Elizabeth A. Phelan

Older Adults' Views of “Successful Aging”—How Do They Compare with Researchers' Definitions?

Objectives: To determine whether older adults have thought about aging and aging successfully and to compare their perceptions of successful aging with attributes of successful aging identified in the published literature.

Association of Incident Dementia With Hospitalizations

CONTEXT Dementia is associated with increased rates and often poorer outcomes of hospitalization, including worsening cognitive status. New evidence is needed to determine whether some admissions of persons with dementia might be potentially preventable. OBJECTIVE To determine whether dementia onset is associated with higher rates of or different reasons for hospitalization, particularly for ambulatory care-sensitive conditions (ACSCs), for which proactive outpatient care might prevent the need for a hospital stay. DESIGN, SETTING, AND PARTICIPANTS Retrospective analysis of hospitalizations among 3019 participants in Adult Changes in Thought (ACT), a longitudinal cohort study of adults aged 65 years or older enrolled in an integrated health care system. All participants had no dementia at baseline and those who had a dementia diagnosis during biennial screening contributed nondementia hospitalizations until diagnosis. Automated data were used to identify all hospitalizations of all participants from time of enrollment in ACT until death, disenrollment from the health plan, or end of follow-up, whichever came first. The study period spanned February 1, 1994, to December 31, 2007. MAIN OUTCOME MEASURES Hospital admission rates for patients with and without dementia, for all causes, by type of admission, and for ACSCs. RESULTS Four hundred ninety-four individuals eventually developed dementia and 427 (86%) of these persons were admitted at least once; 2525 remained free of dementia and 1478 (59%) of those were admitted at least once. The unadjusted all-cause admission rate in the dementia group was 419 admissions per 1000 person-years vs 200 admissions per 1000 person-years in the dementia-free group. After adjustment for age, sex, and other potential confounders, the ratio of admission rates for all-cause admissions was 1.41 (95% confidence interval [CI], 1.23-1.61; P < .001), while for ACSCs, the adjusted ratio of admission rates was 1.78 (95% CI, 1.38-2.31; P < .001). Adjusted admission rates classified by body system were significantly higher in the dementia group for most categories. Adjusted admission rates for all types of ACSCs, including bacterial pneumonia, congestive heart failure, dehydration, duodenal ulcer, and urinary tract infection, were significantly higher among those with dementia. CONCLUSION Among our cohort aged 65 years or older, incident dementia was significantly associated with increased risk of hospitalization, including hospitalization for ACSCs.

Successful aging - Where next?

The idea of “successful aging” has been the subject of research for a broad range of academic disciplines for more than 3 decades. Early mention of “successful aging” can be found in the work of social scientists in the United States during the 1960s and 1970s. 1–6 During the 1980s and 1990s, psychologists and behavioral scientists addressed successful aging. 7–11 Over the last 2 decades, physicians and health services researchers have contributed to theories of successful aging. 12–19 In recent years, this concept has gained increased attention, likely because of a combination of demographic trends and social forces. Baby boomers—those born between 1946 and 1965—face the prospect of surviving to very old age, and those who have already reached the age of 65 have a life expectancy of an additional 16 to 20 years. 20 Furthermore, analyses using longitudinal data suggest that, in addition to living longer, people are healthier and more active than before and that rates of disability and institutionalization will continue to fall in the future. 21–24 Finally, older adults are more highly educated than previous generations and are interested in health-related matters. 25 Because of this combination of circumstances, healthcare providers may find their patients seeking information about how to age successfully. Some patients may want to apply scientific findings to their own situations to maximize their personal likelihood of aging successfully. We therefore conducted a review of published literature that has attempted to define successful aging and the factors that might predict success. Articles were identified from the following sources: (1) MEDLINE search (using the key terms “successful aging,” “normal aging,” “theories of aging,” “centenarians”); (2) psycINFO search (using the same key terms as in (1)); (3) on-line card catalog search (using the key term “aging”) of the University of Washington libraries, which contain over 1.9 million book titles; (4) recommendations from local reviewers of the manuscript; and (5) reference lists of all articles and books found by the procedures just described. No exclusions were made for year of publication. Studies were excluded if they used a definition of successful aging that had already been identified, if they focused on a related concept (e.g., healthy aging, effective aging, elite aging) but made no mention of the term “successful aging,” or if they were not published in English. We were not seeking to provide a comprehensive literature review on lifestyle factors that promote healthy aging. Neither did we intend to propose a definition of successful aging or argue for the validity of the concept of successful aging—as a stand-alone construct or in comparison with other related, but nonetheless distinct, concepts such as healthy aging. Rather, our intent was simply to identify and present in a highly summarized format the many and varying definitions of successful aging that have been put forth in the literature over the past 30 to 40 years. We intend this summary to be a succinct reference for clinicians who care for aging adults and researchers engaged in the study of aging. In addition, we offer a rationale for exploring the public’s definition(s) of successful aging; we also suggest questions and design considerations for those seeking to pursue further work related to this concept.

Development of STEADI: a fall prevention resource for health care providers.

Falls among people aged ≥65 years are the leading cause of both injury deaths and emergency department visits for trauma. Research shows that many falls are preventable. In the clinical setting, an effective fall intervention involves assessing and addressing an individual’s fall risk factors. This individualized approach is recommended in the American and British Geriatrics Societies’ (AGS/BGS) practice guideline. This article describes the development of STEADI (Stopping Elderly Accidents, Deaths, and Injuries), a fall prevention tool kit that contains an array of health care provider resources for assessing and addressing fall risk in clinical settings. As researchers at the Centers for Disease Control and Prevention’s Injury Center, we reviewed relevant literature and conducted in-depth interviews with health care providers to determine current knowledge and practices related to older adult fall prevention. We developed draft resources based on the AGS/BGS guideline, incorporated provider input, and addressed identified knowledge and practice gaps. Draft resources were reviewed by six focus groups of health care providers and revised. The completed STEADI tool kit, Preventing Falls in Older Patients—A Provider Tool Kit, is designed to help health care providers incorporate fall risk assessment and individualized fall interventions into routine clinical practice and to link clinical care with community-based fall prevention programs.

A study of the diagnostic accuracy of the PHQ-9 in primary care elderly

BackgroundThe diagnostic accuracy of the Patient Health Questionnaire-9 (PHQ-9) for assessment of depression in elderly persons in primary care settings in the United States has not been previously addressed. Thus, the purpose of this study was to evaluate the test performance of the PHQ-9 for detecting major and minor depression in elderly patients in primary care.MethodsA prospective study of diagnostic accuracy was conducted in two primary care, university-based clinics in the Pacific Northwest of the United States. Seventy-one patients aged 65 years or older participated; all completed the PHQ-9 and the 15-item Geriatric Depression Scale (GDS) and underwent the Structured Clinical Interview for Depression (SCID). Sensitivity, specificity, area under the receiver operating characteristic (ROC) curve, and likelihood ratios (LRs) were calculated for the PHQ-9, the PHQ-2, and the 15-item GDS for major depression alone and the combination of major plus minor depression.ResultsTwo thirds of participants were female, with a mean age of 78 and two chronic health conditions. Twelve percent met SCID criteria for major depression and 13% minor depression. The PHQ-9 had an area under the curve (AUC) of 0.87 (95% confidence interval [CI], 0.74-1.00) for major depression, while the PHQ-2 and the 15-item GDS each had an AUC of 0.81 (95% CI for PHQ-2, 0.64-0.98, and for 15-item GDS, 0.70-0.91; P = 0.551). For major and minor depression combined, the AUC for the PHQ-9 was 0.85 (95% CI, 0.73-0.96), for the PHQ-2, 0.80 (95% CI, 0.68-0.93), and for the 15-item GDS, 0.71 (95% CI, 0.55-0.87; P = 0.187).ConclusionsBased on AUC values, the PHQ-9 performs comparably to the PHQ-2 and the 15-item GDS in identifying depression among primary care elderly.

The Effects of a Community-Based Exercise Program on Function and Health in Older Adults: The EnhanceFitness Program:

This study examined the effectiveness of participation in EnhanceFitness (EF) (formerly the Lifetime Fitness Program), an established community-based group exercise program for older adults. EF incorporated performance and health status measure testing in year 2000. Initial performance was compared to age and gender-based norms to classify participants as within or at or above normal limits (WNL) or below (BNL). In 2,889 participants who participated in outcomes testing, improvements were observed at 4 and 8 months on performance tests for both subgroups. Participants’ self-rating of health improved at 8 months. All participants improved on performance tests. Implementation of performance-based measures in community studies is possible. Challenges included selecting measures, staff training, collecting performance measures, and deciding on time points for data collection. Older adults can maintain and/or improve physical function through participation in EnhanceFitness.

Outcomes of a community-based dissemination of the health enhancement program

OBJECTIVES: We previously found in an efficacy trial that a health promotion program prevented functional decline and reduced hospitalizations in community‐dwelling older people with chronic conditions. We sought to evaluate the effectiveness of the program in its dissemination phase.

A Longitudinal Analysis of Total 3-Year Healthcare Costs for Older Adults Who Experience a Fall Requiring Medical Care

OBJECTIVES: To compare longitudinal changes in healthcare costs between fallers admitted to the hospital at the time of the fall (admitted), those not admitted to the hospital (nonadmitted), and nonfaller controls; test hypotheses related to differences in mean costs between and within these groups over time; and estimate the costs attributable to falling.

High Prevalence of Falls, Fear of Falling, and Impaired Balance in Older Adults with Pain in the United States: Findings from the 2011 National Health and Aging Trends Study

To determine the prevalence of clinically relevant falls‐related outcomes according to pain status in older adults in the United States.

Understanding Older Adults’ Motivators and Barriers to Participating in Organized Programs Supporting Exercise Behaviors

Little is known about older adults’ perceptions of organized programs that support exercise behavior. We conducted semi-structured interviews with 39 older adults residing in King County, Washington, who either declined to join, joined and participated, or joined and then quit a physical activity-oriented program. We sought to explore motivators and barriers to physical activity program participation and to elicit suggestions for marketing strategies to optimize participation. Two programs supporting exercise behavior and targeting older persons were the source of study participants: Enhance®Fitness and Physical Activity for a Lifetime of Success. We analyzed interview data using standard qualitative methods. We examined variations in themes by category of program participant (joiner, decliner, quitter) as well as by program and by race. Interview participants were mostly females in their early 70s. Approximately half were non-White, and about half had graduated from college. The most frequently cited personal factors motivating program participation were enjoying being with others while exercising and desiring a routine that promoted accountability. The most frequent environmental motivators were marketing materials, encouragement from a trusted person, lack of program fees, and the location of the program. The most common barriers to participation were already getting enough exercise, not being motivated or ready, and having poor health. Marketing messages focused on both personal benefits (feeling better, social opportunity, enjoyability) and desirable program features (tailored to individual needs), and marketing mechanisms ranged from traditional written materials to highly personalized approaches. These results suggest that organized programs tend to appeal to those who are more socially inclined and seek accountability. Certain program features also influence participation. Thoughtful marketing that involves a variety of messages and mechanisms is essential to successful program recruitment and continued attendance.