John M. Parrish

Evaluating the cost-effectiveness of fall prevention programs that reduce fall-related hip fractures in older adults.

OBJECTIVES: To model the incremental cost‐utility of seven interventions reported as effective for preventing falls in older adults.

The Memory Fitness Program: Cognitive Effects of a Healthy Aging Intervention

CONTEXT Age-related memory decline affects a large proportion of older adults. Cognitive training, physical exercise, and other lifestyle habits may help to minimize self-perception of memory loss and a decline in objective memory performance. OBJECTIVE The purpose of this study was to determine whether a 6-week educational program on memory training, physical activity, stress reduction, and healthy diet led to improved memory performance in older adults. DESIGN A convenience sample of 115 participants (mean age: 80.9 [SD: 6.0 years]) was recruited from two continuing care retirement communities. The intervention consisted of 60-minute classes held twice weekly with 15-20 participants per class. Testing of both objective and subjective cognitive performance occurred at baseline, preintervention, and postintervention. Objective cognitive measures evaluated changes in five domains: immediate verbal memory, delayed verbal memory, retention of verbal information, memory recognition, and verbal fluency. A standardized metamemory instrument assessed four domains of memory self-awareness: frequency and severity of forgetting, retrospective functioning, and mnemonics use. RESULTS The intervention program resulted in significant improvements on objective measures of memory, including recognition of word pairs (t([114]) = 3.62, p <0.001) and retention of verbal information from list learning (t([114]) = 2.98, p <0.01). No improvement was found for verbal fluency. Regarding subjective memory measures, the retrospective functioning score increased significantly following the intervention (t([114]) = 4.54, p <0.0001), indicating perception of a better memory. CONCLUSIONS These findings indicate that a 6-week healthy lifestyle program can improve both encoding and recalling of new verbal information, as well as self-perception of memory ability in older adults residing in continuing care retirement communities.

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.

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.

Group Dynamics in a Discussion Group for Older Adults: Does Gender Play a Role?

Lifelong learning programs continue to grow in span and scope. Few studies, however, have investigated how older adults themselves participate in group learning. The central question explored in our study was as follows: Does gender play a role in group dynamics for older adults? Two groups of volunteers (age 62 to 96 years) enrolled in a 16-week discussion group. Groups were videotaped and turns at talk were counted. Results revealed that although men were the minority, they accounted for a substantial proportion of the turns at talk for both groups. Further research on lifelong learning is needed to understand how gender dynamics may affect older learners.

The Erickson Life Study: A Five-Year Examination of a Screening Tool in a Continuing Care Retirement Community

Continuing care retirement communities are an increasingly popular housing choice for older adults. The purpose of this study is to evaluate the validity of an entrance tool to predict transitions over a 5-year time period. A sample of 261 participants was recruited. A discriminant analysis revealed that baseline scores correctly classified the Year 5 status of 71.3% of the cases, with 69.6% of those who experienced a change in status classified correctly. The use of the tool potentially provides the staff an objective means for pinpointing the areas where services may be required for the residents’ well-being.