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Background The long-term care setting poses unique challenges and opportunities for effective knowledge translation. The objectives of this review are to (1) synthesize barriers and facilitators to implementing evidence-based guidelines in long-term care, as defined as a home where residents require 24-h nursing care, and 50% of the population is over the age of 65 years; and (2) map barriers and facilitators to the Behaviour Change Wheel framework to inform theory-guided knowledge translation strategies. Methods Following the guidance of the Cochrane Qualitative and Implementation Methods Group Guidance Series and the ENTREQ reporting guidelines, we systematically reviewed the reported experiences of long-term care staff on implementing evidence-based guidelines into practice. MEDLINE Pubmed, EMBASE Ovid, and CINAHL were searched from the earliest date available until May 2021. Two independent reviewers selected primary studies for inclusion if they were conducted in long-term care and reported the perspective or experiences of long-term care staff with implementing an evidence-based practice guideline about health conditions. Appraisal of the included studies was conducted using the Critical Appraisal Skills Programme Checklist and confidence in the findings with the GRADE-CERQual approach. Findings After screening 2680 abstracts, we retrieved 115 full-text articles; 33 of these articles met the inclusion criteria. Barriers included time constraints and inadequate staffing, cost and lack of resources, and lack of teamwork and organizational support. Facilitators included leadership and champions, well-designed strategies, protocols, and resources, and adequate services, resources, and time. The most frequent Behaviour Change Wheel components were physical and social opportunity and psychological capability. We concluded moderate or high confidence in all but one of our review findings. Conclusions Future knowledge translation strategies to implement guidelines in long-term care should target physical and social opportunity and psychological capability, and include interventions such as environmental restructuring, training, and education.

With an aging population, numerous assistive and monitoring technologies are under development to enable older adults to age in place. To facilitate aging in place, predicting risk factors such as falls and hospitalization and providing early interventions are important. Much of the work on ambient monitoring for risk prediction has centered on gait speed analysis, utilizing privacy-preserving sensors like radar. Despite compelling evidence that monitoring step length in addition to gait speed is crucial for predicting risk, radar-based methods have not explored step length measurement in the home. Furthermore, laboratory experiments on step length measurement using radars are limited to proof-of-concept studies with few healthy subjects. To address this gap, a radar-based step length measurement system for the home is proposed based on detection and tracking using a radar point cloud followed by Doppler speed profiling of the torso to obtain step lengths in the home. The proposed method was evaluated in a clinical environment involving 35 frail older adults to establish its validity. Additionally, the method was assessed in people’s homes, with 21 frail older adults who had participated in the clinical assessment. The proposed radar-based step length measurement method was compared to the gold-standard Zeno Walkway Gait Analysis System, revealing a 4.5 cm/8.3% error in a clinical setting. Furthermore, it exhibited excellent reliability (ICC(2,k) = 0.91, 95% CI 0.82 to 0.96) in uncontrolled home settings. The method also proved accurate in uncontrolled home settings, as indicated by a strong consistency (ICC(3,k) = 0.81 (95% CI 0.53 to 0.92)) between home measurements and in-clinic assessments.

Detecting early changes in walking speed can allow older adults to seek preventative rehabilitation. Currently, there is a lack of consensus on which assessments to use to assess walking speed and how to continuously monitor walking speed outside of the clinic. Chirp is a privacy-preserving radar sensor developed to continuously monitor older adults' safety and mobility without the need for cameras or wearable devices. Our study purpose was to evaluate the inter-sensor reliability, intrasession test-retest reliability, and concurrent validity of Chirp in a clinical setting. We recruited 35 community-dwelling older adults (mean age 75.5 (standard deviation: 6.6) years, 86% female). All participants lived alone in an urban city in southwestern Ontario and had access to a smart device with wireless internet. Data were collected with a 4-meter ProtoKinetics ZenoTM Walkway (pressure sensors) with the Chirp sensor (radar positioning) at the end of the walkway. We assessed participants walking speed during normal and adaptive locomotion experimental conditions (walking-while-talking, obstacle, narrow walking, fast walking). We selected walking speed as a measure as it is a good predictor of functional mobility but also is associated with physical and cognitive functioning in older adults. Each of the experimental conditions was conducted twice in a randomized order, with fast walking trials performed last. For intra-session reliability testing, we conducted two blocks of walks within a participant session separated by approximately 30 minutes. Intraclass Correlation Coefficient(A,1) (ICC(A,1)) was used to assess the reliability and validity. Linear regression, adjusted for gender, was used to investigate the association between Chirp and cognition and health-related quality of life scores. Chirp walking speed inter-sensor reliability ICC(A,1) = 0.999[95% Confidence Interval [CI]: 0.997 to 0.999] and intrasession test-retest reliability [ICC(A,1) = 0.921, 95% CI: 0.725 to 0.969] were excellent across all experimental conditions. Chirp walking speed concurrent validity compared to the ProtoKinetics ZenoTM Walkway was excellent across experimental conditions [ICC(A,1) = 0.993, 95% CI: 0.985 to 0.997]. We found a weak association between walking speed and cognition scores using the Montreal Cognitive Assessment across experimental conditions (estimated β-value = 7.79, 95% CI: 2.79 to 12.80) and no association between walking speed and health-related quality of life using the 12-item Short Form Survey across experimental conditions (estimated β-value = 6.12, 95% CI: -7.12 to 19.36). Our results demonstrate that Chirp is a reliable and valid measure to assess walking speed parameters in clinics among older adults.

ObjectivesThis study describes the prototype testing and clinical validation of the Fit-Frailty App, a fully guided, interactive mobile health (mHealth) app to assess frailty and sarcopenia. This multi-dimensional tool is freely available on the App Store and considers medical history, physical performance, cognition, nutrition, daily function and psychosocial domains. To guide management, a total frailty score and clinical summary of underlying “risk flags” are provided. Our objectives were to examine usability, feasibility, criterion and construct validity.DesignCross-sectionalSettingOutpatient geriatric medicine clinicParticipantsCommunity-dwelling older adults, age 65 years or olderMethodsThe primary outcome of the clinical validation study was criterion validity. A research nurse administered the Fit-Frailty App during a routine clinic appointment. Clinicians simultaneously completed a paper-based frailty index (FI) tool with similar items from a comprehensive geriatric assessment (FI-CGA). Total scores for both assessments were computed using the cumulative deficits frailty index scoring method. Intraclass and Pearson correlation coefficients and 95% CIs were calculated to examine criterion validity. Secondary outcomes were construct validity, feasibility (eg, completion rates, safety occurrences, resources) and usability (eg, ratings on ease of use, time to complete the app).ResultsIn the clinical validation study (n=75, mean age 79.2, SD=7.0, 53% female), the mean total Fit-Frailty App score was 0.33 (SD=0.13) with 73% of our sample considered frail or severely frail. The app presented comparable results to FI-CGA (moderate to good validity; ICC=0.65, 95%CI=0.50–0.76) with a strong association between the measures (r=0.74, 95%CI=0.62–0.83). In our prototype and clinical cohorts, the app had a 100% completion rate with no safety occurrences and had high usability ratings.ConclusionsThe Fit-Frailty App is a feasible and valid tool that can be used in research and clinical settings to comprehensively assess frailty and sarcopenia by non-geriatricians and could assist with developing targeted interventions.

Background The Coronavirus (COVID-19) pandemic has exacerbated the risk for poor physical and mental health outcomes among vulnerable older adults. Multicomponent interventions could potentially prevent or reduce the risk of becoming frail; however, there is limited evidence about utilizing alternative modes of delivery where access to in-person care may be challenging. This randomized feasibility trial aimed to understand how a multicomponent rehabilitation program can be delivered remotely to vulnerable older adults with frailty during the pandemic. Methods Participants were randomized to either a multimodal or socialization arm. Over a 12-week intervention period, the multimodal group received virtual care at home, which included twice-weekly exercise in small group physiotherapy-led live-streamed sessions, nutrition counselling and protein supplementation, medication consultation via a videoconference app, and once-weekly phone calls from student volunteers, while the socialization group received only once-weekly phone calls from the volunteers. The RE-AIM (Reach, Effectiveness, Adoption, Implementation and Maintenance) framework was used to evaluate the feasibility of the program. The main clinical outcomes were change in the 5-times sit-to-stand test (5 × STS) and Depression, Anxiety and Stress Scale (DASS-21) scores. The feasibility outcomes were analyzed using descriptive statistics and expressed as frequencies and mean percent with corresponding confidence intervals (CI). Analysis of covariance (ANCOVA) was used for the effectiveness component. Results The program enrolled 33% ( n  = 72) of referrals to the study ( n  = 220), of whom 70 were randomized. Adoption rates from different referral sources were community self-referrals (60%), community organizations (33%), and healthcare providers (25%). At the provider level, implementation rates varied from 75 to 100% for different aspects of program delivery. Participant’s adherence levels included virtual exercise sessions 81% (95% CI : 75–88%), home-based exercise 50% (95% CI : 38–62%), protein supplements consumption 68% (95% CI : 55–80%), and medication optimization 38% (95% CI : 21–59%). Most participants (85%) were satisfied with the program. There were no significant changes in clinical outcomes between the two arms. Conclusion The GERAS virtual frailty rehabilitation study for community-dwelling older adults living with frailty was feasible in terms of reach of participants, adoption across referral settings, adherence to implementation, and participant’s intention to maintain the program. This program could be feasibly delivered to improve access to socially isolated older adults where barriers to in-person participation exist. However, trials with larger samples and longer follow-up are required to demonstrate effectiveness and sustained behavior change. Trial registration ClinicalTrials.gov NCT04500366. Registered August 5, 2020, https://clinicaltrials.gov/ct2/show/NCT04500366

Background Dance is a mind-body activity of purposeful rhythmic movement to music. There is growing interest in using dance as a form of cognitive and physical rehabilitation. This manuscript describes the development of GERAS DANcing for Cognition and Exercise (DANCE) and evaluates its feasibility in older adults with cognitive and mobility impairments. Methods The progressive dance curricula were delivered for 15 weeks (1-h class; twice weekly). Participants were eligible if they were community-dwelling older adults aged 60+ with early cognitive or mobility impairment able to follow three-step commands and move independently. Feasibility outcomes included recruitment/retention, adherence, participant satisfaction, safety, and adverse events. Results Twenty-five older adults (mean (standard deviation [ SD ]) age = 77.55 (6.10) years, range 68–90 years) with early cognitive (Montreal Cognitive Assessment score ( SD ) = 21.77 (4.05)) and mobility (92% were pre-frail/frail as indicated on the Fried Frailty Phenotype) impairments were recruited from a geriatric out-patient clinic or within the community. A total of 20/25 (80%) participants completed the study. Average class attendance was 72%, and self-reported homework adherence “most-days / every day” was 89%. A stepwise progression in the dance curricula was observed with increases in motor complexity and balance demands, and 95% of participants rated the program as a “just-right” challenge. Ninety percent of participants rated GERAS DANCE as excellent, and 100% would recommend the program to a friend or family member. Over 50% of participants connected outside of class time for a self-initiated coffee club. Adverse events of falls and fractures were reported for 2 participants, which occurred at home unrelated to the dance intervention during the study period. Pre-determined thresholds for feasibility were met for all outcomes. Discussion GERAS DANCE is a feasible and enjoyable program for older adults with early cognitive or mobility impairments. GERAS DANCE curriculum grading (duration; sequence; instructions) and motor complexity increases in agility, balance, and coordination appear appropriately tailored for this population. Future work will explore the feasibility of GERAS DANCE in new settings (i.e., virtually online, community centers, or retirement homes) and the mind-body-social benefits of dance.

Background Cognitive impairment is characterized by problems in thinking, memory, language, and judgment that are greater than cognitive changes in normal aging. Considering the unprecedented growth of the older adult population and the projected increase in the prevalence of cognitive impairment, it is imperative to find effective strategies to improve or maintain cognitive function in older adults. The objective of this review is to summarize the effects of dance versus any other control group on cognitive function, physical function, adverse events, and quality of life in older adults. Method We will search the following databases MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) to identify the randomized controlled trials (RCTs) evaluating the effects of dance on cognitive function among older adults. Also, we will search http://apps.who.int/trialsearch , clinicaltrials.gov and conference abstracts to identify ongoing and unpublished studies. There will be no restrictions on language, date, or journal of publication. Reviewers will independently and in duplicate screen for eligible studies using pre-defined criteria. Data extraction from eligible studies will be performed independently and in duplicate. The Cochrane risk of bias tool will be used to assess the risk of bias of studies. Our primary outcome of interest is cognitive function, more specifically the executive function domain. We will include other domains as well such as processing speed and reaction time. Secondary outcomes of interest are physical function. The secondary outcomes also include adverse events including falls and quality of life. We will use Review Manager (RevMan 5.3) to pool the effect of dance for each outcome where possible. Results will be presented as relative risks along with 95% confidence intervals for dichotomous outcomes and as mean differences, or standardized mean differences along with 95% confidence intervals, for continuous outcomes. We will assess the certainty of the evidence using the GRADE approach and present findings in a Summary of Findings table. Discussion This systematic review, to our best knowledge the first-ever, will synthesize the available evidence on the effects of dance on cognitive function among older people. Systematic review registration PROSPERO CRD42017057138

Background Life space mobility ‐ how far and how often someone moves through their environment ‐ is a meaningful marker of physical function, cognitive health, and independence. In older adults with mild cognitive impairment (MCI), life space often becomes restricted and can accelerate functional decline. This study evaluated the impact of Cognitive Groove, brought to you by GERAS DANCE, on life space mobility in older adults with and without MCI. Method Cognitive Groove is a structured, community‐based rehabilitation program designed for older adults with early cognitive and/or mobility challenges. The program was delivered across 12 YMCA sites in Southern Ontario, Canada. The program included in‐person dance classes (twice weekly, 1 hour each) and at‐home balance exercises (10 minutes daily) over 12‐weeks. Life space mobility was assessed using the Life Space Assessment (LSA), cognitive function with the Montreal Cognitive Assessment (MoCA), and physical function with the Short Physical Performance Battery (SPPB). MCI was defined as a baseline MoCA score of 18‐25. Paired t‐tests examined the changes from baseline to 12 weeks, and the chi‐square test assessed changes in LSA frequency. Statistical significance was p ≤0.05. Result A total of 106 older adults (age = 76.10(7.0) years; range 61–93) participated in Cognitive Groove. There were 61 older adults classified with MCI and 45 without MCI. Program adherence was high, with an average attendance of 75% (18/24 sessions). By the end of the program, older adults with MCI were moving farther and more often in their daily lives (p ≤0.05). Their life space became similar to those without MCI, whose movement stayed the same during the program (p >0.05). Notably, older adults with MCI reported more frequent travel outside their neighbourhood but within their town (Life Space Level 4, p <0.001). MoCA scores improved by 1.04 points in the MCI group, exceeding the minimal clinically important difference of 1.0, and both groups demonstrated significant improvements in SPPB scores (p <0.001). Conclusion These findings suggest that Cognitive Groove not only enhances physical performance, but also life space mobility, by fostering community re‐engagement among older adults with MCI to support functional independence and active aging.

There is growing interest in conceptualizing and diagnosing frailty. Less is understood, however, about older adults’ perceptions of the term “frail”, and the implications of being classified as “frail”. The purpose of this scoping review was to map the breadth of primary studies; and describe the meaning, perceptions, and perceived implications of frailty language amongst community-dwelling older adults. Eight studies were included in the review and three core themes were identified: (1) understanding frailty as inevitable age-related decline in multiple domains, (2) perceiving frailty as a generalizing label, and (3) perceiving impacts of language on health and health care utilization. Clinical practice recommendations for health care professionals working with individuals with frailty include: (1) maintaining a holistic view of frailty that extends beyond physical function to include psychosocial and environmental constructs, (2) using person-first language, and (3) using a strengths-based approach to discuss aspects of frailty.

Life space mobility - how far and how often someone moves through their environment - is a meaningful marker of physical function, cognitive health, and independence. In older adults with mild cognitive impairment (MCI), life space often becomes restricted and can accelerate functional decline. This study evaluated the impact of Cognitive Groove, brought to you by GERAS DANCE, on life space mobility in older adults with and without MCI. Cognitive Groove is a structured, community-based rehabilitation program designed for older adults with early cognitive and/or mobility challenges. The program was delivered across 12 YMCA sites in Southern Ontario, Canada. The program included in-person dance classes (twice weekly, 1 hour each) and at-home balance exercises (10 minutes daily) over 12-weeks. Life space mobility was assessed using the Life Space Assessment (LSA), cognitive function with the Montreal Cognitive Assessment (MoCA), and physical function with the Short Physical Performance Battery (SPPB). MCI was defined as a baseline MoCA score of 18-25. Paired t-tests examined the changes from baseline to 12 weeks, and the chi-square test assessed changes in LSA frequency. Statistical significance was p ≤0.05. A total of 106 older adults (age = 76.10(7.0) years; range 61-93) participated in Cognitive Groove. There were 61 older adults classified with MCI and 45 without MCI. Program adherence was high, with an average attendance of 75% (18/24 sessions). By the end of the program, older adults with MCI were moving farther and more often in their daily lives (p ≤0.05). Their life space became similar to those without MCI, whose movement stayed the same during the program (p >0.05). Notably, older adults with MCI reported more frequent travel outside their neighbourhood but within their town (Life Space Level 4, p <0.001). MoCA scores improved by 1.04 points in the MCI group, exceeding the minimal clinically important difference of 1.0, and both groups demonstrated significant improvements in SPPB scores (p <0.001). These findings suggest that Cognitive Groove not only enhances physical performance, but also life space mobility, by fostering community re-engagement among older adults with MCI to support functional independence and active aging.