Nancy M. Gell

Patterns of Technology Use Among Older Adults With and Without Disabilities

PURPOSE OF THE STUDY The purpose of this study was to describe prevalence of technology use among adults ages 65 and older, particularly for those with disability and activity-limiting symptoms and impairments. DESIGN AND METHODS Data from the 2011 National Health and Aging Trends Study, a nationally representative sample of community-dwelling Medicare beneficiaries (N = 7,609), were analyzed. Analysis consisted of technology use (use of e-mail/text messages and the internet) by sociodemographic and health characteristics and prevalence ratios for technology usage by disability status. RESULTS Forty percent of older adults used e-mail or text messaging and 42.7% used the internet. Higher prevalence of technology use was associated with younger age, male sex, white race, higher education level, and being married (all p values <.001). After adjustment for sociodemographic and health characteristics, technology use decreased significantly with greater limitations in physical capacity and greater disability. Vision impairment and memory limitations were also associated with lower likelihood of technology use. IMPLICATIONS Technology usage in U.S. older adults varied significantly by sociodemographic and health status. Prevalence of technology use differed by the type of disability and activity-limiting impairments. The internet, e-mail, and text messaging might be viable mediums for health promotion and communication, particularly for younger cohorts of older adults and those with certain types of impairment and less severe disability.

The Feasibility of Reducing Sitting Time in Overweight and Obese Older Adults

Background. Overweight and obese older adults have high sedentary time. We tested the feasibility and preliminary effects of a sedentary time reduction intervention among adults over age 60 with a body mass index over 27 kg/m2 using a nonrandomized one-arm design. Methods. Participants (N = 25, mean age = 71.4, mean body mass index = 34) completed an 8-week theory-based intervention targeting reduced total sitting time and increased sit-to-stand transitions. An inclinometer (activPAL™) measured the primary outcomes, change in total sitting time and sit-to-stand transitions. Secondary outcomes included physical activity (ActiGraph GT3X+ accelerometer), self-reported sedentary behaviors, physical function (Short Physical Performance Battery), depressive symptoms (8-item Patient Health Questionnaire), quality of life (PROMIS), and study satisfaction. Paired t tests examined pre–post test changes in sitting time, sit-to-stand transitions, and secondary outcomes. Results. Inclinometer measured sitting time decreased by 27 min/day (p < .05) and sit-to-stand transitions increased by 2 per day (p > .05), while standing time increased by 25 min/day (p < .05). Accelerometer measured sedentary time, light-intensity, and moderate-to-vigorous physical activity improved (all p values ≤ .05). Self-reported sitting time, gait speed, and depressive symptoms also improved (all p values < .05). Effect sizes were small. Study satisfaction was high. Conclusions. Reducing sitting time is feasible, and the intervention shows preliminary evidence of effectiveness among older adults with overweight and obesity. Randomized trials of sedentary behavior reduction in overweight and obese older adults, most of whom have multiple chronic conditions, may be promising.

Mobility device use in older adults and incidence of falls and worry about falling: findings from the 2011-2012 National Health and Aging Trends Study

To examine the prevalence of mobility device use in community‐dwelling older adults in the United States and to investigate the incidence of falls and worry about falling according to type and number of mobility devices used.

Built environment attributes related to GPS measured active trips in mid-life and older adults with mobility disabilities

BACKGROUND Understanding factors which may promote walking in mid-life and older adults with mobility impairments is key given the association between physical activity and positive health outcomes. OBJECTIVE To examine the relationship between active trips and objective measures of the home neighborhood built environment. METHODS Global positioning systems (GPS) data collected on 28 adults age 50+ with mobility disabilities were analyzed for active trips from home. Objective and geographic information systems (GIS) derived measures included Walk Score, population density, street connectivity, crime rates, and slope within the home neighborhood. For this cross-sectional observational study, we conducted mean comparisons between participants who took active trips from home and those who did not for the objective measures. Effect sizes were calculated to assess the magnitude of group differences. RESULTS Nine participants (32%) took active trips from home. Walking in the home neighborhood was significantly associated with GIS derived measures (Walk Score, population density, and street density; effect sizes 0.9-1.2). Participants who used the home neighborhood for active trips had less slope within 1 km of home but the difference was not significant (73.5 m ± 22 vs. 100.8 m ± 38.1, p = 0.06, d = 0.8). There were no statistically significant differences in mean scores for crime rates between those with active trips from home and those without. CONCLUSIONS The findings provide preliminary evidence that more walkable environments promote active mobility among mid-life and older adults with mobility disabilities. The data suggest that this population can and does use active transportation modes when the built environment is supportive.

Rehabilitation Services Use and Patient-Reported Outcomes Among Older Adults in the United States

OBJECTIVE To characterize rehabilitation service use among community-dwelling older adults in the United States by identifying predictors of rehabilitation utilization, patient-reported functional improvement, and rehabilitation goal attainment. DESIGN Cross-sectional analysis of the 2015 National Health and Aging Trends Study, which used an age-stratified, multistage sampling design and oversampled blacks and the oldest old (≥85y). SETTING Standardized, in-person home interviews and physical performance testing. PARTICIPANTS Nationally representative sample of community-dwelling Medicare beneficiaries (N=7487) aged ≥65 years. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Rehabilitation services use (physical therapy, occupational therapy, and speech therapy) across all settings in the last year, patient-reported functional improvement, and patient-reported rehabilitation goal attainment. RESULTS Twenty percent of older adults reported rehabilitation use in the last year. In a multivariable model, rehabilitation use was significantly lower among blacks and higher among those with higher education, chronic medical conditions, pain, history of falls, and severe limitations in physical performance. Overall, 72% reported functional improvement during rehabilitation, and 75% reported meeting their goals by discharge. Improved function was associated with longer duration of rehabilitation. A significantly lower percentage of older adults with bothersome pain and severe physical limitations reported meeting rehabilitation goals. CONCLUSIONS Most older adults who received rehabilitation reported functional improvement and meeting rehabilitation goals. However, social disparities were evident with lower rehabilitation utilization among blacks and those with less education. Importantly, functional improvement and goal attainment did not vary by demographics or diagnoses. Longer duration of rehabilitation and improved pain management may be necessary for functional improvement and goal attainment.

A psychometric examination of multimorbidity and mental health in older adults

Objectives: Multimorbidity, the presence of multiple chronic medical conditions, is particularly prevalent in older adults. We examined the relationship of multimorbidity with mental health, social network and activity limitations in the National Health and Aging Trends Study, a nationally representative, age-stratified sample of older adults. Method: After excluding participants who used a proxy to complete the survey and those who did not answer any of the depressive symptoms, anxiety symptoms and positive and negative affect items, the final sample was 7026. A disease count of 10 conditions (heart disease, hypertension, arthritis, osteoporosis, diabetes, lung disease, stroke, dementia, cancer, fracture) was used. Results: Factor analysis indicated a one factor structure for disease count was tenable, although cancer did not appear to fit the model. Therefore, a count of the nine other diseases was used. Disease count was related to increased depressive symptoms, anxiety symptoms and negative affect and less positive affect. All individual diseases including cancer were related to worse mental health as was having two or more conditions. Disease count, having two or more conditions and several individual diseases (heart disease, hypertension, arthritis, cancer and fracture) were also related to increases in social network size while other individual diseases (osteoporosis, diabetes, lung disease, stroke and dementia) were related to decreases in social network size. All the measures of multimorbidity and individual diseases were associated with the increased odds of activity limitations. Conclusions: Results support a broader focus for older adults with multimorbidity that includes mental health needs.

Relationships between sitting time and health indicators, costs, and utilization in older adults.

Objective To examine whether self-reported sitting time is related to various health indicators, health costs, and utilization in adults over age 65. Methods A retrospective cross-sectional cohort study was conducted using the electronic health record (EHR) from an integrated health system in Washington State. Members who completed an online health risk assessment (HRA) between 2009 and 2011 (N = 3538) were eligible. The HRA assessed sitting time, physical activity, and health status. Diagnosis codes for diabetes and cardiovascular disease (CVD), height and weight for body mass index (BMI) calculations, health care utilization and health costs were extracted from the EHR. Linear regression models with robust standard errors tested differences in sitting time by health status, BMI category, diabetes and CVD, health costs, and utilization adjusting for demographic variables, BMI, physical activity, and health conditions. Results People classified as overweight and obese, that had diabetes or CVD, and with poorer self-rated health had significantly higher sitting time (p < .05). Total annual adjusted health care costs were

The Use of Text Messaging to Promote Physical Activity in Working Women: A Randomized Controlled Trial.

126 higher for each additional hour of sitting (p < .05; not significant in final models including health conditions). Conclusion Sitting time may be an important independent health indicator among older adults.

How do they do it: working women meeting physical activity recommendations.

BACKGROUND The study evaluated the effects of a text message intervention on physical activity in adult working women. METHODS Eighty-seven participants were randomized to an intervention (n = 41) or control group (n = 46). Pedometer step counts and measures of self-efficacy were collected at baseline, 12 weeks, and 24 weeks. Intervention participants received approximately 3 text messages per week that were motivational, informational, and specific to performing physical activity. RESULTS ANCOVA results showed a significant difference between groups for mean steps per day at 12 weeks (6540.0 vs. 5685.0, P = .01) and no significant difference at 24 weeks (6867.7 vs. 6189.0, P = .06). There was no change in mean step counts during or after the intervention compared with baseline. There was a significant difference between groups for mean self-efficacy scores at 12 weeks (68.5 vs. 60.3, P = .02) and at 24 weeks (67.3 vs. 59.0, P = .03). CONCLUSIONS Intervention participants had higher step counts after 12 and 24 weeks compared with a control group; however, the difference was significant only at the midpoint of the intervention and was attributable to a decrease in steps for the control group. Text messaging did not increase step counts but may be a cost-effective tool for maintenance of physical activity behavior.

Oral contraceptive use and fracture risk around the menopausal transition

OBJECTIVE To identify factors that facilitate adherence to physical activity among employed women. METHODS Participants were 103 employed women (Mean 44.4 years ±11.8). Measures included physical activity by accelerometry, location by global positioning systems, and psychosocial constructs, perception of worksite policies and the built environment by questionnaire. RESULTS Meeting physical activity recommendations was significantly associated with use of the built environment, self-regulation, perception of higher land-use mix diversity, and perception of lower infrastructure and safety for walking. Perception of worksite policies, self-efficacy, and social support were not associated with meeting recommendations. CONCLUSIONS The findings provide evidence that working womens physical activity behavior is influenced by both psychosocial and environmental factors.