Quality of life in older adults: Benefits from the productive engagement in physical activity

Participation and Quality of Life Among Older Adults: Comparison Study of Ethnic Majority and Minority Groups

IMPORTANCE

Participation is a central determinant of older adults' health and quality of life (QoL). Examining participation and QoL among older adults from different ethnic groups through an occupational justice lens is vital in occupational therapy.

OBJECTIVE

To compare participation (objective and subjective) and QoL among older adults from two ethnic populations (Arab and Jewish) and to examine the relationships between sociodemographics, health-related variables, and participation with QoL in both groups.

DESIGN

Cross-sectional quantitative and comparative.

SETTING

Community-dwelling older adults in Israel.

PARTICIPANTS

A total of 190 adults ages 65 yr and older (90 Arabs, 100 Jews) who had not been hospitalized in the past month.

OUTCOMES AND MEASURES

We used a background questionnaire, the four-item Patient Health Questionnaire for Anxiety and Depression, the Experiencing Day-to-Day Life Questionnaire, and the World Health Organization Quality of Life-Brief Version.

RESULTS

The minority group reported lower education, poorer health, and lower participation and QoL scores compared with the majority group. Making ends meet, education, health-related variables, and participation were significantly correlated with QoL in both groups, with a higher correlation between subjective participation and QoL in the Arab group.

CONCLUSIONS AND RELEVANCE

Participation and QoL vary among older adults from different ethnic groups, with sociodemographics and health-related variables interconnected in both groups. The findings support the study hypotheses, highlighting the potential role of social factors on participation and the importance of encouraging subjective participation to enhance QoL, especially among minority groups. Further studies among diverse minority groups are recommended. Plain-Language Summary Participation, or involvement in purposeful and meaningful daily activities, is a central determinant of older adults' health and quality of life. This study examined differences in sociodemographics, health, participation, and quality of life among older adults from ethnic majority versus minority groups. The study emphasizes the potential impact of social aspects on participation and the importance of encouraging subjective participation to improve quality of life, especially among minority groups. Developing and tailoring occupational therapy intervention programs that address inequities through the lens of occupational justice can promote participation in meaningful activities and enhance older adults' quality of life, especially among minority groups.

Enhancing Quality of Life: Key Factors from Long-Term Social Care Residents' Perspectives

The purpose of this study was to investigate the most important factors shaping the quality of life in a social care institution from the clients' perspective. This study examines factors beyond direct care that affect the quality of life for clients in social care institutions, focusing on Riga Municipality's Social Care Center "Gailezers". Structured interviews with 95 clients assessed six domains: autonomy, relationships, activities, environment, food, and care quality. This study emphasizes the need to align services with clients' views to enhance their well-being. Based on the results, this study aimed to develop practical proposals for adjusting the content and organization of social care services to better align with the clients' understanding of the factors affecting their quality of life in the institution.

Sense of belonging and its positive association with physical activity levels and negative association with sedentary behaviors in residential aged care facilities in COVID-19 pandemic: a longitudinal study

Introduction

The COVID-19 pandemic reduced physical activity levels and increased sedentary behavior among older adults in residential care facilities. Another effect of this crisis was that facilitating a sense of social belonging through in-person social activities, such as group exercises or communal meals, became difficult. This study examines the relationship between physical activity, sedentary behavior, and sense of social belonging in older adults.

Methods

This longitudinal study, which lasted 10 months, involved 57 older adults in residential care facilities. Participants completed the Échelle de mesure du Sentiment d'Appartenance Sociale (ESAS) questionnaire three times and wore an accelerometer on their waists for 1 week each time to measure sedentary time and physical activity levels. The ESAS questionnaire, a validated tool for evaluating social belonging in older adults, measures social belonging through a series of questions that assess an individual's feelings of acceptance and intimacy within their social group.

Results

Participants were predominantly sedentary (7.30 h/day) and engaged in low-intensity physical activities (2.9 h/day). They did not meet the recommended 150 min/week of moderate-to-vigorous physical activity. The sense of social belonging was high, with mean scores of 6.75 (ESAS), 7.08 (Acceptance), and 6.43 (Intimacy). Light physical activity was negatively associated with sedentary time. The sense of social belonging was positively associated with light physical activity and negatively correlated to sedentary time.

Conclusion

This study underscores the importance of light physical activity and a sense of social belonging in reducing sedentary behavior among older adults in residential care facilities. By promoting social interactions and light physical activity, we can enhance the well-being of this population, especially during pandemic conditions. The study's findings should inspire future interventions to focus on these aspects, thereby improving health outcomes in residential care facilities for older adults.

Factors associated with physical fitness and disparities in population segments among older adults: A cross-sectional study

Objectives

This study aimed to investigate the factors associated with physical fitness and disparities in population segments among older adults, using data from the National Physical Fitness Surveilling Survey of China.

Study design

A cross-sectional study.

Methods

A total of 13524 older adults aged 60-79 years were involved in the study. Participants completed physical fitness assessments encompassing body fat percentage, lung capacity, high leg raise in place, grip strength, seated forward bending, 30-s sit-to-stand test, single-leg standing with eyes closed, and choice reaction time. A profile analysis model was constructed by feature extraction, label design and clustering using principal component analysis and k-prototypes. Factors associated with physical fitness were analyzed using ordered probit regression, and within-group differences were evaluated through the bootstrap method.

Results

The older adults were categorized into four clusters based on the clustering results (Cluster I: n = 2728, Cluster II: n = 6067, Cluster III: n = 4189, Cluster IV: n = 540). Significant positive associations were identified between moderate-to-vigorous transport-related activities ( α  = 0.001, p < 0.05), moderate-to-vigorous household chores ( α  = 0.003, p < 0.01), work-related physical activity ( α  = 0.001, p < 0.01), exercise ( α  = 0.002, p < 0.01) and physical fitness levels. Conversely, the number of illnesses ( α  = -0.089, p < 0.01) and sedentary behavior ( α  = -0.002, p < 0.05) were negatively associated with physical fitness. Inflection points were observed, indicating shifts from lower level to higher physical fitness levels as the volume of diverse moderate-to-vigorous physical activities increased. Disparities in factors associated with physical fitness were identified across the different clusters. The associations of household chores, transport-related activities, and work-related physical activity with physical fitness lacked robustness during heterogeneity processing. In contrast, exercise consistently demonstrated a facilitating role across all clusters. Furthermore, greater marginal effects on achieving higher physical fitness test scores were observed among individuals classified as inactive when engaging in more moderate-to-vigorous activities and exercise.

Conclusion

The findings demonstrate that engagement in moderate-to-vigorous physical activities and exercise is associated with a significantly higher probability of achieving better physical fitness among older adults. Participating in physical activities and exercise should be encouraged based on population segments for precise and quantitative interventions to improve physical fitness.

Types of Home and Community-Based Physical Activity and Their Effects on the Older Adults' Quality of Life: A Systematic Review and Meta-Analysis

Home and community-based physical activity (HCBPA) has been extensively utilized among older adults. Nevertheless, the varying types of HCBPA, including different duration, intensity, and frequency, have sparked controversy regarding their impact on the quality of life in older adults. This study aims to explore the effects of HCBPA on QoL in older adults. We conducted a systematic review and retrieved studies published from January 2000 to April 2023 from multiple databases (PubMed, Embase, Cochrane, and the Web of Science Library). Seventeen articles met the inclusion criteria for this study. Long-term HCBPA interventions may have a more pronounced positive impact on older adults' quality of life than short-term ones, with the intervention's intensity and frequency playing a key role in its effectiveness. The results of the meta-analyses showed significant differences in PCS but not in MCS, both with low certainty of evidence. Policymakers should prioritize the importance of promoting HCBPA interventions with appropriate duration, intensity, and frequency to create a more age-inclusive society.

Development and validation of a questionnaire to evaluate the productive engagement of Chinese older adults in the community

BACKGROUND

The evaluation of productive engagement of old adults has become a challenging task because cultural, ethical, religious, and other personal values may influence perceptions of the meaning and consequences of productive engagement. Assessing the productive engagement of the older adults is crucial to promote active and productive aging. The objective of this study was to develop and validate a questionnaire concerning the productive engagement of Chinese older adults in the community.

METHODS

A draft scale was created via a literature review and interviews with 17 older adults in the community, following the cross-cultural framework for productive engagement in later life. Content validity was assessed by seven experts. Subsequently, a preliminary questionnaire containing 33 items was developed and its psychometric properties were evaluated.

RESULTS

The final version of the questionnaire was composed of 27 items distributed across five dimensions. The overall standardized Cronbach's α for the productive engagement questionnaire was 0.904, with individual dimension values ranging from 0.759 to 0.869. Nearly all dimensions displayed satisfactory factor loadings. The correlation coefficient between each item's score and its respective dimension ranged from 0.473 to 0.723.

CONCLUSIONS

The developed questionnaire exhibited good validity and reliability, showing promise for effectively evaluating the productive engagement level of Chinese older adults within the community.

TRIAL REGISTRATION

Not applicable.

Activity and Participation Are Associated With Future Falls, Hospitalizations, and Emergency Visits in Community-Dwelling Older Adults

OBJECTIVE

Activity and participation are important for older adults as they are associated with well-being and quality of life. Falls, emergency department (ED) visits, and hospitalizations are adverse health outcomes that impact older adults. Limited research has investigated whether measurement of activity and participation are related to adverse health events in community dwelling older adults. This study sought to examine the association between activity and participation with falls, ED visits, and hospitalization over 1 year in community dwelling older adults.

METHODS

A secondary analysis of a longitudinal clinical trial of 341 community dwelling older adults was conducted. The sample mean age was 80.9 (SD = 7.7) years and 83% were female. One-year risk of falls was associated with baseline Late Life Function and Disability Instrument (LLFDI) components of overall function and disability (frequency and limitations dimensions). Incident rate ratios (IRRs) and 95% CIs were calculated.

RESULTS

For each five-point higher score (clinically meaningful difference) in activity as measured by LLFDI-overall function (adjusted for age, race, sex, comorbidities and fall history), there was an 18% lower rate of falls (IRR = 0.82, 95% CI = 0.74-0.92), 12% reduction in hospitalizations (IRR = 0.88; 95% CI = 0.77-0.99), and 11% lower rate of emergency room visits (IRR = 0.89, 95% CI = 0.81-0.98). Greater participation as measured by the LLFDI limitations dimension was related to fewer falls (IRR = 0.93, 95% CI = 0.87-1.00) and hospitalizations (IRR = 0.91, 95% CI = 0.83-0.99).

CONCLUSION

Greater activity and participation are associated with a lower incidence of falls, ED visits, and hospitalizations representing an important consideration for targeted physical therapist interventions.

IMPACT STATEMENT

Physical therapists are uniquely positioned to identify and address reduced activity and participation. If activity and participation are specifically targeted and improved through physical therapy, undesirable distal health outcomes might be prevented or minimized.

LAY SUMMARY

Greater activity and participation were found to be related to lower rate of falls, ED visits, and hospitalizations in a sample of 341 older adults who lived in the community.

Capturing multiple assistive technology use and its impact in later life: lessons learned from distinct measurement approaches

PURPOSE

Assistive technology (AT) use is prevalent in older adulthood and can accommodate activity difficulties to support well-being. However, within the context of multiple activity difficulties and multiple technology use, it is unclear how to best assess their combined effects on older adults' health outcomes. This study proposed four distinct approaches to quantify multiple AT use and examined their respective impact in later life.

MATERIAL AND METHODS

Using data from the 2015 round of the National Health and Aging Trends Study (n = 6,936), we compared four indices to summarize the state of multiple AT use among the U.S. older population: binary, item-specific, cumulative, and accommodative. Separate regression analyses tested the impact of each index on older adults' well-being and restricted participation in meaningful activities.

RESULTS

In 2015, 59.9% of the respondents were identified as AT users. Among these users, 53.8% reported using two or more technologies when performing daily self-care and mobility activities. The implications of multiple AT use for health outcomes varied across the four indices. Approaches that captured elements of person-technology fit provided the most nuanced and actionable insights on the benefits of using AT to support well-being.

CONCLUSIONS

ATs were commonly adopted by older adults in everyday activities. Overall, findings suggest that there are multiple approaches to conceptualize the independent, cumulative, or balanced effects of multiple AT use. Each measurement approach has unique implications for understanding the impacts of using ATs on older adults' health outcomes.

The association between osteoporosis and quality of life among older adults in Southern Iran: findings from the Bushehr Elderly Health Program

BACKGROUND & OBJECTIVE

Osteoporosis is a growing public health concern, particularly among the aging population. This study aimed to evaluate the association between osteoporosis and quality of life (QoL) in a sample of older adults.

METHODS

This cross-sectional study utilized data from all the participants of Bushehr Elderly Health program (BEHP), phase 2. QoL was assessed using the 12-Item Short Form Survey (SF-12 Questionnaire), and participants were classified as having osteoporosis or not based on the WHO diagnostic criteria. The physical (PCS) and mental (MCS) component summaries of QoL were estimated. The association between osteoporosis and QoL was evaluated separately for men and women, considering various health and lifestyle factors using linear regression analysis.

RESULTS

The study included 2,399 participants (average age 71.27 ± 7.36 years). 1,246 were women and 1,153 were men. Osteoporosis was present in 59% of women and 23% of men. Participants with osteoporosis had significantly lower PCS scores compared to those without osteoporosis (women: 38.1 vs. 40.2, p < 0.001; men: 44.3 vs. 45.8, p: 0.002). However, there was no statistically significant difference in MCS scores. Stratified by sex, osteoporosis was significantly associated with PCS in women [β = -2.14 (-3.13, -1.15)] and men [β = -1.53 (-2.52, -0.54)]. After accounting for relevant variables, the association remained significant in women [β=-0.95 (-1.87, -0.03)], but not in men [β=-0.63 (-1.55,0.28)].

CONCLUSION

This study highlights the significant association between osteoporosis and the physical component of QoL in both older men and women, particularly among women. Further research and interventions focusing on enhancing physical QoL in individuals with osteoporosis are warranted to promote healthier aging.

Patient engagement in multimorbidity: a systematic review of patient-reported outcome measures

Background

People with multimorbidity are increasingly engaged, enabled, and empowered to take responsibility for managing their health status. The purpose of the study was to systematically review and appraise the psychometric properties of tools measuring patient engagement in adults with multimorbidity and their applicability for use within engagement programs.

Methods

PubMed, Scopus, Web of Science, and PsycInfo were searched from inception to 1 July 2021. Gray literature was searched using EBSCO host-database "Open dissertation". The reference lists of studies meeting the inclusion criteria were searched to identify additional eligible studies. The screening of the search results and the data extraction were performed independently by two reviewers. The methodological quality of the included studies was evaluated with the COSMIN checklist. Relevant data from all included articles were extracted and summarized in evidence synthesis tables.

Results

Twenty articles on eight tools were included. We included tools that measure all four dimensions of patient engagement (i.e., engagement, empowerment, activation, and participation). Their psychometric properties were analyzed separately. Most tools were developed in the last 10 years in Europe or the USA. The comparison of the estimated psychometric properties of the retrieved tools highlighted a significant lack of reliable patient engagement measures for people with multimorbidity. Available measures capture a diversity of constructs and have very limited evidence of psychometric properties that are vital for patient-reported measures, such as invariance, reliability, and responsiveness.

Conclusion

This review clarifies how patient engagement, as operationalized in measures purporting to capture this concept, overlaps with, and differs from other related constructs in adults with multimorbidity. The methodological quality of psychometric tools measuring patient engagement in adults with multimorbidity could be improved.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=259968, identifier CRD42021259968.

Self-perceptions of aging, physical activity, and depressive symptoms in older community residents with varied neighborhood walkability in Taiwan

BACKGROUND

Prior research has identified the mediating effect of physical activity in the relationship between self-perceptions of aging and physical health. However, this impact on mental health is unknown, and the influence of environmental contexts proposed by ecological models in this regard remains largely unexplored. Therefore, this study aimed to investigate the role of physical activity in the relationship between self-perceptions of aging and depressive symptoms in older adults, and compare the impact across four levels of neighborhood walkability.

METHODS

A sample of 1,055 community-dwelling older adults aged 65 or above was obtained through random-digit-dialing computer-assisted telephone interviewing. The individual's neighborhood walkability was calculated using Walk Score®, and categorized into four levels: car-dependent, somewhat walkable, very walkable, and walker's paradise. Partial least squares structural equation modelling was employed.

RESULTS

We found that more positive self-perceptions of aging were associated with fewer depressive symptoms and a mediation effect of physical activity in this relationship. Among the four levels of neighborhood walkability, the mediation effect of physical activity was only statistically significant in the lowest level (car-dependent). The findings supported our hypotheses regarding the mediating effect of self-perceptions of aging on depressive symptoms via physical activity. Neighborhood walkability might potentially influence the mediating role of physical activity.

CONCLUSIONS

This study emphasizes key areas on intervention programs and policy formulation to promote mental health in older adults.

Exploring Wellness Through Concept Analysis

Modern wellness is a concept that has been discussed in the literature since the 1960's. To better understand wellness complexities in a school setting, a concept analysis was conducted using a modified version of Walker and Avant's method incorporating the nursing paradigm in the implications. A literature review was conducted and except for background information, the publication dates were limited to 2017-2022. Key search terms included "wellness," "school wellness," "wellness concept." Additional literature reviews were conducted based on data related to the definitions, attributes, antecedents, and consequences of wellness that were collected from the reviewed studies. Defining attributes of wellness included healthy habits, conscientiousness, and optimum state of health. The antecedents, consequences, and empirical referents of wellness were identified with examples from the literature and case exemplars. Wellness is a dynamic process that has unique implications for school health and school nurses. This concept analysis lays the foundation for future research incorporating nursing domains.

Why Rural-to-Urban Migrant Workers in China Continue Working After Age 60: A Qualitative Analysis

BACKGROUND AND OBJECTIVES

This study aims to examine why rural-to-urban migrant workers in China remain in the workforce after age 60.

RESEARCH DESIGN AND METHODS

Semistructured interviews were conducted and transcribed. Interview transcriptions were coded and analyzed by inductive content analysis.

RESULTS

Rural-to-urban migrant workers in China continue to work even after they reach age 60 for reasons related to personal and family finances, as well as cognitive motivational, sociocultural, and working condition factors.

DISCUSSION AND IMPLICATIONS

Findings from this study deepen our understanding of the specific reasons why older rural-to-urban migrant workers in China continue working after age 60. While these findings emphasize the need for improved welfare programs and enhanced health care for older migrant workers, they also underscore the importance of providing a healthy and safe work environment for older workers.

Effects of semi-immersive virtual reality exercise on the quality of life of community-dwelling older adults: Three-month follow-up of a randomized controlled trial

Objective

This study aimed to examine the effects of semi-immersive virtual reality (VR)-based exercise on the quality of life of older adults.

Methods

It used a randomized controlled trial design. Older adults (mean age: 72.16 ± 4.9 years) were randomly assigned to experimental (n = 48) and control (n = 50) groups. The experimental group engaged in semi-immersive VR exercise for 75-90 min, twice a week, for 12 weeks and partook in no other intervention between the end of the exercise intervention and follow-up. Control group members did not participate in any similar program during the intervention or follow-up periods. Both groups completed three assessments: at baseline (pre-test), post-intervention (post-test), and 3 months later (follow-up). Quality of life was assessed using the World Health Organization Quality of Life Instrument-Older Adults Module.

Results

Generalized estimating equation analyses indicated that the experimental group exhibited significant post-intervention improvements in quality of life in terms of sensory ability, autonomy, social participation/isolation, death and dying domain, and overall quality of life scores. However, none of these significant effects were maintained 3 months after exercise intervention cessation.

Conclusions

Semi-immersive VR exercise may be a feasible strategy toward enhancing the quality of life of older adults. However, the participants' quality of life was not maintained upon exercise cessation, indicating that older adults need to be encouraged to exercise regularly to maintain a good quality of life. VR may need to be combined with other modes of intervention in the future to facilitate long-term quality-of-life improvement in older adults.

Effectiveness of online-based cognitive intervention in community-dwelling older adults with cognitive dysfunction: A systematic review and meta-analysis

BACKGROUND

Mild cognitive impairment (MCI) or mild dementia imposes a substantial burden on patients, families, and social systems. For MCI or mild dementia patient, cognitive training is required to prevent progression to dementia. With advances in digital health, cognitive interventions using information and communication technology (ICT) have become essential for maintaining independence and functioning in dementia patients.

OBJECTIVES

This study aimed to examine the effectiveness of an ICT-based cognitive intervention in community-dwelling older adults with MCI or mild dementia.

METHODS

A literature search was performed in four databases: Ovid-Medline, Ovid-EMBASE, Cochrane Library, and CINAHL. We selected studies published up to April 15, 2021, on topics related to cognitive interventions using ICT in older adults with MCI or mild dementia.

RESULTS

Forty-four studies were included in the analysis. Our meta-analysis showed that ICT-based cognitive interventions significantly improved the Mini-Mental State Examination score in the intervention group compared with that in the control group. Additionally, cognitive training using ICT was significantly effective for a period of more than 30 min, more than 6 weeks, and multi-domain content. Moreover, a significant reduction in depression was found in the intervention group compared with that in the control group.

CONCLUSIONS

ICT-based cognitive intervention had a positive effect on cognitive function, depression, and quality of life in older adults with MCI or mild dementia. Application of ICT-based cognitive training to community-dwelling older adults with MCI or mild dementia should be expanded, and nurses should play a pivotal role in mediating between these older adults.

Relationship between specific leisure activities and successful aging among older adults

Background/Objectives

This study was designed to investigate the association between specific leisure activities and successful aging among older adults, using data from the Chinese Longitudinal Healthy Longevity Survey.

Methods

A total of 7689 older adults were involved in this study and categorized as successful aging group (n = 3989; 51.8%) or non-successful aging group (n = 3703; 48.2%). Participants were identified as successful aging if they had a score of more than 3 points, or as non-successful aging. The points were based on the following five items and each item was assigned 1 point: self-rated health, self-rated psychological status or mood, cognitive function, activities of daily life, and physical activity. Six activities including gardening work, reading newspapers or books, raising domestic animals or pets, playing cards or mahjong, watching TV or listening to radio, and participating in social activities were collected to reflect leisure activities. Chi-square tests, independent sample t-test, and logistic regression analyses were employed to explore the association between specific leisure activities and successful aging.

Results

The prevalence of successful aging was 51.8% among Chinese older adults. A significant positive relationship was found between the frequency of participation in specific leisure activities and successful aging (p < 0.05). Older adults who usually participated in leisure activities had greater odds for successful aging compared to those who never participated in leisure activities (adjusted odds ratio (OR): 1.31 (95% CI: 1.15-1.49) to 1.88 (95% CI: 1.62-2.19)). Older adults participating in one or more leisure activities had greater odds for successful aging compared to those who did not participate in leisure activities (adjusted OR: 1.51 (95% CI: 1.30-1.76) to 4.10 (95% CI: 2.44-6.89)).

Conclusions

The findings provide evidence that participating more frequently and in more leisure activities was associated with a greater probability of successful aging among Chinese older adults. Encouraging older people to participate frequently in a larger number of leisure activities may be a key to promote successful aging. Therefore, the frequency and number of participation in leisure activities should be highlighted and targeted for promoting successful aging.

Perceived occupational engagement and gaps among community-dwelling older adults in Malaysia

Introduction

Engagement in occupations is an essential aspect of daily life among older people. Changes in age are often associated with changes in the pattern of engagement in occupations. However, the relationship between the actual and desired activities pattern of occupational engagement remains unclear among community-dwelling older adults in Malaysia. This study aimed to determine occupational engagement for each activity and occupational gaps related to domains among the older adults.

Method

A cross-sectional study was conducted among 335 community-dwelling older people, using the Malay version of the Occupational Gaps Questionnaire (OGQ-M).

Findings

The findings indicate that there are significant differences in occupational engagement across domains: leisure (p < 0.001), social (p = 0.04) and total occupational domains (p < 0.001). There is a significant difference between actual and desired performed activities in doing laundry (p = 0.031), outdoor activities (p < 0.001), listening to the radio and watching television/video (p = 0.003), helping and supporting others (p = 0.019), travelling for pleasure (p < 0.001) and performing voluntary work (p = 0.025).

Conclusion

In conclusion, OGQ is a useful tool in screening the occupational gaps among community-dwelling older adults. Age, health and continuity of roles and responsibility as caretakers of the family are several factors that lead to higher occupational gaps among the older people in the community. With the emergence of occupational engagement and gaps, advancements in health care delivery are necessary for retirement planning among community-dwelling older adults in enhancing active participation towards better retirement life.

Methods for Successful Aging: An Aesthetics-Oriented Perspective Derived from Richard Shusterman's Somaesthetics

This study explored Richard Shusterman's somaesthetics to understand the rationale for his view on enhancing the body experience of older adults and increasing their participation in art; it also examined methods or successful aging to enhance the theoretical foundation for educational gerontology. Accordingly, the research objectives were to (1) analyze the definition of successful aging; (2) clarify the role of body experience and participation in art in promoting successful aging among older adults; (3) explore and discuss Shusterman's somaesthetics; and (4) explore methods for successful aging derived from Shusterman's somaesthetics. This study mainly explored educational philosophy by collecting, reading, analyzing, logically reviewing, and interpreting the literature on this topic. During this exploration, methods for successful aging were reviewed. The findings are as follows: (1) shifting focus of successful aging to the bodies of older adults; (2) cultivating the body consciousness of older adults enables them to understand themselves and pursue virtue, happiness, and justice; (3) popular art can be integrated to promote the aesthetic ability of older adults and encourage their physical participation in the aesthetic process; (4) older adult education should cultivate the somaesthetic sensitivity of older adults; (5) older adult education should incorporate the physical training of older adults to help them enhance their self-cultivation and care for their body, cultivate virtue, and live a better life; and (6) older adult education should integrate the body and mind of older adults.

Comparative Analysis of Physical Activity Detected via an External Accelerometer and Cardiac Implantable Electronic Devices

Background

Physical activity (PA) has become an important health issue for decades. Cardiovascular implantable electronic devices (CIEDs) have built-in PA-recording functions. We aimed to compare PA measurements using an external accelerometer (ActiGraph GT3X+) and internal accelerometers (Abbott, Biotronik, and Medtronic CIEDs).

Methods

This was a prospective, single-center observational study. The device-measured 7-day average PA was collected, and GT3X+ -measured 7-day average PA was used as the gold-standard, including all daily observations of activity. Pearson’s correlation coefficients were used to compare the correlations between GT3X+ -measured and CIED-measured PA. Bland-Altman plots were used to analyze measurement agreement, and intraclass correlation coefficients were used to analyze reliability.

Results

In total, 720 patients treated with CIEDs were surveyed between November 2020 and April 2021, 60 of them were analyzed after patient screening by our protocol. Each manufacturer included 20 patients for the final analysis. The CIED-measured PAs of Abbott, Biotronik, and Medtronic were 3.0 ± 1.5, 2.6 ± 1.8, and 3.8 ± 2.5 h per day, respectively; the GT3X+ -measured PAs were 6.9 ± 2.8, 6.0 ± 2.4, and 6.4 ± 2.5 h per day, respectively. Moderate and significant correlations were found in patients using Abbott, Biotronik, and Medtronic CIEDs (r = 0.534, p = 0.015; r = 0.465, p = 0.039; r = 0.677, p = 0.001, respectively). Bland-Altman plots and intraclass correlation coefficients both showed a significant correlation and reliability between the average PA measured by GT3X+ and CIEDs (hours per day).

Conclusion

Although the PA recording function of CIEDs includes a single-axis accelerometer, it has a moderate correlation compared with the triaxial accelerometer of the GT3X+. However, CIEDs seem to underestimate PA for 3–4 h compared to the GT3X+.

Functional Status, Quality of Life, and Physical Activity of Senior Club Members-A Cross-Sectional Study

This study aims to assess the functional status, quality of life, and physical activity (PA) of the elderly who are members of senior social clubs. The study included 63 participants (65-95 years old) who were members of a seniors club. The study utilized the following instruments: Barthel scale, Lawton's scale of Instrumental Activities of Daily Living (IADL), WHO Quality of Life-BREF questionnaire, author's survey questionnaire containing questions about the type of PA. Duration of membership in the senior club has a statistically significant effect on Barthel index score (F = 19.68, p < 0.001) and Lawton's IADL scale results (F = 17.59, p < 0.001). All four domains of life quality were strongly related to the duration of attendance to senior clubs. Participants who attended the senior club for more than five years were more likely to report a longer PA duration than participants who attended the senior club for less than 5 years (Chi2 = 25.84, p < 0.001). Attendance to senior social clubs has a strong positive impact on functional status, quality of life, and PA of the elderly. Moreover, our study identified numerous social-demographic factors associated with PA, quality of life, and functional status of senior club members.

Comparison of Activity and Participation, and Mental and Physical Functions of Immediate Post-Acute and Distant Post-Acute Adults with Chronic Cardiac Conditions

This study compared activity participation, and mental and physical functions of two different groups of adults with chronic cardiac conditions. Eleven participants were assessed at the immediate post-acute stage and 26 participants were at the distant post-acute stage. Participants at distant post-acute were significantly more physically active (p < .001), more activity-limited in cognition-related activities (p = .035) and reported more depressive symptoms than immediate post-acute (p = .046). No significant difference in participation level was found. More attention to functional cognition and depressive symptoms at immediate post-acute and individualized approaches to remove participation barriers in complex activities at distant post-acute are likely needed for adults with chronic cardiac conditions.

Neighborhood Environments and Utilitarian Walking Among Older vs. Younger Rural Adults

Introduction: Walking has the potential to promote health across the life span, but age-specific features of the neighborhood environment (NE), especially in rural communities, linked with walking have not been adequately characterized. This study examines the relationships between NE and utilitarian walking among older vs. younger adults living in US rural towns.

Methods: Data for this cross-sectional study came from telephone interviews in 2011–2012 with 2,140 randomly sampled younger (18–64 years, n = 1,398) and older (65+ years, n = 742) adults, collecting personal and NE perception variables. NE around each participant's home was also measured objectively using geographic information system techniques. Separate mixed-effects logistic regression models were estimated for the two age groups, predicting the odds of utilitarian walking at least once a week.

Results: Perceived presence of crosswalks and pedestrian signals was significantly related to utilitarian walking in both age groups. Among older adults, unattended dogs, lighting at night, and religious institutions were positively while steep slope was negatively associated with their walking. For younger adults, traffic speed (negative, –), public transportation (positive, +), malls (–), cultural/recreational destinations (+), schools (+), and resource production land uses such as farms and mines (–) were significant correlates of utilitarian walking.

Conclusion: Different characteristics of NE are associated with utilitarian walking among younger vs. older adults in US rural towns. Optimal modifications of NE to promote walking may need to reflect these age differences.

The Relationship between Experienced Respiratory Symptoms and Health-Related Quality of Life in the Elderly with Chronic Obstructive Pulmonary Disease

Background

Chronic obstructive pulmonary disease (COPD) is one of the diseases that usually present at an advanced age. Respiratory symptoms in patients with COPD are the most important for making treatment decisions and understanding the adverse effects on health-related quality of life (HRQoL). This study aimed to investigate HRQoL in elderly patients with COPD and examine the relationship between this in relation to respiratory symptoms experienced by them and their demographic characteristics.

Methods

This is a descriptive, correlational study of elderly patients with COPD who were hospitalized in five different hospitals in an urban area of Iran. A consecutive sampling method was used. Demographic data form, the respiratory symptoms component of St. George's Respiratory Questionnaire (SGRQ), and the Short Form 36 Health Survey Questionnaire (SF-36) were applied for data collection.

Results

The patients (n = 217) reported low HRQoL, and this impairment was more observed in the physical component. There was a significant inverse relationship between the experienced respiratory symptoms and physical (p=0.03) and mental (p < 0.001) components of HRQoL. Moreover, the female gender, the low level of education, the increased duration of the disease, the increased number of hospitalizations during the past year, and the use of two classes of drugs simultaneously were associated with the impaired HRQoL.

Conclusion

Our findings inform healthcare providers about the negative impacts of respiratory symptoms and other related factors on the HRQoL of elderly patients with COPD. Nurses and other healthcare providers should proactively identify respiratory symptoms and design appropriate caring strategies to improve HRQoL among this group.

Association between physical function and onset of coronary heart disease in a cohort of community-dwelling older populations: The SONIC study

BACKGROUND

Physical function is a strong predictor of the adverse outcomes of cardiovascular disease in older populations. However, studies of healthy older people on the prevention of coronary heart disease (CHD) are very limited.

OBJECTIVES

We prospectively examined the association of walking speed and handgrip strength with CHD in the community-dwelling older populations.

METHODS

The study cohort in Japan included 1272 older people free from heart disease at the baseline. Physical function was identified based on walking speed and handgrip strength assessment at the survey site. Any new case of CHD was identified based on a self-reported doctor's diagnosis. Cox-proportion hazard models were adjusted for covariate factors to examine the CHD risk.

RESULTS

During the 7-year follow-up, 45 new cases of CHD (25 men and 20 women) were documented. Slow walking speed was strongly associated with CHD risk after adjusting for all confounding factors in the total participants and women (hazard ratio (HR)= 2.53, 95%confidence interval (CI), 1.20-5.33, p=0.015, and HR= 4.78, 95% CI,1.07-21.35, p=0.040, respectively), but not in men. Weak grip strength was associated with CHD after age-adjustment (HR= 2.45, 95%CI, 1.03-5.81, p=0.043) only in men. However, after additional multivariate adjustment, the associations were getting weaker.

The relationship between physical performance and quality of life and the level of physical activity among the elderly

BACKGROUND

Loss of physical function during the process of aging might affect the quality of life. Physical function assessment tests predicts outcomes such as falls, institutionalization, and death. Studies assessing the association of physical function with quality of life and physical activity level of elderly population in India is scarce. Hence we aimed to assess the physical function of community dwelling older adults and to determine its association with physical activity levels and quality of life.

MATERIALS AND METHODS

This was a cross-sectional analytical study. 89 community dwelling older adults between 60 and 80 years of age were recruited. Physical function was assessed by standing balance, walking speed, and grip strength. Quality of life was assessed by WHO QOL BREF questionnaire and physical activity level was assessed by International Physical activity Questionnaire.

RESULTS

Standing balance was reduced in 24% and walking speed was decreased in 33% of the participants. Males had higher walking speed, and grip strength. Quality of life was better among males. Standing balance, walking speed and grip strength was significantly higher in moderate - heavy activity levels. There was positive correlation between physical function and quality of life. There was also positive correlation between physical activity level and quality of life.

CONCLUSION

Physical function, quality of life and physical activity level were decreased. Males had better physical function and quality of life. Physically active individuals had better physical function and quality of life. Early detection of decreased physical function and increase in physical activity level could result in better quality of life among elderly.

Predictors of Health-Related Quality-of-Life Status Among Elderly Patients With Cardiovascular Diseases

OBJECTIVES

Quality of life is an important patient-reported outcome in the care of older patients with chronic diseases owing to aging-associated limited physical activity and poor health status. The current study aimed to evaluate health-related quality of life and its predictors among elderly cardiac outpatients.

METHODS

A descriptive, nonexperimental, cross-sectional study was carried out from May 2018 to October 2018 in outpatient departments of a tertiary-care hospital. The population under study were patients aged ≥65 years with at least 1 cardiovascular condition. The EQ-5D-3L (Euro QOL) and Barthel index were used to measure the quality of life and performance of activities of daily living, respectively. Linear regression analysis was performed by using SPSS version 21.

RESULTS

Of a total of 386 patients, 198 patients (51.3%) reported impairment in the mobility domain, and 70.5% (n = 272) of patients indicated impairment in the depression domain. Mann-Whitney tests revealed EQ-5D scores, and visual analogue scale scores significantly differed by hospital admissions (P = .001), fall history (P < 0.001), and activities of daily living (P < .001). Kruskal-Wallis analysis revealed that EQ-5D index value and visual analogue scale score were significantly lower among patients who had comorbidities and who were exposed to polypharmacy (5-9 medications) (P < .001). In multivariate linear regression analysis, self-reported health (P = .006) and performance of activities of daily living (P < .001) were reported as influencing factors on health-related quality of life.

CONCLUSION

Findings indicated poor quality of life among older patients with cardiovascular diseaese or heart diseases in Pakistan. Measures should be taken to improve patients' perception and to enhance awareness regarding the importance of doing daily living activities as a predictor of good quality of life.

The importance of physical function as a clinical outcome: Assessment and enhancement

The burgeoning population of older adults is intrinsically prone to cardiovascular disease (CVD) in a context of multimorbidity and geriatric syndromes. Risks include high susceptibility to functional decline, with many older adults tipping towards patterns of sedentary behavior and to downstream effects of frailty, falls, disability, poor quality of life, as well as increased morbidity and mortality even if the incident CVD was treated perfectly. While physical activity has been shown to moderate these patterns both as primary or secondary preventive medical care, the majority of older adults fail to meet physical activity recommendations. Clinicians of all specialities, including CVD medicine, can benefit from greater proficiency in functional assessments for their older adults, as well as from insights how to initiate effective functional enhancing approaches even in older adults who may be frail, deconditioned, and medically complex. Pertinent functional assessments include traditional cardiovascular metrics of cardiorespiratory fitness, as well as strength and balance. This review summarizes the components of a wide-ranging functional assessment that can be used to enhance care for older adults with CVD, as well as interventions to improve physical function.

Isotemporal substitution modeling on sedentary behaviors and physical activity with depressive symptoms among older adults in the U.S.: The national health and nutrition examination survey, 2007-2016

BACKGROUND

Late-life depression is a great burden of public health. Previous studies reported that physical activity is associated with reduced depressive symptoms among older adults, while the competing nature of physical activity and sedentary behaviors has been largely neglected in studies. We aimed to examine the associations of replacing sedentary behaviors with walking/bicycling or moderate-to-vigorous physical activity (MVPA) with depressive symptoms in older adults.

METHODS

A cross-sectional analysis was conducted among 8374 older adults (60 years or older) included in the National Health and Nutrition Examination Survey (NHANES), 2007-2016. The Global Physical Activity Questionnaire was used to measure self-reported time for sedentary behaviors, walking/bicycling, and MVPA. The 9-item Patient Health Questionnaire was used to measure depressive symptoms (including overall, somatic, and cognitive). Z-scores were created for depressive symptoms. Isotemporal substitution models using multivariable linear regression were applied to examine the associations of sedentary behaviors, walking/bicycling, and MVPA with z-scores of depressive symptoms.

RESULTS

Replacing 30 min/day sedentary behaviors with 30 min/day of MVPA (beta (β) = -0.10, 95% confidence interval (CI): -0.14, -0.06) or 30 min/day of walking/bicycling (β = -0.04, 95% CI: -0.06, -0.02) was associated with lower z-score for depressive symptoms. Replacing 30 min/day of walking/bicycling for 30 min/day of MVPA was associated with lower z-score for depressive symptoms (β = -0.06, 95% CI: -0.10, -0.02).

LIMITATIONS

A cross-sectional study design precludes causal inferences.

CONCLUSION

Replacing sedentary behaviors with walking/bicycling or MVPA is associated with lower depressive symptoms among older adults. Future research is expected to investigate the effectiveness of physical activity on prevention and treatment of late-life depression.

A Conceptual Guideline to Age-Friendly Outdoor Space Development in China: How Do Chinese Seniors Use the Urban Comprehensive Park? A Focus on Time, Place, and Activities

The aim of this paper is to narrow the gap between the theoretical findings from past studies and current open space development through evaluating the behavior pattern and landscape preferences of seniors in urban parks in China. Combining an on-site observational approach with a questionnaire, the research has taken place in two successful traditional comprehensive parks in Xi’an, Shaanxi, China. The results for time, place, and activities were analyzed and depicted in figures. Design guidelines have been provided based on the analysis; new perspectives for further investigations have been pointed out for landscape architects and urban planners to carry on exploring the process of establishing a successful age-friendly outdoor space.