Daily Affect and Daily Prospective Memory in People after Stroke and Their Partners: The Moderating Role of Resting Heart Rate.

INTRODUCTION: Experimental research suggests that affect may influence prospective memory performance, but real-life evidence on affect-prospective memory associations is limited. Moreover, most studies have examined the valence dimension of affect in understanding the influence of affect on cognitive performance in daily life, with insufficient consideration of the arousal dimension. To maximize ecological validity, the current study examined the relationships between daily affect and daily prospective memory using repeated daily assessments and the role of resting heart rate on these relationships. We examined both valence and arousal of daily affect by categorizing affect into four dimensions: high-arousal positive affect, low-arousal positive affect, high-arousal negative affect, and low-arousal negative affect. METHOD: We examined existing data collected from community-dwelling couples, of which at least one partner had a stroke history. The analytic sample included 111 adults (Mage = 67.46 years, SD = 9.64; 50% women) who provided 1,274 days of data. Among the participants, 58 were living with the effects of a stroke and 53 were partners. Participants completed daily event-based prospective memory tasks (in morning and/or evening questionnaires), reported daily affect in the evening, and wore a wrist-based Fitbit device to monitor resting heart rate over 14 consecutive days. RESULTS: Results from multilevel models show that, within persons, elevated high-arousal negative affect was associated with worse daily prospective memory performance. In addition, lower resting heart rate attenuated the inverse association between high-arousal negative affect and lowered prospective memory performance. We did not find significant associations of high- or low-arousal positive affect and low-arousal negative affect with daily prospective memory. DISCUSSION: Our findings are in line with the resource allocation model and the cue-utilization hypothesis in that high-arousal negative affect is detrimental to daily prospective memory performance. Lower resting heart rate may buffer individuals' prospective memory performance from the influence of high-arousal negative affect. These findings are consistent with the neurovisceral integration model on heart-brain connections, highlighting the possibility that cardiovascular fitness may help maintain prospective memory into older adulthood.

Having a Good Time Together: The Role of Companionship in Older Couples' Everyday Life.

INTRODUCTION: Companionship (i.e., enjoyable shared activities) is associated with higher emotional and relational well-being. However, the role of companionship for emotional well-being and relationship satisfaction in older couples' everyday life is not well understood. This article studies time-varying associations of companionship with emotional and relational well-being as older couples engage in their everyday life. METHODS: Participants provided three data points a day over 7 days using electronic surveys that were simultaneously completed by both partners. A total of 118 older heterosexual couples reported momentary companionship, positive and negative affect, and closeness. Data were analyzed using an intensive longitudinal dyadic score model. RESULTS: Couples with higher average companionship showed lower overall negative affect, more overall positive affect, and higher overall closeness. During moments of elevated momentary companionship, partners reported more positive affect, less negative affect, and higher closeness. Regarding between-couple partner differences, i.e., when the female partner's momentary companionship was higher on average than the male partner's momentary companionship, the female partner also showed less negative affect, more positive affect, and higher closeness than the male partner. During moments in which the female partner's momentary companionship was higher than the male partner's momentary companionship, the female partner showed less negative affect, more positive affect, and higher closeness than the male partner. DISCUSSION: Older couples show a consistent link between companionship and emotional well-being and closeness in everyday life emphasizing the importance of studying companionship in close relationships.

A rapid point-of-care ultrasound marker for muscle mass and muscle strength in older adults.

BACKGROUND/OBJECTIVES: Sarcopenia is defined as the gradual age-associated loss of both muscle quantity and strength in older adults, and is associated with increased mortality, falls, fractures and hospitalisations. Current sarcopenia criteria use dual-energy X-ray absorptiometry (DXA) measures of muscle mass, a test that cannot be performed at the bedside, unlike point-of-care ultrasound (PoCUS). We examined the association between ultrasonic measures of muscle thickness (MT, vastus medialis muscle thickness) and measures of muscle quantity and strength in older adults. METHODS: A total of 150 older adults (age ≥ 65; mean age 80.0 ± 0.5 years, 66 women, 84 men) were recruited sequentially from geriatric medicine clinics. Each subject had lean body mass (LBM, by bioimpedance assay), grip strength, mid-arm biceps circumference (MABC), gait speed and MT measured. All initial models were adjusted for biological sex. RESULTS: In our final parsimonious models, MT showed a strong significant correlation with all measures of muscle mass, including LBM (Standardised ß = 0.204 ± 0.058, R2 = 0.577, P < 0.001) and MABC (Standardised ß = 0.141 ± 0.067, R2 = 0.417, P = 0.038). With respect to measures of muscle quality, there was a strong significant correlation with grip strength (Standardised ß = 0.118 ± 0.115, R2 = 0.511, P < 0.001) but not with subject performance (gait speed). CONCLUSIONS: MT showed strong correlations with both measures of muscle mass (LBM and MABC) and with muscle strength (grip strength). Although more work needs to be done, PoCUS shows potential as a screening tool for sarcopenia in older adults.

Baroreflex function and postprandial hypotension in older adults.

PURPOSE: Postprandial hypotension (PPH) is a common but poorly understood etiology for fainting in older adults. One potential mechanism is age-related baroreflex dysfunction. We examined baroreflex function in older adults with PPH and without PPH (noPPH) during a standardized meal test. METHODS: 57 adults (age ≥ 65; 24 PPH, 33 noPPH, mean age 77.9 ± 0.9 years, 54% female) were recruited and had meal tests performed. The baroreflex effectiveness index (BEI, %) and baroreflex sensitivity (BRS, ms/mm Hg) were calculated using the sequence method. RESULTS: Baseline BEI (22 ± 2 versus 23 ± 2 percent, t = - 0.411, p = 0.682) and BRS (14.1 ± 2.4 versus 13.8 ± 2.5 ms/mm of Hg, t = - 0.084, p = 0.933) were similar in PPH and noPPH subjects. During the meal test PPH subjects showed significantly lower BEI as compared to noPPH subjects (time × PPH, F = 2.791, p = 0.042), while there was no difference in the postprandial change in BRS (time, F = 0.618, p = 0.605). CONCLUSION: Patients with PPH demonstrated an acute postprandial decrease in baroreflex effectiveness during meal testing as compared with normal subjects, suggesting a potential contributing mechanism for this condition.

Cortisol Synchrony in Older Couples: Daily Socioemotional Correlates and Interpersonal Differences.

OBJECTIVE: Social relationships can have positive and negative influences, and these associations are particularly pronounced in old age. This study focuses on everyday interpersonal physiological dynamics (cortisol synchrony) in older couples and investigates its associations with partner presence, positive daily partner interactions, and empathy. METHODS: We conducted coordinated multilevel analyses using data from two samples of older couples from Vancouver, Canada, and Berlin, Germany (study 1: n = 85 couples aged 60-87 years; study 2: n = 77 couples aged 66-85 years), who completed questionnaires and provided salivary cortisol samples five to seven times daily for 7 days. RESULTS: Significant dyadic covariation in cortisol (synchrony) was present across studies (study 1/2: b = 0.04/0.03, p < .001/.001). Partner presence was only associated with greater cortisol synchrony in study 1 (b = 0.06, p = .003) but not in study 2 (b = 0.02, p = .187). Cortisol synchrony was higher when partners reported prior positive socioemotional partner interactions (study 1: b = 0.09, p = .005; study 2: b = 0.04, p = .005). There was no statistically significant association between cortisol synchrony and empathic concern (b = 0.01, p = .590) or perspective taking (b = 0.02, p = .065). CONCLUSIONS: Moments of social bonding are intertwined with physiological synchrony in everyday life. The implications of potential repeated transmission of stress in the context of high synchrony for individual health and relationship functioning warrant further investigation.

Moving in Sync: Hourly Physical Activity and Sedentary Behavior are Synchronized in Couples.

BACKGROUND: Overall time spent in moderate-to-vigorous intensity physical activity (MVPA) and sedentary behavior are both correlated in couples. Knowledge about the nature and psychosocial correlates of such dyadic covariation could inform important avenues for physical activity promotion. PURPOSE: The present study investigates hour-by-hour covariation between partners (i.e., synchrony) in MVPA and sedentary behavior as partners engage in their daily lives and links it with person-level MVPA/sedentary behavior, temporal characteristics, and relationship variables. METHODS: We used 7-day accelerometer data from two couple studies (Study 1, n = 306 couples, aged 18-80 years; Study 2, n = 108 couples, aged 60-87 years) to estimate dyadic covariation in hourly MVPA and sedentary behavior between partners. Data were analyzed using coordinated multilevel modeling. RESULTS: In both studies, hourly MVPA and sedentary behavior exhibited similarly sized dyadic covariation between partners in the low-to-medium range of effects. Higher MVPA synchrony between partners was linked with higher individual weekly MVPA and higher individual weekly sedentary levels, whereas higher sedentary synchrony between partners was associated with higher individual weekly MVPA but lower individual weekly sedentary levels. MVPA and sedentary synchrony were higher in the morning and evening, more pronounced on weekends, and associated with more time spent together, longer relationship duration, and time-varying perceptions of higher partner closeness. CONCLUSIONS: This study demonstrates that MVPA and sedentary behaviors do not occur in a social vacuum. Instead, they are linked with close others such as partners. Thus, capitalizing on social partners may increase the effectiveness of individual-level physical activity interventions.

Blood pressure measurement and the prevalence of postprandial hypotension.

BACKGROUND: Postprandial hypotension (PPH) is a serious condition that has been shown to be an independent risk factor for falls, fractures and death. PURPOSE: The prevalence of this problem in older adults with a past history of falls has shown a wide variability in the literature; the present study seeks to examine how the frequency with which blood pressure is measured impacts the prevalence and severity of PPH. METHODS: Older adults were recruited sequentially from a geriatric medicine falls clinic for meal testing (n=95). All subjects (mean age 77.5±0.7 years, 61±5% female) were fasting prior to each 90 min standardized meal test. A Finometer (Finapres Medical Systems BV) was used to monitor blood pressure. Beat-by-beat systolic (SBP) measures were averaged for 0.5, 1, 2, 3, 5, 6, 9, 10, 15, 18, 30, 45 and 90 min respectively during the meal test. RESULTS: Using the original diagnostic method of checking mean blood pressure every 10 min resulted in a PPH prevalence of 42.1±5.1% in our population, with an overall range from 81.1±4.0% to 11.6±3.3% depending on the frequency of calculating SBP. The maximal observed postprandial decrease in SBP also showed a significant difference with blood pressure measurement frequency (p.

Activity Profile and Energy Expenditure Among Active Older Adults, British Columbia, 2011-2012.

INTRODUCTION: Time spent by young adults in moderate to vigorous activity predicts daily caloric expenditure. In contrast, caloric expenditure among older adults is best predicted by time spent in light activity. We examined highly active older adults to examine the biggest contributors to energy expenditure in this population. METHODS: Fifty-four community-dwelling men and women aged 65 years or older (mean, 71.4 y) were enrolled in this cross-sectional observational study. All were members of the Whistler Senior Ski Team, and all met current American guidelines for physical activity. Activity levels (sedentary, light, and moderate to vigorous) were recorded by accelerometers worn continuously for 7 days. Caloric expenditure was measured using accelerometry, galvanic skin response, skin temperature, and heat flux. Significant variables were entered into a stepwise multivariate linear model consisting of activity level, age, and sex. RESULTS: The average (standard deviation [SD]) daily nonlying sedentary time was 564 (92) minutes (9.4 [1.5] h) per day. The main predictors of higher caloric expenditure were time spent in moderate to vigorous activity (standardized ß = 0.42 [SE, 0.08]; P < .001) and male sex (standardized ß = 1.34 [SE, 0.16]; P < .001). A model consisting of only moderate to vigorous physical activity and sex explained 68% of the variation in caloric expenditure. An increase in moderate to vigorous physical activity by 1 minute per day was associated with an additional 16 kcal expended in physical activity. CONCLUSION: The relationship between activity intensity and caloric expenditure in athletic seniors is similar to that observed in young adults. Active older adults still spend a substantial proportion of the day engaged in sedentary behaviors.

Accelerometer-based measures of sedentary behavior and cardio-metabolic risk in active older adults.

PURPOSE: Sedentary behavior has been proposed as an independent cardio-metabolic risk factor even in adults who are physically active through recreational activity. Because little is known about the metabolic effects of sedentariness in seniors, the relationship between sedentary behavior and cardio-metabolic risk was examined in physically active older adults. METHODS: Fifty-four community dwelling men and women > 65 years of age (mean 71.5 years) were enrolled in this cross-sectional observational study. Subjects were in good health and free of known diabetes. Activity levels (sedentary, light, moderate to vigorous activity time per day) were recorded with accelerometers worn continuously for 7 days. Cardio-metabolic risk factors measured consisted of the American Heart Association diagnostic criteria for metabolic syndrome (waist circumference, triglycerides, high-density lipoprotein, systolic blood pressure and fasting glucose) as well as low-density lipoprotein (LDL). The relationships between activity measures and cardio-metabolic risk factors were examined. Significant variables were then entered into a stepwise multivariate regression model. RESULTS: All but one subject achieved exercise levels recommended by the American College of Sports Medicine. The average proportion of time spent at a sedentary activity level each day was 72.7%. From the regression analysis, the only significant association found between cardio-metabolic risk outcomes and activity predictors was between LDL and sedentary time, with LDL detrimentally associated with average sedentary time per day (Standardized Beta Correlation Coefficient 0.302, p < 0.05). CONCLUSION: Sedentary behavior is associated with an adverse metabolic effect on LDL in seniors, even those who meet guideline recommendations for an active "fit" adult.

Physical activity correlates with arterial stiffness in community-dwelling individuals with stroke.

BACKGROUND: Physical inactivity contributes to atherosclerotic processes, which manifest as increased arterial stiffness. Arterial stiffness is associated with myocardial demand and coronary perfusion and is a risk factor for stroke and other adverse cardiac outcomes. Poststroke mobility limitations often lead to physical inactivity and sedentary behaviors. This exploratory study aimed to identify functional correlates, reflective of daily physical activity levels, with arterial stiffness in community-dwelling individuals >1 year poststroke. METHODS: Carotid-femoral pulse wave velocity (cfPWV) was measured in 35 participants (65% men; mean ± SD age 66.9 ± 6.9 years; median time poststroke 3.7 years). Multivariable regression analyses examined the relationships between cfPWV and factors associated with daily physical activity: aerobic capacity (VO2 peak), gait speed, and balance ability (Berg Balance Scale). Age and the use of antihypertensive medications, known to be associated with pulse wave velocity, were also included in the model. RESULTS: Mean cfPWV was 11.2 ± 2.4 m/s. VO2 peak and age were correlated with cfPWV (r = -0.45 [P = .006] and r = 0.46 [P = .004], respectively). In the multivariable regression analyses, age and the use of antihypertensive medication accounted for 20.4% of the variance of cfPWV, and the addition of VO2 peak explained an additional 4.5% of the variance (R2 = 0.249). CONCLUSIONS: We found that arterial stiffness is elevated in community-dwelling, ambulatory individuals with stroke relative to healthy people. Multivariable regression analysis suggests that aerobic capacity (VO2 peak) may contribute to the variance of cfPWV after accounting for the effects of age and medication use. Whether intense risk modification and augmented physical activity will improve arterial stiffness in this population remains to be determined.

Let's Enjoy an Evening on the Couch? A Daily Life Investigation of Shared Problematic Behaviors in Three Couple Studies.

Symptom-system fit theory proposes that problematic behaviors are maintained by the social system (e.g., the couple relationship) in which they occur because they help promote positive relationship functioning in the short-term. Across three daily life studies, we examined whether mixed-gender couples reported more positive relationship functioning on days in which they engaged in more shared problematic behaviors. In two studies (Study 1: 82 couples who smoke; Study 2: 117 couples who are inactive), days of more shared problematic behavior were accompanied by higher daily closeness and relationship satisfaction. A third study with 79 couples post-stroke investigating unhealthy eating failed to provide evidence for symptom-system fit. In exploratory lagged analyses, we found more support for prior-day problematic behavior being associated with next-day daily relationship functioning than vice-versa. Together, findings point to the importance of a systems perspective when studying interpersonal dynamics that might be involved in the maintenance of problematic behaviors.

Daily Rumination-Affect Associations in Dyads During the COVID-19 Pandemic.

OBJECTIVES: Negative and repetitive self-oriented thinking (rumination) is associated with lower well-being and health. The social context of rumination remains underexplored and mostly centers on marital relationships. To embrace the diversity of older adult relationships, this study includes a range of different relationships (e.g., spouses, siblings, friends, etc.) and examines the role of rumination by close others on individual well-being during the coronavirus disease 2019 pandemic. METHODS: Using daily diary data from 140 Canadian older adults (M = 72.21 years, standard deviation [SD] = 5.39, range: 63-87 years, 47% women, 71% university educated) and a close other of their choice (M = 59.95 years, SD = 16.54, range: 18-83 years, 78% women, 81% university educated), this project builds on past research examining daily life rumination dynamics from a dyadic perspective. For 10 days, both dyad members reported their daily rumination and affect quality in the evening. RESULTS: Multilevel models replicate past work showing that individual rumination was associated with higher negative affect (within-person: b = 0.27, p < .001, between-person: b = 0.57, p < .001) and lower positive affect (within-person: b = -0.18, p < .001, between-person: b = -0.29, p < .001). Importantly, we additionally observed that partner rumination was associated with higher negative affect (b = 0.03, p = .038) and lower positive affect (b = -0.04, p = .023), highlighting the social context of rumination. DISCUSSION: Findings illustrate the significance of rumination for the self and others and underline the merit of taking a dyadic perspective on what is typically viewed as an individual-level phenomenon.

Daily solitude and well-being associations in older dyads: Evidence from daily life assessments.

Older adults spend significant time by themselves, especially since COVID-19. Solitude has been associated with positive and negative outcomes. Partners need to balance social connectedness with time for one's own needs. This project examines how individual and partner solitude are associated with daily affect and relationship quality in dyads of older adults and a close other. One-hundred thirty-six older adults plus a close other rated their relationship quality and reported affect, solitude, and its characteristics (desired and bothersome) every evening for 10 days. Over and above overall associations, individual and partner effects emerged; when individual desired solitude was up, participants reported more positive affect and their partners less negative affect. When bothersome solitude was up, participants and their partners alike reported more negative affect and less positive affect. Desired solitude was associated with more support, whereas bothersome solitude was associated with less partner support. Findings provide further evidence on the potential benefits of solitude, highlighting the importance of considering the social context of what is often believed to be an individual-level phenomenon.

Aerobic training in older adults with type 2 diabetes and vasodepressive carotid sinus hypersensitivity.

BACKGROUND AND AIMS: Vasodepressive carotid sinus hypersensitivity (V-CSH) is a common but incurable etiology for fainting in older adults with diabetes (OADM), and is diagnosed by carotid sinus massage (CSM). Aerobic exercise has been shown to be an effective therapy for other neuroautonomic etiologies of syncope (such as orthostatic hypotension), but the effectiveness of aerobic training in V-CSH remains unknown. We examined whether aerobic training could attenuate the vasodepressive response to CSM in OADM (older adults with type 2 diabetes) subjects complicated by V-CSH. METHODS: Forty OADM subjects (mean age 72.2 ± 0.7) complicated by V-CSH were recruited. Subjects were randomized to each of two groups: an aerobic group (AT, n = 20, 3 months vigorous aerobic exercise), and a nonaerobic (NA, n = 20, no aerobic exercise) group. Exercise sessions were supervised by a certified exercise trainer three times per week. The vasodepressive response [defined as the decrease in systolic blood pressure (SBP) during CSM] was measured before and after the training intervention using a Finometer. RESULTS: The intervention had no impact on the number of subjects that met the criteria for V-CSM in either the AT or NA groups, regardless of the criteria used (-10, -20, -30, -40 and -50 mmHg). There was no training effect on the vasodepressive response in either the AT or NA group (P = 0.214, 2-way analysis of variance, -30 mmHg definition for V-CSH). CONCLUSIONS: Aerobic training has no effect on the SBP response to CSM in OADM subjects with V-CSH. Unlike in other neuroautonomic etiologies for fainting, aerobic exercise is not effective as a treatment for V-CSH, at least in the OADM population.

Everyday Pain in Middle and Later Life: Associations with Daily and Momentary Present-Moment Awareness as One Key Facet of Mindfulness.

This study investigated everyday associations between one key facet of mindfulness (allocating attention to the present moment) and pain. In Study 1, 89 community-dwelling adults (33-88 years; Mage = 68.6) who had experienced a stroke provided 14 daily end-of-day present-moment awareness and pain ratings. In Study 2, 100 adults (50-85 years; Mage = 67.0 years) provided momentary present-moment awareness and pain ratings three times daily for 10 days. Multi-level models showed that higher trait present-moment awareness was linked with lower overall pain (both studies). In Study 1, participants reported less pain on days on which they indicated higher present-moment awareness. In Study 2, only individuals with no post-secondary education reported less pain in moments when they indicated higher present-moment awareness. Findings add to previous research using global retrospective pain measures by showing that present-moment awareness might correlate with reduced pain experiences, assessed close in time to when they occur.

Sleep efficiency and the metabolic risk score in very active older women and men.

Study Objectives: Sleep disruption is a risk factor for obesity, diabetes, and cardiovascular disease in older adults. How physical activity (PA) interacts with the negative cardiometabolic effects of poor sleep is not known. We objectively measured sleep efficiency (SE) in very active older adults and examined the association between SE and a continuous Metabolic Syndrome Risk Score (cMSy). Methods: Very active older adults (age ≥65 years) from a Master's Ski Team (Whistler, Canada) were recruited. Each participants wore an activity monitor (SenseWear Pro) continuously for 7 days to provide measures of both daily energy expenditure (metabolic equivalents, METs) and SE. All components of the metabolic syndrome were measured and a principal component analysis was used to compute a continuous metabolic risk score (cMSy, sum of eigenvalues ≥1.0). Results: A total of 54 participants (mean age 71.4 years, SD 4.4 years, and 24 men and 30 women) were recruited and had very high PA levels (>2.5 h per day of exercise). Initially, there was no significant association between SE and cMSy (p = 0.222). When stratified by biological sex, only men showed a significant negative association between SE and cMSy (Standardized ß = -0.364 ± 0.159, p = 0.032). Conclusions: Only older men show a significant negative association between poor SE and increased cardiometabolic risk, despite high levels of PA.

Partner Contributions to Goal Pursuit: Findings From Repeated Daily Life Assessments With Older Couples.

OBJECTIVES: This study focuses on the role of spouses for facilitating goal progress during a phase in life when individual resources for goal pursuit are particularly limited. Specifically, we examined the moderating role of relationship characteristics in old age for time-varying partner involvement-goal progress associations as couples engaged in their everyday lives. We also assessed time-varying associations between everyday goal progress, effectiveness of partner contributions, and spousal satisfaction with this contribution. METHODS: We used multilevel modeling to analyze data from 118 couples (Mage = 70 years, SD = 5.9; 60-87 years, 50% women; 57% White). Both partners reported their personal goals and provided information on relationship satisfaction, conflict, and support. They also provided simultaneous ratings of everyday goal progress, effort, partner involvement as well as effectiveness of and satisfaction with partner contribution up to three times daily over 7 days. RESULTS: In line with expectations, higher relationship satisfaction and support and lower conflict were associated with higher goal progress when the partner was involved in goal pursuit. Both effectiveness of and satisfaction with partner contributions were positively associated with everyday goal progress. DISCUSSION: Whether partner involvement is beneficial for goal progress depends on characteristics of the relationship as well as what partners actually do in everyday life. This highlights the importance of considering both stable person characteristics as well as time-varying processes to capture the complexity of goal pursuit in older couples.

Exploring behavior change techniques for reablement: A scoping review.

BACKGROUND: Reablement is a team-based person-centered health and social care model, most commonly available for community-dwelling older adults. Understanding the components of reablement and how it is delivered, received, and enacted facilitates best evidence and practice. Determining behavior change techniques (BCTs) or strategies is an important step to operationalize implementation of reablement. OBJECTIVE: We conducted a scoping review of peer-reviewed literature to identify BCTs used within reablement studies. METHODS: We registered our study with the Joanna Briggs Institute and conducted five database searches. Inclusion criteria were peer-reviewed studies focused on adults and older adults without significant cognitive impairment or dementia receiving reablement, and all study designs, years, and languages. We excluded studies focused on reablement for people with dementia or reablement training programs. The last search was on April 8, 2021. Two authors screened independently at Level 1 (title and abstract) and 2 (full text). Two authors adjudicated BCTs for each study, and a third author confirmed the final list. RESULTS: We identified 567 studies (591 publications) and included 21 studies (44 publications) from six global locations. We identified 27 different BCTs across all studies. The three most common BCTs for reablement were goal setting (behavior), social support (unspecified), and instruction on how to perform a behavior. CONCLUSIONS: We highlight some behavioral components of reablement and encourage detailed reporting to increase transparency and replication of the intervention. Future research should explore effective BCTs (or combinations of) to include within reablement to support health behavior adoption and maintenance.

Defining and implementing patient-centered care: An umbrella review.

OBJECTIVES: Patient- or person-centered care (PCC) integrates people's preferences, values, and beliefs into health decision-making. Gaps exist for defining and implementing PCC; therefore, we aimed to identify core elements of PCC and synthesize implementation facilitators and barriers. METHODS: We conducted an overview of systematic reviews (umbrella review) and included peer-reviewed literature for adults in community/primary care settings. Two reviewers independently screened at Level 1 and 2, extracted data and appraised the quality of reviews. Three reviewers conducted a thematic analysis, and we present a narrative synthesis of findings. RESULTS: There were 2371 citations screened, and 10 systematic reviews included. We identified 10 PCC definitions with common elements, such as patient empowerment, patient individuality, and a biopsychosocial approach. Implementation factors focused on communication, training healthcare providers, and organizational structure. CONCLUSIONS: We provide a synthesis of key PCC elements to include in a future definition, and an overview of elements to consider for implementing PCC into practice. We extend existing literature by identifying clinician empowerment and culture change at the systems-level as two future areas to prioritize to enable routine integration of PCC into practice. PRACTICE IMPLICATIONS: Findings may be useful for researchers and or health providers delivering and evaluating PCC.

Short-term aerobic exercise reduces nitroglycerin-induced orthostatic intolerance in older adults with type 2 diabetes.

AIMS/HYPOTHESIS: Older adults are at a high risk for syncope due to orthostatic intolerance (OI), and this risk increases with comorbid type 2 diabetes and vasoactive medications. Despite many benefits, previous investigations have shown worsening OI with aerobic training. We examined whether aerobic exercise reduced OI in older adults with type 2 diabetes who were given a short-acting vasoactive agent (nitroglycerin). METHODS: Forty older adults (25 males and 15 females, mean age 71.4 ± 0.7 years, ranging in age from 65 to 83 years) with type 2 diabetes were recruited. Subjects were randomized to each of 2 groups: an aerobic group (3 months of vigorous aerobic exercise) and a nonaerobic (no aerobic exercise) group. Exercise sessions were supervised by a certified exercise trainer 3 times per week. After being given 400 µg of sublingual nitroglycerin, each subject was placed in a 70° head-up tilt for 30 minutes. RESULTS: When the 2 groups were compared using a Cox proportional hazards model, tilt table tolerance was significantly better in the aerobic group as compared to in the nonaerobic group (χ(2)(MC) = 7.271, P = 0.007). CONCLUSIONS: Our findings indicate that a relatively short aerobic exercise intervention can improve postnitroglycerin orthostatic tolerance in older adults with type 2 diabetes.