Cognitive prescriptions for reducing dementia risk factors among Black/African Americans: feasibility, acceptability, and preliminary efficacy.

OBJECTIVES: Black/African Americans (B/AAs) have double the risk of Alzheimer's disease and related dementia than Whites, which is largely driven by health behaviors. This study examined the feasibility, acceptability, and preliminary efficacy of a pilot randomized clinical trial of an individualized multidomain health behavior intervention among middle-aged and older B/AAs (dubbed Cognitive Prescriptions [CogRx]). DESIGN: Thirty-nine community-dwelling B/AA participants aged 45-65 without significant cognitive impairment were randomized to one of three groups: CogRx, Psychoeducation, or no-contact control. The Psychoeducation and CogRx groups received material on dementia prevalence, prognosis, and risk factors, while the CogRx group additionally received information on their risk factor profile across the five CogRx domains (physical, cognitive, and social activity, diet, sleep). This information was used for developing tailored 3-month goals in their suboptimal areas. RESULTS: The CogRx program had high retention (all 13 CogRx participants completed the 3-month program and 97% of the full sample completed at least 1 follow-up) and was well-received as exhibited by qualitative and quantitative feedback. Themes identified in the positive feedback provided by participants on the program included: increased knowledge, goal-setting, personalization, and motivation. The COVID-19 pandemic was a consistent theme that emerged regarding barriers of adherence to the program. All three groups improved on dementia knowledge, with the largest effects observed in CogRx and Psychoeducation groups. Increases in cognitive, physical, and overall leisure activities favored the CogRx group, whereas improvements in sleep outcomes favored Psychoeducation and CogRx groups as compared to the control group. CONCLUSION: The CogRx program demonstrated feasibility, acceptability, and preliminary efficacy in increasing dementia knowledge and targeted health behaviors. Further refinement and testing of the implementation and effectiveness of similar person-centered dementia prevention approaches are needed on a larger scale in diverse populations. Such findings may have implications for clinical and public health recommendations. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT03864536.

Texting Older Sisters to Step to Manage Obesity in Older Black Women: A Feasibility Study.

INTRODUCTION: Black women are disproportionately classified as overweight or obese and physically inactive. Social support and culturally relevant and age-appropriate physical active interventions are needed to reduce inactivity and to prevent weight gain among this group. Mobile-health text messages have shown to be an acceptable, feasible and interactive way to promote physical activity among older Black women. STUDY DESIGN: This feasibility, 12-week RCT, deployed between August 2020 and December 2020, aimed to determine the feasibility and effectiveness of a mobile health intervention that focused on increasing physical activity behaviors among community-dwelling, older Black women who were age ≥60 years and classified with overweight or obesity. SETTING/PARTICIPANTS: Community-dwelling, older Black women. INTERVENTION: The intervention group received physical activity promotion text messages daily, whereas the control group received 1 neutral message related to general health information weekly. MEASURES: At baseline and post intervention assessments, researchers obtained HbA1c levels, weight, BMI, waist circumference, and questionnaires related to physical activity. Post-intervention satisfaction was also collected through a survey. RESULTS: The intervention group had an average increase of approximately 700 steps per day more than the control group, lost more waist circumference inches (2.2) than the controls, and averaged more pound loss (2.5) than controls. The control group had a greater HbA1c reduction, whereas the intervention group remained stable. The text messages were 100% readable, and 95% of the women stated the study was motivational. Overall, 12% of participants suggested that future studies should include more in-person social support, and 8.3% said that daily text messages were too much. CONCLUSIONS: Findings suggest that a mobile health physical activity intervention that uses self-monitoring techniques in conjunction with motivational cues, is an acceptable delivery method and a promising strategy to increase physical activity behaviors among this population, which is feasible, potentially efficacious, and low cost. TRIAL REGISTRATION: NCT04114071.

Rationale and protocol for a pilot randomized controlled trial of a cognitive prescription intervention for reducing dementia risk factors among African Americans.

BACKGROUND & PURPOSE: African Americans (AAs) are twice as likely to develop dementia than Whites, which may be driven by poorer dementia knowledge and lifestyle factors. This article provides the rationale and protocol for a pilot clinical trial examining a tailored multi-domain lifestyle modification intervention in middle-aged and older AAs. This study will explore the feasibility and efficacy of individualized Cognitive Prescriptions (CogRx) which target five domains: physical activity, cognitive activity, diet, sleep, and social activity. Theoretical underpinnings include Social Cognitive Theory and the Health Belief Model, which suggest that tailored risk factor information, goal-setting, and outcome expectations along with addressing self-efficacy and barriers will promote behavior change. STUDY DESIGN: This study plans to enroll 150 community-dwelling AA participants aged 45-65 without significant cognitive impairment. After baseline assessment including data-driven assessment of deficiencies in each of the five CogRx domains, participants are randomized with equal allocation to either: psychoeducation + CogRx, psychoeducation only, or no-contact control. The psychoeducation and CogRx groups receive general psychoeducation on dementia prevalence, prognosis, and risk factors, while the CogRx group also receives information on their risk factor profile and develops a tailored 3-month intervention plan, consisting of simple evidence-based strategies to implement. The CogRx condition receives text-messaging reminders and adherence queries and provides feedback on this program. CONCLUSION: This study tests a novel multi-domain dementia prevention intervention and has several strengths, including enrolling middle-aged AAs with a focus on prevention, assessing adherence and self-efficacy, tailoring the intervention, and examining dementia knowledge. The goal is to yield new perspectives on person-centered dementia prevention approaches in diverse populations, and ultimately impact clinical and public health recommendations for maintaining cognitive health, thereby reducing disparities in dementia. Modifications to study design due to COVID-19 and future directions are discussed.

Promoting Physical Activity Through Policy at a Single Safety-Net Clinic: A Pilot Study.

BACKGROUND: Physical inactivity is a major issue for African Americans that contributes to increased risk for chronic conditions including obesity, heart disease, diabetes, and cognitive decline. The purpose of this single-clinic pilot study aimed to determine if a physical activity policy would increase primary-care provider discussions of physical activity during clinic visits using the Exercise is Medicine initiative as a guide. METHODS: The study design involved data collection at three time points. Participants were recruited from a single clinic providing high quality healthcare without regard to ability to pay. Participants included 109 African American patients between the ages of 24 and 81 (39 pre-intervention, 40 at 6 weeks post-intervention, and 30 at 12-months post-intervention). The primary outcome measure was participants' answers related to whether a physical activity discussion occurred with their primary-care provider. RESULTS: At baseline, 13% of participants reported a physical activity discussion with their provider, this increased to 33% at 6 weeks post-intervention. However, at 12-months post-intervention, the percentage of participants who reported a physical activity discussion decreased to 23%. CONCLUSION: Exercise is an underused evidence-based strategy that should be prescribed as a medicine to prevent and manage many chronic health conditions. This pilot study demonstrated the feasibility of improving provider-patient communications related to the importance of daily physical activity behaviors. Further research is needed to determine how to employ and sustain a clinic level policy that will encourage physical activity discussions at every visit.

Physical Activity Promotion in a Safety-net Clinic: Does the Provider Make a Difference? A Pilot Study.

BACKGROUND: Despite the long-term health benefits of physical activity, many Americans across the lifespan do not meet the recommended levels. However, physical activity discussions in the clinic setting may hold promise. The purpose of this study aimed to understand health care providers' beliefs and practices about physical activity discussions being a part of patients' healthcare treatment. METHODS: Semi-structured, audiotaped interviews were conducted to elicit narratives from ten health care providers. Interview data were transcribed verbatim, then coded and analyzed by two qualitative researchers using NVivo12. RESULTS: Three major themes emerged: importance of regular PA counseling for vulnerable populations, patients' lack of regular physical activity, including subthemes of lack of time, current health conditions, and social determinants of health, and healthcare provider's reflections about their own physical activity. CONCLUSION: Healthcare providers have an important role when it comes to promoting good health. Having physical activity discussions with patients at every clinic visit is a great opportunity to encourage patients to engage in healthy lifestyle behaviors such as regular physical activity. From this pilot study, implications for practice may include increased awareness of the healthcare providers to discuss physical activity at every visit, which may lead to improved provider-patient communications related to the benefits of daily physical activity behaviors. These discussions may even have a secondary gain of encouraging the providers themselves to adopt the healthy behavior and thereby serve as a role model for their patients.

Improving outcomes in patients with prediabetes through a lifestyle modification program.

BACKGROUND AND PURPOSE: Type 2 diabetes and obesity are prevalent throughout the United States, and they occur at even higher rates in some southern states. This project aimed at improving outcomes for overweight/obese patients with prediabetes, thus reducing their risk of progression to type 2 diabetes. METHODS: Twenty-four adults with a diagnosis of prediabetes and body mass index ≥ 25 completed this 3-month program. The Rapid Eating Assessment for Patients (REAPs) tool was used to assess eating habits and physical activity levels. The Single-Item Literacy Screener was used to screen for limited reading ability. The following preintervention and postintervention data were obtained: weight, A1c, REAP score, and REAP Physical Activity question (REAP-PA). INTERVENTION: Monthly group educational sessions were conducted followed by individualized goal setting. The content of the sessions encompassed a lifestyle modification program based on the first five sessions of the Centers for Disease Control and Prevention "Prevent T2"curriculum, incorporating the Southern-style diet, food choices, and activity resources available in the local community. RESULTS: Results revealed a significant (p < 0.05) decrease in weight (average 4.0 ± 4.2 kg), REAP score (average 17.6 ± 16.6), and REAP-PA (average 0.6) after intervention. A1c values decreased slightly but were not statistically significant, which may be due to the limited sample size. Those with limited reading ability showed a slightly greater A1c loss than those with adequate literacy. CONCLUSIONS: A 3-month lifestyle modification program resulted in improvement in weight, eating habits, physical activity level, and A1c in overweight/obese patients at risk for type 2 diabetes.

Associations of Depression, Physical Activity, and Diabetes with Self-Rated Health in Black Men.

Black men have higher rates of diabetes that are compounded by obesity and limited physical activity leading to poor self-rated health. The purpose of this study was to provide a nationally representative snapshot of indicators for lower self-rated health in Black men with diabetes. An exploratory secondary analysis was conducted of self-report data, physical measurements, and clinical assessments from the 2009-2010 National Health and Nutrition Examination Survey (NHANES) dataset. The analytic sample included 270 Black men 45 years of age or older, who were randomly selected from the dataset through statistical processes. After adjusting for sociodemographic and physiologic characteristics, having diabetes (ß = -0.13), fewer days of physical activity (ßß = 0.13), and more depressive symptoms (ßß = -0.34) had statistically significant associations with self-rated health scores (ps < 0.05). Such associations support the use of self-rated health indices as a monitor for quality of life in clinical practice and identify gaps in research related to self-rated health in Black men.

Visual Performance and Occupational Safety Among Aging Workers.

With the rapid growth of the aging workforce, age-related conditions may negatively influence overall workplace safety and health among these workers and their employers. In this summary, we have outlined details about visual acuity, glare sensitivity, and contrast sensitivity, which are common age-related vision changes that can potentially affect their occupational safety. The occupational health nurse is well positioned to address these concerns by instructing aging workers about potential development of vision change and ensuring they receive the appropriate vision screening. By assisting employers to modify work environments to accommodate this population, the occupational health nurse can reduce the risk of injury, as well as positively impact the health of their aging workforce.

Exercise is Medicine as a Vital Sign: Challenges and Opportunities.

Exercise is widely recognized as a critical component of a healthy lifestyle by multiple scientific and regulatory bodies. Yet only 35% of adults in the United States even report engaging in regular physical activity. In response to this challenge, the Exercise is Medicine (EIM) initiative encourages clinicians in all settings to regularly assess and counsel patients on physical activity in an attempt to reduce levels of inactivity. The purpose of this article is to highlight key challenges to the implementation of the EIM initiative to promote physical activity and to identify potential opportunities to overcome these challenges. EIM is a global health initiative that endorses "exercise" to be a "vital sign" in all clinical settings. Specifically to assess and compare the patient's physical activity level to national guidelines for physical activity and then promote discussions or referrals based on results. Since its 2007 launch, advocates of the EIM initiative have increased global awareness to promote the EIM mission of integrating and implementing physical activity into healthcare systems, local communities, and individuals' daily lives. Physical activity is fundamental to the overall health of all people across all geographic locations and throughout the lifespan. Promoting physical activity as a healthy lifestyle change has specific challenges but necessary to decrease health disparities related to inactivity.

Texting Older Sisters to Step: The TOSS Study.

The purpose of our two-phase study was to develop acceptable text messages to increase physical activity. Four focus groups (two for each phase) were conducted with older African American women who had access to texting-capable mobile phones and were in the contemplation stage for physical activity. The mean age of Phase 1 participants (n = 12) was 71 and ranged from 65 to 86 years. Content analysis was used to identify fundamental themes that were later used to develop text messages. Six categories emerged from the data and 31 text messages were developed based on focus group input and national recommendations. The mean age of Phase 2 participants (n = 9) was 67 and ranged from 65 to 75 years. Descriptive statistics revealed 100% of participants understood all messages. When messages were evaluated individually, a minimum of 78% felt each message motivated activity and 67% said lengths were perfect. Findings identified messages that were relevant and potentially motivational to stimulate physical activity among this population.

Understanding health policy to improve primary care management of obesity.

NPs are ideal candidates for implementing positive health changes for obese patients. Providers have medical expertise and can promote obesity reduction strategies to their patients. Increased awareness of the influence of health policy and clinical implications for obesity management are needed.

Depression and physical functioning among older Americans with diabesity: NHANES 2009-2010.

BACKGROUND: Caring for older adults with diabesity can be challenging for primary care nurse practitioners. The purpose of this study was to examine whether there would be an additive effect of diabesity on depressive symptoms and physical functioning of older adults. We hypothesized that there is an additive effect of diabesity on depressive symptoms and physical functioning among older adults with one or neither condition. METHODS: We performed a cross-sectional analysis of data from National Health and Nutrition Examination Surveys collected from African-American and Caucasian adults aged 65 and over between 2009 and 2010. Multivariate linear regression models were utilized. The sample consisted of 918 participants. In covariate-adjusted models, participants with diabesity reported more depressive symptoms than people with neither condition. Individuals with diabesity and those with obesity alone reported significantly more difficulty with physical function when compared to participants with neither condition. CONCLUSION: Findings suggest that diabesity was more burdensome to older adults than either condition alone. More research is needed to understand the interplay between depression, physical function, and diabesity. IMPLICATIONS FOR PRACTICE: To disrupt the adverse effects of diabesity burden, increased nurse practitioner awareness of this phenomenon may be beneficial in improving and maintaining physical and mental health among older adults.

Associations of Social Support and Self-Efficacy With Quality of Life in Older Adults With Diabetes.

Older adults are disproportionately affected by diabetes, which is associated with increased prevalence of cardiovascular disease, decreased quality of life (QOL), and increased health care costs. The purpose of the current study was to assess the relationships between social support, self-efficacy, and QOL in a sample of 187 older African American and Caucasian individuals with diabetes. Greater satisfaction with social support related to diabetes (but not the amount of support received) was significantly correlated with QOL. In addition, individuals with higher self-efficacy in managing diabetes had better QOL. In a covariate-adjusted regression model, self-efficacy remained a significant predictor of QOL. Findings suggest the potential importance of incorporating the self-efficacy concept within diabetes management and treatment to empower older adults living with diabetes to adhere to care. Further research is needed to determine whether improving self-efficacy among vulnerable older adult populations may positively influence QOL.

A phenomenological study of obesity and physical activity in southern African American older women.

African American women are more likely to be classified as overweight or obese than European American women and little is known about this phenomenon. The purpose of this qualitative study was to explore the lived experiences of overweight and obese African American older women living in the southern regions of the United States. Semistructured, audiotaped interviews were conducted to elicit narratives from nine participants. Interview data were transcribed verbatim and then coded and analyzed using Colaizzi's phenomenological analysis framework. Three major categories emerged: impact of health conditions, incongruent perceptions, and the desire for independence. The focus of culturally appropriate interventions aimed at increasing physical activity for this group should incorporate activities that will help them remain independent, because weight loss is not a primary motivator.