Katherine H. Leith

Exploring the service needs and experiences of persons with TBI and their families: The South Carolina experience

Primary objective: This article presents the results of four focus groups with persons with traumatic brain injury (TBI) and their families living in South Carolina. The objective was to learn what participants perceive their service needs to be and where they experience service gaps in the existing system of TBI services. Methods and procedures: Four focus groups were conducted. In each group, a convenience sample of persons <5 years post-injury and family members responded to 10 semi-structured questions. Main outcomes: Qualitative content analysis revealed overwhelming consensus regarding the need for (1) early, continuous, comprehensive service delivery; (2) information/education; (3) formal/informal advocacy; (4) empowerment of persons with TBI/families; and (5) human connectedness/social belonging. Conclusions: Persons with TBI and families in South Carolina experience the service system as unorganized, uneducated, unresponsive and uncaring. Effective strategies are needed that link services into an ongoing continuum of TBI care, increase TBI-specific education and awareness and foster social re-integration.

Physical Activity and Older Adults: Expert Consensus for a New Research Agenda

PURPOSE This study sought to advance the state of knowledge regarding physical activity and aging by identifying areas of agreement among experts regarding topics that are well understood versus those that are in urgent need of continued research efforts. DESIGN AND METHODS We used a web-based survey with snowball sampling to identify 348 experts who were invited to complete a brief web-based survey. Responses were received from 38% of invited respondents. RESULTS Respondents reported that the efficacy and effectiveness of several types of physical activity were well understood but the dose-response relationship required for a health benefit was not. In general, more research is needed examining the effectiveness of programs on cognitive health outcomes and the impact of multiple risk factor programs. With respect to translation, more research is needed on how to maintain older adults in evidence-based programs and how to adapt programs for special populations. Researchers agreed that racial/ethnic minorities; persons with low socioeconomic status; and those with physical, intellectual, or mental health disability were substantially understudied. Finally, research on maintenance, implementation, and reach with respect to these populations was judged to be more urgently needed than research on efficacy and effectiveness. IMPLICATIONS A substantial amount of consensus was found across a national group of experts. These findings should be instrumental in forging a new research agenda in the area of aging and physical activity.

Physical activity and older adults

PURPOSE This study sought to advance the state of knowledge regarding physical activity and aging by identifying areas of agreement among experts regarding topics that are well understood versus those that are in urgent need of continued research efforts. DESIGN AND METHODS We used a web-based survey with snowball sampling to identify 348 experts who were invited to complete a brief web-based survey. Responses were received from 38% of invited respondents. RESULTS Respondents reported that the efficacy and effectiveness of several types of physical activity were well understood but the dose-response relationship required for a health benefit was not. In general, more research is needed examining the effectiveness of programs on cognitive health outcomes and the impact of multiple risk factor programs. With respect to translation, more research is needed on how to maintain older adults in evidence-based programs and how to adapt programs for special populations. Researchers agreed that racial/ethnic minorities; persons with low socioeconomic status; and those with physical, intellectual, or mental health disability were substantially understudied. Finally, research on maintenance, implementation, and reach with respect to these populations was judged to be more urgently needed than research on efficacy and effectiveness. IMPLICATIONS A substantial amount of consensus was found across a national group of experts. These findings should be instrumental in forging a new research agenda in the area of aging and physical activity.

The Steps to Health Randomized Trial for Arthritis A Self-Directed Exercise Versus Nutrition Control Program

BACKGROUND Despite the established benefits of exercise for adults with arthritis, participation is low. Safe, evidence-based, self-directed programs, which have the potential for high reach at a low cost, are needed. PURPOSE To test a 12-week, self-directed, multicomponent exercise program for adults with arthritis. DESIGN Randomized controlled trial. Data were collected from 2010 to 2012. Data were analyzed in 2013 and 2014. SETTING/PARTICIPANTS Adults with arthritis (N=401, aged 56.3 [10.7] years, 85.8% women, 63.8% white, 35.2% African American, BMI of 33.0 [8.2]) completed measures at a university research center and participated in a self-directed exercise intervention (First Step to Active Health(®)) or nutrition control program (Steps to Healthy Eating). INTERVENTION Intervention participants received a self-directed multicomponent exercise program and returned self-monitoring logs for 12 weeks. MAIN OUTCOME MEASURES Self-reported physical activity, functional performance measures, and disease-specific outcomes (arthritis symptoms and self-efficacy) assessed at baseline, 12 weeks, and 9 months. RESULTS Participants in the exercise condition showed greater increases in physical activity than those in the nutrition control group (p=0.01). Significant improvements, irrespective of condition, were seen in lower body strength, functional exercise capacity, lower body flexibility, pain, fatigue, stiffness, and arthritis management self-efficacy (p values<0.0001). More adverse events occurred in the exercise than nutrition control condition, but only one was severe and most were expected with increased physical activity. CONCLUSIONS The exercise program improves physical activity, and both programs improve functional and psychosocial outcomes. Potential reasons for improvements in the nutrition control condition are discussed. These interventions have the potential for large-scale dissemination. This study is registered at Clinicaltrials.gov NCT01172327.

The Healthy Aging Research Network: Resources for Building Capacity for Public Health and Aging Practice

There is an urgent need to translate science into practice and help enhance the capacity of professionals to deliver evidence-based programming. We describe contributions of the Healthy Aging Research Network in building professional capacity through online modules, issue briefs, monographs, and tools focused on health promotion practice, physical activity, mental health, and environment and policy. We also describe practice partnerships and research activities that helped inform product development and ways these products have been incorporated into real-world practice to illustrate possibilities for future applications. Our work aims to bridge the research-to-practice gap to meet the demands of an aging population.

Dementia and co‐occurring chronic conditions: a systematic literature review to identify what is known and where are the gaps in the evidence?

The challenges posed by people living with multiple chronic conditions are unique for people with dementia and other significant cognitive impairment. There have been recent calls to action to review the existing literature on co‐occurring chronic conditions and dementia in order to better understand the effect of cognitive impairment on disease management, mobility, and mortality.

Using Social Network Analysis to Assess Mentorship and Collaboration in a Public Health Network

Introduction Addressing chronic disease burden requires the creation of collaborative networks to promote systemic changes and engage stakeholders. Although many such networks exist, they are rarely assessed with tools that account for their complexity. This study examined the structure of mentorship and collaboration relationships among members of the Healthy Aging Research Network (HAN) using social network analysis (SNA). Methods We invited 97 HAN members and partners to complete an online social network survey that included closed-ended questions about HAN-specific mentorship and collaboration during the previous 12 months. Collaboration was measured by examining the activity of the network on 6 types of products: published articles, in-progress manuscripts, grant applications, tools, research projects, and presentations. We computed network-level measures such as density, number of components, and centralization to assess the cohesiveness of the network. Results Sixty-three respondents completed the survey (response rate, 65%). Responses, which included information about collaboration with nonrespondents, suggested that 74% of HAN members were connected through mentorship ties and that all 97 members were connected through at least one form of collaboration. Mentorship and collaboration ties were present both within and across boundaries of HAN member organizations. Conclusion SNA of public health collaborative networks provides understanding about the structure of relationships that are formed as a result of participation in network activities. This approach may offer members and funders a way to assess the impact of such networks that goes beyond simply measuring products and participation at the individual level.

Effect of Physical Activity, Social Support, and Skills Training on Late-Life Emotional Health: A Systematic Literature Review and Implications for Public Health Research

Purpose Given that emotional health is a critical component of healthy aging, we undertook a systematic literature review to assess whether current interventions can positively affect older adults’ emotional health. Methods A national panel of health services and mental health researchers guided the review. Eligibility criteria included community-dwelling older adult (aged ≥ 50 years) samples, reproducible interventions, and emotional health outcomes, which included multiple domains and both positive (well-being) and illness-related (anxiety) dimensions. This review focused on three types of interventions – physical activity, social support, and skills training – given their public health significance and large number of studies identified. Panel members evaluated the strength of evidence (quality and effectiveness). Results In all, 292 articles met inclusion criteria. These included 83 exercise/physical activity, 25 social support, and 40 skills training interventions. For evidence rating, these 148 interventions were categorized into 64 pairings by intervention type and emotional health outcome, e.g., strength training targeting loneliness or social support to address mood. 83% of these pairings were rated at least fair quality. Expert panelists found sufficient evidence of effectiveness only for skills training interventions with health outcomes of decreasing anxiety and improving quality of life and self-efficacy. Due to limitations in reviewed studies, many intervention–outcome pairings yielded insufficient evidence. Conclusion Skills training interventions improved several aspects of emotional health in community-dwelling older adults, while the effects for other outcomes and interventions lacked clear evidence. We discuss the implications and challenges in moving forward in this important area.

Developing a Framework and Priorities to Promote Mobility Among Older Adults

Mobility, broadly defined as movement in all of its forms from ambulation to transportation, is critical to supporting optimal aging. This article describes two projects to develop a framework and a set of priority actions designed to promote mobility among community-dwelling older adults. Project 1 involved a concept-mapping process to solicit and organize action items into domains from a broad group of stakeholders to create the framework. Concept mapping uses qualitative group processes with multivariate statistical analysis to represent the ideas visually through maps. A snowball technique was used to identify stakeholders (n = 211). A 12-member steering committee developed a focus prompt, “One specific action that can lead to positive change in mobility for older adults in the United States is . . .” Project 2 included a Delphi technique (n = 43) with three iterations to prioritize four to six items using results from the concept mapping rating process. Project 1 resulted in 102 items across nine domains (Research to Practice, Independence and Engagement, Built Environment and Safety, Transportation, Policy, Housing and Accessibility, Community Supports, Training, and Coordinated Action). The number of items ranged from 6 to 18 per domain. Project 2 resulted in agreement on four items that reflect the importance of promoting environmental strategies through collaborative initiatives aimed at planning and best practices focusing on environmental enhancements or transit, training of professionals, and integration of mobility into state and local public health plans. These findings can be applied to support coordinated, multidisciplinary research and practice to promote mobility among older adults.

Editor's Choice: Physical Activity and Older Adults: Expert Consensus for a New Research Agenda

PURPOSE This study sought to advance the state of knowledge regarding physical activity and aging by identifying areas of agreement among experts regarding topics that are well understood versus those that are in urgent need of continued research efforts. DESIGN AND METHODS We used a web-based survey with snowball sampling to identify 348 experts who were invited to complete a brief web-based survey. Responses were received from 38% of invited respondents. RESULTS Respondents reported that the efficacy and effectiveness of several types of physical activity were well understood but the dose-response relationship required for a health benefit was not. In general, more research is needed examining the effectiveness of programs on cognitive health outcomes and the impact of multiple risk factor programs. With respect to translation, more research is needed on how to maintain older adults in evidence-based programs and how to adapt programs for special populations. Researchers agreed that racial/ethnic minorities; persons with low socioeconomic status; and those with physical, intellectual, or mental health disability were substantially understudied. Finally, research on maintenance, implementation, and reach with respect to these populations was judged to be more urgently needed than research on efficacy and effectiveness. IMPLICATIONS A substantial amount of consensus was found across a national group of experts. These findings should be instrumental in forging a new research agenda in the area of aging and physical activity.