Chronic Non-cancer Pain and Associated Risks of Incident Mild Cognitive Impairment and Alzheimer's Disease and Related Dementias in Middle-Aged and Older Adults.

The goal of this study is to investigate the association between chronic non-cancer pain (CNCP) and mild cognitive impairment (MCI)/Alzheimer's disease and related dementias (ADRDs) development among adults aged ≥50 using administrative claims data from a national commercial health insurance company during 2007-2017. To reduce selection bias, propensity-score matching was applied to select comparable CNCP and non-CNCP patients. Time-dependent Cox proportional-hazards regressions were conducted to estimate the hazard ratios (HRs) of incident MCI/ADRDs. Of 170,900 patients with/without CNCP, 0.61% developed MCI and 2.33% had been diagnosed with ADRDs during the follow-up period. Controlling for potential confounders, CNCP patients had a 123% increase in MCI risk (HR = 2.23; 95% CI = 1.92-2.58) and a 44% increase in ADRDs risk (HR = 1.44; 95% CI = 1.34-1.54) relative to non-CNCP patients. CNCP is a risk factor for MCI/ADRDs. Promoting awareness and improving early CNCP diagnosis in middle-aged and older adults should be incorporated into cognitive impairment and dementia prevention.

An application of the reasoned action approach to clinical students' intention toward a career in geriatrics.

Guided by the reasoned action approach, this study examined select individual, information, and social factors that influence intention toward pursuing a career in geriatrics among 314 clinical medical and nursing students in Ghana. A Poisson regression showed attitude toward older persons was a significant influencing factor of intention to choose a career in geriatrics for medical students (B = 0.015, SE = 0.0048, p = 0.002) but not nursing students (B = 0.009, SE = 0.0145, p = 0.512). Personal interest was, however, a significant influencing factor for both medical and nursing students (B = 0.462, SE = 0.0592, p = 0.000) and (B = 0.015, SE = 0.0048, p = 0.002), respectively. Nursing students with moderate to strong interest were 1.6 times more likely to express an intention to specialize in geriatrics, and medical students were 1.5 times more likely to express an intention to specialize in geriatrics. The results show that the most important factor influencing geriatric career intention is students' personal interest in the field. Evidence-based interventions such as early educational and practice exposure to the field and interactions with older adults are recommended.

Stressful Life Events and Patterns of Polysubstance Use Among U.S. Late Middle-Aged and Older Adults: A Latent Class Analysis.

The goals of this study were to identify patterns of polysubstance use and their associations with stressful life events among U.S. late middle-aged and older adults and examine whether gender moderates these associations. Adults aged 50 and older (N = 14,738) from the National Epidemiological Survey on Alcohol and Related Conditions-III were included. Latent class analysis was conducted to identify patterns of polysubstance use. Weighted multinomial logistic regression was estimated with a generalized structural equation model. Three different polysubstance use patterns (non-users/low substance users; cannabis and excessive alcohol users; painkiller and sedative/tranquilizer misusers) were identified. Higher levels of stressful life events were associated with patterns of polysubstance use. Gender moderated the association between stressful life events and co-misusing painkillers and sedatives/tranquilizers (p < 0.05). Substance use prevention efforts should consider aging adults' patterns of polysubstance use and associated stressful life events when designing and implementing gender-specific polysubstance use prevention interventions.

The message matters: Advertisement framing and college women's beliefs toward exercise.

Objective: This study explores college women's beliefs and experiences about exercise informed by different framing strategies, and how they may influence exercise engagement. Participants: Four focus groups were conducted with 19 undergraduate women at a large public Midwestern university.Methods: Four differently framed group exercise advertisements were used to prompt focus group discussions on beliefs and intentions to exercise. Transcribed data were analyzed with a thematic content approach.Results: Undergraduate female participants described more positive beliefs that influence intention with a well-being-framed advertisement. More negative beliefs were described when the advertisement focused on enhancing appearance. Participants of color believed that seeing more representation of diversity in advertisements would make engaging in exercise easier.Conclusion: Positive beliefs linked to a "well-being" frame and diverse imagery of women in exercise advertisements may improve intention to exercise, increasing physical activity among women.

Cognitive dysfunction prevalence and associated factors in older breast cancer survivors.

OBJECTIVES: The purpose of this study was to examine the prevalence and factors associated with objective and subjective cognitive dysfunction in older breast cancer survivors (BCS). MATERIALS AND METHODS: This cross-sectional descriptive study leveraged previously collected data from older BCS (n = 335). Separate linear regression models were used to determine relationships between demographic factors (age, education), medical factors (comorbidities), disease factors (time since diagnosis, cancer stage), cancer-related symptoms (depressive symptoms, anxiety, fatigue, sleep disturbance) and cognitive dysfunction measures, including objective learning, delayed recall, attention, executive function-working memory, verbal fluency and subjective attentional function. RESULTS: Cognitive dysfunction was prevalent with up to 18.6% of older BCS experiencing mild-moderate dysfunction (1.5 standard deviations below mean of non-cancer controls) in at least one cognitive domain. Poor to moderate subjective attentional function was reported by 26% of older BCS. More depressive symptoms were significantly related to poorer cognitive function including learning (p < .01), delayed recall (p < .05), verbal fluency (p < .001), and subjective attentional function (p < .001) but not attention and executive function-working memory. Age, education, anxiety, and fatigue were also negatively associated with cognitive function in some models (p < .05-0.001). CONCLUSION: Cognitive dysfunction is common among older BCS and depressive symptoms, anxiety, and fatigue are related factors. Importantly, depressive symptoms were not only related to self-report, but also to cognitive performance. Healthcare providers should be aware of and assess for related factors and cognitive dysfunction itself in older BCS even years after diagnosis and treatment thorough geriatric assessment. Future longitudinal research is needed to discern these relationships.

'Tracking Together'-Simultaneous Use of Human and Dog Activity Trackers: Protocol for a Factorial, Randomized Controlled Pilot Trial.

Dog-walkers are more likely to achieve moderate-intensity physical activity. Linking the use of activity trackers with dog-walking may be beneficial both in terms of improving the targeted behavior and increasing the likelihood of sustained use. This manuscript aims to describe the protocol of a pilot study which intends to examine the effects of simultaneous use of activity trackers by humans and their dogs on the physical activity level of humans and dogs. This study uses nonprobability sampling of dog owners of age 25-65 (N = 80) and involves four parallel groups in an observational randomized controlled trial with a 2 × 2 factorial design, based on use of dog or human activity trackers for eight weeks. Each group consists of dog-human duos, in which both, either or none are wearing an activity tracker for eight weeks. At baseline and end, all human subjects wear ActiGraph accelerometers that quantify physical activity for one week. Commercial activity trackers are used for tracking human and dog activity remotely. Additional measures for humans are body composition and self-reported physical activity. Dog owners also report dog's weight and physical activity using a questionnaire. A factorial analysis of covariance (ANCOVA) is used to compare physical activity across the four groups from baseline to week-10.

Medical students perspectives and consideration of geriatrics for future practice. An exploratory study of a public medical school in Ghana.

Ghana has one of the fastest growing aging populations in sub-Sahara Africa, but little is known about the geriatric workforce. A sample of 12 medical students in one Ghanaian public university participated in an exploratory qualitative study to share their perspectives on specialty choices in Ghana, interest in working with older patients, and their consideration of geriatrics for future practice. The findings revealed limited knowledge of geriatrics as well as low interest in its selection as a specialty for future practice. These were attributable to multi-faceted factors, including the lack of both exposure to geriatric medicine and geriatrics-focused training for students in this institution. It is critical that geriatric education be prioritized and incorporated in medical schools to nurture students' interest and future consideration of the specialty. This will help bolster the number of geriatric-oriented physicians and secure specialized care for the aging population.

Stimulators of medical students' interest in geriatric medicine-A Systematic Review.

OBJECTIVES: This study is a systematic review on stimulators of interest in pursuing a geriatric career among medical students in different countries. The review also assessed whether there were differences or similarities based on geographic regions or income categorisations. METHODS: A 20-year (1998-2018) review of quality primary research articles was conducted (n = 10). For analysis, studies were categorised into low- and middle-income countries (LMICs), and high-income countries, based on World Health Organization and World Bank's income grouping for the 2019 fiscal year. RESULTS: The frequently mentioned stimulators of interest in geriatrics were as follows: cultivating positive attitudes towards older people, participation in geriatric-related interventions and positive experiences during a geriatric training. Lack of published peer-reviewed articles from the LMICs limited the researchers' ability to compare the two income groups. CONCLUSION: Suggestions to improve future systematic reviews that consider global factors, global participation or any aspect of global inclusion are discussed.

Development and Psychometric Testing of the Diabetes Caregiver Activity and Support Scale.

Purpose The purpose of this study was to develop and psychometrically test the Diabetes Caregiver Activity and Support Scale (D-CASS), a measure of how difficult or easy caregiver activity and supportive behaviors are for family caregivers of persons with type 2 diabetes (T2DM). Methods Internal consistency reliability, test-retest reliability, criterion-related validity, and construct validity were examined in 101 family caregivers of persons with T2DM. Participants were recruited using study brochures distributed at a large hospital in the Midwest and at statewide American Indian Pow Wows. Additionally, study brochures were available via a link on Facebook. Data collection occurred by telephone, face-to-face, or through Facebook using measures with evidence of reliability and validity. Family caregivers were predominately female (82.2%), spouses (50.2%), and American Indian (17%), African American (24%), or white (55%). Data were analyzed using descriptive statistics and psychometric analyses. Results The psychometric analyses resulted in an 11-item D-CASS with evidence of internal consistency reliability (alpha = .82) and test-retest reliability. Evidence of construct validity was obtained using 3 hierarchical multiple regressions guided by a conceptual model. Factor analysis supported the unidimensionality of the D-CASS. Conclusion The 11-item D-CASS is a brief and easy to administer instrument that has evidence of reliability and validity in family caregivers of persons with T2DM.

Needs and Concerns of Family Caregivers of Persons With Type 2 Diabetes: An Integrated Review of Cross-cultural Literature With Implications for the American Indian Population.

PURPOSE: The purposes of this review were to identify the needs and concerns of family caregivers of persons with type 2 diabetes and to develop recommendations for future research on family caregivers of American Indians with type 2 diabetes. Searching the Cumulative Index to Nursing and Allied Health, Ovid, and PubMed, an extensive literature review was conducted using 10 search terms for articles published from 1990 to 2013. References of retrieved studies were also searched. CONCLUSIONS: On the basis of the search criteria, 6 studies exploring the needs and concerns of family caregivers of persons with type 2 diabetes were identified. Findings were placed in 5 predetermined categories derived from Bakas et al's needs and concerns framework: (1) finding information and resources related to type 2 diabetes, (2) dealing with the emotions and behaviors of the care recipient, (3) providing physical care, (4) providing instrumental care, and (5) dealing with one's own personal responses to caregiving. The cross-cultural literature helped identify common ground and specific literature about the experiences of American Indian caregivers. Further research is needed on the needs of caregivers of persons with type 2 diabetes, particularly those in the Native American and other minority populations. Findings can be used to develop interventions to improve outcomes for these caregivers.

PARO robot affects diverse interaction modalities in group sensory therapy for older adults with dementia.

We evaluated the seal-like robot PARO in the context of multi-sensory behavioral therapy in a local nursing home. Participants were 10 elderly nursing home residents with varying levels of dementia. We report three principle findings from our observations of interactions between the residents, PARO, and a therapist during seven weekly therapy sessions. Firstly, we show PARO provides indirect benefits for users by increasing their activity in particular modalities of social interaction, including visual, verbal, and physical interaction, which vary between primary and non-primary interactors. Secondly, PARO's positive effects on older adults' activity levels show steady growth over the duration of our study, suggesting they are not due to short-term "novelty effects." Finally, we show a variety of ways in which individual participants interacted with PARO and relate this to the "interpretive flexibility" of its design.

DigiSwitch: a device to allow older adults to monitor and direct the collection and transmission of health information collected at home.

Home monitoring represents an appealing alternative for older adults considering out-of-home long term care and an avenue for informal caregivers and health care providers to gain decision-critical information about an older adults' health and well-being. However, privacy concerns about having 24/7 monitoring, especially video monitoring, in the home environment have been cited as a major barrier in the design of home monitoring systems. In this paper we describe the design and evaluation of "DigiSwitch", a medical system designed to allow older adults to view information as it is collected about them and temporarily cease transmission of data for privacy reasons. Results from a series of iterative user studies suggest that control over the transmission of monitoring data from the home is helpful for maintaining user privacy. The studies demonstrate that older adults are able to use the DigiSwitch system to monitor and direct the collection and transmission of health information in their homes, providing these participants with a way to simultaneously maintain privacy and benefit from home monitoring technology.

Synergy and sensibility: a course on entrepreneurship in gerotechnologies.

"Health, Technology, and Aging" is a course developed to address three significant contemporary trends: aging populations, increasingly ubiquitous technology, and the economic imperative to encourage entrepreneurship. Course content is a blend of gerontology, informatics, and entrepreneurship designed for nonbusiness majors. Six interdisciplinary faculty modeled synergistic teamwork for the student teams. Findings suggest that students appreciated the interdisciplinary approach to teaching and learning and perceived gerotechnology as a promising market for business development. An external panel of judges scored student projects as well described, persuasive, and creative. Two plans of the four projects were judged to have potential for funding.