Pain is an unpleasant sensory and emotional experience. 1 Pain is a complex phenomenon derived from sensory stimuli or neurologic injury and modified by individual memory, expectations, and emotions. 2 Pain is usually associated with injury or a pathophysiologic process that causes an uncomfortable experience and is usually described in such terms. Although there are no objective biologic markers of pain, an individual’s description and selfreport usually provides accurate, reliable, and sufficient evidence for the presence and intensity of pain. 3 Persistent pain can be defined as a painful experience that continues for a prolonged period of time that may or may not be associated with a recognizable disease process. The terms persistent and chronic are often used interchangeably in the medical literature. Unfortunately for many elderly persons, chronic pain has become a label associated with negative images and stereotypes often associated with longstanding psychiatric problems, futility in treatment, malingering, or drug-seeking behavior. The term persistent pain may foster a more positive attitude by patients and professionals for the many effective treatments that are available to help alleviate suffering. 4 The clinical manifestations of persistent pain are commonly multifactorial. Because of the complex interplay among these factors across several domains (physiologic, psychologic, and social), discriminating which factors are most important for the purpose of treatment can be very challenging. Further complicating this task is the fact that pain expression and hence the importance of specific factors commonly vary, not only across individuals but also over time in one individual. Elderly persons have been defined by demographers, insurers, and employers as those aged 65 years and over. In healthcare discussions, the elderly persons often described are those who are most frail, with health and disability problems typically encountered in the older population. By age 75 many persons exhibit some frailty and chronic illness. In the population above age 75, morbidity, mortality, and social problems rise rapidly, resulting in substantial strains on the healthcare system and societal safety nets. This group represents the fastest growing segment of the total population. 5 The greatest challenges in geriatric medicine are represented by the oldest, sickest, and most frail patients with multiple medical problems and few social supports. The guideline panel focused its attention on this group as it prepared this update. Persistent pain is common in older people. 6 A Louis Harris telephone survey found that one in five older Americans (18%) are taking analgesic medications regularly (several times a week or more), and 63% of those had taken prescription pain medications for more than 6 months. 7 Older people are more likely to suffer from arthritis, bone and joint disorders, back problems, and other chronic conditions. This survey also found that 45% of patients who take pain medications regularly had seen three or more doctors for pain in the past 5 years, 79% of whom were primary care physicians. Previous studies have suggested that 25% to 50% of community-dwelling older people suffer important pain problems. 6,8,9 Pain is also common among nursing home residents. 10,11 It has been estimated that 45% to 80% of them have substantial pain that is undertreated. Studies of both the community-dwelling and nursing home populations have found that older people commonly have several sources of pain, which is not surprising, as older patients commonly have multiple medical problems. A high prevalence of dementia, sensory impairments, and disability in this population make assessment and management more difficult. The consequences of persistent pain among older people are numerous. Depression, anxiety, decreased socialization, sleep disturbance, impaired ambulation, and increased healthcare utilization and costs have all been found to be associated with the presence of pain in older people. Although less thoroughly described, many other conditions are known to be worsened potentially by the presence of pain, including gait disturbances, slow rehabilitation, and adverse effects from multiple drug prescriptions. 12 Psychosocial factors affect and are affected by pain in older patients. It has been shown that older adults with good coping strategies have significantly lower pain and This guideline was developed and written under the auspices of the American Geriatrics Society (AGS) Panel on Persistent Pain in Older Persons and approved by the AGS Board of Directors on April 8, 2002.

The management of persistent pain in older persons.

Purpose: The purpose of this study was to determine if exercise operates in a dose-response fashion to influence well-being and to postpone dependency. Methods: A computer-assisted search was made by using the following key words: resistance training, strength training, function, exercise, elderly, quality of life, frailty, physical activity, independence, performance, aerobic training, mobility, well-being, and disability. Review articles and personal files were also used, and a critical review of research studies meeting the criteria described in the methods section of the article was conducted. Results: In large sample correlational studies and prospective longitudinal studies, researchers consistently report that measures of physical function in old adults are related to feelings of well-being, and that old adults who are physically active also report higher levels of well-being and physical function, but the results of randomized intervention studies of aerobic and/or resistive strength training do not always support this relationship. Even if changes in well-being and physical function were reported, no evidence was found that levels of intensity operated in a dose-response fashion to influence these changes. Research design problems included ineffective aerobic or strength training treatments, widely varying participation and effort of the research participants, and both treatment and physical function tests that were not appropriate for the physical status of the participants. Conclusion: The most consistent results were that long-term physical activity is related to postponed disability and independent living in the oldest-old subjects. Even in individuals with chronic disease, systematic participation in physical activities enhances physical function.

Exercise dose-response effects on quality of life and independent living in older adults.

WOOD, R. H., R. REYES, M. A. WELSCH, J. FAVALORO-SABATIER, M. SABATIER, C. M. LEE, L. G. JOHNSON, and P. F. HOOPER. Concurrent cardiovascular and resistance training in healthy older adults. Med. Sci. Sports Exerc., Vol. 33, No. 10, 2001, pp. 1751–1758. Purpose: The recommendations for exercise training and physical activity for older adults include cardiovascular and resistance training components (CVT and RT, respectively). The purpose of the present investigation was to compare the fitness benefits of concurrent CVT and RT with those attained through an equivalent duration of CVT or RT alone. Methods: Thirty-six participants (ages 60–84) were assigned to a control group or to one of three exercise treatment groups. The treatment groups exercised three times per week for 12 wk using RT (N = 11), CVT (N = 10), or CVT and RT (BOTH, N = 9). Pre- and post-training, participants performed a submaximal exercise test (GXT), five repetition-maximum strength tests (5RM), and the AAHPERD functional fitness test for older adults. Results: All exercise treatment groups revealed lower resting heart rate and rate-pressure product; lower exercise diastolic blood pressure and rating of perceived exertion; increased GXT duration; increased leg, back, and shoulder 5RM scores; and improved AAHPERD flexibility, coordination, and cardiovascular endurance scores. The exercise treatment groups responded differently on the following: RT and BOTH enhanced arm and chest strength more than CVT; and BOTH enhanced AAHPERD strength and agility scores more than CVT or RT. Conclusions: Concurrent CVT and RT is as effective in eliciting improvements in cardiovascular fitness and 5RM performance as CVT or RT, respectively. Moreover, incorporating both CVT and RT in exercise programs for older adults may be more effective in optimizing aspects of functional fitness than programs that involve only one component.

http://www.luzimarteixeira.com.br/wp-content/uploads/2015/07/Concurrent-cardiovascular-and-resistance.pdf

Concurrent cardiovascular and resistance training in healthy older adults.

In Usability and Accessibility Engineering, metric standards are vital. However, the development of a set of reciprocal metrics—which can serve as an extension of, and supplement to, current standards—becomes indispensable when the specific needs of end-user groups, such as the elderly and people with disabilities, are concerned. While ISO 9126 remains critical to the usability of a product, the needs of the elderly population are forcing the integration of other factors. Familiarity and recognisability are not relevant to someone with no experience and therefore no referent; however, acceptance becomes a major factor in their willingness to learn something new and this acceptance requires trust based on association. Readability and legibility are of less relevance to a blind person than to someone with failing eyesight. This paper describes some usability metrics ascertained on the basis of experiments made with applications for elderly people throughout the summer term of 2007. The factors that influence the older users’ acceptance of software, including the extent of their previous exposure to technology, are evaluated in order to provide short guidelines for software developers on how to design and develop software for the elderly. The evaluation of the expectations, behavior, abilities, and limitations of prospective end-users is considered of primary importance for the development of technology. A total of N = 31 participants (22 women/9 men) took part in various tests. The participants’ ages ranged from 49 to 96 years with an average age of 79. Five of the tests were designed for a PDA or cellular phone, one test was designed for a laptop PC. Of the total of 55 tests, 52 tests provided sufficient data to evaluate the results. In 23 of the tests, all tasks were completed. As a main outcome, it can be experimentally proved that the acceptance is related to a factor, which is this paper is called PET (Previous Exposure to Technology). This is discussed in light of the aforementioned metrics.

The effect of previous exposure to technology on acceptance and its importance in usability and accessibility engineering

RESUMO O exercicio e o treinamento fisico sao conhecidos por promover diversas alteracoes, incluindo beneficios cardiorrespiratorios, aumento da densidade mineral ossea e diminuicao do risco de doencas cronico-degenerativas. Recentemente outro aspecto tem ganhando notoriedade: trata-se da melhoria na funcao cognitiva. Embora haja grande controversia, diversos estudos tem demonstrado que o exercicio fisico melhora e protege a funcao cerebral, sugerindo que pessoas fisicamente ativas apresentam menor risco de serem acometidas por desordens mentais em relacao as sedentarias. Isso mostra que a participacao em programas de exercicios fisicos exercem beneficios nas esferas fisica e psicologica e que, provavelmente, individuos fisicamente ativos possuem um processamento cognitivo mais rapido. Embora os beneficios cognitivos do estilo de vida fisicamente ativo parecam estar relacionados ao nivel de atividade fisica regular, ou seja, exercicio realizado durante toda a vida, sugerindo uma “reserva cognitiva”, nunca e tarde para se iniciar um programa de exercicios fisicos. Dessa forma, o uso do exercicio fisico como alternativa para melhorar a funcao cognitiva parece ser um objetivo a ser alcancado, principalmente em virtude da sua aplicabilidade, pois se trata de um metodo relativamente barato, que pode ser direcionado a grande parte da populacao. Assim, o objetivo da presente revisao e o de discutir os aspectos associativos entre exercicio fisico e funcao cognitiva, permitindo uma ponderacao entre o seu uso enquanto alternativa e elemento coadjuvante.

/pdf/exercicio-fisico-e-funcao-cognitiva-uma-revisao-4y3rhydegw.pdf

Exercício físico e função cognitiva: uma revisão

It has been suggested that physical and cognitive functions are associated with health-related quality of life (HRQL). Previous work examining the relationship between physical ability and HRQL is equivocal, and information about cognitive function in relation to HRQL is largely restricted to people with cognitive impairments. We investigated the relationships of physical ability and cognitive performance to HRQL in 44 older adults (72-93 years). The results suggest significant relationships between the endurance item of the AAHPERD test and the physical mobility and pain components of HRQL and between AAHPERD agility scores and the physical mobility component of HRQL. Visual simple-reaction time and the backward digit-span memory test were found to be related to physical mobility. The subject-performed-tasks memory test was related to the social component of HRQL. These data support the use of the AAHPERD test for characterizing physical ability of older adults as it relates to HRQL and identify specific...

Kristi L. Metoyer

Papers

Physical Fitness, Cognitive Function, and Health-Related Quality of Life in Older Adults