Anda Botoseneanu

Light Intensity physical activity and sedentary behavior in relation to body mass index and grip strength in older adults: cross-sectional findings from the Lifestyle Interventions and Independence for Elders (LIFE) study.

Background Identifying modifiable determinants of fat mass and muscle strength in older adults is important given their impact on physical functioning and health. Light intensity physical activity and sedentary behavior are potential determinants, but their relations to these outcomes are poorly understood. We evaluated associations of light intensity physical activity and sedentary time—assessed both objectively and by self-report—with body mass index (BMI) and grip strength in a large sample of older adults. Methods We used cross-sectional baseline data from 1130 participants of the Lifestyle Interventions and Independence for Elders (LIFE) study, a community-dwelling sample of relatively sedentary older adults (70-89 years) at heightened risk of mobility disability. Time spent sedentary and in light intensity activity were assessed using an accelerometer worn for 3–7 days (Actigraph GT3X) and by self-report. Associations between these exposures and measured BMI and grip strength were evaluated using linear regression. Results Greater time spent in light intensity activity and lower sedentary times were both associated with lower BMI. This was evident using objective measures of lower-light intensity, and both objective and self-reported measures of higher-light intensity activity. Time spent watching television was positively associated with BMI, while reading and computer use were not. Greater time spent in higher but not lower intensities of light activity (assessed objectively) was associated with greater grip strength in men but not women, while neither objectively assessed nor self-reported sedentary time was associated with grip strength. Conclusions In this cross-sectional study, greater time spent in light intensity activity and lower sedentary times were associated with lower BMI. These results are consistent with the hypothesis that replacing sedentary activities with light intensity activities could lead to lower BMI levels and obesity prevalence among the population of older adults. However, longitudinal and experimental studies are needed to strengthen causal inferences.

Social Stratification of Body Weight Trajectory in Middle-Age and Older Americans: Results From a 14-Year Longitudinal Study

Objective: To depict the trajectory of BMI from middle to late adulthood and to examine social variations in BMI trajectories. Method: Eight waves (1992-2006) of the Health and Retirement Study involving a nationally representative sample of Americans aged 51 to 61 years at baseline were used. Changes in BMI were analyzed using hierarchical linear modeling with time-constant and time-varying covariates. Results: BMI increased linearly over time. Compared with Caucasians, African-Americans had higher BMI levels, while Hispanics had similar BMI levels, but lower rates of increase over time. Higher education predicted lower BMI levels and was not associated with the rate of change. Younger age-at-baseline predicted lower BMI level and lower rate of increase. No gender differences were found. Discussion: Observed racial/ethnic and educational differences in BMI trajectory from middle to old age inform policies and interventions aimed at modifying health risks and reducing health disparities in old age.

Multimorbidity Combinations and Disability in Older Adults

BACKGROUND Multimorbidity (multiple co-occurring chronic diseases) is associated with greater likelihood of disability and mortality, above and beyond the risk attributable to individual diseases. This study identifies prevalent multimorbidity patterns and evaluates their association with disability among U.S. older adults. METHODS Prospective cohort study using longitudinal Health and Retirement Study data (2010-2012). We included 8,782 participants aged 65 years and older and used negative binomial models to examine prospective disability, measured by the combined activities of daily living-instrumental activities of daily living index. Multimorbidity was defined as the co-occurring combination of at least two of the following chronic diseases: hypertension, cardiovascular disease, lung disease, diabetes, cancer, arthritis, stroke, cognitive impairment, or high depressive symptoms (CES-D score ≥ 4). RESULTS We found 291 unique disease combinations with 1 to 1,167 older adults per disease combination. The three most prevalent combinations were: (a) hypertension and arthritis (n = 1,167); (b) hypertension, arthritis, and cardiovascular disease (n = 510); and (c) hypertension, arthritis, and diabetes (n = 430). Only one of the prevalent combinations included depressive symptoms (in combination with arthritis, hypertension; n = 129). This group showed the highest level of activities of daily living-instrumental activities of daily living disability compared to healthy participants or participants with a single disease (either included in the combination or different from diseases in the combination) even after adjusting for age, gender, education, race/ethnicity, and body mass index. CONCLUSIONS Clinicians stand to gain from a better understanding of which disease combinations are more and less disabling among older adults. Understanding how multimorbidity combinations relate to functional status is an important step towards reducing disability and sustaining independent living among older adults.

Socioeconomic Stratification and Multidimensional Health Trajectories: Evidence of Convergence in Later Old Age

OBJECTIVES This research sought to examine socioeconomic stratification in the joint trajectories of physical, emotional, and cognitive functioning among older Americans and how it differs by age groups. METHODS We used data from a nationally representative sample of 9,237 Americans age 65 or older from the Health and Retirement Study, who were observed biennially from 1998 to 2010. Joint trajectories of physical, emotional, and cognitive functioning were characterized using a group-based mixture model. We then applied multinomial logistic regression analysis to evaluate their linkages with socioeconomic status and how the linkages differ by age groups. RESULTS We identified four distinct patterns of joint changes in physical, emotional, and cognitive functioning over time. Accounting for 29.3%, 23.5%, 24.5%, and 22.6% of the older Americans, respectively, these trajectory patterns characterized groups of individuals experiencing minimal to severe levels of impairment and deterioration. Lower education, income, and net worth were associated with trajectories featuring greater impairment or more rapid deterioration in these functional dimensions. Disparities based on education, however, attenuated in later old age, whereas health benefits associated with higher income and higher net worth persisted into advanced age. DISCUSSION Distinct patterns of joint trajectories of physical, emotional, and cognitive functioning exist in old age. There were significant socioeconomic differences in the joint trajectories, with education-based inequality in health converging in later old age. Further research identifying strategies to alleviate the disproportionate burden of poor multidimensional health trajectories in lower socioeconomic groups is important.

Achieving public health legal preparedness: how dissonant views on public health law threaten emergency preparedness and response

BACKGROUND Effective management of modern public health emergencies requires the coordinated efforts of multiple agencies representing various disciplines. Organizational culture differences between public health (PH) and emergency management (EM) entities may hinder inter-agency collaboration. We examine how PH and EM differ in their approach to PH law and how such differences affect their collaboration towards PH preparedness. METHODS We conducted 144 semi-structured interviews with local and state PH and EM officials between April 2008 and November 2009. Thematic qualitative analysis in ATLAS.ti was used to extract characteristics of each agencys approach to PH legal preparedness. RESULTS Two conflicting approaches to the law emerge. The PH approach is characterized by perceived uncertainty regarding legal authority over preparedness planning tasks; expectation for guidance on interpretation of existing laws; and concern about individual and organizational liability. The EM approach reveals perception of broad legal authority; flexible interpretation of existing laws; and ethical concerns over infringement of individual freedoms and privacy. CONCLUSIONS Distinct interpretations of preparedness law impede effective collaboration for PH preparedness. Clarification of legal authority mandates, designation within laws of scope of preparedness activities and guidance on interpretation of current federal and state laws are needed.

Latent Heterogeneity in Long-Term Trajectories of Body Mass Index in Older Adults

Objectives: To evaluate latent heterogeneity in long-term trajectories of body weight in older adults. Methods: We analyzed 14-year longitudinal data on 10,314 older adults from the Health and Retirement Study. Semiparametric mixture models identified latent subgroups of similar trajectories of body mass index (BMI). Results: Five distinct trajectory subgroups emerged: normal starting-BMI with accelerated increase over time (trajectory #1), overweight and increasing (trajectory #2), borderline-obese and increasing (trajectory #3), obese and increasing (trajectory #4), and morbidly obese with decelerating gain (trajectory #5). Blacks and Hispanics had greater risk of membership in ascending high-BMI trajectory groups. Females had approximately half the risk of following overweight and obese increasing BMI trajectories compared with males. Discussion: Distinct latent subgroups of BMI trajectories and significant racial/ethnic and gender trajectory heterogeneity exist in the older adult population. The propensity of men and minorities to experience high-risk BMI trajectories may exacerbate existing disparities in morbidity/ mortality in older age.

The Effect of Stability and Change in Health Behaviors on Trajectories of Body Mass Index in Older Americans: A 14-Year Longitudinal Study

BACKGROUND Obesity is increasingly prevalent among older adults, yet little is known about the impact of health behaviors on the trajectories of body weight in this age group. METHODS We examined the effect of time-varying smoking, physical activity (PA), alcohol use, and changes thereof, on the 14-year (1992-2006) trajectory of body- mass index (BMI) in a cohort of 10,314 older adults from the Health and Retirements Study, aged 51-61 years at baseline. Hierarchical linear modeling (HLM) quantifies the effect of smoking, PA, and alcohol use (user status, initiation and cessation) on intercept and rate-of-change in BMI trajectory, and tests for variations in the strength of association between each behavior and BMI. RESULTS Over 14 years (82,512 observations), BMI increased approximated by a quadratic function. Smoking and PA (user status and initiation) were associated with significantly lower BMI trajectories over time. Cessation of smoking and PA resulted in higher BMI trajectories over time. The weight-gaining effect of smoking cessation increased, while the strength of association between BMI trajectories and PA or alcohol use were constant over time. Socio-economic and health status differences explained the effects of alcohol use on BMI trajectory. CONCLUSIONS In older adults, smoking and PA, and changes thereof, vary in their long-term effect on trajectories of BMI. Barring increases in PA levels, older smokers who quit today are expected to gain significantly more weight than two decades ago. This knowledge is essential for the design of smoking cessation, physical activityPA, and weight-control interventions in older adults.

The Role of Law in Public Health Preparedness: Opportunities and Challenges

We report the results of a study designed to assess and evaluate how the law shapes the public health systems preparedness activities. Based on 144 qualitative interviews conducted in nine states, we used a model that compared the objective legal environment with how practitioners perceived the laws. Most local public health and emergency management professionals relied on what they perceived the legal environment to be rather than on an adequate understanding of the objective legal requirements. Major reasons for the gap include the lack of legal training for local practitioners and the difficulty of obtaining clarification and consistent legal advice regarding public health preparedness. Narrowing the gap would most likely improve preparedness outcomes. We conclude that there are serious deficiencies in legal preparedness that can undermine effective responses to public health emergencies. Correcting the lack of legal knowledge, coupled with eliminating delays in resolving legal issues and questions during public health emergencies, could have measurable consequences on reducing morbidity and mortality.

Prevalence of Metabolic Syndrome and Its Association with Physical Capacity, Disability, and Self-Rated Health in Lifestyle Interventions and Independence for Elders Study Participants

To evaluate the prevalence of metabolic syndrome (MetS) and its association with physical capacity, disability, and self‐rated health in older adults at high risk of mobility disability, including those with and without diabetes mellitus.

Long-Term Trajectories of Lower Extremity Function in Older Adults: Estimating Gender Differences While Accounting for Potential Mortality Bias

BACKGROUND Gender-specific trajectories of lower extremity function (LEF) and the potential for bias in LEF estimation due to differences in survival have been understudied. METHODS We evaluated longitudinal data from 690 initially nondisabled adults age 70 or older from the Precipitating Events Project. LEF was assessed every 18 months for 12 years using a modified Short Physical Performance Battery (mSPPB). Hierarchical linear models with adjustments for length-of-survival estimated the intraindividual trajectory of LEF and differences in trajectory intercept and slope between men and women. RESULTS LEF declined following a nonlinear trajectory. In the full sample, and among participants with high (mSPPB 10-12) and intermediate (mSPPB 7-9) baseline LEF, the rate-of-decline in mSPPB was slower in women than in men, with no gender differences in baseline mSPPB scores. Among participants with low baseline LEF (mSPPB ≤6), men had a higher starting mSPPB score, whereas women experienced a deceleration in the rate-of-decline over time. In all groups, participants who survived longer had higher starting mSPPB scores and slower rates-of-decline compared with those who died sooner. CONCLUSIONS Over the course of 12 years, older women preserve LEF better than men. Nonadjustment for differences in survival results in overestimating the level and underestimating the rate-of-decline in LEF over time.