Objectively Measured Physical Activity and Sedentary Behaviors Among Older Adults in Assisted Living Facilities: A Scoping Review.

Older adults in assisted living facilities (ALF) are at risk for low physical activity (PA) and high sedentary behavior (SB), both of which place them at risk for negative health outcomes. The purpose of this scoping review was to synthesize evidence describing the volume of device-measured PA/SB, factors associated with PA/SB, and interventions designed to change PA/SB in older adults living in ALF. Twenty articles representing 15 unique studies were identified from eight electronic databases and grey literature. Residents in ALF spent 96-201 min/day in light PA (n = 2 studies), 1-9.74 min/day in moderate to vigorous PA (n = 2 studies), and 8.5-11.01 hr/day of SB during waking hours (n = 3 studies). Factors associated with PA included 16 personal factors (n = 6 articles), one social factor (n = 2 articles), and two environmental factors (n = 2 articles). Factors associated with SB included 14 personal factors (n = 4 articles) and one social factor (n = 1 article). No intervention successfully changed PA/SB.

Including Socially Isolated Black, Older Old Adults (Aged 80 and Above) with and without Mild Cognitive Impairment in a Clinical Trial: Recruitment Strategies and Perspectives.

Objective: This study describes strategies for the recruitment of socially isolated older old Black individuals to participate in the "Internet-based conversational engagement clinical trial (I-CONECT)" (Clinical Trial.gov: NCT02871921) and lessons learned in this critical population segment. Methods: Best practice strategies to recruit the target population included mass mailings, advertisements, and direct community outreach, including the collaboration with a community group created to reach Black individuals interested in research participation. We also made protocol changes to measure recruitment criteria for older old Black adults more accurately and to increase their participation. Results: Descriptive data related to the challenges and successes in recruiting Black participants compared to the White participants is presented. The primary site contacted 17,523 primarily White potential participants and enrolled/randomized 145 White and 2 Asian/mixed race participants (0.8%). The Midwest site contacted 12,141 Black potential participants and enrolled/randomized 39 (0.3%) participants. Discussion: While best practices were employed, several factors complicated recruitment, including the need to adjust recruitment criteria, navigate regional regulations, and respect diverse community preferences. Conclusion: Older old African Americans are reachable and willing to participate in research when considering their beliefs and practices, influenced by their community and experience.

Development and preliminary psychometric evaluation of the COPD-related Stigma Scale.

BACKGROUND: Stigma experiences contribute to psychological distress and negatively affect healthcare-seeking behavior in people with chronic obstructive pulmonary disease (COPD). Most evidence comes from qualitative research, and no well-established measure of COPD-related stigma exists. Prior research yielded a preliminary measure of COPD-related stigma, but it required item reduction and validation. OBJECTIVES: The purpose of this study was to revise the preliminary measure, reduce the number of items, identify underlying constructs, and evaluate the reliability and validity of the shortened version. METHODS: A descriptive, cross-sectional study was conducted. Participants (N = 148; mean = 64 ± 7.27 years) completed the 51-item preliminary COPD-related Stigma Scale (COPDSS). Item-level analysis was conducted before running exploratory factor analysis (EFA). Reliability was assessed using Cronbach's alpha. Convergent validity and known-groups validity were evaluated. RESULTS: In the item-level analysis, eight items were deleted, leaving 43 items for factor analysis. A four-factor model with 24 items (α = 0.93) was derived from EFA: social stigma (α = 0.95), felt stigma (α = 0.95), anticipated stigma-oxygen (α = 0.80), and smoking-related stigma (α = 0.81). The 24-item COPDSS was significantly correlated with the 8-item Stigma Scale for Chronic Illness (r = 0.83), the Hospital Anxiety and Depression Scale (r = 0.57), and the PROMIS Physical Function (r = -0.48). The 24-item COPDSS discriminated between known groups based on age (p = .03), use of inhalers (p = .002) and use of supplemental oxygen (p < .001), and psychological distress levels (ps < .001). CONCLUSION: Findings support the reliability and validity of the 24-item COPDSS. This instrument can be used to understand underlying stigma processes in people with COPD.

Barriers and motivators to promotion of physical activity participation for older adults with mild cognitive impairment or dementia: An umbrella review.

BACKGROUND: Due to the growing aging population worldwide, cognitive disorders including mild cognitive impairment and dementia is considered a major public health priority. Currently, physical activity is a promising non-drug therapy, however, people with mild cognitive impairment or dementia are more likely to be physically inactive. OBJECTIVE: To identify the barriers and motivators affecting participation in physical activity in older people with mild cognitive impairment or dementia. DESIGN: An umbrella review. METHODS: The Joanna Briggs Institute (JBI) methodology for umbrella reviews was adopted in this study. We searched the PubMed, Embase, Web of science, CINAHL, Cochrane, Scopus and Proquest to identify relevant articles published in English from inception to October 2022. Two researchers independently screened and selected articles against preselected inclusion criteria. Eligible studies were appraised for methodological quality using the combined Meta Quality Appraisal Tool and Assessment of Multiple Systematic Reviews Tool. The Grading of Recommendations Assessment Development and Evaluation- Confidence in the Evidence from Reviews of Qualitative Research tool was employed to determine the confidence level in the evidence of the extracted factors. Theoretical Domain Framework (TDF) was used to map barriers and motivators to physical activity participation. Behavior change techniques (BCTs) was utilized to develop theoretically-informed implementation strategies. RESULTS: Fourteen relevant reviews (covered over 219 primary studies) were included in this review. A total of 31 factors were identified from the selected reviews. Three factors with the strongest supporting evidence for their influence on participation were: resources/material resources, social support, and perceived competence. According to the behavior change techniques, six implementation strategies (providing supervision, developing tailored interventions, providing safe and promoting environment, helping to increase participants' motivation and adherence, integrating all kinds of social support, and providing suitable staffing) were developed. CONCLUSIONS: The evidence presented in this umbrella review suggests that a multilevel stakeholder approach and a system-wide viewpoint should be adopted. Through the Theoretical Domain Framework, we not only identified construct factors for future interventions, but also revealed understudied fields in this research areas. This umbrella review generates data that is expected to inform the development of implementation strategies based on the intervention-mapping approach, which will promote participation in physical activity. REGISTRATION: This study was registered with the PROSPERO (CRD42022371535).

The Internet-Based Conversational Engagement Clinical Trial (I-CONECT) in Socially Isolated Adults 75+ Years Old: Randomized Controlled Trial Protocol and COVID-19 Related Study Modifications.

Background: Increasing social interactions through communication technologies could offer a cost-effective prevention approach that slows cognitive decline and delays the onset of Alzheimer's disease. This paper describes the protocol of an active project named "Internet-based conversational engagement clinical trial (I-CONECT)" (ClinicalTrials.gov: NCT02871921). The COVID-19 pandemic related protocol modifications are also addressed in the current paper. Methods: I-CONECT is a multi-site, assessor-blind, randomized controlled behavioral intervention trial (RCT). We aim to randomize 320 socially isolated adults 75+ years old [160 Caucasian and 160 African American participants, 50:50 split between those with normal cognition and mild cognitive impairment (MCI)] recruited from the community to either the video chat intervention group or the control group (1:1 allocation). Those in the video chat group receive a computer and Internet service for the duration of the study, which they use to video chat with study staff for 30 min/day 4×/week for 6 months (high dose), and then 2×/week for an additional 6 months (maintenance dose). Both video chat and control groups have a brief (about 10 min) telephone check-in with study staff once per week. The primary outcome is the change in global cognitive function measured by Montreal Cognitive Assessment (MoCA) from baseline to 6 months. Secondary outcomes include changes in cognition in memory and executive function domains, emotional well-being measured by NIH Toolbox emotional battery, and daily functional abilities assessed with the Revised Observed Tasks of Daily Living (OTDL-R). Eligible participants have MRIs at baseline and 6 months. Participants contribute saliva for genetic testing (optional consent), and all video chats, weekly check-in calls and neuropsychological assessment sessions are recorded for speech and language analysis. The pandemic halted research activities and resulted in protocol modifications, including replacing in-person assessment with remote assessment, remote deployment of study equipment, and revised targeted sample size. Discussion: This trial provides user-friendly hardware for the conversational-based intervention that can be easily provided at participants' homes. The trial aspires to use age and culture-specific conversational materials and a related platform developed in this trial for enhancing cognitive reserve and improving cognitive function.

Sleep-Wake Disturbances and Episodic Memory in Older Adults.

Sleep-wake disturbances have been associated with episodic memory loss, but past studies were limited by use of single measures of objective or perceived disturbances. Notably, cognitive reserve and depressive symptoms have been associated with sleep-wake disturbances and poorer episodic memory in older adults. The aims of this study were to determine the relationship between episodic memory and sleep-wake disturbances using objective and perceived measures in older adults and to examine cognitive reserve and depressive symptoms as moderators of this relationship. In this descriptive study, 62 healthy older adults (mean age: 69.9 years; 75.8% women) were recruited from the University of Michigan Clinical Research Program. Objective sleep-wake disturbances were measured by 7-day actigraphy and perceived sleep-wake disturbances by the Pittsburgh Sleep Quality Index and Epworth Sleepiness Scale. Episodic memory was measured by the Hopkins Verbal Learning Test-Revised. Analyses involved Pearson's correlation coefficients and hierarchical multiple regression. Results showed that more objectively measured sleep disruption was associated with poorer episodic memory and more perceived daytime sleepiness was associated with better episodic memory. Cognitive reserve and depressive symptoms were not moderators of this relationship. In this study, the relationship between sleep-wake disturbances and episodic memory differed by type of measure, objective or perceived. Future studies are needed using multiple measures of episodic memory to further understand the sleep-wake disturbances and episodic memory relationship in a larger diverse sample of healthy older adults.

Assisted Living Residents' Sense of Belonging and Psychosocial Outcomes.

Little is known about the psychosocial adjustment of older adults in the assisted living environment. A sense of belonging has been linked to psychological health and a lack of belonging could lead to loneliness. We conducted a cross-sectional descriptive study to examine relationships between social engagement, sense of belonging, and psychological outcomes. Seventy female and 30 male assisted living residents participated. The mean age was 83.9 (range 65-99) years. Structural equation modeling (SEM) revealed that older age, higher physical function, and greater sense of belonging were associated with fewer negative psychosocial outcomes (depression and loneliness) and that sense of belonging functioned as a mediator between social engagement and psychosocial outcomes. Additional work is needed to fully understand how sense of belonging and other factors influence psychosocial outcomes.

Acupuncture and Acupressure for Dementia Behavioral and Psychological Symptoms: A Scoping Review.

Due to the dangers associated with psychotropic medications, there is an urgent need for non-pharmacologic therapies to treat behavioral and psychological symptoms of dementia (BPSD). Acupuncture and acupressure are safe and well-tolerated non-pharmacologic therapies for this population, but currently no review has explored acutherapy for management of distressing dementia symptoms. This review synthesizes research on acupuncture and acupressure for BPSD. Upon searching five databases, 15 studies met inclusion/exclusion criteria. Nine examined acupressure, six acupuncture, and eight were randomized controlled trials. The percent of studies demonstrating statistically significant improvements in symptoms were: activities of daily living (ADLs; 75%), agitation (100%), anxiety (67%), depression (100%), mood (100%), neuropsychological disturbances (67%), and sleep disturbances (100%). Variations in study design, intervention procedures, and outcomes limit interpretations about effectiveness. It is recommended that further research be done to examine the efficacy of these therapies and promote generalizability.

The Experience and Meaning of Physical Activity in Assisted Living Facility Residents.

Assisted living (AL) residents engage in very low levels of physical activity (PA), placing them at increased risk for mobility disability and frailty. But many residents in AL may not perceive the need to increase their PA. This study explored the experience, meaning, and perceptions of PA in 20 older adults in AL. The factors associated with PA were also examined. Qualitative data were collected using semistructured interviews and analyzed using phenomenological methodology. Six themes were identified: PA was experienced as planned exercise, activities of daily living, and social activities based on a schedule or routine; PA meant independence and confidence in the future; residents perceived themselves as being physically active; social comparisons influenced perception of PA; personal health influenced PA; motivations and preferences influenced PA. The findings highlight the importance of residents' personal perceptions of PA and effects of the social milieu in the congregate setting on PA.

"The Filter is Kind of Broken": Family Caregivers' Attributions About Behavioral and Psychological Symptoms of Dementia.

OBJECTIVES: Behavioral and psychological symptoms of dementia (BPSD) are common, often challenging to manage, and may erode caregivers' well-being. Few studies have explored caregivers' perspectives of what causes these behaviors, but such attributions may be important-particularly if they negatively impact the care dyad. This study examined causal attributions about BPSD among individuals caring for a family member with dementia. DESIGN: In-depth qualitative data were obtained from family caregivers of older adults with dementia. SETTING: As part of a larger study (NINR R01NR014200), four focus groups were conducted with caregivers by an experienced facilitator. PARTICIPANTS: A total of 26 family caregivers participated in the four focus groups. MEASUREMENTS: Caregivers reported their own attributions about the causes of their care recipient's BPSD. Sessions were audio-recorded. Data were transcribed, coded to determine relevant concepts, and reduced to identify major categories. RESULTS: Five categories were determined. Caregivers attributed BPSD to: 1) neurobiological disease factors; 2) physical symptoms or comorbid health conditions; 3) psychological reactions to dementia; 4) shifting social roles and relationships following dementia onset; and 5) environmental changes such as lack of routine and medical transitions (e.g., hospitalization). Despite this seemingly multifactorial attribution to BPSD etiology, a number of respondents also indicated that BPSD were at least partly within the care recipient's control. CONCLUSIONS: Family caregivers attribute BPSD to a range of care recipient and environmental factors. Caregivers' own causal beliefs about BPSD may reflect unmet educational needs that should be considered in the development of targeted interventions to minimize caregiving stress.

Managing behavioral disturbances in a patient with dementia.

A 92-year-old patient with Parkinson disease and dementia provides an opportunity for the advanced practice registered nurse to shift thinking about behavioral disturbances in dementia, away from controlling behavior with pharmacologic approaches, such as antipsychotics, toward understanding behavior by applying the nonpharmacologic Describe, Investigate, Create, and Evaluate method.

Demographic and Socioenvironmental Characteristics of Black and White Community-Dwelling Caregivers and Care Recipients' Behavioral and Psychological Symptoms of Dementia.

The purpose of the current study was to compare the association between caregiver background characteristics and care recipients' behavioral and psychological symptoms of dementia (BPSD) in Black and White community-dwelling family caregivers. Using logistic regression models, caregiver/care recipient dyad data from the Aging Demographics and Memory Study were used to describe associations between caregiver background characteristics (i.e., demographic and socioenvironmental variables) and care recipients' BPSD (i.e., hallucinations, delusions, agitation, depression) (N = 755). Results showed that Black caregivers were more likely to be female, younger, an adult child, have less education, and live in the South (p ≤ 0.05); they were less likely to be married. Several caregiver background characteristics were associated with care recipients' depression and agitation, but not with other BPSD. Caregiver background characteristics may play a role in the recognition and reporting of BPSD and should be considered when working with families of individuals with dementia.

Psychiatric disorders impacting critical illness.

An astounding 30% to 50% of older patients who are hospitalized for a medical condition also have a psychiatric disorder. The intent of this article is to prepare acute care nurses to meet the mental health needs of older adults with a critical illness and prevent untoward sequelae of medical events. The authors discuss the importance of baseline assessment data, issues related to informed consent, manifestations of common psychiatric disorders that may be seen in older adults in the acute care setting, as well as strategies to improve patient outcomes.

Acute coronary syndromes in older adults: a review of literature.

INTRODUCTION: Acute coronary syndromes (ACS) are the leading cause of death in older adults, aged 65 years or older. The clinical presentation varies, and the absence of chest pain may occur. Our purpose was to synthesize the published literature (2000-2012) to (1) examine the initial ED presentation of older adults with confirmed ACS, (2) identify knowledge gaps, (3) determine whether gender differences exist in the presentation of ACS, and (4) describe recommendations for practice and research. METHODS: A systematic review was conducted from September 2000 to September 2012. RESULTS: The review suggests that older adults with ACS report chest pain more commonly when arriving to the emergency department. Older adults have higher in-hospital mortality rates than adults aged younger than 65 years. However, older adults reporting an absence of chest pain on arrival are twice as likely to die compared with older adults with chest pain. With regard to gender differences, we note that men are more likely to present with chest pain whereas women are more likely to present with nausea. Women have higher in-hospital mortality rates both with and without chest pain presentation. Delay in time to arrival, as well as delay to primary percutaneous intervention, is reported for older adults with and without chest pain. DISCUSSION: Older adults with ACS are at risk for higher mortality rates and delays in time to treatment modalities. Early recognition of symptoms suggestive of ACS by the emergency triage nurse can improve patient outcomes.

Cognitive health in older adults.

This article addresses both the theoretical and practical issues associated with cognitive aging, including the implications of neurophysiological changes in the brain as well as practical ways of screening for changes that may be problematic or may actually enhance healthy cognitive adaptations.