Preliminary investigation of interactive associations of sleep and pain with cognition in sedentary middle-aged and older adults.

STUDY OBJECTIVES: The objective of this study was to examine independent and interactive associations between self-reported sleep (sleep efficiency and total sleep time [TST]) and pain with cognition in sedentary middle-aged and older adults. METHODS: Seventy-five sedentary adults at least 50 years of age (Mage = 63.24, standard deviation = 8.87) completed 14 daily diaries measuring sleep and pain. Weekly average sleep efficiency, TST, and pain were computed. Participants also completed computerized cognitive tasks: Letter Series (reasoning), N-back (working memory), Symbol Digit Modalities Test (processing speed, attention), and Number Copy (processing speed). Multiple regression analyses were conducted to determine independent and interactive (with pain) associations of sleep efficiency and TST with cognition, controlling for age, education, and sex. RESULTS: Sleep efficiency and pain interacted in their associations with Letter Series performance and N-back difference scores (2-back minus 1-back). Specifically, higher sleep efficiency was associated with better reasoning and working memory in those with highest pain but not average or lowest pain. TST and pain also interacted in their associations with Letter Series performance. Specifically, longer TST associated with worse reasoning in those with lowest (not average or highest) pain. CONCLUSIONS: Preliminary results show that in sedentary middle-aged and older adults, pain and sleep interact in their associations with executive function tasks. Higher sleep efficiency may be associated with better reasoning and working memory in those with highest pain. Lower TST may be associated with better reasoning in those with lowest pain. Studies evaluating temporal associations between sleep, pain, and cognition are needed.

Anxiety and executive functions in mid-to-late life: the moderating role of sleep.

Objectives: The goal of the study was to examine the influence of sleep efficiency on the relationship between anxiety and executive functions.Method: Secondary data analyses of 82 community-dwelling middle-aged and older adults were performed (M age = 63.00, SD = 8.64). Anxiety was measured using the trait anxiety subscale of the State-Trait Anxiety Inventory. Sleep efficiency was measured using one-week of sleep diary data. Two executive functions, cognitive flexibility and inductive reasoning, were measured using the Trail-Making Test and Letter Series task, respectively. SPSS PROCESS macro software version 2 was used to assess the moderating role of sleep efficiency in the relationship between anxiety and executive functions.Results: Sleep significantly moderated the relationship between anxiety and inductive reasoning. Among middle-aged and older adults with high anxiety, those with good sleep efficiency displayed significantly better inductive reasoning than those with poor sleep efficiency after controlling for age, gender, and education (ΔR2 = .05, p = .017). Sleep efficiency did not significantly moderate the relationship between anxiety and cognitive flexibility.Conclusion: Sleep efficiency weakened the association between anxiety and inductive reasoning in middle-aged and older adults. Evidence from the study suggests better sleep may limit the negative effects of anxiety on executive functions in mid-to-late life. Further research is needed to elucidate the impact of anxiety and sleep on executive functions in clinical populations with anxiety.

Pain inconsistency and sleep in mid to late-life: the role of depression.

Objectives: Inconsistency in pain may lead to depression, which may then influence sleep. Thus, the purpose of this study was to examine whether depression mediates the relationship between day-to-day inconsistency in pain and sleep in middle aged to older adults. Methods: Baseline measures from the Active Adult Mentoring Project were used for secondary data analysis. Participants included 82 adults in mid- to late-life. Pain was assessed for seven consecutive days on an 11-point Likert-scale, with pain inconsistency defined as the seven-day individual standard deviation. A self-report daily diary was used to assess sleep efficiency (SE), total wake time (TWT), total sleep time (TST), and sleep quality (SQ), and depression was assessed using the BDI-II. Results: Mediation analyses revealed that depression partially mediated the relationship between pain inconsistency and SE, TWT, and SQ but not TST. Conclusions: Results indicate that depression may be an important factor through which pain inconsistency influences sleep. Although further research is warranted, these preliminary findings suggest that intervening on both pain inconsistency and depression may be one way to improve sleep in older adults.

Sleep and Pain in Mid- to Late-Life: An Exploration of Day-to-Day Pain Inconsistency.

OBJECTIVES: This study examined how different quantifications of pain (average vs. day-to-day inconsistency) are related to sleep in older adults beyond known predictors. METHODS: Baseline measures from the Active Adult Mentoring Project were used for secondary analyses. Participants included 82 adults in mid- to late-life. Depression was assessed with the BDI-II. Pain intensity was assessed over seven days on a 11-point Likert-scale, while sleep efficiency (SE), total sleep time (TST), and total wake time (TWT) were assessed using a self-report diary. RESULTS: Regression analyses revealed that pain inconsistency was associated with both SE and TWT and accounted for significant variance over age, gender, and depression. In contrast, average pain was not associated with SE, TST, or TWT. CONCLUSIONS: The findings indicate that pain inconsistency may be a more meaningful predictor of sleep disturbance than average pain level, suggesting that one's ability to regulate pain may be related to one's ability to engage in optimal sleep in mid- to late-life. CLINICAL IMPLICATIONS: Pain inconsistency appears to contribute more to sleep disturbance than average pain. Pain inconsistency in late-life warrants greater attention and may be an area of clinical intervention through activity-pacing or coping skills training.

Refining a Prostate Cancer Survivor's Toolkit.

Men who have undergone radical prostatectomy for the treatment of prostate cancer often lack knowledge about post-surgical care to bridge this gap in knowledge. Thus, we developed, refined, and validated a prostate cancer survivor's toolkit, which provides these men in the care required after this procedure.

Development and Psychometric Evaluation of the Chinese Feeding Difficulty Index (Ch-FDI) for People with Dementia.

AIMS: To develop and evaluate the psychometric properties of a Chinese Feeding Difficulty Index (Ch-FDI) which assesses feeding difficulties in people with dementia (PwD). RESEARCH DESIGN AND METHOD: Scale items were developed using literature review based on Model of Feeding Difficulty. Content validity was evaluated and items were modified by expert panel. Following translation and back-translation, the Ch-FDI was piloted on residents with dementia. The reliability was tested by inter-rater reliability and test-retest reliability. Internal reliability was established by calculating Cronbach's α coefficient. The concurrent validity was evaluated by correlating with similar scale, the Edinburgh Feeding Evaluation in Dementia (EdFED). The exploratory factor analysis (EFA) with varimax rotation and parallel analysis (PA) was performed to test construct validity. METHOD: Participants were recruited from long-term care facilities in Taiwan. A total of 213 residents with dementia participated in this study during May, 2010 to February, 2011. RESULTS: Content validation, translation and psychometric testing were completed on the 19 items of the Ch-FDI. The translated scale was piloted on 213 residents with dementia of feeding difficulty who were recruited from eight long-term care facilities in Taiwan. The reliability was supported by the internal consistency of Cronbach's α of 0.68 and a test-retest coefficient of 0.85. The content validity, face validity, concurrent validity, and construct validity were used. CONCLUSIONS: The Ch-FDI is a newly developed scale with fair psychometric properties aimed to measure feeding difficulties among residents with dementia in long-term care facilities in Taiwan. Using this reliable and valid tool can help healthcare providers to assess feeding problems of PwD and provide feeding assistance in order to promote quality of care during mealtime in long-term care facilities.

Using posturography to measure balance control during seated tai chi.

BACKGROUND: Tai Chi for Arthritis (TCA) is recognized by the CDC as an evidenced-based program to prevent falls in older adults. Although seated Tai Chi is recommended for those unable to stand, little is known about balance control during seated TCA. PURPOSE: To explore the use of posturography to assess differences between experts and non-expert practitioners of seated TCA. METHODS: Twenty-three participants were recruited from those attending a Tai cChi workshop. While seated in a hard back chair centered on a force platform, participants performed selected forms from TCA and then did them in a continuous sequence. Center of pressure (CoP) indices to assess balance were normalized by height and then compared between expert and non-expert participants. RESULTS: Experts had significantly greater average velocity and path length (p = 0.02) for the entire sequence and open/close, but not for CoP 95% Confidence ellipse area. No significant differences in the CoP were found for commencement, wave hands, or single whip. CONCLUSIONS: A few differences in balance control while performing seated TCA movements were found. Future studies are needed to determine whether these can be accounted for by quality of the Tai Chi movements or factors associated with the seated position.

The role of resilience and social support in predicting postdeployment adjustment in otherwise healthy Navy personnel.

The purpose of this study was to determine if resilience, social support, and exposure to combat, stressful deployment environments, and additional stressful life events predicted short-term (12 months or less) postdeployment adjustment in a relatively healthy subset of Navy service members. One hundred and thirty-two service members between 3 and 6 months postdeployment completed anonymous surveys at a deployment health center. Service members with probable post-traumatic stress disorder and those who were at risk for harm to self or others were excluded. There was relatively low variance in exposure to combat, stressful deployment environments, and additional stressful life events for this convenience sample. Although the sample was a relatively healthy subset of service members and conclusions may not be generalizable to larger populations, 56% endorsed considerable adjustment difficulties. Results of logistic regression indicated that greater resilience, greater postdeployment social support, and less stressful deployment environments predicted greater postdeployment adjustment. Resilience and postdeployment social support remained significant predictors of postdeployment adjustment when controlling for covariates. Results also suggest that individual augmentee experience may be a protective factor against postdeployment adjustment difficulties-at least in otherwise healthy service members.

Tai chi intervention improves dynamic postural control during gait initiation in older adults: a pilot study.

Tai Chi intervention has been shown to be beneficial for balance improvement. The current study examined the effectiveness of Tai Chi to improve the dynamic postural control among older adults with mobility disability. Six sedentary older adults with mobility disability participated in a 16-week Tai Chi intervention consisting of one hour sessions three times a week. Dynamic postural control was assessed pre- and post intervention as participants initiated gait in four stepping conditions: forward; 45° medially, with the stepping leg crossing over the other leg; 45° and 90° laterally. The center of pressure (CoP) displacement, velocity, and its maximum separation distance from the center of mass in the anteroposterior, mediolateral, and resultant directions were analyzed. Results showed that in the postural phase, Tai Chi increased the CoP mediolateral excursions in the medial (13%) and forward (28%) conditions, and resultant CoP center of mass distance in the medial (9%) and forward (19%) conditions. In the locomotion phase, the CoP mediolateral displacement and velocity significantly increased after the Tai Chi intervention (both by > 100% in the two lateral conditions). These results suggest that through alteration in CoP movement characteristics, Tai Chi intervention might improve the dynamic postural control during gait initiation among older adults.

Exercise and sleep in community-dwelling older adults: evidence for a reciprocal relationship.

Exercise behaviour and sleep are both important health indicators that demonstrate significant decreases with age, and remain modifiable well into later life. The current investigation examined both the chronic and acute relationships between exercise behaviour and self-reported sleep in older adults through a secondary analysis of a clinical trial of a lifestyle intervention. Seventy-nine community-dwelling, initially sedentary, older adults (mean age = 63.58 years, SD = 8.66 years) completed daily home-based assessments of exercise behaviour and sleep using daily diary methodology. Assessments were collected weekly and continued for 18 consecutive weeks. Multilevel models revealed a small positive chronic (between-person mean-level) association between exercise and wake time after sleep onset, and a small positive acute (within-person, day-to-day) association between exercise and general sleep quality rating. The within-person exercise and general sleep quality rating relationship was found to be reciprocal (i.e. sleep quality also predicted subsequent exercise behaviour). As such, it appears exercise and sleep are dynamically related in older adults. Efforts to intervene on either sleep or exercise in late-life would be wise to take the other into account. Light exposure, temperature regulation and mood may be potential mechanisms of action through which exercise can impact sleep in older adults.

Exploring behavioral markers of long-term physical activity maintenance: a case study of system identification modeling within a behavioral intervention.

Efficacious interventions to promote long-term maintenance of physical activity are not well understood. Engineers have developed methods to create dynamical system models for modeling idiographic (i.e., within-person) relationships within systems. In behavioral research, dynamical systems modeling may assist in decomposing intervention effects and identifying key behavioral patterns that may foster behavioral maintenance. The Active Adult Mentoring Program was a 16-week randomized controlled trial of a group-based, peer-delivered physical activity intervention targeting older adults. Time-intensive (i.e., daily) physical activity reports were collected throughout the intervention. We explored differential patterns of behavior among participants who received the active intervention (N = 34; 88% women, 64.1 ± 8.3 years of age) and either maintained 150 minutes/week of moderate to vigorous intensity physical activity (MVPA; n = 10) or did not (n = 24) at 18 months following the intervention period. We used dynamical systems modeling to explore whether key intervention components (i.e., self-monitoring, access to an exercise facility, behavioral initiation training, behavioral maintenance training) and theoretically plausible behavioral covariates (i.e., indoor vs. outdoor activity) predicted differential patterns of behavior among maintainers and nonmaintainers. We found that maintainers took longer to reach a steady-state of MVPA. At week 10 of the intervention, nonmaintainers began to drop whereas maintainers increased MVPA. Self-monitoring, behavioral initiation training, percentage of outdoor activity, and behavioral maintenance training, but not access to an exercise facility, were key variables that explained patterns of change among maintainers. Future studies should be conducted to systematically explore these concepts within a priori idiographic (i.e., N-of-1) experimental designs.

Peer volunteers improve long-term maintenance of physical activity with older adults: a randomized controlled trial.

BACKGROUND: Using peer volunteers as delivery agents may improve translation of evidence-based physical activity promotion programs for older adults. This study examined whether tailored support from older peer volunteers could improve initiation and long-term maintenance of physical activity behavior. METHODS: Participants were randomized to 2 16-week, group-based programs: (1) peer-delivered, theory-based support for physical activity behavior change; or (2) an intervention typically available in community settings (basic education, gym membership, and pedometer for self-monitoring), attention-matched with health education. Moderate-to-vigorous physical activity (MVPA) was assessed via daily self-report logs at baseline, at the end of the intervention (16 weeks), and at follow-up (18 months), with accelerometry validation (RT3) in a random subsample. RESULTS: Seven peer volunteers and 81 sedentary adults were recruited. Retention at the end of the trial was 85% and follow-up at 18 months was 61%. Using intent-to-treat analyses, at 16 weeks, both groups had similar significant improvements in MVPA. At 18 months, the group supplemented with peer support had significantly more MVPA. CONCLUSIONS: Trained peer volunteers may enhance long-term maintenance of physical activity gains from a community-based intervention. This approach has great potential to be adapted and delivered inexpensively in community settings.

Strategies for feeding patients with dementia.

OVERVIEW: Despite the high prevalence of dementia among elderly patients in hospitals and nursing homes and the strong association between dementia and feeding difficulty, few sources adequately address effective feeding interventions. Basing their discussion on the conceptual model that grew out of a previously published systematic literature review, the authors address a wide range of assessment and intervention practices specific to various observed behaviors that may aid in feeding patients with dementia.

Malnutrition and feeding difficulty in Taiwanese older with dementia.

AIMS AND OBJECTIVES: To determine differences in the physical and psychological factors and feeding difficulty between people who are well-nourished and malnourished and to determine the predictors of risk of malnutrition and malnutrition in Taiwanese residents with dementia. BACKGROUND: Malnutrition is a common problem among nursing home residents but frequently is unrecognised. Nutritional status of older people is associated with cognitive impairment and patients with dementia have high risk for malnutrition because of difficulties in eating. DESIGN: A cross-sectional design was used to determine predictors of risk of malnutrition and malnutrition. METHODS: Subjects were recruited from five Taiwanese long-term care facilities. Data were collected using Mini Nutritional Assessment Screening Form, body mass index, Short Portable Mental Status Questionnaire, Barthel index, Edinburgh Feeding Evaluation in Dementia scale and eating time. RESULTS: Eighty-three subjects participated. According to the Mini Nutritional Assessment Screening Form cut-point scores, 75 (90·4%) residents with dementia had risk of malnutrition. However, using the World Health Organization (WHO) body mass index cut-point of <18·5, the prevalence rate of malnutrition was 19%. Using logistic regression, gender (odds ratio: 38·627, 95% CI: 1·927-774·407) and eating time (odds ratio: 0·814, 95% CI: 0·689-0·962) were significant predictors of risk of malnutrition. However, only gender (odds ratio: 6·12, 95% CI: 1·05-35·662) was a significant predictor of malnutrition using the WHO body mass index cut-point. CONCLUSIONS: The prevalence of the risk for malnutrition was high in residents with dementia in Taiwanese nursing homes. Feeding difficulty, activities of daily living dependence, cognitive impairment, number of medications and age increased with malnutrition while shorter eating times were associated with poorer nutrition. However, when the factors were considered together, only being female and eating time were significant risk factors for malnutrition. Being female was the only significant factor of malnutrition. RELEVANCE TO CLINICAL PRACTICE: Monthly monitoring of weight and assessment with Mini Nutritional Assessment Screening Form are essential to early identification of emerging malnutrition and implementation of interventions. Providing nutritional supplements and energy and protein-dense food may be needed for good nutrition and more time for eating or feeding assistance may delay malnutrition or even improve nutritional status.

Peer Volunteers Improve Long-Term Maintenance of Physical Activity With Older Adults: A Randomized Controlled Trial.

BACKGROUND: Using peer volunteers as delivery agents may improve translation of evidence-based physical activity promotion programs for older adults. This study examined whether tailored support from older peer volunteers could improve initiation and long-term maintenance of physical activity behavior. METHODS: Participants were randomized to 2 16-week, group-based programs: (1) peer-delivered, theory-based support for physical activity behavior change; or (2) an intervention typically available in community settings (basic education, gym membership, and pedometer for self-monitoring), attention-matched with health education. Moderate-to-vigorous physical activity (MVPA) was assessed via daily self-report logs at baseline, at the end of the intervention (16 weeks), and at follow-up (18 months), with accelerometry validation (RT3) in a random subsample. RESULTS: Seven peer volunteers and 81 sedentary adults were recruited. Retention at the end of the trial was 85% and follow-up at 18 months was 61%. Using intent-to-treat analyses, at 16 weeks, both groups had similar significant improvements in MVPA. At 18 months, the group supplemented with peer support had significantly more MVPA. CONCLUSIONS: Trained peer volunteers may enhance long-term maintenance of physical activity gains from a community-based intervention. This approach has great potential to be adapted and delivered inexpensively in community settings.

Predictors of modifications in instrumental activities of daily living in persons with heart failure.

OBJECTIVES: The objective of this study was to identify factors related to disability in heart failure (HF) patients using a modified version of the model of disability proposed by Nagi. The hypothesized relationships among pathology (severity of HF and comorbidity), impairment (dyspnea, fatigue, muscle strength), functional limitation (functional capacity), and disability (modification in instrumental activities of daily living [IADLs]) were assessed as well as the influence of age and sex on pathways to disability. METHODS AND RESULTS: Using a cross-sectional design, a convenience sample of 48 men and 53 women (mean age, 59.5 years) with New York Heart Association class II-IV was recruited at a HF clinic. Path analyses via Amos revealed that 71% of the variance in modifications in IADLs was explained by the significant predictors of dyspnea (B = .67), functional capacity (B = -.25), and age (B = .19). Dyspnea and comorbidity also had indirect effects on modification in IADLs through functional capacity. Age also had an indirect effect on modification in activities of daily living through functional capacity, and sex had an indirect effect through dyspnea and functional capacity. CONCLUSION: Patients with HF may benefit from interventions targeted at reducing dyspnea with daily activities and improving functional capacity to prevent disability.

Psychometric properties of the Task Self-Efficacy Scale for everyday activities in older adults.

Physical and cognitive factors contribute to independence in daily activities, but the confidence to perform an activity (self-efficacy) also contributes to it. The purpose of this study was to assess the psychometric properties of the Task Self-efficacy Scale (TSE) for confidence in performing daily activities, Validity and reliability were assessed in 278 older adults with scores on all items on the TSE for analysis. Factor analysis revealed two factors (self-care and mobility) explaining 72.42% of the variance in the items. Moderate to large correlations were found between the TSE for Self-Care and TSE for Mobility to exertion (.90 to .93, respectively) and fatigue (-.79 to -.84, respectively) associated with activities assessed in the TSE. The expected differences in TSE were found between those with and without mobility difficulties, fear of falls, and shortness of breath with activity. Cronbach's alpha was .96.

A randomized study of the effects of t'ai chi on muscle strength, bone mineral density, and fear of falling in women with osteoarthritis.

PURPOSE: Individuals with osteoarthritis can experience difficulty walking and poor strength, possibly leading to falls and fractures. Exercise has been found to increase strength and bone mineral density. The purpose of this study was to determine the effects of 6 months of t'ai chi on knee muscle strength, bone mineral density, and fear of falling in older women with osteoarthritis. METHODS: Eighty-two (82) women with osteoarthritis, recruited from outpatient clinics and community health centers, were randomly assigned to either a t'ai chi group and took part in a t'ai chi program, or a control group. Of these, 30 subjects (mean age = 63 years) in the t'ai chi group and 35 (mean age = 61 years) in the control group completed post-test measures at 6 months. RESULTS: After the 6-month study period, subjects in the t'ai chi program had significantly greater knee extensor endurance (pre- to post-test mean increase = 36.4 W/kg, versus 1.1 W/kg for the controls), and significantly greater bone mineral density in the neck of the proximal femur (mean change = 0.09, versus -0.10 for the controls), Ward's triangle (mean change = 0.04, versus -0.04 for the controls), and trochanter (mean change = 0.07, versus -0.05 for the controls) than the controls. However, knee extensor and flexor strength did not differ significantly between the groups. The fear of falling during daily activities reduced significantly more in the t'ai chi group (mean change = -2.40, versus 0.66 for the controls). CONCLUSIONS: T'ai chi increased knee extensor muscle endurance and bone mineral density in older women with osteoarthritis, and decreased their fear of falling during daily activities. Further study with long-term follow-up is needed to substantiate the role of t'ai chi exercise in the prevention of fall and its related fracture.

Adhering to a t'ai chi program to improve glucose control and quality of life for individuals with type 2 diabetes.

PURPOSE: This study was to examine the effects of adherence to a 6-month t'ai chi exercise program on glucose control, diabetic self-care activities, and quality of life among individuals with type 2 diabetes. METHOD: The data from a quasi-experimental study at multisite health-promotion centers in Korea with pretest and 3- and 6-month post-test measures were used. Ninety-nine (99) adults diagnosed with type 2 diabetes and HbA1c 6.0 or higher were included in the analysis. The t'ai chi intervention consisted of 19 movements from Yang and Sun styles provided twice a week for 6 months. Sixty-two (62) subjects completed both pretest and post-test measures. To achieve the desired outcomes, subjects needed to complete 80% of the sessions of the t'ai chi program, and 31 subjects who met this criteria were compared to those who did not (n = 31). Outcome measures included glucose control (fasting blood sugar, HbA1c), diabetic self-care activities, and quality of life (36-Item Short Form Health Survey, version 2). RESULTS: Using repeated measure analysis of variance for baseline, 3 months, and 6 months, the adherent group had greater decline in fasting glucose (interaction effect F = 5.60, df = 2, p < 0.05) and HbA1c (interaction effect F = 4.15, df = 2, p < 0.05) than the nonadherers. The adherent group performed significantly more diabetic self-care activities (interaction effect F = 5.13, df = 2, p < 0.05), and had better quality of life in mental component summary, social functioning, mental health, and vitality as compared to the nonadherent group. The significant differences in quality of life remained after adjusting for self-care activities except for mental health, which was no longer significant. CONCLUSION: For those with type 2 diabetes, t'ai chi could be an alternative exercise intervention to increase glucose control, diabetic self-care activities, and quality of life. Whether t'ai chi can reduce or prevent diabetic complications requires further study.