Measuring music engagement in older adults: the UNE music in aging wellness scale (MAWS).

OBJECTIVES: Engagement with music (i.e. listening, moving to the beat, joining in, performance) is documented to enhance cognition, mood, socialization, and a host of other wellness indicators in advancing age. A number of comprehensive scales measure this engagement, but a brief, accessible scale designed for general use with older adults is lacking. This project was undertaken to create and offer preliminary validation of the 7-item Music in Aging Wellness Scale (MAWS). METHOD: Seven items reflecting aspects of music engagement (ME) were developed by expert opinion (e.g. 'I always tap my foot or sway my body to good music') for completion on a 1-7, strongly disagree to strongly agree, Likert scale. These were subject to exploratory factor analysis (EFA) (n = 349 cases) along with a set of six experimental items on ageism. It was hypothesized these items would cluster by content, thus showing separation into distinct factors. RESULTS: This was achieved and the resulting measure showed sound internal consistency (0.82), split-half reliability (0.71), and one-year test-retest (0.83). The MAWS total score was found to correlate significantly in expected directions with common gerontological measures. High scorers reported less depression, more mastery, less loneliness, and larger social networks. No association was found for worry-based anxiety and self-reported cognitive decline. CONCLUSION: This preliminary reliability and validity study suggests that the MAWS may be an appropriate outcome and tracking measure for older adults involved in music-wellness interventions. Future research will further validate MAWS characteristics and associations with other established measures in this important field.

Sleep movements and respiratory coupling as a biobehavioral metric for early Alzheimer's disease in independently dwelling adults.

INTRODUCTION: Sleep disorder is often the first symptom of age-related cognitive decline associated with Alzheimer's disease (AD) observed in primary care. The relationship between sleep and early AD was examined using a patented sleep mattress designed to record respiration and high frequency movement arousals. A machine learning algorithm was developed to classify sleep features associated with early AD. METHOD: Community-dwelling older adults (N = 95; 62-90 years) were recruited in a 3-h catchment area. Study participants were tested on the mattress device in the home bed for 2 days, wore a wrist actigraph for 7 days, and provided sleep diary and sleep disorder self-reports during the 1-week study period. Neurocognitive testing was completed in the home within 30-days of the sleep study. Participant performance on executive and memory tasks, health history and demographics were reviewed by a geriatric clinical team yielding Normal Cognition (n = 45) and amnestic MCI-Consensus (n = 33) groups. A diagnosed MCI group (n = 17) was recruited from a hospital memory clinic following diagnostic series of neuroimaging biomarker assessment and cognitive criteria for AD. RESULTS: In cohort analyses, sleep fragmentation and wake after sleep onset duration predicted poorer executive function, particularly memory performance. Group analyses showed increased sleep fragmentation and total sleep time in the diagnosed MCI group compared to the Normal Cognition group. Machine learning algorithm showed that the time latency between movement arousals and coupled respiratory upregulation could be used as a classifier of diagnosed MCI vs. Normal Cognition cases. ROC diagnostics identified MCI with 87% sensitivity; 89% specificity; and 88% positive predictive value. DISCUSSION: AD sleep phenotype was detected with a novel sleep biometric, time latency, associated with the tight gap between sleep movements and respiratory coupling, which is proposed as a corollary of sleep quality/loss that affects the autonomic regulation of respiration during sleep. Diagnosed MCI was associated with sleep fragmentation and arousal intrusion.

Cross-Generational Understandings of Ageism and Its Perceived Impacts on Personal-Public Health.

In 2016, the World Health Organization (WHO) launched a global campaign to combat ageism, emphasizing its potential harm to personal and public health. This qualitative focus group study explored generational differences in understanding the WHO's definition and impact of ageism among baby boomers (ages 60-72; n = 17) and silent generation members (ages 78-85; n = 10). Verbatim transcripts were analyzed via a grounded theory approach, and representative themes and quotations were extracted by consensus. Members of both age groups initially downplayed personal impacts of ageism in favor of a broader discussion of age-related discrimination on a societal level. As each discussion progressed, however, participants acknowledged economic, social, and health impacts linked with ageism, but primarily for others. Both groups noted ageist actors in places of employment, healthcare settings, restaurants, retirement communities, and within family networks. Interestingly, each group rated risk of harm by ageism as greater for the other group. Our findings highlight challenges associated with the translation of a broad public health campaign to engage specific stakeholder subgroups. We discuss future research, education, and training initiatives across all ages to address the detrimental impacts of ageism.

Telecollaboration in gerontology service learning: Addressing isolation & loneliness in a pandemic.

Social isolation and loneliness present significant challenges for the mental and physical health of older adults. Social distancing, mask wearing, and other precautions necessitated by the COVID-19 pandemic add to these challenges. This article details a telecollaborative service-learning project to engage older adults online and provide applied experiences for students. From March through October 2020, 54 students from Social Work (Master, Bachelor), the College of Osteopathic Medicine (COM; DO), and Occupational Therapy (Master) provided telephone support and Zoom™ based programming for older adults affiliated with the University of New England. Creative offerings were piloted weekly and debriefed on Friday afternoons in the spring, leading to more structured 8-week schedules in summer and fall. Peer-to-peer support took place between older adults with experience in video meetings and those willing to learn. Bidirectional and intergenerational benefits were noted as older adults and students navigated the exigencies of the pandemic and learned important lessons with and from each other to advance knowledge and improve quality of life.

Impairment for Medication Management in Older Adults: Validity of a Family Report Measure.

Objectives: Medication nonadherence can have significant consequences for the health of older adults. Difficulty managing medications is often a sign of cognitive impairment, and monitoring is an early caregiving task for family members. This study examined a screening tool for independence in medication management.Methods: Reliability and validity of the screening tool were assessed in a sample of 152 female care partners for a relative aged 65+years.Results: The tool showed sound test-retest reliability, convergent and discriminant validity, and test utility, such that medication assistance was not better predicted by a global rating of cognitive impairment.Conclusions: In context of cognitive impairment, detection of medication mismanagement could be improved in both primary care and specialty health encounters through adoption of this single-item screening tool.Clinical Implications: This single-item report can be used to quickly facilitate discussions of medication management and cognitive impairment screening in office visits. The item also shows promise for efficient measurement of impairment in medication management than typical IADL assessment language.

Transportation and Aging: An Updated Research Agenda to Advance Safe Mobility among Older Adults Transitioning From Driving to Non-driving.

Engagement in civic, social, and community life plays an important role in health, well-being, and quality of life, and requires individuals to be mobile in their environment. In this article, we review what is currently known about 2 areas relevant to safe mobility for older drivers and identify future research in these areas. Using a framework for transportation and safe mobility, 2 key areas were selected for review: the process of transitioning to non-driving and the maintenance of mobility after driving has ceased. This article serves as a companion to another article that used the same approach to explore safe mobility issues for older adults who are still driving. We found that although there has been progress in supporting transitioning process to non-driving and improving mobility options for older adults following driving cessation, many knowledge gaps still exist. We identified several research topics that would benefit from continued scientific inquiry. In addition, several themes emerged from the review, including the need for: multidisciplinary, community-wide solutions; large-scale, longitudinal studies; improved education and training for older adults and the variety of stakeholders involved in older adult transportation; and the need for programs and interventions that are flexible and responsive to individual needs and situational differences.

Staff time requirements for postoperative pain management: Comparison of sufentanil sublingual tablet system and intravenous patient-controlled analgesia.

OBJECTIVE: Assessment and allocation of required staff time for postoperative pain management for two different pa-tient-controlled technologies, sufentanil sublingual tablet system (SSTS) and intravenous analgesia (PCiA). DESIGN: Activity-based evaluation. SETTING: The study was conducted at four German hospitals based on the availability of the two technologies studied and their respective bed capacity broadly reflecting the German hospital landscape. PATIENTS AND PARTICIPANTS: Staff activities were recorded for 162 SSTS and 154 PCiA procedures. Every hospital recorded around 40 procedures for each technology between December 2016 and July 2017. INTERVENTIONS: Staff time was recorded if a patient received one of the two considered postoperative pain management technologies and was under treatment of a trained nurse. No further criteria were defined. Documentation of resource utilization covered all staff activities concerning the two technologies by detailed activity recording forms. MAIN OUTCOME MEASURE(S): Staff time for five identified process areas (preparation of therapy option, provisioning at patients' bed, therapy, removal of therapy option, reprocessing, and storage) with significant impact on the entire process. RESULTS: The average staff time required for SSTS to manage the entire process was 36 minutes whereas for PCiA it was 49 minutes (p < 0.0001). In all process areas, SSTS showed significantly less staff time requirements. CONCLUSIONS: In comparison to PCiA, SSTS requires significantly less staff time to manage postoperative pain in the studied setting.

Predictors of Readiness for Mobility Transition in Older Drivers.

We administered the Assessment of Readiness for Mobility Transition (ARMT) to 301 older drivers and compared total scores with participant characteristics. Overall, 18% of participants were not attitudinally ready for mobility transition, while 19% were very ready. Notably, participants with hospitalizations in the past year were either very ready for mobility transition (20% vs 14% without hospitalizations) or not ready at all (30% vs 17%). Significant health events may polarize reactions towards mobility transition. Individualizing communication about driving cessation readiness could help address such differing views. To further consider its effectiveness, ARMT could be utilized in mobility transition counseling interventions.

Inter-Rater Reliability of Neck Reflex Points in Women with Chronic Neck Pain.

BACKGROUND: Neck reflex points (NRP) are tender soft tissue areas of the cervical region that display reflectory changes in response to chronic inflammations of correlated regions in the visceral cranium. Six bilateral areas, NRP C0, C1, C2, C3, C4 and C7, are detectable by palpating the lateral neck. We investigated the inter-rater reliability of NRP to assess their potential clinical relevance. METHODS: 32 consecutive patients with chronic neck pain were examined for NRP tenderness by an experienced physician and an inexperienced medical student in a blinded design. A detailed description of the palpation technique is included in this section. Absence of pain was defined as pain index (PI) = 0, slight tenderness = 1, and marked pain = 2. Findings were evaluated either by pair-wise Cohen's kappa (ĸ) or by percentage of agreement (PA). RESULTS: Examiners identified 40% and 41% of positive NRP, respectively (PI > 0, physician: 155, student: 157) with a slight preference for the left side (1.2:1). The number of patients identified with >6 positive NRP by the examiners was similar (13 vs. 12 patients). ĸ values ranged from 0.52 to 0.95. The overall kappa was ĸ = 0.80 for the left and ĸ = 0.74 for the right side. PA varied from 78.1% to 96.9% with strongest agreement at NRP C0, NRP C2, and NRP C7. Inter-rater agreement was independent of patients' age, gender, body mass index and examiner's experience. CONCLUSION: The high reproducibility suggests the clinical relevance of NRP in women.

Dementia spousal caregivers and past transgressions: Measuring and understanding forgiveness experiences.

The transition from "wife" to "caregiver" for a cognitively impaired husband can be an overwhelming experience. Communication patterns change and small conflicts can grow, at times bringing angry feelings and new burdens. Engagement with forgiveness processes may benefit wives by lowering resentment over past tensions, restoring trust, and enhancing the overall caregiving experience. This study examined the utility of the Enright Forgiveness Inventory (EFI) within a sample of caregiving wives. Our intent was to better understand this population's experience with forgiveness when other contextual factors were likely to influence this process. Forgiveness scores on the EFI were positively related to the cognitive status of the care recipient, a particularly important finding for clinical intervention, and inversely related to marital distress and state anxiety.

Injections of Local Anesthetics into the Pharyngeal Region Reduce Trapezius Muscle Tenderness.

BACKGROUND: Neck pain is a frequent reason for seeking medical advice. Neuroanatomical findings suggest a close connection between the pharynx and the trapezius region. Irritation of the pharynx may induce tenderness of this area. Specific tender points, called neck reflex points (NRPs), can be identified here with high reproducibility. We hypothesized that therapeutic local anesthesia (TLA; or neural therapy, NT) in the pharyngeal region can reduce tenderness in patients with therapy-resistant neck pain. PATIENTS AND METHODS: 17 consecutive female patients with chronic cervical pain and positive trapezius NRPs received bilateral injections of 0.5 ml 1% procaine into the palatine velum. The NRPs were assessed using a 3-level pain index (PI = 0, 1, or 2) before and 3-5 min after each injection. RESULTS: We found a significant reduction in tenderness of the NRP of the trapezius region (NRP C7) immediately after TLA/NT. 30 positive NRPs were found before therapy and only 13 after therapy (p < 0.01). The average PI of the NRP C7 was 1.24 ± 0.77 before and 0.35 ± 0.59 after therapy (right side), and 1.34 ± 0.59 before and 0.59 ± 0.69 after therapy (left side). The pre- and post-therapy PI values were significantly different on both the right and left sides of the trapezius region (p < 0.01). No adverse effects were observed. CONCLUSIONS: Pharyngeal irritation may induce and maintain therapy-resistant cervical pain in patients with chronic pharyngeal disease. These patients could benefit from remote TLA/NT injections in the pharyngeal region.

Clinician Effectiveness in Assessing Fitness to Drive of Medically At-Risk Older Adults.

OBJECTIVES: To model the relative contributions of driver data and clinical judgments to clinical ratings of driver capability for a state licensing authority and to compare ratings with on-road test results. DESIGN: Retrospective, logistic regression. SETTING: Missouri Driver License Bureau. PARTICIPANTS: Adults aged 60 and older (N = 652; 52% male) evaluated by a physician of their choosing and a portion subsequently road tested (n = 286). MEASUREMENTS: Clinical data from an evidence-based physician statement (Form 1528). A three-level rating (likely capable, unclear, not capable) was collapsed into two outcomes (0 likely capable; 1 unclear, not capable) as the dependent variable. Independent variables (predictors) were age, sex, driving exposure, recent crash or police action, number of medical conditions, medication side effects, driver insight, and disease functional severity rating for driving. RESULTS: Three variables in the model (Nagelkerke coefficient of determination = 0.64; P < .001) were significant in the expected direction: disease functional severity for driving (odds ratio (OR = 6.65), insight (OR = 2.35), and age (OR = 1.06). Proportionately more drivers rated likely capable (73%) passed the road test than those rated unclear or not capable (62%). CONCLUSION: Judgments of disease severity, decrements in driver insight, and older age influenced clinician ratings of driving capability. Correspondence of physician ratings to on-road test outcomes was imperfect, highlighting the complexities in translation of clinical judgments to on-road performance. Both means of assessment have important and additive roles in driver licensing.

A randomized crash injury prevention trial of transitioning high-risk elders from driving.

UNLABELLED: Supplemental digital content is available in the text. BACKGROUND: Older adults with medical conditions that impair function are at risk for experiencing a motor vehicle crash. This randomized controlled trial tested an intervention to reduce crash-related risk among older patients. METHODS: A 2-to-1 allocation ratio resulted in comparisons between 26 intervention and 13 attention control (n = 39) group members who were recruited from inpatient and outpatient settings. The intervention consisted of two sessions of facilitated planning in which participants' health, transportation alternatives, attitudes/emotions regarding a change in mobility, and actions to ensure continued safe mobility were discussed. Moreover, all participants received supportive telephone calls during the 6-month intervention period. RESULTS: Results showed that when compared with the control group, the intervention group had significantly better subjective health, had fewer high-risk driving behaviors, and drove less distance on excursions from home at follow-up. Yet, simple repeated-measures analyses were not significant. CONCLUSION: Results suggest that facilitated planning may help ease the transition to driving retirement among some high-risk older patients. Larger samples and longer study duration are needed to confirm these effects and to measure direct crash and injury outcomes. A significant proportion of high-risk patients do not plan for driving retirement and remain a crash risk. LEVEL OF EVIDENCE: Therapeutic/care management study, level III.

Family reports of medically impaired drivers in Missouri: cognitive concerns and licensing outcomes.

This study investigated reasons why older adults (n=689) were reported to the Driver License Bureau, Missouri Department of Revenue, by family members as potentially unfit to drive with an emphasis on cognitive concerns and associated licensing outcomes. A total of 448 drivers were reported to have some cognitive issue; common symptoms included confusion, memory loss, and becoming lost while driving. Diagnostic labels (Alzheimer's disease (AD), cognitive impairment/dementia, brain injury/insult) were listed for 365 cases. A physician evaluation is required for license review. Of those with a diagnostic label, half (51%, n=187) failed to submit this evaluation and almost all were de-licensed immediately. Of those evaluated by a physician, diagnostic agreement between family members and physicians was high for specific conditions (100% for AD, 97% for acute brain injury), and less so for cognitive impairment/dementia (75%). This latter finding suggests that physicians and family members may understand cognitive symptoms differently. Whether cognitively impaired or not, few family reported drivers in this sample (∼2%) retained a valid license. Family members may be in the best position to recognize when medical-functional deficits impact on driving safety, and physicians and driver licensing authorities would do well to take their observations into account with respect to older driver fitness.

Content and face validity of the marwitmeuser caregiver grief inventory (short form) in African American caregivers.

There may be cultural differences in the experience of predeath grief in African American (AA)/Black caregivers for persons with Alzheimers disease (AD). The most commonly used screening tool, the Marwit and Meuser Caregiver Grief Inventory-Short Form (MMCGI-SF), was developed from focus groups with primarily Caucasian/White caregivers. Interviews were held with 19 AA spouse and adult child caregivers for persons with mild, moderate, and severe AD, and data were coded and compared with scale items on the MCMGI-SF to assess validity. Results from this study provide evidence for content and face validity of the MMCGI-SF for use in AA caregivers.

The instructional impact of the American Medical Association's Older Drivers Project online curriculum.

The Older Drivers Project (ODP) of the American Medical Association has provided evidence-based training for clinicians since 2003. More than 10,000 physicians and other professionals have been trained via an authoritative manual, the Physician's Guide to Assessing & Counseling Older Drivers, and an associated continuing medical education five-module curriculum offered formally by multidisciplinary teams from 12 U.S. States from 2003 to 2008. An hour-long, online version was piloted with medical residents and physicians (N = 259) from six academic and physician office sites from 2010 to 2011. Pre/postsurveys were completed. Most rated the curriculum of high quality and relevant to their practice. A majority (88%) reported learning a new technique or tool, and 89% stated an intention to incorporate new learning into their daily clinical practice. More than one half (62%) reported increased confidence in addressing driving. This transition from in-person to online instruction will allow the ODP to reach many more clinicians, at all levels of training, in the years to come.