = 30, mean age 79.0 (7.1)). The rehabilitation programme consisted of a 20-week rehabilitation period containing assessments and interventions based on each individual’s goals, and group-based physical exercise plus social interaction twice a week for 16 weeks at a rehabilitation unit. After 5 and 14 months, the interdisciplinary team followed up participants over two four-week periods. For both groups, dates of deaths and decision to move to nursing home over three years, as well as interventions for the relevant periods, were collected. Blinded assessors measured physical functions, physical activity, activities of daily living, cognitive functions, nutritional status, and neuropsychiatric symptoms at baseline and at 5, 12, 24, and 36 months.

Results: Participants in the intervention group received a mean of 70.7 (20.1) interventions during the 20-week rehabilitation period, delivered by all ten team professions. The corresponding figures for the control group were 5.8 (5.9). In the intervention group, all but one participated in rehabilitation planning, including goal setting, and attendance in the exercise and social interaction groups was 74.8%. None of the adverse events (n = 19) led to any manifest injury or disease. Cox proportional hazard regression showed a non-significant lower relative risk (HR = 0.620, 95% CI 0.27–1.44) in favour of the intervention for moving to nursing home or mortality during the 36-month follow-up period. Linear mixed-effect models showed non-significant but potentially clinically meaningful between-group differences in gait, physical activity, and neuropsychological symptoms in favour of the intervention.

Conclusions: The rehabilitation programme seems feasible among community-dwelling older people with dementia. The overall results merit proceeding to a future definitive randomised controlled trial, exploring effects and cost-effectiveness. One could consider to conduct the programme earlier in the course of dementia, adding cognitive training and a control attention activity.

Trial registration: The study protocol, ISRCTN59155421, was registered online 4/11/2015.

BACKGROUND: Despite well-known positive effects of pulmonary rehabilitation, access is limited. New strategies to improve access are advocated, including the use of eHealth tools.

OBJECTIVES: The aim of this study was to explore prospective users' preferences for an eHealth tool to support the self-management of physical activity and exercise training in COPD.

METHODS: A qualitative research design was applied. Data was collected in six, audio recorded, digital co-creation workshops, which were guided by a participatory and appreciative action and reflection approach. A total of 17 prospective users took part in the process, including people with COPD (n = 10), relatives (n = 2), health care givers (n = 4) and a patient organization representative (n = 1). During the workshops, pre-selected relevant topics to exploring end-users' preferences for eHealth support in self-management in COPD were discussed. The workshops were recorded and transcribed. Data was analysed using inductive qualitative content analysis.

RESULTS: The overarching theme "fusing with, rather than replacing existing support structures" was uncovered when the two-sided relationship between positive expectations towards digital solutions and the fear of losing access to established rehabilitation systems, emerged in the discussions. Three categories were identified, focused on wishes for an evidence-based support platform of information about COPD, a well-designed eHealth tool including functionalities to motivate in the self-management of physical activity and exercise training, and requirements of various forms of support. Co-creators believed that there were clear benefits in combining the best of digital and existing support systems.

CONCLUSIONS: Co-creators viewed an eHealth tool including support for physical activity and exercise training as a valuable digital complement to the now existing rehabilitation services. A future eHealth tool needs to focus on user-friendliness and prospective users's requests.

Background: Adults with dementia have a high risk of falls and fall-related injuries. A greater slowing of backward walking speed (BWS) relative to forward (FWS) has been indicated with older age, and slower BWS has been related to an increased risk of falls. Similarly, slow BWS relative to FWS has been observed in people with dementia.

Research question: Is slower BWS, and slower BWS relative to FWS associated with increased risk of prospective falls in older adults with dementia?

Methods: In total, 52 women and 12 men with dementia living in nursing homes, mean age 86 years, and mean Mini-Mental State Examination score of 14.2 points were included. BWS and FWS was measured over 2.4 m, and the directional difference (DD) calculated (100*((FWS-BWS)/FWS)). Falls were followed for 6 months by review of fall incident reports in electronic medical records at nursing homes and the regional healthcare provider.

Results: Altogether, 95 falls occurred with mean incidence rate 3.1 falls per person-years. Of included participants, 15 (23%) fell once, and 17 (27%) fell twice or more. In negative binomial regression analyses, greater DD was associated with lower prospective incidence fall rate ratio, IRR (IRR= 0.96, p < .001), while BWS was not (IRR= 0.04, p = .126).

Significance: In this study of adults with dementia, slower BWS was not associated with prospective falls. However, slower BWS relative to forward (greater DD) was associated with fewer falls, and possibly a protective response. This is novel research, yet results are promising and indicate that assessing walking speed in multiple directions may inform fall risk in adults with dementia.