Student experiences with an interprofessional hope-based healthy aging research project.

Interprofessional education (IPE) and research enhances learning, team-based communication, and cross-disciplinary collaborations, which can result in higher quality care for older adults. Despite the importance of IPE, it remains underutilized in higher education, demonstrating the need for extracurricular IPE opportunities. This study describes an interprofessional research project that brought together faculty, undergraduate, and graduate students from several health and social science disciplines to design and deliver a 15-week healthy aging program for older adults living in the urban Circumpolar North. Five faculty and one graduate research assistant led the project while eight students team-taught weekly, 1-hour sessions in the community focusing on healthy lifestyles within a framework of Persuasive Hope Theory. This paper describes the project, the student training procedures, and reports the results of the student satisfaction survey regarding their involvement with the research. Using a student self-assessment survey, students report gains in thinking like a scientist, increased confidence conducting research tasks, benefits from teamwork, and greater consideration of the needs of older adults in their field of study. Despite a small sample size, this study also suggests that students may be more likely to consider a career working with older adults if given hands-on experiences.

Starting a university gerontology research laboratory: experiences from researchers in public health and psychology.

Although founding and directing an independent research laboratory is often expected of faculty at American universities, there are several barriers to successful completion of this important task. There is little guidance in the literature regarding exactly how to go about starting a research laboratory. The guidance that exists for faculty often focuses on running research labs in the "hard sciences," such as biomedical science and engineering, leaving social and behavioral scientists out of such considerations. Additionally, smaller or teaching-focused universities often have little infrastructure or support for starting a research lab, so faculty at these institutions may not know where to begin. These barriers are significant concerns for junior faculty, who are often unprepared for the realities and challenges of starting a successful research lab while obtaining other milestones required for promotion and tenure. We present two examples of recently-formed gerontology research laboratories begun by junior faculty, one in the psychology department of a research university and one in public health at a teaching-focused university. Our case studies present the reader with specific examples, lessons learned, and guidance for starting their own gerontology research laboratory in higher education, whether as a physical or virtual space, as well as recommendations on maintaining its functioning during a global pandemic.

"I learned that I am loved": Older adults and undergraduate students mutually benefit from an interprofessional service-learning health promotion program.

Although benefits of service-learning and interprofessional education (IPE) have been well documented to be effective for students in gerontology, few curricula appear to integrate both aspects into a single experience for undergraduate students in public health. We discuss the development and implementation of an IPE service-learning health promotion program embedded within two different departments at a mid-sized university. Students worked in interdisciplinary teams and acquired IPE learning outcomes while they engaged in their first experiences working with diverse older adults at a low-income independent-living housing community. Twenty-five students each team-taught two sessions on nutrition, physical activity, and stress reduction techniques in a 10-week program. Qualitative and quantitative results showed significant learning outcomes from the students about the needs of the aging population and increased comfort working with seniors. Older participants in the program also reported positive health and psychological outcomes from participation. Challenges, next steps, and recommendations are also discussed.

Interactions Between Diet, Physical Activity, and the Sociocultural Environment for Older Adult Health in the Urban Subarctic.

This study sought to examine the relationship between the sociocultural factors that shape diet, physical activity, and nutritional status outcomes among seniors in Anchorage, Alaska. Alaskan seniors are an ideal study population because the state has the fastest growing senior population in the United States. Since much health research in the circumpolar north focuses on the influence of the economic or rural environment on nutrition, there is a need to investigate the ways social relationships shape diet, physical activity patterns, and nutritional status in urban spaces. This cross-sectional study included 82 community-living men and women (mean age = 74 years) in Anchorage. Participants underwent anthropometric measurements and completed questionnaires on their dietary intake, physical activity, and the sociocultural influences on their diet and exercise practices. T-tests indicate that diet and physical activity practices in this sample do not meet national recommendations and that diet differs adversely from national reference samples. Mann-Whitney U tests indicate the media and friends are associated with increases in energy expenditure. Family influences increased fruit consumption, while participation in cultural and social events increased intake of fats and sweets. Reaching older adults through a variety of channels, including the media, social networks, and culturally responsive programs can alleviate some of the barriers to healthy diet and exercise patterns.

"With Age Comes Wisdom:" a Qualitative Review of Elder Perspectives on Healthy Aging in the Circumpolar North.

Cross-cultural research has shown marked variation in health outcomes across the world's older adult populations. Indeed, older adults in the Circumpolar North experience a variety of health disparities. Because aging is a biological process rooted in sociocultural context, there exists great variation in the ways older adults define and experience healthy, or "successful," aging in their communities. The aim of this analysis was to synthesize qualitative research among older residents (aged 50+ years) in the Circumpolar North to identify a definition of healthy aging common in the region. A thorough review was conducted across a variety of academic search databases for peer-reviewed, qualitative studies conducted among community-dwelling older adults. The search strategy initially identified 194 articles; 23 articles met the inclusion criteria. Included studies were coded and analyzed using Grounded Theory to examine underlying themes of healthy aging in the Circumpolar North. The findings reveal the importance older adults place on respect, their relationship to the land, and psychosocial resilience into multidimensional models of healthy aging. This research also highlights the need for increased translational research with populations in the Circumpolar North that are under-represented in the literature.

What Motivates Older Adults to Improve Diet and Exercise Patterns?

Dietary intake and physical activity are lifestyle behaviors that are learned, developed, and practiced throughout an individual's lifetime. These lifestyle behaviors have a profound role on health and quality of life--with late-life changes still resulting in notable improvements. Despite well documented benefits of behavior change, such changes are extremely challenging. The purpose of this study is to better understand from the perspective of older adults themselves, the factors that may influence their likelihood of making lifestyle changes. Participants were recruited two primary care clinics. 104 older adults ranging in age from 65 to 95 were included. Participants were interviewed about their motivations and plans to change diet and physical activity behaviors following a routine primary care visit. All interviews were transcribed and transcripts were analyzed using a line-by-line coding approach. Older adults reported that their likelihood of making a lifestyle change related to perceptions of old age, personal motivation, and perceived confidence in the ability to make effective changes. These findings suggest the importance of creating more positive images of old age and tailoring health promotion efforts to older adults' motivations and confidence in their ability to make behavior changes.

Acceptability and Feasibility of Physical Activity Assessment Methods for an Appalachian Population.

Nowhere is improving understanding and accurate assessment of physical activity more important for disease prevention and health promotion than among health disparities populations such as those residing in rural and Appalachian regions. To enhance accurate assessment of physical activity and potentially improve intervention capacity, we conducted a mixed-methods study examining the acceptability and feasibility of self-report physical activity questionnaires, pedometers, and accelerometers among rural Appalachian children, adolescents, and adults. Most participants reported positive experiences with all three physical activity assessment tools. Several acceptability ratings differed by age group and by sex within each age group. With very few exceptions, no significant differences in acceptability were found by race, education, employment status, health status, BMI categories, income levels, or insurance status within age groups or overall. Several factors may impact the choice of the physical activity assessment method, including target population age, equipment cost, researcher burden, and potential influence on physical activity levels. Children and adolescents appear to have more constraints on when they can wear pedometers and accelerometers. While pedometers are inexpensive and convenient, they may influence physical activity levels, rather than simply measure them. Accelerometers, while less influential on behavior, consume extensive resources, including high purchase costs and researcher burden.

Why Gerontology Needs Anthropology: Toward an Applied Anthropological Gerontology.

In this essay, we argue that gerontologists should increase their engagement with anthropologists to increase transdisciplinary collaboration, fulfill the interdisciplinary promise of gerontology as a field, and to ensure the work of anthropologists is formed by, and employed in, situations where meaningful engagement with practitioners and policymakers can lead to social change. Anthropology is the study of human societies in historical, biological, and sociocultural context, comprising a holistic field of study that can contribute unique methods, approaches, and theories to the field of gerontology. Although increasing amounts of anthropological scholarship have focused on older adulthood, this critical work of anthropologists still needs to be utilized by those in positions of power to enact change. Furthermore, the work conducted by anthropologists of aging has not consistently been recognized as anthropological scholarship. Therefore, a notable gap exists between the promise of the anthropology of aging and the utilization of the field, its findings, and engagement with the broader gerontological academy. As such, the contributions of anthropology to aging scholarship and the resulting reduction in inequities in the aging experience are not always adequately recognized. By examining the history of anthropology's engagement with aging and the lifecourse, we argue for a more applied anthropological gerontology. We conclude with a call to action to ensure that anthropological gerontology is seen as a fundamental branch of scholarship, both within anthropology and gerontology, which can be used to improve the lived experiences of older adults globally.

Pilot study of the effectiveness and acceptability of an automatic toothbrush among residents in long-term care.

AIMS: Reduced mobility and/or low cognitive functioning may make it difficult for residents with special care needs in long-term care homes to brush their own teeth every day. Demands on caregiving staff in these homes may also result in skipping essential toothbrushing tasks, resulting in poor oral health. METHODS AND RESULTS: This article provides the results of a 6-week pilot study that tested the effectiveness and acceptability of the Willo automatic toothbrush "robot" used among residents in long-term care compared to their regular toothbrush. Using a non-randomized delayed-start design with a convenience sample (age 38-82 years, mean = 66.9), each study participant underwent biofilm assessments at three timepoints: (1) baseline as the study began (mean = 2.33), (2) after using their regular toothbrush daily for 3 weeks (mean = 2.21), and (3) after using the Willo automatic toothbrush daily for 3 weeks (mean = 0.31). Using t-tests and repeated measures ANOVA, the Willo was significantly more effective than regular toothbrushing at reducing biofilm (p = .00004) and gingivitis (p = .002) over time. Participants also responded to brief weekly satisfaction surveys about their experiences using the two different brushes. The Willo was generally tolerated among participants, who largely reported that the brush was easy to use, not uncomfortable, and did not cause pain or bleeding. While approximately half of the study participants reported liking the Willo, the remainder did not want to replace their regular brush with the Willo, for a variety of reasons. CONCLUSION: We recommend more research on the effectiveness and acceptability of automatic toothbrushes with long-term care residents, caregivers, and others who may benefit from their use.

Fruit and vegetable intake, physical activity, and functional fitness among older adults in urban Alaska.

Older adults often face barriers to obtaining recommended diet, physical activity, and fitness levels. Understanding these patterns can inform effective interventions targeting health beliefs and behavior. This cross-sectional study included a multicultural sample of 58 older adults (aged 55+ years, M=71.98) living in independent senior housing in urban Southcentral Alaska. Participants completed a questionnaire and the Senior Fitness Test that assessed self-reported fruit and vegetable intake, physical activity, self-efficacy, and functional fitness. T-tests and bivariate correlation analyses were used to test six hypotheses. Results indicated that participants had low physical activity but had a mean fruit and vegetable intake that was statistically significantly higher than the hypothesized "low" score. Only 4.26% of participants met functional fitness standards for balance/agility, and 8.51% met standards for lower-body strength. However, 51.1% met standards for upper-body strength and 46.8% met standards for endurance The results also indicated that nutrition self-efficacy and exercise self-efficacy were positively related to fruit and vegetable intake and physical activity levels, respectively. Interestingly, income was not related to nutrition or activity patterns. These data complicate the picture on dietary and physical activity patterns for older adults in Alaska and offer recommendations for future health promotion activities.

Appalachian women's perspectives on breast and cervical cancer screening.

INTRODUCTION: Although breast and cervical cancer screening rates have been increasing over the three past decades, many Appalachian women in the USA do not receive screening, leading to disproportionate mortality rates. The aims of this study were to: (1) better understand barriers to and facilitators of breast and cervical cancer screening among Appalachian women; and (2) identify strategies to increase cancer screening. METHODS: Eight focus groups and 19 key informant interviews were conducted with 79 participants. Tape-recorded session were transcribed and content analyzed. RESULTS: Findings consistent with screening determinants research include: inadequate personal and community resources, attitudinal and knowledge barriers, and competing demands. Less commonly described factors include family cancer history, personal health habits, and the multiple influences of healthcare providers. CONCLUSIONS: Interpreting findings in terms of consumer information processing theory, healthcare providers and supports play a key role in educating and influencing the screening uptake among Appalachian Kentucky women. These findings have the potential to inform innovative and culturally consonant intervention approaches capable of increasing screening and decreasing mortality rates.

Where Are All the Men? A Qualitative Review of the Barriers, Facilitators, and Recommendations to Older Male Participation in Health Promotion Interventions.

OBJECTIVE: Older men have lower participation rates than females in health promotion interventions. We conducted a qualitative review of 20 years of existing research across a variety of academic search databases to outline the barriers, facilitators, and recommendations for this imbalance. DATA SOURCE: A systematic search was conducted across Google Scholar, PubMed, MEDLINE, CINAHL, Academic Search Premier, Psychology and Behavioral Sciences Collection, and Web of Science from dates January 1, 2000 - December 31, 2020. STUDY INCLUSION AND EXCLUSION CRITERIA: Abstracts were screened based on: original research, English language, recruitment or participation, health promotion or health program, and male gender. DATA EXTRACTION: Of 1194 initial search results, 383 article abstracts were thoroughly screened for inclusion and 26 articles met inclusion criteria. SYNTHESIS: Included studies were coded and analyzed using Grounded Theory. RESULTS: Barriers included masculine gender roles as well as program scope, environment, and gender of the instructors and other participants. Facilitators included creating social groups of older males that participate in a variety of activities together, including hobbies and health promotion, over a long period of time. CONCLUSION: Health promotion interventions should involve men in all aspects of program planning and implementation, take into account men's existing relationships and interests to create gender-sensitive programming, and clearly delineate the benefits to participation.

Community strategies to address cancer disparities in Appalachian Kentucky.

Central Appalachian residents suffer disproportionate health disparities, including an all-cancer mortality rate 17% higher than the general population. During 10 focus groups and 19 key informant interviews, 91 Appalachian residents identified cancer screening challenges and strategies. Challenges included (1) inadequate awareness of screening need, (2) insufficient access to screening, and (3) lack of privacy. Strategies included (1) witnessing/storytelling, (2) capitalizing on family history, (3) improving publicity about screening resources, (4) relying on lay health advisors, and (5) bundling preventive services. These insights shaped our community-based participatory research intervention and offered strategies to others working in Appalachia, rural locales, and other traditionally underserved communities.

Utilizing the "One Health" Model to Study Human Aging in Urban Environments.

The "One Health" concept has resulted in a rich research literature that integrates human and animal systems, with a focus on zoonotic diseases; however, this narrow focus is at the expense of one of the leading causes of global human mortality: non-infectious, chronic diseases. Here, we provide a viewpoint that applying the integrated One Health framework to public health issues such as the impact of stressful urban environments on the process of human aging has the potential to elucidate potential causal mechanisms that have previously gone unnoticed. Given the success of the One Health paradigm in studying human health in rural areas, we posit that this model would be a useful tool for studying human, animal, and environmental interactions in urban settings.

Pilot of a Communication Program for Dementia Caregivers Using Improvisational Techniques.

Background/Objectives: This paper is a brief report on a novel pilot program called Improv to Improve for family dementia caregivers to build resilience, communication skills, and improve social caregiving situations in order to reduce caregiver burden and low mood. Methods: We conducted a 6-week improv training for family caregivers including pre- and post-program evaluation of caregiver mood utilizing the Beck Depression Inventory and the Zarit Burden Interview and care-recipient symptoms with the Neuropsychiatric Inventory Questionnaire. Results: Six family caregivers participated in the pilot project and reported small improvements (d = 0.28) in caregiver's mood and significant improvements in care-recipient's symptom severity and distress (d = 0.50). Participants all reported agreeing or strongly agreeing with program satisfaction questions and found the training to be useful. Conclusions: These findings have implications for broader implementation of improvisational techniques for educating family dementia caregivers.

Using Concept Mapping Methods to Define "Healthy Aging" in Anchorage, Alaska.

This exploratory research project captured a multidimensional model of healthy aging in Anchorage, Alaska, by utilizing the Concept Mapping (CM) methodology with a sample of 53 older adults (aged 55+), aging advocates, public health professionals, and senior service providers. Multidimensional scaling and cluster analyses were conducted to map the relationship between 100 aspects of healthy aging, resulting in 12 distinct concepts of healthy aging. Study participants identified both lifestyle factors and aspects of their environment, providing results that can inform future research and policy development. The perspectives of older adults are scarce in the literature, but how they conceptualize the factors that contribute to healthy aging can have profound influence on behaviors and health outcomes. In addition, CM is a little-used methodology in gerontology that fosters community capacity building, meaningful contributions, and trusting research partnerships. We also provide recommendations for using these methods with older adults.

Older Patients' Recall of Lifestyle Discussions in Primary Care.

Despite the known benefits of engaging in healthy diet and physical activity across the life span, suboptimal diet and physical inactivity are pervasive among older adults. While health care providers can promote patients' engagement in health behaviors, patient recall of recommendations tends to be imperfect. This study sought to better understand older adults' recall of dietary and physical activity discussions in primary care. One hundred and fifteen adults aged 65 and older were interviewed immediately following a routine primary care visit on whether and what they recalled discussing pertaining to diet and physical activity. Compared against transcripts, most patients accurately recalled their diet and physical activity discussions. The inclusion of a recommendation, and for diet discussions longer duration, increased the likelihood of patient recall for these health behavior discussions. These findings suggest that specific recommendations and an extra minute of discussion, at least for dietary discussions, increase the likelihood of accurate patient recall.

"It's just a way of fitting in:" Tobacco use and the lived experience of lesbian, gay, and bisexual appalachians.

UNLABELLED: Lesbian, gay, and bisexual (LGB) people are affected by multiple health disparities and risk factors, including tobacco use. Few studies to date have examined tobacco use specifically in rural LGB populations, and none has investigated the intersections of identity, rural LGB culture, and tobacco. The purpose of this study was to explore the perspective of Appalachian LGB people regarding tobacco use. METHODS: . Nineteen LGB-identified Appalachian residents participated in audiotaped, semi-structured interviews. Two authors analyzed and coded transcripts through constant comparison, and determined themes through consensus. RESULTS: Five themes emerged: the convergence of Appalachian and LGB identities, tacit awareness of LGB identity by others, culture and tobacco use, perceived associations with tobacco use, and health beliefs and health care. CONCLUSIONS: LGB Appalachians connect stress and culture to tobacco, but seem less aware that partial concealment of their identity might be a source of the stress that could influence their smoking.

Perspectives on healthy eating among Appalachian residents.

PURPOSE: Extensive attention has been focused on improving the dietary intake of Americans. Such focus is warranted due to increasing rates of overweight, obesity, and other dietary-related disease. To address suboptimal dietary intake requires an improved, contextualized understanding of the multiple and intersecting influences on healthy eating, particularly among those populations at greatest risk of and from poor diet, including rural residents. METHODS: During 8 focus groups (N = 99) and 6 group key informant interviews (N = 20), diverse Appalachian rural residents were queried about their perceptions of healthy eating, determinants of healthy food intake, and recommendations for improving the dietary intake of people in their communities. Participants included church members and other laypeople, public health officials, social service providers, health care professionals, and others. FINDINGS: Participants offered insights on healthy eating consistent with the categories of individual, interpersonal, community, physical, environmental, and society-level influences described in the socioecological model. Although many participants identified gaps in dietary knowledge as a persistent problem, informants also identified extraindividual factors, including the influence of family, fellow church members, and schools, policy, advertising and media, and general societal trends, as challenges to healthy dietary intake. We highlight Appalachian residents' recommendations for promoting healthier diets, including support groups, educational workshops, cooking classes, and community gardening. CONCLUSIONS: We discuss the implications of these findings for programmatic development in the Appalachian context.

Perceptions of smoking cessation programs in rural Appalachia.

OBJECTIVES: To identify perspectives on smoking cessation programs in Appalachian Kentucky, a region with particularly high smoking rates and poor health outcomes. METHODS: Insufficient existing research led us to conduct 12 focus groups (smokers and nonsmokers) and 23 key informant interviews. RESULTS: Several findings previously not described in this high-risk population include (1) transition from pro-tobacco culture toward advocacy for tobacco cessation approaches, (2) region-specific challenges to program access, and (3) strong and diverse social influences on cessation. CONCLUSIONS: To capitalize on changes from resistance to support for smoking cessation, leaders should incorporate culturally appropriate programs and characteristics identified here.