This study examined the association between physical fitness and successful aging in Taiwanese older adults. The researchers defined successful aging as being independent in activities of daily living, having no cognitive impairment or depression, and good social functioning. They assessed 378 older adults and found that 26.5% met the criteria for successful aging. After adjusting for demographic and health factors, tests of grip strength, chair stands, walking distance, timed up-and-go, and functional reach were individually associated with successful aging. However, in a multivariate model only cardiopulmonary endurance, mobility, muscle strength, and balance were significantly associated with successful aging. The study suggests maintaining these physical functions is important for aging successfully.
Physical Activity Level Analyses and Chronic-Degenerative Disease Risks In Do...IJERDJOURNAL
Abstract:- It is of common belief that physical activity can restore damages caused to people's health due to the stressful everyday work routine. The energy expenditure on physical activities is directly related to the frequency, duration and intensity of human movements developed on many tasks. Thus, the main objective of this paper was to evaluate this energy consumption in public school teachers from the city of Horizonte, Ceara, discussing about degenerative chronic disease risks. 30 teachers, 9 men and 21 women within the age of 25 to 59 years old, were evaluated. Their Body Mass Index (BMI) was calculated in order to classify them as normal, overweight and obese. As an instrument, the long version of the International Physical Activity Questionnarie (IPAQ) was used, once it is more recommended to national prevalence studies due to the possibility of international comparison. This instrument contains several questions related to frequency (days per week) and duration (time per day) spent on moderate and vigorous physical activities and walking. The questionnarie also captures the energy expenditure in METs, in order to classify the selected individuals according to intensity: “sedentary” (< 1,5 METs), “low” (1,5 < METs < 3,0), “moderate” (3,9 < METs < 5,9) and “high” (≥ 6,0 METs). These analyses were performed using the Epi Info™ program, which used descriptive statistics. The results showed that the teachers present a good level of physical activity with 46,67% classified as high, 40% as moderate and 13,13% as low. The individuals also presented significant degree of overweight and obesity, 43% and 34% respectively, and only 23% within the acceptable weight range. Therefore, it could be concluded that, among the modifiable risk factors, the physical activity and the body mass control play important roles when it comes to chronic-degenerative disease prevention
1) This study examined the effects of an 8-week physical exercise program on happiness among 120 older adults in Iran.
2) Participants were randomly assigned to an experimental group that participated in the exercise program or a control group.
3) Results showed that the exercise program significantly improved happiness in the experimental group, while happiness did not improve in the control group.
Running head: PHYSICAL ACTIVITY AND SELF-EFFICACY 1
PHYSICAL ACTIVITY AND SELF-EFFICACY 2
The Relationship between Physical Activity and Self-Efficacy in Schools
Abstract
Few studies have examined the relationship between physical activities and health outcomes among adolescents. The majority of the adult population knows much about health-risk behaviours of adolescents, and knows less about their health-promoting behaviours. The purpose of the study was to determine the relationship between physical activity levels and self-efficacy among adolescents.
Introduction
According to Start Active, regular physical activity associates with benefits for physical and mental health (as cited in Roberts et al, 2015). Studies have indicated that health life traits and styles have an impact on lifelong health and life quality. Childhood poor diet and physical inactivity have been risk factors for a multitude of chronic health condition in adulthood (Matthews et al, 2015). According to the Centers for Disease Control and Prevention for children, only 42% of children and 8% of adolescents achieve current recommended physical activity.
Most students studying in Hoca Ahment Yesevi University were hound to have health issues emanating from lack of physical exercise and personal fitness programs (Ozkan, 2015). Up to 70 per cent of university students are reported as not participating in regular free-time physical activity or exercise (Haase et al, 2004, as cited in Roberts et al, 2014). Simon et al (2015) mentioned that majority of the adult population fails to achieve recommended daily exercise, 30-minutes moderate intensity exercise. When physical activity is conducted regularly as the researchers found out, it is likely to improve the physical fitness of the students and generally of people and therefore contributing heavily to better healthy life styles. Achieving daily exercise was shown to promote better sleep quality and higher psychological functioning in adolescents (Kalak et al, 2012, as cited in Rew et al, 2015).
Styles and activities that promote the health of humans increase their chances of wellbeing and therefore promote healthy living. In achieving well-being in health, there must be a mentioned engagement in activities which are likely to enhance the same such as proper exercises and fitness methods. Health promotion takes quite a multidimensional structure, that is, intellectual, mental, physical and social and therefore a number of behaviours which are meant at promoting behaviours are identified by health professionals and other researchers. These behaviours include life appreciation, stress management, health responsibility, social support, exercise and better nutrition. Therefore a general conclusion is arrived at that physical activity and exercise have an impact on the quality of human life and can actually aid its improveme.
R E S E A R C H A R T I C L ERelationship Between Frequenc.docxcatheryncouper
This research article examined the relationship between frequency and intensity of physical activity and health behaviors in adolescents. Researchers analyzed survey data from over 800 high school students regarding their physical activity levels and health behaviors over the past 30 days. They found that adolescents who engaged in high levels of vigorous physical activity were less likely to use marijuana or engage in heavy marijuana use, consumed more healthy carbohydrates and fats, used stress management techniques more frequently, and reported better quality of sleep compared to those with low vigorous physical activity. Few differences were seen based on frequency of moderate physical activity. The findings suggest frequent vigorous physical activity in adolescents may reduce risky behaviors and promote healthy behaviors. More research is needed to better understand these relationships.
Is Trunk Posture in Walking a Better Marker than Gait Speed in Predicting Dec...Gautam Singh
This study aimed to identify early posture adaptations during walking that precede declines in gait speed among healthy older adults. The study found that a significant number of older adults demonstrated posture changes when walking, even those who maintained a normal walking speed. The extent of posture adaptation was greater in more vulnerable older adults. While gait speed is used to screen for frailty, the study suggests identifying trunk posture changes earlier may help plan preventive interventions for at-risk older adults before their gait speed declines.
American Journal of Multidisciplinary Research and Development is indexed, refereed and peer-reviewed journal, which is designed to publish research articles.
Evidence based physical activity for school age youthbeatriz9911
This document summarizes an expert panel's review of evidence on the effects of physical activity on health outcomes in school-age youth. The panel identified over 850 relevant articles through a systematic search. They found:
1) Most intervention studies showed benefits of 30-45 minutes per day of moderate to vigorous physical activity 3-5 days per week. However, the panel believed greater amounts would be needed for benefits under normal circumstances.
2) The panel concluded that school-age youth should participate in 60 minutes or more per day of moderate to vigorous physical activity from a variety of activities.
3) Physical activity was associated with reduced adiposity, especially for overweight youth, and improved cardiovascular health factors like blood lipid levels and aer
The document summarizes a randomized controlled trial that examined whether increasing subjective well-being through a 12-week positive psychology intervention could improve physical health in healthy adults. 155 community participants were randomly assigned to a treatment or wait-list control group. The treatment group received weekly positive psychology exercises aimed at increasing happiness. Results found that the treatment improved self-reported physical health measures like number of sick days over the previous month, compared to the control group. Improvements in subjective well-being from the treatment also predicted decreases in number of sick days over time, providing some evidence for a causal link between happiness and physical health.
Physical Activity Level Analyses and Chronic-Degenerative Disease Risks In Do...IJERDJOURNAL
Abstract:- It is of common belief that physical activity can restore damages caused to people's health due to the stressful everyday work routine. The energy expenditure on physical activities is directly related to the frequency, duration and intensity of human movements developed on many tasks. Thus, the main objective of this paper was to evaluate this energy consumption in public school teachers from the city of Horizonte, Ceara, discussing about degenerative chronic disease risks. 30 teachers, 9 men and 21 women within the age of 25 to 59 years old, were evaluated. Their Body Mass Index (BMI) was calculated in order to classify them as normal, overweight and obese. As an instrument, the long version of the International Physical Activity Questionnarie (IPAQ) was used, once it is more recommended to national prevalence studies due to the possibility of international comparison. This instrument contains several questions related to frequency (days per week) and duration (time per day) spent on moderate and vigorous physical activities and walking. The questionnarie also captures the energy expenditure in METs, in order to classify the selected individuals according to intensity: “sedentary” (< 1,5 METs), “low” (1,5 < METs < 3,0), “moderate” (3,9 < METs < 5,9) and “high” (≥ 6,0 METs). These analyses were performed using the Epi Info™ program, which used descriptive statistics. The results showed that the teachers present a good level of physical activity with 46,67% classified as high, 40% as moderate and 13,13% as low. The individuals also presented significant degree of overweight and obesity, 43% and 34% respectively, and only 23% within the acceptable weight range. Therefore, it could be concluded that, among the modifiable risk factors, the physical activity and the body mass control play important roles when it comes to chronic-degenerative disease prevention
1) This study examined the effects of an 8-week physical exercise program on happiness among 120 older adults in Iran.
2) Participants were randomly assigned to an experimental group that participated in the exercise program or a control group.
3) Results showed that the exercise program significantly improved happiness in the experimental group, while happiness did not improve in the control group.
Running head: PHYSICAL ACTIVITY AND SELF-EFFICACY 1
PHYSICAL ACTIVITY AND SELF-EFFICACY 2
The Relationship between Physical Activity and Self-Efficacy in Schools
Abstract
Few studies have examined the relationship between physical activities and health outcomes among adolescents. The majority of the adult population knows much about health-risk behaviours of adolescents, and knows less about their health-promoting behaviours. The purpose of the study was to determine the relationship between physical activity levels and self-efficacy among adolescents.
Introduction
According to Start Active, regular physical activity associates with benefits for physical and mental health (as cited in Roberts et al, 2015). Studies have indicated that health life traits and styles have an impact on lifelong health and life quality. Childhood poor diet and physical inactivity have been risk factors for a multitude of chronic health condition in adulthood (Matthews et al, 2015). According to the Centers for Disease Control and Prevention for children, only 42% of children and 8% of adolescents achieve current recommended physical activity.
Most students studying in Hoca Ahment Yesevi University were hound to have health issues emanating from lack of physical exercise and personal fitness programs (Ozkan, 2015). Up to 70 per cent of university students are reported as not participating in regular free-time physical activity or exercise (Haase et al, 2004, as cited in Roberts et al, 2014). Simon et al (2015) mentioned that majority of the adult population fails to achieve recommended daily exercise, 30-minutes moderate intensity exercise. When physical activity is conducted regularly as the researchers found out, it is likely to improve the physical fitness of the students and generally of people and therefore contributing heavily to better healthy life styles. Achieving daily exercise was shown to promote better sleep quality and higher psychological functioning in adolescents (Kalak et al, 2012, as cited in Rew et al, 2015).
Styles and activities that promote the health of humans increase their chances of wellbeing and therefore promote healthy living. In achieving well-being in health, there must be a mentioned engagement in activities which are likely to enhance the same such as proper exercises and fitness methods. Health promotion takes quite a multidimensional structure, that is, intellectual, mental, physical and social and therefore a number of behaviours which are meant at promoting behaviours are identified by health professionals and other researchers. These behaviours include life appreciation, stress management, health responsibility, social support, exercise and better nutrition. Therefore a general conclusion is arrived at that physical activity and exercise have an impact on the quality of human life and can actually aid its improveme.
R E S E A R C H A R T I C L ERelationship Between Frequenc.docxcatheryncouper
This research article examined the relationship between frequency and intensity of physical activity and health behaviors in adolescents. Researchers analyzed survey data from over 800 high school students regarding their physical activity levels and health behaviors over the past 30 days. They found that adolescents who engaged in high levels of vigorous physical activity were less likely to use marijuana or engage in heavy marijuana use, consumed more healthy carbohydrates and fats, used stress management techniques more frequently, and reported better quality of sleep compared to those with low vigorous physical activity. Few differences were seen based on frequency of moderate physical activity. The findings suggest frequent vigorous physical activity in adolescents may reduce risky behaviors and promote healthy behaviors. More research is needed to better understand these relationships.
Is Trunk Posture in Walking a Better Marker than Gait Speed in Predicting Dec...Gautam Singh
This study aimed to identify early posture adaptations during walking that precede declines in gait speed among healthy older adults. The study found that a significant number of older adults demonstrated posture changes when walking, even those who maintained a normal walking speed. The extent of posture adaptation was greater in more vulnerable older adults. While gait speed is used to screen for frailty, the study suggests identifying trunk posture changes earlier may help plan preventive interventions for at-risk older adults before their gait speed declines.
American Journal of Multidisciplinary Research and Development is indexed, refereed and peer-reviewed journal, which is designed to publish research articles.
Evidence based physical activity for school age youthbeatriz9911
This document summarizes an expert panel's review of evidence on the effects of physical activity on health outcomes in school-age youth. The panel identified over 850 relevant articles through a systematic search. They found:
1) Most intervention studies showed benefits of 30-45 minutes per day of moderate to vigorous physical activity 3-5 days per week. However, the panel believed greater amounts would be needed for benefits under normal circumstances.
2) The panel concluded that school-age youth should participate in 60 minutes or more per day of moderate to vigorous physical activity from a variety of activities.
3) Physical activity was associated with reduced adiposity, especially for overweight youth, and improved cardiovascular health factors like blood lipid levels and aer
The document summarizes a randomized controlled trial that examined whether increasing subjective well-being through a 12-week positive psychology intervention could improve physical health in healthy adults. 155 community participants were randomly assigned to a treatment or wait-list control group. The treatment group received weekly positive psychology exercises aimed at increasing happiness. Results found that the treatment improved self-reported physical health measures like number of sick days over the previous month, compared to the control group. Improvements in subjective well-being from the treatment also predicted decreases in number of sick days over time, providing some evidence for a causal link between happiness and physical health.
Full paper physical actvity ,mental health and quality of life of athletesalonzo mortejo
This study examined the physical activity, mental health, and quality of life of 176 university student athletes in the Philippines amidst the COVID-19 pandemic. Quantitative data was collected using questionnaires on physical activity, quality of life, and mental health. Qualitative data from interviews identified key coping strategies used by athletes, including maintaining a positive mindset, family support, prayer, and staying productive. The findings provide insight into how the pandemic has impacted athletes and will help inform policies to support their needs during this difficult time.
AbstractThis informative report focuses on filling information.docxbartholomeocoombs
Abstract
This informative report focuses on filling information gaps regarding adherence to physical activity and exercise in the health care spectrum of older adults and an overview of the benefits of physical activity for OAs. Healthy People 2000, 2010, and 2020 are public health programs from the US Department of Health and Human Services that set national goals and objectives for promoting health and preventing disease. The programs include ten leading health indicators that reflect major health problems, which concern OAs. Exercise and physical activity are among the most important factors affecting health and longevity, but exercise adherence is a significant hindrance in achieving health goals in the elderly. Exercise adherence in OAs is a multifactorial problem encompassing many bio-psychosocial factors. Factors affecting adherence in the elderly include socioeconomic status, education level, living arrangements, health status, pacemakers, physical fitness, and depression. Improving adherence could have a significant impact on longevity, quality of life, and health care costs.
Keywords: Geriatric Medicine, Health Care, Health Professionals, Exercise Adherence
Introduction
Geriatric health care delivery is a major public health issue. Geriatrics refers to diagnosing and treating older adults (OA) with complex medical conditions and social problems. A recent report from the World Health Organization (WHO) stated, “OA are generally defined according to a range of characteristics including chronological age, change in social role and changes in functional capabilities. In high-resourced countries older age is generally defined in relation to retirement from paid employment and receipt of a pension, at 60 or 65 years. With increasing longevity some countries define a separate group of oldest people, those over 85 years. In low-resourced countries with shorter life-spans, older people may be defined as those over 50 years” (World Health Organization, 2010a). OA are the largest and fastest growing segment of the population, which present significant challenges to the health care system. Understanding the factors contributing to the health practices of OA is important for professionals, paraprofessionals, and paid and unpaid caregivers who need basic and continuing geriatric education to improve care. Adherence to physical activity and exercise programs is a critical but poorly understood area for promoting health and longevity.
The terms physical activity and exercise are often used interchangeably, but they are different. Physical activity involves movement produced by skeletal muscles that require energy from metabolism. It is grouped as occupational, sports, conditioning, household, or other activities. Exercise is a subset of physical activity that is planned, structured, and repetitive. It promotes health, fitness, and skill and the results of the program can be measured with specific tests (Caspersen, Powell, & Christenson, 1985; F.
This capsule commentary summarizes the cohort study carried out by Zhang et al. in Oshaki, Japan in 2006. The paper attempted to determine whether healthy lifestyle behaviors could increase disability-free survival in the elderly.
ORIGINALARTICLESEVIDENCE BASED PHYSICAL ACTIVITY FOR SCH.docxalfred4lewis58146
ORIGINAL
ARTICLES
EVIDENCE BASED PHYSICAL ACTIVITY FOR SCHOOL-AGE YOUTH
WILLIAM B. STRONG, MD,* ROBERT M. MALINA, PHD,* CAMERON J. R. BLIMKIE, PHD, STEPHEN R. DANIELS, MD, PHD,
RODNEY K. DISHMAN, PHD, BERNARD GUTIN, PHD, ALBERT C. HERGENROEDER, MD, AVIVA MUST, PHD, PATRICIA A. NIXON, PHD,
JAMES M. PIVARNIK, PHD, THOMAS ROWLAND, MD, STEWART TROST, PHD, AND FRANCxOIS TRUDEAU, PHD
Objectives To review the effects of physical activity on health and behavior outcomes and develop evidence-based
recommendations for physical activity in youth.
Study design A systematic literature review identified 850 articles; additional papers were identified by the expert
panelists. Articles in the identified outcome areas were reviewed, evaluated and summarized by an expert panelist. The strength
of the evidence, conclusions, key issues, and gaps in the evidence were abstracted in a standardized format and presented and
discussed by panelists and organizational representatives.
Results Most intervention studies used supervised programs of moderate to vigorous physical activity of 30 to 45 minutes
duration 3 to 5 days per week. The panel believed that a greater amount of physical activity would be necessary to achieve similar
beneficial effects on health and behavioral outcomes in ordinary daily circumstances (typically intermittent and unsupervised
activity).
Conclusion School-age youth should participate daily in 60 minutes or more of moderate to vigorous physical activity that
is developmentally appropriate, enjoyable, and involves a variety of activities. (J Pediatr 2005;146:732-7)
R
ecommendations for appropriate amounts of physical activity for the US
population, including school-age youth, have been developed by several
organizations and agencies.1 Although recent reviews have summarized the
benefits of regular physical activity on the health of youth and its potential for reducing the
incidence of chronic diseases that are manifested in adulthood,
2-5
a more systematic
approach is indicated. This report presents results of a systematic evaluation of evidence
dealing with the effects of regular physical activity on several health and behavioral
outcomes in US school-age youth, with the goal of developing a recommendation for the
amount of physical activity deemed appropriate to yield beneficial health and behavioral
outcomes.
METHOD
Under a contract with the Divisions of Nutrition and Physical Activity and
Adolescent and School Health of the Centers for Disease Control and Prevention and the
Constella Group, an expert panel was convened to review and evaluate available evidence
on the influence of physical activity on several health and behavioral outcomes in youth
aged 6 to 18 years. The co-chairs of the panel selected panelists on the basis of expertise in
specific areas: adiposity, cardiovascular health (lipids and lipoproteins, blood pressure, the
metabolic syndrome, type 2 diabetes mellitus, cardiovascular reactivity, heart rate
variab.
This study examined clustering patterns and correlates of multiple health behaviors in middle-aged Koreans with metabolic syndrome. 331 individuals with metabolic syndrome completed surveys about sociodemographics, health behaviors, and psychological characteristics. The results showed that men were more likely than women to engage in multiple unhealthy behaviors like smoking and heavy drinking. Certain combinations of health behaviors like smoking and heavy drinking clustered together. Those with lower self-regulation were more likely to engage in unhealthy behaviors. The findings support examining multiple health behaviors together rather than individually to develop effective interventions for metabolic syndrome.
The study surveyed 198 Greek students aged 15-17 years on their physical activity levels using the stages of change model. The majority (63%) were physically active in stages 4 or 5, with 53% in stage 5 having maintained an active lifestyle for over 6 months. Boys showed higher activity levels than girls at 75% versus 54%. Younger students (1st grade) had higher activity levels than older students (78% versus 50% for 3rd grade). Thus, inactivity seemed more pronounced among girls and older students. The researchers concluded that physical activity programs and services should emphasize girls and older students more prone to inactivity.
The good life --assessing the relative importance of physical, psychological,...Younis I Munshi
The study examined the interrelationships between physical dysfunction, self-efficacy, psychological distress, exercise, and quality of well-being in osteoarthritis patients. It found that exercise was directly related to physical functioning but not related to self-efficacy, psychological distress, or quality of well-being. Self-efficacy and psychological distress were significantly related to quality of well-being, suggesting that treatments focusing on these may be most effective for improving well-being in osteoarthritis patients.
This study investigated the prevalence of urinary incontinence (UI) among female group fitness instructors, including yoga and Pilates teachers, in Norway. The key findings were:
1) 26.3% of the 685 female instructors reported experiencing UI, with most reporting stress UI that occurred during physical activity or exercise.
2) Yoga and Pilates instructors had a similar prevalence of UI to other fitness instructors, with 25.9% reporting UI.
3) Older instructors and those with longer teaching careers had a significantly higher prevalence of UI, while use of oral contraceptives was protective against UI.
1ANNOTATED BIBLIOGRAPHY FOR SEDENTARY LIFESTYLESTHESE ARE.docxhyacinthshackley2629
1
ANNOTATED BIBLIOGRAPHY FOR SEDENTARY LIFESTYLES
THESE ARE THE INSTRUCTORS REMARKS AFTER GRADING AND GIVING ME A ZERO/100. PLEASE CORRECT THIS DOCUMENT FOR ME. THANKS.
I HAVE ALSO ATTACHED A Turnitin Report in pdf format.
Hi, Jude. Your Turnitin report showed that 74% of your draft matches sources that were not cited properly. Please review the plagiarism tutorial in the syllabus, and review the APA materials on how to cite sources. Paraphrase your sources whenever possible; this shows you understand the material and can restate it in your own words. This also enables you to claim ownership of the language while still giving credit for the ideas. When you use source material verbatim, make sure to place it in quotation marks. Avoid copying and pasting large chunks of text. Even if you include proper citations, your essay will lack originality. Please review the attached Turnitin report so you can see which sections need attention. I will review your draft and update your score once you've rewritten it in your own words and cited sources properly. Please note the late policy in the syllabus. Let me know if you have any questions. Thanks.
Annotated Bibliography for Sedentary Lifestyles
Jude Kum
DeVry University
Sedentary lifestyle is predominant in our everyday life be it in workplace, school, social or homes and the fact is we have got accustomed to sitting down and doing many things forgetting the impact this is causing to our health. People fail to realize how valuable exercise is in their life and especially in improving their health and well-being. Sitting down on the computer with all focused attention and forgetting that we need to get up and even eat cause problems to many people.
Guedes, N.G., Lopes, M.V., Leite de Araujo, T. Moreira, R.P. and Martins, L.C. G. (2010). Predictive Factors of the Nursing Diagnosis Sedentary Lifestyle in People with High Blood Pressure. Public Health Nursing. Vol. 28 No. 2, p. 193-200. Wiley Periodicals, Inc.
The research question for the study conducted by Guesdes, et al (2010) is based on the following: 1.what is the result of the defining characteristics and related factors of sedentary lifestyle diagnosis in patients with high blood pressure? 2. What are the predictive value and possible predictors of the nursing diagnosis sedentary lifestyle in patients with high blood pressure? The study looked at the validation of diagnostic groupings of the population being studied including aspects of their clinical situations. The study looked at diagnosis resulting from insufficient physical activity, intolerance of activity, fatigue, impaired physical mobility, self-care deficit.
My assessment: Using this article, I will bring out the important indicators and useful predictors for identification of sedentary lifestyle; demonstrated the benefits of physical fitness, verbalized preferences for activities that are to accomplish real training or exercises. I will point out appr.
draft adult participation in excercise-3Oliver Oxby
This study examined barriers and motivations for exercise participation among adults in South Bradford. Questionnaires were given to two groups - a weight maintenance group and weight loss group. Barriers identified included lack of time, cost, lack of confidence in joining a gym, and associating exercise with boredom. The weight maintenance group exercised more minutes per week than the weight loss group, but the weight loss group exercised more times per week. Limitations included a small sample size focused only on clients of one company.
AN OVERVIEW OF PHYSICAL ACTIVITY AND HEALTH LITERACY IN ADULT POPULATION WITH...IAEME Publication
This document discusses a study on physical activity and health literacy among adults in Kanyakumari District, India. The study aims to measure satisfaction and health awareness among adults due to the impact of physical activity and health literacy. It involved collecting primary data through questionnaires from 200 respondents. The results showed that most adults maintain lifestyle changes and understand the causes of health conditions. In terms of physical activity, most preferred morning walks or outdoor games. Regarding health literacy, many gained knowledge from media or read about disease prevention. The study found physical activity helped adults access correct health information and choose foods without preservatives.
This study investigated the determinants of physical activity in ovarian cancer survivors through a survey of 359 survivors in Alberta, Canada. 31.1% of survivors met physical activity guidelines. Younger age, higher education/income, employment, lower BMI, longer time since diagnosis, earlier disease stage and being disease-free were associated with meeting guidelines. Intention was the strongest correlate of physical activity and was influenced by attitude and perceived behavioral control. Improving health and weight control were key motivators for activity, while lack of time and motivation were barriers.
Crimson Publishers-Functionality and Attitudes in Relation to Aging of Elderl...CrimsonPublishersGGS
Functionality and Attitudes in Relation to Aging of Elderly Women Practicing Physical Exercises by Daniel Vicentini de Oliveira in Gerontology & Geriatrics studies
The objective was to verify the attitudes regarding old age and the functional capacity of elderly women practicing physical exercises. This is a cross-sectional study, realized with 200 women. The Functional Protocol of the Latin American Development Group for Maturity (GDLAM) and the Scale for Assessment of Attitudes in Relation to Old Age was used. There was a significant correlation only in the stand up from sitting position test, with the domains of expectations regarding activity (r=-0.31), satisfaction with life (r=0.38) and death anxiety (r=-0.27). It can be concluded that there is correlation between some domains of the functional capacity test and the attitudes towards old age.
Does physical-activity-and-sport-practice-lead-to-a-healthier-lifestyle-and-e...Annex Publishers
The prevalence of childhood obesity has been increasing rapidly and there is general consensus that good nutritional practices and physical activity should be encouraged as early as possible in life. The aim of this study was to describe and to compare the current lifestyle and dietary pattern of normal weight (NW) and overweight + obese (OW+OB) male adolescents who are physically active.
Methods: This observational and retrospective study was based on clinical records analysis of male adolescents aged 11-18 years who had undergone a medical evaluation at a Medical Sport Centre (Pavia, Italy) during 2009, and had filled in a self-administered life style questionnaire.
Results: The results showed that out of 1423 clinical records 23.0% of subjects were OW, 5.4% OB and 71.6% NW. We invited all the overweight and obese subjects to participate in the study, 308 of them (75.8%) agreed. Then we randomly enrolled an equivalent number of NW participants (n=308) in the medical evaluation at the sports center with similar characteristics as for socio-economic status, physical activity and age for a whole sample of 616 subjects. We handled them a validated lifestyle questionnaire. The questionnaire analysis was used to compare OW+OB and NW participants, as far as eating habits, sedentary activities and time spent in sports. All the subjects frequently skipped breakfast, did not consume fruit and vegetables daily and had a high soft drinks intake. Inverse correlations were found between weight and physical activity (p=0.01). Sedentary activities were preferred by about 25% and 66 % of the NW and OW+OB groups respectively. The percentage of smokers was similar within the two groups (14%).
Conclusions: Adolescents eating habits are incorrect, despite BMI and sports practice. Sports practice seems contributing to lower spare time physical inactivity, but does not improve eating habits. Public health interventions should focus on the reinforcement of leisure time physical activity, besides nutrition education and behavioral education programs in order to prevent obesity in the adulthood.
The document summarizes the key topics from a 2013 convention on the integration of health. It discusses: 1) cardiovascular disease as a top global killer, focusing on heart and brain; 2) risk factors like lifestyle and aging that contribute to CVD; and 3) approaches to prevention through science, health education, and promoting healthy communities. The goal is to integrate knowledge on CVD causes and solutions to improve population health outcomes.
A Practical Measure of Balance, Gait, and Muscular Power in Older Adults: The...Kyle Menkosky
This document describes the Short Physical Performance Battery (SPPB), which is a validated test used to assess physical function in older adults. The SPPB examines balance, gait, and lower body strength through tests of standing balance, walking speed, and repeated chair stands. It provides an overall score of 0-12 based on performance in each test. Studies have shown SPPB scores predict disability, nursing home admission, and mortality in older adults. The document argues the SPPB is a practical test that can be used in cardiac and pulmonary rehabilitation to safely identify frailty and guide exercise interventions to improve outcomes in older patients.
A Master’s Thesis for OTH-670- Research Seminar IIJulia Christian
This document appears to be a thesis submitted by two occupational therapy students to fulfill requirements for a master's degree. It includes an abstract that summarizes a study on the effects of physical activity on adolescent well-being. The thesis contains sections on literature review, methods, results, and discussion. The literature review explores trends in adolescent physical activity, definitions of wellness, the impact of physical activity on different aspects of wellness, and environmental factors related to physical activity. The purpose is to examine the association between physical activity and adolescent wellness. The methods section describes the mixed methods study design, including surveys distributed to high school students to collect data on physical activity and wellness. The results and discussion sections analyze and interpret the findings of
- The study systematically reviewed physical activity interventions for adolescent cancer patients and survivors. Four controlled trials involving physical activity during or after cancer treatment were identified.
- The limited evidence available suggests physical activity is safe for adolescent cancer patients, but more high-quality studies are needed to determine effectiveness on health outcomes due to few existing studies.
- Future research should investigate optimal timing, settings, durations and intensities of physical activity interventions as well as potential moderating factors like age, gender and cancer type.
Research process | Meta-analysis research | Systematic review and meta-analysisPubrica
Pubrica’s research and writing teams provide scientific and medical research papers that authors and practitioners may find useful. Pubrica medical writers assist you in creating and rewriting the introduction by informing the reader about the constraints of the selected study subject. Our experts understand the sequence in which the confined subject, problem, and backdrop are followed by the targeted location in which the hypothesis is presented.
Read more @ https://pubrica.com/academy/meta-analysis/critical-review-of-meta-analysis-conducted-in-this-paper/
Visit us @ https://pubrica.com/services/research-services/systematic-review/
…if one of the primary purposes of education is to teach young .docxanhlodge
“…if one of the primary purposes of education is to teach young people the skills, knowledge, and critical awareness to become productive members of a diverse and democratic society, a broadly conceptualize multicultural education can have a decisive influence.” Textbook page 338.
What steps do you think schools can or should take to promote our democracy in today’s very diverse country?
Food festivals and celebrating a cultural holiday will not be accepted as an answer. Those are examples of tokenism to make the dominant culture feel like they are doing something. These two activities are fun and interesting, but not how we will strengthen our democracy.
.
✍Report OverviewIn this assignment, you will Document an.docxanhlodge
✍
Report Overview
In this assignment, you will
Document and reflect on your university education and on learning experiences outside of the university;
Articulate how your upper-level coursework is an integrated and individualized curriculum built around your interests; and
Highlight the experiences, skills, and projects that show what you can do.
A successful report submission will be the product of many hours of work over several weeks.
A report earning maximum available points will be a carefully curated and edited explanation of your work that provides tangible evidence of—and insights into—your competencies and capabilities over time. In each section of this report, you are (1) telling a story about your own abilities, and (2) providing specific examples and evidence that illustrate and support your claims.
✍
Required Report Sections
Here the sections are listed as they must appear in your final graded submission. You’ll arrange the sections in this order when
submitting
the final report BUT you won’t follow this order when
writing
drafts of each section.
Note that each section description contains a Pro Tip that tells you how to proceed with the work – what to attempt first, second, and third, etc.
❖ I. Statement of Purpose ❖
Step 1.
Read these four very different
examples of successful Statement of Purpose sections
.
Step 2.
Consider the differences in tone, style, level of detail etc. Your own statement of purpose may resemble one of these. Indeed, writing a first draft based on an example or combination of examples is a good idea. BUT don’t let these examples limit your thinking or personal expression. You may want to begin with a quote from a famous person, use a quote from your mom, or skip the quote. You may want to discuss your personal motivations or get right down to the facts. You may want to list your classes or discuss how your work-life led you to this path.
Step 3.
Write a rough draft – let’s call that Statement of Purpose 1.0. Write Statement of Purpose 1.0 as quickly as you can and then put it away until after you have completed most of the report. Forget about Statement of Purpose 1.0 until most of your report is at least in draft form.
Step 4.
Once you have a draft of all sections of your report, you are in a good position to revise Statement of Purpose 1. You are ready for Step 4. Take Statement of Purpose 1.0 out its dusty vault and hold it up to the sun. Ah. Now read your report draft and compare it to the claims you made in Statement of Purpose 1.0. Ask yourself these questions:
Does Statement of Purpose 1.0. accurately introduce my report?
Are there important ideas or representative experiences in the report that should be highlighted in the Statement of Purpose but aren’t? Remember this isn’t a treasure hunt where its your reader’s job to figure out what matters. It’s your job to show the reader what matters.
If Statement of Purpose 1.0. isn’t the best map it can be for th.
More Related Content
Similar to Scanned by CamScannerScanned by CamScannerRE.docx
Full paper physical actvity ,mental health and quality of life of athletesalonzo mortejo
This study examined the physical activity, mental health, and quality of life of 176 university student athletes in the Philippines amidst the COVID-19 pandemic. Quantitative data was collected using questionnaires on physical activity, quality of life, and mental health. Qualitative data from interviews identified key coping strategies used by athletes, including maintaining a positive mindset, family support, prayer, and staying productive. The findings provide insight into how the pandemic has impacted athletes and will help inform policies to support their needs during this difficult time.
AbstractThis informative report focuses on filling information.docxbartholomeocoombs
Abstract
This informative report focuses on filling information gaps regarding adherence to physical activity and exercise in the health care spectrum of older adults and an overview of the benefits of physical activity for OAs. Healthy People 2000, 2010, and 2020 are public health programs from the US Department of Health and Human Services that set national goals and objectives for promoting health and preventing disease. The programs include ten leading health indicators that reflect major health problems, which concern OAs. Exercise and physical activity are among the most important factors affecting health and longevity, but exercise adherence is a significant hindrance in achieving health goals in the elderly. Exercise adherence in OAs is a multifactorial problem encompassing many bio-psychosocial factors. Factors affecting adherence in the elderly include socioeconomic status, education level, living arrangements, health status, pacemakers, physical fitness, and depression. Improving adherence could have a significant impact on longevity, quality of life, and health care costs.
Keywords: Geriatric Medicine, Health Care, Health Professionals, Exercise Adherence
Introduction
Geriatric health care delivery is a major public health issue. Geriatrics refers to diagnosing and treating older adults (OA) with complex medical conditions and social problems. A recent report from the World Health Organization (WHO) stated, “OA are generally defined according to a range of characteristics including chronological age, change in social role and changes in functional capabilities. In high-resourced countries older age is generally defined in relation to retirement from paid employment and receipt of a pension, at 60 or 65 years. With increasing longevity some countries define a separate group of oldest people, those over 85 years. In low-resourced countries with shorter life-spans, older people may be defined as those over 50 years” (World Health Organization, 2010a). OA are the largest and fastest growing segment of the population, which present significant challenges to the health care system. Understanding the factors contributing to the health practices of OA is important for professionals, paraprofessionals, and paid and unpaid caregivers who need basic and continuing geriatric education to improve care. Adherence to physical activity and exercise programs is a critical but poorly understood area for promoting health and longevity.
The terms physical activity and exercise are often used interchangeably, but they are different. Physical activity involves movement produced by skeletal muscles that require energy from metabolism. It is grouped as occupational, sports, conditioning, household, or other activities. Exercise is a subset of physical activity that is planned, structured, and repetitive. It promotes health, fitness, and skill and the results of the program can be measured with specific tests (Caspersen, Powell, & Christenson, 1985; F.
This capsule commentary summarizes the cohort study carried out by Zhang et al. in Oshaki, Japan in 2006. The paper attempted to determine whether healthy lifestyle behaviors could increase disability-free survival in the elderly.
ORIGINALARTICLESEVIDENCE BASED PHYSICAL ACTIVITY FOR SCH.docxalfred4lewis58146
ORIGINAL
ARTICLES
EVIDENCE BASED PHYSICAL ACTIVITY FOR SCHOOL-AGE YOUTH
WILLIAM B. STRONG, MD,* ROBERT M. MALINA, PHD,* CAMERON J. R. BLIMKIE, PHD, STEPHEN R. DANIELS, MD, PHD,
RODNEY K. DISHMAN, PHD, BERNARD GUTIN, PHD, ALBERT C. HERGENROEDER, MD, AVIVA MUST, PHD, PATRICIA A. NIXON, PHD,
JAMES M. PIVARNIK, PHD, THOMAS ROWLAND, MD, STEWART TROST, PHD, AND FRANCxOIS TRUDEAU, PHD
Objectives To review the effects of physical activity on health and behavior outcomes and develop evidence-based
recommendations for physical activity in youth.
Study design A systematic literature review identified 850 articles; additional papers were identified by the expert
panelists. Articles in the identified outcome areas were reviewed, evaluated and summarized by an expert panelist. The strength
of the evidence, conclusions, key issues, and gaps in the evidence were abstracted in a standardized format and presented and
discussed by panelists and organizational representatives.
Results Most intervention studies used supervised programs of moderate to vigorous physical activity of 30 to 45 minutes
duration 3 to 5 days per week. The panel believed that a greater amount of physical activity would be necessary to achieve similar
beneficial effects on health and behavioral outcomes in ordinary daily circumstances (typically intermittent and unsupervised
activity).
Conclusion School-age youth should participate daily in 60 minutes or more of moderate to vigorous physical activity that
is developmentally appropriate, enjoyable, and involves a variety of activities. (J Pediatr 2005;146:732-7)
R
ecommendations for appropriate amounts of physical activity for the US
population, including school-age youth, have been developed by several
organizations and agencies.1 Although recent reviews have summarized the
benefits of regular physical activity on the health of youth and its potential for reducing the
incidence of chronic diseases that are manifested in adulthood,
2-5
a more systematic
approach is indicated. This report presents results of a systematic evaluation of evidence
dealing with the effects of regular physical activity on several health and behavioral
outcomes in US school-age youth, with the goal of developing a recommendation for the
amount of physical activity deemed appropriate to yield beneficial health and behavioral
outcomes.
METHOD
Under a contract with the Divisions of Nutrition and Physical Activity and
Adolescent and School Health of the Centers for Disease Control and Prevention and the
Constella Group, an expert panel was convened to review and evaluate available evidence
on the influence of physical activity on several health and behavioral outcomes in youth
aged 6 to 18 years. The co-chairs of the panel selected panelists on the basis of expertise in
specific areas: adiposity, cardiovascular health (lipids and lipoproteins, blood pressure, the
metabolic syndrome, type 2 diabetes mellitus, cardiovascular reactivity, heart rate
variab.
This study examined clustering patterns and correlates of multiple health behaviors in middle-aged Koreans with metabolic syndrome. 331 individuals with metabolic syndrome completed surveys about sociodemographics, health behaviors, and psychological characteristics. The results showed that men were more likely than women to engage in multiple unhealthy behaviors like smoking and heavy drinking. Certain combinations of health behaviors like smoking and heavy drinking clustered together. Those with lower self-regulation were more likely to engage in unhealthy behaviors. The findings support examining multiple health behaviors together rather than individually to develop effective interventions for metabolic syndrome.
The study surveyed 198 Greek students aged 15-17 years on their physical activity levels using the stages of change model. The majority (63%) were physically active in stages 4 or 5, with 53% in stage 5 having maintained an active lifestyle for over 6 months. Boys showed higher activity levels than girls at 75% versus 54%. Younger students (1st grade) had higher activity levels than older students (78% versus 50% for 3rd grade). Thus, inactivity seemed more pronounced among girls and older students. The researchers concluded that physical activity programs and services should emphasize girls and older students more prone to inactivity.
The good life --assessing the relative importance of physical, psychological,...Younis I Munshi
The study examined the interrelationships between physical dysfunction, self-efficacy, psychological distress, exercise, and quality of well-being in osteoarthritis patients. It found that exercise was directly related to physical functioning but not related to self-efficacy, psychological distress, or quality of well-being. Self-efficacy and psychological distress were significantly related to quality of well-being, suggesting that treatments focusing on these may be most effective for improving well-being in osteoarthritis patients.
This study investigated the prevalence of urinary incontinence (UI) among female group fitness instructors, including yoga and Pilates teachers, in Norway. The key findings were:
1) 26.3% of the 685 female instructors reported experiencing UI, with most reporting stress UI that occurred during physical activity or exercise.
2) Yoga and Pilates instructors had a similar prevalence of UI to other fitness instructors, with 25.9% reporting UI.
3) Older instructors and those with longer teaching careers had a significantly higher prevalence of UI, while use of oral contraceptives was protective against UI.
1ANNOTATED BIBLIOGRAPHY FOR SEDENTARY LIFESTYLESTHESE ARE.docxhyacinthshackley2629
1
ANNOTATED BIBLIOGRAPHY FOR SEDENTARY LIFESTYLES
THESE ARE THE INSTRUCTORS REMARKS AFTER GRADING AND GIVING ME A ZERO/100. PLEASE CORRECT THIS DOCUMENT FOR ME. THANKS.
I HAVE ALSO ATTACHED A Turnitin Report in pdf format.
Hi, Jude. Your Turnitin report showed that 74% of your draft matches sources that were not cited properly. Please review the plagiarism tutorial in the syllabus, and review the APA materials on how to cite sources. Paraphrase your sources whenever possible; this shows you understand the material and can restate it in your own words. This also enables you to claim ownership of the language while still giving credit for the ideas. When you use source material verbatim, make sure to place it in quotation marks. Avoid copying and pasting large chunks of text. Even if you include proper citations, your essay will lack originality. Please review the attached Turnitin report so you can see which sections need attention. I will review your draft and update your score once you've rewritten it in your own words and cited sources properly. Please note the late policy in the syllabus. Let me know if you have any questions. Thanks.
Annotated Bibliography for Sedentary Lifestyles
Jude Kum
DeVry University
Sedentary lifestyle is predominant in our everyday life be it in workplace, school, social or homes and the fact is we have got accustomed to sitting down and doing many things forgetting the impact this is causing to our health. People fail to realize how valuable exercise is in their life and especially in improving their health and well-being. Sitting down on the computer with all focused attention and forgetting that we need to get up and even eat cause problems to many people.
Guedes, N.G., Lopes, M.V., Leite de Araujo, T. Moreira, R.P. and Martins, L.C. G. (2010). Predictive Factors of the Nursing Diagnosis Sedentary Lifestyle in People with High Blood Pressure. Public Health Nursing. Vol. 28 No. 2, p. 193-200. Wiley Periodicals, Inc.
The research question for the study conducted by Guesdes, et al (2010) is based on the following: 1.what is the result of the defining characteristics and related factors of sedentary lifestyle diagnosis in patients with high blood pressure? 2. What are the predictive value and possible predictors of the nursing diagnosis sedentary lifestyle in patients with high blood pressure? The study looked at the validation of diagnostic groupings of the population being studied including aspects of their clinical situations. The study looked at diagnosis resulting from insufficient physical activity, intolerance of activity, fatigue, impaired physical mobility, self-care deficit.
My assessment: Using this article, I will bring out the important indicators and useful predictors for identification of sedentary lifestyle; demonstrated the benefits of physical fitness, verbalized preferences for activities that are to accomplish real training or exercises. I will point out appr.
draft adult participation in excercise-3Oliver Oxby
This study examined barriers and motivations for exercise participation among adults in South Bradford. Questionnaires were given to two groups - a weight maintenance group and weight loss group. Barriers identified included lack of time, cost, lack of confidence in joining a gym, and associating exercise with boredom. The weight maintenance group exercised more minutes per week than the weight loss group, but the weight loss group exercised more times per week. Limitations included a small sample size focused only on clients of one company.
AN OVERVIEW OF PHYSICAL ACTIVITY AND HEALTH LITERACY IN ADULT POPULATION WITH...IAEME Publication
This document discusses a study on physical activity and health literacy among adults in Kanyakumari District, India. The study aims to measure satisfaction and health awareness among adults due to the impact of physical activity and health literacy. It involved collecting primary data through questionnaires from 200 respondents. The results showed that most adults maintain lifestyle changes and understand the causes of health conditions. In terms of physical activity, most preferred morning walks or outdoor games. Regarding health literacy, many gained knowledge from media or read about disease prevention. The study found physical activity helped adults access correct health information and choose foods without preservatives.
This study investigated the determinants of physical activity in ovarian cancer survivors through a survey of 359 survivors in Alberta, Canada. 31.1% of survivors met physical activity guidelines. Younger age, higher education/income, employment, lower BMI, longer time since diagnosis, earlier disease stage and being disease-free were associated with meeting guidelines. Intention was the strongest correlate of physical activity and was influenced by attitude and perceived behavioral control. Improving health and weight control were key motivators for activity, while lack of time and motivation were barriers.
Crimson Publishers-Functionality and Attitudes in Relation to Aging of Elderl...CrimsonPublishersGGS
Functionality and Attitudes in Relation to Aging of Elderly Women Practicing Physical Exercises by Daniel Vicentini de Oliveira in Gerontology & Geriatrics studies
The objective was to verify the attitudes regarding old age and the functional capacity of elderly women practicing physical exercises. This is a cross-sectional study, realized with 200 women. The Functional Protocol of the Latin American Development Group for Maturity (GDLAM) and the Scale for Assessment of Attitudes in Relation to Old Age was used. There was a significant correlation only in the stand up from sitting position test, with the domains of expectations regarding activity (r=-0.31), satisfaction with life (r=0.38) and death anxiety (r=-0.27). It can be concluded that there is correlation between some domains of the functional capacity test and the attitudes towards old age.
Does physical-activity-and-sport-practice-lead-to-a-healthier-lifestyle-and-e...Annex Publishers
The prevalence of childhood obesity has been increasing rapidly and there is general consensus that good nutritional practices and physical activity should be encouraged as early as possible in life. The aim of this study was to describe and to compare the current lifestyle and dietary pattern of normal weight (NW) and overweight + obese (OW+OB) male adolescents who are physically active.
Methods: This observational and retrospective study was based on clinical records analysis of male adolescents aged 11-18 years who had undergone a medical evaluation at a Medical Sport Centre (Pavia, Italy) during 2009, and had filled in a self-administered life style questionnaire.
Results: The results showed that out of 1423 clinical records 23.0% of subjects were OW, 5.4% OB and 71.6% NW. We invited all the overweight and obese subjects to participate in the study, 308 of them (75.8%) agreed. Then we randomly enrolled an equivalent number of NW participants (n=308) in the medical evaluation at the sports center with similar characteristics as for socio-economic status, physical activity and age for a whole sample of 616 subjects. We handled them a validated lifestyle questionnaire. The questionnaire analysis was used to compare OW+OB and NW participants, as far as eating habits, sedentary activities and time spent in sports. All the subjects frequently skipped breakfast, did not consume fruit and vegetables daily and had a high soft drinks intake. Inverse correlations were found between weight and physical activity (p=0.01). Sedentary activities were preferred by about 25% and 66 % of the NW and OW+OB groups respectively. The percentage of smokers was similar within the two groups (14%).
Conclusions: Adolescents eating habits are incorrect, despite BMI and sports practice. Sports practice seems contributing to lower spare time physical inactivity, but does not improve eating habits. Public health interventions should focus on the reinforcement of leisure time physical activity, besides nutrition education and behavioral education programs in order to prevent obesity in the adulthood.
The document summarizes the key topics from a 2013 convention on the integration of health. It discusses: 1) cardiovascular disease as a top global killer, focusing on heart and brain; 2) risk factors like lifestyle and aging that contribute to CVD; and 3) approaches to prevention through science, health education, and promoting healthy communities. The goal is to integrate knowledge on CVD causes and solutions to improve population health outcomes.
A Practical Measure of Balance, Gait, and Muscular Power in Older Adults: The...Kyle Menkosky
This document describes the Short Physical Performance Battery (SPPB), which is a validated test used to assess physical function in older adults. The SPPB examines balance, gait, and lower body strength through tests of standing balance, walking speed, and repeated chair stands. It provides an overall score of 0-12 based on performance in each test. Studies have shown SPPB scores predict disability, nursing home admission, and mortality in older adults. The document argues the SPPB is a practical test that can be used in cardiac and pulmonary rehabilitation to safely identify frailty and guide exercise interventions to improve outcomes in older patients.
A Master’s Thesis for OTH-670- Research Seminar IIJulia Christian
This document appears to be a thesis submitted by two occupational therapy students to fulfill requirements for a master's degree. It includes an abstract that summarizes a study on the effects of physical activity on adolescent well-being. The thesis contains sections on literature review, methods, results, and discussion. The literature review explores trends in adolescent physical activity, definitions of wellness, the impact of physical activity on different aspects of wellness, and environmental factors related to physical activity. The purpose is to examine the association between physical activity and adolescent wellness. The methods section describes the mixed methods study design, including surveys distributed to high school students to collect data on physical activity and wellness. The results and discussion sections analyze and interpret the findings of
- The study systematically reviewed physical activity interventions for adolescent cancer patients and survivors. Four controlled trials involving physical activity during or after cancer treatment were identified.
- The limited evidence available suggests physical activity is safe for adolescent cancer patients, but more high-quality studies are needed to determine effectiveness on health outcomes due to few existing studies.
- Future research should investigate optimal timing, settings, durations and intensities of physical activity interventions as well as potential moderating factors like age, gender and cancer type.
Research process | Meta-analysis research | Systematic review and meta-analysisPubrica
Pubrica’s research and writing teams provide scientific and medical research papers that authors and practitioners may find useful. Pubrica medical writers assist you in creating and rewriting the introduction by informing the reader about the constraints of the selected study subject. Our experts understand the sequence in which the confined subject, problem, and backdrop are followed by the targeted location in which the hypothesis is presented.
Read more @ https://pubrica.com/academy/meta-analysis/critical-review-of-meta-analysis-conducted-in-this-paper/
Visit us @ https://pubrica.com/services/research-services/systematic-review/
Similar to Scanned by CamScannerScanned by CamScannerRE.docx (20)
…if one of the primary purposes of education is to teach young .docxanhlodge
“…if one of the primary purposes of education is to teach young people the skills, knowledge, and critical awareness to become productive members of a diverse and democratic society, a broadly conceptualize multicultural education can have a decisive influence.” Textbook page 338.
What steps do you think schools can or should take to promote our democracy in today’s very diverse country?
Food festivals and celebrating a cultural holiday will not be accepted as an answer. Those are examples of tokenism to make the dominant culture feel like they are doing something. These two activities are fun and interesting, but not how we will strengthen our democracy.
.
✍Report OverviewIn this assignment, you will Document an.docxanhlodge
✍
Report Overview
In this assignment, you will
Document and reflect on your university education and on learning experiences outside of the university;
Articulate how your upper-level coursework is an integrated and individualized curriculum built around your interests; and
Highlight the experiences, skills, and projects that show what you can do.
A successful report submission will be the product of many hours of work over several weeks.
A report earning maximum available points will be a carefully curated and edited explanation of your work that provides tangible evidence of—and insights into—your competencies and capabilities over time. In each section of this report, you are (1) telling a story about your own abilities, and (2) providing specific examples and evidence that illustrate and support your claims.
✍
Required Report Sections
Here the sections are listed as they must appear in your final graded submission. You’ll arrange the sections in this order when
submitting
the final report BUT you won’t follow this order when
writing
drafts of each section.
Note that each section description contains a Pro Tip that tells you how to proceed with the work – what to attempt first, second, and third, etc.
❖ I. Statement of Purpose ❖
Step 1.
Read these four very different
examples of successful Statement of Purpose sections
.
Step 2.
Consider the differences in tone, style, level of detail etc. Your own statement of purpose may resemble one of these. Indeed, writing a first draft based on an example or combination of examples is a good idea. BUT don’t let these examples limit your thinking or personal expression. You may want to begin with a quote from a famous person, use a quote from your mom, or skip the quote. You may want to discuss your personal motivations or get right down to the facts. You may want to list your classes or discuss how your work-life led you to this path.
Step 3.
Write a rough draft – let’s call that Statement of Purpose 1.0. Write Statement of Purpose 1.0 as quickly as you can and then put it away until after you have completed most of the report. Forget about Statement of Purpose 1.0 until most of your report is at least in draft form.
Step 4.
Once you have a draft of all sections of your report, you are in a good position to revise Statement of Purpose 1. You are ready for Step 4. Take Statement of Purpose 1.0 out its dusty vault and hold it up to the sun. Ah. Now read your report draft and compare it to the claims you made in Statement of Purpose 1.0. Ask yourself these questions:
Does Statement of Purpose 1.0. accurately introduce my report?
Are there important ideas or representative experiences in the report that should be highlighted in the Statement of Purpose but aren’t? Remember this isn’t a treasure hunt where its your reader’s job to figure out what matters. It’s your job to show the reader what matters.
If Statement of Purpose 1.0. isn’t the best map it can be for th.
☰Menu×NURS 6050 Policy and Advocacy for Improving Population H.docxanhlodge
☰
Menu
×
NURS 6050 Policy and Advocacy for Improving Population Health
Back to Course Home
Course Calendar
Syllabus
Course Information
Resource List
Support, Guidelines, and Policies
Module 1
Module 2
Module 3
Module 4
Module 5
Module 6
.
▪ Learning Outcomes1.Understand the basic concepts and termin.docxanhlodge
▪
Learning Outcomes:1.
Understand the basic concepts and terminology used in Strategic Management. (Lo 1.2)2.
Understand the Corporation Social Responsibility
(Lo 1.4).3.
Explain how executive leadership is an important part of strategic management (Lo 3.4)
✓
Question 1
: How does strategic management typically evolve in a corporation? (
1Mark)
✓
Question 2
: Discuss the influence of globalization, social responsibility and environmental sustainability on strategic management of a corporation.(
2 Marks
)
✓
Question 3:
In what ways can a corporation’s structure and culture be internal strengths or weaknesses? Justify your answer by examples from real market. (
1Mark)
✓
Question 4:
When does a corporation need a board of directors? Justify your answer by an example from Saudi market.
(1 Mark)
Notes:
-
Your answers
(for the
4
questions)
MUST include at least
three scholarly peer-reviewed references
,
using a proper referencing style (APA).
Keep in mind that these scholarly references
can be found
in the
Saudi Digital Library (SDL).
-
Make sure to support your statements with logic and argument, citing all sources referenced.
Your answers should not include m
.
● What are some of the reasons that a MNE would choose internationa.docxanhlodge
● What are some of the reasons that a MNE would choose international expansion through an acquisition? An IJV? An alliance?
● What are the variables that would influence the decision?
● Which choice do you believe is best for the likely benefit of the firm? (Cite and reference).
.
▶︎ Prompt 1 Think about whether you identify with either Blue or .docxanhlodge
▶︎ Prompt 1:
Think about whether you identify with either Blue or Red or "Left vs. Right" characteristics of conservative or liberal, left or right America. Do you see yourself, or the people in the place you grew up, on either side of the divide, or perhaps in a different political category? Share some ways in which you identify with some of the descriptions, or ways in which they seem foreign to you.
I'll attach the picture below
.
⁞ InstructionsChoose only ONE of the following options .docxanhlodge
⁞ Instructions
Choose only
ONE
of the following options below and, in your post, write a paraphrase that avoids plagiarism of the paragraph you have chosen. Your paraphrase can be as long as the excerpt you have chosen, but should not duplicate any phrasing from the excerpt. If you must, you can quote up to three words in a phrase.
Choose to paraphrase ONE of the excerpts below:
Option 1
Morrison began writing Sula in 1969, a time of great activism among African Americans and others who were working toward equal civil rights and opportunities. The book addresses issues of racism, bigotry, and suppression of African Americans; it depicts the despair people feel when they can't get decent jobs, and the determination of some to survive. Eva, for example, cuts off her leg in order to get money to raise her family. Morrison shows how, faced with racist situations, some people had to grovel to whites simply to get by, as Helene does on a train heading through the South. Others, however, fought back, as Sula does when she threatens some white boys who are harassing her and Nel.
or
Option 2
In 1993, Morrison was awarded the Nobel Prize for literature, and thus became the first African American and only the eighth woman ever to win the award. According to Maureen O'Brien in Publishers Weekly, Morrison said, "What is most wonderful for me personally is to know that the Prize has at last been awarded to an African American. I thank God that my mother is alive to see this day." In 1996, she received the National Book Foundation Medal for Distinguished Contribution to American Letters.
.
⁞ InstructionsChoose only ONE of the following options below.docxanhlodge
⁞ Instructions
Choose only
ONE
of the following options below and, in your post, write a paraphrase that avoids plagiarism of the paragraph you have chosen. Your paraphrase can be as long as the excerpt you have chosen, but should not duplicate any phrasing from the excerpt. If you must, you can quote up to three words in a phrase.
When you are done posting your paraphrase, reply to at least one classmate’s paraphrase, commenting on what s/he has done well and what s/he can improve with the wording. Your response should be written in no fewer than 75 words.
Choose to paraphrase ONE of the excerpts below:
Option 1
Morrison began writing Sula in 1969, a time of great activism among African Americans and others who were working toward equal civil rights and opportunities. The book addresses issues of racism, bigotry, and suppression of African Americans; it depicts the despair people feel when they can't get decent jobs, and the determination of some to survive. Eva, for example, cuts off her leg in order to get money to raise her family. Morrison shows how, faced with racist situations, some people had to grovel to whites simply to get by, as Helene does on a train heading through the South. Others, however, fought back, as Sula does when she threatens some white boys who are harassing her and Nel.
or
Option 2
In 1993, Morrison was awarded the Nobel Prize for literature, and thus became the first African American and only the eighth woman ever to win the award. According to Maureen O'Brien in Publishers Weekly, Morrison said, "What is most wonderful for me personally is to know that the Prize has at last been awarded to an African American. I thank God that my mother is alive to see this day." In 1996, she received the National Book Foundation Medal for Distinguished Contribution to American Letters.
Your discussion post will be graded according to the following criteria:
- Clear paraphrase the selected text in your own words with minimal use of quotations
.
⁞ InstructionsAfter reading The Metamorphosis by Frank .docxanhlodge
⁞ Instructions
After reading
The Metamorphosis
by Frank Kafka , choose
one
of the following assertions and write a 200-word response supporting why you agree or disagree with it.
Gregor’s transformation highlights his isolation and alienation before his metamorphosis.
Or
Despite having become an insect, Gregor is more humane and sensitive than his family.
Or
If Gregor had been a stronger person, he would have been able to avoid all of the suffering and alienation he endures.
.
⁞ InstructionsAfter reading all of Chapter 5, please se.docxanhlodge
⁞ Instructions:
After reading all of
Chapter 5
, please select
ONE
of the following
primary source readings
:
“Utilitarianism” by John Stuart Mill
(starting on page 111)
-or-
“A Theory of Justice” by John Rawls
(starting on page 115)
-or-
“The Entitlement Theory of Justice” by Robert Nozick
(starting on page 122)
Write a short, objective summary of
250-500 words
which summarizes the main ideas being put forward by the author in this selection. Your summary should include no direct quotations from any author. Instead, summarize in your own words, and include a citation to the original. Format your Reading Summary assignment according to either MLA or APA formatting standards, and attach as either a .doc, .docx, or .rtf filetype. Other filetypes, or assignments that are merely copy/pasted into the box will be returned ungraded.
.
⁞ InstructionsAfter reading all of Chapter 2, please select.docxanhlodge
⁞ Instructions:
After reading all of
Chapter 2
, please select
ONE
of the following
primary source readings
:
“Anthropology and the Abnormal” by Ruth Benedict
(starting on page 33)
-or-
“Trying Out One’s New Sword” by Mary Midgley
(starting on page 35)
Write a short, objective summary of
250
which summarizes the main ideas being put forward by the author in this selection.
Write a short summary that identifies the thesis and outlines the main argument.
Reading summaries are not about your opinion or perspective – they are expository essays that explain the content of the reading.
All reading summaries must include substantive content based on the students reading of the material.
Reading Material: Doing Ethics
ORIGINIAL WORK. NO PLAGIARISM
.
⁞ Instructions After reading all of Chapter 9, please .docxanhlodge
⁞ Instructions:
After reading all of
Chapter 9
, please select the following
primary source reading
:
“A Defense of Abortion” by Judith Jarvis Thomson
(starting on page 237)
Write a short, objective summary of
250-500 words
which summarizes the main ideas being put forward by the author in this selection. Your summary should include no direct quotations from any author. Instead, summarize in your own words, and include a citation to the original. Format your Reading Summary assignment according to either MLA or APA formatting standards, and attach as either a .doc, .docx, or .rtf filetype. Other filetypes, or assignments that are merely copy/pasted into the box will be returned ungraded.
.
…Multiple intelligences describe an individual’s strengths or capac.docxanhlodge
“…Multiple intelligences describe an individual’s strengths or capacities; learning styles describe an individual’s traits that relate to where and how one best learns” (textbook quote, [H2] Learning Styles].
This week you’ve read about the importance of getting to know your students in order to create relevant and engaging lesson plans that cater to multiple intelligences and are multimodal.
Assignment Instructions:
A. Using
SurveyMonkey
, create a survey that has:
At least five questions based on Gardner’s theory
Five questions on individual learning style inventory
A specific targeted student population grade level (elementary/ middle/ high school/adults)
Include the survey link for your peers
B. Post a minimum 150 word introduction to your survey, using at least one research-based article (cited in APA format) explaining how it will:
Evaluate students’ readiness
Assist in the creation of differentiated lesson plans.
.
••• JONATHAN LETHEM CRITICS OFTEN USE the word prolifi.docxanhlodge
- Jonathan Lethem is known for publishing many novels, stories, essays and other works across different genres. He is described as a "protean" or shape-shifting writer.
- Lethem believes creativity comes from influence and interaction with other works, not isolated originality. He celebrates the "ecstasy of influence" where culture is built upon what came before through borrowing and remixing.
- Many artists, including musicians, visual artists and writers, engage in practices that borrow and reuse elements from other works but these practices are seen as essential to creativity rather than plagiarism. Appropriation and remixing are at the core of cultural production.
•••••iA National Profile ofthe Real Estate Industry and.docxanhlodge
•••••i
A National Profile of
the Real Estate Industry and
the Appraisal Profession
by J. Reid Cummings and Donald R. Epley, PhD, MAI, SRA
FEATURES
T
J- he
he real estate industry has been devastated on many fronts' in the years
following the Great Recession, whieh began in 2007^ due to the bursting of the
housing bubble and the subsequent finaneial crisis relating to the mortgage
market meltdown.' The implosion of the mortgage markets initially began when
two Bear Stearns mortgage-backed securities hedge funds, holding nearly $10
billion in assets, disintegrated into nothing.* Panie quickly spread to financial
institutions that could not hide the extent of their toxic, subprime exposures, and
a massive, worldwide credit squeeze ensued; outright fear soon replaced panic.
Subsequent eredit tightening and substantial illiquidity in the financial markets
rapidly and severely affected the housing and construction markets.' Throughout
the United States, properties of all kinds saw dramatic value declines.
In thousands of cases, real estate foreclosures disrupted people's lives,
forced businesses to close, eaused financial institutions to falter, capsized wbole
market segments, devastated entire industries, and squeezed municipal and state
government budgets dependent upon use and property tax revenues.* While the
effeets of property value declines and the waves of foreclosures in markets across
the country captured most of the headlines, one significant impact of the upheaval
in US real estate markets has gone largely unreported: its impact on employment
in the real estate industry, and specifically, the real estate appraisal profession.
This article presents a
current employment
profile of the US real
estate industry, with
special attention given
to appraisal profes-
sionals. It serves as an
informative picture of
the appraisal profession
for use as a benchmark
for future assessment
of growth. As a
component of the real
estate industry, the
appraisal profession
ranks as the smallest
in employment, is
highly correlated to
movements in empioy-
ment of brokers and
agents, and relies on
commerciai banking,
credit, and real estate
lessors and managers
to deliver its products.
1. James R. DeLisle, "At the Crossroads of Expansion and Recession," TheAppraisalJournal 75, no. 4 (Fall 2007):
314-322; James R. DeLisle, "The Perfect Storm Rippiing Over to Reai Estate," The Appraisal Journal 76, no,
3 (Summer 2008): 200-210.
2. Randaii W. Eberts, "When Wiii US Empioyment Recover from tiie Great Recession?" International Labor Brief
9, no. 2 (2011): 4-12 (W. E. Upjohn Institute for Employment Research): Chad R. Wilkerson, "Recession and
Recovery Across the Nation: Lessons from History," Economic Review 94, no. 2 (2009): 5-24.
3. Kataiina M. Bianco, The Subprime Lending Crisis: Causes and Effects of the Mortgage Meltdown (New York:
CCH, inc., 2008): Lawrence H. White, "Fédérai Reserve Policy and the Housing Bubbie," in Lessons Fro.
Let us consider […] a pair of cases which I shall call Rescue .docxanhlodge
“Let us consider […] a pair of cases which I shall call Rescue I and Rescue II. In the first Rescue story we are hurrying in our jeep to save some people – let there be five of them – who are imminently threatened by the ocean tide. We have not a moment to spare, so when we hear of a single person who also needs rescuing from some other disaster we say regretfully that we cannot rescue him, but must leave him to die. To most of us, this seems clear […]. This is Rescue I and with it I contrast Rescue II. In this second story we are again hurrying to the place where the tide is coming in in order to rescue the party of people, but this time it is relevant that the road is narrow and rocky. In this version, the lone individual is trapped (do not ask me how) on the path. If we are to rescue the five we would have to drive over him. But can we do so? If we stop he will be all right eventually: he is in no danger unless from us. But of course, all five of the others will be drowned. As in the first story, our choice is between a course of action that will leave one man dead and five alive at the end of the day and a course of action which will have the opposite result. (Philippa Foot, “Killing and Letting Die,” from Abortion and Legal Perspectives, eds. Garfield and Hennessey, 2004, University of Massachusetts Press)
1. What would Mill tell the rescuer to do, in Rescue I and Rescue II, according to his theory of utilitarianism? Be clear in explaining Mill’s recommendation, and how he would justify it. In doing so, you must include a discussion of the following:
o The Principle of Utility and how it would specifically apply in this situation—who gets “counted” and how?
2. What would Kant tell the rescuer to do, in Rescue I and Rescue II, according to his deontological theory? Be clear in explaining Kant’s recommendation and how he would justify it. In doing so, you must include a discussion of the following:
o The first version of the Categorical Imperative and how it would specifically apply in these two situations (hint, you have to say what the maxim would be and what duty would be generated according to it).
o The second version of the Categorical Imperative and how it would specifically apply in this situation.
3. Explain one criticism of both Mill and Kant. Afterward, argue for which ethical approach, on your view is superior. Be specific and provide reasons for your claim.
.
• Enhanced eText—Keeps students engaged in learning on th.docxanhlodge
• Enhanced eText—Keeps students engaged in learning on their own time,
while helping them achieve greater conceptual understanding of course
material. The worked examples bring learning to life, and algorithmic practice
allows students to apply the very concepts they are reading about. Combining
resources that illuminate content with accessible self-assessment, MyLab
with Enhanced eText provides students with a complete digital learning
experience—all in one place.
• MediaShare for Business—Consisting of a curated collection of business
videos tagged to learning outcomes and customizable, auto-scored
assignments, MediaShare for Business helps students understand why they
are learning key concepts and how they will apply those in their careers.
Instructors can also assign favorite YouTube clips or original content and
employ MediaShare’s powerful repository of tools to maximize student
accountability and interactive learning, and provide contextualized feedback
for students and teams who upload presentations, media, or business plans.
• Writing Space—Better writers make great
learners who perform better in their courses.
Designed to help you develop and assess concept
mastery and critical thinking, the Writing Space
offers a single place to create, track, and grade
writing assignments, provide resources, and
exchange meaningful, personalized feedback with
students, quickly and easily. Thanks to auto-graded, assisted-graded, and create-your-own assignments, you
decide your level of involvement in evaluating students’ work. The auto-graded option allows you to assign
writing in large classes without having to grade essays by hand. And because of integration with Turnitin®,
Writing Space can check students’ work for improper citation or plagiarism.
• Branching, Decision-Making Simulations—Put your students in the
role of manager as they make a series of decisions based on a realistic
business challenge. The simulations change and branch based on their
decisions, creating various scenario paths. At the end of each simulation,
students receive a grade and a detailed report of the choices they made
with the associated consequences included.
Engage, Assess, Apply
• Learning Catalytics™—Is an interactive, student response tool that
uses students’ smartphones, tablets, or laptops to engage them in
more sophisticated tasks and thinking. Now included with MyLab
with eText, Learning Catalytics enables you to generate classroom
discussion, guide your lecture, and promote peer-to-peer learning
with real-time analytics.
• LMS Integration—You can now link from Blackboard Learn, Brightspace
by D2L, Canvas, or Moodle to MyManagementLab. Access assignments,
rosters, and resources, and synchronize grades with your LMS gradebook.
For students, single sign-on provides access to all the personalized
learning resources that make studying more efficient and effective.
• Reporting Dashboard—View, analyze, and re.
• Here’s the approach you can take for this paperTitle.docxanhlodge
This document outlines the structure for a 15-20 page paper on risk management for an organization. It should include an introduction providing background on the selected organization, descriptions of 3 risks with their impacts and recommendations for managing each risk, a conclusion, and references. The paper needs a title page and should follow APA style formatting.
•Your team will select a big data analytics project that is intr.docxanhlodge
•Your team will select a big data analytics project that is introduced to an organization of your choice … please address the following items:
•Provide a background of the company chosen.
•Determine the problems or opportunities that that this project will solve. What is the value of the project?
•Describe the impact of the problem. In other words, is the organization suffering financial losses? Are there opportunities that are not exploited?
•Provide a clear description regarding the metrics your team will use to measure performance. Please include a discussion pertaining to the key performance indicators (KPIs).
•Recommend a big data tool that will help you solve your problem or exploit the opportunity, such as Hadoop, Cloudera, MongoDB, or Hive.
•Evaluate the data requirements. Here are questions to consider: What type of data is needed? Where can you find the data? How can the data be collected? How can you verify the integrity of the data?
•Discuss the gaps that you will need to bridge. Will you need help from vendors to do this work? Is it necessary to secure the services of other subject matter experts (SMEs)?
•What type of project management approach will you use this initiative? Agile? Waterfall? Hybrid? Please provide a justification for the selected approach.
•Provide a summary and conclusion.
.
Gender and Mental Health - Counselling and Family Therapy Applications and In...PsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
How to Setup Default Value for a Field in Odoo 17Celine George
In Odoo, we can set a default value for a field during the creation of a record for a model. We have many methods in odoo for setting a default value to the field.
Temple of Asclepius in Thrace. Excavation resultsKrassimira Luka
The temple and the sanctuary around were dedicated to Asklepios Zmidrenus. This name has been known since 1875 when an inscription dedicated to him was discovered in Rome. The inscription is dated in 227 AD and was left by soldiers originating from the city of Philippopolis (modern Plovdiv).
Andreas Schleicher presents PISA 2022 Volume III - Creative Thinking - 18 Jun...EduSkills OECD
Andreas Schleicher, Director of Education and Skills at the OECD presents at the launch of PISA 2022 Volume III - Creative Minds, Creative Schools on 18 June 2024.
🔥🔥🔥🔥🔥🔥🔥🔥🔥
إضغ بين إيديكم من أقوى الملازم التي صممتها
ملزمة تشريح الجهاز الهيكلي (نظري 3)
💀💀💀💀💀💀💀💀💀💀
تتميز هذهِ الملزمة بعِدة مُميزات :
1- مُترجمة ترجمة تُناسب جميع المستويات
2- تحتوي على 78 رسم توضيحي لكل كلمة موجودة بالملزمة (لكل كلمة !!!!)
#فهم_ماكو_درخ
3- دقة الكتابة والصور عالية جداً جداً جداً
4- هُنالك بعض المعلومات تم توضيحها بشكل تفصيلي جداً (تُعتبر لدى الطالب أو الطالبة بإنها معلومات مُبهمة ومع ذلك تم توضيح هذهِ المعلومات المُبهمة بشكل تفصيلي جداً
5- الملزمة تشرح نفسها ب نفسها بس تكلك تعال اقراني
6- تحتوي الملزمة في اول سلايد على خارطة تتضمن جميع تفرُعات معلومات الجهاز الهيكلي المذكورة في هذهِ الملزمة
واخيراً هذهِ الملزمة حلالٌ عليكم وإتمنى منكم إن تدعولي بالخير والصحة والعافية فقط
كل التوفيق زملائي وزميلاتي ، زميلكم محمد الذهبي 💊💊
🔥🔥🔥🔥🔥🔥🔥🔥🔥
A Visual Guide to 1 Samuel | A Tale of Two HeartsSteve Thomason
These slides walk through the story of 1 Samuel. Samuel is the last judge of Israel. The people reject God and want a king. Saul is anointed as the first king, but he is not a good king. David, the shepherd boy is anointed and Saul is envious of him. David shows honor while Saul continues to self destruct.
CapTechTalks Webinar Slides June 2024 Donovan Wright.pptxCapitolTechU
Slides from a Capitol Technology University webinar held June 20, 2024. The webinar featured Dr. Donovan Wright, presenting on the Department of Defense Digital Transformation.
Contiguity Of Various Message Forms - Rupam Chandra.pptx
Scanned by CamScannerScanned by CamScannerRE.docx
1. Scanned by CamScanner
Scanned by CamScanner
RESEARCH ARTICLE
Association between Physical Fitness and
Successful Aging in Taiwanese Older Adults
Pay-Shin Lin1,2☯‡*, Chih-Chin Hsieh1☯‡, Huey-Shinn
Cheng3, Tsai-Jou Tseng1, Shin-
Chang Su1
1 Department of Physical Therapy & Graduate Institute of
Rehabilitation Science, College of Medicine,
Chang Gung University, Taoyuan, Taiwan, 2 Health Aging
Research Center, Chang Gung University &
Chang Gung Memorial Hospital, Taoyuan, Taiwan, 3 Internal &
Geriatric Medicine, Chang Gung Memorial
Hospital, LinKou Branch, Taoyuan, Taiwan
☯ These authors contributed equally to this work.
‡ PSL and CCH are co-first authors on this work.
* [email protected]
Abstract
Population aging is escalating in numerous countries
worldwide; among them is Taiwan,
2. which will soon become an aged society. Thus, aging
successfully is an increasing concern.
One of the factors for achieving successful aging (SA) is
maintaining high physical function.
The purpose of this study was to determine the physical fitness
factors associated with SA
in Taiwanese older adults (OAs), because these factors are
intervenable. Community-
dwelling OAs aged more than 65 years and residing in Northern
Taiwan were recruited in
this study. They received a comprehensive geriatric assessment,
which includes sociode-
mographic data, health conditions and behaviors, activities of
daily living (ADL) and instru-
mental ADL (IADL) function, cognitive and depressive status,
and quality of life. Physical
fitness tests included the grip strength (GS), 30-second sit-to-
stand (30s STS), timed up-
and-go (TUG), functional reach (FR), one-leg standing, chair
sit-and-reach, and reaction
time (drop ruler) tests as well as the 6-minute walk test
(6MWT). SA status was defined as
follows: complete independence in performing ADL and IADL,
satisfactory cognitive status
3. (Mini-Mental State Examination� 24), no depression (Geriatric
Depression Scale < 5), and
favorable social function (SF subscale� 80 in SF-36). Adjusted
multiple logistic regression
analyses were performed. Among the total recruited OAs (n =
378), 100 (26.5%) met the
aforementioned SA criteria. After adjustment for
sociodemographic characteristics and
health condition and behaviors, some physical fitness tests,
namely GS, 30s STS, 6MWT,
TUG, and FR tests, were significantly associated with SA
individually, but not in the multi-
variate model. Among the physical fitness variables tested,
cardiopulmonary endurance,
mobility, muscle strength, and balance were significantly
associated with SA in Taiwanese
OAs. Early detection of deterioration in the identified functions
and corresponding interven-
tion is essential to ensuring SA.
PLOS ONE | DOI:10.1371/journal.pone.0150389 March 10,
2016 1 / 12
OPEN ACCESS
Citation: Lin P-S, Hsieh C-C, Cheng H-S, Tseng T-J,
Su S-C (2016) Association between Physical Fitness
and Successful Aging in Taiwanese Older Adults.
PLoS ONE 11(3): e0150389. doi:10.1371/journal.
5. Introduction
The aging crisis is spreading worldwide. Taiwan is no
exception; its aging population is forecast
to surpass 14% by 2017, and to rapidly increase to 20% by 2025
[1]. In this severe population
aging era, if older people live longer but not in a healthy
manner, caring for them will place an
extreme burden on themselves, their families, and society.
Therefore, successfully aging (SA) is
a major health care and socioeconomic priority [2]. SA enables
older people to lead an inde-
pendent, high-quality, and dignified life. Rowe and Kahn [3]
proposed the concept of SA and
three constituent components: avoiding disease and disability,
maintaining high cognitive and
physical function, and engagement with life. A more
comprehensive definition proposed by
Young and colleagues [4] includes three health domains:
physiological (e.g. diseases and func-
tional impairments), psychological (e.g. emotional vitality), and
social (e.g. spirituality and
adaptation through social support mechanisms).
In the past four decades, scientist and clinicians have sought to
develop a definition that
would improve the general understanding of SA. In 2006, Depp
and Jest [5] reviewed 29 stud-
ies, noticing several variations of the SA definition in the
reviewed articles. They concluded
that the most frequently described SA components were
physical function or disability (26 of
29), followed by cognitive function, life satisfaction or well-
being, and social or productive
engagement.
6. Studies of different countries have proposed varying definitions
of SA. In Spain, Formiga
and colleagues [6] defined SA as achieving a Barthel Index (BI)
scores of�90 and a Mini-Men-
tal State Examination (MMSE) score of�24, as well as never
having been institutionalized. In
Singapore, Ng and colleagues [7] adapted the most rigorous
criteria for defining SA. They
defined SA as having good or excellent self-reported health
status, being independent in per-
forming instrumental activities of daily life (IADL), scoring�26
on the MMSE and�5 on the
Geriatric Depression Scale (GDS), being engaged in at least one
social and one productive
activity, and reporting a high level of life satisfaction. In
Australia, Parslow and colleagues [8]
defined SA as reporting high-level physical and mental health
and life satisfaction. Researchers
have also varied in definitions concerning the three SA
domains. Being independent in per-
forming activities of daily life (ADL) or IADL has been
frequently used for defining the physi-
cal component of SA. Several studies on SA conducted by
MacArthur, investigating and
longitudinally following OAs with high functioning, could be
considered the earliest and most
renowned studies on SA [9–11]. From then, many SA-related
factors have been reported, such
as health behaviors (smoking, physical activity, and exercise),
comorbidity, nutrition, and
some sociodemographic variables (age, sex, marital status,
education, and living arrangement)
[5–7,12–14].
High physical function is a crucial factor for SA; measures of
7. functional performance and
physical fitness are important, simple, and objective
observations of physical function in older
people. In addition, deterioration of these measures usually
precedes functional dependence,
which facilitates early detection and prevention. In the
MacArthur studies, the maintaining of
high physical performance was predicted by sociodemographic
data and health status charac-
teristics, exercise behavior, and emotional support from a social
network [10,11]. Furthermore,
several physical performance tests can detect the early onset of
functional dependence in OAs
without disabilities [15,16].
Recently, Kuh and colleagues [17] summarized the findings of a
review on the indicators of
healthy aging, focusing on objective measures of physical
capability, such as grip strength,
walking speed, chair rises, and standing balance. They
concluded these standardized physical
performance tests were significantly correlated with healthy
aging. However, associations of
these tests with SA needs to be further elaborated.
Physical Fitness and Successful Aging
PLOS ONE | DOI:10.1371/journal.pone.0150389 March 10,
2016 2 / 12
SA-associated factors may vary depending on cultural context.
Few related studies have
used Taiwanese older people as the study sample. In this study,
we explored SA-associated fac-
8. tors and predictors, specifically physical fitness tests (PFTs), in
Taiwan’s older population.
Because physical fitness is trainable, early detection and
intervention is possible.
Methods
Participants
Community-dwelling OAs aged more than 65 years were
recruited through an internal medi-
cine clinic and a community-based elderly home in Taoyuan,
Taiwan. The subjects were
screened by a medical doctor in the clinic and by two trained
physical therapists in the elderly
home. Subjects’ inclusion criteria were able to follow
instructions and perform PFTs indepen-
dently with or without assistive devices. The exclusion criteria
were any health problems or
acute trauma that would limit participation in the PFTs. The
study was approved by the Insti-
tutional Review Board of Chang Gung Memorial Hospital, and
written informed consent was
obtained from each subject prior to the initial assessment.
Measurements
Comprehensive geriatric assessment (CGA). The subjects
received a CGA by a well-
trained research assistant. Data on sociodemographic
characteristics were collected, including
age, sex, marital status, educational level, and living
arrangement. The health condition was
assessed by recording the number of comorbidities and fall
occurrences in the past year. Health
behaviors were assessed including smoking and alcohol
consumption (no, formerly, or yes),
9. sleeping quality (good or insomnia), and physical activity or
exercise (type, frequency, and
duration). The level of independence was measured by ADL
[18] and IADL [19]. The subjects
were asked if any difficulty in performing six ADLs, namely
eating, transferring, toileting, bath-
ing, walking indoors, and dressing, and five IADLs, namely
shopping, transportation, making
phone calls, taking medications, and managing money.
Cognitive function was measured using
the Chinese version of the MMSE [20], which has been
sufficiently validated in Taiwan [21,22].
Depression status was measured using the Chinese version of
the GDS short form [23], which
was adequately validated in Taiwan [24]. Quality of life was
evaluated using the Chinese ver-
sion of the Medical Outcomes study 36-Item Short Form (SF-
36) [25]. The SF-36 comprises
eight subscales with scores ranging from 0 to 100 for each scale
and two weighted summary
scales, namely the physical and mental component summary
scores.
Physical fitness tests (PFTs). PFTs consisted of the nine
following assessment items. First,
body composition was evaluated by calculating the body mass
index (BMI).
Muscle strength was measured with the grip strength (GS) by
using a Jamar1 hand dyna-
mometer (Sammons Preston, Bolingbrook, IL, USA) [26]. As
recommended by the American
Society of Hand Therapists, subjects were instructed to adopt
the standard testing position
[27], which is seated with shoulder and forearm of the test arm
in a neutral position and the
10. elbow flexed at 90°. The maximum force was recorded twice for
the dominant hand and the
higher value was used for analysis.
Muscle endurance was measured using the 30-second sit-to-
stand (30s STS) test [28]. Sub-
jects were instructed to keep their arms folded and rise as fast
as possible from a seat, which
was 0.42 m from the floor. The score was recorded as the
number of full stands performed in
30 seconds.
Aerobic endurance was assessed using the 6-minute walk test
(6MWT) [28]. Subjects were
instructed to walk as fast and as far as possible along a 25-m
corridor in 6 minutes and were
Physical Fitness and Successful Aging
PLOS ONE | DOI:10.1371/journal.pone.0150389 March 10,
2016 3 / 12
given encouragement throughout the test. The total distance
walked within 6 minutes was
recorded.
Flexibility was assessed using the sit-and-reach test (SRT) [28].
Subjects completed trials by
assuming a sitting position on the edge of a chair, with one leg
extended and both hands over-
lapped and reaching toward the toes. The distance (in cm) from
the extended third finger to
the tip of the toe (+ beyond or–behind the toe) in two trials was
recorded, and the better perfor-
11. mance was used for analysis.
Balance was assessed using the functional reach (FR) test and
one-leg standing (OLS) with
eyes closed test. The FR test was performed using a Rolyan1
Functional Reach Measuring
Device (Sammons Preston). Subjects completed trials in a
standing position adjacent to a wall
with the test arm raised forward at 90° of shoulder flexion. The
farthest distance (in cm) was
recorded while subjects reached forward without taking their
heels off the floor [29], and after
practice, the mean value of two trials was used for analysis. In
the OLS test, subjects completed
trials by standing on one leg for as long as possible with the
contralateral hip and knee both
flexed at 90° and with their eyes closed [30]. The performance
time was recorded until the sus-
pended leg touched the floor, and after practice, the longest
time of two trials was used for
analysis.
The timed up-and-go (TUG) test [31] was used to assess
dynamic balance and agility. Sub-
jects stood up from a seated position, walked 3 m, turned
around, and returned to the seated
position on a chair. After a practice trial, the shortest time of
two test trials was recorded.
Finally, the reaction time was assessed using the drop ruler
(DR) test [32]. The subjects tried
to catch a ruler that was dropped without warning. The distance
(in cm) between the bottom of
the ruler and the marking where the dropped ruler was caught
by the subject was recorded.
This procedure was repeated five times. The lowest and highest
12. results were discarded and the
average of the remaining three results was used for analysis.
Definition of Successful Aging
Young [4] proposed a multidimensional model for SA that
includes three domains, namely
physiological, psychological, and sociological. Therefore, we
operationally defined the criteria
of SA status as respondents reporting follows:
1. Independence for performing each ADL and IADL activity
[33,34].
2. Free of cognitive impairment and depressive symptoms if
their MMSE score�24 [35] and
GDS score<5 [24], respectively.
3. Having satisfactory social functioning if their social function
subscale score of SF-36 was
more than 80. We used 80 as a cutoff because in a normative
sample of Taiwanese adults, 81
and 73 were the mean scores reported by healthy OAs aged 65–
74 and>75 years, respec-
tively [25].
According to these criteria, the subjects were categorized into
two groups: SA and non-SA.
Statistical Analysis
Descriptive statistics of sociodemographic characteristics,
health conditions, health behavior,
and PFTs were obtained for both the SA and non-SA groups.
The t test was used for comparing
continuous variables, and the chi-square test was used for
categorical variables. To determine
the variables associated with SA, series logistic regression
13. analyses were performed. By using
SA status as a dependent variable and possible correlated
factors as independent variables, we
constructed series logistic regression models. Sociodemographic
characteristics, health
Physical Fitness and Successful Aging
PLOS ONE | DOI:10.1371/journal.pone.0150389 March 10,
2016 4 / 12
conditions, and health behaviors were entered in model 1. For
the univariate logistic regression
(model 2), each PFT was added individually. Finally, all the
variables of PFTs were included in
a multivariate logistic regression (model 3).
Adjusted odds ratios (ORs) with 95% confidence intervals (CIs)
were calculated. All analy-
ses were performed using SPSS 20.0. The significance level
was set at P< 0.05.
Multiple imputation procedures were performed for missing
values [36]. The procedure
involved generating five complete datasets from a set of values
yielded using the aforemen-
tioned logistic and linear regression models, for the categorical
and continuous variables [37].
The results were similar after multiple imputations, therefore,
results of the original data with-
out imputations are reported in the present study.
Results
This study enrolled 378 OAs with a mean age of 77.6 ± 6.9
14. years (60–102 years), 52.6% of
whom were women. Regarding education, 55.2% of the subjects
had received� 9 years of edu-
cation. Almost 60% of the subjects were married, and 70% lived
with their families or others.
Of the subjects, 202 (53.4%) were physically independent, 228
(60.3%) were cognitively and
emotionally well-functioning, and 222 (58.7%) reported
satisfactory social function. Overall,
100 (26.5%) subjects met the multidimensional criteria for SA
(Table 1).
Table 2 shows the comparison results of the sociodemographic
characteristics, health
related factors, and physical fitness measures between SA and
non-SA groups. Compared with
the non-SA group, the subjects with SA were younger, had a
higher level of education (>junior
high school), and were more likely to live with others. They
reported frequent regular exercise
(�2 days a week) and fewer falls (�1 in the past year).
Significant differences were observed in
the height and weight of the SA group subjects, who were
generally taller and heavier than the
non-SA subjects; however, BMI did not differ significantly
between two groups. In addition, no
significant difference in the number of comorbidities was
observed between two groups.
All PFTs, except the chair SRT, revealed significant differences
between the SA and non-SA
groups (Table 2). Compared with the non-SA group, the SA
group achieved a stronger GS, per-
formed more repetitions in the 30s STS test, walked a longer
distance within 6 minutes, had a
longer FR, required less time to complete the TUG test, caught
15. the ruler higher in the ruler
drop test, and stood for longer in the OLS test.
In the first logistic regression (model 1), age, education, and
regular exercise were found to
be significantly associated with SA; however, after multiple
imputations, there was a minor
Table 1. Prevalence of successful aging.
N = 378 Prevalence
1. Good physical function 53.4
Independent of ADL 84.4
Independent of IADL 55.6
2. Good cognitive and emotional function 60.3
MMSE≧24 73.5
GDS<5 77.0
3. Well social function (score>80) 58.7
Successful aginga 26.5
Values are in %. ADL: activities of daily living; IADL:
instrumental activities of daily living; MMSE: Mini-
Mental State Examination; GDS: Geriatric Depression Scales.
aCombined criteria (1 and 2 and 3).
doi:10.1371/journal.pone.0150389.t001
16. Physical Fitness and Successful Aging
PLOS ONE | DOI:10.1371/journal.pone.0150389 March 10,
2016 5 / 12
change that the variable of height but not education showed
significant difference (Table 3). In
model 2, the GS, 30s STS, TUG, and FR tests as well as the
6MWT were significantly associated
with SA after adjusting for sociodemographic characteristics,
health conditions, and health
behaviors (Table 4). Hosmer and Lemeshow tests revealed a
good model fit for all models with
no multicollinearity (none of the independent variables in the
analyses had a standard error
larger than 2.0), and an adequate overall accuracy rate (70.1%–
75.5%). Significant PFT vari-
ables associated with SA and their unadjusted and adjusted ORs
are presented in Table 4. For
every 1-meter increase in the 6MWT, the odds of achieving SA
were 2.057 times higher. By
contrast, for every 1-second increase in the TUG test, the odds
of achieving SA decreased by
19%.
However, after all the physical fitness variables were added to
the multivariate logistic
model, none were found to be significantly associated with SA
(data not shown).
Table 2. Comparisons of measures of sociodemographic, health
condition, health behavior and physical fitness tests between SA
and non-SA.
17. SA (n = 100) Non-SA (n = 278) p value
Sociodemographic data
Age (years) 75.91±7.31 78.20±6.70 0.004a
Female, n(%) 47(47.0%) 152(54.7%) 0.187
Education >9 years, n(%) 58(66.7%) 85(36.6%) 0.000a
Married, n(%) 51(60.7%) 133(58.3%) 0.705
Live with families or others, n(%) 50(59.5%) 167(73.2%)
0.019a
Height (cm) 160.95±7.98 156.73±8.51 0.000a
Weight (kg) 63.10±10.61 59.01±11.09 0.002a
BMI 24.36±3.63 24.03±3.90 0.476
Health condition
Falls >1, n(%) 3(3.0%) 38(13.7%) 0.003a
Comorbidity 1.24±1.00 1.41±1.05 0.181
Health behavior
Regular exercise, n(%) 88(88.0%) 181(65.6%) 0.000a
No smoking, n(%) 82(82.8%) 218(79.3%) 0.446
No drinking, n(%) 83(83.8%) 241(87.6%) 0.341
Normal sleep, n(%) 73(73.7%) 182(66.9%) 0.210
18. Physical fitness tests
Grip strength (kg) 27.45±8.08 22.72±7.64 0.000a
30s STS (no. stands) 15.53±5.36 12.68±4.86 0.000a
6MWT (meter) 4.19±0.98 3.36±1.13 0.000a
TUG (seconds) 9.86±2.83 14.45±8.47 0.000a
Functional reach (cm) 28.53±5.83 23.62±6.69 0.000a
One leg standing (seconds) 4.09±4.36 2.99±4.46 0.045a
Chair sit-and-reach (cm) 0.45±13.16 -2.16±13.07 0.111
Ruler test (cm) 35.59±9.29 39.68±9.61 0.000a
Values are in mean±SD unless otherwise stated. SA: successful
aging; non-SA: no successful aging; BMI: body mass index;
Regular exercise: having
regular exercise at least two days a week for more than 20
minutes; Normal sleep: no insomnia; Falls>1: falls occurrence
over once in the past year. 30s
STS: 30-second sit to stand test; 6MWT: Six Minute Walk test;
TUG: Timed Up and Go test.
ap<0.05
doi:10.1371/journal.pone.0150389.t002
Physical Fitness and Successful Aging
PLOS ONE | DOI:10.1371/journal.pone.0150389 March 10,
19. 2016 6 / 12
Discussion
In our sample of 378 community-dwelling Taiwanese OAs,
26.5% were recognized as in a SA
status. In addition to age, education, and regular exercise, we
found some PFT variables,
namely GS, 30s STS, 6MWT, TUG, and FR tests, to be
significant factors associated with SA
status.
Table 3. Factors associated with SA in model 1 from original
and imputed data respectively.
Variables OR (95% CI) After multiple imputation OR (95% CI)
Sociodemographic data
Age 0.951 (0.907–0.999)a 0.956(0.918–0.996)a
Gender 1.431 (0.543–3.773) 1.883(0.823–4.305)
Education 2.375 (1.214–4.647)a 1.936(0.963–3.892)
Marital status 1.384 (0.659–2.907) 1.115(0.570–2.179)
Live arrangement 0.624 (0.290–1.340) 0.718(0.356–1.448)
Height 1.062 (0.998–1.129) 1.084(1.027–1.143)a
Weight 1.015 (0.982–1.049) 1.010(0.983–1.039)
Health condition
20. Falls >1 0.606 (0.124–2.953) 0.534(0.146–1.952)
Comorbidity 1.112 (0.803–1.539) 0.964(0.728–1.277)
Health behavior
Regular exercise 2.414 (1.095–5.325)a 2.599(1.272–5.310)a
No smoking 1.971 (0.748–5.194) 1.446(0.642–3.258)
No drinking 0.792 (0.305–2.055) 0.861(0.378–1.961)
Normal sleep 1.391 (0.704–2.748) 1.223(0.690–2.169)
SA: successful aging; OR: odds ratio; CI: confidence interval;
BMI: body mass index; Regular exercise:
having regular exercise for more than 20 minutes at least two
days a week; Normal sleep: no insomnia;
Falls>1: falls occurrence over once in the past year.
ap<0.05
doi:10.1371/journal.pone.0150389.t003
Table 4. Physical fitness tests associated with SA in both
unadjusted and adjusted univariate logistic
regressions.
Physical fitness tests Unadjusted Adjusted
Grip strength 1.077(1.045–1.110) a 1.077(1.018–1.139) a
30s STS 1.116(1.062–1.173) a 1.102(1.021–1.190) a
6MWT 2.159(1.654–2.820) a 2.057 (1.402–3.020) a
21. TUG 0.795(0.728–0.869) a 0.810 (0.708–0.927) a
Functional reach 1.131(1.084–1.180) a 1.089 (1.023–1.160) a
One leg standing 1.053(0.995–1.116) 0.986 (0.919–1.058)
Chair sit-and-reach 1.015(0.996–1.035) 1.013 (0.984–1.043)
Ruler test 0.955(0.930–0.980) a 0.972 (0.938–1.007)
Values are in odds ratio (95% confidence interval); Adjusted:
adjusted for sociodemographic, health
condition, health behavior measures.
30s STS: 30-second sit to stand test; 6MWT: Six Minute Walk
test; TUG: Timed Up and Go test.
ap<0.05
doi:10.1371/journal.pone.0150389.t004
Physical Fitness and Successful Aging
PLOS ONE | DOI:10.1371/journal.pone.0150389 March 10,
2016 7 / 12
Previous studies [5–7,12–14,33] have reported wide-ranging
rates of SA prevalence, from
0.4% to 95%. Regarding other primarily ethic Chinese older
populations, the SA prevalence in
our study is similar to that reported in Singapore (28.6%) [7]
but not to that reported in Hong
Kong (0.7%–33.1%) [13] and in Shanghai (46.2%) [14]. Several
22. methodological factors, such as
differences in sample characteristics and operational definitions
of SA, may contribute to this
variability [5]. Self-reported and performance-based
assessments are both valid and reliable
methods for assessing ADL or IADL; however, in our study,
using self-reported ADL or IADL
measurements for defining SA may have led to overestimation
of the number of subjects with
SA. The heterogeneity and lack of consistency in the SA
definition are the main limitations of
research on SA [38]. However, we attempted to use the most
suitable multidimensional defini-
tion of SA in our study.
The first logistic regression (model 1) revealed that some
sociodemographic characteristics
were associated with SA. In accordance with previous studies
[13,14], our results showed that a
younger age and higher level of education were associated with
SA. However, the number of
comorbidities was not a significant factor. Previous studies
[4,8,39] have also proposed that
chronic illness is not a necessary barrier to SA. By contrast,
performing regular exercise for
�20 min more than twice a week is beneficial. According to one
study [40], the SA rate in the
physically active Canadian older population was more than
twice that in older populations of
other countries, even after adjusting for demographic
covariates. Maintaining a high physical
activity level by performing regular exercise results in
improved physical function and fitness,
and thus aids older people to achieve SA.
Our results showed that GS, 30s STS, 6MWT, TUG, and FR test
23. results were significant fac-
tors associated with an SA status. A review performed by den
Ouden and colleagues [41]
describes positive associations of high handgrip and lower
extremity strength and quick gait
speed on physical mobility. Results of a 10-year follow-up
study [42] also reported that high
handgrip strength and leg strength were both associated with a
lower risk of ADL disabilities.
Formiga and colleagues [6] conducted a survey involving 328
community-dwelling OAs.
Results showed that successful agers exhibited significantly
higher scores on the Tinetti Gait
Scale than did unsuccessful agers. Achour and colleagues [12]
used a physical questionnaire to
evaluate the amount of physical activity in 686 subjects aged
over 65 years and determined the
relationships between exercise capacity and life satisfaction and
self-rated health after 7 years.
The results showed oxygen uptake (VO2) peak and activity
index were the most significant fac-
tors associated with self-reported health condition and life
satisfaction. Our results were in
agreement with those of the aforementioned studies. In
conclusion, older people with more
favorable muscle strength/endurance, gait and balance
performance, and aerobic endurance
exhibit higher physical function, exercise capacity, and
independence in performing ADL;
thus, they are more able to achieve SA.
PFTs are easy to conduct in clinical and community settings.
Previous research showed
their predictability on adverse outcomes. Some tests, such as
GS, timed chair raises, walking
24. speed, and standing balance, can predict mortality [43]; tests
such as timed chair raises [44]
and TUG [45] can predict disability, and others such as gait
speed can predict demand for per-
sonal care [46]. Rikli and Jones [47] developed standards for
tests that can predict the level of
capacity required for OAs to maintain physical independence,
which is a necessary component
of SA. For example, to predict a high probability of maintaining
independence, the recom-
mended score for the 30s STS test is�14 for women aged 70–74
years. Thus, an appropriate
exercise regimen can be prescribed by health professionals
aimed toward improving lower
extremity muscle strength and endurance to achieve satisfactory
performance in the 30s STS
test, i.e. physical function improvement. Therefore, PFTs are
valuable for OAs to monitor their
functional status, and for professionals to screen and detect OAs
at high risk.
Physical Fitness and Successful Aging
PLOS ONE | DOI:10.1371/journal.pone.0150389 March 10,
2016 8 / 12
In this study, some PFTs, such as OLS, chair SRT, and DR tests
showed no significant asso-
ciation with SA. Data of the OLS test was not normally
distributed and exhibited the floor
effect. Therefore, more functional and dynamic balance tests,
such as TUG and FR, could be
more suitable options than the OLS for measuring the balance
performance in the older
25. population.
Flexibility, a variable closely relevant to pain and discomfort, is
also necessary for OAs to
maintain a better functional state and remain independent. A
similar result to our study was
reported by Chow et al [48]; they investigated the association of
out-of-home activities and
physical fitness with SA, and found that muscular strength and
cardiovascular fitness were sig-
nificant factors for SA, but not flexibility. Limited joint range-
of-motion is more closely associ-
ated with functional state than is flexibility. Unsatisfactory
flexibility may not represent a joint
range-of-motion limitation; however, it influences body
functioning and dependence ability.
The mean of chair SRT tests in our study were similar to those
reported in a previous study
[49].
The DR test represents the reaction time. Our results showed
that a quick reaction time or
agility is not a crucial determinant of SA.
The final multivariate logistic model found that no PFT
variables were significantly associ-
ated with SA after adjustment. After excluding
multicollinearity, it is possible that the sample
size in our study was insufficient and may have caused model
instability.
In addition to an insufficient sample size, this study has several
other limitations. First, the
study was based on a convenience sample from Northern
Taiwan. Different regions may pos-
sess different SA-associated factors; therefore, the results
26. should be generalized with caution,
and further research should include random sampling of a
representative geographical areas.
Moreover, we did not include OAs who could not perform the
PFTs. Although they did not
meet the SA criteria described in our study, this does not mean
that they were unsuccessful
agers. Montross et al [39] reported that of subjects who rated
themselves as successful agers,
only 30% were free of disability. SA can be considered a
subjective concept; however, in this
study, we attempted to define it objectively. SA is a
multidimentinal concept, which can be
achieved through adaption and compensation [4]. Thus, our
results cannot be generalized to
all the older population.
Second, the social domain of the SA definition adopted in our
study may not be a standard
measure. The SF-36 score may not fully represent the extent of
a person’s engagement with life.
A measurement bias may have developed. Third, certain data
were missing in our study; how-
ever, the results were similar after multiple imputation
procedures.
Finally, we conceptually defined independence in performing
ADL or IADL as the physical
component of SA, which logically may be correlated with
improved physical fitness. However,
the measures of physical fitness representing mobility function
is in a different construct to the
ADL measure. Improved physical fitness can help to achieve
independence in performing
ADL; however, a successful ager who is completely independent
in performing ADL or IADL
27. may not necessarily have strong physical fitness. Moreover,
deterioration of the SA-related fit-
ness measures usually precedes functional dependence, which
makes early detection and pre-
vention possible.
Conclusions
In this study, we aimed to determine the factors associated with
SA among Taiwanese commu-
nity-dwelling OAs. In the sample of 378 subjects, 26.5% of
them were successful agers. Our
results suggested that, apart from the known factors of age,
education level, and regular exer-
cise, PFTs are also SA-associated significant factors. Favorable
cardiopulmonary endurance,
Physical Fitness and Successful Aging
PLOS ONE | DOI:10.1371/journal.pone.0150389 March 10,
2016 9 / 12
muscle strength and endurance, and balance and mobility are
crucial SA-associated factors.
However, these factors could be cause or effect. A longitudinal
study is required to investigate
the causality of the determined factors. PFTs are easy to
perform in community or clinical set-
tings. Thus, these tests are recommended for the early detection
and monitoring of SA status in
OAs.
Acknowledgments
We thank all the participants for their time and efforts in
completing the physically demanding
28. tests.
Author Contributions
Conceived and designed the experiments: PSL HSC. Performed
the experiments: TJT SCS PSL
HSC. Analyzed the data: CCH. Contributed
reagents/materials/analysis tools: PSL HSC. Wrote
the paper: CCH PSL.
References
1. Chang HT, Lai HY, Hwang IH, Ho MM, Hwang SJ. Home
healthcare services in Taiwan: a nationwide
study among the older population. BMC health services
research. 2010; 10:274. Epub 2010/09/22. doi:
10.1186/1472-6963-10-274 PMID: 20854692; PubMed Central
PMCID: PMC2955015.
2. Kalache A, Gatti A. Active ageing: a policy framework.
Advances in gerontology = Uspekhi gerontologii
/ Rossiiskaia akademiia nauk, Gerontologicheskoe obshchestvo.
2003; 11:7–18. Epub 2003/06/25.
PMID: 12820516.
3. Rowe JW, Kahn RL. Successful aging. The Gerontologist.
1997; 37(4):433–40. Epub 1997/08/01.
PMID: 9279031.
4. Young Y, Frick KD, Phelan EA. Can successful aging and
chronic illness coexist in the same individ-
ual? A multidimensional concept of successful aging. Journal of
the American Medical Directors Asso-
ciation. 2009; 10(2):87–92. Epub 2009/02/04. doi:
10.1016/j.jamda.2008.11.003 PMID: 19187875.
5. Depp CA, Jeste DV. Definitions and predictors of successful
29. aging: a comprehensive review of larger
quantitative studies. The American journal of geriatric
psychiatry: official journal of the American Asso-
ciation for Geriatric Psychiatry. 2006; 14(1):6–20. Epub
2006/01/13. doi: 10.1097/01.JGP.0000192501.
03069.bc PMID: 16407577.
6. Formiga F, Ferrer A, Megido MJ, Chivite D, Badia T, Pujol
R. Low co-morbidity, low levels of malnutri-
tion, and low risk of falls in a community-dwelling sample of
85-year-olds are associated with successful
aging: the Octabaix study. Rejuvenation research. 2011;
14(3):309–14. Epub 2011/05/10. doi: 10.
1089/rej.2010.1131 PMID: 21548756.
7. Ng TP, Broekman BF, Niti M, Gwee X, Kua EH.
Determinants of successful aging using a multidimen-
sional definition among Chinese elderly in Singapore. The
American journal of geriatric psychiatry: offi-
cial journal of the American Association for Geriatric
Psychiatry. 2009; 17(5):407–16. Epub 2009/04/25.
doi: 10.1097/JGP.0b013e31819a808e PMID: 19390298.
8. Parslow RA, Lewis VJ, Nay R. Successful aging:
development and testing of a multidimensional model
using data from a large sample of older australians. Journal of
the American Geriatrics Society. 2011;
59(11):2077–83. Epub 2011/11/19. doi: 10.1111/j.1532-
5415.2011.03665.x PMID: 22091484.
9. Berkman LF, Seeman TE, Albert M, Blazer D, Kahn R, Mohs
R, et al. High, usual and impaired function-
ing in community-dwelling older men and women: findings
from the MacArthur Foundation Research
Network on Successful Aging. Journal of clinical epidemiology.
1993; 46(10):1129–40. Epub 1993/10/
30. 01. PMID: 8410098.
10. Seeman TE, Charpentier PA, Berkman LF, Tinetti ME,
Guralnik JM, Albert M, et al. Predicting changes
in physical performance in a high-functioning elderly cohort:
MacArthur studies of successful aging. J
GERONTOL. 1994; 49(3):M97–M108. PMID: 8169338
11. Seeman TE, Berkman LF, Charpentier PA, Blazer DG,
Albert MS, Tinetti ME. Behavioral and psycho-
social predictors of physical performance: MacArthur studies of
successful aging. J GERONTOL SER
A BIOL SCI MED SCI. 1995; 50(4):M177–M83.
12. Achour EC, Barthelemy JC, Lionard KC, Trombert B,
Lacour JR, Thomas-Anterion C, et al. Level of
physical activity at the age of 65 predicts successful aging
seven years later: the PROOF study.
Physical Fitness and Successful Aging
PLOS ONE | DOI:10.1371/journal.pone.0150389 March 10,
2016 10 / 12
http://dx.doi.org/10.1186/1472-6963-10-274
http://www.ncbi.nlm.nih.gov/pubmed/20854692
http://www.ncbi.nlm.nih.gov/pubmed/12820516
http://www.ncbi.nlm.nih.gov/pubmed/9279031
http://dx.doi.org/10.1016/j.jamda.2008.11.003
http://www.ncbi.nlm.nih.gov/pubmed/19187875
http://dx.doi.org/10.1097/01.JGP.0000192501.03069.bc
http://dx.doi.org/10.1097/01.JGP.0000192501.03069.bc
http://www.ncbi.nlm.nih.gov/pubmed/16407577
http://dx.doi.org/10.1089/rej.2010.1131
http://dx.doi.org/10.1089/rej.2010.1131
http://www.ncbi.nlm.nih.gov/pubmed/21548756
31. http://dx.doi.org/10.1097/JGP.0b013e31819a808e
http://www.ncbi.nlm.nih.gov/pubmed/19390298
http://dx.doi.org/10.1111/j.1532-5415.2011.03665.x
http://www.ncbi.nlm.nih.gov/pubmed/22091484
http://www.ncbi.nlm.nih.gov/pubmed/8410098
http://www.ncbi.nlm.nih.gov/pubmed/8169338
Rejuvenation research. 2011; 14(2):215–21. Epub 2011/04/02.
doi: 10.1089/rej.2010.1101 PMID:
21453015.
13. Chou KL, Chi I. Successful aging among the young-old, old-
old, and oldest-old Chinese. Int J Aging
Hum Dev. 2002; 54(1):1–14. doi: 10.2190/9k7t-6kxm-c0c6-
3d64 PMID: 12003497
14. Li C, WuW, Jin H, Zhang X, Xue H, He Y, et al. Successful
aging in Shanghai, China: Definition, distri-
bution and related factors. Int Psychogeriatr. 2006; 18(3):551–
63. doi: 10.1017/s1041610205002966
PMID: 16478568
15. Gill TM, Williams CS, Tinetti ME. Assessing risk for the
onset of functional dependence among older
adults: the role of physical performance. Journal of the
American Geriatrics Society. 1995; 43(6):603–
9. Epub 1995/06/01. PMID: 7775716.
16. Gill TM, Williams CS, Richardson ED, Tinetti ME.
Impairments in physical performance and cognitive
status as predisposing factors for functional dependence among
nondisabled older persons. The jour-
nals of gerontology Series A, Biological sciences and medical
sciences. 1996; 51(6):M283–8. Epub
1996/11/01. PMID: 8914500.
32. 17. Kuh D, Karunananthan S, Bergman H, Cooper R. A life-
course approach to healthy ageing: maintaining
physical capability. The Proceedings of the Nutrition Society.
2014; 73(2):237–48. Epub 2014/01/25.
doi: 10.1017/S0029665113003923 PMID: 24456831; PubMed
Central PMCID: PMC3981474.
18. Katz S, Ford AB, Moskowitz RW, Jackson BA, Jaffe MW.
Studies of Illness in the Aged. The Index of
Adl: A Standardized Measure of Biological and Psychosocial
Function. JAMA: the journal of the Ameri-
can Medical Association. 1963; 185:914–9. Epub 1963/09/21.
PMID: 14044222.
19. Lawton MP, Brody EM. Assessment of older people: self-
maintaining and instrumental activities of daily
living. The Gerontologist. 1969; 9(3):179–86. Epub 1969/01/01.
PMID: 5349366.
20. Guo NW, Liu HC, Wong PF, Liao KK, Yan SH, Lin KP, et
al. Chinese version and norms of the Mini-
Mental State Examination. J Chin Rehabil Med. 1988;(16: ):52–
9.
21. Liu HC, Lin KN, Teng EL, Wang SJ, Fuh JL, Guo NW, et
al. Prevalence and subtypes of dementia in
Taiwan: a community survey of 5297 individuals. Journal of the
American Geriatrics Society. 1995; 43
(2):144–9. Epub 1995/02/01. PMID: 7836638.
22. Liu CK, Lin RT, Chen YF, Tai CT, Yen YY, Howng SL.
Prevalence of dementia in an urban area in tai-
wan. Journal of the Formosan Medical Association = Taiwan yi
zhi. 1996; 95(10):762–8. Epub 1996/10/
01. PMID: 8961673.
33. 23. Lee H-cB, Chiu HFK, KowkWY, Leung CM, et al. Chinese
elderly and the GDS short form: A prelimi-
nary study. Clinical Gerontologist: The Journal of Aging and
Mental Health. 1993; 14(2):37–42.
24. Lim PP, Ng LL, Chiam PC, Ong PS, Ngui FT, Sahadevan S.
Validation and comparison of three brief
depression scales in an elderly Chinese population.
International journal of geriatric psychiatry. 2000;
15(9):824–30. Epub 2000/09/14. PMID: 10984729.
25. Tseng H-M, Lu J-FR, Tsai Y-J. Assessment of Health-
related Quality of Life in Taiwan (Ⅱ): Norming and
Validation of SF-36 Taiwan Version. Taian J Public Health.
2003; 22(6):512–8.
26. Schaubert KL, Bohannon RW. Reliability and validity of
three strength measures obtained from commu-
nity-dwelling elderly persons. Journal of strength and
conditioning research / National Strength & Con-
ditioning Association. 2005; 19(3):717–20. Epub 2005/08/13.
doi: 10.1519/R-15954.1 PMID:
16095431.
27. Therapists ASoH. Clinical Assessment Recommendations:
American Society of Hand Therapists;
1992.
28. Rikli RE, Jones CJ. Senior Fitness Test Manual: Human
Kinetics; 2012.
29. Duncan PW,Weiner DK, Chandler J, Studenski S. Functional
reach: a new clinical measure of balance.
Journal of gerontology. 1990; 45(6):M192–7. Epub 1990/11/01.
PMID: 2229941.
34. 30. Vellas BJ, Rubenstein LZ, Ousset PJ, Faisant C, Kostek V,
Nourhashemi F, et al. One-leg standing bal-
ance and functional status in a population of 512 community-
living elderly persons. Aging (Milano).
1997; 9(1–2):95–8. Epub 1997/02/01. PMID: 9177591.
31. Podsiadlo D, Richardson S. The timed "Up & Go": a test of
basic functional mobility for frail elderly per-
sons. Journal of the American Geriatrics Society. 1991;
39(2):142–8. Epub 1991/02/01. PMID:
1991946.
32. Johnson L, Nelson B. Practical Measurements for
Evaluation in Physical Education. New York: Mac-
millan; 1986.
33. McLaughlin SJ, Connell CM, Heeringa SG, Li LW, Roberts
JS. Successful aging in the United States:
prevalence estimates from a national sample of older adults.
The journals of gerontology Series B, Psy-
chological sciences and social sciences. 2010; 65B(2):216–26.
Epub 2009/12/17. doi: 10.1093/geronb/
gbp101 PMID: 20008481; PubMed Central PMCID:
PMC2981444.
Physical Fitness and Successful Aging
PLOS ONE | DOI:10.1371/journal.pone.0150389 March 10,
2016 11 / 12
http://dx.doi.org/10.1089/rej.2010.1101
http://www.ncbi.nlm.nih.gov/pubmed/21453015
http://dx.doi.org/10.2190/9k7t-6kxm-c0c6-3d64
http://www.ncbi.nlm.nih.gov/pubmed/12003497
http://dx.doi.org/10.1017/s1041610205002966
36. 37. IBM. IBM SPSSMissing Values 20: IBM; 2011. Available
from: ftp://ftp.boulder.ibm.com/software/
analytics/spss/documentation/statistics/20.0/zh_TW/client/Manu
als/IBM_SPSS_Missing_Values.pdf.
38. Cosco TD, Prina AM, Perales J, Stephan BC, Brayne C.
Operational definitions of successful aging: a
systematic review. International psychogeriatrics / IPA. 2014;
26(3):373–81. Epub 2013/12/07. doi: 10.
1017/S1041610213002287 PMID: 24308764.
39. Montross LP, Depp C, Daly J, Reichstadt J, Golshan S,
Moore D, et al. Correlates of self-rated success-
ful aging among community-dwelling older adults. The
American journal of geriatric psychiatry: official
journal of the American Association for Geriatric Psychiatry.
2006; 14(1):43–51. Epub 2006/01/13. doi:
10.1097/01.JGP.0000192489.43179.31 PMID: 16407581.
40. Baker J, Meisner BA, Logan AJ, Kungl AM, Weir P.
Physical activity and successful aging in canadian
older adults. J Aging Phys Activ. 2009; 17(2):223–35.
41. den Ouden ME, Schuurmans MJ, Arts IE, van der Schouw
YT. Physical performance characteristics
related to disability in older persons: a systematic review.
Maturitas. 2011; 69(3):208–19. Epub 2011/
05/21. doi: 10.1016/j.maturitas.2011.04.008 PMID: 21596497.
42. den Ouden ME, Schuurmans MJ, Brand JS, Arts IE,
Mueller-Schotte S, van der Schouw YT. Physical
functioning is related to both an impaired physical ability and
ADL disability: a ten year follow-up study
in middle-aged and older persons. Maturitas. 2013; 74(1):89–94.
Epub 2012/11/20. doi: 10.1016/j.
37. maturitas.2012.10.011 PMID: 23159191.
43. Cooper R, Kuh D, Hardy R. Objectively measured physical
capability levels and mortality: systematic
review and meta-analysis. BMJ. 2010; 341:c4467. Epub
2010/09/11. doi: 10.1136/bmj.c4467 PMID:
20829298; PubMed Central PMCID: PMC2938886.
44. Wang CY, Yeh CJ, Hu MH. Mobility-related performance
tests to predict mobility disability at 2-year fol-
low-up in community-dwelling older adults. Archives of
gerontology and geriatrics. 2011; 52(1):1–4.
Epub 2009/12/01. doi: 10.1016/j.archger.2009.11.001 PMID:
19945178.
45. Toraman A, Yildirim NU. The falling risk and physical
fitness in older people. Archives of gerontology
and geriatrics. 2010; 51(2):222–6. Epub 2009/11/27. doi:
10.1016/j.archger.2009.10.012 PMID:
19939475.
46. Shimada H, Suzuki T, SuzukawaM, Makizako H, Doi T,
Yoshida D, et al. Performance-based assess-
ments and demand for personal care in older Japanese people: a
cross-sectional study. BMJ open.
2013; 3(4). Epub 2013/04/13. doi: 10.1136/bmjopen-2012-
002424 PMID: 23578683; PubMed Central
PMCID: PMC3641481.
47. Rikli RE, Jones CJ. Development and validation of
criterion-referenced clinically relevant fitness stan-
dards for maintaining physical independence in later years. The
Gerontologist. 2013; 53(2):255–67.
Epub 2012/05/23. doi: 10.1093/geront/gns071 PMID: 22613940.
48. Chow HW, Chen HC, Lin LL. Association between out-of-
38. home trips and older adults' functional fitness.
Geriatrics & gerontology international. 2014; 14(3):596–604.
Epub 2013/09/07. doi: 10.1111/ggi.12143
PMID: 24007358.
49. Chen HT, Lin CH, Yu LH. Normative physical fitness scores
for community-dwelling older adults. The
journal of nursing research: JNR. 2009; 17(1):30–41. Epub
2009/04/09. doi: 10.1097/JNR.
0b013e3181999d4c PMID: 19352227.
Physical Fitness and Successful Aging
PLOS ONE | DOI:10.1371/journal.pone.0150389 March 10,
2016 12 / 12
http://dx.doi.org/10.1093/geront/gns005
http://www.ncbi.nlm.nih.gov/pubmed/22403165
http://www.ncbi.nlm.nih.gov/pubmed/1512391
http://dx.doi.org/10.1111/j.1532-5415.2008.02168.x
http://dx.doi.org/10.1111/j.1532-5415.2008.02168.x
http://www.ncbi.nlm.nih.gov/pubmed/19220562
ftp://ftp.boulder.ibm.com/software/analytics/spss/documentation
/statistics/20.0/zh_TW/client/Manuals/IBM_SPSS_Missing_Val
ues.pdf
ftp://ftp.boulder.ibm.com/software/analytics/spss/documentation
/statistics/20.0/zh_TW/client/Manuals/IBM_SPSS_Missing_Val
ues.pdf
http://dx.doi.org/10.1017/S1041610213002287
http://dx.doi.org/10.1017/S1041610213002287
http://www.ncbi.nlm.nih.gov/pubmed/24308764
http://dx.doi.org/10.1097/01.JGP.0000192489.43179.31
http://www.ncbi.nlm.nih.gov/pubmed/16407581
http://dx.doi.org/10.1016/j.maturitas.2011.04.008
http://www.ncbi.nlm.nih.gov/pubmed/21596497
http://dx.doi.org/10.1016/j.maturitas.2012.10.011
40. Jeanette M Daly, Amy N Schmeidel Klein and Gerald J Jogerst
ABSTRACT
Aims: To explore through interviews of critical care nurses their
perspectives on elder abuse to achieve a better understanding of
the problems
of reporting and generate ideas for improving the process.
Background: In 44 states and the District of Columbia health
care providers are required by law to report elder abuse but the
patient,
patient’s family and health care providers all have barriers to
reporting allegations of elder abuse.
Design: This study design is qualitative.
Method: Through a mailed survey, critical care nurses were
invited to participate in a taped in-depth qualitative interview.
Results: Ten nurses were interviewed. A thematic analysis was
used to describe the following core themes: types of elder
abuse, suspicions
of elder abuse, reporting of elder abuse, barriers to reporting
elder abuse, legislation and improvement in practice.
Conclusions: Critical care nurses are aware of elder abuse and
somewhat systematically evaluate for abuse at admission to
their unit. They
recognize signs and symptoms of abuse and are suspicious when
it is warranted. They are aware of why an older person does not
want to
report abuse and take this into consideration when soliciting
information. Facts, values and experience influence personally
defining abuse,
suspicion and dependence for each individual health care
professional.
Relevance to clinical practice: Critical care unit protocols
and/or policies and procedure for reporting elder abuse are
needed in critical
care settings and are warranted for providing quality of care.
41. Key words: Critical care • Elder abuse • Mandatory reporting •
Qualitative study
A recent national study found 1 in 10 of 5777
respondents, persons 60 years and older, reported
emotional, physical or sexual mistreatment or potential
neglect in the last year (Acierno et al., 2010). It is difficult
for persons who are older to report mistreatment.
Victims have many reasons for not reporting elder
mistreatment, including fear of retaliation, being
afraid of institutionalization, being ashamed, lack of
information on who to contact for reporting and
thinking no one can help (National Research Council
of the National Academies, 2003).
In the critical care setting, patients are treated for
brief but severe episodes of illness, and the intensity of
the situation may not allow for exploration or thoughts
of elder abuse. Barriers for health care providers in
the critical care setting for reporting elder abuse are
Authors: JM Daly, RN, PhD, Associate Research Scientist,
Department of
Family Medicine, University of Iowa, Iowa City, IA, USA; AN
Schmeidel
Klein, BA, Medical Student (M4), Carver College of Medicine,
University of
Iowa, Iowa City, IA, USA; GJ Jogerst, MD, Professor/Associate
Head,
Department of Family Medicine, University of Iowa, Iowa City,
IA, USA
Address for correspondence: JM Daly, Department of Family
Medicine, University of Iowa, 01290-F PFP, 200 Hawkins
Drive, Iowa City,
IA 52242, USA
E-mail: [email protected]
43. older, findings indicated that the patients were poorly
screened for elder abuse and 7 persons were victims
of abuse, neglect or self-neglect; but only two cases
had intervention by adult protective services (Bird
et al., 1998). In another study, physicians were found to
report only 2% of all suspected cases (Rosenblatt et al.,
1996). In the same study, a substantially larger number
of cases were reported by social workers (18%) and
nurses (26%).
From 2010 to 2050, the US population is expected
to grow from 310 to 439 million, and by 2030 one
in five persons will be 65 years and older. Health
care professionals in all settings will need to become
increasingly aware of elder abuse and reporting
mechanisms (Vincent and Velkoff, 2010). From 2010
to 2030, the dependency ratio (number of persons
65 years and older to every 100 persons of traditional
working age) will increase from 22 to 35 persons. The
higher the dependency ratio, the greater the potential
burden on health care (US Census Bureau, 2011).
Reasons for lack of reporting are understudied.
While laws require reporting regardless of mitigating
circumstances, most health care professionals consider
the broader context of the patient before reporting,
including patient autonomy and rights, patient-
physician confidentiality, quality of life and future
patient-health care professional relationships (Daly
et al., 2003). Rodriguez et al. (2006) interviewed a
convenience sample of 20 family and general internal
medicine physicians to identify their perspectives on
mandated reporting of elder abuse. They reported
that physicians worry about future physician-patient
rapport and trust, patient quality of life and physician
control when deciding to make an elder abuse report
44. (Rodriguez et al., 2006). Schmeidel and colleagues
expanded that study and interviewed nurses and
physicians in primary care settings with a main
conclusion that pragmatic elder abuse education
is necessary and the reporting system may need
reorganization (Schmeidel et al., 2012).
This study continues the author’s earlier work
and examines the perspectives of other health care
professionals, critical care nurses. It has been noted
that there is sparse research regarding critical care
nurses and their perceptions of elder abuse (Burgess
et al., 2006; Daly et al., 2011). The purpose of this study
was to explore through interviews of critical care
nurses their perspectives on elder abuse, to achieve
a better understanding of the problems of reporting
and to generate ideas for improving the process.
This qualitative approach using in-depth interviews
is appropriate for exploring a complex domain that is
not fully understood – in this case, perspectives on and
barriers to mandatory reporting of elder abuse – and
is meant to be hypothesis generating rather than
hypothesis testing.
METHODS
The methods for this project were approved by
the Institutional Review Board of the University of
Iowa. Methods are described for subject recruitment,
instrument, interviews and qualitative analyses.
Subject recruitment
A list of critical care nurses was obtained from the Iowa
Board of Nursing. All nurses employed in critical care
settings were selected from three counties in Iowa. A
cover letter with the list of interview questions was
45. sent to all 396 nurses. Also included in the envelope
was a form to complete and return in a postage-paid
envelope indicating the respondent would participate
in this study. Contact information was provided on
the form. After receipt of agreement to participate, a
researcher contacted the respondent and set up a time
and place for interview. Thirty-eight envelopes from
nurses were returned as undeliverable. No further
attempts were made to engage non-responders after
the initial invitation letter.
Instrument and interviews
An interview guide developed by Rodriguez and
colleagues (2006) was used for this study. The guide
had 13 open-ended interview questions (Appendix A)
and was developed from literature review and expert
input. The questions were developed for physicians
and were modified for the critical care nurses. No
demographic information was collected because of
the sensitivity of the topic. Anonymity was protected
because a respondent could indicate they were aware
of an elder abuse incident and had not reported it,
which would be in violation of Iowa laws.
One interviewer (A. S.) was trained in ethnographic
techniques, and she has conducted similar research.
The interviews were conducted in the respondent’s or
interviewer’s office. At the beginning of the interview,
respondents were reminded not to indicate who they
were or the names of any of the abuse victims.
Interviews lasted from 20 to 50 min, were all tape-
recorded, and transcribed verbatim.
Qualitative analysis
A multi-step process of thematic analysis was used
to identify the core themes that represent the per-
47. Nurses reported the kinds of abuse they may encounter
as emotional abuse, financial exploitation, neglect
and physical abuse. None of the nurses reported
sexual abuse, and one nurse stated: ‘I’m trying to
think. . .I don’t think we’ve ever seen sexual. . .not to
my knowledge’. Another nurse stated, ‘I’ve worked in
the surgical intensive care unit for over 20 years and
I haven’t seen any signs of any physical abuse, partly
because as a nurse in the ICU, you’re usually so busy
you don’t have time to scratch your nose’.
Neglect issues were frequently mentioned and
described as the patient having many sores on the
body, bruises, needing hygiene care and looking
malnourished. One nurse reported, ‘They will be very
filthy. They’ll have sores. It’s obvious they haven’t been
bathed or shampooed for a long time. So we see a lot
of that type of thing’.
An example of financial exploitation was provided.
‘The patient was on a ventilator, controlled life support,
and the family wanted us to wake him up to sign his
social security check. And that was kind of like a red
flag right there. And the patient was in for 3 months,
and the only time we saw the family was the first of
the month when the check came in’.
A report of actual abuse occurring in the intensive
care unit was depicted by a nurse. ‘I had one case
where the wife would come in every day and sat for
3 hours next to her husband’s bed, and shortly after
she left the ventilator alarm would always go off, and
we could never figure out why, and we always ended
up changing the tubing. Well, we sat and watched her
one day, and she sat there with her sewing needles
48. and was poking all these holes in the ventilator tubing.
And she’d called in later, asking, ‘‘Oh, is he still alive’’?
So, that was something we did report’.
Suspicions of elder abuse
Nurses report being suspicious of elder abuse if the
patient (a) depicts being malnourished and unkempt;
(b) has bruising or other marks on the body with
no reasonable explanation; (c) has burn marks in
places where the patient can not reach; (d) can not
provide a clear explanation/reluctance to answer
questions; or (e) if a family member hovers or appears
uncomfortable with health care professionals present.
Many reported suspicions because of evidence such as
sores on their body and the patient being hungry.
Two nurses reported their admission questionnaire
asks about their care at home and if they are safe.
One reported, ‘The joint commission standards have
mandated that we ask people, you know, have you
been sexually abused, have you ever been physically
abused, and that sort of thing. So, my particular
situation, it’s rare. . .we ask those questions to an
awake and oriented person. Well, most of our people
come to us completely anesthetized from the operating
room, and by the time they do wake up they’re pretty
disoriented’.
A nurse described one situation as, ‘an elderly
gentleman came in with cigarette burns on his back,
and he did not smoke, and a step-son who was a
primary care giver did. We just kind of figured that
had to be the son. There was no logical explanation for
it [other] than that. And it wasn’t a single burn; it was
multiple burns on his back’.
50. seem right here’. Stressing the importance of physical
injuries, one nurse would find the physician probably
first, so that the physical conditions can be dealt with,
and then we have our nurse managers, and the nurse
managers’ then are required to notify appropriate
people’.
Nurses generally seemed to let someone else do
the actual reporting to the state’s adult protective
services agency. ‘No, I’ve never reported the abuse.
I’ve told them what I’ve noticed, and then the social
worker does the report’. And another similar response,
‘We’ve got the chain of command: our charge nurses,
or supervisor, and so on. It’s always worked. We have
an excellent social worker’.
Another similar theme to reporting was that the
nurses did not know what happens after the allegation
is reported to the social worker. A nurse described,
‘I’m not sure how the system works as far as reporting
up past the social worker. . .where it’s supposed to
go, but I’d always go to the social worker’. Similarly,
nurses did not know the end result of the case, if it was
founded or not. A nurse conveyed, ‘I don’t really know
whatever happens afterwards. It goes to the manager,
it goes to the social worker, and then it goes to. . .I
don’t know, like a safety officer or something and then
it goes. . .I don’t know where it goes. It goes to some
federal officer and then state gets notified. So, it’s like,
where does it go? It’s like out there in virtual space or
something’. Another nurse said, ‘We never find out a
result’.
In emergency situations, a nurse reported, ‘If it was
severe enough you would have to call the authorities.
Absolutely, call the police and make sure whoever
51. the perpetrator was had no access to the patient’. And
because of the shift changes and staffing, another nurse
conveyed, ‘. . .because we do 12-hour shifts, but there
are a lot of nurses that take care of these patients, so
you always want to make sure to give your thoughts
and your feedback to give it to the next nurse to be
sure it doesn’t fall through the cracks. Because you’re
not going to come back a week later and be like, Well
you know I thought there could potentially be. . .You
don’t want that’.
Barriers to reporting elder abuse
Reasons provided by the nurses why patients are
reluctant to report being abused include being scared,
feeling they deserve the abuse, it may get worse when
they get home, fear of being relocated to a nursing
home or different institution, fear of abandonment or
they do not want to get their children in trouble. One
nurse stated, ‘You have an inverse ratio of power in that
relationship, whether it’s with a spouse, or a neighbor,
or a child, or whoever the perpetrator is. These people
are older. They are dependent on who ever or at
least their perception is that they are dependent on
that person for whatever, shelter, food, clothing, care,
money, or whatever. I think they are afraid to disrupt
it’. Another nurse reiterated the same thought, ‘people
that are co-dependent on other people tend to need
that other person and tend to justify [the abuse]’.
A similar thread across interviews was that the
perpetrator was a relative and they did not want to
get them in trouble. The nurse felt the patient thinks,
‘Oh, I brought this child up, this is how I brought them
up to be. They get real touchy when it’s their kid’.
53. 5 years thereafter. Additional content to this curricu-
lum was suggested, as ‘more education about it [report-
ing abuse], what we can and cannot do. And our legal
liability, are we putting ourselves up for a lawsuit’.
Another complaint about the law was ‘the law doesn’t
lay out the signs and symptoms [of abuse], doesn’t tell
you when you see it. It doesn’t give you that way of
noticing the abuse. It just gives you a way of contacting
the law enforcement. It doesn’t give you a way of recog-
nizing the abuse or. . .how to recognize the symptoms’.
I think it’s adequate, but like I said I’d like to have some-
thing on elderly abuse and just abuse in general annu-
ally. Because I don’t think every 3 years is enough’.
In response to the law needing to be better enforced,
one nurse stated, ‘we don’t have investigators out
there’. Indicating that the law should provide for
additional investigators for conducting investigations
of alleged abuse. Another final thought on the law was,
‘in the best of all worlds, we wouldn’t have abuse [and
then wouldn’t need the law]’.
Improvement in practice
Various ideas were suggested for improving nursing
practice for elder abuse in critical care. Suggestions
included the following: conduct health history in
private, ask safety questions on admission assessment,
readdress the issue of elder abuse at discharge from the
unit, establish the reporting of elder abuse as a priority
for the unit and offer elder abuse education in addition
to that required by law.
One nurse reports, ‘On admissions, we ask questions
like, Are you in a relationship where you feel unsafe?
Are you in a relationship where you are being harmed
54. by someone? Do you want to harm yourself’? Those
kinds of things. We ask those questions, and that
gives them an opportunity to say, ‘Yes’. Emphasizing
the need for admission assessment, another nurse
responded, ‘You know, I think probably. . . , you have
to identify that there is truly a problem, and for
example, a problem there. Epidemiology comes up,
documents transmission of one bacteria from one
patient to another that can be stopped by washing
your hands. And they show that there is a problem.
And if there is problem that it can be changed by doing
this. So, I think that if you could document that there
is some type of abuse going on, then I think there is
more motivation, and maybe that’s how to change’.
Additional education was suggested by providing
information about the seriousness of elder abuse. A
nurse suggested, ‘I think it should almost be like an
annual thing that they cover in the hospital. Because,
I don’t know, I think with the way the economic
situation is out there. . . .I just think things are going
to get worse instead of better and I think we need
to be more aware of that’. Another nurse stated, ‘Just
keeping the education going’.
In conclusion to the interviews, one nurse stated, ‘I
just really think we’re on top of it. Not to toot our own
horn, but I really do, I really think that we’re on top
of it. . .any admission, I mean, we’re really looking at
those things whether you realize it or not’.
DISCUSSION
The purpose of this study was to explore the
perspectives of critical care nurses on elder abuse
to achieve a better understanding of the problems of
55. reporting and generate ideas for improving the process.
A variety of responses emerged, some responses
similar for a particular concept and dissimilar for other
concepts.
Intensive care nurses are aware of the different types
of elder abuse. They described different scenarios
regarding emotional abuse, financial exploitation,
neglect and physical abuse and noted that none were
aware of sexual abuse. Being aware of abuse is the
first step in caring for persons who are at-risk or
are victims of abuse. Burgess and colleagues (2006)
emphasize the importance for critical care nurses of
having protocols in place to detect and manage elder
sexual abuse. Protocols would allow nurses to detect
abusive instances but also identify risk factors that
may contribute to abuse and establish a mechanism for
reporting the suspicion or allegation of abuse.
These nurses want to do the right thing: i.e. to
ensure that victims of elder abuse are identified and
properly cared for during their ICU stay and after
discharge. ICU policies and procedures must be an
integral part of the standards of care. Hoyt provides
a compliance checklist for forensic issues in the ICU
that includes the following: (a) staff orientation for use
of abuse and neglect screening tools with appropriate
documentation, (b) forensic case management criteria,
(c) management of sentinel events (such as death from
neglect), (d) equipment and supplies for evidentiary
specimens available in a dedicated, locked storage
area, (e) references and resources available to all staff
members and (f) procedures that include collection
of specimens, photo documentation, chain-of-custody
and reporting/referral (Hoyt, 2006).
57. the report. No feedback is provided to them about
further investigation by the state’s adult protective
services unit. This lack of feedback may be a reason
why one nurse thought there were not enough
investigators in the state. Hospital social services
could implement a protocol that provides feedback
to reporters when they are notified of the decision
by adult protective services to accept the report and
provide an outcome of the investigation. Having such
a mechanism in place would raise awareness of elder
abuse and provide the reporter with more confidence
that the extra work of investigating was worth the
effort.
No new information was gleaned from the nurses’
perceptions regarding the older person’s rationale for
not reporting elder abuse. The nurses described the
law for dependent elder abuse on a continuum, from
not being necessary to the need for it to be in place. As
health care professionals in Iowa, nurses are required
by law to be mandatory reporters. A suggestion from
nurses in critical care units is that they be notified when
the abuse they have reported to hospital employees is
actually reported to adult protective services. Hospital
employees who report the allegation of abuse receive
the results of adult protective services investigations
and should report those results to the health care
professionals involved in the collection of relevant
information.
While Iowa is currently the only state with manda-
tory training on dependent adult abuse, confusion still
persists as to the actual law surrounding both abuse
and mandatory reporting, especially by nurses (Jogerst
et al., 2003). Differing institutional requirements and
chains of command may contribute to this confusion.
58. However, when asked what changes or improvements
could be made, many people from all groups sug-
gested more frequent and more practical education.
While currently mandated for every 5 years in Iowa,
participants requested refreshers to be given as often
as yearly. They also desired content to focus on specific
cases, how to identify elder abuse, as well as how to
best respond.
Some novel and useful suggestions were offered for
improving critical care practice in relation to elder
abuse. Assessment for abuse or risk factors of abuse is
acknowledged on admission to a unit; however, one
nurse thought this assessment should also occur at
discharge from the unit. Persons admitted to critical
care are in critical condition and usually not of
sound mind to answer questions or provide relevant
information, but at discharge their health has improved
and useful information may be obtained.
Even though Iowa law requires dependent adult
abuse education, the numbers of elder abuse inves-
tigations and substantiations have not changed since
1988, when this law was implemented (Jogerst et al.,
2003). These nurses believe education is valuable and
indicated they want more education than that which is
required every 5 years.
While this sample size was small, it was appropriate
in order to fulfil our study purpose which was to
identify the range and complexity of issues and barriers
perceived by critical care nurses in relation to elder
abuse and within the sample size range for similar
exploratory qualitative studies (Rice and Ezzy, 1999).
Our sample was limited to three counties in Iowa which
60. Training for Students in Health Professions Schools
and the University of Iowa Carver College of Medicine.
WHAT IS KNOWN ABOUT THIS TOPIC
• Elder abuse presents in any health care setting, including
critical care.
• In Iowa, health care providers are required to report
suspicions of elder abuse.
WHAT THIS PAPER ADDS
• Protocols for reporting elder abuse are needed in critical care
settings.
• Barriers for older patients in critical care not reporting abuse
are similar to other settings, including fear of retaliation,
perpetrator is a
relative and physical injury.
REFERENCES
Acierno R, Hernandez MA, Amstadter AB, Resnick HS, Steve
K,
Muzzy W, Kilpatrick DG. (2010). Prevalence and correlates
of emotional, physical, sexual, and financial abuse and
potential neglect in the United States: the national elder
mistreatment study. American Journal of Public Health; 100:
292–297.
Aravanis SC, Adelman RD, Breckman R, Fulmer TT, Holder E,
Lachs M, O’Brien JG, Sanders AB. (1993). Diagnostic and
treatment guidelines on elder abuse and neglect. Archives
of Family Medicine; 2: 371–388.
Beaulaurier RL, Seff LR, Newman FL. (2008). Barriers to help-
61. seeking for older women who experience intimate partner
violence: a descriptive model. Journal of Women & Aging; 20:
231–248.
Bird PE, Harrington DT, Barillo DJ, McSweeney A, Shirani KZ,
Goodwin CW. (1998). Elder abuse: a call to action. Journal of
Burn Care & Rehabilitation; 19: 522–527.
Burgess AW, Watt ME, Brown KM, Petrozzi D. (2006).
Manage-
ment of elder sexual abuse cases in critical care settings.
Critical
Care Nursing Clinics of North America; 18: 313–319.
Clark-Daniels CL, Daniels RS, Baumhover LA. (1990).
Physicians’
and nurses’ responses to abuse of the elderly: a comparative
study of two surveys in Alabama. Journal of Elder Abuse &
Neglect; 1: 57–72.
Crabtree B, Miller W. (1999). Doing Qualitative Research, 2nd
edn.
Thousand Oaks, CA: Sage Publications Inc.
Daly JM, Jogerst GJ. (2001). Statute definitions of elder abuse.
Journal of Elder Abuse & Neglect; 13: 39–57.
Daly JM, Jogerst GJ. (2005). Association of knowledge of adult
protective services legislation with rates of reporting of abuse
in Iowa nursing homes. Journal of the American Medical
Directors
Association; 6: 113–120.
Daly JM, Jogerst GJ, Brinig M, Dawson J. (2003). Mandatory
reporting: relationship of APS statute language on state
reported elder abuse. Journal of Elder Abuse & Neglect; 15:
62. 1–21.
Daly JM, Merchant ML, Jogerst GJ. (2011). Elder abuse
research:
a systematic review. Journal of Elder Abuse & Neglect; 23:
348–365.
Hoyt CA. (2006). Integrating forensic science into nursing
processes in the ICU. Critical Care Nursing Quarterly; 29:
259–270.
Jogerst GJ, Daly JM, Dawson J, Brinig M, Schmuch G. (2003).
Required education for Iowa mandatory reporters of elder
abuse. Journal of Elder Abuse & Neglect; 15: 59–73.
Krueger P, Patterson C. (1997). Detecting and managing elder
abuse: challenges in primary care. Canadian Medical
Association
Journal; 157: 1095–1100.
National Research Council of the National Academies. (2003).
Elder mistreatment: epidemiological assessment methodol-
ogy. In: Bonnie RJ, Wallace RB, (eds), Elder Mistreatment:
Abuse, Neglect, and Exploitation in an Aging America. Wash-
ington, DC: The National Academies Press, 261–302.
Rice P, Ezzy D. (1999). Qualitative Research Methods: A
Health Focus.
Oxford: Oxford University Press.
Rodriguez MA, Wallace SP, Woolf NH, Mangione CM. (2006).
Mandatory reporting of elder abuse: between a rock and a
hard place. Annals of Family Medicine; 4: 403–409.
Rosenblatt DE, Cho KH, Durance PW. (1996). Reporting
mistreat-
63. ment of older adults: the role of physicians. Journal of the
American Geriatrics Society; 44: 65–70.
Schmeidel AN, Daly JM, Rosenbaum ME, Schmuch GA, Jogerst
GJ. (2012). Healthcare professionals’ perspectives on barriers
to elder abuse detection and reporting in primary care settings.
Journal of Elder Abuse & Neglect; 24: 17–36.
Taylor DK, Bachuwa G, Evans J, Jackson-Johnson V. (2006).
Assessing barriers to the identification of elder abuse and
neglect: a community wide survey of primary care physicians.
Journal of the National Medical Association; 98: 403–404.
US Census Bureau. (2011). Aging boomers will increase depen-
dency ratio, census bureau projects: older American pop-
ulation to become more diverse. http://www.census.gov/
newsroom/releases/archives/aging_population/
cb10-72.html (accessed 25/07/11).
Vincent GK, Velkoff VA. (2010). The next four decades: the
older population in the United States: 2010 to 2050.
http://www.census.gov/prod/2010pubs/p25-1138.pdf
(accessed 25/07/11).
Winfrey M, Smith A. (1999). The suspiciousness factor: critical
care nursing and forensics. Critical Care Nursing Quarterly; 22:
1–7.
APPENDIX A: OPEN-ENDED INTERVIEW
QUESTIONS
Instructions: Remember, during the interview, I will be
taping our conversation. Please provide no information
that would identify yourself or any of your patients.
We are interested in understanding nurse’s thoughts on
addressing elder abuse in the outpatient clinical setting.
66. Introduction
In India, the phenomenon of population ageing has
resulted in various challenges on family and the society.
With changes in the family system, older people are no
longer considered an asset to the family. Individualistic
attitude and craving for personal achievements leads
to intergenerational tension and elder abuse within the
family.
‘Elder abuse is a single or repeated act of, or lack of
appropriate action, occurring within any relationship
where there is an expectation of trust which causes harm
or distress to an older person’.(1) Abuse usually occurs
at two sites—home and institution. Abuse occurring at
home is usually not reported either due to unawareness
of the victims regarding different legal provisions or
due to fear of grave consequences by the abuser or due
to social taboo.
The impact of abuse on physical and psychological
healt h of the victims as well as quality of life
is enormous. Abuse can exacerbate chronic and
d i s a b l i n g c o n d i t i o n o f o l d e r p e r s o n a n d
m a k e
t h e p e r s o n m o r e d e p e n d e n t , v u l n e r a b l e , a
n d
marginalized.(2)
Indian data are limited. Lack of well-validated
s c r e e n i n g t o o l m a y b e o n e r e a s o n f o r p o o r
documentation. Hwalek–Sengstock Elder Abuse
Screening Test (H-S EAST) is a tool with 15 items
which targets three domains: violation of personal
r i g h t s o r d i r e c t a b u s e a n d c o n t e x t u a l f a c
67. t o r s
contributing of vulnerability and potentially abusive
situations.(3) The present study was conducted to
assess the prevalence and type of abuse among
community dwelling elderly and to study the various
risk factors associated with it.
Prevalence and Risk Factors of Abuse among
Community Dwelling Elderly of Guwahati City,
Assam
Anku Moni Saikia, Neelakshi Mahanta1, Ajaya Mahanta2,
Ashok Jyoti Deka3, Arupjyoti Kakati4
Departments of Community Medicine, 1Medicine, 2Neurology,
and 4Physiology, Gauhati Medical College, Guwahati,
3Department of Community
Medicine, Fakhruddin Ali Ahmed Medical College, Barpeta,
Assam, India
ABSTRACT
Background: In spite of tremendous impact on health, elder
abuse is still an underreported and unrecognized issue.
Objectives: To
assess the prevalence of abuse among community dwelling
elderly and to identify the various risk factors. Materials and
Methods:
This community-based cross-sectional study was conducted in
10 randomly selected wards of Guwahati city. A total of 331
elderly (60 years and above) were interviewed. Abuse was
screened by Hwalek-Sengstock Elder Abuse Screening Test (H-
S EAST).
Results: The study revealed 9.31% prevalence. Neglect was the
most common type of abuse reported. Age, sex, socioeconomic
status, living status, and functional status were found to be
significantly associated with abuse. Conclusion: Abuse is
prevalent
68. among elderly population.
Keywords: Elderly abuse, Hwalek–Sengstock Elder Abuse
Screening Test, maltreatment, risk factors
Address for correspondence:
Dr. Anku Moni Saikia, Department of Community Medicine,
Gauhati Medical College, Guwahati - 781 032, Assam, India.
E-mail: [email protected]
Received: 19-06-14, Accepted: 05-11-14
Access this article online
Quick Response Code:
Website:
www.ijcm.org.in
DOI:
10.4103/0970-0218.164406
Short Communication
Saikia, et al.: Prevalence and risk factors of elder abuse
Indian Journal of Community Medicine/Vol 40/Issue 4/October
2015 280
Materials and Methods
This community-based cross-sectional study was
carried out in Guwahati City from 1st April 2013
to 30th June 2013. This capital city is the gateway
to northeastern states with a population of 968,549
69. according to 2011 census. Considering the fact
that prevalence of abuse varies with sociocultural
context of the study setting and there is no authentic
prevalence available, sample size was calculated
using the formula; n = 4PQ/L2, where P was taken as
50%(4) and allowable error as 10% of P. The calculated
sample size was 400. After applying the exclusion
criteria, 69 were excluded, the final sample size became
331. Elderly above 60 years of age and both sexes
were included in the study. Elderly with known or
diagnosed psychiatric illnesses including dementia,
scoring ≥5 on 15-item Geriatric Depression Scale, and
also who failed to comprehend the interview were
excluded considering the fact that screening tool
used in the study is based on direct questioning of the
elderly. Approval from Institutional Ethics Committee
was obtained for the study.
Out of 31 municipality wards of the city, 10 wards
were selected randomly. From each ward, 40 elderly
were selected. House-to-house visits were made until
the desired sample was met. From each household, all
eligible elderly were included in the study. Information
w a s c o l l e c t e d o n a p r e d e s i g n e d a n d p r e t e
s t e d
schedule. Modified Kuppuswamy’s Scale was used
for assessment of socioeconomic status. Functional
status was assessed by Barthel Index. Financially
independent elders were those who had one or other
means of current income which was sufficient for self-
maintenance. H-S EAST was used to detect the elders
at risk of abuse. The instrument was translated into
the local language and again retranslated to reassure
validity. The person showing suggestive scoring was
again asked more on type of abuses and perpetrators
of abuse. Attempts were made to identify types of
70. abuse. The working definitions of these types of abuse
are based on the World Health Organization (WHO)
definitions. The study focused on abuse of elderly in
the home settings only. No attempt was made to verify
the signs of abuse.
Results
Out of the total 331 elderly interviewed, abuse was
found in 31 (9.36%). Statistically significant association
was observed between age, gender, living status,
socioeconomic status, and functional status with
abuse [Table 1]. However, financial dependency was
not found to be significantly associated with abuse
(P < 0.05).
Neglect was reported by all males and females followed
by verbal abuse. Physical abuse was reported by two
(9.09%) elderly and significantly both were females
[Figure 1].
Table 2 depicts the perpetrators of abuse in the family. It
was seen that, the main perpetrator of abuse was son
(51.61%) and followed by daughters-in-laws (48.39%).
Table 1: Prevalence of abuse according to certain variables
Age (in years) Abuse χ2 and
P - valueYes
(n = 31)
No
(n = 300)
Total
(n = 331)
71. 60-74 15 (5.38) 264 (94.62) 279 (100) χ2 = 43.591
75-84 12 (26.09 34 (73.91) 46 (100) P = 0.000
> 85 4 (66.67) 2 (33.33) 6 (100)
Sex
Female 22 (14.19) 133 (85.81) 155 (100) χ2 = 8.005
Male 9 (5.11) 167 (94.88) 176 (100) P = 0.005
Living status
Living with spouse 4 (28.57) 10 (71.43) 14 (100) χ2 = 38.228
Living with spouse
and children
6 (2.65) 220 (97.35) 226 (100) P = 0.000
Living with children/
relatives without
21 (23.08) 70 (76.92) 91 (100)
Spouse
Functional status
Intact 10 (3.97) 242 (96.03) 252 (100) χ2 = 36.235
Non-intact 21 (26.58) 58 (73.42) 79 (100) P = 0.000
Socioeconomic
status
Upper 2 (25) 6 (75) 8 (100) χ2 = 21.502
Upper-middle 8 (11.76) 60 (88.24) 68 (100) P = 0.000
Lower-middle 5 (16.13) 72 (83.87) 77 (100)
Lower-lower 9 (5.70) 149 (94.30) 158 (100)
Lower 7 (35) 13 (65) 20 (100)
Financial status
72. Independent 18 (13.33) 117 (86.67) 135 (100) χ2 = 4.228
Dependent 13 (6.63) 183 (93.97) 196 (100) P < 0.05
22 (100%)
20 (90.9%)
18 (81.82%)
2 (9.09%)
9 (100%) 9 (100%)
6 (66.67%)
0
5
10
15
20
25
NEGLECT VERBAL FINANCIAL PHYSICAL
ABUSE
FEMALE MALE
Figure 1: Bar diagram showing different types of abuses in male
and
females
73. Saikia, et al.: Prevalence and risk factors of elder abuse
281 Indian Journal of Community Medicine/Vol 40/Issue
4/October 2015
Discussion
The prevalence of elder abuse in the present study
could be viewed as a tip of an iceberg. However,
t h e p r e s e n t f i n d i n g w a s s o m e w h a t l o w e r t
h a n
that reported by Skirbekk and James.(5) The range
of abuse reported by different studies was wide
(3.2-27.5%), possibly reflecting true variation in
above rates across cultures as well as defining and
measuring abuse.(6) Various studies across the globe
have shown higher prevalence of elder abuse in the
community.(7-10) HelpAge India in their study found
a national prevalence of 23%. However, Sivsagar
District from Assam was included and abuse was not
reported at all.(11) Higher prevalence in the present
study than reported by HelpAge India could be
attributed to the urban setting of the study. Regarding
the types of abuse, our findings were in conformity
with other studies.(7-9)
Son, being the main perpetrator of abuse, could be partly
due to fact that living with son was the most favored
option in the study area.
A statistically significant association was observed
between age, sex, living status, functional status, and
socioeconomic status [Table 1]. Age, sex, poverty,
functional dependency, and low socioeconomic status
were identified as risk factors for reported elder
74. mistreatment by various authors.(3,7,11) Women were
found to be more at risk. This could be due to their
status in the society as well as their economically
disadvantageous position.
The present study could be an eye-opener for policy
makers to institute appropriate interventions. The issue
needs to be fully explored.
Acknowledgment
We deeply acknowledge the elders for participating in the
study. We also acknowledge Anjana Moyee Saikia, Statistician,
Department of Community Medicine, Gauhati Medical College
for statistical inputs.
References
1. Krug EG, Dahlberg LL, Mercy JA, Zwi AB, Lozano R.
Editors.
World report on violence and health. Geneva: WHO;2002:123-
45.
Available from: www.who.int/violence_injury/violence/world_
report/en/. [Last accessed on 2013 Feb].
2. Gupta R, Chaudhuri A. Elder abuse in a cross-cultural
context:
Assessment, policy and practice. Indian J Gerontol
2008;22:373-93.
3. Perel-Levin S. Discussing screening for elder abuse at
primary
health centre level. Geneva: WHO. 2008:129. Available from:
www.who.int ageing/publications/discussing_Elder_Abuseweb.
pdf. [Last accessed on 2013 Feb].
4. Sarmukaddam SB, Garad SG. On validity of assumption