Journal of Aging Research The latest articles from Hindawi Publishing Corporation © 2016 , Hindawi Publishing Corporation . 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. Falls Reduction and Exercise Training in an Assisted Living Population Wed, 05 Aug 2015 09:35:58 +0000 Multicomponent exercise programs are currently an efficacious fall prevention strategy among community dwelling older adults although research documents differential falls susceptibility among frail older adults. This study aimed to examine the association between the Boston FICSIT (Frailty and Injuries: Cooperative Studies of Intervention Techniques) exercise program (the original exercise program to demonstrate that nursing home residents can increase strength) and falls incidents in an assisted living community. A descriptive cross-sectional study matched exercise charts for frequency and duration of training with number of reported fall incidents. Among 39 participants, 33% () reported a fall incident. Adults without a fall history reported more time in aerobic (26.30 versus 20.00, P value ) and strength (1.50 versus 0.50, P value ) training sessions compared to those with a fall history. Multivariate models adjusting for covariates illustrated a significant protective association between strength training and fall incidents (; 95% , 0.85). In this cross-sectional study, this progressive resistance exercise training program into an assisted living population was associated with a decrease in the number of fall incidents. Kimberly J. Alvarez, Shannen Kirchner, Serena Chu, Sarah Smith, Wendy Winnick-Baskin, and Thelma J. Mielenz Copyright © 2015 Kimberly J. Alvarez et al. All rights reserved. Which Part of a Short, Global Risk Assessment, the Risk Instrument for Screening in the Community, Predicts Adverse Healthcare Outcomes? Wed, 05 Aug 2015 09:02:16 +0000 The Risk Instrument for Screening in the Community (RISC) is a short, global risk assessment to identify community-dwelling older adults’ one-year risk of institutionalisation, hospitalisation, and death. We investigated the contribution that the three components of the RISC (concern, its severity, and the ability of the caregiver network to manage concern) make to the accuracy of the instrument, across its three domains (mental state, activities of daily living (ADL), and medical state), by comparing their accuracy to other assessment instruments in the prospective Community Assessment of Risk and Treatment Strategies study. RISC scores were available for 782 patients. Across all three domains each subtest more accurately predicted institutionalisation compared to hospitalisation or death. The caregiver network’s ability to manage ADL more accurately predicted institutionalisation (AUC 0.68) compared to hospitalisation (AUC 0.57, ) or death (AUC 0.59, ), comparing favourably with the Barthel Index (AUC 0.67). The severity of ADL (AUC 0.63), medical state (AUC 0.62), Clinical Frailty Scale (AUC 0.67), and Charlson Comorbidity Index (AUC 0.66) scores had similar accuracy in predicting mortality. Risk of hospitalisation was difficult to predict. Thus, each component, and particularly the caregiver network, had reasonable accuracy in predicting institutionalisation. No subtest or assessment instrument accurately predicted risk of hospitalisation. Rónán O’Caoimh, Carol FitzGerald, Una Cronin, Anton Svendrovski, Yang Gao, Elizabeth Healy, Elizabeth O’Connell, Gabrielle O’Keeffe, Eileen O’Herlihy, Elizabeth Weathers, Nicola Cornally, Patricia Leahy-Warren, Francesc Orfila, Constança Paúl, Roger Clarnette, and D. William Molloy Copyright © 2015 Rónán O’Caoimh et al. All rights reserved. Variations in Community Prevalence and Determinants of Recreational and Utilitarian Walking in Older Age Mon, 03 Aug 2015 13:56:02 +0000 Background. Regular walking is critical to maintaining health in older age. We examined influences of individual and community factors on walking habits in older adults. Methods. We analyzed walking habits among participants of a prospective cohort study of 745 community-dwelling men and women, mainly aged 70 years or older. We estimated community variations in utilitarian and recreational walking, and examined whether the variations were attributable to community differences in individual and environmental factors. Results. Prevalence of recreational walking was relatively uniform while prevalence of utilitarian walking varied across the 16 communities in the study area. Both types of walking were associated with individual health and physical abilities. However, utilitarian walking was also strongly associated with several measures of neighborhood socioeconomic status and access to amenities while recreational walking was not. Conclusions. Utilitarian walking is strongly influenced by neighborhood environment, but intrinsic factors may be more important for recreational walking. Communities with the highest overall walking prevalence were those with the most utilitarian walkers. Public health promotion of regular walking should take this into account. Elizabeth Procter-Gray, Suzanne G. Leveille, Marian T. Hannan, Jie Cheng, Kevin Kane, and Wenjun Li Copyright © 2015 Elizabeth Procter-Gray et al. All rights reserved. Health Status and Health Determinants of Older Immigrant Women in Canada: A Scoping Review Mon, 27 Jul 2015 06:12:45 +0000 Increasing international migration in the context of aging populations makes a comprehensive understanding of older immigrant women’s health status and determinants of their health particularly urgent. Using Arksey and O’Malley’s framework, we conducted a scoping review to examine the available literature on the health of older immigrant women in Canada. We searched CINAHL, PsycINFO, Embase, Medline, and Cochrane databases for the period of 1990 to 2014 for Canadian-based, peer-reviewed studies on the topic. A total of 20 articles met the inclusion criteria. These articles were divided into six areas of focus: physical health; mental health; abuse; health promotion and chronic disease prevention; barriers to healthcare access and utilization; and health beliefs, behaviours, and practices. Our results show that the health of older immigrant women is affected by the interplay of various social determinants of health including the physical and social environment; economic conditions; cultural beliefs; gendered norms; and the healthcare delivery system. Our results also revealed that older immigrant women tend to have more health problems, underutilize preventive services, such as cancer screening, and experience more difficulties in accessing healthcare services. Sepali Guruge, Birpreet Birpreet, and Joan A. Samuels-Dennis Copyright © 2015 Sepali Guruge et al. All rights reserved. Cumulative Weight Exposure Is Associated with Different Weight Loss Strategies and Weight Loss Success in Adults Age 50 or Above Thu, 28 May 2015 14:10:58 +0000 Objectives. To evaluate if cumulative weight exposure is associated with weight loss strategy choices and weight loss success. Methods. Data from the National Health and Nutrition Examination Survey were used; a total of 4,562 people age 50 years or older who reported trying to lose weight in the last year were studied. Cumulative weight exposure (CWE) score was defined as the sum of body mass index points above 25 kg/m2 at the age of 25, 10 years ago, 1 year ago, and now. Weight loss strategies were self-reported and weight loss success was defined as reaching a 5% weight loss in the last year. Results. Chosen strategies for weight loss vary across tertiles of CWE. Participants in the highest CWE tertile were about 4 to 20 times more likely to lose at least 5% of body weight in the past year compared to those in the lowest CWE tertile ().  Discussion. Strategies used to lose weight and weight loss success using different weight loss strategies vary considerably across cumulative weight exposure. Thus, cumulative weight exposure might be a variable worth considering when intervening with this population. Martin Sénéchal, Jana Slaght, and Danielle R. Bouchard Copyright © 2015 Martin Sénéchal et al. All rights reserved. Intramuscular Olanzapine in the Management of Behavioral and Psychological Symptoms in Hospitalized Older Adults: A Retrospective Descriptive Study Sun, 24 May 2015 11:30:57 +0000 Background. While behavioral and psychological symptoms are frequent in hospitalized older adults with dementia or delirium, data supporting the off-label use of intramuscular atypical antipsychotics remain scarce. We examined the use of short-acting intramuscular (IM) olanzapine in hospitalized older adults to manage behavioral and psychological symptoms. Methods. A retrospective observational study of inpatients 65 years or older with at least one order for olanzapine IM during admission in urban Ontario Canada was conducted. Patient demographics, prescriptions for olanzapine IM, reason for administration, perceived effectiveness, adverse events, concurrently prescribed psychotropics, comorbidities, and patient discharge destination were recorded. Results. Among 82 patients aged 65–96 years (mean ± SD 79.3 ± 7.7) 85 cases were identified. Cognitive impairment or dementia affected 63.5% and 50.6% had comorbidities. Olanzapine IM was ordered 102 times and 34 patients (41%) received at least one dose. The intended efficacy was achieved in 79.4% of 78 cases of 124 doses given (62.9%). Fourteen (41%) patients who received doses experienced adverse events, with sedation and hypotension being the most common. Conclusions. Olanzapine IM appears effective in hospitalized older adults but is associated with potential adverse events. Structured monitoring and documentation are needed to ensure safe use in this high-risk population. Silvia Duong, Kam-Tong Yeung, and Feng Chang Copyright © 2015 Silvia Duong et al. All rights reserved. An Open-Label Trial of Memantine for Cognitive Impairment in Patients with Posttraumatic Stress Disorder Tue, 12 May 2015 09:09:01 +0000 Background. Studies using standard neuropsychological instruments have demonstrated memory deficits in patients with PTSD. We evaluated the efficacy and safety of the N-methyl-D-aspartate antagonist memantine in veterans with PTSD and cognitive impairment. Methods. Twenty-six veterans with PTSD and cognitive impairment received 16 weeks of memantine in an open-label fashion. Cognition was assessed using the Spatial Span, Logical Memory I, and Letter-Number Sequencing subtests of the Wechsler Memory Scale III and the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). RBANS measures attention, language, visuospatial skills, and immediate and delayed memories. The Clinician Administered PTSD Scale (CAPS), Hamilton Depression Scale (HAM-D), Hamilton Anxiety Scale (HAM-A), Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q), and Sheehan Disability Scale (SDS) were secondary outcome measures. Results. There was a significant improvement in RBANS, both total and subscale scores (), over time. There was a reduction in total CAPS scores, avoidance/numbing symptoms (CAPS-C) and hyperarousal symptoms (CAPS-D), HAM-D, Q-LES-Q, and SDS scores. However, there was no reduction in reexperiencing (CAPS-B) and HAM-A scores. Memantine was well tolerated. Conclusions. Memantine improved cognitive symptoms, PTSD symptoms, and mood in veterans with PTSD. Randomized double-blind studies are needed to validate these preliminary observations. Sriram Ramaswamy, Jayakrishna Madabushi, John Hunziker, Subhash C. Bhatia, and Frederick Petty Copyright © 2015 Sriram Ramaswamy et al. All rights reserved. Older Primary Care Patients’ Attitudes and Willingness to Screen for Dementia Mon, 20 Apr 2015 07:07:01 +0000 Objective. To understand older primary care patients’ perceptions of the risks and benefits of dementia screening and to measure the association between attitudes and screening behaviors. Methods. Eligible patients completed the Perceptions Regarding Investigational Screening for Memory in Primary Care (PRISM-PC) questionnaire and then were asked to undergo dementia screening by a telephone screening instrument. Results. Higher scores on the PRISM-PC questionnaire items that measure attitudes about benefits of screening were associated with decreased odds of refusing screening. Participants who refused screening had significantly lower PRISM-PC questionnaire scores on the items that measure perceived benefits compared to those who agreed to screening. Participants who refused screening were less likely to agree on screening for other conditions, such as depression and cancer. Participants who know someone with Alzheimer’s disease (AD) were less likely to refuse screening. Discussion. Patients’ attitudes about the benefits of dementia screening are associated with their acceptance of dementia screening. Nicole R. Fowler, Anthony J. Perkins, Hilary A. Turchan, Amie Frame, Patrick Monahan, Sujuan Gao, and Malaz A. Boustani Copyright © 2015 Nicole R. Fowler et al. All rights reserved. 10-Hydroxy-2-decenoic Acid, the Major Lipid Component of Royal Jelly, Extends the Lifespan of Caenorhabditis elegans through Dietary Restriction and Target of Rapamycin Signaling Thu, 19 Feb 2015 07:02:02 +0000 Royal jelly (RJ) produced by honeybees has been reported to possess diverse health-beneficial properties and has been implicated to have a function in longevity across diverse species as well as honeybees. 10-Hydroxy-2-decenoic acid (10-HDA), the major lipid component of RJ produced by honeybees, was previously shown to increase the lifespan of Caenorhabditis elegans. The objective of this study is to elucidate signaling pathways that are involved in the lifespan extension by 10-HDA. 10-HDA further extended the lifespan of the daf-2 mutants, which exhibit long lifespan through reducing insulin-like signaling (ILS), indicating that 10-HDA extended lifespan independently of ILS. On the other hand, 10-HDA did not extend the lifespan of the eat-2 mutants, which show long lifespan through dietary restriction caused by a food-intake defect. This finding indicates that 10-HDA extends lifespan through dietary restriction signaling. We further found that 10-HDA did not extend the lifespan of the long-lived mutants in daf-15, which encodes Raptor, a target of rapamycin (TOR) components, indicating that 10-HDA shared some longevity control mechanisms with TOR signaling. Additionally, 10-HDA was found to confer tolerance against thermal and oxidative stress. 10-HDA increases longevity not through ILS but through dietary restriction and TOR signaling in C. elegans. Yoko Honda, Yoko Araki, Taketoshi Hata, Kenji Ichihara, Masafumi Ito, Masashi Tanaka, and Shuji Honda Copyright © 2015 Yoko Honda et al. All rights reserved.