Environmental Predictors of Unmet Home-and Community-Based Service Needs of Older Adults.

Home- and community-based services (HCBS) for many older adults are an essential component of aging-in-place. Andersen developed the contemporary model used to predict service use. Researchers have modified the model to examine need. Studies that attempt to predict unmet needs have explained only 10% to 15% of the variance. This study is based on the supposition that lack of accounting for environmental factors has resulted in such small explanatory power. Through the use of 2008 Southeastern Pennsylvania Household Health Survey data, this exploratory study modeled predictors of unmet HCBS needs. Findings reveal that lack of access to healthy foods and poor housing quality have a significant relationship to unmet HCBS needs. This model predicted 54% of the variance. Results reveal environmental questions to ask, a way to identify older adults with unmet HCBS needs and environmental barriers that if addressed may reduce older adults' eventual need for health services and HCBS.

Building an integrated research/policy planning age-friendly agenda.

This article describes an innovative model for integrating research into a policy and planning agenda aimed to help neighborhoods become more supportive of older adults. Philadelphia Corporation for Aging (PCA) established Age-Friendly Philadelphia (AFP) to catalyze efforts to improve the physical and social environments for seniors. The Research Program at PCA became an important part of this effort by providing multiple types of supports to PCA staff and other stakeholders. Most notably, the research program worked with planners to adopt the United States Environmental Protection Agency's Aging Initiative model for Philadelphia. That model focuses on (1) staying active, connected, and engaged; (2) development and housing; (3) transportation and mobility; and (4) staying healthy. Examples of practice efforts actualized using this research are also presented. By developing a new approach to the way research can support practice initiatives, AFP has been able to increase its effectiveness, and researchers have found better ways to work collaboratively with professionals in policy, planning, and practice. The PCA model should be considered as a framework for similar efforts aimed at creating age-friendly communities.

Is "Walkability" A Useful Concept for Gerontology?

The study tested two hypotheses. 1) In a walkable neighborhood, residents will exercise more, eat healthier, and suffer from less obesity. 2) That relation will be stronger for the elderly. Health was measured by physical activity, number of portions of fruits and vegetables eaten, and BMI. "Walkability" was measured by a set of environmental items that formed three distinct factors. The three health outcomes were related to the three environmental factors. Age was not a significant predictor. While environment does play a significant role in health outcomes the ways that role is expressed and its relation to age is complex.

Exercise and social activity improve everyday function in long-term care residents.

OBJECTIVES: This study examined the effects of high-intensity resistance strength training and walking (E), individualized social activity (SA), and resistance training and walking combined with social activity (ESA) on everyday function in long-term care (LTC) residents and explored the relationship between change in everyday function and change in sleep. DESIGN: The study used data from The Effect of Activities and Exercise on Sleep, a randomized controlled trial. SETTING: Residential LTC facilities. PARTICIPANTS: A total of 119 participants who had measures of everyday function and sleep at baseline and postintervention. INTERVENTIONS: The E group exercised 5 days a week. The SA group was involved in social activities 5 days a week. The ESA group received both E and SA interventions. The usual care (UC) control group participated in usual activities. MEASUREMENTS: Everyday function was measured by the Nursing Home Physical Performance Test. Nighttime sleep was measured by attended polysomnography. RESULTS: The UC and SA groups showed a decline in everyday function, whereas the E and ESA groups showed improvement. There were statistically significant differences between the groups, with pairwise comparisons showing significant improvements in the ESA group over the SA group (95% confidence interval, -3.94 to -0.97) and the UC group (95% confidence interval, -3.69 to -0.64). No relationship was found between change in everyday function and change in sleep. CONCLUSION: Seven weeks of high-intensity resistance strength training and walking, combined with individualized social activities (ESA), improved everyday function among LTC residents, independent of change in sleep.

Strength training, walking, and social activity improve sleep in nursing home and assisted living residents: randomized controlled trial.

OBJECTIVES: To compare the effects of physical resistance strength training and walking (E), individualized social activity (SA), and E and SA (ESA) with a usual care control group on total nocturnal sleep time in nursing home and assisted living residents. DESIGN: Pretest-posttest experimental design with assignment to one of four groups for 7 weeks: E (n=55), SA (n=50), ESA (n=41), and usual care control (n=47). SETTING: Ten nursing homes and three assisted living facilities. PARTICIPANTS: One hundred ninety-three residents were randomly assigned; 165 completed the study. INTERVENTION: The E group participated in high-intensity physical resistance strength training 3 days a week and on 2 days walked for up to 45 minutes, the SA group received social activity 1 hour daily 5 days a week, the ESA group received both E and SA, and the control group participated in usual activities provided in the homes. MEASUREMENT: Total nocturnal sleep time was measured using 2 nights of polysomnography before and 2 nights of polysomnography after the intervention. Sleep efficiency (SE), non-rapid eye movement (NREM) sleep, rapid eye movement sleep, and sleep onset latency were also analyzed. RESULTS: Total nocturnal sleep time was significantly greater in the ESA group than in the control group (adjusted means 364.2 minutes vs 328.9 minutes), as was SE and NREM sleep. CONCLUSION: High-intensity physical resistance strength training and walking combined with social activity significantly improved sleep in nursing home and assisted living residents. The interventions by themselves did not have significant effects on sleep in this population.

Asking neutral versus leading questions: implications for functional limitation measurement.

UNLABELLED: National surveys of older Americans routinely have included functional limitation items using either a leading approach ("how much difficulty do you have...") or a neutral approach ("do you have any difficulty..."). This article evaluates the performance of scales based on these two approaches. METHODS: Using responses from 595 randomly selected participants to the 1994 Health and Retirement Study, the authors compared prevalences and evaluated scales based on each approach with respect to the extent of missing data, face validity, reliability, predictive validity, convergent validity, and robustness of odds ratios in predictive models. RESULTS: The authors found that leading questions provided higher estimates of functional limitations than neutral questions, but both approaches yielded scales with similar validity and reliability. However, for both approaches, scales incorporating degree of difficulty had better validity and reliability than those based on counts of tasks. All four approaches yielded substantially similar coefficients in a model predicting disability onset. DISCUSSION: The authors conclude that, because they minimize survey time without compromising validity and reliability, items that explicitly capture degree of difficulty by asking "How much difficulty do you have..." may be the optimal approach for survey designers.

The relationships among anxiety, depression, and pain in a geriatric institutionalized sample.

This study sought to determine if depression and/or anxiety is uniquely related to pain after controlling for the strong association between anxiety and depression. Both depression and anxiety were assessed in an elderly institutionalized sample using: (1) research-based diagnoses based on Diagnostic and Statistical Manual-revised 3rd edition (DSM-IIIR) criteria, and (2) evaluations of one's recent affective states using the Profile of Moods States (POMS). Pain was assessed by pain intensity and number of pain complaints. A series of path models indicated that: (1) both research-based anxiety and depression share unique variance with pain, and (2) only POMS anxiety is uniquely related to pain. A path model using both measures of anxiety and depression indicated that only the anxiety measures are significantly related to pain. However, POMS anxiety sustained a significantly greater relationship with pain than did research-based anxiety.