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Effects of the Finnish Alzheimer disease exercise trial (FINALEX): a randomized controlled trial.

https://arctichealth.org/en/permalink/ahliterature114708
Source
JAMA Intern Med. 2013 May 27;173(10):894-901
Publication Type
Article
Date
May-27-2013
Author
Kaisu H Pitkälä
Minna M Pöysti
Marja-Liisa Laakkonen
Reijo S Tilvis
Niina Savikko
Hannu Kautiainen
Timo E Strandberg
Author Affiliation
Unit of Primary Health Care, Helsinki University Central Hospital, Finland. kaisu.pitkala@helsinki.fi
Source
JAMA Intern Med. 2013 May 27;173(10):894-901
Date
May-27-2013
Language
English
Publication Type
Article
Keywords
Activities of Daily Living
Aged
Aged, 80 and over
Alzheimer Disease - economics - therapy
Caregivers
Day Care - economics - organization & administration
Exercise Therapy - economics - methods - organization & administration
Female
Finland - epidemiology
Follow-Up Studies
House Calls - economics
Humans
Independent living
Male
Physical Therapists
Prospective Studies
Quality of Life
Treatment Outcome
Abstract
Few rigorous clinical trials have investigated the effectiveness of exercise on the physical functioning of patients with Alzheimer disease (AD).
To investigate the effects of intense and long-term exercise on the physical functioning and mobility of home-dwelling patients with AD and to explore its effects on the use and costs of health and social services.
A randomized controlled trial.
A total of 210 home-dwelling patients with AD living with their spousal caregiver.
The 3 trial arms included (1) group-based exercise (GE; 4-hour sessions with approximately 1-hour training) and (2) tailored home-based exercise (HE; 1-hour training), both twice a week for 1 year, and (3) a control group (CG) receiving the usual community care.
The Functional Independence Measure (FIM), the Short Physical Performance Battery, and information on the use and costs of social and health care services.
All groups deteriorated in functioning during the year after randomization, but deterioration was significantly faster in the CG than in the HE or GE group at 6 (P = .003) and 12 (P = .015) months. The FIM changes at 12 months were -7.1 (95% CI, -3.7 to -10.5), -10.3 (95% CI, -6.7 to -13.9), and -14.4 (95% CI, -10.9 to -18.0) in the HE group, GE group, and CG, respectively. The HE and GE groups had significantly fewer falls than the CG during the follow-up year. The total costs of health and social services for the HE patient-caregiver dyads (in US dollars per dyad per year) were $25,112 (95% CI, $17,642 to $32,581) (P = .13 for comparison with the CG), $22,066 in the GE group ($15,931 to $28,199; P = .03 vs CG), and $34,121 ($24,559 to $43,681) in the CG.
An intensive and long-term exercise program had beneficial effects on the physical functioning of patients with AD without increasing the total costs of health and social services or causing any significant adverse effects.
anzctr.org.au Identifier: ACTRN12608000037303.
Notes
Comment In: Ann Intern Med. 2013 Aug 20;159(4):JC1024026274
Comment In: MMW Fortschr Med. 2013 Nov 7;155(19):3224475662
Comment In: JAMA Intern Med. 2013 May 27;173(10):901-223588877
PubMed ID
23589097 View in PubMed
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Exercise rehabilitation on home-dwelling patients with Alzheimer's disease--a randomized, controlled trial. Study protocol.

https://arctichealth.org/en/permalink/ahliterature140239
Source
Trials. 2010;11:92
Publication Type
Article
Date
2010
Author
Kaisu H Pitkala
Minna M Raivio
Marja-Liisa Laakkonen
Reijo S Tilvis
Hannu Kautiainen
Timo E Strandberg
Author Affiliation
Unit of General Practice, Helsinki University Central Hospital, University of Helsinki, PO Box 20, 00014 University of Helsinki, Finland. kaisu.pitkala@kolumbus.fi
Source
Trials. 2010;11:92
Date
2010
Language
English
Publication Type
Article
Keywords
Aged
Alzheimer Disease - economics - physiopathology - psychology - rehabilitation
Caregivers
Clinical Protocols
Cognition
Cost of Illness
Cost-Benefit Analysis
Day Care - economics
Depression - etiology
Disability Evaluation
Exercise Therapy - economics
Finland
Frail Elderly
Health Care Costs
Humans
Independent living
Mobility Limitation
Neuropsychological Tests
Postural Balance
Quality of Life
Research Design
Time Factors
Treatment Outcome
Walking
Abstract
Besides cognitive decline, Alzheimer's disease (AD) leads to physical disability, need for help and permanent institutional care. The trials investigating effects of exercise rehabilitation on physical functioning of home-dwelling older dementia patients are still scarce. The aim of this study is to investigate the effectiveness of intensive exercise rehabilitation lasting for one year on mobility and physical functioning of home-dwelling patients with AD.
During years 2008-2010, patients with AD (n = 210) living with their spousal caregiver in community are recruited using central AD registers in Finland, and they are offered exercise rehabilitation lasting for one year. The patients are randomized into three arms: 1) tailored home-based exercise twice weekly 2) group-based exercise twice weekly in rehabilitation center 3) control group with usual care and information of exercise and nutrition. Main outcome measures will be Guralnik's mobility and balance tests and FIM-test to assess physical functioning. Secondary measures will be cognition, neuropsychiatric symptoms according to the Neuropsychiatric Inventory, caregivers' burden, depression and health-related quality of life (RAND-36). Data concerning admissions to institutional care and the use and costs of health and social services will be collected during a two year follow-up.
To our knowledge this is the first large scale trial exploring whether home-dwelling patients with AD will benefit from intense and long-lasting exercise rehabilitation in respect to their mobility and physical functioning. It will also provide data on cost-effectiveness of the intervention.
ACTRN12608000037303.
Notes
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PubMed ID
20925948 View in PubMed
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Needs and care of older people living at home in Iceland.

https://arctichealth.org/en/permalink/ahliterature130632
Source
Scand J Public Health. 2012 Feb;40(1):1-9
Publication Type
Article
Date
Feb-2012
Author
Sigurveig H Sigurdardottir
Gerdt Sundstrom
Bo Malmberg
Marie Ernsth Bravell
Author Affiliation
Faculty of Social Work, School of Social Sciences, University of Iceland, Iceland. sighsig@hi.is
Source
Scand J Public Health. 2012 Feb;40(1):1-9
Date
Feb-2012
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Caregivers
Family Characteristics
Female
Health Care Surveys
Health Services Research
Health Services for the Aged - utilization
Home Care Services - utilization
Home Nursing - utilization
Humans
Iceland
Independent living
Male
Needs Assessment
Qualitative Research
Social Support
Abstract
The Icelandic old-age care system is universal and the official goal is to support older people live independently for as long as possible. The aim of this study is to analyse living conditions and use of formal and informal care of older people in Iceland.
The results are based on the new study ICEOLD, a telephone survey which included questions on social network, health, activities of daily living, and received support from the community and/or from relatives, neighbours, and friends.
Almost half of the sample (47%) receives some kind of care, with 27% of them receiving only informal care, which is understood to mean that informal care is of great importance and families are the main providers of help. For hypothetical future long-term care, older people wish to be cared for in their homes, but those already in need of assistance prefer to be cared for in institutions.
Caring relatives are the main providers of support to older people in their homes and it is important to provide them with suitable formal support when the care responsibility increases.
As the care system in Iceland is now under reconstruction, the important contribution of informal carers must be recognised and taken into account when planning the care of older people.
PubMed ID
21983193 View in PubMed
Less detail

Persons with Dementia and Their Caregivers Using GPS.

https://arctichealth.org/en/permalink/ahliterature281980
Source
Stud Health Technol Inform. 2015;217:212-21
Publication Type
Article
Date
2015
Author
Tone Øderud
Bjørg Landmark
Sissel Eriksen
Anne Berit Fossberg
Sigrid Aketun
May Omland
Karl-Gerhard Hem
Elisabeth Østensen
Dag Ausen
Source
Stud Health Technol Inform. 2015;217:212-21
Date
2015
Language
English
Publication Type
Article
Keywords
Activities of Daily Living
Aged
Caregivers
Data Collection - methods
Dementia
Female
Geographic Information Systems - utilization
Humans
Independent living
Male
Norway
Personal Autonomy
Abstract
The aim of the study is to generate knowledge on the use of Global Positioning Systems (GPS) to support autonomy and independence for persons with dementia. By studying a larger cohort of persons with dementia (n=208) and their caregivers, this study provides essential knowledge for planning and implementing GPS technology as a part of public health care services. Commercially available GPS technology was provided to the cohort of 208 persons with dementia from nineteen different Norwegian municipalities. The participants used GPS when performing outdoor activities as part of their daily life during a period of time between 2012 and 2014. Their family caregivers were instructed on how to use the GPS technology for locating the participants. The study documents that using GPS for locating persons with dementia provide increased safety for the person with dementia, their family caregivers and their professional caregivers. Furthermore the results confirm that by using GPS, persons with dementia may maintain their autonomy, enjoy their freedom and continue their outdoor activities despite the progression of the disease. Preconditions for successful implementation are that health professionals are trained to assess the participant's needs, that ethical dilemmas are considered, that caregivers have adequate knowledge about using the technology and that procedures and routines for administrating the GPS and locating persons with dementia are established. Early intervention and close collaboration between persons with dementia, family caregivers and professional caregivers are important for successful implementation of GPS in public health care.
PubMed ID
26294475 View in PubMed
Less detail