The memory fitness program: cognitive effects of a healthy aging intervention.

CONTEXT: Age-related memory decline affects a large proportion of older adults. Cognitive training, physical exercise, and other lifestyle habits may help to minimize self-perception of memory loss and a decline in objective memory performance. OBJECTIVE: The purpose of this study was to determine whether a 6-week educational program on memory training, physical activity, stress reduction, and healthy diet led to improved memory performance in older adults. DESIGN: A convenience sample of 115 participants (mean age: 80.9 [SD: 6.0 years]) was recruited from two continuing care retirement communities. The intervention consisted of 60-minute classes held twice weekly with 15-20 participants per class. Testing of both objective and subjective cognitive performance occurred at baseline, preintervention, and postintervention. Objective cognitive measures evaluated changes in five domains: immediate verbal memory, delayed verbal memory, retention of verbal information, memory recognition, and verbal fluency. A standardized metamemory instrument assessed four domains of memory self-awareness: frequency and severity of forgetting, retrospective functioning, and mnemonics use. RESULTS: The intervention program resulted in significant improvements on objective measures of memory, including recognition of word pairs (t([114]) = 3.62, p <0.001) and retention of verbal information from list learning (t([114]) = 2.98, p <0.01). No improvement was found for verbal fluency. Regarding subjective memory measures, the retrospective functioning score increased significantly following the intervention (t([114]) = 4.54, p <0.0001), indicating perception of a better memory. CONCLUSIONS: These findings indicate that a 6-week healthy lifestyle program can improve both encoding and recalling of new verbal information, as well as self-perception of memory ability in older adults residing in continuing care retirement communities.

The role of spiritual experiences and activities in the relationship between chronic illness and psychological well-being.

Our research explores the correlates of spiritual experiences over a 2-year period in a sample of older adults (N = 164; mean age 81.9 years) living in a continuing care retirement community. Utilizing responses to the Daily Spiritual Experiences Scale, scores were analyzed for changes over time and for their hypothesized moderating effect in the relationship between chronic illness impact and markers of psychological well-being (as measured by the Geriatric Depression and Life Satisfaction scales). Repeated measures ANOVA indicated a significant decline (P < .01) in the reported spiritual experiences over a 2-year period of time, and t tests showed a significant difference by gender (P < .01) in years 1 and 2, with women reporting higher levels of spiritual experiences than men. Analyses found low spirituality scores associated with low life satisfaction in all years (baseline: r = -.288, P < .01; year 1: r = -.209, P < .05; year 2: r = -.330, P < .001). Only weak associations were detected between low spirituality and the presence of depressive symptoms at baseline (r = .186, P < .05) and year 2 (r = .254, P < .01). Moderation effects of spirituality on the relationship between chronic illness impact and markers of psychological well-being were explored in all years, with a statistically significant effect found only for the presence of depressive symptoms in year 2. Higher impact of chronic illnesses is associated with more depressive symptoms under conditions of low spirituality. Future research may center upon longer-duration evaluation of reliance upon spiritual practices and their impact in care management models.

Health and medical services use: a matched case comparison between CCRC residents and national health and retirement study samples.

Little is known about the health status of adults living in continuing care retirement communities (CCRC). Using matched-case control, 458 adults from the Health and Retirement Study (HRS) or a CCRC-based sample were compared on total comorbidity, self-rated health, home health services use, and hospitalizations. At year 2, the CCRC sample reported more comorbidities (96%) but significantly better self-rated health (96% good/excellent) than the HRS sample (93% comorbidity, 73% good/excellent; p < .01). There were no significant differences in frequency of home health use or hospitalization. Living in a CCRC appears to be associated with higher self-ratings of health in this sample.

Older men's knowledge of osteoporosis and the prevalence of risk factors.

It has been estimated that up to 45% of men in the United States have low bone density. Yet, only a few studies have examined men's knowledge of bone health and disease. Men's knowledge of sex-specific issues related to osteoporosis is especially not well understood. We surveyed 1535 community-dwelling men with a mean age of 79 yr. The assessed risk factors included a current diagnosis of low bone mass, positive history for fracture, recent level of physical activity, and current medications with the potential to affect bone health. Knowledge about male risk factors for osteoporosis was also assessed, including the effects of advancing age, frame size, fracture risk, calcium and Vitamin D supplementation, low testosterone level, and treatment for prostate cancer. Within this sample, only 11% of the men reported a current diagnosis of low bone mass, whereas 11% reported a prior hip fracture. Only 5% of the sample reported taking some type of Food and Drug Administration-approved medication for osteoporosis. In the aggregate, the participating men answered only 39% of the 6 male osteoporosis-knowledge questions correctly. It is imperative that bone health promotion campaigns that have educated many women effectively now expand their focus to advance the bone health of men also.

The effect of the addition of osteoporosis education to a bone health screening program for older adults.

Osteoporosis affects approximately 26% of women and 4% of men after the age of 65 years. However, the diffusion of knowledge about osteoporosis risk factors, prevention and treatment remains low. The purpose of this longitudinal study was to investigate the value of adding initial and refresher osteoporosis education classes to a bone health screening program. A convenience sample of 376 men (n = 62) and women (n = 314) over the age of 62 years was assigned randomly to the Screening plus Education (n =193) or Screening only (n = 183) groups. Participants in both study groups demonstrated an increase in knowledge about osteoporosis, regardless of group assignment and other factors, over the two years of the study. Self-reported calcium use increased for all women and for men in the education group from baseline to year one, with a decline thereafter. There was no effect on exercise behaviors. This study points out the critical need for a more comprehensive and personalized bone health program that includes more than classroom-based education.

Participant Satisfaction and Perceptions About Program Impact in the Medicaid Incentives for Prevention of Chronic Disease Pilot Program.

PURPOSE: Evaluate the Centers for Medicare & Medicaid Incentives for Prevention of Chronic Diseases (MIPCD) program in terms of participant satisfaction and self-reported program impact. DESIGN: Participant survey (mail/telephone follow-up), English and Spanish (N = 2274). SETTINGS: Ten states in MIPCD program. PARTICIPANTS: Medicaid beneficiaries. INTERVENTION: Incentive-based health promotion programs targeting diabetes prevention and management, smoking cessation, and weight, hypertension, and cholesterol management. MEASURES: Dependent measures are (1) overall program satisfaction and (2) self-reported program impact, operationalized as whether program helped with understanding health issues, learning ways to take care of health, and encouraging healthy lifestyle changes. ANALYSIS: Multilevel multivariable ordinal logistic regression models to identify predictors of overall program satisfaction and program impact. RESULTS: Sixty-seven percent were very satisfied with the program, and 76% strongly agreed the program encouraged healthy lifestyle changes. Age (59+ vs <45 years) and being female predicted overall program satisfaction. Satisfaction with specific aspects of the program including communication with staff, accessibility, and incentives predicted higher overall satisfaction. Age (45-52 vs <45 years) and being black or Hispanic predicted higher program impact. Points redeemable for rewards performed worse than money-valued incentives in terms of encouraging lifestyle changes (odds ratio [OR], 0.30; 95% confidence interval [CI], 0.11-0.82). Participants receiving incentives valued at $25 to <$100 were more likely to report higher agreement that the program helped them learn ways to care for their health (OR, 1.72; 95% CI, 1.21-2.44) and encouraged lifestyle changes (OR, 1.46; 95% CI, 1.02-2.10), compared to participants receiving incentives valued at $0 to <$25. Incentives valued at $100 to <$400 predicted higher agreement that the program helped with understanding of health issues (OR, 1.62; 95% CI, 1.13-2.33), compared to incentives valued at $0 to <$25. CONCLUSION: Effective chronic disease prevention programs are needed for Medicaid populations. Study findings highlight important considerations for incentive-based programs.

Using step activity monitoring to characterize ambulatory activity in community-dwelling older adults.

OBJECTIVES: To explore the potential of using step activity monitoring to detect differences in ambulatory activity associated with advancing age and declining function in community-dwelling seniors. DESIGN: Cross-sectional pilot study. SETTING: General communities of Seattle, Washington; Catonsville, Maryland; and Durham, North Carolina. PARTICIPANTS: Thirty healthy younger adults, 28 healthy older adults, and 12 older adults reporting functional limitations. MEASUREMENTS: Ambulatory activity data were collected over 6 days with the StepWatch 3. Average daily values were calculated for number of steps, number of minutes of activity, number of activity bouts, variability of minute-to-minute activity, and randomness of minute-to-minute activity fluctuations. RESULTS: Healthy older adults engaged in fewer bouts of activity (P=.03) and displayed less-variable activity (P=.02) than younger adults. Older adults reporting functional limitations not only engaged in fewer bouts of activity (P=.009) and less variable activity (P<.001) than younger adults, but also accumulated fewer total steps (P=.003) and minutes of activity (P=.008) and had less-random minute-to-minute activity fluctuations (P=.02). CONCLUSION: Step activity monitoring data were useful for detecting differences in ambulatory activity according to age and functional limitation. Monitor-based measures reflecting patterns of ambulatory activity show promise for use in studies of physical functioning.

A home-based pedometer-driven walking program to increase physical activity in older adults with osteoarthritis of the knee: a preliminary study.

OBJECTIVES: To determine whether a home-based pedometer-driven walking program with arthritis self-management education (Walk +) would increase physical activity, muscle strength, and functional performance in older adults with osteoarthritis (OA) of the knee as opposed to arthritis self-management education alone (EDU). DESIGN: A randomized two-by-three (group-by-time) design with participants assigned to Walk + (n = 17, mean age +/- standard deviation = 69.6 +/- 6.7) or EDU (n = 17, age = 70.8 +/- 4.7). SETTING: Community located in the Baltimore-Washington area. PARTICIPANTS: Thirty-four community-dwelling adults, aged 60 and older with symptomatic knee OA and self-reported functional impairment. INTERVENTIONS: Both groups received 12 hours of the Arthritis Self-Management program over 12 weeks and were followed for an additional 12 weeks. In addition, the Walk + group received individualized instruction in the use of a pedometer, with the goal of increasing their step count by 30% of their baseline step count. MEASUREMENTS: The outcome measures were physical activity (daily step counts and total activity vector magnitude as measured by a pedometer and Tritrac-R3D accelerometer), quadriceps femoris strength (isometric peak torque), and functional performance tasks (100-foot walk-turn-walk, timed stair climb, timed chair rise, and pain status). RESULTS: Daily steps walked showed a significant group-by-time interaction (P =.04) after controlling for age. From baseline to completion of training, a 23% increase in daily steps occurred in the Walk + group and a 15% decrease in the EDU group. Although steps increased in the Walk + group, total activity vector magnitude was maintained, suggesting a more efficient gait. The Walk + group became quicker than the EDU group in the normal-pace walk-turn-walk (P =.04). An isometric strength gain of 21% postintervention was seen in the Walk + group, compared with a loss of 3.5% in the EDU group. CONCLUSION: In older adults with symptomatic knee OA, Walk + appears to increase walking, with improvements in muscle strength and walking performance. The use of a home-based pedometer-driven program to increase physical activity, strength, and function in this population warrants further research.

Uniting to improve end-of-life care.

Survey results measure the impact of a national invitational nursing conference on end-of-life care.

Health care quality improvement publication trends.

To analyze the extent of academic interest in quality improvement (QI) initiatives in medical practice, annual publication trends for the most well-known QI methodologies being used in health care settings were analyzed. A total of 10 key medical- and business-oriented library databases were examined: PubMed, Ovid MEDLINE, EMBASE, CINAHL, PsycINFO, ISI Web of Science, Scopus, the Cochrane Central Register of Controlled Trials, ABI/INFORM, and Business Source Complete. A total of 13 057 articles were identified that discuss at least 1 of 10 well-known QI concepts used in health care contexts, 8645 (66.2%) of which were classified as original research. "Total quality management" was the only methodology to demonstrate a significant decline in publication over time. "Continuous quality improvement" was the most common topic of study across all publication years, whereas articles discussing Lean methodology demonstrated the largest growth in publication volume over the past 2 decades. Health care QI publication volume increased substantially beginning in 1991.

"One of my fears is that physically or mentally, the time will come where I'll be unable to drive anymore. and I'm not looking forward to that": a mixed methods feasibility study to assess older driver's risk impairment.

Sixty-seven older adults were assessed using multiple validated tools. The current study aimed to identify high-, medium-, and low-risk impairment among older drivers and to explore high-risk drivers' reactions to being told their results. Of 67 adults screened from a convenience sample of older drivers, nine high-risk participants, four completed in-depth follow-up qualitative interviews. The quantitative assessment algorithm identified 13% as high risk, 30% as medium risk, and 57% as low risk, and only Trails B distinguished the medium- and high-risk impairment groups. Although the assessment tests did not predict future crash involvement over a 7-month period, four participants in the medium- and high-risk impairment categories had been involved in a crash during the 5 years prior to the study compared with none of those who screened low risk. Only three participants (1 high risk) voluntarily surrendered their driver's licenses after the assessment, and one participant in the in-depth interviews reported that the assessment influenced the decision to stop driving. There may be some benefit in using driving record history and assessment results to determine driving risk impairment level. However, more research is needed to determine the best combination of tools to predict risk level. How to best communicate risk levels remains to be determined, although results from the older drivers in this study underscore the need for great sensitivity when identifying areas of concern about driving ability.

Older men's knowledge about osteoporosis and educational interventions to increase osteoporosis knowledge in older men: a systematic review.

OBJECTIVE: The prevalence of osteoporosis and low bone density in men over the age of 65 is approximately 45%. The public health response to a disease affecting almost half of a given population includes assessment of knowledge and design of educational interventions in order to improve screening and prevention. The aim of this systematic review is two fold. We aim to describe older men's knowledge about the osteoporosis disease process, risk factors, and prevention. Second, we examine educational interventions designed to increase older men's knowledge about osteoporosis. METHODS: Computerized literature searches were performed with multiple databases including Academic Search Premier, CINAHL, MEDLINE, SocINDEX, and Psychology and Behavioral Sciences Collection. Studies were considered if they included men aged 50 years or older, included a measure of osteoporosis knowledge and/or had an intervention designed to change osteoporosis knowledge and/or lifestyle risk factors for osteoporosis. RESULTS: Thirteen studies were included in the review. Nine of the studies were cross-sectional studies on men's knowledge of osteoporosis. All of the studies found that men have minimal knowledge of the osteoporosis disease process, risk factors, and prevention. Four studies focused on education about osteoporosis. Educational interventions were found to increase initiation of calcium supplementation and knowledge about osteoporosis prevention. CONCLUSION: Older men know remarkably little about the osteoporosis disease process, risk factors for the disease, or prevention. Education has the potential to improve this situation. Unfortunately, so few clinical trials have occurred that the best method for improving men's knowledge cannot be stated. Future studies examining knowledge and education of osteoporosis for men need to use validated instruments with a focus on risk factors pertinent to men.

Validation of the male osteoporosis knowledge quiz.

The purpose of this study was to validate the six-item Men's Osteoporosis Knowledge Quiz (MOKQ). The MOKQ asks questions about risk factors that are pertinent to men, such as the risk for developing low bone mass related to hormone treatment for prostate cancer and the importance of testosterone for bone mass. A survey was sent to 242 men with a mean age of 83.2 years. The mean number of questions answered correctly in response to the six-item MOKQ was 2.37. Convergent validity was examined by correlating the score achieved on the MOKQ with the score achieved on the total Facts on Osteoporosis Quiz. The Pearson correlation coefficient for the MOKQ and the Facts on Osteoporosis Quiz was r = .76. Reliability was demonstrated by computing a Cronbach's alpha for the MOKQ (r = .72). The MOKQ was found to have adequate reliability and validity in assessing older men's knowledge about osteoporosis.

Enhancing older driver safety: A driving survey and evaluation of the CarFit program.

OBJECTIVE: To evaluate CarFit, an educational program designed to promote optimal alignment of driver with vehicle. METHODS: A driving activity survey was sent to 727 randomly selected participants living in retirement communities. Drivers (n=195) were assigned randomly to CarFit intervention (n=83, M age=78.1) or Comparison (n=112, M age=79.6) groups. After 6months, participants completed a post-test of driving activity and CarFit recommendations. RESULTS: Nonconsenting drivers were older and participated in fewer driving activities. CarFit participation was moderate (71%) with 86% of the participants receiving recommendations. 60% followed the recommendations at the 6-month re-evaluation). The CarFit (67.6%) and Comparison (59.3%) groups reported at least one type of self-regulation of driving activity at baseline. There was no significant change in the driving behaviors at the six-month follow-up. CONCLUSION: CarFit was able to detect addressable opportunities that may contribute to the safety of older drivers. IMPACT ON INDUSTRY: CarFit recommendations may need stronger reinforcement in order to be enacted by a participant.

Associations of back and leg pain with health status and functional capacity of older adults: findings from the retirement community back pain study.

OBJECTIVE: Low back pain (LBP) is the most frequently reported musculoskeletal problem in older adults, but its impact on health status is not well understood. Our objective was to determine whether LBP and concurrent leg pain are associated with health-related quality of life (HRQOL) and function in a cohort of older adults, and to examine care-seeking behaviors related to LBP. METHODS: This was a population-based, cross-sectional survey study of 522 community-dwelling men and women (67.4%) ages >or=62 living in 4 retirement communities in Maryland and northern Virginia. LBP status in the past year was categorized as no pain in the low back or leg, LBP only, and LBP with leg pain. HRQOL and function were measured with the Medical Outcomes Study Short Form 36 (SF-36). RESULTS: A total of 26.8% of the sample reported LBP only and 21.3% reported LBP plus leg pain. Participants with LBP and LBP plus leg pain had lower scores in all SF-36 domains, reflecting worse HRQOL (P < 0.0001). LBP and LBP plus leg pain were associated with 2-fold greater odds of falling and increased difficulty lifting grocery bags, walking several blocks, and bathing. LBP plus leg pain was associated with difficulty in social interactions (odds ratio 10.63, 95% confidence interval 3.57-31.60). Less than half sought care for LBP and those who did had poorer health status and greater pain burden. CONCLUSION: LBP is common among older adults and strongly associated with reduced HRQOL and function. These findings argue strongly for both identifying cases of LBP by health care practitioners and pursuing effective treatments for LBP given the potential consequences.

Testing the reliability and validity of computer-mediated social support measures among older adults: a pilot study.

With the increasing number of older adult online users, the Internet and e-mail are becoming a new source of social support for older adults. To assess this computer-mediated social support, two traditional social support measures were modified: (1) the Lubben Social Network Scale and (2) the Medical Outcomes Study Social Support Survey. The purpose of this pilot study was to test the reliability and validity of these modified measures. This study was a single group descriptive study with two data collection points. Data were collected using Web surveys. A total of 38 older adult participants completed the first survey; 35, the second survey. The findings of this preliminary study provided evidence for the reliability, content validity, and, to a limited extent, construct validity, of the modified measures. Additional studies with a larger representative sample are needed to further examine the psychometric aspects of these measures.

Skeletal muscle damage and recovery.

Muscular strength is essential for recovery after an acute illness. Disuse atrophy of muscle begins within 4 hours of the start of bed rest resulting in decreases in muscle mass, muscle cell diameter, and the number of muscle fibers. Strenuous exercise of atrophic muscle can lead to muscle damage including sarcolemmal disruption, distortion of the myofibrils' contractile components, and cytoskeletal damage. Assessment of skeletal muscle for disuse atrophy is done clinically at the bedside through strength assessment. Examination of the muscle itself can be conducted through the use of nuclear magnetic resonance imaging, whereas muscle strength can be quantified with a computerized dynamometer. Biochemical markers, including creatine kinase and troponin, also are available for the assessment of skeletal muscle damage. Activity management in the critical care environment focuses on an individualized plan, developed in cooperation with the recovering patient, with the goal of preserving and improving atrophic skeletal muscle.

The effect of neuromuscular electrical stimulation on arthritis knee pain in older adults with osteoarthritis of the knee.

The objective of this study was to examine the short- and long-term effects of a home-based, 12-week neuromuscular electrical stimulation (NMES) of the quadriceps femoris to decrease arthritis knee pain in older adults with osteoarthritis of the knee. The study sample (N = 38) was randomly assigned to the NMES treatment plus education group or the arthritis education-only group. Pain was measured in both groups with the McGill Pain Questionnaire (MPQ) at baseline, during the intervention at weeks 4, 8, 12, and at follow-up and with the Arthritis Impact Measurement Scale 2-Pain Subscale (AIMS2-PS) at baseline and week 12. The NMES Pain Diary (PD) was completed 15 minutes before and after each stimulation session. There was a significant 22% decline in pain 15 minutes after as compared with immediately before each NMES treatment (p <.001), as measured by the PD. No significant group differences were found between the 2 groups over the course of the intervention and follow-up. These findings indicate that a home-based NMES intervention reduced arthritis knee pain 15 minutes after a NMES treatment.

The relationship of arthritis self-efficacy to functional performance in older men and women with osteoarthritis of the knee.

The objective of this study was to examine the relationship between arthritis self-efficacy (ie, the confidence a person has in the ability to perform a specific task) and self-reported functional performance among older men and women with osteoarthritis (OA) of the knee. The findings suggest that the relationship between arthritis self-efficacy and functional performance varies with gender. An older woman's confidence in her ability to perform tasks affects her perceived functional performance. However, this perception may not be true for older men with OA of the knee.

A home-based protocol of electrical muscle stimulation for quadriceps muscle strength in older adults with osteoarthritis of the knee.

OBJECTIVE: To determine whether home-based neuromuscular electrical stimulation (NMES) applied to the quadriceps femoris (QF) muscle increases strength, physical activity, and physical performance in older adults with knee osteoarthritis (OA). METHODS: Thirty-four adults (> 60 yrs) with radiographically confirmed symptomatic knee OA were randomized to NMES plus education or education only (EDU). The primary outcome was isometric QF peak torque (PTIso), with secondary outcomes of daily step counts, total activity vector magnitude, 100-foot walk-turn-walk, timed stair climb, chair rise, and pain. The NMES group used a portable electrical muscle stimulator 3 days a week for unilateral QF training with incremental increases in the intensity of isometric contraction to 30-40% of maximum over 12 weeks. Both groups received the 12-week Arthritis Self-Management course and were followed an additional 12 weeks. RESULTS: The stimulated knee-extensor showed a 9.1% increase in 120 degrees PTIso compared to a 7% loss in the EDU group (time x group interaction for 120 degrees PTIso; p = 0.04). The chair rise time decreased by 11% in the NMES group, whereas the EDU group saw a 7% reduction (p = 0.01, time; p = 0.9, group). Similarly, both groups improved their walk time by approximately 7% (p = 0.02, time; p = 0.61 group). Severity of pain reported following intervention did not differ between groups. CONCLUSION: In older adults with knee OA, a home-based NMES protocol appears to be a promising therapy for increasing QF strength in adults with knee OA without exacerbating painful symptoms.