What matters when it comes to measuring Age-Friendly Health System transformation.

Thousands of health systems are now recognized as "Age-Friendly Health Systems," making this model one of the most widely disseminated - and most promising- models to redesign care delivery for older adults. Sustaining these gains will require demonstrating the impact on care delivery and outcomes of older adults. We propose a new measurement model to more tightly link Age-Friendly Health System transformation to outcomes within each "M" (What Matters, Medications, Mobility, and Mentation). We evaluated measures based on the following characteristics: (1) conceptual responsiveness to changes brought about by practicing "4Ms" care; (2) degree to which they represent outcomes that matter to older adults; and (3) how they can be feasibly, reliably, and validly measured. We offer specific examples of how novel measures are currently being used where available. Finally, we present measures that could capture system-level effects across "M"s. We tie these suggestions together into a conceptual measurement model for AFHS transformation, with the intent to spur discussion, debate, and iterative improvement in measures over time.

Prior Night Sleep Affects Next-Day Pain Interference Among Community-Dwelling Older Adults With Lower Extremity Chronic Pain.

Emergent work suggests that sleep is a robust biobehavioral predictor of pain; however, it remains unclear how sleep is prospectively linked to pain on a day-to-day basis among older adults. The current prospective study examined how sleep duration (total sleep time), quality (sleep efficiency, wake after sleep onset), and late and irregular sleep timing influenced next-day pain perception among community-dwelling older adults (N = 10; 65 matched observations) with lower extremity chronic pain over 1 week. Multilevel modeling estimated the association between sleep (Actigraph GT9X Link) and pain perception (Brief Pain Inventory Short Form). Increased wake after sleep onset (B = 0.19, p = 0.04), sleep variability (B = 0.02, p = 0.01), and later midsleep time (B = 0.40, p < 0.05) were associated with increased pain interference the following day. Findings support the idea that timely sleep interventions may reduce the effect of poor sleep on next-day pain in older adults. [Research in Gerontological Nursing, 14(4), 173-179.].

Using a Real-Time Locating System to Measure Walking Activity Associated with Wandering Behaviors Among Institutionalized Older Adults.

A real-time locating system (RTLS) can be used to track the walking activity of institutionalized older adults in long-term care who are at risk for wandering behaviors. The benefits of a RTLS are objective and continuous measurements of activity. Self-report methods of activity, especially wandering, by health care staff are vulnerable to floor effects and recall bias, and continuous clinical or research observation over the long-term can be time-consuming and expensive. Health care staff also fail to recognize the onset and/or duration of wandering behaviors, which are associated with a variety of adverse health outcomes in this population but amenable to intervention. RTLS technologies can measure the walking activity of institutionalized residents with cognitive impairment over time with a high degree of accuracy. This is particularly useful for the study of wandering, defined as walking for at least 60 seconds with few (if any) breaks in activity. Wandering is associated with disease progression, hospitalizations, falls and death. Previous work suggests older adults with poor balance ability and high sustained walking activity may be particularly susceptible to poor health outcomes. RTLS's are used to assess cognitive impairment and factors associated with gait and balance; however, supplemental paper and pencil gait/balance tools may be used to further refine risk profiles. This project discusses the use of a RTLS to measure walking activity and also gait quality and balance ability measures on this population.

What do parents have to do with my cognitive reserve? Life course perspectives on twelve-year cognitive decline.

BACKGROUND/AIMS: To examine the cognitive reserve hypothesis by comparing the contribution of early childhood and life course factors related to cognitive functioning in a nationally representative sample of older Americans. METHODS: We examined a prospective, national probability cohort study (Health and Retirement Study; 1998-2010) of older adults (n=8,833) in the contiguous 48 United States. The main cognitive functioning outcome was a 35-point composite of memory (recall), mental status, and working memory tests. The main predictors were childhood socioeconomic position (SEP) and health, and individual-level adult achievement and health. RESULTS: Individual-level achievement indicators (i.e., education, income, and wealth) were positively and significantly associated with baseline cognitive function, while adult health was negatively associated with cognitive function. Controlling for individual-level adult achievement and other model covariates, childhood health presented a relatively small negative, but statistically significant association with initial cognitive function. Neither individual achievement nor childhood SEP was statistically linked to decline over time. CONCLUSIONS: Cognitive reserve purportedly acquired through learning and mental stimulation across the life course was associated with higher initial global cognitive functioning over the 12-year period in this nationally representative study of older Americans. We found little supporting evidence that childhood economic conditions were negatively associated with cognitive function and change, particularly when individual-level achievement is considered.

Reliability and validity of the Jefferson Scale of Empathy in undergraduate nursing students.

Evidence has been reported in support of the reliability and validity of the Jefferson Scale of Physician Empathy (JSPE) when used with physicians, medical students, and nurses. This study examined the psychometrics of a modified version of the scale in undergraduate nursing students. The modified version of the JSPE was administered to 333 nursing students at different levels of training. Three underlying constructs, that is, "Perspective Taking," "Compassionate Care," and "Standing in Patient's Shoes" emerged from the factor analysis of the scale that were consistent with the conceptual framework of empathy, thus supporting the construct validity of the scale. The coefficient alpha was .77. Scores of the empathy scale were significantly correlated with the scores of the Jefferson Scale of Attitudes toward Physician-Nurse Collaboration (r = .38, p < .001). Women scored higher than men, and those with more clinical experiences scored higher than others. It was concluded that the empathy scale used in this study is a psychometrically sound instrument for measuring empathy in undergraduate nursing students.

The health of older Mexican Americans in the long run.

OBJECTIVES: We compared risk for several medical illnesses between immigrant and US-born older Mexican Americans to determine the relationship between functional health and years of US residency among immigrants. METHODS: Cross-sectional, multistage probability sample data for 3050 Mexican Americans aged 65 years or older from 5 US southwestern states were analyzed. Self-rated health, medical illnesses, and functional measures were examined in multivariate regression models that included nativity and years of US residency as key predictors. RESULTS: Self-rated health and medical illnesses of immigrant and US-born groups did not differ significantly. Immigrants with longer US residency had significantly higher cognitive functioning scores and fewer problems with functional activities after adjustment for predisposing and medical need factors. CONCLUSIONS: Among older Mexican Americans, immigrant health advantages over their US-born counterparts were not apparent. Immigrants had better health functioning with longer US residency that may derive from greater socioeconomic resources. Our findings suggest that the negative acculturation-health relationship found among younger immigrant adults may become a positive relationship in later life.

Antidepressant use in a nationally representative sample of community-dwelling US Latinos with and without depressive and anxiety disorders.

BACKGROUND: Antidepressant drugs are among the most widely prescribed drugs in the United States; however, little is known about their use among major ethnic minority groups. METHOD: Collaborative Psychiatric Epidemiology Surveys (CPES) data were analyzed to calculate nationally representative estimates of Latino and non-Latino White adults antidepressant use. SETTING: The 48 coterminous United States was the setting. PARTICIPANTS: Household residents aged 18 years and older (N=9,250). MAIN OUTCOME: Past year antidepressant use. RESULTS: Compared to non-Latino Whites, few Latinos, primarily Mexican Americans, with 12-month depressive and/or anxiety disorders reported past year antidepressant use. Mexican Americans (OR=0.48; 95%CI=0.30-0.77) had significantly lower odds of use compared to non-Latino Whites, which were largely unaffected by factors associated with access to care. Over half of antidepressant use was by respondents not meeting 12-month criteria for depressive or anxiety disorders. Lifetime depressive and anxiety disorders explained another 21% of past year antidepressant use, leaving another 31% of drug use unexplained. DISCUSSION: We found a disparity in antidepressant use for Mexican Americans compared to non-Latino Whites that was not accounted for by differences in need and factors associated with access to care. About one third of antidepressant use was by respondents not meeting criteria for depressive or anxiety disorders. Our findings underscore the importance of disaggregating Latino ethnic groups. Additional work is needed to understand the medical and economic value of antidepressant use beyond their primary clinical targets.

The Jefferson Scale of Attitudes toward Physician-Nurse Collaboration: a study with undergraduate nursing students.

The Jefferson Scale of Attitudes toward Physician-Nurse Collaboration (JSAPNC) was administered to 333 undergraduate nursing students. The underlying factors, item-total score correlations and reliability of the JSAPNC were examined. A significant correlation was observed between scores of the JSAPNC and the Jefferson Scale of Empathy (r = 0.38). It was hypothesized that: (1) Women would score higher than men on the JSAPNC, (2) Scores on the JSAPNC would increase as students progress in their nursing education, (3) Scores on the JSAPNC would be higher for students with work experiences in health care, and (4) Scores on the JSAPNC would be higher for those with a higher level of education prior to nursing school. Hypotheses 1, 3 and 4 were confirmed at a conventional statistical level of significance (p < 0.05), and hypothesis 2 was confirmed at a marginal significance level (p = 0.06). No significant differences were observed on scores of the JSAPNC among undergraduate nursing students grouped by ethnic minority, specialty plan, academic major prior to nursing school, or marital status. Implications for future studies in nursing education are discussed.

Memory decline and depressive symptoms in a nationally representative sample of older adults: the Health and Retirement Study (1998-2004).

BACKGROUND/AIMS: Inconsistencies in the relationship between depression and cognitive decline may exist because the expected cognitive domains at risk have not been specified in previous study designs. We aimed to examine the relationship between depressive symptoms and verbal episodic memory functioning over time. METHODS: Data from a prospective cohort study (Health and Retirement Study; 1998-2004; n = 18,465), a multistage national probability sample of older adults in the United States, were analyzed. Verbal learning and memory of a 10-word list learning task were the main outcomes. Depressive symptoms (Center for Epidemiologic Studies - Depression Scale) constituted the main predictor. RESULTS: Depressive symptoms were associated with significantly lower immediate (-0.05; p < 0.001) and delayed (-0.06; p < 0.001) word list recall scores after controlling for demographics and baseline and time-varying cardiovascular disease risks and diseases. CONCLUSIONS: In this US national study of older adults, elevated depressive symptoms were associated with declines in episodic learning and memory over time. These associations were little affected by the demographic or medical conditions considered in this study. The results suggest that learning and memory decline may be a long-term feature associated with depressive symptoms among the nation's older adult population.