American journal of preventive medicine
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Balance is important for the safe performance of many activities that allow older people to remain independent in their community. Housework, cooking, shopping, and travel generally require the ability to stand, reach, turn, and bend down and pick up objects from the floor. Multiple interacting factors are implicated in the deterioration of balance. ⋯ Home-based exercise programs that included low-intensity strength and balance training have improved balance and reduced fall rates by about 40% compared to controls. Class-based exercise programs in senior centers or exercise centers have improved balance and physical performance, and some have reduced falls. Programs such as tai chi and social dance look promising and should be further investigated.
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Despite the increased focus on disability as an important research outcome, there remains a need to improve disability instrumentation. This article discusses the need for improved operational differentiation in instruments used to assess disability outcomes. ⋯ Computer adaptive testing is discussed as a promising avenue for resolving the methodologic limitations inherent in existing outcome instruments. Priorities for future research that move the field forward in both of these areas are discussed.
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Physical activity and exercise are widely purported to enhance health and minimize or prevent functional loss and disability. Yet, do the benefits of late-life physical activity or exercise extend beyond disease and impairment-level factors? Does late-life physical activity minimize or prevent functional limitations and disability? To address these questions, a best-evidence framework was used to examine the effects of late-life physical activity on disablement outcomes. ⋯ Furthermore, this review shows a discrepancy between prospective and experimental studies: several well-conducted prospective studies show a beneficial effect of physical activity on minimizing disability, whereas the majority of experimental studies that have examined disability as an outcome do not show improvements in disability. Three research priorities are identified that would advance the science in this field: (1). development of a clear conceptual and theoretical framework of late-life physical activity and assessment; (2). use of a disablement outcomes framework to examine the outcomes of late-life physical activity; and (3). development of a mechanism of action explaining the relationship between physical activity and exercise and disablement outcomes.
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Data on the involvement of nonphysician healthcare providers in colorectal cancer (CRC) screening delivery are sparse. This article describes physicians' use of nurse practitioners and physician assistants to provide CRC screening with the fecal occult blood test (FOBT), flexible sigmoidoscopy, and colonoscopy, as well as physicians' attitudes toward using these providers to perform flexible sigmoidoscopy. ⋯ These results show current involvement of nurse practitioners and physician assistants in the delivery of CRC screening to be limited. Use of nonphysician healthcare providers for CRC screening with FOBT and flexible sigmoidoscopy is one possible solution to the challenge of boosting low screening rates. However, physician beliefs about the ability of nurse practitioners and physician assistants to perform flexible sigmoidoscopy are a potential barrier to increasing the involvement of nonphysician providers in CRC screening delivery.