Expectations Regarding Aging, Physical Activity, and Physical Function in Older Adults

Just as expected? Older adults' aging expectations are associated with subjective cognition

OBJECTIVES

This study investigated the relationship between older adults' expectations regarding aging and subjective cognition. Specifically, we examined whether the three domains of aging expectations (physical health, mental health, and cognitive function) were associated with two aspects of subjective cognition: current subjective cognition and subjective cognitive decline (SCD).

METHOD

An online survey was conducted among U.S. adults aged 65-90 (N = 581; Mage=71.4, SD ± 4.81; 51% female). Measures included the 12-item Expectations Regarding Aging scale, the 8-item PROMIS Cognitive Abilities scale (current subjective cognition), and the 12-item Everyday Cognition scale (SCD). We used generalized linear models to examine associations between overall aging expectations and its three domains with current subjective cognition ratings and SCD.

RESULTS

We found that more positive expectations regarding physical health, mental health, and cognitive function in aging were associated with higher ratings of current subjective cognition as well as lower SCD. The magnitude of effects across aging expectations domains were similar for both aspects of subjective cognition.

CONCLUSION

Aging expectations are malleable and influence an individual's perceptions of their cognitive functioning. Modifying older adults' aging expectations could support healthier cognitive aging through increased awareness and accurate assumptions about the aging process.

Keep it Movin': Design and methods of a church-based physical activity program to improve physical function among midlife and older black adults

BACKGROUND

Older Black adults have high rates of physical function (PF) limitations. Physical activity (PA) is effective for improving PF and reducing mobility disability risk; however, community-based PA interventions focused on improving PF for older Black adults are lacking. Given the importance of churches as trusted institutions in Black communities, church-based interventions developed through community collaborations may help increase access to PA interventions.

METHODS

Keep it Movin' is a church-based cluster randomized controlled trial testing the effectiveness of a 24-week group-based (intervention arm) versus a self-guided (comparator arm) program in improving PF among Black adults aged ≥ 40 years with PF limitations (short physical performance battery [SPPB] score ≤ 9). A church-wide virtual walking program is available to congregants in both arms. The intervention arm receives weekly group-based classes held at the church that include education, goal setting, and structured PA (walking, lower-extremity strength, balance, and stretching). The comparator arm receives educational materials about PA appropriate for people with PF limitations. Outcomes are assessed at 6 (program completion) and 12 months (maintenance). The primary outcome is PF change as measured by the SPPB at 6 months. Secondary outcomes include change in moderate-to-vigorous PA, social support and self-efficacy for PA, quality of life, and self-reported PF. Factors related to successful adoption, implementation, and maintenance are assessed using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework.

CONCLUSION

This is the first study to evaluate the effectiveness of a group-based PA program delivered in Black churches to improve PF.

The Relationship between Marital Satisfaction and Spiritual Well-Being of Chinese Older Adults: The Mediating Effect of Psychological Security and Aging Expectations

This study explores the relationship between marital satisfaction and spiritual well-being in older adults and the role of psychological security and aging expectations in older adult relationships. A convenient sample cross-sectional research method collected data from 367 older adults in Sichuan Province, China. A chain mediation model was constructed using quantitative analysis methods to test the relationship between marital satisfaction and older adults' spiritual well-being and the potential mediating roles of psychological security and aging expectations. The research conclusions are as follows: marital satisfaction positively correlates with spiritual well-being, and psychological security and aging expectations play independent chain mediating roles.

Associations Between Components of Self-Management Theory and Falls Among Older Adults

PURPOSE

To examine the relationship of key individual and family self-management theory (IFSMT) components, including self-management process variables on proximal (self-management behaviors) and distal (falls) outcomes in older adults.

METHOD

A secondary data analysis was conducted using data of 99 older adults living in continuing care retirement communities in the U.S. Midwest. Descriptive statistics, multiple regression, and logistic regression were performed to analyze the data.

RESULTS

The multiple regression model demonstrated a positive association between self-efficacy for physical activity and steps per day. The logistic regression model showed that high expectations regarding aging are associated with reduced likelihood of meeting daily protein intake.

CONCLUSION

Key components of the IFSMT, such as self-efficacy, steps per day, and expectations regarding aging, are important when designing self-management interventions to prevent falls. [Journal of Gerontological Nursing, 50(8), 19-28.].

Rating of Perceived Exertion: A Large Cross-Sectional Study Defining Intensity Levels for Individual Physical Activity Recommendations

BACKGROUND

Physical inactivity is a growing risk factor worldwide, therefore getting people into sports is necessary. When prescribing physical activity, it is essential to recommend the correct training intensities. Cardiopulmonary exercise testing (CPX) enables precise determination of individuals' training intensities but is unavailable for a broad population. Therefore, the Borg scale allows individuals to assess perceived exertion and set their intensity easily and cost-efficiently. In order to transfer CPX to rating of perceived exertion (RPE), previous studies investigated RPE on specific physiological anchors, e.g. blood lactate (bLa) concentrations, but representativeness for a broad population is questionable. Some contradictory findings regarding individual factors influencing RPE occur, whereas univariable analysis has been performed so far. Moreover, a multivariable understanding of individual factors influencing RPE is missing. This study aims to determine RPE values at the individual anaerobic threshold (LT2) and defined bLa concentrations in a large cohort and to evaluate individual factors influencing RPE with multivariable analysis.

METHODS

CPX with bicycle or treadmill ergometer of 6311 participants were analyzed in this cross-sectional study. RPE values at bLa concentrations 2 mmol/l, 3 mmol/l, 4 mmol/l, and LT2 (first rise in bLa over baseline + 1.5 mmol/l) were estimated by spline interpolation. Multivariable cumulative ordinal regression models were performed to assess the influence of sex, age, type of ergometry, VO2max, and duration of exercise testing on RPE.

RESULTS

Median values [interquartile range (IQR)] of the total population were RPE 13 [11; 14] at 2 mmol/l, RPE 15 [13; 16] at 3 mmol/l, RPE 16 [15; 17] at 4 mmol/l, and RPE 15 [14; 16] at LT2. Main influence of individual factors on RPE were seen especially at 2 mmol/l: male sex (odds ratio (OR) [95%-CI]: 0.65 [0.587; 0.719]), treadmill ergometry (OR 0.754 [0.641; 0.886]), number of stages (OR 1.345 [1.300; 1.394]), age (OR 1.015 [1.012; 1.018]), and VO2max (OR 1.023 [1.015; 1.030]). Number of stages was the only identified influencing factor on RPE at all lactate concentrations/LT2 (3 mmol/l: OR 1.290 [1.244; 1.336]; 4 mmol/l: OR 1.229 [1.187; 1.274]; LT2: OR 1.155 [1.115; 1.197]).

CONCLUSION

Our results suggest RPE ≤ 11 for light intensity, RPE 12-14 for moderate intensity, and RPE 15-17 for vigorous intensity, which slightly differs from the current American College of Sports Medicine (ACSM) recommendations. Additionally, we propose an RPE of 15 delineating heavy and severe intensity domain. Age, sex, type of ergometry, duration of exercise, and cardiopulmonary fitness should be considered when recommending individualized intensities with RPE, primarily at lower intensities. Therefore, this study can be used as a new guideline for prescribing individual RPE values in the clinical practice, predominantly for endurance type exercise.

The Level of Expectations Regarding Aging Among Older Adults: A Systematic Review and Meta-analysis

OBJECTIVE

To systematically review the level of expectations regarding aging (ERA) among older adults.

DESIGN

Systematic review and meta-analysis.

SETTING AND PARTICIPANTS

Adults aged 60 years and older in any setting.

METHODS

We searched 11 databases for cross-sectional studies that reported ERA scores among older adults using the ERA survey from inception to May 1, 2022, without language restrictions. Two researchers independently selected studies, extracted data, and assessed quality. The mean scores and standard deviations of the ERA survey and its subscales were pooled using the Stata software (version 17.0).

RESULTS

Twelve studies with 3664 participants were included in this study. The pooled mean scores of overall ERA were 37.85 (95% CI, 33.54-42.16). Specifically, the pooled scores for expectations regarding physical health, mental health, and cognitive function were 31.67 (95% CI, 27.42-35.92), 43.69 (95% CI, 38.99-48.39), and 33.28 (95% CI, 29.56-37.00), respectively. No statistically significant differences between groups were observed in any subgroup analysis.

CONCLUSIONS AND IMPLICATIONS

The level of ERA among older adults is relatively low, particularly concerning cognitive function and physical health dimensions. These findings may provide a valuable reference for public health professionals and policymakers to intervene and manage the health problems of older adults.

Validity and Reliability of Persian Version of the 12-Item Expectations Regarding Aging Survey

Objective:The present study was designed to assess the construct validity and reliability of the Persian version of the 12-item Expectations Regarding Aging (ERA) survey among the older adult Iranian population. Methods: The Persian version of this scale was developed using translation and revision in the current study. The construct validity was assessed through exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). The reliability was assessed through internal consistency (Cronbach's alpha and McDonald's omega), composite reliability (CR), and maximal reliability (MaXR). The data compiled online was based on a sample of 400 older adults aged 65 years and older. Results: The Persian version includes 12 items loading onto three factors with 12 items explaining 46.633% of the total variance with excellent internal consistency and reliability. Conclusion: The Persian version of ERA is reliable and valid that can be used to assess the ERA concept among older adults.

The longitudinal impact of the COVID-19 pandemic on health behaviors, psychosocial factors, and cognitive functioning in older adults

Background: Older adults are at a greater risk for contracting and experiencing severe illness from COVID-19 and may be further affected by pandemic-related precautions (e.g., social distancing and isolation in quarantine). However, the longitudinal impact of the COVID-19 pandemic on older adults is unclear. The current study examines changes in health behaviors, psychosocial factors, and cognitive functioning in a large sample of older adults using a pre-pandemic baseline and longitudinal follow-up throughout 9 months of the COVID-19 pandemic. Methods: One hundred and eighty-nine older adults (ages 65-89) were recruited from a multisite clinical trial to complete additional virtual assessments during the COVID-19 pandemic. Mixed effects models evaluated changes in health behaviors, psychosocial factors, and cognitive functioning during the pandemic compared to a pre-pandemic baseline and over the course of the pandemic (i.e., comparing the first and last COVID-19 timepoints). Results: Compared to their pre-pandemic baseline, during the pandemic, older adults reported worsened sleep quality, perceived physical health and functioning, mental health, slight increases in depression and apathy symptoms, reduced social engagement/perceived social support, but demonstrated better performance on objective cognitive tasks of attention and working memory. Throughout the course of the pandemic, these older adults reported continued worsening of perceived physical health and function, fewer depression symptoms, and they demonstrated improved cognitive performance. It is important to note that changes on self-report mood measures and cognitive performance were relatively small regarding clinical significance. Education largely served as a protective factor, such that greater years of education was generally associated with better outcomes across domains. Conclusions: The present study provides insights into the longitudinal impact of the COVID-19 pandemic on health behaviors, psychosocial factors, and cognitive functioning in a population disproportionately affected by the virus. Replicating this study design in a demographically representative older adult sample is warranted to further inform intervention strategies targeting older adults negatively impacted by the COVID-19 pandemic.

Effects of Physical Activity on Daily Physical Function in Chinese Middle-Aged and Older Adults: A Longitudinal Study from CHARLS

OBJECTIVE

Impaired daily physical function has become a common health problem among Chinese middle-aged and elderly people. The aim of this study was to investigate the effects of physical activity on daily physical function in Chinese middle-aged and older adults.

METHODS

Data from 9056 participants in the China Health and Retirement Longitudinal Study (CHARLS) from 2011 to 2018 were included in this study. Physical activity levels were expressed as metabolic equivalents, and the impairment of daily physical function was determined in a self-reported format by the Activities of Daily Living Scale and the Instrumental Activities of Daily Living Scale. The association between different levels of physical activity and impaired daily physical function was analyzed using Cox proportional hazards regression models.

RESULTS

During a mean follow-up period of 6.73 years, 1379 middle-aged and older adults had impaired physical function. After adjusting for all covariates, participants with a physical activity volume (PAV) ≥ 600 MET-minutes/week had a 61% lower risk of impaired daily physical function than those who were physically inactive (HR = 0.39, 95% CI 0.35-0.44). Participants with a PAV of 1800-2999 MET-minutes/week had the lowest risk of impaired daily physical function (HR = 0.33, 95% CI 0.26-0.42). Subgroup analysis showed that participants with a PAV ≥ 600 MET-minutes/week had a greater reduction in the risk of impaired daily physical function among participants who were male, older than or equal to 65 years, and without respiratory disease compared to participants who were physically inactive.

CONCLUSIONS

This study showed that a PAV ≥ 600 MET-minutes/week could reduce the risk of impaired daily physical function in Chinese middle-aged and elderly people. However, a higher PAV is not better; a PAV in the range of 1800-2999 MET-minutes/week can be more effective in preventing daily physical function impairment in Chinese middle-aged and elderly people.

Health-Related Expectations Regarding Aging among Middle-Aged and Older Japanese: Psychometric Performance and Novel Findings from the ERA-12-J

BACKGROUND AND OBJECTIVES

Health-related expectations regarding aging is a gerontological construct that is potentially predictive of morbidity and mortality in later life. The Expectations Regarding Ageing scale (ERA-12) is a widely used measure of health-related expectations, although it has not previously been administered in Japanese. The present research aimed to elucidate the psychometric properties of the first Japanese translation of the ERA-12 and evaluate health-related expectations among middle-aged and older Japanese.

RESEARCH DESIGN AND METHODS

Repeated online surveys were conducted with representative quota samples of middle-aged and older adults in Tokyo during 2021 (N = 1600). Primary outcome measures included total and subscale scores on a Japanese translation of the ERA-12 (ERA-12-J) addressing perceptions of physical, mental, and cognitive health. Standard measures were also used to gather information regarding respondent demographic details, general health, and health-related behavior.

RESULTS

The ERA-12-J and associated subscales showed acceptable test-retest reliability (t(1598) = 0.60, p = 0.63), internal consistency (α > 0.80), inter-item correlation (r = 0.21-0.78) and item-total correlation (r = 0.53-0.73). Confirmatory Factor Analysis verified the hypothesized three-factor structure and construct validity on four common indices of fit (GFI = 0.968; CFI = 0.978; AGFI = 0.950; RMSEA = 0.059). ERA-12-J scores among Japanese respondents revealed prevailing negative sentiments concerning physical and cognitive health, with less negative sentiment regarding mental health. Significant and independent differences emerged concerning gender and age cohort, with middle-aged adults and females holding more negative expectations about their future health.

DISCUSSION AND IMPLICATIONS

The ERA-12-J provides a sound basis for the elucidation of health-related expectations about aging in Japan and a useful tool for international comparative studies. Education and workplace intervention may be required in Japan to address age and gender disparities in health-related expectations.

Older People Living with HIV Were Less Physically Active Than Their Uninfected Counterparts in China: A Matched-Sample Mediation Analysis

The study compared the level of physical activity (PA) between older people living with HIV (PLWH) and their HIV-negative counterparts in China and tested the mediational roles of self-compassion, attitudes toward aging, and perceived stress in the between-group difference in PA. From December 2017 to August 2018, face-to-face interviews were conducted among 337 and 363 HIV-positive and -negative people aged ≥ 50 in Yongzhou City, Hunan, China. Path analysis was performed. The proportions of low, moderate, and high levels of PA in the HIV-positive and -negative groups were 18.9% versus 6.7%, 43.1% versus 32.0%, and 38.0% versus 61.3%, respectively, yielding a statistically significant difference. The path analysis showed that older PLWH reported less self-compassion and positive attitudes toward aging, which was in turn associated with more perceived stress and ultimately associated with less PA. Chinese older PLWH were more sedentary than their HIV-negative counterparts. Future PA interventions may modify the mediators.

Older Adults' Experiences of Behavior Change Support in a Digital Fall Prevention Exercise Program: Qualitative Study Framed by the Self-determination Theory

Background

Exercise is an effective intervention to prevent falls in older adults; however, long-term adherence is often poor. To increase adherence, additional support for behavior change has been advocated. However, consistency in the reporting of interventions using behavior change techniques is lacking. Recently, a classification system has been developed to increase consistency in studies using behavior change techniques within the self-determination theory.

Objective

This study aimed to explore expressions of self-determination among community-dwelling older adults using a self-managed digital fall prevention exercise program comprising behavior change support (the Safe Step program), which was developed in co-creation with intended users.

Methods

The qualitative study design was based on open-ended responses to questionnaires, and individual and focus group interviews. A deductive qualitative content analysis was applied using the classification system of motivation and behavior change techniques as an analytical matrix, followed by an inductive analysis. Twenty-five participants took part in a feasibility study and exercised in their homes with the Safe Step program for 4 months. The exercise program was available on computers, smartphones, and tablets, and was fully self-managed.

Results

In the deductive analysis, expressions of support were demonstrated for all three basic human psychological needs, namely, autonomy, competence, and relatedness. These expressions were related to 11 of the 21 motivation and behavior change techniques in the classification system. The inductive analysis indicated that autonomy (to be in control) was valued and enabled individual adaptations according to different rationales for realizing exercise goals. However, the experience of autonomy was also two-sided and depended on the participants’ competence in exercise and the use of technology. The clarity of the program and exercise videos was seen as key for support in performance and competent choices. Although augmented techniques for social support were requested, support through relatedness was found within the program.

Conclusions

In this study, the Safe Step program supported the establishment of new exercise routines, as well as the three basic human psychological needs, with autonomy and competence being expressed as central in this context. Based on the participants’ experiences, a proposed addition to the classification system used as an analytical matrix has been presented.

Trial Registration

ClinicalTrials.gov NCT02916849; https://clinicaltrials.gov/ct2/show/NCT02916849

Improving Expectations Regarding Aging in Younger Adults: A Classroom Study

Younger adults generally hold negative attitudes and stereotypes about aging, which can affect the success with which they age as well as how they interact with older generations in everyday settings. The current study sought to improve expectations about aging in a largely first-year undergraduate student population through a small, discussion-based course on successful aging. Students in the successful aging course and a control course completed the 12-item expectations regarding aging (ERA) scale at the beginning and the end of the 10-week academic quarter. Students in the aging class also provided adjectives that came to mind when thinking about older adults. Students in the successful aging course had higher ERA scores at the end of the quarter than at the beginning of the quarter, but scores in the control class did not change. Further analyses indicated students' expectations about cognitive functioning and physical health improved, but not expectations about mental health. In addition, self-generated adjectives were more positive at the end than the beginning of the quarter, but some negative adjectives persisted. Thus, a smaller, discussion-based class about aging led to a more positive view of aging, suggesting that negative attitudes about aging may be modifiable by a short intervention in early adulthood. These results can have implications for how younger adults interact with older adults and how they may prepare for, hold future expectations about, and ultimately experience older age.

The differences in self-perceptions of aging, health-related quality of life and their association between urban and rural Chinese older hypertensive patients

Background

Most hypertensive clients are elderly, whose health-related quality of life (HRQL) may be associated with self-perceptions of aging (older individuals’ beliefs about their own aging). Meanwhile, culture and health disparities between rural and urban populations are substantial. Whether there are differences in self-perceptions of aging, HRQL, and their association among elderly hypertensive clients in urban and rural areas remains unknown. The objective of this study was to investigate and compare self-perceptions of aging and HRQL and their association among urban and rural older Chinese hypertensive clients.

Methods

A cross-sectional investigation was conducted in 15 urban community clinics and 22 village clinics from Suzhou, China. Older hypertensive adults were invited to complete a self-administered questionnaire addressing socio-demographic and clinical information, HRQL and self-perceptions of aging.

Results

There were 492 urban participants and 537 rural participants included in the analyses. The physical (40.0 ± 12.1 vs. 30.9 ± 8.9, P <  0.001) and mental (51.5 ± 8.3 vs. 46.0 ± 7.8, P <  0.001) HRQL scores of urban participants were all higher than those of rural ones. Urban participants’ scores on dimensions of “timeline cyclical”, “consequences negative”, and “control negative” of self-perceptions of aging questionnaire (APQ) were lower than those of rural participants (P <  0.001, respectively), while the scores on dimensions of “consequences positive” and “control positive” were higher (P <  0.001, respectively). Adjusted multivariate linear regression showed that participants who had worse self-perceptions of aging had poorer HRQL. Some APQ dimensions associated with urban or rural hypertensive elders’ HRQL were different.

Conclusions

Older hypertensive clients in rural areas have poorer self-perceptions of aging and HRQL than those in urban areas. Health care professionals should pay more attention to HRQL and self-perceptions of aging of older hypertensive clients in rural areas.

Rate of Perceived Exertion and Cardiorespiratory Fitness in Older Adults with and without Alzheimer's Disease

Exercise has many benefits for physical and cognitive health in older adults, yet there are many barriers to exercise adherence in this population. Subjective perception of exercise difficulty, or rate of perceived exertion (RPE), may especially be a barrier to exercise in individuals with Alzheimer's disease (AD), due to changes in initiation and motivation that accompany changes in cognition and brain function. RPE is the most commonly used measure of subjective effort in exercise research, yet the relationship between RPE and objective fitness is not fully understood in older adults. A better understanding is needed to support initiation, engagement, and maintenance of exercise and determine the appropriateness for use of RPE as a measure in this population. Our study aimed to 1) evaluate the degree to which objective measures of cardiorespiratory fitness correlates with the most commonly used subjective measure of effort, RPE and 2) examine any difference in the relationship between objective cardiorespiratory fitness and RPE between individuals with and without AD. We explored these relationships during a graded exercise test. Objective fitness and subjective effort were negatively associated. Independent of cardiorespiratory fitness, older age, female gender, cognitive impairment, and use of heart medications predicted greater self-reported effort during exercise. Results are discussed in terms of social psychological phenomena and potential neuropsychological deficits leading to increased subjective feelings of effort. These findings establish that the RPE measure may not be appropriate and may even detract from effort during graded exercise testing among older adults with AD.

Younger and Older Adults' Mood and Expectations Regarding Aging During COVID-19

The 2019 novel coronavirus disease (COVID-19) has broadly impacted our daily lives. Here, we used a longitudinal approach to investigate older adults' mood and expectations regarding aging before and during the global pandemic (Study 1). We also examined age differences in mood, expectations regarding aging, COVID-19 attitudes, and loneliness using a cross-sectional approach (Study 2). In Study 1, older adults completed a mood and expectations regarding aging survey up to 2 years prior to the pandemic and again in April, 2020 (during the pandemic). Participants also completed surveys regarding COVID-19 attitudes and loneliness. In Study 2, a United States sample of younger and older adults completed these surveys during the pandemic. Older adults' mood and expectations regarding aging remained fairly constant, and younger adults showed lower mood and expectations regarding aging than did older adults, despite older adults showing greater concern about COVID-19. Overall, we find that some older adults seem to be resilient with respect to their mood and expectations regarding aging. These findings reveal important preliminary implications for how older adults may be impacted as a result of lifestyle changes necessary for well-being and the well-being of society.

It's a Matter of Perspective: The Role of Aging Expectations and Self-Efficacy Towards Engagement in Healthy Lifestyles Among Older Adults

This study aimed to investigate whether aging expectations predict engagement in healthy lifestyles. Furthermore, it aimed to determine whether self-efficacy mediates the relationship between aging expectations and engagement in healthy lifestyles. This study enlisted 95 respondents who were 60 years old and older in a large metropolitan area in the Philippines. A four-part instrument package was utilized to measure the respondent's (1) demographic profile, (2) aging expectations using the Expectations Regarding Aging (ERA-12) Survey, (3) engagement in healthy lifestyles using Health-Promoting Lifestyle Profile II (HPLP-II), and (4) self-efficacy using the Self-efficacy for Self-direction in Health Scale. Data were analyzed using linear regression and mediation analysis. Results show that aging expectations and self-efficacy predicted engagement in healthy lifestyles. Moreover, self-efficacy was found to be a significant mediator between the variables. Programs that promote a positive aging expectation and high self-efficacy should be pursued by the government and non-government organizations.