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Manning KM, Hall KS, Sloane R, Magistro D, Rabaglietti E, Lee CC, Castle S, Kopp T, Giffuni J, Katzel L, McDonald M, Miyamoto M, Pearson M, Jennings SC, Bettger JP, Morey MC. Longitudinal analysis of physical function in older adults: The effects of physical inactivity and exercise training. Aging Cell 2024; 23:e13987. [PMID: 37681737 PMCID: PMC10776115 DOI: 10.1111/acel.13987] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 08/28/2023] [Accepted: 08/29/2023] [Indexed: 09/09/2023] Open
Abstract
Lack of exercise contributes to systemic inflammation and is a major cause of chronic disease. The long-term impact of initiating and sustaining exercise in late life, as opposed to sustaining a sedentary lifestyle, on whole-body health measures such as physical performance is not well known. This is an exploratory study to compare changes in physical performance among older adults initiating exercise late in life versus inactive older adults. Data from two observational cohorts were included in this analysis, representing two activity groups. The Active group cohort comprises older adults (n = 318; age 72.5 ± 7.2 years) enrolled in a supervised exercise program, "Gerofit." The inactive group comprises older adults (n = 146; age 74.5 ± 5.5 years) from the Italian study "Act on Ageing" (AOA) who self-reported being inactive. Participants in both groups completed physical performance battery at baseline and 1-year including: 6-min walk test, 30-s chair stand, and timed up-and-go. Two-sample t-tests measured differences between Gerofit and AOA at baseline and 1-year across all measures. Significant between-group effects were seen for all performance measures (ps = 0.001). The AOA group declined across all measures from baseline to 1 year (range -18% to -24% change). The Gerofit group experienced significant gains in function for all measures (range +10% to +31% change). Older adults who initiated routine, sustained exercise were protected from age-related declines in physical performance, while those who remained sedentary suffered cumulative deficits across strength, aerobic endurance, and mobility. Interventions to reduce sedentary behaviors and increase physical activity are both important to promote multi-system, whole-body health.
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Affiliation(s)
- Kenneth M. Manning
- Geriatric Research, Education, and Clinical CenterVA Health Care SystemDurhamNorth CarolinaUSA
| | - Katherine S. Hall
- Geriatric Research, Education, and Clinical CenterVA Health Care SystemDurhamNorth CarolinaUSA
- Department of Medicine, Center for the Study of Aging/Claude D. Pepper Older Americans Independence CenterDuke University Medical CenterDurhamNorth CarolinaUSA
| | - Richard Sloane
- Geriatric Research, Education, and Clinical CenterVA Health Care SystemDurhamNorth CarolinaUSA
- Department of Medicine, Center for the Study of Aging/Claude D. Pepper Older Americans Independence CenterDuke University Medical CenterDurhamNorth CarolinaUSA
| | | | | | - Cathy C. Lee
- Geriatric Research, Education, and Clinical CenterVA Greater Los Angeles Healthcare SystemLos AngelesCaliforniaUSA
- David Geffen School of Medicine at UCLALos AngelesCaliforniaUSA
| | - Steven Castle
- Geriatric Research, Education, and Clinical CenterVA Greater Los Angeles Healthcare SystemLos AngelesCaliforniaUSA
- David Geffen School of Medicine at UCLALos AngelesCaliforniaUSA
| | | | - Jamie Giffuni
- Geriatric Research, Education and Clinical CenterVA Maryland Health Care SystemBaltimoreMarylandUSA
| | - Leslie Katzel
- Geriatric Research, Education and Clinical CenterVA Maryland Health Care SystemBaltimoreMarylandUSA
- School of MedicineUniversity of Maryland School of MedicineBaltimoreMarylandUSA
| | - Michelle McDonald
- Geritaric Rehabilitation and Clinical CenterVA Pacific Health Care SystemHonoluluHawaiiUSA
| | - Miles Miyamoto
- Geritaric Rehabilitation and Clinical CenterVA Pacific Health Care SystemHonoluluHawaiiUSA
| | - Megan Pearson
- Geriatric Research, Education, and Clinical CenterVA Health Care SystemDurhamNorth CarolinaUSA
| | - Stephen C. Jennings
- Geriatric Research, Education, and Clinical CenterVA Health Care SystemDurhamNorth CarolinaUSA
| | - Janet Prvu Bettger
- Department of Orthopedic SurgeryDuke University Medical CenterDurhamNorth CarolinaUSA
- Roybal CenterDuke University Medical CenterDurhamNorth CarolinaUSA
| | - Miriam C. Morey
- Geriatric Research, Education, and Clinical CenterVA Health Care SystemDurhamNorth CarolinaUSA
- Department of Medicine, Center for the Study of Aging/Claude D. Pepper Older Americans Independence CenterDuke University Medical CenterDurhamNorth CarolinaUSA
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Parker DC, Kraus WE, Huffman KM, Morey MC, Hall KS, Cohen HJ. Association of plasma inflammatory and metabolic biomarkers with plasma ADRD biomarkers in community‐dwelling older adults. Alzheimers Dement 2022. [DOI: 10.1002/alz.065521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Fernandez D, Wilkins SS, Melrose RJ, Hall KM, Abbate LM, Morey MC, Castle SC, Zeng A, Lee CC. Physical Function Effects of Live Video Group Exercise Interventions for Older Adults: A Systematic Review and Veteran's Gerofit Group Case Study. Telemed J E Health 2022. [DOI: 10.1089/tmj.2022.0175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Daniel Fernandez
- Geriatric Research, Education, and Clinical Center and Mental Health, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Stacy Schantz Wilkins
- Geriatric Research, Education, and Clinical Center and Mental Health, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- David Geffen School of Medicine at UCLA, Departments of Internal Medicine and Psychiatry, Los Angeles, California, USA
| | - Rebecca J. Melrose
- Geriatric Research, Education, and Clinical Center and Mental Health, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- David Geffen School of Medicine at UCLA, Departments of Internal Medicine and Psychiatry, Los Angeles, California, USA
| | - Katherine M. Hall
- Geriatric Research, Education, and Clinical Center, VA Health Care System, Durham, North Carolina, USA
- Department of Orthopedic Surgery, Duke University Medical Center, Durham, North Carolina, USA
- Roybal Center, Duke University Medical Center, Durham, North Carolina, USA
- Center for the Study of Aging/Claude D. Pepper Older Americans Independence Center, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Lauren M. Abbate
- Geriatric Research, Education, and Clinical Center, Eastern Colorado Health Care System, Aurora, Colorado, USA
- Department of Emergency Medicine, University of Colorado, Aurora, Colorado, USA
| | - Miriam C. Morey
- Geriatric Research, Education, and Clinical Center, VA Health Care System, Durham, North Carolina, USA
- Center for the Study of Aging/Claude D. Pepper Older Americans Independence Center, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Steven C. Castle
- Geriatric Research, Education, and Clinical Center and Mental Health, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- David Geffen School of Medicine at UCLA, Departments of Internal Medicine and Psychiatry, Los Angeles, California, USA
| | - Angela Zeng
- Geriatric Research, Education, and Clinical Center and Mental Health, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Cathy C. Lee
- Geriatric Research, Education, and Clinical Center and Mental Health, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- David Geffen School of Medicine at UCLA, Departments of Internal Medicine and Psychiatry, Los Angeles, California, USA
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Kaufman BG, Allen KD, Coffman CJ, Woolson S, Caves K, Hall K, Hoenig HM, Huffman KM, Morey MC, Hodges NJ, Ramasunder S, van Houtven CH. Cost and Quality of Life Outcomes of the STepped Exercise Program for Patients With Knee OsteoArthritis Trial. Value Health 2022; 25:614-621. [PMID: 35365305 DOI: 10.1016/j.jval.2021.09.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 08/31/2021] [Accepted: 09/30/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVES This study aimed to evaluate the cost-effectiveness of the randomized clinical trial STEP-KOA (STepped Exercise Program for patients with Knee OsteoArthritis). METHODS The trial included 230 intervention and 115 control participants from 2 Veterans Affairs (VA) medical centers. A decision tree simulated outcomes for cohorts of patients receiving arthritis education (control) or STEP-KOA (intervention), which consisted of an internet-based exercise training program (step 1), phone counseling (step 2), and physical therapy (step 3) according to patient's response. Intervention costs were assessed from the VA perspective. Quality of life (QOL) was measured using 5-level EQ-5D US utility weights. Incremental cost-effectiveness ratios (ICERs) were calculated as the difference in costs divided by the difference in quality-adjusted life-years (QALYs) between arms at 9 months. A Monte Carlo probabilistic sensitivity analysis was used to generate a cost-effectiveness acceptability curve. RESULTS The adjusted model found differential improvement in QOL utility weights of 0.042 (95% confidence interval 0.003-0.080; P=.03) for STEP-KOA versus control at 9 months. In the base case, STEP-KOA resulted in an incremental gain of 0.028 QALYs and an incremental cost of $279 per patient for an ICER of $10 076. One-way sensitivity analyses found the largest sources of variation in the ICER were the impact on QOL and the need for a VA-owned tablet. The probabilistic sensitivity analysis found a 98% probability of cost-effectiveness at $50 000 willingness-to-pay per QALY. CONCLUSIONS STEP-KOA improves QOL and has a high probability of cost-effectiveness. Resources needed to implement the program will decline as ownership of mobile health devices increases.
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Affiliation(s)
- Brystana G Kaufman
- Duke University, Durham, NC, USA; Durham VA Medical Center, Durham, NC, USA.
| | - Kelli D Allen
- Durham VA Medical Center, Durham, NC, USA; University of North Carolina, Chapel Hill, NC
| | - Cynthia J Coffman
- Durham VA Medical Center, Durham, NC, USA; Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC, USA
| | | | - Kevin Caves
- Durham VA Medical Center, Durham, NC, USA; Duke Older Americans Independence Center, Duke University Medical Center, Durham, NC, USA
| | - Katherine Hall
- Durham VA Medical Center, Durham, NC, USA; Department of Medicine, Duke University Medical Center, Durham, NC, USA; Duke Older Americans Independence Center, Duke University Medical Center, Durham, NC, USA
| | - Helen M Hoenig
- Durham VA Medical Center, Durham, NC, USA; Department of Medicine, Duke University Medical Center, Durham, NC, USA; Duke Older Americans Independence Center, Duke University Medical Center, Durham, NC, USA
| | - Kim M Huffman
- Duke University, Durham, NC, USA; Durham VA Medical Center, Durham, NC, USA; Duke Older Americans Independence Center, Duke University Medical Center, Durham, NC, USA
| | - Miriam C Morey
- Durham VA Medical Center, Durham, NC, USA; Department of Medicine, Duke University Medical Center, Durham, NC, USA; Duke Older Americans Independence Center, Duke University Medical Center, Durham, NC, USA
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Oyedeji CI, Hall K, Luciano A, Morey MC, Strouse JJ. The Sickle Cell Disease Functional Assessment (SCD-FA) tool: a feasibility pilot study. Pilot Feasibility Stud 2022; 8:53. [PMID: 35246265 PMCID: PMC8895638 DOI: 10.1186/s40814-022-01005-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 02/16/2022] [Indexed: 01/15/2023] Open
Abstract
Background The life expectancy for individuals with sickle cell disease (SCD) has greatly increased over the last 50 years. Adults with SCD experience multiple complications such as cardiopulmonary disease, strokes, and avascular necrosis that lead to limitations that geriatric populations often experience. There are no dedicated instruments to measure functional decline and functional age to determine risk of future adverse outcomes in older adults with SCD. The objective of this study was to assess the feasibility of performing the Sickle Cell Disease Functional Assessment (SCD-FA). Methods We enrolled 40 adults with SCD (20 younger adults aged 18–49 years as a comparison group and 20 older adults aged 50 years and older) in a single-center prospective cohort study. Participants were recruited from a comprehensive sickle cell clinic in an academic center in the southeastern United States. We included measures validated in an oncology geriatric assessment enriched with additional physical performance measures: usual gait speed, seated grip strength, Timed Up and Go, six-minute walk test, and 30-second chair stand. We also included an additional cognitive measure, which was the Montreal Cognitive Assessment, and additional patient-reported measures at the intersection of sickle cell disease and geriatrics. The primary outcome was the proportion completing the assessment. Secondary outcomes were the proportion consenting, duration of the assessment, acceptability, and adverse events. Results Eighty percent (44/55) of individuals approached consented, 91% (40/44) completed the SCD-FA in its entirety, and the median duration was 89 min (IQR 80–98). There were no identified adverse events. On the acceptability survey, 95% (38/40) reported the length as appropriate, 2.5% (1/40) reported a question as upsetting, and 5% (2/40) reported portions as difficult. Exploratory analyses of physical function showed 63% (25/40) had a slow usual gait speed (< 1.2 m/s). Conclusion The SCD-FA is feasible, acceptable, and safe and physical performance tests identified functional impairments in adults with SCD. These findings will inform the next phase of the study where we will assess the validity of the SCD-FA to predict patient-important outcomes in a larger sample of adults with SCD.
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Affiliation(s)
- Charity I Oyedeji
- Department of Medicine, Division of Hematology, Duke University School of Medicine, Durham, NC, USA. .,Duke Claude D. Pepper Older Americans Independence Center, Durham, NC, USA. .,Department of Medicine, and Duke Comprehensive Sickle Cell Center, Duke University School of Medicine, Durham, NC, USA.
| | - Katherine Hall
- Duke Claude D. Pepper Older Americans Independence Center, Durham, NC, USA.,Department of Medicine, Division of Geriatrics, Duke University, Durham, NC, USA.,Geriatric Research, Education and Clinical Center, Durham Veterans Affairs Medical Center, Durham, NC, USA
| | - Alison Luciano
- Duke Claude D. Pepper Older Americans Independence Center, Durham, NC, USA
| | - Miriam C Morey
- Duke Claude D. Pepper Older Americans Independence Center, Durham, NC, USA.,Department of Medicine, Division of Geriatrics, Duke University, Durham, NC, USA.,Geriatric Research, Education and Clinical Center, Durham Veterans Affairs Medical Center, Durham, NC, USA
| | - John J Strouse
- Department of Medicine, Division of Hematology, Duke University School of Medicine, Durham, NC, USA.,Duke Claude D. Pepper Older Americans Independence Center, Durham, NC, USA.,Department of Medicine, and Duke Comprehensive Sickle Cell Center, Duke University School of Medicine, Durham, NC, USA.,Division of Pediatric Hematology-Oncology, Duke University, Durham, NC, USA
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Briggs BC, Hall KS, Jain C, Macrea M, Morey MC, Oursler KK. Assessing Moderate to Vigorous Physical Activity in Older Adults: Validity of a Commercial Activity Tracker. Front Sports Act Living 2022; 3:766317. [PMID: 35047769 PMCID: PMC8761971 DOI: 10.3389/fspor.2021.766317] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 12/06/2021] [Indexed: 12/14/2022] Open
Abstract
Purpose: Despite the potential for commercial activity devices to promote moderate to vigorous physical activity (MVPA), limited information is available in older adults, a high-priority target population with unique gait dynamics and energy expenditure. The study purpose was to investigate the content validity of the Garmin Vivosmart HR device for step counts and MVPA in adults ≥65 years of age in free-living conditions. Methods: Thirty-five participants (M age= 73.7 (6.3) years) wore Garmin and ActiGraph GT3X+ devices for a minimum of 2 days. Accuracy and intra-person reliability were tested against a hip worn ActiGraph device. Separate analyses were conducted using different accelerometer cut-off values to define MVPA, a population-based threshold (≥2,020 counts/minute) and a recommended threshold for older adults (≥1,013 counts/minute). Results: Overall, the Garmin device overestimated MVPA compared with the hip-worn ActiGraph. However, the difference was small using the lower, age-specific, MVPA cut-off value [median (IQR) daily minutes; 50(85) vs. 32(49), p = 0.35] in contrast to the normative standard (50(85) vs. 7(24), p < 0.001). Regardless of the MVPA cut-off, intraclass correlation showed poor reliability [ICC (95% CI); 0.16(-0.40, 0.55) to 0.35(-0.32, 0.7)] which was supported by Bland-Altman plots. Garmin step count was both accurate (M step difference: 178.0, p = 0.22) and reliable [ICC (95% CI; 0.94) (0.88, 0.97)]. Conclusion: Results support the accuracy of a commercial activity device to measure MVPA in older adults but further research in diverse patient populations is needed to determine clinical utility and reliability over time.
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Affiliation(s)
- Brandon C. Briggs
- Geriatric Research and Education, Salem VA Medical Center, Salem, VA, United States,Department of Health and Human Performance, Concordia University Chicago, River Forest, IL, United States
| | - Katherine S. Hall
- Geriatric Research, Education, Clinical Center Durham Veterans Affairs Healthcare System, Durham, NC, United States,Center for the Study of Aging and Department of Medicine, Duke University Medical Center, Durham, NC, United States
| | - Chani Jain
- Geriatric Research and Education, Salem VA Medical Center, Salem, VA, United States
| | - Madalina Macrea
- Section of Pulmonary and Sleep, Salem VA Medical Center, Salem, VA, United States,Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, United States
| | - Miriam C. Morey
- Geriatric Research, Education, Clinical Center Durham Veterans Affairs Healthcare System, Durham, NC, United States,Center for the Study of Aging and Department of Medicine, Duke University Medical Center, Durham, NC, United States
| | - Krisann K. Oursler
- Geriatric Research and Education, Salem VA Medical Center, Salem, VA, United States,Department of Medicine, Virginia Tech Carilion School of Medicine, Roanoke, VA, United States,*Correspondence: Krisann K. Oursler
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Ogawa EF, Harris R, Dufour AB, Morey MC, Bean J. Reliability of Virtual Physical Performance Assessments in Veterans During the COVID-19 Pandemic. Arch Rehabil Res Clin Transl 2021; 3:100146. [PMID: 34589696 PMCID: PMC8463460 DOI: 10.1016/j.arrct.2021.100146] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Objective To determine the reliability of 3 physical performance tests performed via a telehealth visit (30-s arm curls test, 30-s chair stand test, 2-min step test) among community-dwelling older veterans. Design Cross sectional study. Setting Virtual. Participants Veterans (N=55; mean age 75y) who enrolled in Gerofit, a virtual group exercise program. Interventions Not applicable. Main Outcome Measures Participants were tested by 2 different assessors at 1 time point. The intraclass correlation coefficient (ICC) with 95% confidence intervals and Bland-Altman plots were used as measures of reliability. To assess generalizability, ICCs were further evaluated by health conditions (type 2 diabetes, arthritis, obesity, depression). Results Assessments were conducted among 55 participants. The ICC was above 0.98 for all 3 tests across health conditions and Bland-Altman plots indicated that there were no significant systematic errors in the measurement. Conclusions The virtual physical performance measures appear to have high reliability and the findings are generalizable across health conditions among veterans. Thus, they are reliable for evaluating physical performance in older veterans in virtual settings.
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Affiliation(s)
- Elisa F Ogawa
- Geriatric Research, Education, and Clinical Center/Veterans Affairs Boston Healthcare System, Boston, MA.,Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA
| | - Rebekah Harris
- Geriatric Research, Education, and Clinical Center/Veterans Affairs Boston Healthcare System, Boston, MA
| | - Alyssa B Dufour
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA.,Department of Medicine, Harvard Medical School, Boston MA
| | - Miriam C Morey
- Geriatric Research, Education, and Clinical Center/Veterans Affairs Healthcare System, Durham, NC.,Department of Medicine, Duke University Center for Aging/Claude D. Pepper Older Americans Independence Center, Durham, NC
| | - Jonathan Bean
- Geriatric Research, Education, and Clinical Center/Veterans Affairs Boston Healthcare System, Boston, MA.,Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA.,Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA
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Browne J, Morey MC, Beckham JC, Bosworth HB, Porter Starr KN, Bales CW, McDermott J, Sloane R, Gregg JJ, Hall KS. Diet quality and exercise in older veterans with PTSD: a pilot study. Transl Behav Med 2021; 11:2116-2122. [PMID: 34487181 PMCID: PMC8846334 DOI: 10.1093/tbm/ibab116] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Older veterans with posttraumatic stress disorder (PTSD) are at increased risk of obesity and cardiometabolic disease. Physical activity and healthy eating are two behaviors that impact health, functional independence, and disease risk in later life, yet few studies have examined the relationship between PTSD and diet quality. This secondary analysis aimed to: (a) characterize the diet quality of older veterans with PTSD in comparison to U.S. dietary guidelines and (b) explore if participation in a supervised exercise intervention spurred simultaneous changes in dietary behavior. Diet quality was assessed with the Dietary Screener Questionnaire (DSQ), which measures daily intake of fiber, calcium, added sugar, whole grain, dairy, and fruits/vegetables/legumes. The sample included 54 military veterans ≥ 60 years old with PTSD who participated in a randomized controlled pilot trial comparing 12 weeks of supervised exercise (n = 36) to wait-list usual care (n = 18). The DSQ was administered at baseline and 12 weeks. Consumption of added sugar exceeded U.S. dietary guideline recommendations and consumption of whole grains, fruits/vegetables/legumes, fiber, calcium, and dairy fell short. Participation in the supervised exercise intervention was not associated with changes in diet quality. Results revealed that the diet quality of older veterans with PTSD is poor, and while the exercise intervention improved health through exercise, it did not make veterans any more likely to adopt a more healthful diet. Interventions targeting diet, or diet + exercise, are needed to manage the increased risk of obesity and cardiometabolic disease present in older veterans with PTSD.
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Affiliation(s)
- Julia Browne
- Geriatric Research, Education and Clinical Center, VA Durham Healthcare System, Durham, NC, USA
| | - Miriam C Morey
- Geriatric Research, Education and Clinical Center, VA Durham Healthcare System, Durham, NC, USA,Department of Medicine, Division of Geriatrics, Duke University, Durham, NC, USA,Center for the Study of Aging and Human Development, Duke University, Durham, NC, USA
| | - Jean C Beckham
- Mental Illness Research, Education, and Clinical Center, VA Durham Healthcare System, Durham, NC, USA,Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
| | - Hayden B Bosworth
- Center for the Study of Aging and Human Development, Duke University, Durham, NC, USA,Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA,Health Services Research and Development Service, Center of Innovation to Accelerate Discovery and Practice Transformation, VA Durham Healthcare System, Durham, NC, USA
| | - Kathryn N Porter Starr
- Geriatric Research, Education and Clinical Center, VA Durham Healthcare System, Durham, NC, USA,Department of Medicine, Division of Geriatrics, Duke University, Durham, NC, USA,Center for the Study of Aging and Human Development, Duke University, Durham, NC, USA
| | - Connie W Bales
- Geriatric Research, Education and Clinical Center, VA Durham Healthcare System, Durham, NC, USA,Department of Medicine, Division of Geriatrics, Duke University, Durham, NC, USA,Center for the Study of Aging and Human Development, Duke University, Durham, NC, USA
| | - Jessica McDermott
- Geriatric Research, Education and Clinical Center, VA Durham Healthcare System, Durham, NC, USA
| | - Richard Sloane
- Geriatric Research, Education and Clinical Center, VA Durham Healthcare System, Durham, NC, USA,Center for the Study of Aging and Human Development, Duke University, Durham, NC, USA
| | - Jeffrey J Gregg
- Department of Medicine, Division of Geriatrics, Duke University, Durham, NC, USA,Mental and Behavioral Health Service, Durham VA Health Care System, Durham, NC, USA
| | - Katherine S Hall
- Geriatric Research, Education and Clinical Center, VA Durham Healthcare System, Durham, NC, USA,Department of Medicine, Division of Geriatrics, Duke University, Durham, NC, USA,Center for the Study of Aging and Human Development, Duke University, Durham, NC, USA,Correspondence to: KS Hall,
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Pavon JM, Fish LJ, Colón-Emeric CS, Hall KS, Morey MC, Pastva AM, Hastings SN. Towards "mobility is medicine": Socioecological factors and hospital mobility in older adults. J Am Geriatr Soc 2021; 69:1846-1855. [PMID: 33755991 DOI: 10.1111/jgs.17109] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 02/11/2021] [Accepted: 02/19/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Understanding the factors that influence hospital mobility, especially in the context of a heightened focus on falls prevention, is needed to improve care. OBJECTIVE This qualitative study uses a socioecological framework to explore factors that influence hospital mobility in older adults. DESIGN Qualitative research PARTICIPANTS: Semi-structured interviews and focus groups were conducted with medically-ill hospitalized older adults (n = 19) and providers (hospitalists, nurses, and physical and occupational therapists (n = 48) at two hospitals associated with an academic health system. APPROACH Interview and focus group guides included questions on perceived need for mobility, communication about mobility, hospital mobility culture, and awareness of patients' walking activity. Data were analyzed thematically and mapped onto the constructs of the socioecological model. KEY RESULTS A consistent theme among patients and providers was that "mobility is medicine." Categories of factors reported to influence hospital walking activity included intrapersonal factors (patients' health status, fear of falls), interpersonal factors (patient-provider communication about mobility), organizational factors (clarity about provider roles and responsibilities, knowledge of safe patient handling, reliance on physical therapy for mobility), and environmental factors (falls as a never event, patient geographical locations on hospital units). Several of these factors were identified as potentially modifiable targets for intervention. Patients and providers offered recommendations for improving awareness of patient's ambulatory activity, assigning roles and responsibility for mobility, and enhancing education and communication between patients and providers across disciplines. CONCLUSION Patients and providers identified salient factors for future early mobility initiatives targeting hospitalized older adults. Consideration of these factors across all stages of intervention development and implementation will enhance impact and sustainability.
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Affiliation(s)
- Juliessa M Pavon
- Duke University, Durham, North Carolina, USA.,Geriatric Research Education Clinical Center, Durham Veteran Affairs Medical Center, Durham, North Carolina, USA.,Claude D. Pepper Older Americans Independence Center, Duke University, Durham, North Carolina, USA
| | | | - Cathleen S Colón-Emeric
- Duke University, Durham, North Carolina, USA.,Geriatric Research Education Clinical Center, Durham Veteran Affairs Medical Center, Durham, North Carolina, USA.,Claude D. Pepper Older Americans Independence Center, Duke University, Durham, North Carolina, USA
| | - Katherine S Hall
- Duke University, Durham, North Carolina, USA.,Geriatric Research Education Clinical Center, Durham Veteran Affairs Medical Center, Durham, North Carolina, USA.,Claude D. Pepper Older Americans Independence Center, Duke University, Durham, North Carolina, USA
| | - Miriam C Morey
- Duke University, Durham, North Carolina, USA.,Geriatric Research Education Clinical Center, Durham Veteran Affairs Medical Center, Durham, North Carolina, USA.,Claude D. Pepper Older Americans Independence Center, Duke University, Durham, North Carolina, USA
| | - Amy M Pastva
- Duke University, Durham, North Carolina, USA.,Claude D. Pepper Older Americans Independence Center, Duke University, Durham, North Carolina, USA
| | - Susan N Hastings
- Duke University, Durham, North Carolina, USA.,Geriatric Research Education Clinical Center, Durham Veteran Affairs Medical Center, Durham, North Carolina, USA.,Claude D. Pepper Older Americans Independence Center, Duke University, Durham, North Carolina, USA.,Health Services Research & Development, Durham Veterans Affairs Medical Center, Durham, North Carolina, USA
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10
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Allen KD, Woolson S, Hoenig HM, Bongiorni D, Byrd J, Caves K, Hall KS, Heiderscheit B, Hodges NJ, Huffman KM, Morey MC, Ramasunder S, Severson H, Van Houtven C, Abbate LM, Coffman CJ. Stepped Exercise Program for Patients With Knee Osteoarthritis : A Randomized Controlled Trial. Ann Intern Med 2021; 174:298-307. [PMID: 33370174 PMCID: PMC10405203 DOI: 10.7326/m20-4447] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Evidence-based models are needed to deliver exercise-related services for knee osteoarthritis efficiently and according to patient needs. OBJECTIVE To examine a stepped exercise program for patients with knee osteoarthritis (STEP-KOA). DESIGN Randomized controlled trial. (ClinicalTrials.gov: NCT02653768). SETTING 2 U.S. Department of Veterans Affairs sites. PARTICIPANTS 345 patients (mean age, 60 years; 15% female; 67% people of color) with symptomatic knee osteoarthritis. INTERVENTION Participants were randomly assigned in a 2:1 ratio to STEP-KOA or an arthritis education (AE) control group, respectively. The STEP-KOA intervention began with 3 months of an internet-based exercise program (step 1). Participants who did not meet response criteria for improvement in pain and function after step 1 progressed to step 2, which involved 3 months of biweekly physical activity coaching calls. Participants who did not meet response criteria after step 2 went on to in-person physical therapy visits (step 3). The AE group received educational materials via mail every 2 weeks. MEASUREMENTS Primary outcome was Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score. Scores for the STEP-KOA and AE groups at 9 months were compared by using linear mixed models. RESULTS In the STEP-KOA group, 65% of participants (150 of 230) progressed to step 2 and 35% (81 of 230) to step 3. The estimated baseline WOMAC score for the full sample was 47.5 (95% CI, 45.7 to 49.2). At 9-month follow-up, the estimated mean WOMAC score was 6.8 points (CI, -10.5 to -3.2 points) lower in the STEP-KOA than the AE group, indicating greater improvement. LIMITATION Participants were mostly male veterans, and follow-up was limited. CONCLUSION Veterans in STEP-KOA reported modest improvements in knee osteoarthritis symptoms compared with the control group. The STEP-KOA strategy may be efficient for delivering exercise therapies for knee osteoarthritis. PRIMARY FUNDING SOURCE Department of Veterans Affairs, Health Services Research and Development Service.
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Affiliation(s)
- Kelli D Allen
- Durham VA Health Care System, Durham, and University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (K.D.A.)
| | - Sandra Woolson
- Durham VA Health Care System, Durham, North Carolina (S.W., D.B., N.J.H.)
| | - Helen M Hoenig
- Durham VA Health Care System and Duke University, Durham, North Carolina (H.M.H., K.S.H., K.M.H., M.C.M., S.R.)
| | - Dennis Bongiorni
- Durham VA Health Care System, Durham, North Carolina (S.W., D.B., N.J.H.)
| | - James Byrd
- Greenville VA Health Care Center, Greenville, North Carolina (J.B.)
| | - Kevin Caves
- Duke University, Durham, North Carolina (K.C.)
| | - Katherine S Hall
- Durham VA Health Care System and Duke University, Durham, North Carolina (H.M.H., K.S.H., K.M.H., M.C.M., S.R.)
| | | | - Nancy Jo Hodges
- Durham VA Health Care System, Durham, North Carolina (S.W., D.B., N.J.H.)
| | - Kim M Huffman
- Durham VA Health Care System and Duke University, Durham, North Carolina (H.M.H., K.S.H., K.M.H., M.C.M., S.R.)
| | - Miriam C Morey
- Durham VA Health Care System and Duke University, Durham, North Carolina (H.M.H., K.S.H., K.M.H., M.C.M., S.R.)
| | - Shalini Ramasunder
- Durham VA Health Care System and Duke University, Durham, North Carolina (H.M.H., K.S.H., K.M.H., M.C.M., S.R.)
| | | | - Courtney Van Houtven
- Durham VA Health Care System and Duke University School of Medicine, Durham, North Carolina (C.V.)
| | - Lauren M Abbate
- VA Eastern Colorado Health Care System and University of Colorado School of Medicine, Aurora, Colorado (L.M.A.)
| | - Cynthia J Coffman
- Durham VA Health Care System and Duke University Medical Center, Durham, North Carolina (C.J.C.)
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11
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Wilkins SS, Melrose RJ, Hall KS, Blanchard E, Castle SC, Kopp T, Katzel LI, Holder A, Alexander N, McDonald MKS, Tayade A, Forman DE, Abbate LM, Harris R, Valencia WM, Morey MC, Lee CC. PTSD Improvement Associated with Social Connectedness in Gerofit Veterans Exercise Program. J Am Geriatr Soc 2020; 69:1045-1050. [PMID: 33368144 DOI: 10.1111/jgs.16973] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 11/05/2020] [Accepted: 11/08/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Post-traumatic stress disorder (PTSD) is common in Veterans. Symptoms can perpetuate into late life, negatively impacting physical and mental health. Exercise and social support are beneficial in treating anxiety disorders such as PTSD in the general population, although less is known about the impact on Veterans who have lived with PTSD for decades. This study assessed associations between social connectedness, physical function and self-reported change in PTSD symptoms among older Veterans specifically participating in Gerofit. DESIGN Prospective clinical intervention. SETTING Twelve sites of Veterans Affairs (VA) Gerofit exercise program across the United States. PARTICIPANTS Three hundred and twenty one older Veteran Gerofit participants (mean age = 74) completed physical assessments and questionnaires regarding physical and emotional symptoms and their experience. MEASUREMENTS Measures of physical function, including 30-second chair stands, 10-m and 6-min walk were assessed at baseline and 3 months; change in PTSD symptoms based on the Diagnostic Statistical Manual-5 (DSM-5) assessed by a self-report questionnaire; and social connection measured by the Relatedness Subscale of the Psychological Need Satisfaction in Exercise scale (PNSE) were evaluated after 3 months of participation in Gerofit. RESULTS Ninety five (29.6%) Veterans reported PTSD. Significant improvement was noted in self-rated PTSD symptoms at 3 months (P < .05). Moderate correlation (r = .44) was found between social connectedness with other participants in Gerofit and PTSD symptom improvement for those Veterans who endorsed improvement (n = 59). All participants improved on measures of physical function. In Veterans who endorsed PTSD there were no significant associations between physical function improvement and PTSD symptoms. CONCLUSION Veterans with PTSD that participated in Gerofit group exercise reported symptom improvement, and social connectedness was significantly associated with this improvement. In addition to physical health benefits, the social context of Gerofit may offer a potential resource for improving PTSD symptoms in older Veterans that warrants further study.
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Affiliation(s)
- Stacy Schantz Wilkins
- VA Greater Los Angeles Healthcare System; Geriatric Research, Education, and Clinical Center and Mental Health, Los Angeles, California, USA.,Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Rebecca J Melrose
- VA Greater Los Angeles Healthcare System; Geriatric Research, Education, and Clinical Center and Mental Health, Los Angeles, California, USA.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Katherine S Hall
- Geriatric Research, Education, and Clinical Center, VA Health Care System, Durham, North Carolina, USA.,Center for the Study of Aging/Claude D. Pepper Older Americans Independence Center, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Erin Blanchard
- VA Greater Los Angeles Healthcare System; Geriatric Research, Education, and Clinical Center and Mental Health, Los Angeles, California, USA
| | - Steven C Castle
- VA Greater Los Angeles Healthcare System; Geriatric Research, Education, and Clinical Center and Mental Health, Los Angeles, California, USA.,Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Teresa Kopp
- Department of Physical Medicine and Rehabilitation, VA Medical Center, Canandaigua, New York, USA
| | - Leslie I Katzel
- Geriatric Research, Education and Clinical Center, VA Maryland Health Care System, Baltimore, Maryland, USA.,Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Alice Holder
- Department of Physical Therapy, VA Cincinnati Medical Center, Cincinnati, Ohio, USA
| | - Neil Alexander
- Geriatric Research, Education, and Clinical Center, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA.,School of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Michelle K S McDonald
- Geriatric Rehabilitation and Clinical Center, VA Pacific Health Care System, Honolulu, Hawaii, USA
| | - Arti Tayade
- Geriatrics and Extended Care, VA Puget Sound Health Care System, Seattle, Washington, USA.,Division of Gerontology & Geriatric Medicine, University of Washington, Seattle, Washington, USA
| | - Daniel E Forman
- Pittsburgh Geriatric Research, Education, and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA.,Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Geriatric Research, Education, and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
| | - Lauren M Abbate
- Geriatric Research, Education, and Clinical Center, Eastern Colorado Health Care System, Aurora, Colorado, USA.,Department of Emergency Medicine, University of Colorado, Aurora, Colorado, USA
| | - Rebekah Harris
- Geriatric Research, Education, and Clinical Center, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Willy M Valencia
- Geriatric Research, Education, and Clinical Center, Miami Healthcare System, Florida, USA.,University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Miriam C Morey
- Geriatric Research, Education, and Clinical Center, VA Health Care System, Durham, North Carolina, USA.,Center for the Study of Aging/Claude D. Pepper Older Americans Independence Center, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Cathy C Lee
- VA Greater Los Angeles Healthcare System; Geriatric Research, Education, and Clinical Center and Mental Health, Los Angeles, California, USA.,Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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12
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Hall KS, Morey MC, Beckham JC, Bosworth HB, Sloane R, Pieper CF, Pebole MM. Warrior Wellness: A Randomized Controlled Pilot Trial of the Effects of Exercise on Physical Function and Clinical Health Risk Factors in Older Military Veterans With PTSD. J Gerontol A Biol Sci Med Sci 2020. [DOI: 10.1093/gerona/glz255 7973256] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Military veterans living with post-traumatic stress disorder (PTSD) face significant physical and functional health disparities, which are often aggravated over time and in the context aging. Evidence has shown that physical activity can positively impact age-related health conditions, yet exercise trials in older adults with mental disorders are rare. Our study was a tailored and targeted pilot exercise intervention for older veterans with PTSD.
Methods
Fifty-four older veterans with PTSD (mean age = 67.4 years, 90.7% male, 85.2% non-white) were randomized to supervised exercise (n = 38) or wait-list usual care (n = 18) for 12 weeks. Physical activity (MET-min/wk) and aerobic endurance (assessed with the 6-minute walk test) were primary outcomes. Secondary outcomes were physical performance (strength, mobility, balance), cardiometabolic risk factors (eg, waist circumference), and health-related quality of life.
Results
At 12 weeks, a large effect of the intervention on physical activity levels (Cohen’s d = 1.37) was observed compared to wait-list usual care. Aerobic endurance improved by 69 m in the exercise group compared to 10 m in wait-list group, reflecting a moderate between-group effect (Cohen’s d = 0.50). Between-group differences on 12-week changes in physical performance, cardiometabolic risk factors, and health-related quality of life ranged from small to large effects (Cohen’s d = 0.28–1.48), favoring the exercise arm.
Conclusion
Participation in supervised exercise improved aerobic endurance, physical performance, and health-related clinical factors in older veterans with PTSD; a medically complex population with multiple morbidity. Group exercise is a low-cost, low-stigma intervention, and implementation efforts among older veterans with PTSD warrants further consideration.
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Affiliation(s)
- Katherine S Hall
- VA Durham Healthcare System, Geriatric Research, Education, and Clinical Center, North Carolina
- Department of Population Health Sciences, Duke University, Durham, North Carolina
- VA Durham Healthcare System, Geriatric Research, Education, and Clinical Center, North Carolina
| | - Miriam C Morey
- VA Durham Healthcare System, Geriatric Research, Education, and Clinical Center, North Carolina
- Department of Population Health Sciences, Duke University, Durham, North Carolina
| | - Jean C Beckham
- VA Durham Healthcare System, Mental Illness Research, Education, and Clinical Center, North Carolina
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina
| | - Hayden B Bosworth
- Department of Population Health Sciences, Duke University, Durham, North Carolina
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina
- VA Durham Healthcare System, Health Services Research and Development, Center of Innovation to Accelerate Discovery and Practice Transformation, North Carolina
| | - Richard Sloane
- VA Durham Healthcare System, Geriatric Research, Education, and Clinical Center, North Carolina
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina
| | - Carl F Pieper
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina
| | - Michelle M Pebole
- VA Durham Healthcare System, Geriatric Research, Education, and Clinical Center, North Carolina
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13
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Hall KS, Morey MC, Beckham JC, Bosworth HB, Sloane R, Pieper CF, Pebole MM. Warrior Wellness: A Randomized Controlled Pilot Trial of the Effects of Exercise on Physical Function and Clinical Health Risk Factors in Older Military Veterans With PTSD. J Gerontol A Biol Sci Med Sci 2020; 75:2130-2138. [PMID: 31646339 DOI: 10.1093/gerona/glz255] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Military veterans living with post-traumatic stress disorder (PTSD) face significant physical and functional health disparities, which are often aggravated over time and in the context aging. Evidence has shown that physical activity can positively impact age-related health conditions, yet exercise trials in older adults with mental disorders are rare. Our study was a tailored and targeted pilot exercise intervention for older veterans with PTSD. METHODS Fifty-four older veterans with PTSD (mean age = 67.4 years, 90.7% male, 85.2% non-white) were randomized to supervised exercise (n = 38) or wait-list usual care (n = 18) for 12 weeks. Physical activity (MET-min/wk) and aerobic endurance (assessed with the 6-minute walk test) were primary outcomes. Secondary outcomes were physical performance (strength, mobility, balance), cardiometabolic risk factors (eg, waist circumference), and health-related quality of life. RESULTS At 12 weeks, a large effect of the intervention on physical activity levels (Cohen's d = 1.37) was observed compared to wait-list usual care. Aerobic endurance improved by 69 m in the exercise group compared to 10 m in wait-list group, reflecting a moderate between-group effect (Cohen's d = 0.50). Between-group differences on 12-week changes in physical performance, cardiometabolic risk factors, and health-related quality of life ranged from small to large effects (Cohen's d = 0.28-1.48), favoring the exercise arm. CONCLUSION Participation in supervised exercise improved aerobic endurance, physical performance, and health-related clinical factors in older veterans with PTSD; a medically complex population with multiple morbidity. Group exercise is a low-cost, low-stigma intervention, and implementation efforts among older veterans with PTSD warrants further consideration.
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Affiliation(s)
- Katherine S Hall
- VA Durham Healthcare System, Geriatric Research, Education, and Clinical Center, North Carolina.,Department of Population Health Sciences, Duke University, Durham, North Carolina
| | - Miriam C Morey
- VA Durham Healthcare System, Geriatric Research, Education, and Clinical Center, North Carolina.,Department of Population Health Sciences, Duke University, Durham, North Carolina
| | - Jean C Beckham
- VA Durham Healthcare System, Mental Illness Research, Education, and Clinical Center, North Carolina.,Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina
| | - Hayden B Bosworth
- Department of Population Health Sciences, Duke University, Durham, North Carolina.,Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina.,VA Durham Healthcare System, Health Services Research and Development, Center of Innovation to Accelerate Discovery and Practice Transformation, North Carolina
| | - Richard Sloane
- VA Durham Healthcare System, Geriatric Research, Education, and Clinical Center, North Carolina.,Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina
| | - Carl F Pieper
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina
| | - Michelle M Pebole
- VA Durham Healthcare System, Geriatric Research, Education, and Clinical Center, North Carolina
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14
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Pepin MJ, Valencia WM, Bettger JP, Pearson M, Manning KM, Sloane R, Schmader KE, Morey MC. Impact of Supervised Exercise on One-Year Medication Use in Older Veterans with Multiple Morbidities. Gerontol Geriatr Med 2020; 6:2333721420956751. [PMID: 32995368 PMCID: PMC7503003 DOI: 10.1177/2333721420956751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 08/14/2020] [Indexed: 11/16/2022] Open
Abstract
Exercise is touted as the ideal prescription to treat and prevent many chronic diseases. We examined changes in utilization and cost of medication classes commonly prescribed in the management of chronic conditions following participation in 12-months of supervised exercise within the Veterans Affairs Gerofit program. Gerofit enrolled 480 veterans between 1999 and 2017 with 12-months participation, with 453 having one or more active prescriptions on enrollment. Active prescriptions overall and for five classes of medications were examined. Changes from enrollment to 12 months were calculated, and cost associated with prescriptions filled were used to estimate net cost changes. Active prescriptions were reduced for opioids (77 of 164, 47%), mental health (93 of 221, 42%), cardiac (175 of 391, 45%), diabetes (41 of 166, 25%), and lipid lowering (56 of 253, 22%) agents. Cost estimates resulted in a net savings of $38,400. These findings support the role of supervised exercise as a favorable therapeutic intervention that has impact across chronic conditions.
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Affiliation(s)
| | - Willy M Valencia
- Miami Healthcare System, FL, USA.,University of Miami, Miami, FL, USA
| | | | | | | | - Richard Sloane
- Duke University Medical Center, Durham, NC, USA.,Center for Aging/ OAIC, Duke University, NC USA
| | - Kenneth E Schmader
- VA Health Care System, Durham, NC, USA.,Duke University Medical Center, Durham, NC, USA.,Center for Aging/ OAIC, Duke University, NC USA
| | - Miriam C Morey
- VA Health Care System, Durham, NC, USA.,Duke University Medical Center, Durham, NC, USA.,Center for Aging/ OAIC, Duke University, NC USA
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15
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Oyedeji CI, Hall K, Luciano A, Morey MC, Strouse JJ. Geriatric assessment for older adults with sickle cell disease: protocol for a prospective cohort pilot study. Pilot Feasibility Stud 2020; 6:131. [PMID: 32974042 PMCID: PMC7495855 DOI: 10.1186/s40814-020-00673-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 09/01/2020] [Indexed: 11/20/2022] Open
Abstract
Background The life expectancy for people with sickle cell disease (SCD) has improved tremendously over the last 50 years. This population experiences hemolysis and vaso-occlusion in multiple organs that lead to complications such as cardiopulmonary disease, strokes, and avascular necrosis. These complications can limit mobility and aerobic endurance, similar to limitations that often occur in geriatric populations. These sickle-cell and age-related events lead to frequent hospitalization, which further increases the risk of functional decline. We have few tools to measure functional decline in people with SCD. The purpose of this paper is to describe a protocol to evaluate the feasibility of sickle cell disease geriatric assessment (SCD-GA). Methods/design We will enroll 40 adults with SCD (20 age 18–49.99 years and 20 age ≥ 50 years) in a prospective cohort study to assess the feasibility of SCD-GA. The SCD-GA includes validated measures from the oncology geriatric assessment enriched with additional physical and cognitive measures. The SCD-GA will be performed at the first study visit, at 10 to 20 days after hospitalization, and at 12 months (exit visit). With input from a multidisciplinary team of sickle cell specialists, geriatricians, and experts in physical function and physical activity, we selected assessments across 7 domains: functional status (11 measures), comorbid medical conditions (1 measure), psychological state (1 measure), social support (2 measures), weight status (2 measures), cognition (3 measures), and medications (1 measure). We will measure the proportion completing the assessment with feasibility as the primary outcome. Secondary outcomes include the proportion consenting and completing all study visits, duration of the assessment, acceptability, and adverse events. Discussion We present the protocol and rationale for selection of the measures included in SCD-GA. We also outline the methods to determine feasibility and subsequently to optimize the SCD-GA in preparation for a larger multicenter validation study of the SCD-GA.
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Affiliation(s)
- Charity I Oyedeji
- Department of Medicine, Division of Hematology, Duke University School of Medicine, 315 Trent Dr. Suite 261, DUMC Box 3939, Durham, NC 27710 USA.,Duke Claude D. Pepper Older Americans Independence Center, Durham, NC USA
| | - Katherine Hall
- Duke Claude D. Pepper Older Americans Independence Center, Durham, NC USA.,Department of Medicine, Division of Geriatrics, Duke University, Durham, NC USA.,Geriatric Research, Education and Clinical Center, Durham Veterans Affairs Healthcare System, Durham, NC USA
| | - Alison Luciano
- Duke Claude D. Pepper Older Americans Independence Center, Durham, NC USA
| | - Miriam C Morey
- Duke Claude D. Pepper Older Americans Independence Center, Durham, NC USA.,Department of Medicine, Division of Geriatrics, Duke University, Durham, NC USA.,Geriatric Research, Education and Clinical Center, Durham Veterans Affairs Healthcare System, Durham, NC USA
| | - John J Strouse
- Department of Medicine, Division of Hematology, Duke University School of Medicine, 315 Trent Dr. Suite 261, DUMC Box 3939, Durham, NC 27710 USA.,Duke Claude D. Pepper Older Americans Independence Center, Durham, NC USA.,Department of Medicine, and Duke Comprehensive Sickle Cell Center, Duke University School of Medicine, Durham, NC USA.,Division of Pediatric Hematology-Oncology, Duke University, Durham, NC USA
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16
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Manning KM, McNeill DL, Pinheiro SO, Heflin MT, Valencia WM, Lee CC, Castle SC, Katzel L, Giffuni J, Morey MC. An innovative educational clinical experience promoting geriatric exercise. Gerontol Geriatr Educ 2020; 41:20-31. [PMID: 29028419 DOI: 10.1080/02701960.2017.1391802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Formal educational training in physical activity promotion is relatively sparse throughout the medical education system. The authors describe an innovative clinical experience in physical activity directed at medical clinicians on a geriatrics rotation. The experience consists of a single 2 1/2 hour session, in which learners are partnered with geriatric patients engaged in a formal supervised exercise program. The learners are guided through an evidence-based exercise regimen tailored to functional status. This experience provides learners with an opportunity to interact with geriatric patients outside the hospital environment to counterbalance the typical geriatric rotation in which geriatric patients are often seen in clinics or hospitals. In this experience, learners are exposed to fit and engaged geriatric patients successfully living in the community despite chronic or disabling conditions. A survey of 105 learners highlighted positive responses to the experience, with 96% of survey respondents indicating that the experience increased their confidence in their ability to serve as advocates for physical activity for older adults, and 89.5% of responders to a follow-up survey indicating that the experience changed their perception of geriatric patients. Modifications to the experience, implemented at partnering facilities are described. The positive feedback from this experience warrants consideration for implementation in other settings.
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Affiliation(s)
- Kenneth M Manning
- Geriatric Research, Education, and Clinical Center, VA Medical Center, Durham, North Carolina USA
| | - Darien L McNeill
- Geriatric Research, Education, and Clinical Center, VA Medical Center, Durham, North Carolina USA
- University of North Carolina School of Medicine, Chapel Hill, North Carolina USA
| | - Sandro O Pinheiro
- Geriatric Research, Education, and Clinical Center, VA Medical Center, Durham, North Carolina USA
- Center for the Study of Aging/Claude D. Pepper Older Americans Independence Center, Duke University Medical Center, Durham, North Carolina USA
- Department of Medicine, Duke University Medical Center, Durham, North Carolina USA
| | - Mitchell T Heflin
- Geriatric Research, Education, and Clinical Center, VA Medical Center, Durham, North Carolina USA
- Center for the Study of Aging/Claude D. Pepper Older Americans Independence Center, Duke University Medical Center, Durham, North Carolina USA
- Department of Medicine, Duke University Medical Center, Durham, North Carolina USA
| | - Willy M Valencia
- Geriatric Research, Education, and Clinical Center, VA Healthcare System, Miami, Florida USA
- Division of Epidemiology, Division of Geriatric Medicine, University of Miami Miller School of Medicine, Miami, Florida USA
| | - Cathy C Lee
- Geriatric Research, Education, and Clinical Center, Greater Los Angeles VA Healthcare System, Los Angeles, California USA
- David Geffen School of Medicine at the University of California, Los Angeles, California USA
| | - Steven C Castle
- Geriatric Research, Education, and Clinical Center, Greater Los Angeles VA Healthcare System, Los Angeles, California USA
- David Geffen School of Medicine at the University of California, Los Angeles, California USA
| | - Leslie Katzel
- Geriatric Research and Education Clinical Center, Baltimore VA Medical Center, Baltimore, Maryland
- Gerontology and Geriatric Medicine, Department of Medicine, University of Maryland School of Medicine and Geriatric Research and Education Clinical Center, Baltimore, Maryland USA
| | | | - Miriam C Morey
- Geriatric Research, Education, and Clinical Center, VA Medical Center, Durham, North Carolina USA
- Center for the Study of Aging/Claude D. Pepper Older Americans Independence Center, Duke University Medical Center, Durham, North Carolina USA
- Department of Medicine, Duke University Medical Center, Durham, North Carolina USA
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17
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Jennings SC, Manning KM, Bettger JP, Hall KM, Pearson M, Mateas C, Briggs BC, Oursler KK, Blanchard E, Lee CC, Castle S, Valencia WM, Katzel LI, Giffuni J, Kopp T, McDonald M, Harris R, Bean JF, Althuis K, Alexander NB, Padala KP, Abbate LM, Wellington T, Kostra J, Allsup K, Forman DE, Tayade AS, Wesley AD, Holder A, Morey MC. Rapid Transition to Telehealth Group Exercise and Functional Assessments in Response to COVID-19. Gerontol Geriatr Med 2020; 6:2333721420980313. [PMID: 33403222 PMCID: PMC7739082 DOI: 10.1177/2333721420980313] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 10/08/2020] [Accepted: 11/12/2020] [Indexed: 12/25/2022] Open
Abstract
Exercise is critical for health maintenance in late life. The COVID-19 shelter in place and social distancing orders resulted in wide-scale interruptions of exercise therapies, placing older adults at risk for the consequences of decreased mobilization. The purpose of this paper is to describe rapid transition of the Gerofit facility-based group exercise program to telehealth delivery. This Gerofit-to-Home (GTH) program continued with group-based synchronous exercise classes that ranged from 1 to 24 Veterans per class and 1 to 9 classes offered per week in the different locations. Three hundred and eight of 1149 (27%) Veterans active in the Gerofit facility-based programs made the transition to the telehealth delivered classes. Participants' physical performance testing continued remotely as scheduled with comparisons between most recent facility-based and remote testing suggesting that participants retained physical function. Detailed protocols for remote physical performance testing and sample exercise routines are described. Translation to remote delivery of exercise programs for older adults could mitigate negative health effects.
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Affiliation(s)
| | | | - Janet Prvu Bettger
- VA Health Care System, Durham, NC, USA
- Duke University Medical Center, Durham, NC, USA
- Duke University, Durham, NC, USA
| | - Katherine M. Hall
- VA Health Care System, Durham, NC, USA
- Duke University Medical Center, Durham, NC, USA
- Duke University, Durham, NC, USA
| | | | | | | | - Krisann K. Oursler
- Salem VA Medical Center, VA, USA
- Virginia Tech Carilion School of Medicine, Roanoke, USA
| | | | - Cathy C. Lee
- VA Greater Los Angeles Healthcare System, CA, USA
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Steven Castle
- VA Greater Los Angeles Healthcare System, CA, USA
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Willy M. Valencia
- Miami Healthcare System, FL, USA
- University of Miami, Miller School of Medicine, FL, USA
| | - Leslie I. Katzel
- VA Maryland Health Care System, Baltimore, USA
- University of Maryland School of Medicine, Baltimore, USA
| | - Jamie Giffuni
- VA Maryland Health Care System, Baltimore, USA
- University of Maryland School of Medicine, Baltimore, USA
| | | | | | | | - Jonathan F. Bean
- VA Boston Healthcare System, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Katherine Althuis
- VA Ann Arbor Healthcare System, MI, USA
- University of Michigan, Ann Arbor, USA
| | - Neil B. Alexander
- VA Ann Arbor Healthcare System, MI, USA
- University of Michigan, Ann Arbor, USA
| | - Kalpana P. Padala
- Central Arkansas Veterans Healthcare System, Little Rock, USA
- University of Arkansas for Medical Sciences, Little Rock, USA
| | - Lauren M. Abbate
- Eastern Colorado Health Care System, Aurora, USA
- Unverisity of Colorado, Aurora, USA
| | | | - James Kostra
- VA Pittsburgh Healthcare System, PA, USA
- University of Pittsburgh, PA, USA
| | | | - Daniel E. Forman
- VA Pittsburgh Healthcare System, PA, USA
- University of Pittsburgh, PA, USA
- University of Pittsburgh Medical Center, PA, USA
| | - Arti S. Tayade
- VA Puget Sound Health Care System, Seattle, WA, USA
- University of Washington, Seattle, USA
| | | | | | - Miriam C. Morey
- VA Health Care System, Durham, NC, USA
- Duke University Medical Center, Durham, NC, USA
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18
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Parker D, Sloane R, Pieper CF, Hall KS, Kraus VB, Kraus WE, Huebner JL, Ilkayeva OR, Bain JR, Newby LK, Cohen HJ, Morey MC. Age-Related Adverse Inflammatory and Metabolic Changes Begin Early in Adulthood. J Gerontol A Biol Sci Med Sci 2019; 74:283-289. [PMID: 29985987 DOI: 10.1093/gerona/gly121] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Indexed: 12/16/2022] Open
Abstract
Aging is characterized by deleterious immune and metabolic changes, but the onset of these changes is unknown. We measured immune and metabolic biomarkers in adults beginning at age 30. To our knowledge, this is the first study to evaluate these biomarkers in adults aged 30 to over 80. Biomarkers were quantified in 961 adults. Tumor necrosis factor alpha (TNF-α), tumor necrosis factor receptor I (TNFR-I), tumor necrosis factor receptor II (TNFR-II), interleukin (IL)-2, IL-6, VCAM-I, D-Dimer, G-CSF, regulated on activation, normal T cell expressed and secreted (RANTES), matrix metalloproteinase-3 (MMP-3), adiponectin, and paraoxonase activity were measured by ELISA. Acylcarnitines and amino acids (AAs) were measured by mass spectrometry and reduced to a single factor using principal components analysis (PCA). Glycine was analyzed separately. The relationship between age and biomarkers was analyzed by linear regression with sex, race, and body mass index (BMI) as covariates. Age was positively correlated with TNF-α, TNFR-I, TNFR-II, IL-6, IL-2, VCAM-1, D-Dimer, MMP-3, adiponectin, acylcarnitines, and AAs. Age was negative correlated with G-CSF, RANTES, and paraoxonase activity. BMI was significant for all biomarkers except IL-2, VCAM-1, RANTES, paraoxonase activity, and the AA factor. Excluding MMP-3, greater BMI was associated with potentially adverse changes in biomarker concentrations. Age-related changes in immune and metabolic biomarkers, known to be associated with poor outcomes in older adults, begin as early as the thirties.
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Affiliation(s)
- Daniel Parker
- Division of Geriatrics, Duke University School of Medicine, Durham, North Carolina.,Department of Medicine, Duke University School of Medicine, Durham, North Carolina.,Claude D. Pepper Older Americans Independence Center/Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, North Carolina
| | - Richard Sloane
- Claude D. Pepper Older Americans Independence Center/Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, North Carolina
| | - Carl F Pieper
- Claude D. Pepper Older Americans Independence Center/Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, North Carolina.,Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina
| | - Katherine S Hall
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina.,Claude D. Pepper Older Americans Independence Center/Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, North Carolina.,Durham VA Medical Center, North Carolina
| | - Virginia B Kraus
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina.,Claude D. Pepper Older Americans Independence Center/Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, North Carolina.,Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, North Carolina
| | - William E Kraus
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina.,Claude D. Pepper Older Americans Independence Center/Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, North Carolina.,Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, North Carolina.,Division of Cardiology, Duke University School of Medicine, Durham, North Carolina
| | - Janet L Huebner
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, North Carolina
| | - Olga R Ilkayeva
- Claude D. Pepper Older Americans Independence Center/Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, North Carolina.,Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, North Carolina.,Sarah W. Stedman Nutrition and Metabolism Center
| | - James R Bain
- Claude D. Pepper Older Americans Independence Center/Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, North Carolina.,Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, North Carolina.,Sarah W. Stedman Nutrition and Metabolism Center
| | - L Kristin Newby
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina.,Division of Cardiology, Duke University School of Medicine, Durham, North Carolina.,Sarah W. Stedman Nutrition and Metabolism Center.,Duke Clinical and Translational Science Institute, Duke University School of Medicine, Durham, North Carolina
| | - Harvey Jay Cohen
- Division of Geriatrics, Duke University School of Medicine, Durham, North Carolina.,Department of Medicine, Duke University School of Medicine, Durham, North Carolina.,Claude D. Pepper Older Americans Independence Center/Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, North Carolina
| | - Miriam C Morey
- Division of Geriatrics, Duke University School of Medicine, Durham, North Carolina.,Department of Medicine, Duke University School of Medicine, Durham, North Carolina.,Claude D. Pepper Older Americans Independence Center/Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, North Carolina.,Durham VA Medical Center, North Carolina
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19
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Addison O, Serra MC, Katzel L, Giffuni J, Lee CC, Castle S, Valencia WM, Kopp T, Cammarata H, McDonald M, Oursler KA, Jain C, Bettger JP, Pearson M, Manning KM, Intrator O, Veazie P, Sloane R, Li J, Morey MC. Mobility Improvements are Found in Older Veterans After 6-Months of Gerofit Regardless of BMI Classification. J Aging Phys Act 2019; 27:848-854. [PMID: 31170861 PMCID: PMC7184640 DOI: 10.1123/japa.2018-0317] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Veterans represent a unique population of older adults as they are more likely to self-report disability and be overweight or obese compared to the general population. We sought to compare changes in mobility function across the obesity spectrum in older Veterans participating in six-months of Gerofit, a clinical exercise program. 270 Veterans completed baseline, three, and six-month functional assessment and were divided post-hoc into groups: normal weight, overweight, and obese. Physical function assessment included: ten-meter walk time, six-minute walk distance, 30-second chair stands, and eight-foot up-and-go time. No significant weight x time interactions were found for any measure. However, significant (P<0.02) improvements were found for all mobility measures from baseline to three-months and maintained at six-months. Six-months of participation in Gerofit, if enacted nationwide, appears to be one way to improve mobility and function in older Veterans at high risk for disability regardless of weight status.
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Affiliation(s)
- Odessa Addison
- 1 Geriatric Research, Education and Clinical Center, VA Maryland Health Care System, Baltimore, MD
- 2 School of Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Monica C Serra
- 3 Atlanta VA Medical Center, Atlanta, GA
- 4 School of Medicine, Emory University, Atlanta, GA
| | - Leslie Katzel
- 1 Geriatric Research, Education and Clinical Center, VA Maryland Health Care System, Baltimore, MD
- 2 School of Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Jamie Giffuni
- 1 Geriatric Research, Education and Clinical Center, VA Maryland Health Care System, Baltimore, MD
| | - Cathy C Lee
- 5 Geriatric Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System, CA
- 6 David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Steven Castle
- 5 Geriatric Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System, CA
- 6 David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Willy M Valencia
- 7 Geriatric Research, Education, and Clinical Center, Miami Healthcare System, FL
- 8 University of Miami, Miller School of Medicine, Miami, FL
| | | | | | - Michelle McDonald
- 10 Geritaric Rehabilitation and Clinical Center, VA Pacific Health Care System, Honolulu, HI
| | - Kris A Oursler
- 11 Geriatric Research and Education, VA Medical Center, Salem, VA
| | - Chani Jain
- 11 Geriatric Research and Education, VA Medical Center, Salem, VA
| | - Janet Prvu Bettger
- 12 Department of Orthopedic Surgery, Duke University Medical Center, Durham, NC
| | - Megan Pearson
- 13 Geriatric Research, Education, and Clinical Center, VA Health Care System, Durham, NC
| | - Kenneth M Manning
- 13 Geriatric Research, Education, and Clinical Center, VA Health Care System, Durham, NC
| | - Orna Intrator
- 14 Geriatrics and Extended Care Data and Analyses Center, VA Medical Center, Canandaigua, University of Rochester, Medical Center, Rochester, NY
- 15 Center for the Study of Aging / Claude D. Pepper Older Americans Independence Center
| | - Peter Veazie
- 14 Geriatrics and Extended Care Data and Analyses Center, VA Medical Center, Canandaigua, University of Rochester, Medical Center, Rochester, NY
- 15 Center for the Study of Aging / Claude D. Pepper Older Americans Independence Center
| | - Richard Sloane
- 16 Department of Medicine, Duke University Medical Center, Durham, NC
| | - Jiejin Li
- 14 Geriatrics and Extended Care Data and Analyses Center, VA Medical Center, Canandaigua, University of Rochester, Medical Center, Rochester, NY
- 15 Center for the Study of Aging / Claude D. Pepper Older Americans Independence Center
| | - Miriam C Morey
- 13 Geriatric Research, Education, and Clinical Center, VA Health Care System, Durham, NC
- 16 Department of Medicine, Duke University Medical Center, Durham, NC
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20
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Pavon JM, Sloane RJ, Pieper CF, Colón-Emeric CS, Cohen HJ, Gallagher D, Hall KS, Morey MC, McCarty M, Hastings SN. Accelerometer-Measured Hospital Physical Activity and Hospital-Acquired Disability in Older Adults. J Am Geriatr Soc 2019; 68:261-265. [PMID: 31747050 DOI: 10.1111/jgs.16231] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 09/16/2019] [Accepted: 09/20/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND Hospital-acquired disability (HAD) is common and often related to low physical activity while in the hospital. OBJECTIVE To examine whether wearable hospital activity trackers can be used to predict HAD. DESIGN A prospective observational study between January 2016 and March 2017. SETTING An academic medical center. PARTICIPANTS Community-dwelling older adults, aged 60 years or older, enrolled within 24 hours of admission to general medicine (n = 46). MAIN MEASURES Primary outcome was HAD, defined as having one or more new activity of daily living deficits, decline of four or greater on the Late-Life Function and Disability Instrument (calculated between baseline and discharge), or discharge to a skilled nursing facility. Hospital activity (mean active time, mean sedentary time, and mean step counts per day) was measured using ankle-mounted accelerometers. The association of the literature-based threshold of 900 steps/day with HAD was also evaluated. RESULTS Mean age was 73.2 years (SD = 9.5 years), 48% were male, and 76% were white. Median length of stay was 4 days (interquartile range [IQR] = 2.0-6.0 days); 61% (n = 28) reported being able to walk without assistance of another person or walking aid at baseline. Median daily activity time and step counts were 1.1 h/d (IQR = 0.7-1.7 h/d) and 1455.7 steps/day (IQR = 908.5-2643 steps/day), respectively. Those with HAD (41%; n = 19) had lower activity time (0.8 vs 1.4 h/d; P = .04) and fewer step counts (1186 vs 1808 steps/day; P = .04), but no difference in sedentary time, compared to those without HAD. The 900 steps/day threshold had poor sensitivity (40%) and high specificity (85%) for detecting HAD. CONCLUSIONS Low hospital physical activity, as measured by wearable accelerometers, is associated with HAD. Clinicians can utilize wearable technology data to refer patients to physical/occupational therapy services or other mobility interventions, like walking programs. J Am Geriatr Soc 68:261-265, 2020.
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Affiliation(s)
- Juliessa M Pavon
- Duke University, Durham, North Carolina.,Geriatric Research Education Clinical Center, Durham Veteran Affairs Health Care System, Durham, North Carolina.,Duke University Claude D. Pepper Center, Durham, North Carolina
| | - Richard J Sloane
- Duke University, Durham, North Carolina.,Geriatric Research Education Clinical Center, Durham Veteran Affairs Health Care System, Durham, North Carolina.,Duke University Claude D. Pepper Center, Durham, North Carolina
| | - Carl F Pieper
- Duke University, Durham, North Carolina.,Geriatric Research Education Clinical Center, Durham Veteran Affairs Health Care System, Durham, North Carolina.,Duke University Claude D. Pepper Center, Durham, North Carolina
| | - Cathleen S Colón-Emeric
- Duke University, Durham, North Carolina.,Geriatric Research Education Clinical Center, Durham Veteran Affairs Health Care System, Durham, North Carolina.,Duke University Claude D. Pepper Center, Durham, North Carolina
| | - Harvey J Cohen
- Duke University, Durham, North Carolina.,Geriatric Research Education Clinical Center, Durham Veteran Affairs Health Care System, Durham, North Carolina.,Duke University Claude D. Pepper Center, Durham, North Carolina
| | | | - Katherine S Hall
- Duke University, Durham, North Carolina.,Geriatric Research Education Clinical Center, Durham Veteran Affairs Health Care System, Durham, North Carolina.,Duke University Claude D. Pepper Center, Durham, North Carolina
| | - Miriam C Morey
- Duke University, Durham, North Carolina.,Geriatric Research Education Clinical Center, Durham Veteran Affairs Health Care System, Durham, North Carolina.,Duke University Claude D. Pepper Center, Durham, North Carolina
| | | | - Susan N Hastings
- Duke University, Durham, North Carolina.,Geriatric Research Education Clinical Center, Durham Veteran Affairs Health Care System, Durham, North Carolina.,Duke University Claude D. Pepper Center, Durham, North Carolina.,Health Services Research and Development, Durham Veterans Affairs Health Care System, Durham, North Carolina
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21
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lowder YP, Romero K, Ren Y, Pastva AM, Morey MC, Cohen HJ, Chao NJ, Sung AD. GERIATRIC ASSESSMENT BEFORE HEMATOPOIETIC STEM CELL TRANSPLANT IDENTIFIES DEFICITS ACROSS ALL AGES. Innov Aging 2019. [PMCID: PMC6840211 DOI: 10.1093/geroni/igz038.1723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Allogeneic hematopoietic stem cell transplant (HCT) is a lifesaving procedure; however, it is associated with significant morbidity, and treatment-related mortality ranges from 10-30%. Morbidity and mortality have been associated with poor functional status. The geriatric assessment (GA) may allow identification of deficits pre-HCT, allowing intervention and improvement. While focused on older adults, we hypothesize that GA may also identify deficits in younger patients who may be debilitated by chemotherapy or cancer before HCT. We performed a GA in all adult patients at the time of initial evaluation for HCT (between 10/1/17-1/31/19) and again immediately before HCT. Deficits were identified and patients referred to specialists (physical therapy, neuropsychology, etc.) prior to HCT. Among 83 patients, the median age was 58 years (age range: 19-75), 59 (71%) had ≥1 deficits, including 41 (49%) had ≥2 deficits that required referral. The most common deficit was physical function (45, 54%), followed by cognitive function (29, 35%), nutrition (26, 31%), and mental health (7, 8%). Deficits were common across all age groups: 9/16 (56%) 60 years old. To date, 40 patients have undergone HCT; of the 24 with deficits at initial evaluation, 10 (42%) improved at least one deficit, 5 (21%) were unchanged, and 9 (38%) not evaluated. Physical and nutrition deficits were most responsive to intervention. These results suggest that there is a high degree of impairment prior to HCT among both older and younger patients; however, these deficits are amenable to improvement prior to HCT.
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Affiliation(s)
- yen p lowder
- Duke University Hospital, Durham, North Carolina, United States
| | - Kristi Romero
- Duke University Hospital, Durham, North Carolina, United States
| | - Yi Ren
- Duke University Hospital, Durham, North Carolina, United States
| | - Amy M Pastva
- Duke University Hospital, Durham, North Carolina, United States
| | - Miriam C Morey
- Durham Veterans Affairs Health Care system, Durham, North Carolina, United States
| | - Harvey J Cohen
- Duke University Medical Center, Durham, North Carolina, United States
| | - Nelson J Chao
- Duke University Hospital, Durham, North Carolina, United States
| | - Anthony D Sung
- Duke University Hospital, Durham, North Carolina, United States
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22
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Jarvis L, Peterson MJ, Morey MC, Caves K. VALIDATION OF A WALKING SPEED MEASUREMENT DEVICE: GAITBOX. Innov Aging 2019. [PMCID: PMC6840069 DOI: 10.1093/geroni/igz038.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The NIH 4m Walk Test is a clinically validated tool to measure adult walking speed. Human reaction limitations can contribute to measurement error when manually timing gait speed. This is important considering a 0.10m/s decrease in walking speed is associated with a 12% decrease in life expectancy for older adults. The goal of this study was to validate a low cost, custom built device, Gait Box (GB), compared to human timer (HT) and a research grade Sprint Timing System (STS) with an older adult (mean 72.4 + 7.4 years of age) population (N = 35). Validity was assessed via accuracy (correlations), precision (mean differences), and bias (Bland-Altman plots). Results showed strong correlations between the GB and HT (0.99) and the GB and STS (0.98), with negligible mean differences. This demonstrates the GB can be used to accurately and precisely measure gait speed in clinical and research settings.
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Affiliation(s)
| | | | - Miriam C Morey
- Duke Center for Aging/OAIC & Durham VA GRECC, Durham, North Carolina, United States
| | - Kevin Caves
- Duke University, Durham, North Carolina, United States
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23
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Hall KS, Morey MC, Bosworth H, Beckham J, Pebole M. EVALUATING THE ASSOCIATION BETWEEN SLEEP AND MEMORY IN OLDER VETERANS WITH PTSD. Innov Aging 2019. [PMCID: PMC6840043 DOI: 10.1093/geroni/igz038.1000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Sleep disturbances are core symptoms of posttraumatic stress disorder (PTSD), and recent studies also suggest a link between PTSD and cognitive impairment. There is some evidence of an association between sleep disturbances and cognitive abilities, such as memory, though few studies have focused on older adults and fewer still among those with mental health conditions. This study examined the association between subjective memory complaints and sleep (quality and quantity) in older veterans with PTSD. Fifty-four veterans with PTSD (M age=67.4, 85.2% African American, 90.7% men) participated in the study. Sleep was assessed using the Pittsburgh Sleep Quality Inventory (PSQI) and the PSQI Addendum for PTSD (PSQI-A). Memory was assessed using the Frequency of Forgetting Scale (FOF) derived from the Memory Functioning Questionnaire. The relationship between sleep quality parameters and FOF were examined using bivariate correlations and independent samples t test. Over 60% of participants met military-specific criteria for poor sleep (PSQI≥10; PSQI-A>5). Overall sleep quality on the PSQI-A was significantly associated with worse memory (r=-0.38, p<.01). Among specific sleep parameters (e.g., sleep latency, sleep duration), greater daytime dysfunction due to sleepiness was significantly associated with worse memory (r=-0.44, p<.01). Between-group analyses comparing memory complaints across participants classified as ‘poor’ versus ‘good’ sleepers on the PSQI-A approached significance (t(52)=1.93, p=.06). This study suggests that poor sleep may be a correlate of memory complaints among older adults with PTSD. Future studies are needed to determine whether poor sleep is an underlying factor in the link between PTSD and cognitive impairment.
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Affiliation(s)
- Katherine S Hall
- Durham Veterans Affairs Health Care System, Durham, North Carolina, United States
| | - Miriam C Morey
- Durham Veterans Affairs Health Care System, Durham, North Carolina, United States
| | - Hayden Bosworth
- Durham Veterans Affairs Health Care System, Durham, North Carolina, United States
| | - Jean Beckham
- Durham Veterans Affairs Health Care System, Durham, North Carolina, United States
| | - Michelle Pebole
- Durham Veterans Affairs Health Care System, Durham, North Carolina, United States
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24
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Abbate LM, Hall K, Pearson M, Sloane R, Allen KD, Kohrt WM, Morey MC. THE IMPACT OF 3 MONTHS OF SUPERVISED EXERCISE ON CHANGE IN FUNCTION: COMPARISONS BY ARTHRITIS STATUS. Innov Aging 2019. [PMCID: PMC6840462 DOI: 10.1093/geroni/igz038.136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Physical activity is an established intervention for the management of arthritis. This study evaluated the effect of 3 months of participation in Gerofit on physical function by arthritis status. Participants, 519 Veterans aged ≥ 65 years self-reported either no arthritis (NA) (49%), upper body arthritis (UB) (8.2%), lower body arthritis (LB) (12.7%), or both upper and lower body arthritis (UB&LB) (30.4%) upon enrollment. Physical function measures [10-meter usual gait speed (m/s) (GS), arm curls (AC), chair stands (CS), and 6-minute walk (yards) (SMW)] were assessed at baseline and follow-up. Mean differences between time points were calculated. At baseline, compared to NA, LB and UB&LB had slower GS (1.10 and 1.06 vs 1.13) and shorter SMW distance (468.8 and 448.8 vs 490.7). All groups tended to increase physical function, with greatest improvement among LB (GS=0.27, AC=2.06, CS=2.52, SMW=42.53). Participation in Gerofit is associated with functional gains, regardless of burden of disease.
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Affiliation(s)
- Lauren M Abbate
- Rocky Mountain Regional VA Medical Center, Aurora, Colorado, United States
| | - Katherine Hall
- Durham Veterans Affairs Health Care system, Durham, North Carolina, United States
| | - Megan Pearson
- Durham Veterans Affairs Health Care system, Durham, North Carolina, United States
| | - Richard Sloane
- Durham Veterans Affairs Health Care system, Durham, North Carolina, United States
| | - Kelli D Allen
- Durham Veterans Affairs Health Care system, Durham, North Carolina, United States
| | - Wendy M Kohrt
- Rocky Mountain Regional VA Medical Center, Aurora, Colorado, United States
| | - Miriam C Morey
- Durham Veterans Affairs Health Care system, Durham, North Carolina, United States
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25
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Jennings SC, Manning K, Massey O, Bettger JP, Brown CS, Morey MC. MODERNIZING EXERCISE WITH TELE-VIDEO TO REACH A RURAL GERIATRIC POPULATION OF VETERANS. Innov Aging 2019. [PMCID: PMC6841206 DOI: 10.1093/geroni/igz038.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Rural Veterans often lack access to health care. Veterans Affairs (VA) supports telehealth technologies to provide services remotely that are comparable to onsite in-person care. We piloted VA Video Connect (VVC), to deliver an interactive exercise program for Veterans modeled on the VA Gerofit Program, a successful facility-based exercise program. VVC connects an exercise physiologist directly to the home with smart devices. Invitations to join Gerofit were mailed to 216 rural Veterans. Of 17 respondents, 7 (mean age 68) agreed to VVC tele-exercise 1x week for 12 weeks. Two Veterans were lost to follow-up prior to enrollment. Baseline VVC assessments (N=5) were indicative of high functional impairment in comparison to age-based norms: 2-minute step test (67.2 steps, 5th%tile), 30-second chair stands (12.4 stands, 26th%tile), and 30-second arm curls (15.3 curls, 25th%tile). Feasibility, barriers, and program impact will be discussed. Functional impairment indicates need for telehealth to reach Rural Veterans.
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Affiliation(s)
- Stephen C Jennings
- Durham VA Geriatric Research, Education, and Clinical Center (GRECC), Veterans Affairs Health Care System, Durham, North Carolina, United States
| | - Kenneth Manning
- Durham VA Geriatric Research, Education, and Clinical Center (GRECC), Veterans Affairs Health Care System, Durham, North Carolina, United States
| | - Oliver Massey
- Durham VA Veterans Affairs Health Care System, Durham, North Carolina, United States
| | - Janet Prvu Bettger
- Duke Department of Orthopedics, Duke University Medical Center, Durham, North Carolina, United States
| | - Candace S Brown
- Center for Cognitive Neuroscience, Motivated Cognition and Aging Brain Lab, Duke University, Durham, North Carolina Geriatric Research; Education, and Clinical Center (GRECC), Veterans Affairs Health Care System, Durham, North Carolina, United States
| | - Miriam C Morey
- Geriatric Research, Education, and Clinical Center (GRECC), Veterans Affairs Health Care System, Durham, North Carolina Center for the Study of Aging/OAIC, Duke University Medical Center, Durham, North Carolina, United States
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26
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Abstract
Background: Gait speed is a well-known predictor of functional decline and mortality in older adults, but little is known about the origins of gait speed earlier in life. We tested the hypothesis that slow gait reflects accelerated biological aging already at midlife, as well as poor neurocognitive functioning in childhood and childhood-to-midlife cognitive decline. Methods: Prospective study of the population-representative Dunedin Study birth cohort (n=1,037), followed to age 45 (until April 2019). We measured age-45 gait speed in 904 (90.7%) participants and tested associations with key life course factors. Results: The mean (SD) gait speeds (m/s) were: usual: 1.30 (0.17); dual task: 1.16 (0.23); and maximum: 1.99 (0.29). Among midlife adults, those with more physical limitations (β -0.27; P<.001), poorer physical functions (β 0.24–0.36; all P<.001), accelerated biological aging across multiple organ systems (β -0.33), older facial appearance (β -0.25), smaller brain volume (β 0.15), more cortical thinning (β 0.09), smaller cortical surface area (β 0.13), and more white matter hyperintensities (β -0.09) had slower gait speed, all P<.05. Participants with lower IQ in childhood (β 0.34) and midlife (β 0.38) and who exhibited childhood-to-midlife cognitive decline (β 0.10) had slower gait speed at midlife, all P<.01. Adults with poorer neurocognitive function as early as age 3 had slower gait in midlife (β 0.26; P<.001). Conclusion: Adults’ gait speed is more than an indicator of geriatric functional status, it is also an index of midlife aging and lifelong brain health.
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Affiliation(s)
- Line Rasmussen
- Dept. of Psychology and Neuroscience, Duke University, Durham, North Carolina, United States
| | - Avshalom Caspi
- Dept. of Psychology and Neuroscience, Duke University, Durham, North Carolina, United States
| | - Terrie Moffitt
- Dept. of Psychology and Neuroscience, Duke University, Durham, North Carolina, United States
| | - Harvey J Cohen
- Duke University Medical Center, Durham, North Carolina, United States
| | - Miriam C Morey
- Durham Veterans Affairs Health Care System, Durham, North Carolina, United States
| | - Leah Richmond-Rakerd
- Dept. of Psychology and Neuroscience, Duke University, Durham, North Carolina, United States
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27
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Bowling CB, Deng L, Sakhuja S, Morey MC, Jaeger BC, Muntner P. Prevalence of Activity Limitations and Association with Multimorbidity Among US Adults 50 to 64 Years Old. J Gen Intern Med 2019; 34:2390-2396. [PMID: 31435766 PMCID: PMC6848639 DOI: 10.1007/s11606-019-05244-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 05/02/2019] [Accepted: 07/17/2019] [Indexed: 01/02/2023]
Abstract
BACKGROUND Functional limitations may be more common in middle-aged adults than previously recognized. However, there are few published data on the prevalence of activity limitations, and their association with multimorbidity, among adults 50 to 64 years old. OBJECTIVE To describe the prevalence of activity limitations and the association with multimorbidity in middle-aged adults. DESIGN Cross-sectional analysis of US population-based National Health and Nutrition Examination Survey (NHANES) 2011-2016. PARTICIPANTS The total number of community-dwelling NHANES participants aged 50-64 years old is 4217. MAIN MEASURES Chronic conditions included hypertension, high cholesterol, diabetes mellitus, obesity, chronic kidney disease, cancer, stroke, coronary heart disease, heart failure, chronic obstructive pulmonary disease/asthma, arthritis, and depression. Activity limitations were defined as any difficulty within each of four International Classification of Functioning (ICF) domains: functional limitations (kneeling, carrying, standing, sitting, reaching, grasping, pulling), mobility (walking ¼ mile, climbing 10 steps), basic activities of daily living (BADLs; walking, transferring, eating, dressing), and instrumental activities of daily living (IADLs; finances, chores, cooking). We calculated prevalence ratios for activity limitations using generalized estimating equations. KEY RESULTS The prevalence of functional limitations, mobility limitations, BADL difficulty, and IADL difficulty was 34%, 11%, 15%, and 17%, respectively. Seventy-two percent of participants had two or more chronic conditions; 23% had two, 18% had three, 15% had four, and 16% had five or more. Multivariable adjusted prevalence ratios (95% CI) for functional limitations among those with 2, 3, 4, and 5 or more chronic conditions, compared with 0-1 conditions, were 1.94 (1.43-2.63), 2.50 (1.93-3.23), 3.26 (2.48-4.27), and 4.54 (3.48-5.93), respectively (p trend < 0.001). Larger prevalence ratios at a higher number of chronic conditions were present for mobility limitations, BADL difficulty, and IADL difficulty. CONCLUSIONS Problems with function are not limited to older adults and multimorbidity may be helpful for identifying middle-aged adults with a high prevalence of activity limitations.
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Affiliation(s)
- C Barrett Bowling
- Durham Veterans Affairs Geriatric Research Education and Clinical Center, Durham Veterans Affairs Health Care System, Durham, NC, USA. .,Divison of Geriatric Medicine, Department of Medicine, Duke University, Durham, NC, USA.
| | - Luqin Deng
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Swati Sakhuja
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Miriam C Morey
- Durham Veterans Affairs Geriatric Research Education and Clinical Center, Durham Veterans Affairs Health Care System, Durham, NC, USA.,Divison of Geriatric Medicine, Department of Medicine, Duke University, Durham, NC, USA.,Center for the Study of Aging/Claude D. Pepper Older Americans Independence Center (OAIC), Duke University, Durham, NC, USA
| | - Byron C Jaeger
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Paul Muntner
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
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28
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Rasmussen LJH, Caspi A, Ambler A, Broadbent JM, Cohen HJ, d’Arbeloff T, Elliott M, Hancox RJ, Harrington H, Hogan S, Houts R, Ireland D, Knodt AR, Meredith-Jones K, Morey MC, Morrison L, Poulton R, Ramrakha S, Richmond-Rakerd L, Sison ML, Sneddon K, Thomson WM, Hariri AR, Moffitt TE. Association of Neurocognitive and Physical Function With Gait Speed in Midlife. JAMA Netw Open 2019; 2:e1913123. [PMID: 31603488 PMCID: PMC6804027 DOI: 10.1001/jamanetworkopen.2019.13123] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
IMPORTANCE Gait speed is a well-known indicator of risk of functional decline and mortality in older adults, but little is known about the factors associated with gait speed earlier in life. OBJECTIVES To test the hypothesis that slow gait speed reflects accelerated biological aging at midlife, as well as poor neurocognitive functioning in childhood and cognitive decline from childhood to midlife. DESIGN, SETTING, AND PARTICIPANTS This cohort study uses data from the Dunedin Multidisciplinary Health and Development Study, a population-based study of a representative 1972 to 1973 birth cohort in New Zealand that observed participants to age 45 years (until April 2019). Data analysis was performed from April to June 2019. EXPOSURES Childhood neurocognitive functions and accelerated aging, brain structure, and concurrent physical and cognitive functions in adulthood. MAIN OUTCOMES AND MEASURES Gait speed at age 45 years, measured under 3 walking conditions: usual, dual task, and maximum gait speeds. RESULTS Of the 1037 original participants (91% of eligible births; 535 [51.6%] male), 997 were alive at age 45 years, of whom 904 (90.7%) had gait speed measured (455 [50.3%] male; 93% white). The mean (SD) gait speeds were 1.30 (0.17) m/s for usual gait, 1.16 (0.23) m/s for dual task gait, and 1.99 (0.29) m/s for maximum gait. Adults with more physical limitations (standardized regression coefficient [β], -0.27; 95% CI, -0.34 to -0.21; P < .001), poorer physical functions (ie, weak grip strength [β, 0.36; 95% CI, 0.25 to 0.46], poor balance [β, 0.28; 95% CI, 0.21 to 0.34], poor visual-motor coordination [β, 0.24; 95% CI, 0.17 to 0.30], and poor performance on the chair-stand [β, 0.34; 95% CI, 0.27 to 0.40] or 2-minute step tests [β, 0.33; 95% CI, 0.27 to 0.39]; all P < .001), accelerated biological aging across multiple organ systems (β, -0.33; 95% CI, -0.40 to -0.27; P < .001), older facial appearance (β, -0.25; 95% CI, -0.31 to -0.18; P < .001), smaller brain volume (β, 0.15; 95% CI, 0.06 to 0.23; P < .001), more cortical thinning (β, 0.09; 95% CI, 0.02 to 0.16; P = .01), smaller cortical surface area (β, 0.13; 95% CI, 0.04 to 0.21; P = .003), and more white matter hyperintensities (β, -0.09; 95% CI, -0.15 to -0.02; P = .01) had slower gait speed. Participants with lower IQ in midlife (β, 0.38; 95% CI, 0.32 to 0.44; P < .001) and participants who exhibited cognitive decline from childhood to adulthood (β, 0.10; 95% CI, 0.04 to 0.17; P < .001) had slower gait at age 45 years. Those with poor neurocognitive functioning as early as age 3 years had slower gait in midlife (β, 0.26; 95% CI, 0.20 to 0.32; P < .001). CONCLUSIONS AND RELEVANCE Adults' gait speed is associated with more than geriatric functional status; it is also associated with midlife aging and lifelong brain health.
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Affiliation(s)
- Line Jee Hartmann Rasmussen
- Department of Psychology and Neuroscience, Duke University, Durham, North Carolina
- Clinical Research Centre, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - Avshalom Caspi
- Department of Psychology and Neuroscience, Duke University, Durham, North Carolina
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina
- Center for Genomic and Computational Biology, Duke University, Durham, North Carolina
- Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, United Kingdom
| | - Antony Ambler
- Dunedin Multidisciplinary Health and Development Research Unit, Department of Psychology, University of Otago, Dunedin, New Zealand
| | | | - Harvey J. Cohen
- Claude D. Pepper Older Americans Independence Center, Duke University, Durham, North Carolina
- Duke Center for the Study of Aging and Human Development, Duke University, Durham, North Carolina
- Department of Medicine, Duke University, Durham, North Carolina
| | - Tracy d’Arbeloff
- Department of Psychology and Neuroscience, Duke University, Durham, North Carolina
| | - Maxwell Elliott
- Department of Psychology and Neuroscience, Duke University, Durham, North Carolina
| | - Robert J. Hancox
- Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - HonaLee Harrington
- Department of Psychology and Neuroscience, Duke University, Durham, North Carolina
| | - Sean Hogan
- Dunedin Multidisciplinary Health and Development Research Unit, Department of Psychology, University of Otago, Dunedin, New Zealand
| | - Renate Houts
- Department of Psychology and Neuroscience, Duke University, Durham, North Carolina
| | - David Ireland
- Dunedin Multidisciplinary Health and Development Research Unit, Department of Psychology, University of Otago, Dunedin, New Zealand
| | - Annchen R. Knodt
- Department of Psychology and Neuroscience, Duke University, Durham, North Carolina
| | - Kim Meredith-Jones
- Dunedin Multidisciplinary Health and Development Research Unit, Department of Psychology, University of Otago, Dunedin, New Zealand
| | - Miriam C. Morey
- Claude D. Pepper Older Americans Independence Center, Duke University, Durham, North Carolina
- Department of Medicine, Duke University, Durham, North Carolina
- Geriatric Research, Education, and Clinical Center, Durham VA Medical Center, Durham, North Carolina
| | - Lynda Morrison
- Dunedin Multidisciplinary Health and Development Research Unit, Department of Psychology, University of Otago, Dunedin, New Zealand
| | - Richie Poulton
- Dunedin Multidisciplinary Health and Development Research Unit, Department of Psychology, University of Otago, Dunedin, New Zealand
| | - Sandhya Ramrakha
- Dunedin Multidisciplinary Health and Development Research Unit, Department of Psychology, University of Otago, Dunedin, New Zealand
| | - Leah Richmond-Rakerd
- Department of Psychology and Neuroscience, Duke University, Durham, North Carolina
- Frank Porter Graham Child Development Institute, University of North Carolina at Chapel Hill, Chapel Hill
| | - Maria L. Sison
- Department of Psychology and Neuroscience, Duke University, Durham, North Carolina
| | - Kate Sneddon
- Dunedin Multidisciplinary Health and Development Research Unit, Department of Psychology, University of Otago, Dunedin, New Zealand
| | - W. Murray Thomson
- Department of Oral Sciences, University of Otago, Dunedin, New Zealand
| | - Ahmad R. Hariri
- Department of Psychology and Neuroscience, Duke University, Durham, North Carolina
| | - Terrie E. Moffitt
- Department of Psychology and Neuroscience, Duke University, Durham, North Carolina
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina
- Center for Genomic and Computational Biology, Duke University, Durham, North Carolina
- Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, United Kingdom
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Abstract
Behavior change theory was used to explore predictors of long-term adherence (≥2 years) to exercise. A retrospective analysis of data from participants (N = 97) who reached a 6-month follow-up, which served as the baseline, was evaluated for completion of yearly follow-up surveys. Variables examined at baseline, which included age, race, gender, body mass index (BMI), and self-report of comorbidities, symptoms, physical function, and a Barriers Specific Self-Efficacy Scale, were examined with significance set at p < .05. Lower BMI (29.1 ± 5.1 vs. 31.6 ± 6.5, p = .047) and higher self-efficacy to overcome environmental barriers (p = .016) and social isolation (p = .05) were associated with long-term adherence. Self-efficacy to overcome environmental and social barriers, such as inclement weather, access to exercise site, and opportunities for group-based exercise, should be addressed to promote long-term adherence to exercise among older adults.
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Affiliation(s)
- Candace S Brown
- University of North Carolina at Charlotte, USA.,Duke University, Durham, NC, USA.,Durham VA Health Care System, NC, USA
| | - Richard Sloane
- Durham VA Health Care System, NC, USA.,Duke Center for the Study of Aging and Human Development, Durham, NC, USA
| | - Miriam C Morey
- Durham VA Health Care System, NC, USA.,Duke Center for the Study of Aging and Human Development, Durham, NC, USA.,Duke University School of Medicine, Durham, NC, USA
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30
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Blair CK, Jacobs DR, Demark-Wahnefried W, Cohen HJ, Morey MC, Robien K, Lazovich D. Effects of cancer history on functional age and mortality. Cancer 2019; 125:4303-4309. [PMID: 31418826 DOI: 10.1002/cncr.32449] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 07/20/2019] [Accepted: 07/22/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Cancer, its treatment, and associated adverse effects may accelerate the functional aging of cancer survivors. In the current study, the authors used geriatric assessment (GA) to compare the functional age of long-term cancer survivors with that of similarly aged women without a cancer history, and to examine whether functional age influences all-cause mortality differently between these 2 groups. METHODS Participants included 1723 cancer survivors and 11,145 age-matched, cancer-free women enrolled in the Iowa Women's Health Study in 1986 who completed the 2004 questionnaire (at ages 73-88 years). GA domain deficits included ≥2 physical function limitations, ≥2 comorbidities, poor general health, poor mental health, and underweight. The risk of all-cause mortality was estimated for deficits in each GA domain between 4 groups based on the cross-classification of the presence and/or absence of cancer history and GA domain deficit (the referent group was cancer-free women without a GA deficit). RESULTS Both cancer history and GA domain deficits significantly predicted 10-year mortality for all GA domains. Cancer survivors without deficits had a 1.3-fold to 1.4-fold risk of mortality, similar to the 1.1-fold to 1.7-fold risk noted among cancer-free women with deficits (all P < .05). Cancer survivors with deficits were found to have the highest mortality risk for 4 of 5 domains (hazard ratio range, 1.6-2.0). Mortality risk increased with the increasing number of GA deficits, which was greater in cancer survivors compared with cancer-free women. CONCLUSIONS Even without GA deficits, cancer survivors appear to have an excess risk of death compared with women without cancer, and these deficits add to mortality risk. Interventions are needed to maintain or improve functional/physiological capacity as women age, especially in cancer survivors.
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Affiliation(s)
- Cindy K Blair
- Department of Internal Medicine, University of New Mexico, Albuquerque, New Mexico.,Cancer Control and Population Sciences, University of New Mexico Comprehensive Cancer Center, Albuquerque, New Mexico
| | - David R Jacobs
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Wendy Demark-Wahnefried
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, Alabama.,Cancer Prevention and Control, O'Neal Comprehensive Cancer Center at the University of Alabama at Birmingham, Birmingham, Alabama
| | - Harvey J Cohen
- Department of Medicine, Duke University Medical Center, Durham, North Carolina.,Claude D. Pepper Older Americans Independence Center/Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, North Carolina
| | - Miriam C Morey
- Department of Medicine, Duke University Medical Center, Durham, North Carolina.,Claude D. Pepper Older Americans Independence Center/Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, North Carolina.,Geriatric Research, Education, and Clinical Care, VA Medical Center, Durham, North Carolina
| | - Kim Robien
- Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, The George Washington University, Washington, DC
| | - DeAnn Lazovich
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota
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31
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Safeek RH, Hall KS, Lobelo F, del Rio C, Khoury AL, Wong T, Morey MC, McKellar MS. Low Levels of Physical Activity Among Older Persons Living with HIV/AIDS Are Associated with Poor Physical Function. AIDS Res Hum Retroviruses 2018; 34:929-935. [PMID: 29984584 PMCID: PMC6909688 DOI: 10.1089/aid.2017.0309] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Antiretroviral therapy (ART) has prolonged lives of persons living with HIV/AIDS (PLWHA), resulting in greater incidence of aging-related diseases and disability. Physical activity (PA) is recommended for healthy aging, but little is known about PA in older PLWHA. The purpose of this study was to objectively assess PA levels in older PLWHA and the associations with physical function. Twenty-one PLWHA, ≥50 years old, on ART with undetectable HIV-1 viral loads, wore an accelerometer to assess PA, including number of steps, activity intensity, and energy expenditure over 7 days. A physical function performance battery assessing aerobic capacity, strength, and gait speed was also completed. Average age was 66, and 67% were male. An average of 3,442 (interquartile range: 4,613) steps were walked daily, with 254.9 kcals expended. Participants spent most waking hours (75%) sedentary, with minimal hours (24%) in light-intensity activity. Only 5 min per day (35 min per week), on average, were spent in moderate-to-vigorous physical activity (MVPA). Maximal gait speed and 6-min walk test significantly correlated (p < .05) with all PA outcomes. Usual gait speed significantly correlated with all PA outcomes, except for daily kcals and light-intensity activity. Greater PA was associated with better physical performance, while high sedentary time was associated with poorer performance. To our knowledge, this is the first study to objectively measure PA in older PLWHA. Our findings indicate that older PLWHA accumulate substantial sedentary time. Most (86%) do not achieve recommended MVPA levels. This activity profile was associated with poor physical function. Providers should promote PA among PLWHA.
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Affiliation(s)
- Rachel H. Safeek
- Center for AIDS Research at Emory University, Emory University School of Medicine, Atlanta, Georgia
| | - Katherine S. Hall
- Division of Geriatrics, Department of Medicine, Duke University Medical Center, Durham, North Carolina
- Claude D. Pepper Older Americans Independence Center, Duke University Medical Center, Durham, North Carolina
- Geriatric Research, Education and Clinical Center, Durham Veterans Affairs Healthcare System, Durham, North Carolina
| | - Felipe Lobelo
- Exercise is Medicine Global Research and Collaboration Center, Emory Rollins School of Public Health, Emory University, Atlanta, Georgia
- Hubert Department of Global Health, Emory Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Carlos del Rio
- Center for AIDS Research at Emory University, Emory University School of Medicine, Atlanta, Georgia
- Hubert Department of Global Health, Emory Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Audrey L. Khoury
- University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Tammy Wong
- University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Miriam C. Morey
- Division of Geriatrics, Department of Medicine, Duke University Medical Center, Durham, North Carolina
- Claude D. Pepper Older Americans Independence Center, Duke University Medical Center, Durham, North Carolina
- Geriatric Research, Education and Clinical Center, Durham Veterans Affairs Healthcare System, Durham, North Carolina
| | - Mehri S. McKellar
- Claude D. Pepper Older Americans Independence Center, Duke University Medical Center, Durham, North Carolina
- Geriatric Research, Education and Clinical Center, Durham Veterans Affairs Healthcare System, Durham, North Carolina
- Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina
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32
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Briggs BC, Jain C, Morey MC, Blanchard EH, Lee CC, Valencia WM, Oursler KK. Providing Rural Veterans With Access to Exercise Through Gerofit. Fed Pract 2018; 35:16-23. [PMID: 30766328 PMCID: PMC6366594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Clinical video telehealth can be used to deliver functional circuit exercise training to older veterans in remote locations.
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Affiliation(s)
- Brandon C Briggs
- is an Exercise Physiologist, is a Biostatistician, and is a Physician and the Director of Geriatric Research and Education at the Salem VAMC in Virginia. is Associate Director of Research in the Geriatric Research, Education, and Clinical Center (GRECC) at Durham VAMC in North Carolina. is an Exercise Physiologist and is a Physician in the GRECC at the Greater Los Angeles VAHS in California. is a physician in the GRECC at the Miami VAHS in Florida. Dr. Morey is a Professor at Duke University Medical Center in Durham. Dr. Lee is an Associate Professor at the David Geffen School of Medicine at University of California Los Angeles. Dr. Valencia is an Assistant Professor at University of Miami Miller School of Medicine and Florida International University in Miami, Florida. Dr. Oursler is an Associate Professor at Virginia Tech Carilion School of Medicine in Roanoke, Virginia
| | - Chani Jain
- is an Exercise Physiologist, is a Biostatistician, and is a Physician and the Director of Geriatric Research and Education at the Salem VAMC in Virginia. is Associate Director of Research in the Geriatric Research, Education, and Clinical Center (GRECC) at Durham VAMC in North Carolina. is an Exercise Physiologist and is a Physician in the GRECC at the Greater Los Angeles VAHS in California. is a physician in the GRECC at the Miami VAHS in Florida. Dr. Morey is a Professor at Duke University Medical Center in Durham. Dr. Lee is an Associate Professor at the David Geffen School of Medicine at University of California Los Angeles. Dr. Valencia is an Assistant Professor at University of Miami Miller School of Medicine and Florida International University in Miami, Florida. Dr. Oursler is an Associate Professor at Virginia Tech Carilion School of Medicine in Roanoke, Virginia
| | - Miriam C Morey
- is an Exercise Physiologist, is a Biostatistician, and is a Physician and the Director of Geriatric Research and Education at the Salem VAMC in Virginia. is Associate Director of Research in the Geriatric Research, Education, and Clinical Center (GRECC) at Durham VAMC in North Carolina. is an Exercise Physiologist and is a Physician in the GRECC at the Greater Los Angeles VAHS in California. is a physician in the GRECC at the Miami VAHS in Florida. Dr. Morey is a Professor at Duke University Medical Center in Durham. Dr. Lee is an Associate Professor at the David Geffen School of Medicine at University of California Los Angeles. Dr. Valencia is an Assistant Professor at University of Miami Miller School of Medicine and Florida International University in Miami, Florida. Dr. Oursler is an Associate Professor at Virginia Tech Carilion School of Medicine in Roanoke, Virginia
| | - Erin H Blanchard
- is an Exercise Physiologist, is a Biostatistician, and is a Physician and the Director of Geriatric Research and Education at the Salem VAMC in Virginia. is Associate Director of Research in the Geriatric Research, Education, and Clinical Center (GRECC) at Durham VAMC in North Carolina. is an Exercise Physiologist and is a Physician in the GRECC at the Greater Los Angeles VAHS in California. is a physician in the GRECC at the Miami VAHS in Florida. Dr. Morey is a Professor at Duke University Medical Center in Durham. Dr. Lee is an Associate Professor at the David Geffen School of Medicine at University of California Los Angeles. Dr. Valencia is an Assistant Professor at University of Miami Miller School of Medicine and Florida International University in Miami, Florida. Dr. Oursler is an Associate Professor at Virginia Tech Carilion School of Medicine in Roanoke, Virginia
| | - Cathy C Lee
- is an Exercise Physiologist, is a Biostatistician, and is a Physician and the Director of Geriatric Research and Education at the Salem VAMC in Virginia. is Associate Director of Research in the Geriatric Research, Education, and Clinical Center (GRECC) at Durham VAMC in North Carolina. is an Exercise Physiologist and is a Physician in the GRECC at the Greater Los Angeles VAHS in California. is a physician in the GRECC at the Miami VAHS in Florida. Dr. Morey is a Professor at Duke University Medical Center in Durham. Dr. Lee is an Associate Professor at the David Geffen School of Medicine at University of California Los Angeles. Dr. Valencia is an Assistant Professor at University of Miami Miller School of Medicine and Florida International University in Miami, Florida. Dr. Oursler is an Associate Professor at Virginia Tech Carilion School of Medicine in Roanoke, Virginia
| | - Willy M Valencia
- is an Exercise Physiologist, is a Biostatistician, and is a Physician and the Director of Geriatric Research and Education at the Salem VAMC in Virginia. is Associate Director of Research in the Geriatric Research, Education, and Clinical Center (GRECC) at Durham VAMC in North Carolina. is an Exercise Physiologist and is a Physician in the GRECC at the Greater Los Angeles VAHS in California. is a physician in the GRECC at the Miami VAHS in Florida. Dr. Morey is a Professor at Duke University Medical Center in Durham. Dr. Lee is an Associate Professor at the David Geffen School of Medicine at University of California Los Angeles. Dr. Valencia is an Assistant Professor at University of Miami Miller School of Medicine and Florida International University in Miami, Florida. Dr. Oursler is an Associate Professor at Virginia Tech Carilion School of Medicine in Roanoke, Virginia
| | - Krisann K Oursler
- is an Exercise Physiologist, is a Biostatistician, and is a Physician and the Director of Geriatric Research and Education at the Salem VAMC in Virginia. is Associate Director of Research in the Geriatric Research, Education, and Clinical Center (GRECC) at Durham VAMC in North Carolina. is an Exercise Physiologist and is a Physician in the GRECC at the Greater Los Angeles VAHS in California. is a physician in the GRECC at the Miami VAHS in Florida. Dr. Morey is a Professor at Duke University Medical Center in Durham. Dr. Lee is an Associate Professor at the David Geffen School of Medicine at University of California Los Angeles. Dr. Valencia is an Assistant Professor at University of Miami Miller School of Medicine and Florida International University in Miami, Florida. Dr. Oursler is an Associate Professor at Virginia Tech Carilion School of Medicine in Roanoke, Virginia
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33
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Briggs B, Jain C, C Morey M, Blanchard EH, Lee CC, Marcos Valencia W, Oursler KK. PROVIDING RURAL VETERANS ACCESS TO GEROFIT THROUGH CLINICAL VIDEO TELE-HEALTH. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- B Briggs
- Geriatric Research and Education, Salem VA Medical Center, Salem, Virginia, United States
| | - C Jain
- Geriatric Research and Education, Salem VA Medical Center, Salem, VA, USA
| | - Miriam C Morey
- Geriatric Research, Education, and Clinical Center Durham Veterans Affairs Healthcare System, Durham, NC; Center for the Study of Aging and Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - E H Blanchard
- Geriatric Research, Education, and Clinical Center, Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - C C Lee
- Geriatric Research, Education, and Clinical Center, Greater Los Angeles Healthcare System; Department of Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA, USA
| | - W Marcos Valencia
- Miami VA Healthcare System, Geriatric Research, Education, and Clinical Center; Division of Epidemiology and Division of Geriatric Medicine, University of Miami School of Medicine, Miami, FL, USA
| | - K K Oursler
- Geriatric Research and Education, Salem VA Medical Center Salem, VA, USA; Department of Medicine, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
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34
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Noppert GA, Brown CS, Chanti-Ketterl M, Hall KS, Newby LK, Cohen HJ, Morey MC. The Impact of Multiple Dimensions of Socioeconomic Status on Physical Functioning Across the Life Course. Gerontol Geriatr Med 2018; 4:2333721418794021. [PMID: 30186891 PMCID: PMC6113730 DOI: 10.1177/2333721418794021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 06/20/2018] [Accepted: 07/17/2018] [Indexed: 01/18/2023] Open
Abstract
Objective: We used the Physical Performance Across the LifeSpan Study to investigate the relationships of multiple indicators of socioeconomic status (SES), both in early life and late life, with physical function. Method: We examined associations between multiple early and late life SES indicators with physical function measured by aerobic endurance, gait speed, and lower body strength. Results: Higher participant education and household income were associated with increased physical function. In our age-stratified analysis, we observed widening SES disparities with increasing age among those in the two younger strata with lower SES associated with worse physical function. Finally, we observed an association between socioeconomic trend and gait speed, aerobic endurance, and lower body strength. There was also an association between lower aerobic endurance and being in a downward socioeconomic trend. Discussion: These findings highlight the significance of considering multiple dimensions of the social environment as important correlates of physical functioning across the life course.
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Affiliation(s)
- Grace A Noppert
- Carolina Population Center, University of North Carolina, Chapel Hill, NC, USA.,Center for the Study of Aging and Human Development, Duke University, Durham, NC, USA.,School of Medicine, Duke University, Durham, NC, USA.,Duke Population Research Institute, Duke University, Durham, NC, USA
| | - Candace S Brown
- Center for the Study of Aging and Human Development, Duke University, Durham, NC, USA.,School of Medicine, Duke University, Durham, NC, USA.,Center for Child and Family Policy, Duke University, Durham, NC, USA
| | - Marianne Chanti-Ketterl
- Center for the Study of Aging and Human Development, Duke University, Durham, NC, USA.,Joseph and Kathleen Bryan Alzheimer's Disease Research Center, Duke University, Durham, NC, USA
| | - Katherine S Hall
- Center for the Study of Aging and Human Development, Duke University, Durham, NC, USA.,School of Medicine, Duke University, Durham, NC, USA.,Claude D. Pepper Older Americans Independence Center, Durham, NC, USA.,Geriatric Research, Education, and Clinical Center; VA Durham Health Care System, Durham, NC, USA
| | - L Kristin Newby
- Division of Cardiology, Department of Medicine, Duke University, Durham, NC, USA.,Duke Clinical and Translational Science Institute, Durham, NC, USA
| | - Harvey Jay Cohen
- Center for the Study of Aging and Human Development, Duke University, Durham, NC, USA.,School of Medicine, Duke University, Durham, NC, USA.,Claude D. Pepper Older Americans Independence Center, Durham, NC, USA
| | - Miriam C Morey
- Center for the Study of Aging and Human Development, Duke University, Durham, NC, USA.,School of Medicine, Duke University, Durham, NC, USA.,Claude D. Pepper Older Americans Independence Center, Durham, NC, USA.,Geriatric Research, Education, and Clinical Center; VA Durham Health Care System, Durham, NC, USA
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Pavon JM, Sloane RJ, Pieper CF, Colón-Emeric CS, Cohen HJ, Gallagher D, Morey MC, McCarty M, Ortel TL, Hastings SN. Automated versus Manual Data Extraction of the Padua Prediction Score for Venous Thromboembolism Risk in Hospitalized Older Adults. Appl Clin Inform 2018; 9:743-751. [PMID: 30257260 PMCID: PMC6158031 DOI: 10.1055/s-0038-1670678] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 08/09/2018] [Indexed: 10/28/2022] Open
Abstract
OBJECTIVE Venous thromboembolism (VTE) prophylaxis is an important consideration for hospitalized older adults, and the Padua Prediction Score (PPS) is a risk prediction tool used to prioritize patient selection. We developed an automated PPS (APPS) algorithm using electronic health record (EHR) data. This study examines the accuracy of APPS and its individual components versus manual data extraction. METHODS This is a retrospective cohort study of hospitalized general internal medicine patients, aged 70 and over. Fourteen clinical variables were collected to determine their PPS; APPS used EHR data exports from health system databases, and a trained abstractor performed manual chart abstractions. We calculated sensitivity and specificity of the APPS, using manual PPS as the gold standard for classifying risk category (low vs. high). We also examined performance characteristics of the APPS for individual variables. RESULTS PPS was calculated by both methods on 311 individuals. The mean PPS was 3.6 (standard deviation, 1.8) for manual abstraction and 2.8 (1.4) for APPS. In detecting patients at high risk for VTE, the sensitivity and specificity of the APPS algorithm were 46 and 94%, respectively. The sensitivity for APPS was poor (range: 6-34%) for detecting acute conditions (i.e., acute myocardial infarction), moderate (range: 52-74%) for chronic conditions (i.e., heart failure), and excellent (range: 94-98%) for conditions of obesity and restricted mobility. Specificity of the automated extraction method for each PPS variable was > 87%. CONCLUSION APPS as a stand-alone tool was suboptimal for classifying risk of VTE occurrence. The APPS accurately identified high risk patients (true positives), but lower scores were considered indeterminate.
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Affiliation(s)
- Juliessa M. Pavon
- Duke University, Durham, North Carolina, United States
- Geriatric Research Education Clinical Center, Durham Veteran Affairs Medical Center, Durham, North Carolina, United States
- Duke University Claude D. Pepper Center, Duke University, Durham, North Carolina, United States
| | - Richard J. Sloane
- Duke University, Durham, North Carolina, United States
- Geriatric Research Education Clinical Center, Durham Veteran Affairs Medical Center, Durham, North Carolina, United States
- Duke University Claude D. Pepper Center, Duke University, Durham, North Carolina, United States
| | - Carl F. Pieper
- Duke University, Durham, North Carolina, United States
- Geriatric Research Education Clinical Center, Durham Veteran Affairs Medical Center, Durham, North Carolina, United States
- Duke University Claude D. Pepper Center, Duke University, Durham, North Carolina, United States
| | - Cathleen S. Colón-Emeric
- Duke University, Durham, North Carolina, United States
- Geriatric Research Education Clinical Center, Durham Veteran Affairs Medical Center, Durham, North Carolina, United States
- Duke University Claude D. Pepper Center, Duke University, Durham, North Carolina, United States
| | - Harvey J. Cohen
- Duke University, Durham, North Carolina, United States
- Geriatric Research Education Clinical Center, Durham Veteran Affairs Medical Center, Durham, North Carolina, United States
- Duke University Claude D. Pepper Center, Duke University, Durham, North Carolina, United States
| | | | - Miriam C. Morey
- Duke University, Durham, North Carolina, United States
- Geriatric Research Education Clinical Center, Durham Veteran Affairs Medical Center, Durham, North Carolina, United States
- Duke University Claude D. Pepper Center, Duke University, Durham, North Carolina, United States
| | | | | | - Susan N. Hastings
- Duke University, Durham, North Carolina, United States
- Geriatric Research Education Clinical Center, Durham Veteran Affairs Medical Center, Durham, North Carolina, United States
- Duke University Claude D. Pepper Center, Duke University, Durham, North Carolina, United States
- Health Services Research and Development Center of Innovation, Durham Veterans Affairs Health Care System, Durham, North Carolina, United States
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Pavon JM, Sloane RJ, Pieper CF, Colón-Emeric CS, Cohen HJ, Gallagher D, Morey MC, McCarty M, Ortel TL, Hastings SN. Poor Adherence to Risk Stratification Guidelines Results in Overuse of Venous Thromboembolism Prophylaxis in Hospitalized Older Adults. J Hosp Med 2018; 13:403-404. [PMID: 29408946 PMCID: PMC5984140 DOI: 10.12788/jhm.2916] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Juliessa M Pavon
- Duke University, Durham, North Carolina, USA.
- Geriatric Research Education Clinical Center, Durham Veteran Affairs Medical Center, Durham, North Carolina, USA
- Claude D. Pepper Older Americans Independence Center, Duke University, Durham, North Carolina, USA
| | - Richard J Sloane
- Duke University, Durham, North Carolina, USA
- Geriatric Research Education Clinical Center, Durham Veteran Affairs Medical Center, Durham, North Carolina, USA
- Claude D. Pepper Older Americans Independence Center, Duke University, Durham, North Carolina, USA
| | - Carl F Pieper
- Duke University, Durham, North Carolina, USA
- Geriatric Research Education Clinical Center, Durham Veteran Affairs Medical Center, Durham, North Carolina, USA
- Claude D. Pepper Older Americans Independence Center, Duke University, Durham, North Carolina, USA
| | - Cathleen S Colón-Emeric
- Duke University, Durham, North Carolina, USA
- Geriatric Research Education Clinical Center, Durham Veteran Affairs Medical Center, Durham, North Carolina, USA
- Claude D. Pepper Older Americans Independence Center, Duke University, Durham, North Carolina, USA
| | - Harvey J Cohen
- Duke University, Durham, North Carolina, USA
- Geriatric Research Education Clinical Center, Durham Veteran Affairs Medical Center, Durham, North Carolina, USA
- Claude D. Pepper Older Americans Independence Center, Duke University, Durham, North Carolina, USA
| | | | - Miriam C Morey
- Duke University, Durham, North Carolina, USA
- Geriatric Research Education Clinical Center, Durham Veteran Affairs Medical Center, Durham, North Carolina, USA
- Claude D. Pepper Older Americans Independence Center, Duke University, Durham, North Carolina, USA
| | | | | | - Susan N Hastings
- Duke University, Durham, North Carolina, USA
- Geriatric Research Education Clinical Center, Durham Veteran Affairs Medical Center, Durham, North Carolina, USA
- Claude D. Pepper Older Americans Independence Center, Duke University, Durham, North Carolina, USA
- Health Services Research and Development, Durham Veterans Affairs Medical Center, Durham, North Carolina, USA
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Zuo X, Luciano A, Pieper CF, Bain JR, Kraus VB, Kraus WE, Morey MC, Cohen HJ. Combined Inflammation and Metabolism Biomarker Indices of Robust and Impaired Physical Function in Older Adults. J Am Geriatr Soc 2018; 66:1353-1359. [PMID: 29738072 DOI: 10.1111/jgs.15393] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To determine whether combinations of inflammatory markers are related to physical function. DESIGN AND SUBJECTS secondary analysis of baseline of three observational studies of community-dwelling older adults MEASUREMENTS: The baseline data from 3 cohorts of older adults with different health and disease status were employed. Twenty markers of inflammation and metabolism were individually assessed for correlation with usual gait speed and were separated into robust and impairment quartiles. For the robustness and impairment indices, individual markers were selected using step-wise regression over bootstrapping iterations, and regression coefficients were estimated for the markers individually and collectively as an additive score. RESULTS We developed a robustness index involving 6 markers and an impairment index involving 8 markers corresponding positively and negatively with gait speed. Two markers, glycine and tumor necrosis factor receptor 1 (TNFR1), appeared only in the robustness index, and TNFR2; regulated on activation, normal T-cell expressed and secreted; the amino acid factor; and matrix metallopeptidase 3; appeared only in the impairment index. CONCLUSION Indices of biomarkers were associated with robust and impaired physical performance but differ, in composition suggesting potential biological differences that may contribute to robustness and impairment.
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Affiliation(s)
- Xintong Zuo
- Duke-National University of Singapore Medical School, Singapore.,Claude D. Pepper Older Americans Independence Center, Center for the Study of Aging and Human Development, Duke University Medical Center (DUMC), Duke University, Durham, North Carolina
| | - Alison Luciano
- Claude D. Pepper Older Americans Independence Center, Center for the Study of Aging and Human Development, Duke University Medical Center (DUMC), Duke University, Durham, North Carolina
| | - Carl F Pieper
- Claude D. Pepper Older Americans Independence Center, Center for the Study of Aging and Human Development, Duke University Medical Center (DUMC), Duke University, Durham, North Carolina.,Department of Biostatistics and Bioinformatics, DUMC, Duke University, Durham, North Carolina
| | - James R Bain
- Sarah W. Stedman Nutrition and Metabolism Center, DUMC, Duke University, Durham, North Carolina.,Department of Medicine, School of Medicine, Duke University, Durham, North Carolina
| | - Virginia B Kraus
- Claude D. Pepper Older Americans Independence Center, Center for the Study of Aging and Human Development, Duke University Medical Center (DUMC), Duke University, Durham, North Carolina.,Molecular Physiology Institute, DUMC, Duke University, Durham, North Carolina.,Department of Medicine, School of Medicine, Duke University, Durham, North Carolina
| | - William E Kraus
- Claude D. Pepper Older Americans Independence Center, Center for the Study of Aging and Human Development, Duke University Medical Center (DUMC), Duke University, Durham, North Carolina.,Molecular Physiology Institute, DUMC, Duke University, Durham, North Carolina.,Department of Medicine, School of Medicine, Duke University, Durham, North Carolina
| | - Miriam C Morey
- Claude D. Pepper Older Americans Independence Center, Center for the Study of Aging and Human Development, Duke University Medical Center (DUMC), Duke University, Durham, North Carolina.,Department of Medicine, School of Medicine, Duke University, Durham, North Carolina.,Geriatric Research, Education, and Clinical Center, Veterans Affairs Medical Center, Durham, North Carolina
| | - Harvey J Cohen
- Claude D. Pepper Older Americans Independence Center, Center for the Study of Aging and Human Development, Duke University Medical Center (DUMC), Duke University, Durham, North Carolina.,Department of Medicine, School of Medicine, Duke University, Durham, North Carolina
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Whitson HE, Cohen HJ, Schmader KE, Morey MC, Kuchel G, Colon-Emeric CS. Physical Resilience: Not Simply the Opposite of Frailty. J Am Geriatr Soc 2018; 66:1459-1461. [PMID: 29577234 DOI: 10.1111/jgs.15233] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Heather E Whitson
- Center for the Study of Aging and Human Development, School of Medicine, Duke University, Durham, North Carolina.,Departments of Medicine, School of Medicine, Duke University, Durham, North Carolina.,Geriatrics Research, Education, and Clinical Center, Durham Veterans Affairs Medical Center, Durham, North Carolina
| | - Harvey J Cohen
- Center for the Study of Aging and Human Development, School of Medicine, Duke University, Durham, North Carolina.,Departments of Medicine, School of Medicine, Duke University, Durham, North Carolina
| | - Kenneth E Schmader
- Center for the Study of Aging and Human Development, School of Medicine, Duke University, Durham, North Carolina.,Departments of Medicine, School of Medicine, Duke University, Durham, North Carolina.,Geriatrics Research, Education, and Clinical Center, Durham Veterans Affairs Medical Center, Durham, North Carolina
| | - Miriam C Morey
- Center for the Study of Aging and Human Development, School of Medicine, Duke University, Durham, North Carolina.,Departments of Medicine, School of Medicine, Duke University, Durham, North Carolina.,Geriatrics Research, Education, and Clinical Center, Durham Veterans Affairs Medical Center, Durham, North Carolina
| | - George Kuchel
- Center on Aging, University of Connecticut, Farmington, Connecticut
| | - Cathleen S Colon-Emeric
- Center for the Study of Aging and Human Development, School of Medicine, Duke University, Durham, North Carolina.,Departments of Medicine, School of Medicine, Duke University, Durham, North Carolina.,Geriatrics Research, Education, and Clinical Center, Durham Veterans Affairs Medical Center, Durham, North Carolina
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Hall KS, Morey MC, Beckham JC, Bosworth HB, Pebole MM, Pieper CF, Sloane R. The Warrior Wellness Study: A Randomized Controlled Exercise Trial for Older Veterans with PTSD. Transl J Am Coll Sports Med 2018; 3:43-51. [PMID: 29632895 PMCID: PMC5889111 DOI: 10.1249/tjx.0000000000000056] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Posttraumatic stress disorder (PTSD) affects up to 30% of military veterans. Older veterans, many of whom have lived with PTSD symptoms for several decades, report a number of negative health outcomes. Despite the demonstrated benefits of regular exercise on physical and psychological health, no studies have explored the impact of exercise in older veterans with PTSD. This paper describes the development, design, and implementation of the Warrior Wellness exercise pilot study for older veterans with PTSD. Veterans aged ≥60 with a Diagnostic and Statistical Manual of Mental Disorders (DSM-V) diagnosis of PTSD will be recruited and randomized to (a) Warrior Wellness, a 12-week supervised, facility-based exercise intervention, or (b) usual care for 12 weeks. Warrior Wellness is a theory- and evidence-based behavioral intervention that involves 3 sessions per week of multi-component exercise training that targets strength, endurance, balance, and flexibility. Warrior Wellness focuses on satisfaction with outcomes, self-efficacy, self-monitoring, and autonomy. Factors associated with program adherence, defined as the number of sessions attended during the 12 weeks, will be explored. Primary outcomes include PTSD symptoms and cardiovascular endurance, assessed at baseline and 12 weeks. Compared to those in usual care, it is hypothesized that those in the Warrior Wellness condition will improve on these efficacy outcomes. The Warrior Wellness study will provide evidence on whether a short-term exercise intervention is feasible, acceptable, and effective among older veterans with PTSD, and explore factors associated with program adherence. ClinicalTrials.gov Identifier: NCT02295995.
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Affiliation(s)
- Katherine S Hall
- VA Durham Healthcare System, Geriatric Research, Education, and Clinical Center, Durham, NC.,Duke University, Department of Medicine, Durham, NC
| | - Miriam C Morey
- VA Durham Healthcare System, Geriatric Research, Education, and Clinical Center, Durham, NC.,Duke University, Department of Medicine, Durham, NC
| | - Jean C Beckham
- VA Durham Healthcare System, Mental Illness Research, Education, and Clinical Center, Durham, NC.,Duke University, Department of Psychiatry and Behavioral Sciences, Durham, NC
| | - Hayden B Bosworth
- Duke University, Department of Psychiatry and Behavioral Sciences, Durham, NC.,VA Durham Healthcare System, Health Services Research and Development, Durham, NC
| | - Michelle M Pebole
- VA Durham Healthcare System, Geriatric Research, Education, and Clinical Center, Durham, NC
| | - Carl F Pieper
- Duke University, Department of Biostatistics and Bioinformatics, Durham, NC
| | - Richard Sloane
- VA Durham Healthcare System, Geriatric Research, Education, and Clinical Center, Durham, NC.,Duke University, Department of Biostatistics and Bioinformatics, Durham, NC
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40
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Morey MC, Lee CC, Castle S, Valencia WM, Katzel L, Giffuni J, Kopp T, Cammarata H, McDonald M, Oursler KA, Wamsley T, Jain C, Bettger JP, Pearson M, Manning KM, Intrator O, Veazie P, Sloane R, Li J, Parker DC. Should Structured Exercise Be Promoted As a Model of Care? Dissemination of the Department of Veterans Affairs Gerofit Program. J Am Geriatr Soc 2018; 66:1009-1016. [PMID: 29430642 DOI: 10.1111/jgs.15276] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Exercise provides a wide range of health-promoting benefits, but support is limited for clinical programs that use exercise as a means of health promotion. This stands in contrast to restorative or rehabilitative exercise, which is considered an essential medical service. We propose that there is a place for ongoing, structured wellness and health promotion programs, with exercise as the primary therapeutic focus. Such programs have long-lasting health benefits, are easily implementable, and are associated with high levels of participant satisfaction. We describe the dissemination and implementation of a long-standing exercise and health promotion program, Gerofit, for which significant gains in physical function that have been maintained over 5 years of follow-up, improvements in well-being, and a 10-year 25% survival benefit among program adherents have been documented. The program has been replicated at 6 Veterans Affairs Medical Centers. The pooled characteristics of enrolled participants (n = 691) demonstrate substantial baseline functional impairment (usual gait speed 1.05 ± 0.3 m/s, 8-foot up and go 8.7 ± 6.7 seconds, 30-second chair stands 10.7 ± 5.1, 6-minute walk distance 404.31 ± 141.9 m), highlighting the need for such programs. Change scores over baseline for 3, 6, and 12 months of follow-up are clinically and statistically significant (P < .05 all measures) and replicate findings from the parent program. Patient satisfaction ratings of high ranged from 88% to 94%. We describe the implementation process and present 1-year outcomes. We suggest that such programs be considered essential elements of healthcare systems.
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Affiliation(s)
- Miriam C Morey
- Geriatric Research, Education, and Clinical Center, Veterans Affairs Health Care System, Durham, North Carolina.,Center for the Study of Aging/Claude D. Pepper Older Americans Independence Center, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Cathy C Lee
- Geriatric Research, Education, and Clinical Center, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California.,David Geffen School of Medicine, University of California, Los Angeles, California
| | - Steven Castle
- Geriatric Research, Education, and Clinical Center, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California.,David Geffen School of Medicine, University of California, Los Angeles, California
| | - Willy M Valencia
- Geriatric Research, Education, and Clinical Center, Miami Healthcare System, Miami, Florida.,University of Miami, Miller School of Medicine, Miami, Florida
| | - Leslie Katzel
- Geriatric Research, Education and Clinical Center, Veterans Affairs Maryland Health Care System, Baltimore, Maryland.,School of Medicine, University of Maryland, Baltimore, Maryland
| | - Jamie Giffuni
- Geriatric Research, Education and Clinical Center, Veterans Affairs Maryland Health Care System, Baltimore, Maryland
| | - Teresa Kopp
- Veterans Affairs Medical Center, Canandaigua, New York
| | | | - Michelle McDonald
- Geriatric Rehabilitation and Clinical Center, Veterans Affairs Pacific Health Care System, Honolulu, Hawaii
| | - Kris A Oursler
- Geriatric Research, Education, and Clinical Center, Veterans Affairs Medical Center, Salem, Virginia
| | - Timothy Wamsley
- Geriatric Research, Education, and Clinical Center, Veterans Affairs Medical Center, Salem, Virginia
| | - Chani Jain
- Geriatric Research, Education, and Clinical Center, Veterans Affairs Medical Center, Salem, Virginia
| | - Janet P Bettger
- Department of Orthopedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Megan Pearson
- Geriatric Research, Education, and Clinical Center, Veterans Affairs Health Care System, Durham, North Carolina
| | - Kenneth M Manning
- Geriatric Research, Education, and Clinical Center, Veterans Affairs Health Care System, Durham, North Carolina
| | - Orna Intrator
- Geriatrics and Extended Care Data and Analysis Center, Veterans Affairs Medical Center, Canandaigua, New York.,University of Rochester Medical Center, Rochester, New York
| | - Peter Veazie
- Geriatrics and Extended Care Data and Analysis Center, Veterans Affairs Medical Center, Canandaigua, New York.,University of Rochester Medical Center, Rochester, New York
| | - Richard Sloane
- Center for the Study of Aging/Claude D. Pepper Older Americans Independence Center, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Jiejin Li
- Geriatrics and Extended Care Data and Analysis Center, Veterans Affairs Medical Center, Canandaigua, New York.,University of Rochester Medical Center, Rochester, New York
| | - Daniel C Parker
- Geriatric Research, Education, and Clinical Center, Veterans Affairs Health Care System, Durham, North Carolina
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Morey MC, Manning KM, Guo Y, McDonald SR, Heflin MT, Porter Starr KN, Sloane R, Loyack NL, Lagoo-Deenadayalan S. Physical Activity Trackers: Promising Tools to Promote Resilience in Older Surgical Patients. ACTA ACUST UNITED AC 2018; 9. [PMID: 31106298 DOI: 10.29011/2575-9760.001156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Objectives Impending surgery presents a high risk for older adults given their vulnerability to adverse outcomes. New approaches to peri-operative care bring together surgeons, geriatricians, and other Multidisciplinary specialties to co-manage the geriatric surgical patient. However, few have incorporated interventions to promote physical activity (PA) throughout this period. We describe findings from two quality improvement (QI) initiatives that adopted the use of PA trackers to monitor and promote PA during the peri-operative period. Methods QI project within Perioperative Optimization of Senior Health (POSH) clinic at two medical centers (Duke and Durham Veterans Healthcare System (VA)) in Durham, North Carolina. Participants included 38 adults, ages 65+. Participants from POSH-at-Duke received PA trackers with one-time bundled advice from the provider team on nutrition, activity, pain management, medications and other relevant education prior to surgery. Participants from POSH-at-VA received the same one time bundled advice in addition to a visit with an exercise health coach who provided PA guidance followed by weekly PA telephone counseling throughout entire peri-operative period to 4-weeks post-surgery. Primary outcome was daily step counts. Results Ninety three percent of participants approached agreed to use PA trackers. POSH-at-Duke had mean daily step counts of 3,951 at baseline, 4,437 two days prior to surgery, and 1,838 at 4-week post-operative visit as opposed to POSH-at-VA with 2,063 steps at baseline, 5,452 two days prior to surgery, and 4,236 at 4-week post-operative visit, p=0.049 for trajectory differences. Conclusion PA trackers coupled with appropriate continuous PA counseling has a potential utility in promoting resilience in the geriatric surgical candidate.
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Affiliation(s)
- Miriam C Morey
- Geriatric Research, Education and Clinical Center, Durham VA Healthcare System, Durham, North Carolina.,Department of Medicine, Duke University Medical Center, Durham, North Carolina.,Duke Center for the Study of Aging and Human Development/OAIC, Duke University Medical Center, Durham, North Carolina
| | - Kenneth M Manning
- Geriatric Research, Education and Clinical Center, Durham VA Healthcare System, Durham, North Carolina
| | - Ying Guo
- Duke Center for the Study of Aging and Human Development/OAIC, Duke University Medical Center, Durham, North Carolina.,Duke- National University of Singapore Medical School, Singapore
| | - Shelley R McDonald
- Geriatric Research, Education and Clinical Center, Durham VA Healthcare System, Durham, North Carolina.,Department of Medicine, Duke University Medical Center, Durham, North Carolina.,Duke Center for the Study of Aging and Human Development/OAIC, Duke University Medical Center, Durham, North Carolina
| | - Mitchell T Heflin
- Geriatric Research, Education and Clinical Center, Durham VA Healthcare System, Durham, North Carolina.,Department of Medicine, Duke University Medical Center, Durham, North Carolina.,Duke Center for the Study of Aging and Human Development/OAIC, Duke University Medical Center, Durham, North Carolina
| | - Kathryn N Porter Starr
- Geriatric Research, Education and Clinical Center, Durham VA Healthcare System, Durham, North Carolina.,Department of Medicine, Duke University Medical Center, Durham, North Carolina.,Duke Center for the Study of Aging and Human Development/OAIC, Duke University Medical Center, Durham, North Carolina
| | - Richard Sloane
- Geriatric Research, Education and Clinical Center, Durham VA Healthcare System, Durham, North Carolina.,Duke Center for the Study of Aging and Human Development/OAIC, Duke University Medical Center, Durham, North Carolina
| | - Nancy L Loyack
- Surgery, Durham VA Healthcare System, Durham, North Carolina
| | - Sandhya Lagoo-Deenadayalan
- Duke Center for the Study of Aging and Human Development/OAIC, Duke University Medical Center, Durham, North Carolina.,Department of Surgery, Duke University Medical Center, Durham, North Carolina.,Surgery, Durham VA Healthcare System, Durham, North Carolina
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Jamerson BD, Fillenbaum GG, Sloane R, Morey MC. A New Method of Identifying Characteristics of Needing Help to Take Medications in an Older Representative Community-Dwelling Population: The Older Adults Medication Assist Scale. J Am Geriatr Soc 2017; 64:1195-202. [PMID: 27321598 DOI: 10.1111/jgs.14166] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To determine the sociodemographic characteristics, health conditions, and cognitive and functional status associated with baseline prevalence and new need for help taking medication 3 years later and to construct a brief scale indicative of need for help taking medications. DESIGN Retrospective cross-sectional and 3-year longitudinal study. SETTING Five-county area in north-central Piedmont, North Carolina. PARTICIPANTS Representative community-dwelling sample of black and white individuals aged 65 and older (N = 4,136). MEASUREMENTS Information was obtained in person in participants' homes using structured questionnaires. Health conditions included sensory impairment and self-report of physician-diagnosed conditions. Cognitive status was assessed using the 10-item Short Portable Mental Status Questionnaire. Functional status was assessed using the three-item Rosow-Breslau scale, the five-item Katz activity of daily living scale, and a modified six-item Older Americans Resources and Services instrumental activities of daily living scale. RESULTS Characteristics associated with need for help taking medications were aged 80 and older, being male, living with others, having four or more chronic conditions, and impaired cognitive or functional status (c-statistic 0.94, 77.1% sensitivity, 87.9% specificity). Predictors of new need for help with medications 3 years later included aged 75 and older at baseline, being male, and impaired cognitive and functional status (c-statistic 0.75). CONCLUSION This brief scale can help identify persons needing help with medications and could be useful in assisting clinicians with medication management.
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Affiliation(s)
- Brenda D Jamerson
- Claude D. Pepper Older Americans Independence Center, Duke University, Durham, North Carolina.,Center on Biobehavioral Health Disparities Research, Duke University, Durham, North Carolina.,Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina.,Geriatric Research Education and Clinical Center, Veterans Administration Medical Center, Durham, North Carolina
| | - Gerda G Fillenbaum
- Claude D. Pepper Older Americans Independence Center, Duke University, Durham, North Carolina.,Center on Biobehavioral Health Disparities Research, Duke University, Durham, North Carolina
| | - Richard Sloane
- Claude D. Pepper Older Americans Independence Center, Duke University, Durham, North Carolina.,Center for the Study of Aging and Human Development, Duke University, Durham, North Carolina.,Geriatric Research Education and Clinical Center, Veterans Administration Medical Center, Durham, North Carolina
| | - Miriam C Morey
- Claude D. Pepper Older Americans Independence Center, Duke University, Durham, North Carolina.,Center for the Study of Aging and Human Development, Duke University, Durham, North Carolina.,Geriatric Research Education and Clinical Center, Veterans Administration Medical Center, Durham, North Carolina
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43
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Khoury AL, Morey MC, Wong TC, McNeil DL, Humphries B, Frankey K, Pieper CF, Hicks CB, Huffman K, McKellar MS. Diminished physical function in older HIV-infected adults in the Southeastern U.S. despite successful antiretroviral therapy. PLoS One 2017; 12:e0179874. [PMID: 28662079 PMCID: PMC5491055 DOI: 10.1371/journal.pone.0179874] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 04/26/2017] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND As antiretroviral therapy efficacy improves, HIV is gradually being recognized more as a chronic disease within the aging HIV-infected population. While these individuals are surviving into old age, they may, however, be experiencing "accelerated aging" with greater declines in physical function than that observed among comparably matched individuals free of HIV. This decline is not well understood and it remains unclear if physical decline correlates with the degree of immunosuppression based on CD4 lymphocyte nadir. METHODS In a cross-sectional study of accelerated aging in the older HIV-infected population on antiretroviral therapy (ART), physical performance evaluations were completed on a cohort of 107 HIV-infected subjects, age 50 years or older (with no HIV-1 RNA >200 copies/mL in the prior 12 months), and compared to reference ranges for age- and gender-matched HIV-uninfected persons. Physical performance testing consisted of four validated assessments: the 2.4-meter walk, 30-second chair stand, grip strength and 6-minute walk test. RESULTS When compared to age- and gender-matched HIV-uninfected reference controls, older HIV-infected persons had diminished physical function. No correlation was found between physical function and degree of immunosuppression as determined by pre-ART CD4 nadir. CONCLUSIONS Despite improved survival, HIV-infected adults on suppressive ART have diminished physical function compared to HIV-uninfected persons. The degree of HIV-associated immunosuppression does not correlate with the observed degree of physical function decline in older HIV-infected persons, suggesting the decline is mediated by other mechanisms.
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Affiliation(s)
- Audrey L. Khoury
- University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, United States of America
| | - Miriam C. Morey
- Claude D Pepper Older Americans Independence Center, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
- Geriatric Research, Education and Clinical Center, Veterans Affairs Medical Center, Durham, North Carolina, United States of America
| | - Tammy C. Wong
- University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, United States of America
| | - Donna Lynn McNeil
- Office of Research Support, Duke Cancer Institute, Durham, North Carolina, United States of America
| | - Barlett Humphries
- Center for Applied Genomics and Precision Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Katherine Frankey
- Center for Applied Genomics and Precision Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Carl F. Pieper
- Claude D Pepper Older Americans Independence Center, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
- Duke Department of Biostatistics and Bioinformatics, Durham, North Carolina, United States of America
| | - Charles B. Hicks
- Division of Infectious Diseases, University of California San Diego School of Medicine, San Diego, California, United States of America
| | - Kim Huffman
- Claude D Pepper Older Americans Independence Center, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Mehri S. McKellar
- Claude D Pepper Older Americans Independence Center, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
- Division of Infectious Disease, Duke University Medical Center, Durham, North Carolina, United States of America
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Reynolds PG, Biddle ED, Conway PT, Costello DJ, Kopp TL, Morey MC. Implementation of a Veteran Group-Based Aquatic Program Using an Individualized Varied Intensity Protocol. Med Sci Sports Exerc 2017. [DOI: 10.1249/01.mss.0000518063.32986.e7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Hall KS, Cohen HJ, Pieper CF, Fillenbaum GG, Kraus WE, Huffman KM, Cornish MA, Shiloh A, Flynn C, Sloane R, Newby LK, Morey MC. Physical Performance Across the Adult Life Span: Correlates With Age and Physical Activity. J Gerontol A Biol Sci Med Sci 2017; 72:572-578. [PMID: 27356977 PMCID: PMC6075535 DOI: 10.1093/gerona/glw120] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 06/07/2016] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND A number of large-scale population studies have provided valuable information about physical performance in aged individuals; however, there is little information about trajectories of function and associations with age across the adult life span. We developed a mobility-focused physical performance screener designed to be appropriate for the adult life span. METHODS The physical performance battery includes measures of mobility, strength, endurance, and balance. Physical activity (PA) was assessed with accelerometry. We examined age-related trends in physical performance and PA, and the relationship between physical performance and PA across the age range (30-90+), by decade, in 775 participants enrolled in the study 2012-2014. RESULTS Physical performance was worse with increasing age decade. Although men performed better than women across all ages, the decrement by age group was similar between genders. Worsening physical performance was observed as early as the fifth decade for chair stands and balance and in the sixth decade for gait speed and aerobic endurance. The number and strength of significant associations between physical performance and PA increased with greater age: the greatest number of significant associations was seen in the 60-79 age groups, with fewer reported in the 30-59 and 80-90+ age groups. More PA was associated with better physical function. CONCLUSION These results emphasize the importance of a life span approach to studies of function and aging. This work points to the need for a physical performance screener that spans across adulthood as a clinical tool for identifying functional decline.
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Affiliation(s)
- Katherine S Hall
- Duke Claude D. Pepper Older Americans Independence Center
- Duke Center for the Study of Aging and Human Development, and
- Department of Medicine, Duke University, Durham, North Carolina
- Geriatric Research, Education, and Clinical Center, Veterans Affairs Medical Center, Durham, North Carolina
| | - Harvey J Cohen
- Duke Claude D. Pepper Older Americans Independence Center
- Duke Center for the Study of Aging and Human Development, and
- Department of Medicine, Duke University, Durham, North Carolina
| | - Carl F Pieper
- Duke Claude D. Pepper Older Americans Independence Center
- Duke Center for the Study of Aging and Human Development, and
- Department of Biostatistics and Bioinformatics and
| | - Gerda G Fillenbaum
- Duke Claude D. Pepper Older Americans Independence Center
- Duke Center for the Study of Aging and Human Development, and
| | - William E Kraus
- Duke Claude D. Pepper Older Americans Independence Center
- Duke Center for the Study of Aging and Human Development, and
- Department of Medicine, Duke University, Durham, North Carolina
- Duke Molecular Physiology Institute, Duke University, Durham, North Carolina
| | - Kim M Huffman
- Duke Claude D. Pepper Older Americans Independence Center
- Duke Center for the Study of Aging and Human Development, and
- Department of Medicine, Duke University, Durham, North Carolina
- Duke Molecular Physiology Institute, Duke University, Durham, North Carolina
- Physical Medicine and Rehabilitation Service, Veterans Affairs Medical Center, Durham, North Carolina
| | - Melissa A Cornish
- Duke Translational Research Institute, Duke University, Durham, North Carolina
| | - Andrew Shiloh
- Duke Center for the Study of Aging and Human Development, and
| | - Christy Flynn
- Duke Translational Research Institute, Duke University, Durham, North Carolina
| | - Richard Sloane
- Duke Claude D. Pepper Older Americans Independence Center
- Duke Center for the Study of Aging and Human Development, and
- Department of Biostatistics and Bioinformatics and
| | - L Kristin Newby
- Department of Medicine, Duke University, Durham, North Carolina
- Duke Translational Research Institute, Duke University, Durham, North Carolina
| | - Miriam C Morey
- Duke Claude D. Pepper Older Americans Independence Center
- Duke Center for the Study of Aging and Human Development, and
- Department of Medicine, Duke University, Durham, North Carolina
- Geriatric Research, Education, and Clinical Center, Veterans Affairs Medical Center, Durham, North Carolina
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Cowper PA, Peterson MJ, Pieper CF, Sloane RJ, Hall KS, McConnell ES, Bosworth HB, Ekelund CC, Pearson MP, Morey MC. Economic Analysis of Primary Care-Based Physical Activity Counseling in Older Men: The VA-LIFE Trial. J Am Geriatr Soc 2017; 65:533-539. [PMID: 28152170 PMCID: PMC5357188 DOI: 10.1111/jgs.14567] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To perform an economic evaluation of a primary care-based physical activity counseling intervention that improved physical activity levels and rapid gait speed in older veterans. DESIGN Secondary objective of randomized trial that assessed the effect of exercise counseling (relative to usual care) on physical performance, physical activity, function, disability, and medical resource use and cost. SETTING Veterans Affairs Medical Center, Durham, North Carolina. PARTICIPANTS Male veterans aged ≥70 years (n = 398). INTERVENTION An experienced health counselor provided baseline in-person exercise counseling, followed by telephone counseling at 2, 4, and 6 weeks, and monthly thereafter through one year. Each participant's primary care physician provided initial endorsement of the intervention, followed by monthly automated telephone messages tailored to the patient. Individualized progress reports were mailed quarterly. MEASUREMENTS Intervention costs were assessed. Health care resource use and costs were estimated from enrollment through one year follow-up. The incremental cost of achieving clinically significant changes in major trial endpoints was calculated. RESULTS The total direct cost of the intervention per participant was $459, 85% of which was counselor effort. With overhead, program cost totaled $696 per participant. Medical costs during follow-up reached $10,418 with the intervention, versus $12,052 with usual care (difference = -$1,634 (95% confidence interval = -$4,683 to $1,416; P = .29)). Expressed in terms of short-term clinical outcomes, the intervention cost $4,971 per additional patient reaching target exercise levels, or $4,640 per patient achieving a clinically significant change in rapid gait speed. CONCLUSION Improvements in physical activity and rapid gait speed in the physical activity counseling group were obtained at a cost that represents a small fraction of patients' annual health care costs.
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Affiliation(s)
- Patricia A Cowper
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Matthew J Peterson
- Departments of Community Health and Geriatrics, Boonshoft School of Medicine, Wright State University, Dayton, Ohio
| | - Carl F Pieper
- Center for the Study of Aging/Claude D. Pepper Older Americans Independence Center, Duke University Medical Center, Durham, NC
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC
| | - Richard J Sloane
- Center for the Study of Aging/Claude D. Pepper Older Americans Independence Center, Duke University Medical Center, Durham, NC
- School of Nursing, Duke University Medical Center, Durham, North Carolina
| | - Katherine S Hall
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
- Center for the Study of Aging/Claude D. Pepper Older Americans Independence Center, Duke University Medical Center, Durham, NC
- Geriatric Research, Education, and Clinical Center, VA Medical Center, Durham, NC
| | - Eleanor S McConnell
- Center for the Study of Aging/Claude D. Pepper Older Americans Independence Center, Duke University Medical Center, Durham, NC
- School of Nursing, Duke University Medical Center, Durham, North Carolina
- Geriatric Research, Education, and Clinical Center, VA Medical Center, Durham, NC
| | - Hayden B Bosworth
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
- Center for the Study of Aging/Claude D. Pepper Older Americans Independence Center, Duke University Medical Center, Durham, NC
- School of Nursing, Duke University Medical Center, Durham, North Carolina
- Health Services Research and Development Service, VA Medical Center, Durham, NC
| | - Carola C Ekelund
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
| | - Megan P Pearson
- Geriatric Research, Education, and Clinical Center, VA Medical Center, Durham, NC
| | - Miriam C Morey
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
- Center for the Study of Aging/Claude D. Pepper Older Americans Independence Center, Duke University Medical Center, Durham, NC
- Geriatric Research, Education, and Clinical Center, VA Medical Center, Durham, NC
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Serra MC, Addison O, Giffuni J, Paden L, Morey MC, Katzel L. Physical Function Does Not Predict Care Assessment Need Score in Older Veterans. J Appl Gerontol 2017; 38:412-423. [PMID: 28380717 DOI: 10.1177/0733464817690677] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Objective: The Veterans Health Administration's Care Assessment Need (CAN) score is a statistical model, aimed to predict high-risk patients. We were interested in determining if a relationship existed between physical function and CAN scores. Method: Seventy-four older (71 ± 1 years) male Veterans underwent assessment of CAN score and subjective (Short Form-36 [SF-36]) and objective (self-selected walking speed, four square step test, short physical performance battery) assessment of physical function. Results: Approximately 25% of participants self-reported limitations performing lower intensity activities, while 70% to 90% reported limitations with more strenuous activities. When compared with cut points indicative of functional limitations, 35% to 65% of participants had limitations for each of the objective measures. Any measure of subjective or objective physical function did not predict CAN score. Conclusion: These data indicate that the addition of a physical function assessment may complement the CAN score in the identification of high-risk patients.
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Affiliation(s)
- Monica C Serra
- Baltimore VA Medical Center, MD, USA.,University of Maryland School of Medicine, Baltimore, USA
| | - Odessa Addison
- Baltimore VA Medical Center, MD, USA.,University of Maryland School of Medicine, Baltimore, USA
| | | | | | - Miriam C Morey
- Durham VA Medical Center, NC, USA.,Duke University, NC, USA
| | - Leslie Katzel
- Baltimore VA Medical Center, MD, USA.,University of Maryland School of Medicine, Baltimore, USA
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Pavon JM, Sloane R, Morey MC, Hastings SN. Inpatient Mobility Measures As Useful Predictors of Discharge Destination in Hospitalized Older Adults. J Am Geriatr Soc 2017; 65:224-226. [PMID: 28111756 PMCID: PMC5832492 DOI: 10.1111/jgs.14577] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Juliessa M. Pavon
- Duke University Medical Center, Division of Geriatrics, Durham, NC, Duke University Medical Center, Box 3003, Durham, NC 27710, Fax: 919-668-0453
- Durham VAMC GRECC, Durham, NC, Durham VA Medical Center, 508 Fulton St., Durham, NC 27705, Fax: 919-286-6823
- Duke University, Center for the Study of Aging and Human Development, Older Americans Independence Center, Durham, NC, Duke University Medical Center, Box 3003, Durham, NC 27710, Fax: 919-668-0453
| | - Richard Sloane
- Duke University Medical Center, Division of Geriatrics, Durham, NC, Duke University Medical Center, Box 3003, Durham, NC 27710, Fax: 919-668-0453
- Durham VAMC GRECC, Durham, NC, Durham VA Medical Center, 508 Fulton St., Durham, NC 27705, Fax: 919-286-6823
- Duke University, Center for the Study of Aging and Human Development, Older Americans Independence Center, Durham, NC, Duke University Medical Center, Box 3003, Durham, NC 27710, Fax: 919-668-0453
| | - Miriam C. Morey
- Duke University Medical Center, Division of Geriatrics, Durham, NC, Duke University Medical Center, Box 3003, Durham, NC 27710, Fax: 919-668-0453
- Durham VAMC GRECC, Durham, NC, Durham VA Medical Center, 508 Fulton St., Durham, NC 27705, Fax: 919-286-6823
- Duke University, Center for the Study of Aging and Human Development, Older Americans Independence Center, Durham, NC, Duke University Medical Center, Box 3003, Durham, NC 27710, Fax: 919-668-0453
| | - S. Nicole Hastings
- Duke University Medical Center, Division of Geriatrics, Durham, NC, Duke University Medical Center, Box 3003, Durham, NC 27710, Fax: 919-668-0453
- Durham VAMC GRECC, Durham, NC, Durham VA Medical Center, 508 Fulton St., Durham, NC 27705, Fax: 919-286-6823
- Duke University, Center for the Study of Aging and Human Development, Older Americans Independence Center, Durham, NC, Duke University Medical Center, Box 3003, Durham, NC 27710, Fax: 919-668-0453
- Center for Health Services Research in Primary Care, Durham VAMC, 411 W. Chapel Hill St., Durham, NC 27701
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Hall KS, Gregg J, Bosworth HB, Beckham JC, Hoerster KD, Sloane R, Morey MC. Physical Activity Counseling Promotes Physical and Psychological Resilience in Older Veterans with Posttraumatic Stress Disorder. Ment Health Phys Act 2016; 11:53-59. [PMID: 28458721 PMCID: PMC5404826 DOI: 10.1016/j.mhpa.2016.10.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
UNLABELLED Individuals with posttraumatic stress disorder (PTSD) have elevated rates of morbidity, and a sedentary lifestyle can cause and aggravate the physical health needs of adults with PTSD. The primary aim of this paper was to explore the impact of physical activity (PA) counseling (vs. usual care) on physical and psychological outcomes among individuals with PTSD. A secondary aim was to compare these arm effects between those with and without PTSD. METHODS Older (>60 years) overweight veterans with impaired glucose tolerance were randomly assigned to an intervention or a usual care control arm. Of the 302 participants who underwent randomization, 67 (22%) had PTSD. Participants in the intervention arm received one in-person activity counseling session followed by regular PA telephone counseling over 12 months. Physical and psychological outcomes were assessed at baseline, 3, and 12 months. RESULTS Primary Aim (intervention vs. usual care among those with PTSD): PA increased on average from 80 minutes/week to 161 minutes/week among participants in the intervention arm (p=0.01). Large, clinically meaningful improvements in six-minute walk test and psychological health were observed over the course of the intervention (p<0.01). Secondary Aim (PTSD/No PTSD, intervention/usual care): participants with PTSD responded equally well to the intervention compared to participants without PTSD, though we observed significantly greater improvements in vitality and six-minute walk compared to participants without PTSD (p<0.05). CONCLUSIONS Given the epidemic of comorbid psychological illness and lifestyle-related disease among persons with PTSD, our findings support development and implementation of targeted PA interventions in this high-risk population.
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Affiliation(s)
- Katherine S. Hall
- Geriatric Research, Education, and Clinical Center, Durham Veterans Affairs Medical Center, Durham, NC, USA
- Department of Medicine, Duke University Medical Center, Durham, NC, USA
- Claude A. Pepper Center for Aging, Duke University Medical Center, Durham, NC, USA
| | - Jeffrey Gregg
- Mental Health Service, Durham Veterans Affairs Medical Center, Durham, NC, USA
| | - Hayden B. Bosworth
- Department of Medicine, Duke University Medical Center, Durham, NC, USA
- Center for Health Services Research and Development, Durham Veterans Affairs Medical Center, Durham, NC, USA
| | - Jean C. Beckham
- VA Research Service/Veterans Integrated Service Network 6 Mental Illness Research, Education, and Clinical Center, Durham Veterans Affairs Medical Center, Durham, NC, USA
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Katherine D. Hoerster
- Mental Health Service, VA Puget Sound Healthcare System, Seattle Division, Seattle, WA, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA , USA
| | - Richard Sloane
- Geriatric Research, Education, and Clinical Center, Durham Veterans Affairs Medical Center, Durham, NC, USA
- Claude A. Pepper Center for Aging, Duke University Medical Center, Durham, NC, USA
| | - Miriam C. Morey
- Geriatric Research, Education, and Clinical Center, Durham Veterans Affairs Medical Center, Durham, NC, USA
- Department of Medicine, Duke University Medical Center, Durham, NC, USA
- Claude A. Pepper Center for Aging, Duke University Medical Center, Durham, NC, USA
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Duan-Porter W, Cohen HJ, Demark-Wahnefried W, Sloane R, Pendergast JF, Snyder DC, Morey MC. Physical resilience of older cancer survivors: An emerging concept. J Geriatr Oncol 2016; 7:471-478. [PMID: 27478133 DOI: 10.1016/j.jgo.2016.07.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 04/25/2016] [Accepted: 07/18/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To characterize factors contributing to physical resilience in older cancer survivors, as demonstrated by resistance to decline or recovery (resilience). MATERIALS AND METHODS We conducted a secondary analysis of data from a randomized controlled trial of cancer survivors ≥65years old and ≥5years from cancer diagnoses. Physical function was assessed quarterly over 2years, with Short-Form 36 physical function subscale. Participants with ≥2 follow-up assessments (n=594) were evaluated for physical resilience: 1) Resistance was defined as lack of any decline, where decline was a drop of ≥13 points, and 2) resilience (i.e., recovery) was defined as regaining ≥50% of lost function, subsequent to decline. RESULTS Mean age was 73.1years and 89.1% were Caucasian. Forty-nine percent (n=289) were resistant to decline in function; these individuals were younger, had higher education and income, were more likely to be Caucasian, and had higher baseline physical function (mean difference [MD] 7.8 points, 95% CI 5.0-10.8) and general health (MD 7.5 points, 95% CI 4.9-10.1). Fifty-seven percent (n=137 of 239) demonstrated resilience, with 91.2% (n=125) recovering within 6months of declines; these participants had higher baseline physical function (MD 6.6 points, 95% CI 1.8-11.4), but similar pre-decline function. More participants who were resistant, and more who showed resilience, reported high self-efficacy and social support. CONCLUSIONS The majority of older cancer survivors exhibited physical resilience; this was associated with high baseline health, physical function, self-efficacy, and social support. Assessing and targeting psychosocial factors may be important for interventions seeking to promote physical resilience.
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Affiliation(s)
- Wei Duan-Porter
- Health Services Research and Development, Durham VA Medical Center, Durham, NC, USA; Department of Medicine, Duke University School of Medicine, Durham, NC, USA; Duke University Claude D. Pepper Older Americans Independence Center, Durham, NC, USA.
| | - Harvey J Cohen
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA; Duke University Claude D. Pepper Older Americans Independence Center, Durham, NC, USA; Duke University Center for the Study of Aging and Human Development, Durham, NC, USA; Geriatrics Research, Education and Clinical Center, Durham VA Medical Center, Durham, NC, USA
| | - Wendy Demark-Wahnefried
- Department of Preventive Medicine, Department of Nutrition Sciences, University of Alabama, Birmingham, AL, USA; Comprehensive Cancer Center, University of Alabama, Birmingham, AL, USA
| | - Richard Sloane
- Duke University Claude D. Pepper Older Americans Independence Center, Durham, NC, USA; Duke University Center for the Study of Aging and Human Development, Durham, NC, USA; Geriatrics Research, Education and Clinical Center, Durham VA Medical Center, Durham, NC, USA
| | - Jane F Pendergast
- Duke University Claude D. Pepper Older Americans Independence Center, Durham, NC, USA; Duke University Center for the Study of Aging and Human Development, Durham, NC, USA; Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - Denise C Snyder
- Duke Office of Clinical Research, Duke University School of Medicine, Durham, NC, USA
| | - Miriam C Morey
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA; Duke University Claude D. Pepper Older Americans Independence Center, Durham, NC, USA; Duke University Center for the Study of Aging and Human Development, Durham, NC, USA; Geriatrics Research, Education and Clinical Center, Durham VA Medical Center, Durham, NC, USA
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