Jean M. Gaines

A home-based pedometer-driven walking program to increase physical activity in older adults with osteoarthritis of the knee: A preliminary study

OBJECTIVES:  To determine whether a home‐based pedometer‐driven walking program with arthritis self‐management education (Walk +) would increase physical activity, muscle strength, and functional performance in older adults with osteoarthritis (OA) of the knee as opposed to arthritis self‐management education alone (EDU).

Isokinetic Strength Testing in Research and Practice

Age-related losses in lower extremity strength result in functional disabilities that diminish the quality of life for many older adults. Multiple factors, including type of muscle fiber, size of the muscle, length and speed of the muscle at contraction, age, and gender, affect the magnitude of strength generated. Assessment in clinical practice, in order to be cost and time effective, screens older adults for loss in strength. Further evaluation of strength loss requires the use of sophisticated procedures and equipment. Research into the causes of loss of strength and interventions to lessen or prevent loss of strength requires valid and reliable assessment tools. This article examines components of isokinetic muscle strength, the measurement of strength in clinical practice, methods to measure isokinetic strength, and validity and reliability of these measures.

Older men's knowledge about osteoporosis and educational interventions to increase osteoporosis knowledge in older men: A systematic review

OBJECTIVE The prevalence of osteoporosis and low bone density in men over the age of 65 is approximately 45%. The public health response to a disease affecting almost half of a given population includes assessment of knowledge and design of educational interventions in order to improve screening and prevention. The aim of this systematic review is two fold. We aim to describe older mens knowledge about the osteoporosis disease process, risk factors, and prevention. Second, we examine educational interventions designed to increase older mens knowledge about osteoporosis. METHODS Computerized literature searches were performed with multiple databases including Academic Search Premier, CINAHL, MEDLINE, SocINDEX, and Psychology and Behavioral Sciences Collection. Studies were considered if they included men aged 50 years or older, included a measure of osteoporosis knowledge and/or had an intervention designed to change osteoporosis knowledge and/or lifestyle risk factors for osteoporosis. RESULTS Thirteen studies were included in the review. Nine of the studies were cross-sectional studies on mens knowledge of osteoporosis. All of the studies found that men have minimal knowledge of the osteoporosis disease process, risk factors, and prevention. Four studies focused on education about osteoporosis. Educational interventions were found to increase initiation of calcium supplementation and knowledge about osteoporosis prevention. CONCLUSION Older men know remarkably little about the osteoporosis disease process, risk factors for the disease, or prevention. Education has the potential to improve this situation. Unfortunately, so few clinical trials have occurred that the best method for improving mens knowledge cannot be stated. Future studies examining knowledge and education of osteoporosis for men need to use validated instruments with a focus on risk factors pertinent to men.

Older Men's Knowledge of Osteoporosis and the Prevalence of Risk Factors

It has been estimated that up to 45% of men in the United States have low bone density. Yet, only a few studies have examined mens knowledge of bone health and disease. Mens knowledge of sex-specific issues related to osteoporosis is especially not well understood. We surveyed 1535 community-dwelling men with a mean age of 79 yr. The assessed risk factors included a current diagnosis of low bone mass, positive history for fracture, recent level of physical activity, and current medications with the potential to affect bone health. Knowledge about male risk factors for osteoporosis was also assessed, including the effects of advancing age, frame size, fracture risk, calcium and Vitamin D supplementation, low testosterone level, and treatment for prostate cancer. Within this sample, only 11% of the men reported a current diagnosis of low bone mass, whereas 11% reported a prior hip fracture. Only 5% of the sample reported taking some type of Food and Drug Administration-approved medication for osteoporosis. In the aggregate, the participating men answered only 39% of the 6 male osteoporosis-knowledge questions correctly. It is imperative that bone health promotion campaigns that have educated many women effectively now expand their focus to advance the bone health of men also.

Enhancing older driver safety: A driving survey and evaluation of the CarFit program

OBJECTIVE To evaluate CarFit, an educational program designed to promote optimal alignment of driver with vehicle. METHODS A driving activity survey was sent to 727 randomly selected participants living in retirement communities. Drivers (n=195) were assigned randomly to CarFit intervention (n=83, M age=78.1) or Comparison (n=112, M age=79.6) groups. After 6months, participants completed a post-test of driving activity and CarFit recommendations. RESULTS Nonconsenting drivers were older and participated in fewer driving activities. CarFit participation was moderate (71%) with 86% of the participants receiving recommendations. 60% followed the recommendations at the 6-month re-evaluation). The CarFit (67.6%) and Comparison (59.3%) groups reported at least one type of self-regulation of driving activity at baseline. There was no significant change in the driving behaviors at the six-month follow-up. CONCLUSION CarFit was able to detect addressable opportunities that may contribute to the safety of older drivers. IMPACT ON INDUSTRY CarFit recommendations may need stronger reinforcement in order to be enacted by a participant.

Validation of the Male Osteoporosis Knowledge Quiz

The purpose of this study was to validate the six-item Men’s Osteoporosis Knowledge Quiz (MOKQ). The MOKQ asks questions about risk factors that are pertinent to men, such as the risk for developing low bone mass related to hormone treatment for prostate cancer and the importance of testosterone for bone mass. A survey was sent to 242 men with a mean age of 83.2 years. The mean number of questions answered correctly in response to the six-item MOKQ was 2.37. Convergent validity was examined by correlating the score achieved on the MOKQ with the score achieved on the total Facts on Osteoporosis Quiz. The Pearson correlation coefficient for the MOKQ and the Facts on Osteoporosis Quiz was r = .76. Reliability was demonstrated by computing a Cronbach’s alpha for the MOKQ (r = .72). The MOKQ was found to have adequate reliability and validity in assessing older men’s knowledge about osteoporosis.

The Effect of the Addition of Osteoporosis Education to a Bone Health Screening Program for Older Adults

Osteoporosis affects approximately 26% of women and 4% of men after the age of 65 years. However, the diffusion of knowledge about osteoporosis risk factors, prevention and treatment remains low. The purpose of this longitudinal study was to investigate the value of adding initial and refresher osteoporosis education classes to a bone health screening program. A convenience sample of 376 men (n = 62) and women (n = 314) over the age of 62 years was assigned randomly to the Screening plus Education (n =193) or Screening only (n = 183) groups. Participants in both study groups demonstrated an increase in knowledge about osteoporosis, regardless of group assignment and other factors, over the two years of the study. Self-reported calcium use increased for all women and for men in the education group from baseline to year one, with a decline thereafter. There was no effect on exercise behaviors. This study points out the critical need for a more comprehensive and personalized bone health program that includes more than classroom-based education.

Health and Medical Services Use: A Matched Case Comparison Between CCRC Residents and National Health and Retirement Study Samples

Little is known about the health status of adults living in continuing care retirement communities (CCRC). Using matched-case control, 458 adults from the Health and Retirement Study (HRS) or a CCRC-based sample were compared on total comorbidity, self-rated health, home health services use, and hospitalizations. At year 2, the CCRC sample reported more comorbidities (96%) but significantly better self-rated health (96% good/excellent) than the HRS sample (93% comorbidity, 73% good/excellent; p < .01). There were no significant differences in frequency of home health use or hospitalization. Living in a CCRC appears to be associated with higher self-ratings of health in this sample.

Factors associated with hormone replacement therapy use in low-income urban women

Hormone replacement therapy (HRT) in the postmenopausal period results in significant long-term health benefits for aging women. Epidemiologic data suggest it may prevent age-related cardiovascular disease (CVD) and bone loss. Cardiovascular disease is the leading cause of mortality and disability in women.1 African-American women have a higher incidence of CVD and suffer the highest mortality compared to other races.2,3 Hormone replacement therapy use has been shown to decrease the risk of developing CVD by 20 –50%3,4 and overall mortality by 25%.4,5 Osteoporosis effects approximately 50% of women over 50 and 90% of women over 75. It is the major cause of nearly 1.5 million bone fractures in the U. S. annually.6 Postmenopausal bone loss can be decreased with HRT use resulting in a 50% reduction in fractures.7 Although the relationship is less clear, preliminary studies suggest that HRT may reduce the risk of developing Alzheimer’s disease as well.8,9 In spite of evidence supporting the benefits of HRT use, on average less than 40% of women use HRT and less than 50% of those stay on therapy for longer than one year.10 These rates vary significantly for different populations, with many studies reporting the highest use among white, younger, educated women,11–15 although one study found HRT use was more common in older

One of my fears is that physically or mentally, the time will come where I'll be unable to drive anymore. and I'm not looking forward to that: a mixed methods feasibility study to assess older driver's risk impairment.

Sixty-seven older adults were assessed using multiple validated tools. The current study aimed to identify high-, medium-, and low-risk impairment among older drivers and to explore high-risk drivers’ reactions to being told their results. Of 67 adults screened from a convenience sample of older drivers, nine high-risk participants, four completed in-depth follow-up qualitative interviews. The quantitative assessment algorithm identified 13% as high risk, 30% as medium risk, and 57% as low risk, and only Trails B distinguished the medium- and high-risk impairment groups. Although the assessment tests did not predict future crash involvement over a 7-month period, four participants in the medium- and high-risk impairment categories had been involved in a crash during the 5 years prior to the study compared with none of those who screened low risk. Only three participants (1 high risk) voluntarily surrendered their driver’s licenses after the assessment, and one participant in the in-depth interviews reported that the assessment influenced the decision to stop driving. There may be some benefit in using driving record history and assessment results to determine driving risk impairment level. However, more research is needed to determine the best combination of tools to predict risk level. How to best communicate risk levels remains to be determined, although results from the older drivers in this study underscore the need for great sensitivity when identifying areas of concern about driving ability.