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Coyle P, Tripken J, Perera S, Juarez GA, Spencer-Brown L, Cameron K, Brach JS. Dissemination and implementation of evidence-based programs for people with chronic disease: the impact of the COVID-19 pandemic. Front Public Health 2024; 11:1276387. [PMID: 38274541 PMCID: PMC10808618 DOI: 10.3389/fpubh.2023.1276387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 12/15/2023] [Indexed: 01/27/2024] Open
Abstract
Background Using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework, we describe the implementation of evidence-based chronic disease self-management education (CDSME) programs by the Administration for Community Living CDSME Grantees during 2016-2022 and we also explore the impact of the COVID-19 pandemic on implementation. Methods Grantees collected data before and after the implementation of the CDSME programs and contributed to the national data repository. Data components included workshop information, participant information, and organizational data. Results The cohort consisted of 175,973 individuals who participated in 34 CDSME programs across 45 states. Participants had a mean ± SD age of 66.1 ± 14.8 years, were primarily female (65.9%) and had a mean ± SD of 2.6 ± 2.3 chronic conditions. Compared to the pre-COVID-19 strata, those who participated during COVID-19 were on average 1.5 years younger and had slightly less comorbidities. For individuals who had pre and post program self-reported health, 65.3% stayed the same, 24.4% improved, and 10.3% worsened (p < 0.001) after participating in CDSME programs. Conclusion CDSME offers a variety of programs across a broad geographic area to a diverse set of older adults in the US, underscoring the expansive reach of this public health initiative. COVID-19 appears to have shifted participant reach toward a slightly younger and healthier population. Finally, these programs appear to be effective in improving participants' self-rated health. However, these results should be interpreted with caution, given limitations due to missing data and the observational nature of this study design.
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Affiliation(s)
- Peter Coyle
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, United States
| | - Jennifer Tripken
- National Council on Aging Center for Healthy Aging, Arlington, VA, United States
| | - Subashan Perera
- Department of Medicine and Biostatistics, University of Pittsburgh, Pittsburgh, PA, United States
| | - Gardenia A. Juarez
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, United States
| | | | - Kathleen Cameron
- National Council on Aging Center for Healthy Aging, Arlington, VA, United States
| | - Jennifer S. Brach
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, United States
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Iwanaga K, Chen X, Wu JR, Lee B, Deppert B, Tansey TN, Chan C, Tao J, Chan F. Psychometric Validation of the Wisconsin Community Participation Scale in a Sample of People with Chronic Health Conditions and Disabilities Living in the Community. REHABILITATION COUNSELING BULLETIN 2021. [DOI: 10.1177/00343552211063873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Increasing community participation can reduce the risk for functional disabilities; participation is influenced by person and environment contextual factors. Development and validation of a brief community participation assessment can advance and support evidence-based assessment in clinical rehabilitation counseling practice. It will be an invaluable rehabilitation and public health surveillance tool that can be used to gauge the health conditions and participation of people with disabilities. The current study evaluated and validated the Wisconsin Community Participation Scale (WCPS) in 982 individuals with chronic health conditions and disabilities. Participants indicated five most meaningful life roles: (a) being able to get around with or without help, (b) live independently with or without help, (c) live a healthy lifestyle, (d) work, and (e) leisure and recreation activities. The WCPS scores were positively associated with physical health, mental health, and life satisfaction and negatively related to functional disability in the theoretically expected directions. The WCPS can help rehabilitation counselors assess their clients’ current level of participation in meaningful life roles that are important to them. Rehabilitation counselors can use the WCPS assessment data to guide treatment planning and empower clients to build confidence and self-efficacy to participate in personally meaningful activities in the community.
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Affiliation(s)
| | | | - Jia Rung Wu
- Northeastern Illinois University, Chicago, USA
| | | | | | | | - Chetwyn Chan
- The Education University of Hong Kong, Tai Po, Hong Kong
| | - Jing Tao
- Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Fong Chan
- University of Wisconsin–Madison, USA
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Yu X, Yang J, Yin Z, Jiang W, Zhang D. Loneliness mediates the relationships between perceived neighborhood characteristics and cognition in middle-aged and older adults. Int J Geriatr Psychiatry 2021; 36:1858-1866. [PMID: 34214209 DOI: 10.1002/gps.5595] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 06/28/2021] [Indexed: 11/05/2022]
Abstract
OBJECTIVES We aimed to examine whether loneliness mediates these associations between perceived neighborhood characteristics and cognition among middle-aged and older adults. METHODS Data from wave 10 (2010-2012) to wave 13 (2016-2017) of the Health and Retirement Study were analyzed. Perceived neighborhood characteristics were self-reported. Loneliness was measured by Revised University of California Los Angeles (R-UCLA) Loneliness Scale. Cognition was evaluated by the modified version of Telephone Interview for Cognitive Status. Baron and Kenny's causal steps and multiple linear regression models based on Karlson/Holm/Breen (KHB) method were used to examine the mediating effect. RESULTS At baseline, 15,142 participants had no cognitive impairment, and 11,413 individuals were finally included in our analysis after 6-year follow-up. Multiple linear regression models suggested that lower perceived neighborhood physical disorder (β = 0.073, p = 0.033) and greater perceived neighborhood safety (β = 0.350, p = 0.009) were associated with better cognition. KHB test identified the significant mediating effect of loneliness on the relationships between perceived neighborhood physical disorder (β = 0.011, p = 0.016) and perceived neighborhood safety (β = 0.023, p = 0.026) and cognition. CONCLUSIONS Perceived neighborhood characteristics are associated with cognition among middle-aged and older American adults. Loneliness mediated associations between perceived neighborhood physical disorder and perceived neighborhood safety and cognition.
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Affiliation(s)
- Xiaohui Yu
- Department of Epidemiology and Health Statistics, the School of Public Health of Qingdao University, Qingdao, Shandong, China
| | - Jiulong Yang
- Department of primary medical management, Qingdao Municipal Hospital, Qingdao, Shandong, China
| | - Zhenhua Yin
- Department of Epidemiology and Health Statistics, the School of Public Health of Qingdao University, Qingdao, Shandong, China
| | - Wenjie Jiang
- Department of Epidemiology and Health Statistics, the School of Public Health of Qingdao University, Qingdao, Shandong, China
| | - Dongfeng Zhang
- Department of Epidemiology and Health Statistics, the School of Public Health of Qingdao University, Qingdao, Shandong, China
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Abstract
Within the last decade, clustering of comorbidities has become an increasing health problem on a global scale and will continue to challenge healthcare professionals in the coming years. People with multiple diseases find difficulties in managing their daily lives due to the implications each disease brings; attending and keeping up to date with hospital appointments, being prescribed and taking various medications, the effects of mental health and quality of life, and the impact it has on their families. Most research in clinical trials often exclude individuals with multimorbidity and observational studies mainly focus on single disease outcomes, therefore there is an opportunity to encourage future research in an area which could help prevent further cases and improve the lives of those already living with multimorbidity. This review aims to summarise the rising prevalence and most common clusters, highlight the challenges faced in healthcare, and explore ways to improve future research.
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Domènech-Abella J, Switsers L, Mundó J, Dierckx E, Dury S, De Donder L. The association between perceived social and physical environment and mental health among older adults: mediating effects of loneliness. Aging Ment Health 2021; 25:962-968. [PMID: 32067471 DOI: 10.1080/13607863.2020.1727853] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objectives: Despite growing interest in the impact of physical and social environment on mental health, data are lacking on the potential mediating effects of loneliness. We examined it in the association of several social and physical environmental characteristics with mental health among older adults in three municipalities in Flanders (Belgium).Methods: A total of 869 people aged 60 and over were interviewed. Loneliness was assessed through the De Jong Gierveld short scales for emotional and social loneliness. Social participation and social cohesion were assessed following the Neighborhood scales whereas physical environment characteristics were selected from the Neighborhood Environment Walkability Scale. Mental health was assessed through subscale psychological frailty of the Comprehensive Frailty Assessment Instrument plus (CFAI-plus). Linear regression models, including mediation analysis, were used to analyze the survey data.Results: After adjusting for individual characteristics, physical and social environment factors were significantly related to mental health with the significant mediation of emotional and social loneliness. Percentages mediated by both dimensions together were 61% for social cohesion, 43% for social participation, 35% for safety and 25% for mobility. Compared with social loneliness, emotional loneliness was a stronger mediating factor, particularly for mobility and safety. No significant associations between traffic density or basic service availability and mental health were found.Discussion: Improving the social and physical environment might result in a reduction in the prevalence of loneliness and in consequent improvement of mental health among older adults. Special attention should be paid to different types of loneliness.
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Affiliation(s)
- Joan Domènech-Abella
- Department of Sociology, Universitat de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | - Lise Switsers
- Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel (VUB), Brussels, Belgium.,Research Foundation Flanders (FWO), Brussels, Belgium
| | - Jordi Mundó
- Department of Sociology, Universitat de Barcelona, Barcelona, Spain
| | - Eva Dierckx
- Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel (VUB), Brussels, Belgium.,Alexian Psychiatric Hospital, Tienen, Belgium
| | - Sarah Dury
- Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel (VUB), Brussels, Belgium.,Research Foundation Flanders (FWO), Brussels, Belgium
| | - Liesbeth De Donder
- Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel (VUB), Brussels, Belgium
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Gough C, Baker N, Weber H, Lewis LK, Barr C, Maeder A, George S. Integrating community participation in the transition of older adults from hospital to home: a scoping review. Disabil Rehabil 2021; 44:4896-4908. [PMID: 33909534 DOI: 10.1080/09638288.2021.1912197] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Benefits of community participation and physical activity for the health and wellbeing of older adults are well documented. This review aims to answer the question; "How is community participation considered for older adults in the transition from hospital to home?" MATERIALS AND METHODS This scoping review searched key databases using subject headings and keywords. Two independent reviewers selected studies based on a systematic procedure. Inclusion criteria were adults aged ≥60 years, transitioning from hospital to home, reporting on community participation, inclusive of leisure activities, social activities, and physical activity. RESULTS Of 2206 initial unique articles, 19 met inclusion criteria. Articles covered a range of diagnoses, most frequently stroke, hip replacement, or fracture. Numerous measures of community participation were reported, identifying "low" and "reduced" community participation in ten studies. Measures of physical activity, health-related quality of life, sleep quality, and loneliness were variable. Five studies reported interventions and four reported improved components of community participation. Numerous barriers to community participation were identified, with recommendations for future transition care services considered. CONCLUSION There are considerable barriers to promoting community participation in transition care services for older people. Older adults need information to prepare for returning home from hospital and to regain valued leisure and social activities for health-related quality of life.IMPLICATIONS FOR REHABILITATIONCommunity participation is an important component of healthy ageing which health professionals should consider beyond discharge.Levels of mobility and endurance should be considered in terms of facilitating community participation for older adults.Transition care services should provide adequate information to prepare individuals expectations of returning home following hospital stay, whilst attempting to maintain valued leisure and social activities.
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Affiliation(s)
- Claire Gough
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia.,Flinders Digital Health Research Centre, Flinders University, Adelaide, Australia.,Caring Futures Institute, Flinders University, Adelaide, Australia
| | - Nicky Baker
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia.,Flinders Digital Health Research Centre, Flinders University, Adelaide, Australia.,Caring Futures Institute, Flinders University, Adelaide, Australia
| | - Heather Weber
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia.,Flinders Digital Health Research Centre, Flinders University, Adelaide, Australia.,Caring Futures Institute, Flinders University, Adelaide, Australia
| | - Lucy K Lewis
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia.,Caring Futures Institute, Flinders University, Adelaide, Australia.,SHAPE Research Centre, Flinders University, Adelaide, Australia
| | - Christopher Barr
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia.,Flinders Digital Health Research Centre, Flinders University, Adelaide, Australia.,Caring Futures Institute, Flinders University, Adelaide, Australia
| | - Anthony Maeder
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia.,Flinders Digital Health Research Centre, Flinders University, Adelaide, Australia.,Caring Futures Institute, Flinders University, Adelaide, Australia
| | - Stacey George
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia.,Flinders Digital Health Research Centre, Flinders University, Adelaide, Australia.,Caring Futures Institute, Flinders University, Adelaide, Australia
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Gough C, Lewis LK, Barr C, Maeder A, George S. Community participation of community dwelling older adults: a cross-sectional study. BMC Public Health 2021; 21:612. [PMID: 33781223 PMCID: PMC8008662 DOI: 10.1186/s12889-021-10592-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 03/08/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND With the advancing age of the population, and increasing demands on healthcare services, community participation has become an important consideration for healthy ageing. Low levels of community participation have been linked to increased mortality and social isolation. The extent to which community participation has been measured objectively in older adults remains scarce. This study aims to describe where and how older adults participate in the community and determine the feasibility of measurement methods for community participation. METHODS This observational cross-sectional study obtained data from 46 community dwelling older adults. A combination of Global Positioning Systems (GPS), accelerometry, and self-reported diaries were used over a 7-day monitoring period. Feasibility of methods were determined by calculating the loss of GPS data, questionnaires, and comparison of self-reported locations with GPS co-ordinates. Relationships between community participation, physical activity, social interactions, health related quality of life, sleep quality and loneliness were explored. RESULTS Older adults took a median (IQR) of 15 (9.25-18.75) trips out of home over the 7-day monitoring period, most frequently visiting commercial and recreational locations. In-home activities were mainly sedentary in nature, with out of home activities dependent on location type. Self-reported and GPS measures of trips out of home and the locations visited were significantly correlated (self-report 15.7 (5.6) GPS 14.4 (5.8) (r = 0.94)). Significant correlations between both the number of trips taken from home, with social interactions (r = 0.62) and the minutes of moderate to vigorous physical activity (MVPA) (r = 0.43) were observed. Daily MVPA was higher in participants who visited local walk/greenspaces (r = 0.48). CONCLUSION Participants performed more activities with social interactions out of home and visited commercial locations most frequently. The combination of GPS, accelerometry and self-report methods provided a detailed picture of community participation for older adults. Further research is required with older adults of varying health status to generalise the relationships between community participation, location and physical activity. TRIAL REGISTRATION Ethical approval was gained from the Flinders University Social and Behavioural Research Ethics Committee (protocol no. 8176).
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Affiliation(s)
- Claire Gough
- College of Nursing and Health Sciences, Flinders University, Sturt Building N219, GPO Box 2100, Adelaide, SA, 5001, Australia
- Flinders Digital Health Research Centre, Flinders University, Adelaide, Australia
- Caring Futures Institute, Flinders University, Adelaide, Australia
| | - Lucy K Lewis
- College of Nursing and Health Sciences, Flinders University, Sturt Building N219, GPO Box 2100, Adelaide, SA, 5001, Australia
- Caring Futures Institute, Flinders University, Adelaide, Australia
| | - Christopher Barr
- College of Nursing and Health Sciences, Flinders University, Sturt Building N219, GPO Box 2100, Adelaide, SA, 5001, Australia
- Flinders Digital Health Research Centre, Flinders University, Adelaide, Australia
- Caring Futures Institute, Flinders University, Adelaide, Australia
| | - Anthony Maeder
- College of Nursing and Health Sciences, Flinders University, Sturt Building N219, GPO Box 2100, Adelaide, SA, 5001, Australia
- Flinders Digital Health Research Centre, Flinders University, Adelaide, Australia
- Caring Futures Institute, Flinders University, Adelaide, Australia
| | - Stacey George
- College of Nursing and Health Sciences, Flinders University, Sturt Building N219, GPO Box 2100, Adelaide, SA, 5001, Australia.
- Flinders Digital Health Research Centre, Flinders University, Adelaide, Australia.
- Caring Futures Institute, Flinders University, Adelaide, Australia.
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Bowden JL, Hunter DJ, Feng Y. How can neighborhood environments facilitate management of osteoarthritis: A scoping review. Semin Arthritis Rheum 2020; 51:253-265. [PMID: 33387921 DOI: 10.1016/j.semarthrit.2020.09.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 09/09/2020] [Accepted: 09/11/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The association between neighborhood environments and health outcomes has long been recognized, but the importance of environmental factors is less well examined in osteoarthritis (OA). We aimed to give an overview of the literature examining the role of neighborhood built environments in the context of OA self-management. MATERIAL AND METHODS A literature search between 2000 and 2019 was performed using a scoping methodology. Literature examining the influence of neighborhood built environments on health and other outcomes in people with OA, mixed or unspecified arthritis were screened by two independent reviewers. Seven domains were pre-determined based on the World Health Organization European Healthy Cities Framework. Sub-domains and themes were synthesized from the literature. RESULTS We included 27 studies across seven pre-determined domains, 23 sub-domains. We identified 6 key outcomes of physical activity, quality of life, community participation, resource use, psychological health, and other physical health. The majority of studies emphasized the importance of neighborhood built environment on supporting OA self-management, particularly for facilitating physical activity. The impacts on other outcomes were also considered important but were less well studied, especially access to healthy food. CONCLUSIONS This review highlights the potential of better using the built environment to support OA management to address many different outcomes. Understanding the impacts of different environments is the first step, and designing new and novel ways to utilize neighborhoods is needed. Implementing strategies and public policies at a neighborhood level may be a more viable way to curb further increases in the OA epidemic than addressing individual factors alone.
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Affiliation(s)
- Jocelyn L Bowden
- Institute of Bone and Joint Research, the Kolling Institute, The University of Sydney, and Rheumatology Department, Royal North Shore Hospital, Sydney, Australia.
| | - David J Hunter
- Institute of Bone and Joint Research, the Kolling Institute, The University of Sydney, and Rheumatology Department, Royal North Shore Hospital, Sydney, Australia
| | - Yingyu Feng
- Institute of Bone and Joint Research, The Kolling Institute, The University of Sydney, Australia
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Twardzik E, Clarke P, Judd S, Colabianchi N. Neighborhood Participation Is Less Likely among Older Adults with Sidewalk Problems. J Aging Health 2020; 33:101-113. [PMID: 32960717 DOI: 10.1177/0898264320960966] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Objectives: This cross-sectional study examines the association between perceived sidewalk conditions and neighborhood participation among older adults in the REasons for Geographic and Racial Differences in Stroke (REGARDS) study. Methods: Between 2013-2016, 14,233 REGARDS participants completed a second in-home visit. Using logistic regression, we cross-sectionally examined if perceived severity of sidewalk problems was associated with going into the neighborhood less than once compared to 1-7 times per week. Results: The analytic sample included participants (N = 9863) with nonmissing data. The likelihood of going into the neighborhood less than one time per week was greater among participants who reported minor (OR = 1.15; 95% CI: 1.00, 1.33), somewhat serious (OR = 1.41; 95% CI: 1.17, 1.70), and very serious (OR = 1.65; 95% CI: 1.38, 1.98) sidewalk problems in their neighborhood compared to those reporting no sidewalk problems, independent of demographic, socioeconomic, and impairment characteristics. Discussion: Perceived sidewalk problems appear to deter neighborhood participation among older adults.
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Affiliation(s)
- Erica Twardzik
- School of Kinesiology, Ann Arbor, MI, USA.,School of Public Health, Ann Arbor, MI, USA
| | - Philippa Clarke
- School of Public Health, Ann Arbor, MI, USA.,Institute for Social Research, Ann Arbor, MI, USA
| | | | - Natalie Colabianchi
- School of Kinesiology, Ann Arbor, MI, USA.,Institute for Social Research, Ann Arbor, MI, USA
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Domènech-Abella J, Mundó J, Leonardi M, Chatterji S, Tobiasz-Adamczyk B, Koskinen S, Ayuso-Mateos JL, Haro JM, Olaya B. Loneliness and depression among older European adults: The role of perceived neighborhood built environment. Health Place 2019; 62:102280. [PMID: 32479358 DOI: 10.1016/j.healthplace.2019.102280] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 12/13/2019] [Accepted: 12/18/2019] [Indexed: 12/21/2022]
Abstract
Depression and loneliness act in a synergistic way among older adults. We tested two indicators of the perceived neighborhood built environment (BE) as moderators of the association between these conditions in older European adults. Positive perceptions of neighborhood BE were related to lower levels of loneliness but not to major depressive disorder (MDD). Reporting low BE usability was significantly related to a higher likelihood of feeling lonely except for those suffering from MDD, whereas reporting low BE walkability was significantly related with a high likelihood of loneliness particularly among those with MDD. Therefore, improving neighborhood BE and, specifically, its walkability, might result in a reduction in the prevalence of loneliness.
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Affiliation(s)
- Joan Domènech-Abella
- Department of Sociology, Universitat de Barcelona, Barcelona, Spain; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.
| | - Jordi Mundó
- Department of Sociology, Universitat de Barcelona, Barcelona, Spain
| | - Matilde Leonardi
- Department of Neurology, Public Health and Disability, Italian National Neurological Institute "Carlo Besta" Foundation IRCCS (Istituto di ricovero e cura a carattere scientifico), Milan, Italy
| | - Somnath Chatterji
- Department of Health Statistics and Information Systems, World Health Organization, Geneva, Switzerland
| | - Beata Tobiasz-Adamczyk
- Chair of Epidemiology and Preventive Medicine, Department of Medical Sociology, Jagiellonian University Medical College, Krakow, Poland
| | - Seppo Koskinen
- National Institute for Health and Welfare, Helsinki, Finland
| | - Jose Luis Ayuso-Mateos
- Department of Psychiatry, Universidad Autónoma de Madrid, Spain; Instituto de Investigación Sanitaria Princesa (IP), Madrid, Spain; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Josep Maria Haro
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain; Instituto de Investigación Sanitaria Princesa (IP), Madrid, Spain; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain; Kind Saud University, Riyadh, Saudi Arabia
| | - Beatriz Olaya
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
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Theis KA, Brady TJ, Helmick CG, Murphy LB, Barbour KE. Associations of Arthritis-Attributable Interference with Routine Life Activities: A Modifiable Source of Compromised Quality-of-Life. ACR Open Rheumatol 2019; 1:412-423. [PMID: 31777821 PMCID: PMC6857987 DOI: 10.1002/acr2.11050] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 06/17/2019] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE Arthritis patients experience the impact of disease beyond routinely assessed clinical measures. We characterized arthritis-attributable interference in four important routine life domains: 1) recreation/leisure/hobbies; 2) household chores; 3) errands/shopping; and 4) social activities. METHODS Participants were from the Arthritis Conditions Health Effects Survey (2005-2006), a cross-sectional survey of noninstitutionalized US adults 45 years or older with doctor-diagnosed arthritis (n = 1793). We estimated the prevalence of "a lot" of arthritis-attributable interference and quantified the associations between sociodemographic, clinical, and psychological characteristics and "a lot" of arthritis-attributable interference (vs "a little" or "none") in each domain using prevalence ratios (PRs) in multivariable (MV)-adjusted logistic regression models. RESULTS An estimated 1 in 5 to 1 in 4 adults with arthritis reported "a lot" of arthritis-attributable interference in recreation/leisure/hobbies (27%), household chores (25%), errands/shopping (22%), and social activities (18%). The highest prevalence of "a lot" of arthritis-attributable interference was for those unable to work/disabled or reporting severe arthritis symptoms (pain, stiffness, fatigue), anxiety, depression, or no/low confidence in ability to manage arthritis, across domains. In MV-adjusted models, those unable to work/disabled, currently seeing a doctor, or reporting fair/poor self-rated health, severe joint pain, anxiety, or no/low confidence in ability to manage arthritis were more likely to report arthritis-attributable interference than their respective counterparts. Magnitudes varied by domain but were consistently strongest for those unable to work/disabled (MV PR range = 1.8-2.5) and with fair/poor health (MV PR range = 1.7-2.7). CONCLUSION Many characteristics associated with arthritis-attributable interference in routine life activities are potentially modifiable, suggesting unmet need for use of existing evidence-based interventions that address these characteristics and reduce interferences to improve quality of life.
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Affiliation(s)
- K. A. Theis
- National Center for Chronic Disease Prevention and Health PromotionCenters for Disease Control and PreventionAtlantaGA
| | - T. J. Brady
- National Center for Chronic Disease Prevention and Health PromotionCenters for Disease Control and PreventionAtlantaGA
| | - C. G. Helmick
- National Center for Chronic Disease Prevention and Health PromotionCenters for Disease Control and PreventionAtlantaGA
| | - L. B. Murphy
- National Center for Chronic Disease Prevention and Health PromotionCenters for Disease Control and PreventionAtlantaGA
| | - K. E. Barbour
- National Center for Chronic Disease Prevention and Health PromotionCenters for Disease Control and PreventionAtlantaGA
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12
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Theis KA, Murphy LB, Baker NA, Hootman JM. When You Can't Walk a Mile: Walking Limitation Prevalence and Associations Among Middle-Aged and Older US Adults with Arthritis: A Cross-Sectional, Population-Based Study. ACR Open Rheumatol 2019; 1:350-358. [PMID: 31777813 PMCID: PMC6858050 DOI: 10.1002/acr2.11046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 05/24/2019] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE We examined walking limitations and associated characteristics among middle-aged and older US adults with arthritis, overall, and by sex. METHODS Using 2005-2006 Arthritis Conditions and Health Effects Survey (ACHES) data (n = 1793), we estimated "a lot" and "any" ("a lot" or "a little" combined) walking limitation for more than 1 mile (1.6 km) among US adults 45 years or older with arthritis and examined associations (sociodemographics, arthritis symptoms and effects, psychosocial measures, and physical health) with walking limitations in unadjusted and multivariable (MV) adjusted logistic regression models using prevalence ratios (PRs) and 95% confidence intervals, accounting for the complex survey design. RESULTS Respondents frequently reported "a lot" (48%) and "any" (72%) limitation for more than 1 mile. Women reported higher prevalence of all levels of walking limitation versus men (eg, 51% vs 42% for "a lot" overall); additionally, the gap for walking limitations between women and men widened with age. Limitation was high for both sexes at all ages, affecting 1-in-3 to 4-in-5, depending on level of walking limitation. The strongest MV associations for "a lot" of walking limitation among all respondents included substantial and modest arthritis-attributable life interference (PR = 2.5 and 1.6, respectively), age 75 years or older (PR = 1.5), and physical inactivity and fair/poor self-rated health (PR = 1.4 for both). CONCLUSION Walking limitations among middle-aged and older adults are substantial. Existing proven interventions that improve walking ability and physical function may help this population to reduce and delay disability.
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Affiliation(s)
- K. A. Theis
- Centers for Disease Control and PreventionAtlantaGeorgia
| | - L. B. Murphy
- Centers for Disease Control and PreventionAtlantaGeorgia
| | | | - J. M. Hootman
- Centers for Disease Control and PreventionAtlantaGeorgia
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Maintenance and Development of Social Connection by People with Long-term Conditions: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16111875. [PMID: 31141893 PMCID: PMC6603716 DOI: 10.3390/ijerph16111875] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 05/20/2019] [Accepted: 05/24/2019] [Indexed: 11/19/2022]
Abstract
Social connection is important for people’s health and well-being. Social isolation arising from a lack of meaningful connection with others can result in deterioration of well-being with negative consequences for health. For people living with multiple long-term conditions, the building and maintaining of social connection may be challenging. The aim of this study was to explore with people with long-term conditions how they perceive they maintain and develop social connections. We undertook semi-structured interviews with seventeen adults, and analyzed the data for themes. Themes were “Meaningful connection”, “Wherewithal for social connection” and “Impact of a major change in life course”. The findings suggest that social connection is valued, and facilitates meaningful ways to reciprocate support with others, thus enabling access to knowledge and resources for better health and well-being. However, people with long-term conditions can experience challenges to developing and maintaining social connectedness after a major change in life course. We suggest that healthcare providers are well placed to facilitate ways for people with long-term conditions to socially connect with others in their neighbourhood and community, and that this in particular be attended to after a major life change.
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Vaughan MW, Felson DT, LaValley MP, Orsmond GI, Niu J, Lewis CE, Segal NA, Nevitt MC, Keysor JJ. Perceived Community Environmental Factors and Risk of Five-Year Participation Restriction Among Older Adults With or at Risk of Knee Osteoarthritis. Arthritis Care Res (Hoboken) 2017; 69:952-958. [PMID: 28129478 DOI: 10.1002/acr.23085] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Revised: 08/19/2016] [Accepted: 09/06/2016] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Older adults with knee osteoarthritis (OA) who live in environments with mobility barriers may be at greater risk of developing participation restrictions, defined as difficulties in engagement in life situations. We investigated the risk of participation restriction over 5 years due to self-reported environmental features among older adults with knee OA. METHODS Participants from the Multicenter Osteoarthritis (MOST) Study self-reported participation at baseline, 30 months, and 60 months using the instrumental role subscale of the Late Life Disability Index (LLDI). Data on self-reported environmental features were from the Home and Community Environment questionnaire administered in the MOST Knee Pain and Disability study, an ancillary study of MOST. The relative risks (RRs) of developing participation restriction at 60 months, indicated by an LLDI score <67.6 out of a possible 100, due to reported high community mobility barriers and high transportation facilitators, were calculated using robust Poisson regression, adjusting for covariates. RESULTS Sixty-nine of the 322 participants (27%) developed participation restriction by 60 months. Participants reporting high community mobility barriers at baseline had 1.8 times the risk (95% confidence interval [95% CI] 1.2-2.7) of participation restriction at 60 months, after adjusting for covariates. Self-report of high transportation facilitators at baseline resulted in a reduced but statistically nonsignificant risk of participation restriction at 60 months (RR 0.7, 95% CI 0.4-1.1). CONCLUSION Higher perceived environmental barriers impact the risk of long-term participation restriction among older adults with or at risk of knee OA. Approaches aimed at reducing the development of participation restrictions in this population should consider decreasing environmental barriers.
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Affiliation(s)
| | | | | | | | - Jingbo Niu
- Baylor College of Medicine, Houston, Texas
| | | | - Neil A Segal
- University of Kansas Medical Center, Kansas City
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15
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Vaughan M, LaValley MP, AlHeresh R, Keysor JJ. Which Features of the Environment Impact Community Participation of Older Adults? A Systematic Review and Meta-Analysis. J Aging Health 2016; 28:957-78. [DOI: 10.1177/0898264315614008] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: The objective of this study is to identify features of the environment associated with community participation of older adults. Method: A systematic review of studies that examined associations between environment and community participation in older adults was conducted. Environmental features were extracted and grouped using the International Classification of Functioning, Disability, and Health’s environmental categories. Meta-analysis of environmental categories was conducted by calculating combined effect size (ES) estimates. Results: Significant, small to moderate, random ESs were found for six of seven environmental categories: neighborliness (ES = 0.52, 95% confidence interval [CI] = [0.18, 0.87]), social support (ES = 0.38, 95% CI = [0.13, 0.62]), land-use diversity (ES = 0.29, 95% CI = [0.16, 0.42]), transportation (ES = 0.29, 95% CI = [0.15, 0.43]), civil protection (e.g., safety; ES = 0.27, 95% CI = [0.0, 0.54]), and street connectivity/walkability (ES = 0.20, 95% CI = [0.15, 0.26]). Discussion: Community initiatives that address specific features of the social environment and street-level environment may increase community participation of older adults.
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Macera CA, Cavanaugh A, Bellettiere J. State of the Art Review: Physical Activity and Older Adults. Am J Lifestyle Med 2016; 11:42-57. [PMID: 30202313 DOI: 10.1177/1559827615571897] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 12/18/2014] [Accepted: 01/12/2015] [Indexed: 12/31/2022] Open
Abstract
Physical activity is an important component of a healthy lifestyle for all adults and especially for older adults. Using information from the updated 2008 Physical Activity Guidelines, 3 dimensions of physical activity are identified for older adults. These include increasing aerobic activity, increasing muscle-strengthening activity, and reducing sedentary or sitting behavior. Although the overall goal of the physical activity recommendations is to prevent chronic diseases and conditions from developing, many older adults are already affected. Therefore, suggested types of physical activity are described for specific diseases and conditions that are designed to mediate the condition or prevent additional disability. Finally, barriers to participation in physical activity specific to older adults are described, and possible solutions offered. Encouraging older adults to continue or even start a physical activity program can result in major health benefits for these individuals.
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Affiliation(s)
- Caroline A Macera
- Graduate School of Public Health (CAM) San Diego State University, San Diego, California.,Center for Behavioral Epidemiology and Community Health, Graduate School of Public Health (JB) San Diego State University, San Diego, California.,Joint Doctoral Program in Public Health Epidemiology, San Diego State University and University of California at San Diego, San Diego, California (AC)
| | - Alyson Cavanaugh
- Graduate School of Public Health (CAM) San Diego State University, San Diego, California.,Center for Behavioral Epidemiology and Community Health, Graduate School of Public Health (JB) San Diego State University, San Diego, California.,Joint Doctoral Program in Public Health Epidemiology, San Diego State University and University of California at San Diego, San Diego, California (AC)
| | - John Bellettiere
- Graduate School of Public Health (CAM) San Diego State University, San Diego, California.,Center for Behavioral Epidemiology and Community Health, Graduate School of Public Health (JB) San Diego State University, San Diego, California.,Joint Doctoral Program in Public Health Epidemiology, San Diego State University and University of California at San Diego, San Diego, California (AC)
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17
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Galenkamp H, Gagliardi C, Principi A, Golinowska S, Moreira A, Schmidt AE, Winkelmann J, Sowa A, van der Pas S, Deeg DJH. Predictors of social leisure activities in older Europeans with and without multimorbidity. Eur J Ageing 2016; 13:129-143. [PMID: 27358604 PMCID: PMC4902842 DOI: 10.1007/s10433-016-0375-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Older people spend much time participating in leisure activities, such as taking part in organized activities and going out, but the extent of participation may differ according to both individual and environmental resources available. Chronic health problems become more prevalent at higher ages and likely necessitate tapping different resources to maintain social participation. This paper compares predictors of participation in social leisure activities between older people with and those without multimorbidity. The European Project on Osteoarthritis (EPOSA) was conducted in Germany, UK, Italy, The Netherlands, Spain and Sweden (N = 2942, mean age 74.2 (5.2)). Multivariate regression was used to predict social leisure participation and degree of participation in people with and without multimorbidity. Fewer older people with multimorbidity participated in social leisure activities (90.6 %), compared to those without multimorbidity (93.9 %). The frequency of participation was also lower compared to people without multimorbidity. Higher socioeconomic status, widowhood, a larger network of friends, volunteering, transportation possibilities and having fewer depressive symptoms were important for (the degree of) social leisure participation. Statistically significant differences between the multimorbidity groups were observed for volunteering and driving a car, which were more important predictors of participation in those with multimorbidity. In contrast, self-reported income appeared more important for those without multimorbidity, compared to those who had multimorbidity. Policies focusing on social (network of friends), physical (physical performance) and psychological factors (depressive symptoms) and on transportation possibilities are recommended to enable all older people to participate in social leisure activities.
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Affiliation(s)
- Henrike Galenkamp
- Department of Epidemiology and Biostatistics and the EMGO Institute for Health and Care Research, VU University Medical Center, De Boelelaan 1089a, 1081 HV Amsterdam, The Netherlands
| | - Cristina Gagliardi
- National Institute of Health and Science on Ageing (INRCA), Ancona, Italy
| | - Andrea Principi
- National Institute of Health and Science on Ageing (INRCA), Ancona, Italy
| | - Stanislawa Golinowska
- Collegium Medicum Jagiellonian University, Krakow, Poland ; Institute of Labour and Social Studies, Warsaw, Poland ; Center for Social and Economic Research (CASE), Warsaw, Poland
| | - Amilcar Moreira
- Institute of Social Science, University of Lisbon, Lisbon, Portugal
| | - Andrea E Schmidt
- European Centre for Social Welfare Policy and Research, Vienna, Austria
| | | | - Agnieszka Sowa
- Institute of Labour and Social Studies, Warsaw, Poland ; Center for Social and Economic Research (CASE), Warsaw, Poland
| | - Suzan van der Pas
- Department of Epidemiology and Biostatistics and the EMGO Institute for Health and Care Research, VU University Medical Center, De Boelelaan 1089a, 1081 HV Amsterdam, The Netherlands
| | - Dorly J H Deeg
- Department of Epidemiology and Biostatistics and the EMGO Institute for Health and Care Research, VU University Medical Center, De Boelelaan 1089a, 1081 HV Amsterdam, The Netherlands
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Changing definitions altered multimorbidity prevalence, but not burden associations, in a musculoskeletal population. J Clin Epidemiol 2016; 78:116-126. [PMID: 27036547 DOI: 10.1016/j.jclinepi.2016.03.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 02/07/2016] [Accepted: 03/22/2016] [Indexed: 12/21/2022]
Abstract
OBJECTIVES The inclusion of musculoskeletal conditions within multimorbidity research is inconsistent, and working-age populations are largely ignored. We aimed to: (1) estimate multimorbidity prevalence among working-age individuals with a range of musculoskeletal conditions; and (2) better understand the implications of decisions about the number and range of conditions constituting multimorbidity on the strength of associations between multimorbidity and burden (e.g., health status and health care utilization). STUDY DESIGN AND SETTING Using data from the Australian National Health Survey 2007-08, the associations between burden measures and three ways of operationalizing multimorbidity (survey, policy, and research based) within the working-age (18-64 years) musculoskeletal population were estimated using multiple logistic regression (age and gender adjusted). RESULTS Depending on definition, from 20.2% to 75.4% of working-age individuals with musculoskeletal conditions have multimorbidity. Irrespective of definition, multimorbidity was associated with increased likelihood of subjective health burden, pain or musculoskeletal medicines use, nonmusculoskeletal specialist and pharmacist (advice only) consultations, and reduced likelihood of not consulting health professionals. A group with intermediate health outcomes was considered multimorbid by some, but not all definitions. With the restrictive policy and research multimorbidity definitions, this intermediate group is included within the reference population (i.e., are considered nonmultimorbid). This worsens the reference group's apparent health status thereby leveling the comparative burden between those with and without multimorbidity. Consequently, dichotomous cut points lead to similar associations with burden measures despite the increasingly restrictive multimorbidity definitions used. CONCLUSIONS All multimorbidity definitions were associated with burden among the working-age musculoskeletal population. However, dichotomous cut points obscure the gradient of increased burden associated with restrictive definitions.
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Yen IH, Fandel Flood J, Thompson H, Anderson LA, Wong G. How design of places promotes or inhibits mobility of older adults: realist synthesis of 20 years of research. J Aging Health 2014; 26:1340-72. [PMID: 24788714 PMCID: PMC4535337 DOI: 10.1177/0898264314527610] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The objective of this study was to determine the environmental features that best support aging in place. METHOD We conducted a realist synthesis, a theory-driven interpretive method of evidence synthesis, of 120+ articles (published 1991-2011) that attempts to explain how place may influence older adults' decisions about mobility (e.g., physical activity). We developed an initial program theory, reviewed the literature, identified outcomes, analyzed and synthesized patterns, and created a final program theory. RESULTS Safety was a central mechanism, serving as one of the bridges between environmental components (e.g., connectivity, aesthetics, retail and services) and decisions about mobility. Population density, sidewalk presence, and park proximity did not emerge as key factors. DISCUSSION Safety considerations are one of the most prominent influences of older adults' decisions about mobility. Street connectivity, pedestrian access and transit, and retail and services were also important. These factors are amenable to change and can help promote mobility for older adults.
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Affiliation(s)
- Irene H Yen
- University of California, San Francisco, USA
| | | | | | - Lynda A Anderson
- Centers for Disease Control and Prevention, Atlanta, GA, USA Rollins School of Public Health, Atlanta, GA, USA
| | - Geoff Wong
- Barts and the London School of Medicine and Dentistry, London, UK
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20
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Rantakokko M, Iwarsson S, Vahaluoto S, Portegijs E, Viljanen A, Rantanen T. Perceived environmental barriers to outdoor mobility and feelings of loneliness among community-dwelling older people. J Gerontol A Biol Sci Med Sci 2014; 69:1562-8. [PMID: 24864307 DOI: 10.1093/gerona/glu069] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND We examined the association between perceived environmental barriers to outdoor mobility and loneliness among community-dwelling older people. In addition, we studied whether walking difficulties and autonomy in participation outdoors affected this association. METHODS Cross-sectional analyses of face-to-face home interview data with 848 people aged 75-90 years (mean age: 80.1 years; 62% women) gathered within the "Life-Space Mobility in Old Age" (LISPE) project. Self-reports of loneliness, environmental barriers to outdoor mobility, and difficulties in walking 2 km were obtained with structured questionnaires. Autonomy in participation outdoors was assessed with the "Impact on Participation and Autonomy" questionnaire. RESULTS Altogether, 28% of participants reported experiencing loneliness sometimes or often. These participants also reported more difficulties in walking 2 km, restricted autonomy in participation outdoors, and more environmental barriers to outdoor mobility than people not experiencing loneliness. Snowy and icy winter conditions (odds ratio: 1.59 [95% confidence interval: 1.15-2.20]), long distances to services (odds ratio: 1.57 [1.00-2.46]), and hills in the nearby environment (odds ratio: 1.49 [1.05-2.12]) significantly increased the odds for loneliness, even after adjustments for walking difficulties, autonomy in participation outdoors, perceived financial situation, living alone, and health. Path modeling revealed that environmental barriers increased loneliness either through direct association or indirectly through restricted autonomy in participation outdoors. CONCLUSIONS Prospective studies should investigate whether removing environmental barriers to outdoor mobility improves autonomy in participation outdoors and alleviates loneliness among older people.
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Affiliation(s)
- Merja Rantakokko
- Gerontology Research Center and Department of Health Sciences, University of Jyväskylä, Finland.
| | | | - Satu Vahaluoto
- Gerontology Research Center and Department of Health Sciences, University of Jyväskylä, Finland
| | - Erja Portegijs
- Gerontology Research Center and Department of Health Sciences, University of Jyväskylä, Finland
| | - Anne Viljanen
- Gerontology Research Center and Department of Health Sciences, University of Jyväskylä, Finland
| | - Taina Rantanen
- Gerontology Research Center and Department of Health Sciences, University of Jyväskylä, Finland
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Botticello AL, Rohrbach T, Cobbold N. Disability and the built environment: an investigation of community and neighborhood land uses and participation for physically impaired adults. Ann Epidemiol 2014; 24:545-50. [PMID: 24935467 DOI: 10.1016/j.annepidem.2014.05.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 04/21/2014] [Accepted: 05/06/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE There is a need for empirical support of the association between the built environment and disability-related outcomes. This study explores the associations between community and neighborhood land uses and community participation among adults with acquired physical disability. METHODS Cross-sectional data from 508 community-living chronically disabled adults in New Jersey were obtained from among participants in national Spinal Cord Injury Model Systems database. Participants' residential addresses were geocoded to link individual survey data with Geographic Information Systems data on land use and destinations. The influence of residential density, land use mix, destination counts, and open space on four domains of participation were modeled at two geographic scales-the neighborhood (i.e., half mile buffer) and community (i.e., five mile) using multivariate logistic regression. All analyses were adjusted for demographic- and impairment-related differences. RESULTS Living in communities with greater land use mix and more destinations was associated with a decreased likelihood of reporting optimum social and physical activity. Conversely, living in neighborhoods with large portions of open space was positively associated with the likelihood of reporting full physical, occupational, and social participation. CONCLUSIONS These findings suggest that the overall living conditions of the built environment may be relevant to social inclusion for persons with physical disabilities.
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Affiliation(s)
- Amanda L Botticello
- Outcomes and Assessment Department, Kessler Foundation Research Center, West Orange, NJ; Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark.
| | - Tanya Rohrbach
- Department of Science and Engineering, Raritan Valley Community College, Branchburg, NJ
| | - Nicolette Cobbold
- Outcomes and Assessment Department, Kessler Foundation Research Center, West Orange, NJ
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Theis KA, Murphy L, Hootman JM, Wilkie R. Social participation restriction among US adults with arthritis: a population-based study using the International Classification of Functioning, Disability and Health. Arthritis Care Res (Hoboken) 2013; 65:1059-69. [PMID: 23401463 PMCID: PMC4466902 DOI: 10.1002/acr.21977] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Accepted: 01/29/2013] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To examine arthritis impact among US adults with self-reported doctor-diagnosed arthritis using the International Classification of Functioning, Disability and Health (ICF) framework (including the impairments, activity limitations, environmental, and personal factors domains and social participation restriction [SPR] as the outcome) overall and among those with and without SPR, and to identify the correlates of SPR. METHODS Cross-sectional 2009 National Health Interview Survey data were analyzed to examine the distribution of the ICF domain components. Unadjusted and multivariable-adjusted prevalence ratios (PRs) and 95% confidence intervals (95% CIs) were estimated to identify the correlates of SPR. Analyses using SAS, version 9.2 survey procedures accounted for the complex sample design. RESULTS SPR prevalence was 11% of adults with arthritis (5.7 million). After initial multivariable adjustment by ICF domain, serious psychological distress (impairments domain; PR 2.5 [95% CI 2.0-3.2]), ≥5 medical office visits (environmental domain; PR 3.4 [95% CI 2.5-4.4]), and physical inactivity (personal domain; PR 4.8 [95% CI 3.6-6.4]) were most strongly associated with SPR. A combined measure (key limitations [walking, standing, or carrying]; PR 31.2 [95% CI 22.3-43.5]) represented the activity limitations domain. After final multivariable adjustment incorporating all ICF domains simultaneously, the strongest associations with SPR were key limitations (PR 24.3 [95% CI 16.8-35.1]), ≥9 hours of sleep (PR 1.6 [95% CI 1.3-2.0]), and income-to-poverty ratio <2.00 and severe joint pain (PR 1.4 [95% CI 1.2-1.6] for both). CONCLUSION SPR affects 1 of 9 adults with arthritis. This study is the first to use the ICF framework in a population-based sample to identify specific functional activities, pain, sleep, and other areas as priorities for intervention to reduce negative arthritis impacts on disability, including SPR. Increased use of existing clinical and public health interventions is warranted.
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Affiliation(s)
- K A Theis
- Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA.
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Hunter RH, Anderson LA, Belza B, Bodiford K, Hooker SP, Kochtitzky CS, Marquez DX, Satariano WA. Environments for healthy aging: linking prevention research and public health practice. Prev Chronic Dis 2013; 10:E55. [PMID: 23597393 PMCID: PMC3640693 DOI: 10.5888/pcd10.120244] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Safe and well-designed community environments support healthful behaviors that help prevent chronic conditions and unintentional injuries and enable older adults to be active and engaged in community life for as long as possible. We describe the work of the Healthy Aging Research Network (HAN) and partners over the past decade to better understand place-based determinants of health and translate that knowledge to real-world practice, with a focus on environmental strategies. Using key components of the Knowledge to Action framework, we document the importance of a sustained, multidisciplinary, collaborative approach and ongoing interaction between researchers and communities. We share examples of practical tools and strategies designed to engage and support critical sectors with the potential to enhance the health and well-being of older adults and their communities. We conclude with a description of lessons learned in facilitating the translation of prevention research into practice.
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Affiliation(s)
- Rebecca H Hunter
- Center for Health Promotion and Disease Prevention, University of North Carolina, 228 Indian Trail Rd, Chapel Hill, NC 27514, USA.
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