Constance M. Bayles

The decline of grip strength in the menopause: Relationship to physical activity, estrogen use and anthropometric factors

The focus of this study was the relationship of grip strength to age, physical activity and anthropometric factors, in a population of 255 post-menopausal women not on estrogen therapy (mean age = 57.6) and 55 women currently on estrogen replacement therapy (mean age = 56.9). Grip strength was measured as an indicator of muscular strength in the upper limbs. The grip strength of the estrogen users was significantly higher than that of the estrogen abstainers. Grip strength was related to age (r = -0.25, p less than 0.01), and the body habitus parameters of height (r = 0.36, p less than 0.01) and weight (r = 0.18, p less than 0.01). Although estrogen use was univariately correlated with strength (r = 0.16, p less than 0.05), multiple regression analyses revealed that only the height, age and physical activity were independent determinants of grip strength. These data suggest: height is the major determinant of upper body strength in older women; the reduction in physical activity with advancing age may contribute to strength decline, and modest increase in physical activity may retard the loss of strength that accompanies aging; the loss of ovarian estrogen in menopause may be related to the loss of strength in postmenopausal women.

Lower-Body Function, Neighborhoods, and Walking in an Older Population

BACKGROUND Poor lower-body capacity is associated with reduced mobility in older populations. PURPOSE This study sought to determine whether neighborhood environments (e.g., land-use patterns and safety) moderate that association. METHODS The study is based on a cross-sectional sample of 884 people aged > or =65 years identified through service organizations in Alameda County CA, Cook County IL, Allegheny County PA, and Wake and Durham counties NC. In-person interviews focused on neighborhood characteristics, physical and cognitive function, and physical activity and walking. Functional capacity was tested using measures of lower-body strength, balance, and walking speed. The main outcome was time spent walking in a typical week (<150 vs > or =150 minutes per week). Objective environmental measures were also included. Estimates of main and interaction effects were derived from regression models. RESULTS Living in a residential area, compared to a mixed-use or commercial area, was associated with less time spent walking (<150 minutes per week; OR=1.57, 95% CI=1.04, 2.38). Living in a less-compact area (greater median block length) is also significantly associated with less walking for seniors, but only among those with excellent lower-body strength. CONCLUSIONS Neighborhood type is associated with walking among older people, as it is among the general adult population. In individuals with poor lower-body function, no association was found between residence in a less-compact area and walking. For those people, the relationship between neighborhood characteristics and walking requires further study.

Walking and the Preservation of Cognitive Function in Older Populations

PURPOSE This cross-sectional study takes a unique look at the association between patterns of walking and cognitive functioning by examining whether older adults with mild cognitive impairment differ in terms of the community settings where they walk and the frequency, intensity, or duration of walking. DESIGN AND METHODS The sample was based on interviews with 884 adults aged 65 years and older, residing in 4 locations across the United States: Alameda County, California; Cook County, Illinois; Allegheny County, Pennsylvania; and Durham/Wake Counties, North Carolina. Cognitive function was assessed using a modified Mini-Mental State Examination (MMSE) and the Mental Alternation Test (MAT). Multiple linear regressions were conducted between self-reported walking activities and cognitive measures, controlling for psychosocial, demographic, health status, functional performance, and neighborhood characteristics. RESULTS The community setting where people walk and the intensity of walking in their neighborhood were significantly associated with cognitive status. After controlling for individual and neighborhood characteristics, better MAT scores were significantly associated with brisk walking and walking fewer times per week. Compared with the MMSE, the MAT was more likely to be associated with patterns of walking among older adults. Older adults with lower MAT scores were more likely to walk in indoor shopping malls and less in parks, whereas those with higher cognitive function scores on the MMSE were less likely to walk in indoor gyms. IMPLICATIONS This investigation provides insight into the extent to which walking is associated with preservation of cognitive health, setting the stage for future longitudinal studies and community-based interventions.

The “10 Keys” to Healthy Aging 24-Month Follow-Up Results From an Innovative Community-Based Prevention Program

The purpose of this report was to evaluate a prevention program to reduce risk factors for common diseases among older individuals in a lower income community. This randomized community-based study enrolled older adults into a Brief Education and Counseling Intervention or a Brief Education and Counseling Intervention plus a physical activity and (for those with hypertension) a dietary sodium intervention. Outcomes were collected on 389 adults with a mean age of 73.9 years over 24 months. Adherence to the “10 Keys” improved significantly in the proportion meeting goals for low-density lipoprotein cholesterol (+14%), bone mineral density testing (+11%), pneumonia vaccination (+11%), colonoscopy (+14%), and adherence to antihypertensive medication (+9%). This program resulted in significant reductions in key risk factors, increases in immunizations, and adherence to established prevention guidelines over 2 years. Further research is needed to refine the use of community health counselors for translating prevention knowledge into community settings. A major limitation of these studies is the low participation percentage.

The 10 keys to healthy aging: findings from an innovative prevention program in the community.

Objective: To develop and evaluate a novel, comprehensive prevention program for older adults designed to assess and improve adherence to preventive health care goals. Method: In McKeesport, Pennsylvania, 389 men and women aged 65 and older were enrolled. We assessed adherence to 10 preventive health goals, provided education and counseling, and reevaluated after 12 months. Results: At baseline, adherence varied. After 12 months, proportions of participants meeting goals were improved for several areas. Overall, improvements were seen for the proportion of participants meeting goals for low-density lipoprotein (LDL) cholesterol (+43%), blood pressure control in hypertensives (+17%), blood glucose control in diabetics (+50%), and colon cancer screening (+13%). Among those without prior vaccination, influenza vaccine increased by 25% and pneumonia vaccine by 20%. Discussion: This comprehensive prevention program had short-term benefits for improving adherence to established prevention guidelines in older adults. This low-cost effective program could be disseminated nationwide.

Neighborhood characteristics and depressive symptoms in an older population

Objectives: We explored relationships between depressive symptoms and neighborhood environment measures including traffic safety, crime, social capital, and density of businesses in community-dwelling older adults from four different regions of the United States. Method: The Healthy Aging Research Network walking study is a cross-sectional study of 884 adults aged 65+, which included a 10-item Center for Epidemiologic Studies Depression scale of depressive symptoms, demographics, self-reported neighborhood perceptions, and objective neighborhood data. Results: After adjusting for individual covariates, reports of neighborhood crime, unsafe traffic, and unwillingness of neighbors to help each other were significantly positively associated with depressive symptoms among participants. Conclusion: This research suggests an association between self-reported depressive symptoms and the social and built environment; examining causal association requires additional longitudinal research in diverse populations of older adults.

The key to life nutrition program: results from a community-based dietary sodium reduction trial.

OBJECTIVE Evaluation of a dietary Na reduction trial in a community setting. DESIGN Community-based randomized trial. Ten-week nutrition intervention activities focused on lifestyle modification to decrease dietary Na intake, under the supervision of a registered dietitian. Twenty-four hour urine specimens were collected at baseline and follow-up visits to determine 24 h urinary Na excretion. SETTING The University of Pittsburgh Center for Healthy Aging, Key to Life Nutrition Program. SUBJECTS Hypertensive adults at least 65 years of age. RESULTS Mean age of participants was 75 years. Twenty-four hour mean urinary Na excretion at baseline was 3174 mg/d. This reduced to 2944 mg/d (P = 0.30) and 2875 mg/d (P <or= 0.03) at 6- and 12-month follow-ups, respectively. In a sub-sample (urine volume of >or=1000 ml, baseline to 12 months), mean urinary Na excretion decreased from 3220 mg/d to 2875 mg/d (P <or= 0.02). CONCLUSIONS Significant reductions in mean 24 h urinary Na were reported, but results fell short of the recommended guidelines of 1500 mg/d for at-risk individuals. Our results reiterate the difficulty in implementing these guidelines in community-based programmes. More aggressive public health efforts, food industry support and health policy changes are needed to decrease Na levels in older adults to the recommended guidelines.

Mobility Disability in Older Adults: At the Intersection of People and Places

PURPOSE Mobility disability is associated with poor lower body function among older adults. This study examines whether specific types of neighborhood characteristics moderate that association. DESIGN AND METHODS This study is based on a cross-sectional sample of 884 people aged ≥ 65 years identified through service organizations in Alameda County, CA; Cook County, IL; Allegheny County, PA; and Wake and Durham counties, NC. In-person interviews focus on neighborhood characteristics, physical and cognitive function, depression, and walking. Functional capacity is tested using objective measures of lower body strength, balance, and walking speed. Mobility disability, the main study outcome, is measured as self-reported level of difficulty in walking 2-3 neighborhood blocks. Estimates of main and interactive effects are derived from logistic regression models. RESULTS Among older adults with poor lower body function, those who report less proximity to goods and services and barriers to walking report more mobility disability than other older adults. In contrast, among older adults with good lower body function, there is a low prevalence of mobility disability and little association between perceptions of the neighborhood and mobility disability. IMPLICATIONS In addition to more refined longitudinal studies, this research provides a foundation for innovative place-based rehabilitation and hospital discharge programs for older adults newly diagnosed and treated for chronic health conditions.