Eric Bodner

Measuring Life‐Space Mobility in Community‐Dwelling Older Adults

Objectives: To evaluate the validity and reliability of a standardized approach for assessing life‐space mobility (the University of Alabama at Birmingham Study of Aging Life‐Space Assessment (LSA)) and its ability to detect changes in life‐space over time in community‐dwelling older adults.

Inflammatory biomarkers as predictors of hospitalization and death in community-dwelling older adults

Individuals with multimorbidity may be at increased risk of hospitalization and death. Comorbidity indexes do not capture severity of illness or healthcare utilization; however, inflammation biomarkers that are not disease-specific may predict hospitalization and death in older adults. We sought to predict hospitalization and mortality of older adults using inflammation biomarkers. From a prospective, observational study, 370 community-dwelling adults 65 years or older from central Alabama participated in an in-home assessment and provided fasting blood samples for inflammation biomarker testing in 2004. We calculated an inflammation summary score (range 0-4), one point each for low albumin, high C-reactive protein, low cholesterol, and high interleukin-6. Utilizing Cox proportional hazards models, inflammation summary scores were used to predicted time to hospitalization and death during a 4-year follow up period. The mean age was 73.7 (±5.9 yrs), and 53 (14%) participants had summary scores of 3 or 4. The rates of dying were significantly increased for participants with inflammation summary scores of 2, 3, or 4 (hazard ratio (HR) 2.22, 2.78, and 7.55, respectively; p<0.05). An inflammation summary score of 4 significantly predicted hospitalization (HR 5.92, p<0.05). Community-dwelling older adults with biomarkers positive for inflammation had increased rates of being hospitalized or dying during the follow up period. Assessment of the individual contribution of particular inflammation biomarkers in the prediction of health outcomes in older populations and the development of validated summary scores to predict morbidity and mortality are needed.

Symptom Burden Predicts Hospitalization Independent of Comorbidity in Community-Dwelling Older Adults

To determine whether cumulative symptom burden predicts hospitalization or emergency department (ED) visits in a cohort of older adults.

A Structural Equation Model of Religious Activities on Biopsychosocial Outcomes in Adults with HIV

The objective of this study was to examine the relationship between age, years diagnosed with HIV (chronicity), and educational status on religious activities and to examine their role in predicting biopsychosocial outcomes. Study participants were 421 adults with HIV who were receiving services from an AIDS service organization (ASO) in Alabama. Trained personnel administered a survey which assessed age, chronicity, educational status, religious activities, health status, social support, and positive mood. Direct and indirect paths were specified between these variables. The final model fit the data well (GFI = .97, AGFI = .94). There were direct effects between age and chronicity, educational status, religious activities, health status, and social support; direct effects between educational status and religious activities, health status, social support, and positive mood; and direct effects between religious activities and social support. Based upon the model, interventions that may improve biopsychosocial outcomes are posited.

The Role of Religiosity in Mediating Biopsychosocial Outcomes between African Americans and Caucasians with HIV

Religiosity has been shown to be a resource for many adults with HIV, but may be expressed differently by race. In the 2003 AIDS Alabama state‐wide survey, 395 adults with HIV were assessed on a variety of medical and psychosocial measures. Factors were extracted for age, health status, disease duration, education, social support, mood, and religiosity and were specified in separate structural equation models for African Americans and Caucasians, where religiosity mediated the effects of age, education, and chronicity on the biopsychosocial outcomes of health, social support, and mood. African Americans (n = 263) who were older had higher levels of religiosity which was positively associated with social support. For Caucasians (n = 132), religiosity did not mediate biopsychosocial factors. Implications of these findings are posited.

Service utilization and cognitive complaints in adults with HIV: Results from a statewide survey

ABSTRACT The aims of this study were to determine the association between service utilization and subjective cognitive complaints among adults with HIV and to identify the predictors of cognitive complaints as a step forward in improving service utilization in this population. Participants were 385 adults with HIV who were receiving care from AIDS service organizations (ASOs) in Alabama. Trained staff administered a face-to-face questionnaire, which assessed cognitive complaints and diverse aspects of service utilization. Significant correlations were found between cognitive complaints and work status, financial difficulties, difficulty getting medical care, legal problems, medication compliance, emotional problems, housing difficulties, counseling for sexual issues, transportation difficulties, and difficulty getting food. Multiple regression analysis identified the following predictors of cognitive complaints: level of education, physical pain, and stress. Given the association between cognitive complaints and service utilization, interventions aimed at reducing cognitive complaints and improving neuropsychological functioning may enhance service utilization and everyday functioning among adults with HIV.

The Role of Religiosity in Mediating Biopsychosocial Outcomes in Homosexuals and Heterosexuals with HIV: A Structural Equation Modeling Comparison Study

Religiosity has been shown to be a resource for many adults with HIV, but may be expressed differently by sexual orientation. In a state-wide survey, 395 adults with HIV were assessed on a variety of medical and psychosocial measures. Factors were extracted for age, health status, disease duration, education, social support, mood, and religiosity and were specified in a structural equation model for 2 groups (i.e., homosexuals and heterosexuals), where religiosity was proposed to mediate the effects of age, education, and chronicity on the biopsychosocial outcomes of health, social support, and mood. All of the trimmed models fit the data well. For homosexuals (n = 165), religiosity was positively related to social support. For heterosexuals (n = 230), those who were older had higher levels of religiosity but religiosity did not mediate any of the biopsychosocial outcomes. Results from this structural equation modeling comparison study suggest that religiosity may facilitate certain positive biopsychosocial outcomes in different groups.

Life-Space Assessment composite score rationale:

Life-Space Assessment composite score rationale In his recent manuscript, Siordia1 expressed concerns with the University of Alabama at Birmingham (UAB) Life-Space Assessment (LSA) as a measure of community mobility, suggesting that the logic for the composite score (LSA-CS) is problematic and proposing an alternative scoring method. Siordia indicated that “locating clear instructions for how the LSA-CS should be computed is difficult,” but failed to acknowledge that the authors of the original paper2 validating the LSA-CS invited readers to contact them for LSA instructions and SPSS scoring syntax . In fact Dr. Siordia contacted the authors in May 2013 and received instructions, scoring syntax, and copies of publications relevant to the LSA; he did not subsequently request any additional information. We agree with Dr. Siordia that it is important for “radical clarity” regarding the underlying assumptions of measurement tools and their scoring for clinicians or researchers using the assessments. The LSA was developed based upon the classical sociological perspective of life-space constriction associated with aging as older adults adapt to living with disability3 and was designed to enable researchers or clinicians to assess a person’s usual community mobility during the four weeks before the assessment. In contrast to other self-reported mobility measures that focus on specific mobilityrelated tasks (transferring, walking, or climbing stairs), the LSA reflects community participation by assessing where a person actually went, the frequency of movement, the use of help from others or assistive devices. Rather than assessing the person’s perceived ability to carry out a specific mobility-related task, the LSA obtains information about the person’s actual movement in the environment. Frequency and the independence of movement were incorporated into the LSA to capture important changes in mobility not captured by other assessments. Siordia1 highlighted the value of objective measures of mobility-related tasks such as observed gait speed, and pointed out potential difficulties in self-reported measures such as the LSA. For that reason, the original validation of the LSA included an examination of the correlation of four different scoring LSA methods with a composite measure of physical function that included gait speed, timed chair stands, and an assessment of balance.2 The LSA-CS was the most highly correlated score with observed physical performance and approximated a normal distribution; the test-retest reliability of the LSA-CS had an interclass correlation of 0.96.2 Subsequently, the LSA-CS has been validated as an important clinical measure of community mobility, predicting death, nursing home admissions, cognitive change, incident IADL disability, and as a measure reflecting important changes in mobility after hospitalizations and surgery.4–7 The LSA gives credit for the maximal values of life-space of a person, the greatest extent of the area in which they conduct their lives, while adjusting for person-specific adaptations to independent movement. Such scoring allows the assessment to be used clinically at a single point in time and to assess change in mobility at the individual level, perhaps as a trigger to understand factors amenable to intervention. In contrast to observations that require an in-home or clinic visit, the LSA can be administered by telephone or in person, providing a way to monitor changes in community-mobility in 614295 CRE0010.1177/0269215515614295Clinical RehabilitationBaker et al. research-article2015

Effects of Calorie Restriction in Obese Older Adults: The CROSSROADS Randomized Controlled Trial.

Background We lack a comprehensive assessment of the risks and benefits of calorie restriction in older adults at high risk for cardiometabolic disease. Calorie restriction may reduce visceral adipose tissue (VAT) but also have negative effects on lean mass and quality of life. Methods We conducted a 52-week, randomized controlled trial involving 164 older adults with obesity taking at least one medication for hyperlipidemia, hypertension, or diabetes. Interventions included an exercise intervention alone (Exercise), or with diet modification and body weight maintenance (Maintenance), or with diet modification and energy restriction (Weight Loss). The primary outcome was change in VAT at 12 months. Secondary outcomes included cardiometabolic risk factors, functional status, and quality of life. Results A total of 148 participants had measured weight at 12 months. Despite loss of -1.6% ± 0.3% body fat and 4.1% ± 0.7% initial body weight, Weight Loss did not have statistically greater loss of VAT (-192.6 ± 185.2 cm3) or lean mass (-0.4 ± 0.3 kg) compared with Exercise (VAT = -21.9 ± 173.7 cm3; lean mass = 0.3 ± 0.3 kg). Quality of life improved in all groups with no differences between groups. No significant changes in physical function were observed. Weight Loss had significantly greater improvements in blood glucose (-8.3 ± 3.6 mg/dL, p < .05) and HDL-cholesterol (5.3 ± 1.9, p < .01) compared with Exercise. There were no group differences in the frequency of adverse events. Conclusions While moderate calorie restriction did not significantly decrease VAT in older adults at high risk for cardiometabolic disease, it did reduce total body fat and cardiometabolic risk factors without significantly more adverse events and lean mass loss.

Calorie Restriction in Overweight Seniors: Response of Older Adults to a Dieting Study: The CROSSROADS Randomized Controlled Clinical Trial

We conducted a study designed to evaluate whether the benefits of intentional weight loss exceed the potential risks in a group of community-dwelling obese older adults who were at increased risk for cardiometabolic disease. The CROSSROADS trial used a prospective randomized controlled design to compare the effects of changes in diet composition alone or combined with weight loss with an exercise only control intervention on body composition and adipose tissue deposition (Specific Aim #1: To compare the effects of changes in diet composition alone or combined with weight loss with an exercise only control intervention on body composition, namely visceral adipose tissue), cardiometabolic disease risk (Specific Aim #2: To compare the effects of a change in diet composition alone or combined with weight loss with an exercise only control intervention on cardiometabolic disease risk), and functional status and quality of life (Specific Aim #3: To compare the effects of a change in diet composition alone or combined with weight loss with an exercise only control intervention on functional status and quality of life). Participants were randomly assigned to one of three groups: Exercise Only (Control) Intervention, Exercise + Diet Quality + Weight Maintenance Intervention, or Exercise + Diet Quality + Weight Loss Intervention. CROSSROADS utilized a lifestyle intervention approach consisting of exercise, dietary, and behavioral components. The development and implementation of the CROSSROADS protocol, including a description of the methodology, detailing specific elements of the lifestyle intervention, assurances of treatment fidelity, and participant retention; outcome measures and adverse event monitoring; as well as unique data management features of the trial results, are presented in this article.