Tina M. Kruger

Formative research conducted in rural Appalachia to inform a community physical activity intervention.

Purpose. Despite the well-established benefits of physical activity (PA), most Americans, especially those in rural, traditionally underserved areas, engage in considerably less PA than recommended. This study examines perceived barriers to and facilitators of PA and promising organized PA programs among rural Appalachians. Design. Eight focus groups and seven group key informant interviews were conducted. Setting. This study was conducted in eastern Kentucky, in central Appalachia. Subjects. One hundred and fourteen rural Appalachian residents (74% female, 91% white) participated. Measures. Open-ended, semistructured, and structured questions regarding perceptions of, barriers to/facilitators of, and examples of successful/failed PA programs were asked. Analysis. Qualitative data analysis was conducted, including codebook development and steps taken to ensure rigor and transferability. Interrater reliability was over 94%. Results. In addition to barriers that are consistent with those found in other populations, rural Appalachian residents indicated that travel time, family commitments, and inadequate community resources undermine PA. Suggested avenues to increase PA include partnership with churches and the U.S. Department of Agricultures Cooperative Extension Service; programs that include families, are well advertised, and focus on health rather than appearance; and, underlying all suggestions, culturally relevant yet nonstereotyping activities. Conclusions. When developing PA interventions in rural Appalachia, it is important to employ community-based participatory approaches that leverage unique assets of the population and show potential in overcoming challenges to PA.

Alcohol effects on Cognitive Change in Middle-Aged and Older Adults

Objectives: This study examines cognitive outcomes for alcohol drinking status over time, across cognitive ability and age groups. Methods: Data (1998–2005) from n = 571 Seattle Longitudinal Study participants aged 45+years (middle-aged: 45–64, young-old: 65–75, old-old: 75+) were analyzed to examine the alcohol drinking status effect (e.g., abstinent, moderate (less than seven drinks/week), at-risk (more than eight drinks/week)) on cognitive ability (e.g., memory, reasoning, spatial, verbal number, speed abilities). Results: Findings indicated that alcohol drinking status was associated with change in verbal ability, spatial ability, and perceptual speed. Decline in verbal ability was seen among alcohol abstainers and moderate alcohol consumers, but at-risk drinkers displayed relative stability. At-risk old-old adults and middle-aged adults (regardless of drinking status), displayed relative stability in spatial ability. Decline in spatial ability was however present among young-old adults across drinking status, and among abstaining and moderate drinking old-old adults. At-risk drinkers showed the most positive spatial ability trajectory. A gender effect in perceptual speed was detected, with women who abstained from drinking displaying the most decline in perceptual speed compared with women that regularly consumed alcohol, and men displaying decline in perceptual speed across drinking status. Discussion: In this study, consuming alcohol is indicative of cognitive stability. This conclusion should be considered cautiously, due to study bias created from survivor effects, analyzing two time points, health/medication change status, and overrepresentation of higher socioeconomic status and white populations in this study. Future research needs to design studies that can make concrete recommendations about the relationship between drinking status and cognition.

Massage Therapy Usage and Reported Health in Older Adults Experiencing Persistent Pain

BACKGROUND Persistent pain is a frequent complaint among older adults and can greatly decrease quality of life while also contributing to other negative outcomes such as poor health, increased pharmaceutical medication usage, increased rates of depression, and cognitive decline. OBJECTIVE The current study (N = 69) examines the potential impact of massage therapy (MT) in older adults (60+ years) with persistent pain, by comparing self-reported health outcome scores among those who have and have not utilized massage therapy in the past year. DESIGN The current study was derived from a larger study that collected data as part of a one-time, self-report, mail-in survey. PARTICIPANTS Lexington, Kentucky area adults, 60 and older who reported persistent pain were eligible to participate in the study. OUTCOME MEASURES The RAND 36-Item Health Survey was used to determine participant health-related quality of life. RESULTS The current study demonstrated that for older adults experiencing persistent pain, massage is associated with self-report of less limitation due to physical or emotional issues, better emotional health, more energy/less fatigue, better social functioning, and better overall health. Age, education, cumulative morbidities, number of areas in which participants reported experiencing persistent pain, and number of complementary and alternative medicine options in addition to MT utilized in the past year did not affect the association between receipt of massage and better self-reports in those domains. CONCLUSIONS While many causes of pain for older adults elude cure, further study is warranted that examines MT as an intervention to improve coping in older adults with persistent pain.

Differential reports of pain and depression differentiate mild cognitive impairment from cognitively intact elderly participants.

Background: Positive associations between pain and depression in the general population have been well characterized; however, the interplay between pain, depression, and early cognitive decline, characterized as mild cognitive impairment (MCI), is poorly understood. Methods: The current study examined the association of self-reported pain complaints (measured by the 36-item Short Form Health Survey) and self-reported depressive symptoms (measured by the 30-item Geriatric Depression Scale) in cognitively intact participants (n = 492) and participants with a clinical diagnosis of MCI (n = 83). Results: Depressive symptoms and subjective reports of pain were significantly associated in the entire sample (r = .29; P < .0001). Multiple logistic regression modeling (adjusted for age, education, and APOE4 status as covariates) demonstrated that while depressive symptoms were positively associated with the diagnosis of MCI (P < .001), subjective pain reports were negatively associated with MCI (P < .002). Conclusion: While the negative association of subjective pain complaints with MCI might arguably be explained by the development of anosognosia, self-reports of depressive symptoms were actually increased in these participants, suggesting preserved insight into cognitive decline–associated symptoms. It is possible that preferential involvement of limbic circuitry in MCI could explain these findings. Future studies are needed to elucidate the reasons for the dissociation of pain and depressive symptoms in MCI described in the present article.

Perceptions of Smoking Cessation Programs in Rural Appalachia

OBJECTIVES To identify perspectives on smoking cessation programs in Appalachian Kentucky, a region with particularly high smoking rates and poor health outcomes. METHODS Insufficient existing research led us to conduct 12 focus groups (smokers and nonsmokers) and 23 key informant interviews. RESULTS Several findings previously not described in this high-risk population include (1) transition from pro-tobacco culture toward advocacy for tobacco cessation approaches, (2) region-specific challenges to program access, and (3) strong and diverse social influences on cessation. CONCLUSIONS To capitalize on changes from resistance to support for smoking cessation, leaders should incorporate culturally appropriate programs and characteristics identified here.

Evaluation of the Mental Healthiness Aging Initiative: Community Program to Promote Awareness About Mental Health and Aging Issues

The objective of this study is to evaluate the Mental Healthiness Aging Initiative, designed to promote community awareness and knowledge about mental health and aging issues. This study occurred during 2007–2009 in 67 of 120 counties in Kentucky. A rural region (11 counties) received the intervention, consisting of focus groups, Extension Agent training, and television-based social marketing campaign. Partial-intervention counties (29 counties) received only the television-based social marketing campaign. The control counties (27 counties) received no intervention activities. Results indicated that the intervention counties agreed more with being able to assist elder adults with a potential mental illness. Also, the intervention counties understood the risk of consuming alcohol and medications better, but had a poorer recognition of drinking problems in elder adults. These findings need to be considered within study limitations, such as measurement error, degree of intervention exposure, and regional differences across intervention groups. The study demonstrates that community interventions on mental health awareness and knowledge are feasible within majority rural regions, with Extension Agents being gatekeepers, for promoting positive messages about mental health and aging issues.

The Nature and Meaning of Identity in Retired Professional Women

Through this study we sought to understand the complex experience of retirement and the meaning of identity for women who recently retired from a professional career. Through the use of qualitative methods, including photo elicitation, journaling, and a series of two in-depth interviews with each of six women, a fluid description of the meaning of identity among a small, homogenous sample of retired professional women was constructed. Salient themes included consistency of significant identity components from work to retirement, importance of social connectedness, engagement in continued learning; involvement in aspects of former work roles, and the importance of helping others.

Beyond Assessment: Conducting Theoretically Grounded Research on Service-Learning in Gerontology Courses

Service-learning is a useful pedagogical tool and high-impact practice, providing multiple benefits. Gerontology (and other) courses frequently include service-learning activities but lack theory-based, intentional research on outcomes. Here, the authors define service-learning and contextualize it in higher education, provide an overview of research and assessment in service-learning and gerontology courses, demonstrate the shortcomings of program evaluations, and offer suggestions for future research to advance and generate theory.

The Mental Healthiness and Aging Initiative: Lessons from a Social Marketing-Informed Research Campaign in Kentucky

The Mental Healthiness and Aging Initiative (MHAI) was a multifaceted social marketing-informed communication campaign designed to promote community awareness of mental health and aging. We hypothesized that MHAI would extend communication channels, providing a network for rapidly diffusing innovative mental health messages in Kentucky. Key messages discovered during formative research were incorporated into a communication campaign, which included a train-the-trainer curriculum, “Real Life Stories,” social advertising on radio and television, and a 12-month full-color calendar. We evaluated the impact of the train-the-trainer curriculum on the level of mental health and aging knowledge of Family and Consumer Science Agents in the Kentucky Cooperative Extension Service, who later diffused the campaign in local communities. Posttest scores showed a significant improvement (p = .005) in objective knowledge about mental health and aging. Two months after diffusion of MHAI, a random telephone survey of 744 Kentucky residents found that respondents from the full-intervention counties more frequently reported feeling able to assist older adults with a potential mental illness (p = .047) compared to residents in either partial intervention counties (social advertising only) or control counties (no contact). Lessons learned through the MHAI project can be applied by community mental health advocates to improve mental health outcomes.

Management of psychiatric appointments by telephone

Psychiatric treatments fail to produce positive outcomes when patients miss their appointments. Unfortunately, only about half of all patients needing psychiatric treatment actively engage in recommended treatment regimens. 1 The reasons for non-engagement include stigma, ageism (i.e. mental health problems are perceived to be a normal part of ageing) and absence of patient condition insight (denial).2,3 On the other hand, reasons to attend psychiatric appointments are treatment readiness, recognition of treatment benefits, collaborative physicians and positive psychiatric treatment history.4 This implies a need for more patient-centred strategies to increase psychiatric treatment engagement. Simple mail and telephone reminders are an efficient way of increasing treatment awareness and subsequently attendance, but treatment attendance rates vary, depending on the source, time frame and level of automation (approximately 6–84% treatment attendance).5 Thus, a telephone-based intervention modelled on brief motivational interviewing (BMI6) that focuses on individual patient experiences and principles was developed to increase psychiatric treatment engagement. The present study examined a system for psychiatric appointment management (PAM) in community outpatients.