Fibromyalgia status and depressive symptoms are linked to body mass index and physical performance in mid to late life.

Fibromyalgia (FM) is a chronic pain condition that is frequently accompanied by comorbid conditions, including depression. Depression is associated with reduced physical functioning and health, disproportionately affecting middle-aged and older adults with FM. This study examined associations between FM status and depressive symptoms with body mass index (BMI) and several physical performance indicators among middle-aged and older adults. Participants included 239 community-dwelling middle-aged and older adults with or without FM. Depressive symptoms were measured using the Beck Depression Inventory-II (BDI-II), BMI was objectively assessed, and physical performance was measured using the Fullerton Advanced Balance scale, 6-minute walk test, 30-second chair stand, and 8-foot up and go test. A path model using structural equation modeling yielded good fit and revealed that, compared to pain-free adult controls, participants with FM reported more depressive symptoms, which were in turn associated with reduced physical performance across all indicators except BMI, after adjusting for age and symptom severity. Findings suggest that individuals with FM demonstrate disproportionately higher depressive symptoms compared to non-FM controls, which may diminish physical performance after accounting for age and symptom severity. This study supports FM status and depressive symptoms as important considerations when evaluating the health and disability risk of aging adults.

Impact of Affect Balance on Cognitive and Physical Function in Adults With and Without Fibromyalgia.

OBJECTIVE: To identify the potential benefits of heightened levels of affect balance in older adults with and without chronic pain on various cognitive domains, physical performance, and perceived cognitive and physical health. METHOD: Ninety-one older adults, some with and some without fibromyalgia (FM) participated. Objective tests included cognitive (immediate and delayed recall, delayed recognition-CERAD 10-item word list) and physical measures (Fullerton Advanced Balance Scale; lower body strength-30-s chair stand; gait velocity-30-ft. walk). Self-report measures were problems with forgetting, activities of daily living (perceived function), and affect (Positive and Negative Affect Scale [PANAS]). Affect balance was calculated as positive minus negative affect from the PANAS. RESULTS: Hierarchical regression analyses revealed that-regardless of FM status-higher affect balance was associated with better episodic memory performance (immediate recall, delayed recognition), better balance, enhanced lower body strength (more chair stands), and healthier gait (30-ft. walk), as well as less forgetfulness and better perceived functional health. CONCLUSION: Increased affect balance was associated with better objective and subjective health in older adults both without and with chronic pain. Positive psychology treatments which increase affect balance are easy to administer, cost effective, and may add an important, additional treatment modality for maintaining health in normal aging adults as well as those with chronic pain. CLINICAL RELEVANCE: In order to help patients with healthy aging, nurses need to be aware of the potential long-term effect of emotional state on overall function and be able to counsel patients regarding potential treatments to enhance positive global emotions such as resilience.

Genetic and experiential influences on behavior: Twins reunited at seventy-eight years.

Twins living in different countries offer opportunities to explore associations between observed differences and experiential effects. This report compared the life histories, cognitive abilities, personality traits, psychomotor skills, medical characteristics, job satisfaction, social support and social relations of dizygotic (DZ) female twins reunited at 78, the world's longest separated set. The twins' advanced age also enabled a study of how co-twin differences in aging may be associated with current behavioral and social differences. Consistent with previous studies, these dizygotic reared apart (DZA) twins showed discordance across some, but not all, traits. Their different rearing situations and life histories may explain current differences in their responses to meeting their twin. This case highlights the importance of both genetic and rearing factors on behavior, but does not allow firm conclusions regarding the extent to which these sources explain individual developmental differences. However, such data contribute to the growing number of cross-culturally separated twins, generating novel hypotheses that may be assessed using larger samples.

Perceived Stress and Life Stressors in Adults with and without Fibromyalgia.

Chronic medical conditions (i.e., chronic widespread pain) may contribute to accelerated/accentuated aging, such that middle-aged individuals with comorbidities may actually show increased declines in physical, cognitive, and mental health compared to normal aging adults. We examined perceived stress, life stressors, and depression in adults with and without fibromyalgia, a chronic pain condition. Ninety-four participants (52% with fibromyalgia, 78% female) aged 50 to 93 were administered the Perceived Stress Scale, Social Readjustment Rating Scale, and Beck Depression Inventory. Hierarchical regression analyses were conducted: the predictor variables were age, gender, fibromyalgia status, depression, and fibromyalgia-depression interaction. The interaction term significantly predicted perceived stress, but not life stressors. Depression significantly predicted stress for Social Readjustment Rating Scale measures after controlling for covariates. Significant associations were found between perceived stress and life stressors in all participants. In addition, those with fibromyalgia were significantly more likely to report higher levels of stress above standardized scores on both the Perceived Stress Scale and the Social Readjustment Rating Scale. Finally, depressive symptoms played a more significant role than fibromyalgia status in predicting life stressors. Conclusions: These findings emphasize the importance of assessing different types of stress and stressors in individuals with chronic widespread pain and/or depression in mid-life and beyond to better treat individuals with these conditions.

Positive associations between physical and cognitive performance measures in fibromyalgia.

OBJECTIVE: To investigate the associations between perceived physical function (self-report) and physical and cognitive performance (objective assessments) in persons with fibromyalgia (FM). DESIGN: Correlational study. SETTING: Exercise testing laboratory in Southern California. PARTICIPANTS: Community-residing ambulatory adults meeting the American College of Rheumatology 1990 criteria for FM (N=68; mean age, 59.5y). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Composite Physical Function scale, Senior Fitness Test (3 items), Fullerton Advanced Balance scale, 30-foot walk, Trail Making Test parts A and B, Digit Symbol Substitution Test, a composite score of these 3 cognitive measures, attention/executive function composite, processing speed composite, problem solving, inhibition, and episodic memory composite. RESULTS: Hierarchical regression analyses showed that after controlling for age and FM symptoms, better physical performance (based on assessments, not self-report) was associated with higher cognitive function in attention/executive function, processing speed, problem solving, and inhibition. CONCLUSIONS: Researchers should continue to investigate the relationship between physical and cognitive function in both clinical and nonclinical populations, as well as explore changes across time. Because physical activity has been associated with neural improvements, further research may identify whether particular mechanisms, such as neurogenesis, synaptogenesis, or changes in inflammatory marker levels, are involved.

Pain intensity and physical performance among individuals with fibromyalgia in mid-to-late life: The influence of depressive symptoms.

This study investigated the mediating role of depressive symptoms among 147 middle-aged and older adults with FM in the relationship between pain intensity and 4 objective measures of physical performance: Fullerton Advanced Balance scale (FAB), 6-Minute Walk Test (6MWT), 30-Second Chair Stand (30SCS), and 8-Foot Up and Go Test (8FUPGT). Asymptotic mediation analyses revealed that depressive symptoms fully mediated the relationship between pain intensity and FAB (95% CI [-0.40, -0.10]) and 8FUPGT (CI [0.02, 0.11]) and partially mediated the relationship to 6MWT (CI [-9.15, -2.20]) and 30SCS (CI [-0.29, -0.06]). Findings support the evaluation of co-morbid depression in FM.

The role of pain intensity and depressive symptoms in the relationship between sleep quality and postural control among middle-aged and older adults with Fibromyalgia.

OBJECTIVE: Fibromyalgia (FM) is a chronic pain condition often accompanied by sleep problems and depression that are each associated with reduced physical ability including postural control. Research supports a sequential association between pain intensity and depression in FM, and poor sleep quality may play a key role in this relationship. This study aimed to verify a serial pattern of associations among sleep quality, pain intensity, and depressive symptoms and quantify these effects on objective postural control. DESIGN: Community-residing adults diagnosed with FM (n = 155; Mage = 61.08, SD = 7.70; 93% female; 79% White) were included in this cross-sectional study. MAIN OUTCOMES: Participants self-rated sleep quality (restorative sleep, sleep waking, and sleep latency), pain intensity, and depressive symptoms, and the Fullerton Advanced Balance (FAB) scale and 8-Foot Up and Go Test (8FUPGT) measured objective postural control. RESULTS: Findings indicated that the serial association between pain intensity and depressive symptoms fully mediated the relationship between sleep quality and both FAB (95% CI [-.125, -.013]), and 8FUPGT (95% CI [.002, .033]) performance. CONCLUSION: Findings highlight the serial association of pain intensity and depressive symptoms with objective postural control performance and the potential for sleep and depression interventions that may maximize functional outcomes in FM.

Distress as a mediator for pain and activities of daily living in older adults with fibromyalgia.

Introduction: Pain, distress, and activities of daily living impact the lives of those with chronic pain. This study investigated distress (depressive symptoms, anxiety) on the relationship between pain (intensity and pain interference) and activities of daily living in individuals with fibromyalgia while controlling for age. Methods: The current cross-sectional investigation focused on data from 123 men and women with fibromyalgia. Pain intensity, pain interference and anxiety were measured on 0-10 Likert type scales from the National Fibromyalgia Assessment Questionnaire. Depressive symptoms were assessed using the Beck Depression Inventory II. Activities of daily living (basic, instrumental) were measured with the Physical Activity Inventory Scale. Results: It was hypothesized that the relationships between pain intensity and pain interference and activities of daily living in individuals with fibromyalgia would be mediated by the construct of distress while controlling for age. Mediation significantly occurred in both models as predicted. However, those who were older reported lower levels of pain intensity and distress than their younger counterparts, which may be related to time since diagnosis or other factors. Discussion: Results of this study suggest that individuals with chronic pain conditions would benefit from treatment options which address distress, specifically depressive symptoms and anxiety.

Blood pressure as a predictor of everyday cognitive function in aging adults with and without fibromyalgia.

Objective : Both hypotension and hypertension are related to poorer cognitive performance in older adults. However, little attention has been paid to everyday problem solving, a real-world indicator of functionality and independence among aging individuals. Research also suggests that chronic pain may affect the relationship between blood pressure (BP) and cognition. This study examined the relationship between BP and everyday problem solving in older adults with and without fibromyalgia (FM), a chronic pain condition. Method : The study included 99 participants with an FM diagnosis (Mage = 59.95) and 88 healthy older adults (Mage = 68.01). Results : Multiple regression analyses revealed that systolic BP and pulse pressure, but not diastolic BP, were significant predictors of everyday problem solving after controlling for executive function. FM status did not moderate this relationship. Conclusion : These findings indicate that BP is an important factor in functional and cognitive health, especially among aging adults.

The impact of obesity on the social participation of older adults.

Previous research (e.g., R. Puhl & K. P. Brownell, 2001) has indicated that stigma associated with obesity contributes to diminished social engagement for the obese, but there is evidence that this stigma is more pronounced in younger age groups. The present authors investigated whether the negative association between obesity and social participation that is apparent in younger age groups continues in older adulthood. The authors analyzed interview data from 1,439 participants aged 60-93 years (M age = 71 years, SD = 5.7 years) from the Changing Lives of Older Couples Study (D. Carr, R. Nesse, & C. Wortman, 2005). Regression results indicated that hypothesized interactions between age and body mass index (BMI) in predicting social participation were not significant after controlling for demographic variables, health status, depression, and self-esteem. In fact, higher BMI was associated with greater overall and formal social participation (i.e., organizations, volunteer work, church), suggesting not only that stigmatization against the obese appears to decrease with age but also that additional factors play a role.

Aging well: Processing speed inhibition and working memory related to balance and aerobic endurance.

AIM: The present study explored whether certain physical performance measures could be linked to specific cognitive domains in healthy older adults. METHOD: A total of 50 adults (mean age 69.5 years, SD 8.1) were evaluated on physical performance using measures of balance (Fullerton Advanced Balance Scale), functional mobility (8-ft up-and-go), lower body strength (30-s chair stand), gait (30-ft walk velocity) and aerobic endurance (6-min walk). Cognitive measures included Stroop Color-Word Test, Digit Span Backward, Trail Making Tests, Everyday Problems Test, Digit Symbol Substitution and a Brown-Peterson test. Principal component analyses reduced cognition to domains of processing speed, inhibition and working memory. RESULTS: Hierarchical regression analyses were carried out with age and each physical measure as potential predictors of the three cognitive domains. The balance scale and 6-min walk were specifically associated with processing speed, inhibition and working memory. CONCLUSIONS: Better dynamic balance and aerobic endurance predicted enhanced processing speed, inhibition and working memory in older adults, with these last two domains considered components of executive function. Geriatr Gerontol Int 2017; 17: 108-115.

Adoption of online health management tools among healthy older adults: An exploratory study.

As the population ages and chronic diseases abound, overburdened healthcare systems will increasingly require individuals to manage their own health. Online health management tools, quickly increasing in popularity, have the potential to diminish or even replace in-person contact with health professionals, but overall efficacy and usage trends are unknown. The current study explored perceptions and usage patterns among users of online health management tools, and identified barriers and barrier-breakers among non-users. An online survey was completed by 169 computer users (aged 50+). Analyses revealed that a sizable minority (37%) of participants use online health management tools and most users (89%) are satisfied with these tools, but a limited range of tools are being used and usage occurs in relatively limited domains. Improved awareness and education for online health management tools could enhance people's abilities to remain at home as they age, reducing the financial burden on formal assistance programs.

Heterogeneity in fibromyalgia based upon cognitive and physical performance and psychological symptomology.

PURPOSE: This study sought to investigate the existence of subgroups within a fibromyalgia (FM) sample based on physical and cognitive performance measures, as well as self-report psychological measures. A multisystem disorder characterized by widespread musculoskeletal pain and co-morbid conditions, FM can lead to declines in cognitive functioning and difficulty with psychological health. DATA SOURCES: Community participants (n = 57 women) recruited from support groups and university center databases provided documentation of having met the criteria for diagnosis of FM. Measures included validated performance and self-report instruments. Analysis was completed using hierarchical cluster analysis; a four cluster solution was chosen for its level of interpretability. The resulting model identified four distinct subgroups based upon patterns of performance and symptomology. Significant group differences were found on pain, fatigue, stiffness, and level of physical activity. CONCLUSIONS: Study results support the existence of subgroups among the FM population based on levels of cognitive and physical performance and psychological symptoms. IMPLICATIONS FOR PRACTICE: Nurse practitioners aware of potential subgroups within FM should be better prepared to recommend treatment options for patients that target subgroup characteristics (e.g., high vs. low levels of psychological symptoms).

Cognitive performance in women aged 50 years and older with and without fibromyalgia.

OBJECTIVES: Persons with fibromyalgia (FM) report having cognitive dysfunction. Neuropsychological performance was compared across a variety of domains in 43 women with FM (Mage = 63 years) and in 44 women without FM (Mage = 65 years). METHOD: Measures included explicit memory (Consortium to Establish a Registry for Alzheimer's Disease [CERAD] immediate/delayed recall, delayed recognition), aspects of executive function including interference/inhibition (Stroop Color/Word test), working memory (Digit Span Forward/Backward), set-shifting/complex sequencing (Trails B), monitoring (verbal fluency: naming animals), processing speed (Trails A, Digit Symbol Substitution Coding), and problem solving (Everyday Problems Test). RESULTS: Women with FM performed more poorly than controls on executive function (Stroop Color/Word) and one processing speed measure (Digit Symbol Substitution Coding). DISCUSSION: Results partly support altered cognitive function in FM. Mixed findings across cognitive domains among individuals with or without FM is consistent with the literature and suggest that factors beyond those typically controlled for (e.g., heterogeneity in FM) may be influencing findings. Future research is warranted.

Association of employment and working conditions with physical and mental health symptoms for people with fibromyalgia.

PURPOSE: This study examines physical and mental health symptoms among people with fibromyalgia (FM) by employment status and working conditions. METHOD: Secondary data analysis of the 2007 National Fibromyalgia Association Questionnaire study resulted in employment and symptom information for 1702 people of working age with FM. In this cross-sectional internet study, six factors of symptom clusters (physical, mental health, sleeping, concentration, musculoskeletal, support) were seen in the data. Linear regression models used employment, age, income, gender, and education to predict symptom clusters. Among those employed, working conditions were also associated with symptom severity. RESULTS: In the predominately female sample, 51% were working. Of these, 70% worked over 30 hours/week and half had flexible hours. Employment, higher income, and education were strongly associated with fewer symptoms. Working conditions, including level of physical and mental exertion required on the job as well as coworkers' understanding of FM, were related to symptoms, particularly physical and mental health symptoms. Many participants reported modifying their work environment (66%) or changing occupations (33%) due to FM. CONCLUSIONS: Work modifications could allow more people with FM to remain employed and alleviate symptoms. Persons with FM should be counseled to consider what elements of their work may lead to symptom exacerbation.

Typology of chronic pain among overweight Mexican Americans.

Having a better understanding of the intersection between chronic pain and obesity in the Mexican American community can be valuable for pain management specialists in determining treatment, service, and prevention strategies. The objectives of this study were (1) to describe the type and severity of chronic pain among overweight/obese Hispanic adults aged 40 years and older, and (2) to determine the association between chronic pain indices and key demographic variables, including excessive weight. Hispanic adults (N=101) were interviewed using validated questionnaires and measured for BMI and waist circumference. Data analyses revealed that most participants had widespread pain; 60% were suffering severe pain (including back, knee, and shoulder pain); the most common pain location was head (headache, 80%), followed by knee and upper back (75-76%), shoulder (73%) and lower back (73%). Greater obesity was associated with some negative pain outcomes. Results are relevant for pain management with this at-risk population.

Actual and perceived gender differences in the accuracy of surrogate decisions about life-sustaining medical treatment among older spouses.

This study examined the influence of surrogate gender on the accuracy of substituted judgments about the use of life-sustaining treatment in a sample of 249 older adults and their self-selected surrogate decision-makers. Overall, wives were more accurate than husbands at predicting their spouses' treatment wishes. Surrogates' perceptions of their own abilities did not differ by gender but, among patients, husbands had more confidence than wives in their spouses' accuracy as, and comfort being, a surrogate. The results are discussed within the context of broader gender differences in caregiving and highlight the need for more research regarding predictors of surrogate accuracy to assist patients in selecting surrogates who will help protect their end of life wishes.