Journal of Aging Research The latest articles from Hindawi Publishing Corporation © 2016 , Hindawi Publishing Corporation . All rights reserved. Risk Factors for Six Types of Disability among the Older People in Thailand in 2002, 2007, and 2011 Wed, 24 Aug 2016 13:16:23 +0000 Background. There is an important need to characterize risk factors for disability in Thailand, in order to inform effective prevention and control strategies. This study investigated factors associated with risk of 6 types of disability in Thailand’s ageing population in 2002, 2007, and 2011. Methods. Data came from the Cross-Sectional National Surveys of Older Persons in Thailand conducted by the National Statistical Office (NSO) in 2002, 2007, and 2011. Stratified two-stage sampling was employed. Interviews of 24,835, 30,427, and 34,173 elderly people aged 60 and above were conducted in the respective study years. Prevalence of disabilities was measured, and factors associated with disability risk were assessed with probability-weighted multiple logistic regression. Results. Disability prevalence decreased slightly over the study period. The characteristics with greatest positive impact on disability prevalence were not working over the past week (average impact: 61.2%), age (53.7% per decade), and suffering from one or more chronic illnesses (46.3%). Conclusions. The strong observed positive impact of not working on disability prevalence suggests that raising the mandatory retirement age might result in some reduction of disability risk. Also, the observed positive impact of living with others (versus alone) on disability risk was somewhat unexpected. Pattaraporn Khongboon, Sathirakorn Pongpanich, and Robert S. Chapman Copyright © 2016 Pattaraporn Khongboon et al. All rights reserved. The Emerging Roles of the Calcineurin-Nuclear Factor of Activated T-Lymphocytes Pathway in Nervous System Functions and Diseases Mon, 15 Aug 2016 09:31:24 +0000 The ongoing epidemics of metabolic diseases and increase in the older population have increased the incidences of neurodegenerative diseases. Evidence from murine and cell line models has implicated calcineurin-nuclear factor of activated T-lymphocytes (NFAT) signaling pathway, a Ca2+/calmodulin-dependent major proinflammatory pathway, in the pathogenesis of these diseases. Neurotoxins such as amyloid-β, tau protein, and α-synuclein trigger abnormal calcineurin/NFAT signaling activities. Additionally increased activities of endogenous regulators of calcineurin like plasma membrane Ca2+-ATPase (PMCA) and regulator of calcineurin 1 (RCAN1) also cause neuronal and glial loss and related functional alterations, in neurodegenerative diseases, psychotic disorders, epilepsy, and traumatic brain and spinal cord injuries. Treatment with calcineurin/NFAT inhibitors induces some degree of neuroprotection and decreased reactive gliosis in the central and peripheral nervous system. In this paper, we summarize and discuss the current understanding of the roles of calcineurin/NFAT signaling in physiology and pathologies of the adult and developing nervous system, with an emphasis on recent reports and cutting-edge findings. Calcineurin/NFAT signaling is known for its critical roles in the developing and adult nervous system. Its role in physiological and pathological processes is still controversial. However, available data suggest that its beneficial and detrimental effects are context-dependent. In view of recent reports calcineurin/NFAT signaling is likely to serve as a potential therapeutic target for neurodegenerative diseases and conditions. This review further highlights the need to characterize better all factors determining the outcome of calcineurin/NFAT signaling in diseases and the downstream targets mediating the beneficial and detrimental effects. Maulilio John Kipanyula, Wahabu Hamisi Kimaro, and Paul F. Seke Etet Copyright © 2016 Maulilio John Kipanyula et al. All rights reserved. HIV Infection in the Elderly: Arising Challenges Tue, 09 Aug 2016 13:24:30 +0000 Globally there is an increase in the number of people living with HIV at an advanced age (50 years and above). This is mainly due to prolonged survival following the use of highly active antiretroviral therapy. Living with HIV at an advanced age has been shown to be associated with a number of challenges, both clinical and immunological. This minireview aims at discussing the challenges encountered by elderly HIV-infected patients. Bonaventura C. T. Mpondo Copyright © 2016 Bonaventura C. T. Mpondo. All rights reserved. The Effects of Exercise on the Physical Fitness of High and Moderate-Low Functioning Older Adult Women Tue, 12 Jul 2016 14:35:52 +0000 Introduction. Understanding how exercise affects individuals with varying levels of functional ability will provide further insight into the role of exercise during the aging process. It will also aid in the development of exercise programs that are appropriate for a wider spectrum of older adults. Specifically it was the primary aim of this study to determine and compare the effects of 10 weeks of community-based exercise on the cardiovascular endurance, muscular strength, flexibility, and balance fitness components of older adult women with high and moderate-low levels of physical function. Methods. Participants were placed in either the high functioning () or moderate/low functioning () groups based on their level of physical functioning. Fitness components were measured by the Senior Fitness Test and physical function was determined by the Composite Physical Function scale. Results. The results of the 3 × 2 mixed ANOVA statistical analysis showed no significant interaction effect for time ⁎ group for any of the six subtests (chair stand, arm curls, 2-minute step, chair sit-and-reach, back scratch, and 6-foot up-and-go) of the SFT. However, the main effect of time was significant for all fitness components and the main effect of group was significant for all fitness components except lower extremity flexibility. Discussion. Community-based exercise programs offering a variety of exercise types to people with varying levels of functional ability can be useful in maintaining or improving fitness and independence. These programs may also be capable of improving the self-efficacy of lower functioning older adults toward performing daily tasks. R. Christopher Mason, Michael Horvat, and Joe Nocera Copyright © 2016 R. Christopher Mason et al. All rights reserved. The Association between Sleep Problems, Sleep Medication Use, and Falls in Community-Dwelling Older Adults: Results from the Health and Retirement Study 2010 Tue, 12 Jul 2016 09:46:05 +0000 Background. Very few studies have assessed the impact of poor sleep and sleep medication use on the risk of falls among community-dwelling older adults. The objective of this study was to evaluate the association between sleep problems, sleep medication use, and falls in community-dwelling older adults. Methods. The study population comprised a nationally representative sample of noninstitutionalized older adults participating in the 2010 Health and Retirement Study. Proportion of adults reporting sleep problems, sleep medication use, and fall was calculated. Multiple logistic regression models were constructed to examine the impact of sleep problems and sleep medication use on the risk of falls after controlling for covariates. Results. Among 9,843 community-dwelling older adults, 35.8% had reported a fall and 40.8% had reported sleep problems in the past two years. Sleep medication use was reported by 20.9% of the participants. Older adults who do have sleep problems and take sleep medications had a significant high risk of falls, compared to older adults who do not have sleep problems and do not take sleep medications. The other two groups also had significantly greater risk for falls. Conclusion. Sleep problems added to sleep medication use increase the risk of falls. Further prospective studies are needed to confirm these observed findings. Yaena Min, Pramit A. Nadpara, and Patricia W. Slattum Copyright © 2016 Yaena Min et al. All rights reserved. Health Status and Social Networks as Predictors of Resilience in Older Adults Residing in Rural and Remote Environments Sun, 10 Jul 2016 10:00:43 +0000 Purpose. Health status and social networks are associated with resilience among older adults. Each of these factors may be important to the ability of adults to remain in rural and remote communities as they age. We examined the association of health status and social networks and resilience among older adults dwelling in a rural and remote county in the Western United States. Methods. We selected a random sample of 198 registered voters aged 65 years or older from a frontier Wyoming county. Hierarchical linear regression was used to examine the association of health status as well as social networks and resilience. We also examined health status as a moderator of the relationship between social networks and resilience. Results. Family networks () and mental health status () significantly predicted resilience. Mental health status moderated the relationship of family () and friend () networks with resilience. Smaller family and friend networks were associated with greater resilience when mental health status was low, but not when it was high. Conclusion. Efforts to increase mental health status may improve resilience among older adults in rural environments, particularly for those with smaller family and friends networks. Christine McKibbin, Aaron Lee, Bernard A. Steinman, Catherine Carrico, Katelynn Bourassa, and Andrea Slosser Copyright © 2016 Christine McKibbin et al. All rights reserved. Active Ageing Level of Older Persons: Regional Comparison in Thailand Tue, 07 Jun 2016 10:59:25 +0000 Active ageing level and its discrepancy in different regions (Bangkok, Central, North, Northeast, and South) of Thailand have been examined for prioritizing the policy agenda to be implemented. Attempt has been made to test preliminary active ageing models for Thai older persons and hence active ageing index (AAI, ranges from 0 to 1) has been estimated. Using nationally representative data and confirmatory factor analysis approach, this study justified active ageing models for female and male older persons in Thailand. Results revealed that active ageing level of Thai older persons is not high (mean AAIs for female and male older persons are 0.64 and 0.61, resp., and those are significantly different ()). Mean AAI in Central region is lower than North, Northeast, and South regions but there is no significant difference in the latter three regions of Thailand. Special emphasis should be given to Central region and policy should be undertaken for increasing active ageing level. Implementation of an Integrated Active Ageing Package (IAAP), containing policies for older persons to improve their health and economic security, to promote participation in social groups and longer working lives, and to arrange learning programs, would be helpful for increasing older persons’ active ageing level in Thailand. Md. Nuruzzaman Haque Copyright © 2016 Md. Nuruzzaman Haque. All rights reserved. Recruiting and Engaging Older Men in Evidence-Based Health Promotion Programs: Perspectives on Barriers and Strategies Sun, 05 Jun 2016 12:55:51 +0000 Evidence-based health promotion programs are effective at reducing health risks and healthcare costs among older adults, but few men participate in the programs. This mixed methods study aimed to gain insight into the barriers to recruiting and engaging older men in evidence-based health promotion programs offered by the Healthy Aging Regional Collaborative of South Florida (HARC). Fourteen program coordinators participated in a focus group to identify barriers and strategies to improve male participation, and 49 instructors participated in a survey to triangulate the findings. Themes among barriers to male participation included women outnumbering men in the implementation sites and programs, conflict between male gender roles and the programs, and preference for other activities. Themes among strategies included public support of programs by male community leaders, program advertisements featuring males, and adapting program content. Survey results supported themes identified in the focus group. Nearly 78% of the survey respondents agreed that the perception of exercise programs as feminine was a barrier and over 90% of the survey respondents believed program advertisements featuring men would increase male participation. Findings indicate that health promotion programs and recruiting strategies need to be tailored to the unique needs and preferences of older men to improve participation. Chelsie Anderson, Laura R. Seff, Anamika Batra, Chintan Bhatt, and Richard C. Palmer Copyright © 2016 Chelsie Anderson et al. All rights reserved. The Effect of Age on Fracture Risk: A Population-Based Cohort Study Tue, 31 May 2016 11:31:06 +0000 Aim. To precisely estimate the effect of age on the risk of fracture hospitalisation among the Western Australia population over the life course. Methods. This population-based cohort study used hospital data on fractures for the period January 1991 to January 2013 among Western Australians born between 1915 and 1990. Results. The average incidence rates (per 10,000 person-years) of fracture hospitalisation (95% confidence interval) were 50.12 (49.90, 50.35), 55.14 (54.82, 55.48), and 45.02 (44.71, 45.32) for both males and females, males only, and females only, respectively. The age-specific rate of fracture hospitalisation (in natural logarithm form) in adults (>18 years) was well predicted by age at its 1st, 2nd, and 3rd power in males with an adjusted -squared of 0.98 and . For females, the trend was also well predicted by its 1st and 2nd powers (the 3rd power term of age was removed due to its value > 0.8) with an adjusted -squared of 0.99 and . Conclusions. Overall trends in age and gender specific risk of fracture among the Western Australian population were similar to estimates reported from previous studies. The trend in fracture hospitalisation risk over the life course can be almost fully explained by age. Wenbin Liang and Tanya Chikritzhs Copyright © 2016 Wenbin Liang and Tanya Chikritzhs. All rights reserved. The Factors Influencing the Sense of Home in Nursing Homes: A Systematic Review from the Perspective of Residents Mon, 23 May 2016 06:20:10 +0000 Purpose. To provide an overview of factors influencing the sense of home of older adults residing in the nursing home. Methods. A systematic review was conducted. Inclusion criteria were (1) original and peer-reviewed research, (2) qualitative, quantitative, or mixed methods research, (3) research about nursing home residents (or similar type of housing), and (4) research on the sense of home, meaning of home, at-homeness, or homelikeness. Results. Seventeen mainly qualitative articles were included. The sense of home of nursing home residents is influenced by 15 factors, divided into three themes: (1) psychological factors (sense of acknowledgement, preservation of one’s habits and values, autonomy and control, and coping); (2) social factors (interaction and relationship with staff, residents, family and friends, and pets) and activities; and (3) the built environment (private space and (quasi-)public space, personal belongings, technology, look and feel, and the outdoors and location). Conclusions. The sense of home is influenced by numerous factors related to the psychology of the residents and the social and built environmental contexts. Further research is needed to determine if and how the identified factors are interrelated, if perspectives of various stakeholders involved differ, and how the factors can be improved in practice. M. D. Rijnaard, J. van Hoof, B. M. Janssen, H. Verbeek, W. Pocornie, A. Eijkelenboom, H. C. Beerens, S. L. Molony, and E. J. M. Wouters Copyright © 2016 M. D. Rijnaard et al. All rights reserved. The Impact of Social and Cultural Engagement and Dieting on Well-Being and Resilience in a Group of Residents in the Metropolitan Area of Naples Thu, 19 May 2016 09:53:05 +0000 Social isolation and exclusion are associated with poor health status and premature death. A number of related isolation factors, inadequate transportation system and restrictions in individuals’ life space, have been associated with malnutrition in older adults. Since eating is a social event, isolation can have a negative effect on nutrition. Cultural involvement and participation in interactive activities are essential tools to fight social isolation, and they can counteract the detrimental effects of social isolation on health. To provide data supporting the hypothesis that encouraging participation might represent an innovative preventive and health promoting strategy for healthy living and aging, we developed an ad hoc questionnaire to investigate the relationship between cultural participation, well-being, and resilience in a sample of residents in the metropolitan area of Naples. The questionnaire includes a question on adherence to diet or to a special nutritional regimen; in addition, the participants are asked to mention their height and weight. We investigated the relationship between BMI, adherence to diet, and perceived well-being (PWB) and resilience in a sample of 571 subjects over 60 years of age. Here, we present evidence that engagement into social and cultural activities is associated with higher well-being and resilience, in particular in females over 60 years of age. Antonio Rapacciuolo, Pasquale Perrone Filardi, Rosario Cuomo, Vincenzo Mauriello, Maria Quarto, Annamaria Kisslinger, Gianluigi Savarese, Maddalena Illario, and Donatella Tramontano Copyright © 2016 Antonio Rapacciuolo et al. All rights reserved. Weekly Physical Activity Levels of Older Adults Regularly Using a Fitness Facility Wed, 18 May 2016 12:51:07 +0000 The aim of this paper was to determine if weekly physical activity levels were greater in an independent-living older adult population that was regularly participating in structured fitness activities. Also, lifetime exercise history and sex differences were investigated in an effort to understand how they relate to current weekly step activity. Total weekly step counts, measured with a pedometer, were assessed in two older adult groups; the first consisted of members of a local senior center who regularly used the fitness facility ( yrs; mean ± SD) while the second group consisted of members who did not use the fitness facility ( yrs). Participants also completed the Lifetime Physical Activity Questionnaire (LPAQ). No significant difference was found in the total number of weekly steps between groups () or sexes (). The LPAQ suggested a significant decline in activity with aging () but no difference between groups () or sexes (). A relationship was observed between current step activity and MET expenditure over the past year (, ) and from ages 35 to 50 years (, ). The lack of difference in weekly physical activity level between our groups suggests that independent-living older adults will seek out and perform their desired activity, in either a scheduled exercise program or other leisure-time activities. Also, the best predictor of current physical activity level in independent-living older adults was the activity performed over the past year. Michael J. Turner, Emily E. Schmitt, and Tricia Hubbard-Turner Copyright © 2016 Michael J. Turner et al. All rights reserved. Modeling Age-Friendly Environment, Active Aging, and Social Connectedness in an Emerging Asian Economy Wed, 18 May 2016 10:09:01 +0000 This paper empirically tested eight key features of WHO guidelines to age-friendly community by surveying 211 informal caregivers and 402 self-care adults (aged 45 to 85 and above) in Malaysia. We examined the associations of these eight features with active aging and social connectedness through exploratory and confirmatory factor analyses. A structural model with satisfactory goodness-of-fit indices (CMIN/df = 1.11, RMSEA = 0.02, NFI = 0.97, TLI = 1.00, CFI = 1.00, and GFI = 0.96) indicates that transportation and housing, community support and health services, and outdoor spaces and buildings are statistically significant in creating an age-friendly environment. We found a statistically significant positive relationship between an age-friendly environment and active aging. This relationship is mediated by social connectedness. The results indicate that built environments such as accessible public transportations and housing, affordable and accessible healthcare services, and elderly friendly outdoor spaces and buildings have to be put into place before social environment in building an age-friendly environment. Otherwise, the structural barriers would hinder social interactions for the aged. The removal of the environmental barriers and improved public transportation services provide short-term solutions to meet the varied and growing needs of the older population. Ming-Ming Lai, Shi-Ying Lein, Siok-Hwa Lau, and Ming-Ling Lai Copyright © 2016 Ming-Ming Lai et al. All rights reserved. Effect of Electronic Messaging on Physical Activity Participation among Older Adults Tue, 17 May 2016 09:49:54 +0000 The purpose of this study was to determine if electronic messaging would increase min of aerobic physical activity (PA) among older adults. Participants were active older adults (; M age = 60 years, SD = 5.99, and range = 51–74 years). Using an incomplete within-subjects crossover design, participants were randomly assigned to begin the 4-week study receiving the treatment condition (a morning and evening text message) or the control condition (an evening text message). Participants self-reported min of completed aerobic PA by cell phone text. The 1-way within-subjects ANOVA showed significant group differences (). Specifically, when participants were in the treatment condition, they reported significantly greater average weekly min of aerobic PA (M = 96.88 min, SD = 62.9) compared to when they completed the control condition (M = 71.68 min, SD = 40.98). Electronic messaging delivered via cell phones was effective at increasing min of aerobic PA among older adults. Chantrell Antoine Parker and Rebecca Ellis Copyright © 2016 Chantrell Antoine Parker and Rebecca Ellis. All rights reserved. Personality and Perceived Health in Spousal Caregivers of Patients with Lung Cancer: The Roles of Neuroticism and Extraversion Thu, 07 Apr 2016 14:07:32 +0000 Purpose. Family members’ responsibilities for patients with cancer have increased dramatically over the past decade and will likely continue to rise. Given that caregiving is associated with declines in self-care, there is a need for research on caregivers’ perceptions of their own health. The purpose of this study was to examine whether personality is associated with four self-report perceived health items from the SF-36. Methods. The sample consisted of 114 spouses of lung cancer patients who completed cross-sectional measures as part of a larger cohort study on adjustment to the diagnosis and treatment of lung cancer. Predictors of interest were Neuroticism and Extraversion scores from the NEO-FFI. Covariates were age, gender, conscientiousness, depressive symptoms, and objective illness burden. Results. Multivariate analyses revealed that caregivers with higher Extraversion scores were less likely to respond affirmatively to the item “I expect my health to get worse” (OR = 0.90, ). Neuroticism was associated with poorer perceived health (ORs from 1.11 to 1.12, ’s < 0.05). Conclusions. The present cross-sectional findings suggest that personality is associated with responses to SF-36 perceived health items beyond what can be accounted for by objective illness burden and other covariates. The potential overestimation of health among extraverted caregivers may have implications for their health outcomes. Michael Hoerger, Maria Coletta, Silvia Sörensen, Benjamin P. Chapman, Kim Kaukeinen, Xin Tu, and Paul R. Duberstein Copyright © 2016 Michael Hoerger et al. All rights reserved. Optimism and Mortality in Older Men and Women: The Rancho Bernardo Study Thu, 03 Mar 2016 11:29:09 +0000 Purpose. To examine the associations of optimism and pessimism with all-cause, cardiovascular disease (CVD), coronary heart disease (CHD), and cancer mortality in a population-based sample of older men and women followed ≤12 years. Methods. 367 men and 509 women aged ≥50 from the Rancho Bernardo Study attended a 1999–2002 research clinic visit when demographic, behavioral, and medical history were obtained and completed a 1999 mailed survey including the Life Orientation Test-Revised (LOT-R). Mortality outcomes were followed through 2012. Results. Average age at baseline was 74.1 years; during follow-up (mean = 8.1 years), 198 participants died, 62 from CVD, 22 from CHD, and 49 from cancer. Total LOT-R, optimism and pessimism scores were calculated. Participants with the highest optimism were younger and reported less alcohol use and smoking and more exercise. Cox proportional hazard models showed that higher total LOT-R and optimism, but not pessimism scores, were associated with reduced odds of CHD mortality after adjusting for age, sex, alcohol, smoking, obesity, physical exercise, and medication (HR = 0.86, 95% CI = 0.75, 0.99; HR = 0.77, 95% CI = 0.61, 0.99, resp.). No associations were found for all-cause, CVD, or cancer mortality. Conclusions. Optimism was associated with reduced CHD mortality in older men and women. The association of positive attitudes with mortality merits further study. Ericha G. Anthony, Donna Kritz-Silverstein, and Elizabeth Barrett-Connor Copyright © 2016 Ericha G. Anthony et al. All rights reserved. Muscle Strength, Physical Activity, and Functional Limitations in Older Adults with Central Obesity Mon, 29 Feb 2016 08:44:49 +0000 Background. Obesity and muscle weakness are independently associated with increased risk of physical and functional impairment in older adults. It is unknown whether physical activity (PA) and muscle strength combined provide added protection against functional impairment. This study examines the association between muscle strength, PA, and functional outcomes in older adults with central obesity. Methods. Prevalence and odds of physical (PL), ADL, and IADL limitation were calculated for 6,388 community dwelling adults aged ≥ 60 with central obesity. Individuals were stratified by sex-specific hand grip tertiles and PA. Logistic models were adjusted for age, education, comorbidities, and body-mass index and weighted. Results. Overall prevalence of PL and ADL and IADL limitations were progressively lower by grip category. Within grip categories, prevalence was lower for individuals who were active than those who were inactive. Adjusted models showed significantly lower odds of PL OR 0.42 [0.31, 0.56]; ADL OR 0.60 [0.43, 0.84], and IADL OR 0.46 0.35, 0.61] for those in the highest grip strength category as compared to those in the lowest grip category. Conclusion. Improving grip strength in obese elders who are not able to engage in traditional exercise is important for reducing odds of physical and functional impairment. Cassandra M. Germain, John A. Batsis, Elizabeth Vasquez, and Douglas R. McQuoid Copyright © 2016 Cassandra M. Germain et al. All rights reserved. Understanding Muscle Dysfunction in Chronic Fatigue Syndrome Mon, 22 Feb 2016 13:36:28 +0000 Introduction. Chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) is a debilitating disorder of unknown aetiology, characterised by severe disabling fatigue in the absence of alternative diagnosis. Historically, there has been a tendency to draw psychological explanations for the origin of fatigue; however, this model is at odds with findings that fatigue and accompanying symptoms may be explained by central and peripheral pathophysiological mechanisms, including effects of the immune, oxidative, mitochondrial, and neuronal pathways. For example, patient descriptions of their fatigue regularly cite difficulty in maintaining muscle activity due to perceived lack of energy. This narrative review examined the literature for evidence of biochemical dysfunction in CFS/ME at the skeletal muscle level. Methods. Literature was examined following searches of PUB MED, MEDLINE, and Google Scholar, using key words such as CFS/ME, immune, autoimmune, mitochondria, muscle, and acidosis. Results. Studies show evidence for skeletal muscle biochemical abnormality in CFS/ME patients, particularly in relation to bioenergetic dysfunction. Discussion. Bioenergetic muscle dysfunction is evident in CFS/ME, with a tendency towards an overutilisation of the lactate dehydrogenase pathway following low-level exercise, in addition to slowed acid clearance after exercise. Potentially, these abnormalities may lead to the perception of severe fatigue in CFS/ME. Gina Rutherford, Philip Manning, and Julia L. Newton Copyright © 2016 Gina Rutherford et al. All rights reserved. Montreal Cognitive Assessment and Modified Mini Mental State Examination in African Americans Wed, 04 Nov 2015 12:19:33 +0000 Background. Sparse data limit the interpretation of Montreal Cognitive Assessment (MoCA) scores, particularly in minority populations. Additionally, there are no published data on how MoCA scores compare to the widely used Modified Mini Mental State Examination (3MSE). We provide performance data on the MoCA in a large cohort of African Americans and compare 3MSE and MoCA scores, providing a “crosswalk” for interpreting scores. Methods. Five hundred and thirty African Americans with type 2 diabetes were enrolled in African American-Diabetes Heart Study-MIND, a cross-sectional study of cognition and structural and functional brain imaging. After excluding participants with possible cognitive impairment (), mean (SD) MoCA and 3MSE scores are presented stratified by age and education. Results. Participant mean age was 58.2 years (range: 35-83); 61% were female; and 64.9% had >12 years of education. Mean (SD) 3MSE and MoCA scores were 86.9 (8.2) and 19.8 (3.8), respectively. 93.5% of the cohort had a “positive” screen on the MoCA, scoring <26 (education-adjusted), compared with 47.5% on the 3MSE (cut-point < 88). A 3MSE score of 88 corresponded to a MoCA score of 20 in this population. Conclusion. The present data suggest the need for caution when applying proposed MoCA cutoffs to African Americans. Kaycee M. Sink, Suzanne Craft, S. Carrie Smith, Joseph A. Maldjian, Donald W. Bowden, Jianzhao Xu, Barry I. Freedman, and Jasmin Divers Copyright © 2015 Kaycee M. Sink et al. All rights reserved. Exploring Innovative Solutions for Quality of Life and Care of Bed-Ridden Nursing Home Residents through Codesign Sessions Mon, 12 Oct 2015 08:03:28 +0000 Bed-ridden nursing home residents are in need of environments which are homelike and facilitate the provision of care. Design guidance for this group of older people is limited. This study concerned the exploration and generation of innovative environmental enrichment scenarios for bed-ridden residents. This exploration was conducted through a combination of participatory action research with user-centred design involving 56 professional stakeholders in interactive work sessions. This study identified numerous design solutions, both concepts and products that are available on the marketplace and that on a higher level relate to improvements in resident autonomy and the supply of technological items and architectural features. The methodology chosen can be used to explore the creative potential of stakeholders from the domain of healthcare in product innovation. J. van Hoof, M. H. Wetzels, A. M. C. Dooremalen, R. A. Overdiep, M. E. Nieboer, A. M. E. Eyck, P. J. L. M. van Gorkom, E. L. M. Zwerts-Verhelst, S. Aarts, C. Vissers-Luijcks, C. S. van der Voort, M. J. G. A. Moonen, H. A. van de Vrande, C. J. M. L. van Dijck-Heinen, and E. J. M. Wouters Copyright © 2015 J. van Hoof et al. All rights reserved. Genetic Risk Score Predicts Late-Life Cognitive Impairment Sun, 23 Aug 2015 09:13:28 +0000 Introduction. A family history of Alzheimer’s disease is a significant risk factor for its onset, but the genetic risk associated with possessing multiple risk alleles is still poorly understood. Methods. In a sample of 95 older adults (Mean age = 75.1, 64.2% female), we constructed a genetic risk score based on the accumulation of risk alleles in BDNF, COMT, and APOE. A neuropsychological evaluation and consensus determined cognitive status (44 nonimpaired, 51 impaired). Logistic regression was performed to determine whether the genetic risk score predicted cognitive impairment above and beyond that associated with each gene. Results. An increased genetic risk score was associated with a nearly 4-fold increased risk of cognitive impairment (OR = 3.824, = .013) when including the individual gene polymorphisms as covariates in the model. Discussion. A risk score combining multiple genetic influences may be more useful in predicting late-life cognitive impairment than individual polymorphisms. Mariegold E. Wollam, Andrea M. Weinstein, Judith A. Saxton, Lisa Morrow, Beth Snitz, Nicole R. Fowler, Barbara L. Suever Erickson, Kathryn A. Roecklein, and Kirk I. Erickson Copyright © 2015 Mariegold E. Wollam et al. All rights reserved. Active and Healthy Ageing and Independent Living Thu, 06 Aug 2015 08:37:30 +0000 Maddalena Illario, Miriam Vollenbroek-Hutten, David William Molloy, Enrica Menditto, Guido Iaccarino, and Patrik Eklund Copyright © 2015 Maddalena Illario et al. All rights reserved. Sarcopenia Is Associated with High Pulse Pressure in Older Women Wed, 05 Aug 2015 14:36:24 +0000 Introduction. Sarcopenia is a geriatric syndrome associated with impairment of muscle function, metabolism, and cognition in older women. Recent studies have shown a relationship between changes in muscle mass and the cardiovascular system. However, this relationship has not been fully elucidated. Methods. One hundred and thirty community-dwelling Brazilian older women (65.4 ± 6.3 years) were recruited to participate in this study. Data on body composition (via bioelectrical impedance measurements), cardiovascular parameters (using an automatic and noninvasive monitor), and muscle function (using a 3-meter gait speed test) were measured. Results. Sarcopenic older women () presented higher levels of pulse pressure (PP) (60.3 ± 2.6 mmHg) and lower muscle function (0.5 ± 0.0 m/s) compared with nonsarcopenic subjects () (53.7 ± 1.5 mmHg; 0.9 ± 0.0 m/s) (). Linear regression analysis demonstrated a significantly negative association between skeletal muscle index (SMI) and PP levels (, ). Furthermore, sarcopenic older women showed a 3.1-fold increased risk of having higher PP levels compared with nonsarcopenic women (IC = 1.323–7.506) (). Conclusion. Sarcopenic older women showed lower muscle function and higher cardiovascular risk due to increased PP levels compared with nonsarcopenic subjects. Hélio José Coelho Júnior, Samuel da Silva Aguiar, Ivan de Oliveira Gonçalves, Ricardo Aurélio Carvalho Sampaio, Marco Carlos Uchida, Milton Rocha Moraes, and Ricardo Yukio Asano Copyright © 2015 Hélio José Coelho Júnior et al. All rights reserved. Self-Assessment of Adherence to Medication: A Case Study in Campania Region Community-Dwelling Population Wed, 05 Aug 2015 14:18:28 +0000 Objectives. The aim of the study was to assess self-reported medication adherence measure in patients selected during a health education and health promotion focused event held in the Campania region. The study also assessed sociodemographic determinants of adherence. Methods. An interviewer assisted survey was conducted to assess adherence using the Italian version of the 8-item Morisky Medication Adherence Scale (MMAS-8). Participants older than 18 years were interviewed by pharmacists while waiting for free-medical checkup. Results. A total of 312 participants were interviewed during the Health Campus event. A total of 187 (59.9%) had low adherence to medications. Pearson’s bivariate correlation showed positive association between the MMAS-8 score and gender, educational level and smoking (). A multivariable analysis showed that the level of education and smoking were independent predictors of adherence. Individuals with an average level of education (odds ratio (OR), 2.21, 95% confidence interval (CI), 1.08–4.52) and nonsmoker (odds ratio (OR) 1.87, 95% confidence interval (CI), 1.04–3.35) were found to be more adherent to medication than those with a lower level of education and smoking. Conclusion. The analysis showed very low prescription adherence levels in the interviewed population. The level of education was a relevant predictor associated with that result. Enrica Menditto, Francesca Guerriero, Valentina Orlando, Catherine Crola, Carolina Di Somma, Maddalena Illario, Donald E. Morisky, and Annamaria Colao Copyright © 2015 Enrica Menditto et al. All rights reserved. Active Aging: Exploration into Self-Ratings of “Being Active,” Out-of-Home Physical Activity, and Participation among Older Australian Adults Living in Four Different Settings Wed, 05 Aug 2015 13:34:06 +0000 We examined whether self-ratings of “being active” among older people living in four different settings (major city high and lower density suburbs, a regional city, and a rural area) were associated with out-of-home participation and outdoor physical activity. A mixed-methods approach (survey, travel diary, and GPS tracking over a one-week period) was used to gather data from 48 individuals aged over 55 years. Self-ratings of “being active” were found to be positively correlated with the number of days older people spent time away from home but unrelated to time traveled by active means (walking and biking). No significant differences in active travel were found between the four study locations, despite differences in their respective built environments. The findings suggest that additional strategies to the creation of “age-friendly” environments are needed if older people are to increase their levels of outdoor physical activity. “Active aging” promotion campaigns may need to explicitly identify the benefits of walking outdoors to ambulatory older people as a means of maintaining their overall health, functional ability, and participation within society in the long-term and also encourage the development of community-based programs in order to facilitate regular walking for this group. Rosemary L. Aird and Laurie Buys Copyright © 2015 Rosemary L. Aird and Laurie Buys. All rights reserved. Leisure Engagement: Medical Conditions, Mobility Difficulties, and Activity Limitations—A Later Life Perspective Wed, 05 Aug 2015 12:44:51 +0000 Objectives. This study aims to investigate the impact of medical conditions, mobility difficulties, and activity limitations on older people’s engagement in leisure activities. Methods. The analyses are based on a cross regional survey carried out in 2010 in the Bothnia region (Northern Sweden and Western Finland). A posted questionnaire, which included questions on different aspects of leisure engagement, medical history, and health, was sent out to older persons in the region. The final sample consisted of 5435 persons aged 65, 70, 75, and 80 years. The data was analyzed by using ordinary least squares (OLS) multivariate regression. Results. The most important predictor of leisure engagement abstention among older people is the prevalence of activity limitations, whereas mobility difficulties and medical conditions play less important roles. The strong negative association between activity limitations and leisure engagement remains significant even after we control for individual, sociodemographic characteristics, and country. Discussion. This study provides a window into leisure engagement in later life and factors influencing the magnitude of engagement in leisure activities. Ingeborg Nilsson, Fredrica Nyqvist, Yngve Gustafson, and Mikael Nygård Copyright © 2015 Ingeborg Nilsson et al. All rights reserved. Functional Fitness and Self-Reported Quality of Life of Older Women Diagnosed with Knee Osteoarthrosis: A Cross-Sectional Case Control Study Wed, 05 Aug 2015 10:30:06 +0000 Aim. Utilizing a cross-sectional case control design, the aim of this study was to evaluate the functional fitness and self-reported quality of life differences in older people diagnosed with knee osteoarthrosis (O) who participated in health promotion groups. Methods. Ninety older women were distributed into two groups: control without O of the knee (C, ) and a group diagnosed with primary and secondary knee O with grade II or higher, with definite osteophytes (OA, ). Functional fitness was evaluated by specific tests, and the time spent in physical activity and quality of life was evaluated by the IPAQ and WHOQOL (distributed in four domains: physical: P, psychological: PS, social: S, and environmental: E) domain questionnaires. Results. No differences were found between ages of groups (C: ; OA: ; years). The values of the chair stand test (rep) in the OA () group were different when compared to C group (). For the 6-minute walk test (meters), the values obtained for the C () were higher () than the OA () group. The time spent in physical activity (min) was greater () in the control () group compared to OA () group. Higher values () in all domains were found in the C (P: , PS: , S: , E: ) group compared to OA (P: , PS: , S: , E: ) group. Conclusion. Our data suggests that knee O, in older women, can promote a decline in time spent performing physical activity and functional fitness with decline in quality of life with an increase in sitting time. Paula Andréa Malveira Cavalcante, Márcio Roberto Doro, Frank Shiguemitsu Suzuki, Roberta Luksevicius Rica, Andrey Jorge Serra, Francisco Luciano Pontes Junior, Alexandre Lopes Evangelista, Aylton José Figueira Junior, Julien Steven Baker, and Danilo Sales Bocalini Copyright © 2015 Paula Andréa Malveira Cavalcante et al. All rights reserved. A Community-Based, Technology-Supported Health Service for Detecting and Preventing Frailty among Older Adults: A Participatory Design Development Process Wed, 05 Aug 2015 10:28:09 +0000 Frailty is a multifaceted condition that affects many older adults and marks decline on areas such as cognition, physical condition, and nutritional status. Frail individuals are at increased risk for the development of disability, dementia, and falls. There are hardly any health services that enable the identification of prefrail individuals and that focus on prevention of further functional decline. In this paper, we discuss the development of a community-based, technology-supported health service for detecting prefrailty and preventing frailty and further functional decline via participatory design with a wide range of stakeholders. The result is an innovative service model in which an online platform supports the integration of traditional services with novel, Information Communication Technology supported tools. This service is capable of supporting the different phases of screening and offers training services, by also integrating them with community-based services. The service model can be used as a basis for developing similar services within a wide range of healthcare systems. We present the service model, the general functioning of the technology platform, and the different ways in which screening for and prevention of frailty has been localized. Finally, we reflect on the added value of participatory design for creating such health services. Lex van Velsen, Maddalena Illario, Stephanie Jansen-Kosterink, Catherine Crola, Carolina Di Somma, Annamaria Colao, and Miriam Vollenbroek-Hutten Copyright © 2015 Lex van Velsen et al. All rights reserved. Picture Your Nursing Home: Exploring the Sense of Home of Older Residents through Photography Wed, 05 Aug 2015 10:27:18 +0000 The quality of the built environment can impact the quality of life and the sense of home of nursing home residents. This study investigated (1) which factors in the physical and social environment correlate with the sense of home of the residents and (2) which environmental factors are most meaningful. Twelve participants engaged in a qualitative study, in which photography was as a supportive tool for subsequent interviews. The data were analysed based on the six phases by Braun and Clarke. The four themes identified are (1) the physical view; (2) mobility and accessibility; (3) space, place, and personal belongings; and (4) the social environment and activities. A holistic understanding of which features of the built environment are appreciated by the residents can lead to the design and retrofitting of nursing homes that are more in line with personal wishes. J. van Hoof, M. M. Verhagen, E. J. M. Wouters, H. R. Marston, M. D. Rijnaard, and B. M. Janssen Copyright © 2015 J. van Hoof et al. All rights reserved. Is Self-Reported Physical Activity Participation Associated with Lower Health Services Utilization among Older Adults? Cross-Sectional Evidence from the Canadian Community Health Survey Wed, 05 Aug 2015 10:21:23 +0000 Purpose. To examine relationships between leisure time physical activity (LTPA) and health services utilization (H) in a nationally representative sample of community-dwelling older adults. Methods. Cross-sectional data from 56,652 Canadian Community Health Survey respondents aged ≥ 50 years (48% M; 52% F; mean age 63.5 ± 10.2 years) were stratified into three age groups and analysed using multivariate generalized linear modeling techniques. Participants were classified according to PA level based on self-reported daily energy expenditure. Nonleisure PA (NLPA) was categorized into four levels ranging from mostly sitting to mostly lifting objects. Results. Active 50–65-year-old individuals were 27% less likely to report any GP consultations and had 8% fewer GP consultations annually than their inactive peers. Active persons aged 65–79 years were 18% less likely than inactive respondents to have been hospitalized overnight in the previous year . Higher levels of NLPA were significantly associated with lower levels of HSU, across all age groups. Conclusion. Nonleisure PA appeared to be a stronger predictor of all types of HSU, particularly in the two oldest age groups. Considering strategies that focus on reducing time spent in sedentary activities may have a positive impact on reducing the demand for health services. Koren L. Fisher, Elizabeth L. Harrison, Bruce A. Reeder, Nazmi Sari, and Karen E. Chad Copyright © 2015 Koren L. Fisher et al. All rights reserved.