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Lin C, Yeh FC, Glynn NW, Gmelin T, Wei YC, Chen YL, Huang CM, Shyu YC, Chen CK. Associations of depression and perceived physical fatigability with white matter integrity in older adults. Psychiatry Res Neuroimaging 2024; 340:111793. [PMID: 38373367 DOI: 10.1016/j.pscychresns.2024.111793] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 01/31/2024] [Accepted: 02/07/2024] [Indexed: 02/21/2024]
Abstract
BACKGROUNDS Fatigability is prevalent in older adults. However, it is often associated with depressed mood. We aim to investigate these two psychobehavioral constructs by examining their underpinning of white matter structures in the brain and their associations with different medical conditions. METHODS Twenty-seven older adults with late-life depression (LLD) and 34 cognitively normal controls (CN) underwent multi-shell diffusion MRI. Fatigability was measured with the Pittsburgh Fatigability Scale. We examined white matter integrity by measuring the quantitative anisotropy (QA), a fiber tracking parameter with better accuracy than the traditional imaging technique. RESULTS We found those with LLD had lower QA in the 2nd branch of the left superior longitudinal fasciculus (SLF-II), and those with more physical fatigability had lower QA in more widespread brain regions. In tracts associated with more physical fatigability, the lower QA in left acoustic radiation and left superior thalamic radiation correlated with higher blood glucose (r = - 0.46 and - 0.49). In tracts associated with depression, lower QA in left SLF-II correlated with higher bilirubin level (r = - 0.58). DISCUSSION Depression and fatigability were associated with various white matter integrity changes, which correlated with biochemistry biomarkers all related to inflammation.
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Affiliation(s)
- Chemin Lin
- Department of Psychiatry, Keelung Chang Gung Memorial Hospital, Keelung City, Taiwan; College of Medicine, Chang Gung University, Taoyuan County, Taiwan; Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung, Keelung, Taiwan
| | - Fang-Cheng Yeh
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Nancy W Glynn
- Center for Aging and Population Health, Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Theresa Gmelin
- Center for Aging and Population Health, Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Yi-Chia Wei
- College of Medicine, Chang Gung University, Taoyuan County, Taiwan; Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung, Keelung, Taiwan; Department of Neurology, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan; Institute of Neuroscience, National Yang-Ming University, Taipei, Taiwan
| | - Yao-Liang Chen
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Chih-Mao Huang
- Department of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Yu-Chiau Shyu
- Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung, Keelung, Taiwan
| | - Chih-Ken Chen
- Department of Psychiatry, Keelung Chang Gung Memorial Hospital, Keelung City, Taiwan; College of Medicine, Chang Gung University, Taoyuan County, Taiwan; Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung, Keelung, Taiwan.
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Huang AR, Reed NS, Deal JA, Arnold M, Burgard S, Chisolm T, Couper D, Glynn NW, Gmelin T, Goman AM, Gravens-Mueller L, Hayden KM, Mitchell C, Pankow JS, Pike JR, Schrack JA, Sanchez V, Coresh J, Lin FR. Depression and Health-Related Quality of Life Among Older Adults With Hearing Loss in the ACHIEVE Study. J Appl Gerontol 2024; 43:550-561. [PMID: 38016096 PMCID: PMC10981564 DOI: 10.1177/07334648231212291] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023] Open
Abstract
Hearing loss is associated with cognitive/physical health; less is known about mental health. We investigated associations between hearing loss severity, depression, and health-related quality of life among older adults with unaided hearing loss. Data (N = 948) were from the Aging and Cognitive Health Evaluation in Elders Study. Hearing was measured by pure-tone average (PTA), Quick Speech-in-Noise (QuickSIN) test, and the Hearing Handicap Inventory for the Elderly (HHIE-S). Outcomes were validated measures of depression and health-related quality of life. Associations were assessed by negative binomial regression. More severe hearing loss was associated with worse physical health-related quality of life (ratio: .98, 95% CI: .96, 1.00). Better QuickSIN was associated with higher mental health-related quality of life (1.01 [1.00, 1.02]). Worse HHIE-S was associated with depression (1.24 [1.16, 1.33]) and worse mental (.97 [.96, .98]) and physical (.95 [ .93, .96]) health-related quality of life. Further work will test effects of hearing intervention on mental health.
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Affiliation(s)
- Alison R. Huang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Nicholas S. Reed
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jennifer A. Deal
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Michelle Arnold
- College of Science and Mathematics, University of South Florida Sarasota - Manatee, Sarasota, FL, USA
| | - Sheila Burgard
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Theresa Chisolm
- College of Science and Mathematics, University of South Florida Sarasota - Manatee, Sarasota, FL, USA
| | - David Couper
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Nancy W. Glynn
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, PA, USA
| | - Theresa Gmelin
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, PA, USA
| | - Adele M. Goman
- School of Health and Social Care, Edinburgh Napier University, UK
| | - Lisa Gravens-Mueller
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Kathleen M. Hayden
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Christine Mitchell
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - James S. Pankow
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - James Russell Pike
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jennifer A. Schrack
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Victoria Sanchez
- College of Science and Mathematics, University of South Florida Sarasota - Manatee, Sarasota, FL, USA
| | - Josef Coresh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Frank R. Lin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Huang AR, Reed NS, Deal JA, Arnold M, Burgard S, Chisolm T, Couper D, Glynn NW, Gmelin T, Goman AM, Gravens-Mueller L, Hayden KM, Mitchell C, Pankow JS, Pike JR, Sanchez V, Schrack JA, Coresh J, Lin FR. Loneliness and Social Network Characteristics Among Older Adults With Hearing Loss in the ACHIEVE Study. J Gerontol A Biol Sci Med Sci 2024; 79:glad196. [PMID: 37578190 PMCID: PMC10809043 DOI: 10.1093/gerona/glad196] [Citation(s) in RCA: 2] [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] [Received: 03/14/2023] [Indexed: 08/15/2023] Open
Abstract
BACKGROUND Hearing loss is linked to loneliness and social isolation, but evidence is typically based on self-reported hearing. This study quantifies the associations of objective and subjective hearing loss with loneliness and social network characteristics among older adults with untreated hearing loss. METHODS This study uses baseline data (N = 933) from the Aging and Cognitive Health Evaluation in Elders (ACHIEVE) study. Hearing loss was quantified by the better ear, speech-frequency pure tone average (PTA), Quick Speech-in-Noise test, and hearing-related quality of life. Outcomes were validated measures of loneliness and social network characteristics. Associations were assessed by Poisson, negative binomial, and linear regression adjusted for demographic, health, and study design characteristics. RESULTS Participants were mean of 76.8 (4.0) years, 54.0% female, and 87.6% White. Prevalence of loneliness was 38%. Worse PTA was associated with a 19% greater prevalence of moderate or greater loneliness (prevalence ration [PR]: 1.19.95% CI: 1.06, 1.33). Better speech-in-noise recognition was associated with greater social network characteristics (eg, larger social network size [IRR: 1.04, 95% CI: 1.00, 1.07]). Worse hearing-related quality of life was associated with a 29% greater prevalence of moderate or greater loneliness (PR: 1.29, 95% CI: 1.19, 1.39) and worse social network characteristics (eg, more constricted social network size [IRR: 0.96, 95% CI: 0.91, 1.00]). CONCLUSIONS Results suggest the importance of multiple dimensions of hearing to loneliness and social connectedness. Hearing-related quality of life may be a potentially useful, easily administered clinical tool for identifying older adults with hearing loss associated with greater loneliness and social isolation.
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Affiliation(s)
- Alison R Huang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Nicholas S Reed
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jennifer A Deal
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Michelle Arnold
- College of Science and Mathematics, University of South Florida Sarasota–Manatee, Sarasota, Florida, USA
| | - Sheila Burgard
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Theresa Chisolm
- College of Science and Mathematics, University of South Florida Sarasota–Manatee, Sarasota, Florida, USA
| | - David Couper
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Nancy W Glynn
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Theresa Gmelin
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Adele M Goman
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Lisa Gravens-Mueller
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Kathleen M Hayden
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Christine Mitchell
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - James S Pankow
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
| | - James Russell Pike
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Victoria Sanchez
- College of Science and Mathematics, University of South Florida Sarasota–Manatee, Sarasota, Florida, USA
| | - Jennifer A Schrack
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Josef Coresh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Frank R Lin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Schumacher BT, Kehler DS, Kulminski AM, Qiao Y(S, Andersen SL, Gmelin T, Christensen K, Wojczynski MK, Theou O, Rockwood K, Newman AB, Glynn NW. The association between frailty and perceived physical and mental fatigability: The Long Life Family Study. J Am Geriatr Soc 2024; 72:219-225. [PMID: 37814920 PMCID: PMC10843058 DOI: 10.1111/jgs.18624] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 08/21/2023] [Accepted: 09/11/2023] [Indexed: 10/11/2023]
Abstract
BACKGROUND Higher levels of frailty, quantified by a frailty index (FI), may be linked to fatigue severity as tasks become more physically and mentally demanding. Fatigue, a component of frailty research, has been ambiguous and inconsistent in its operationalization. Fatigability-the quantification of vulnerability to fatigue in relation to specific intensity and duration of activities-offers a more sensitive and standardized approach, though the association between frailty and fatigability has not been assessed. METHODS Using cross-sectional data from the Long Life Family Study at Visit 2 (2014-2017; N = 2524; mean age ± standard deviation (SD) 71.4 ± 11.2 years; 55% women; 99% White), we examined associations between an 83-item FI after excluding fatigue items (ratio of number of health problems reported (numerator) out of the total assessed (denominator); higher ratio = greater frailty) and perceived physical and mental fatigability using the Pittsburgh Fatigability Scale (PFS) (range 0-50; higher scores = greater fatigability). RESULTS Participants had mean ± standard deviation FI (0.08 ± 0.06; observed range: 0.0-0.43), PFS Physical (13.7 ± 9.6; 39.5% more severe, ≥15), and PFS Mental (7.9 ± 8.9; 22.8% more severe, ≥13). The prevalence of more severe physical and mental fatigability was higher across FI quartiles. In mixed effects models accounting for family structure, a clinically meaningful 3%-higher FI was associated with 1.9 points higher PFS Physical score (95% confidence interval (CI) 1.7-2.1) and 1.7 points higher PFS Mental score (95% CI 1.5-1.9) after adjusting for covariates. CONCLUSIONS Frailty was associated with perceived physical and mental fatigability severity. Understanding this association may support the development of interventions to mitigate the risks associated with greater frailty and perceived fatigability. Including measurements of perceived fatigability, in lieu of fatigue, in frailty indices has the potential to alleviate the inconsistencies and ambiguity surrounding the operationalization of fatigue and provide a more precise and sensitive measurement of frailty.
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Affiliation(s)
| | - Dustin S. Kehler
- School of Physiotherapy, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Alexander M. Kulminski
- Biodemography of Aging Research Unit, Social Science Research Institute, Duke University, Durham, NC, USA
| | - Yujia (Susanna) Qiao
- Department of Epidemiology, School of Public Health, University of Pittsburgh, PA, USA
| | - Stacy L. Andersen
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Theresa Gmelin
- Department of Epidemiology, School of Public Health, University of Pittsburgh, PA, USA
| | - Kaare Christensen
- Danish Aging Research Center, University of Southern Denmark
- Department of Clinical Biochemistry and Department of Clinical Genetics, Odense University Hospital, Odense, Denmark
| | | | - Olga Theou
- School of Physiotherapy, Dalhousie University, Halifax, Nova Scotia, Canada
- Division of Geriatric Medicine, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Kenneth Rockwood
- Division of Geriatric Medicine, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Anne B. Newman
- Department of Epidemiology, School of Public Health, University of Pittsburgh, PA, USA
| | - Nancy W. Glynn
- Department of Epidemiology, School of Public Health, University of Pittsburgh, PA, USA
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Reed NS, Gravens‐Mueller L, Huang AR, Goman AM, Mitchell CM, Arnold ML, Bolton S, Burgard S, Chisolm TH, Couper D, Deal JA, Evans J, Faucette S, Glynn NW, Gmelin T, Hayden KM, Miller E, Minotti M, Mosley T, Naylor S, Pankow JS, Pike JR, Sanchez VA, Schrack JA, Coresh J, Lin FR. Recruitment and baseline data of the Aging and Cognitive Health Evaluation in Elders (ACHIEVE) study: A randomized trial of a hearing loss intervention for reducing cognitive decline. Alzheimers Dement (N Y) 2024; 10:e12453. [PMID: 38356470 PMCID: PMC10865776 DOI: 10.1002/trc2.12453] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 12/29/2023] [Accepted: 01/12/2024] [Indexed: 02/16/2024]
Abstract
INTRODUCTION Hearing loss is highly prevalent among older adults and independently associated with cognitive decline. The Aging and Cognitive Health Evaluation in Elders (ACHIEVE) study is a multicenter randomized control trial (partially nested within the infrastructure of an observational cohort study, the Atherosclerosis Risk in Communities [ARIC] study) to determine the efficacy of best-practice hearing treatment to reduce cognitive decline over 3 years. The goal of this paper is to describe the recruitment process and baseline results. METHODS Multiple strategies were used to recruit community-dwelling 70-84-year-old participants with adult-onset hearing loss who were free of substantial cognitive impairment from the parent ARIC study and de novo from the surrounding communities into the trial. Participants completed telephone screening, an in-person hearing, vision, and cognitive screening, and a comprehensive hearing assessment to determine eligibility. RESULTS Over a 24-month period, 3004 telephone screenings resulted in 2344 in-person hearing, vision, and cognition screenings and 1294 comprehensive hearing screenings. Among 1102 eligible, 977 were randomized into the trial (median age = 76.4 years; 53.5% female; 87.8% White; 53.3% held a Bachelor's degree or higher). Participants recruited through the ARIC study were recruited much earlier and were less likely to report hearing loss interfered with their quality of life relative to participants recruited de novo from the community. Minor differences in baseline hearing or health characteristics were found by recruitment route (i.e., ARIC study or de novo) and by study site. DISCUSSION The ACHIEVE study successfully completed enrollment over 2 years that met originally projected rates of recruitment. Substantial operational and scientific efficiencies during study startup were achieved through embedding this trial within the infrastructure of a longstanding and well-established observational study. Highlights The ACHIEVE study tests the effect of hearing intervention on cognitive decline.The study is partially nested within an existing cohort study.Over 2 years, 977 participants recruited and enrolled.Eligibility assessed by telephone and in-person for hearing, vision, and cognitive screening.The ACHIEVE study findings will have significant public health implications.
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Affiliation(s)
- Nicholas S. Reed
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- Cochlear Center for Hearing and Public HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Lisa Gravens‐Mueller
- Department of BiostatisticsGillings School of Global Public HealthUniversity of North CarolinaChapel HillNorth CarolinaUSA
| | - Alison R. Huang
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- Cochlear Center for Hearing and Public HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Adele M. Goman
- Cochlear Center for Hearing and Public HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- School of Health and Social CareEdinburgh Napier UniversityEdinburghUK
| | - Christine M. Mitchell
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Michelle L. Arnold
- College of Science and MathematicsUniversity of South Florida Sarasota ‐ ManateeSarasotaFloridaUSA
| | - Spencer Bolton
- George W. Comstock Center for Public Health Research and PreventionJohns Hopkins Bloomberg School of Public HealthHagerstownMarylandUSA
| | - Sheila Burgard
- Department of BiostatisticsGillings School of Global Public HealthUniversity of North CarolinaChapel HillNorth CarolinaUSA
| | - Theresa H. Chisolm
- Department of Communication Sciences and DisordersUniversity of South FloridaTampaFloridaUSA
| | - David Couper
- Department of BiostatisticsGillings School of Global Public HealthUniversity of North CarolinaChapel HillNorth CarolinaUSA
| | - Jennifer A. Deal
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- Cochlear Center for Hearing and Public HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Joshua Evans
- Department of Social Sciences and Health PolicyWake Forest University School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Sarah Faucette
- The MIND CenterUniversity of Mississippi Medical CenterJacksonMississippiUSA
| | - Nancy W. Glynn
- Department of EpidemiologyUniversity of Pittsburgh School of Public HealthPittsburghPennsylvaniaUSA
| | - Theresa Gmelin
- Department of EpidemiologyUniversity of Pittsburgh School of Public HealthPittsburghPennsylvaniaUSA
| | - Kathleen M. Hayden
- Department of Social Sciences and Health PolicyWake Forest University School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Elizabeth Miller
- Division of Epidemiology and Community HealthUniversity of Minnesota School of Public HealthMinneapolisMinnesotaUSA
| | - Melissa Minotti
- George W. Comstock Center for Public Health Research and PreventionJohns Hopkins Bloomberg School of Public HealthHagerstownMarylandUSA
| | - Thomas Mosley
- The MIND CenterUniversity of Mississippi Medical CenterJacksonMississippiUSA
| | - Stacee Naylor
- The MIND CenterUniversity of Mississippi Medical CenterJacksonMississippiUSA
| | - James S. Pankow
- Division of Epidemiology and Community HealthUniversity of Minnesota School of Public HealthMinneapolisMinnesotaUSA
| | - James Russell Pike
- Department of BiostatisticsGillings School of Global Public HealthUniversity of North CarolinaChapel HillNorth CarolinaUSA
| | - Victoria A. Sanchez
- Department of Otolaryngology‐Head and Neck SurgeryUniversity of South FloridaTampaFloridaUSA
| | - Jennifer A. Schrack
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Josef Coresh
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Frank R. Lin
- Cochlear Center for Hearing and Public HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
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Lin FR, Pike JR, Albert MS, Arnold M, Burgard S, Chisolm T, Couper D, Deal JA, Goman AM, Glynn NW, Gmelin T, Gravens-Mueller L, Hayden KM, Huang AR, Knopman D, Mitchell CM, Mosley T, Pankow JS, Reed NS, Sanchez V, Schrack JA, Windham BG, Coresh J. Hearing intervention versus health education control to reduce cognitive decline in older adults with hearing loss in the USA (ACHIEVE): a multicentre, randomised controlled trial. Lancet 2023; 402:786-797. [PMID: 37478886 PMCID: PMC10529382 DOI: 10.1016/s0140-6736(23)01406-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 41.0] [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] [Received: 06/17/2023] [Revised: 06/26/2023] [Accepted: 07/03/2023] [Indexed: 07/23/2023]
Abstract
BACKGROUND Hearing loss is associated with increased cognitive decline and incident dementia in older adults. We aimed to investigate whether a hearing intervention could reduce cognitive decline in cognitively healthy older adults with hearing loss. METHODS The ACHIEVE study is a multicentre, parallel-group, unmasked, randomised controlled trial of adults aged 70-84 years with untreated hearing loss and without substantial cognitive impairment that took place at four community study sites across the USA. Participants were recruited from two study populations at each site: (1) older adults participating in a long-standing observational study of cardiovascular health (Atherosclerosis Risk in Communities [ARIC] study), and (2) healthy de novo community volunteers. Participants were randomly assigned (1:1) to a hearing intervention (audiological counselling and provision of hearing aids) or a control intervention of health education (individual sessions with a health educator covering topics on chronic disease prevention) and followed up every 6 months. The primary endpoint was 3-year change in a global cognition standardised factor score from a comprehensive neurocognitive battery. Analysis was by intention to treat. This trial was registered at ClinicalTrials.gov, NCT03243422. FINDINGS From Nov 9, 2017, to Oct 25, 2019, we screened 3004 participants for eligibility and randomly assigned 977 (32·5%; 238 [24%] from ARIC and 739 [76%] de novo). We randomly assigned 490 (50%) to the hearing intervention and 487 (50%) to the health education control. The cohort had a mean age of 76·8 years (SD 4·0), 523 (54%) were female, 454 (46%) were male, and most were White (n=858 [88%]). Participants from ARIC were older, had more risk factors for cognitive decline, and had lower baseline cognitive scores than those in the de novo cohort. In the primary analysis combining the ARIC and de novo cohorts, 3-year cognitive change (in SD units) was not significantly different between the hearing intervention and health education control groups (-0·200 [95% CI -0·256 to -0·144] in the hearing intervention group and -0·202 [-0·258 to -0·145] in the control group; difference 0·002 [-0·077 to 0·081]; p=0·96). However, a prespecified sensitivity analysis showed a significant difference in the effect of the hearing intervention on 3-year cognitive change between the ARIC and de novo cohorts (pinteraction=0·010). Other prespecified sensitivity analyses that varied analytical parameters used in the total cohort did not change the observed results. No significant adverse events attributed to the study were reported with either the hearing intervention or health education control. INTERPRETATION The hearing intervention did not reduce 3-year cognitive decline in the primary analysis of the total cohort. However, a prespecified sensitivity analysis showed that the effect differed between the two study populations that comprised the cohort. These findings suggest that a hearing intervention might reduce cognitive change over 3 years in populations of older adults at increased risk for cognitive decline but not in populations at decreased risk for cognitive decline. FUNDING US National Institutes of Health.
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Affiliation(s)
- Frank R Lin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA; Center on Aging and Health, Johns Hopkins University, Baltimore, MD, USA.
| | - James R Pike
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Marilyn S Albert
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Michelle Arnold
- Department of Communication Sciences & Disorders, College of Behavioral & Community Sciences, University of South Florida, Tampa, FL, USA
| | - Sheila Burgard
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Theresa Chisolm
- Department of Communication Sciences & Disorders, College of Behavioral & Community Sciences, University of South Florida, Tampa, FL, USA
| | - David Couper
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Jennifer A Deal
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Adele M Goman
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Nancy W Glynn
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, PA, USA
| | - Theresa Gmelin
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, PA, USA
| | - Lisa Gravens-Mueller
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Kathleen M Hayden
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Alison R Huang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - David Knopman
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Christine M Mitchell
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Thomas Mosley
- The MIND Center, University of Mississippi Medical Center, Jackson, MS, USA
| | - James S Pankow
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Nicholas S Reed
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Victoria Sanchez
- Department of Otolaryngology-Head & Neck Surgery, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Jennifer A Schrack
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Center on Aging and Health, Johns Hopkins University, Baltimore, MD, USA
| | - B Gwen Windham
- The MIND Center, University of Mississippi Medical Center, Jackson, MS, USA
| | - Josef Coresh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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7
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Alexandre W, Muhammad H, Agbalajobi O, Zhang G, Gmelin T, Adejumo A, Noll A, Jonassaint NL, DiMartini A, Bataller R, Rogal SS. Alcohol treatment discussions and clinical outcomes among patients with alcohol-related cirrhosis. BMC Gastroenterol 2023; 23:29. [PMID: 36732709 PMCID: PMC9896743 DOI: 10.1186/s12876-023-02656-z] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 01/17/2023] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Alcohol cessation is the cornerstone of treatment for alcohol-related cirrhosis. This study evaluated associations between medical conversations about alcohol use disorder (AUD) treatment, AUD treatment engagement, and mortality. METHODS This retrospective cohort study included all patients with ICD-10 diagnosis codes for cirrhosis and AUD who were engaged in hepatology care in a single healthcare system in 2015. Baseline demographic, medical, liver disease, and AUD treatment data were assessed. AUD treatment discussions and initiation, alcohol cessation, and subsequent 5-year mortality were collected. Multivariable models were used to assess the factors associated with subsequent AUD treatment and 5-year mortality. RESULTS Among 436 patients with cirrhosis due to alcohol, 65 patients (15%) received AUD treatment at baseline, including 48 (11%) receiving behavioral therapy alone, 11 (2%) receiving pharmacotherapy alone, and 6 (1%) receiving both. Over the first year after a baseline hepatology visit, 37 patients engaged in AUD treatment, 51 were retained in treatment, and 14 stopped treatment. Thirty percent of patients had hepatology-documented AUD treatment recommendations and 26% had primary care-documented AUD treatment recommendations. Most hepatology (86%) and primary care (88%) recommendations discussed behavioral therapy alone. Among patients with ongoing alcohol use at baseline, AUD treatment one year later was significantly, independently associated with AUD treatment discussions with hepatology (adjusted odds ratio (aOR): 3.23, 95% confidence interval (CI): 1.58, 6.89) or primary care (aOR: 2.95; 95% CI: 1.44, 6.15) and negatively associated with having Medicaid insurance (aOR: 0.43, 95% CI: 0.18, 0.93). When treatment was discussed in both settings, high rates of treatment ensued (aOR: 10.72, 95% CI: 3.89, 33.52). Over a 5-year follow-up period, 152 (35%) patients died. Ongoing alcohol use, age, hepatic decompensation, and hepatocellular carcinoma were significantly associated with mortality in the final survival model. CONCLUSION AUD treatment discussions were documented in less than half of hepatology and primary care encounters in patients with alcohol-related cirrhosis, though such discussions were significantly associated with receipt of AUD treatment.
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Affiliation(s)
- Wheytnie Alexandre
- grid.21925.3d0000 0004 1936 9000School of Medicine, University of Pittsburgh, Pittsburgh, PA USA
| | - Haseeb Muhammad
- grid.38142.3c000000041936754XHarvard Medical School, Boston, MA USA
| | - Olufunso Agbalajobi
- grid.21925.3d0000 0004 1936 9000Department of Medicine, University of Pittsburgh, Pittsburgh, PA USA
| | - Grace Zhang
- grid.21925.3d0000 0004 1936 9000School of Medicine, University of Pittsburgh, Pittsburgh, PA USA
| | - Theresa Gmelin
- grid.21925.3d0000 0004 1936 9000School of Public Health, University of Pittsburgh, Pittsburgh, PA USA
| | - Adeyinka Adejumo
- grid.21925.3d0000 0004 1936 9000Department of Medicine, University of Pittsburgh, Pittsburgh, PA USA
| | - Alan Noll
- grid.21925.3d0000 0004 1936 9000Department of Medicine, University of Pittsburgh, Pittsburgh, PA USA
| | - Naudia L. Jonassaint
- grid.21925.3d0000 0004 1936 9000Department of Medicine, University of Pittsburgh, Pittsburgh, PA USA ,grid.21925.3d0000 0004 1936 9000Department of Surgery, University of Pittsburgh, Pittsburgh, PA USA
| | - Andrea DiMartini
- grid.21925.3d0000 0004 1936 9000Department of Surgery, University of Pittsburgh, Pittsburgh, PA USA ,grid.21925.3d0000 0004 1936 9000Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA USA
| | - Ramon Bataller
- grid.21925.3d0000 0004 1936 9000Department of Medicine, University of Pittsburgh, Pittsburgh, PA USA
| | - Shari S. Rogal
- grid.21925.3d0000 0004 1936 9000Department of Medicine, University of Pittsburgh, Pittsburgh, PA USA ,grid.21925.3d0000 0004 1936 9000Department of Surgery, University of Pittsburgh, Pittsburgh, PA USA ,grid.413935.90000 0004 0420 3665Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA USA
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8
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Schumacher B, Kehler D, Kulminski A, Andersen S, Gmelin T, Christensen K, Wojczynski M, Glynn N. THE ASSOCIATION BETWEEN FRAILTY AND PERCEIVED FATIGABILITY IN THE LONG LIFE FAMILY STUDY. Innov Aging 2022. [DOI: 10.1093/geroni/igac059.3089] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Abstract
Higher levels of frailty, quantified by a frailty index (FI), may be linked to fatigue severity as tasks become more physically and mentally demanding. However, the association between frailty and fatigability—quantification of vulnerability to fatigue in relation to specific intensity and duration of activities—has not been assessed. Using cross-sectional data from the Long Life Family Study Visit 2 (2014–2017; n=2,524; mean age +/- standard deviation 71.4+/-11.2 years; 55% women; 99% White), we examined the association between a 79-item FI (ratio of number of health problems reported (numerator) out of the 79 (denominator); higher percentage=greater frailty) and perceived physical and mental fatigability using the Pittsburgh Fatigability Scale (PFS) (range 0–50; higher scores=greater fatigability). Mean+/-SD FI scores were 0.08+/-0.06 and mean+/-SD PFS Physical and Mental scores were 13.7+/-9.6 (39.5% more severe, >=15) and 7.9+/-8.9 (22.8% more severe, >=13), respectively. Both PFS subscale scores were higher for each 0.10 increment in FI. Mean PFS scores were 10.7 and 34.2 (Physical) and 5.7 and 28.8 (Mental) for FI scores of < 0.10 (non-frail) and ≥0.30 (moderate-severely frail), respectively. In mixed effects models, a 0.03 higher FI score (accepted clinically meaningful increase in FI) was associated with 1.9-point higher PFS Physical (95% confidence interval (CI) 1.7–2.1) and 1.7-point higher PFS Mental (95% CI 1.5–1.9) scores after accounting for family structure and adjusting for age, sex, field center, body mass index, smoking status, education, and marital status. Individuals with higher FI scores may benefit from targeted interventions to mitigate further poor health outcomes.
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Affiliation(s)
| | - Dustin Kehler
- Dalhousie University , Halifax, Nova Scotia , Canada
| | | | - Stacy Andersen
- Boston University School of Medicine , Boston, Massachusetts , United States
| | - Theresa Gmelin
- University of Pittsburgh , Pittsburgh, Pennsylvania , United States
| | | | - Mary Wojczynski
- Washington University , Saint Louis, Missouri , United States
| | - Nancy Glynn
- School of Public Health, University of Pittsburgh , Pittsburgh, Pennsylvania , United States
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9
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Moored KD, Rosso AL, Gmelin T, Qiao Y(S, Carlson MC, Cawthon PM, Cauley JA, Glynn NW. Life-space Mobility in Older Men: The Role of Perceived Physical and Mental Fatigability. J Gerontol A Biol Sci Med Sci 2022; 77:2329-2335. [PMID: 34718553 PMCID: PMC9678195 DOI: 10.1093/gerona/glab286] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Physical performance and fatigue can limit mobility within the larger environment (life-space mobility). It is unknown whether perceived fatigability, self-reported fatigue anchored to activity intensity and duration, is independently associated with life-space. METHODS We assessed this cross-sectionally in Visit 4 (2014-2016) of the Osteoporotic Fractures in Men Study (MrOS; N = 1 672, Age: Mean = 84.2 ± 4.0 years). The Pittsburgh Fatigability Scale (PFS, range: 0-50; higher = greater fatigability) measured physical (Mean = 16.1 ± 9.4) and mental fatigability (Mean = 7.5 ± 7.9). Life Space Assessment scores incorporated level, frequency, and assistance used for life-space mobility (range: 0-120, higher = greater life-space mobility; life-space constriction: inability to leave neighborhood without assistance). Separate multiple linear and logistic regressions for physical and mental fatigability were sequentially adjusted for demographic, health/lifestyle, and performance measures. RESULTS The mean life-space mobility score was 84.6 ± 21.8, and 18% (n = 296) of men had life-space constriction. Higher physical and mental fatigability were both associated with lower life-space mobility in models adjusted for health and lifestyle factors (Physical PFS: B = -2.37, 95% confidence interval [CI]: [-3.39, -1.35]; Mental PFS: B = -1.79, 95% CI: [-2.73, -0.84]). Men with higher fatigability also had increased risk of life-space constriction (Physical PFS: OR = 1.59, 95% CI: [1.32, 1.92]; Mental PFS: OR = 1.25, 95% CI: [1.08, 1.46]). Associations were larger in magnitude for physical versus mental fatigability. Adjusting for physical performance measures more strongly attenuated associations for physical compared to mental fatigability. CONCLUSIONS Fatigability is linked with real-world mobility in older men, independent of their physical health. This association may be driven by separate physical and cognitive mechanisms worth examining further in longitudinal studies.
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Affiliation(s)
- Kyle D Moored
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pennsylvania, USA
| | - Andrea L Rosso
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pennsylvania, USA
| | - Theresa Gmelin
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pennsylvania, USA
| | - Yujia (Susanna) Qiao
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pennsylvania, USA
| | - Michelle C Carlson
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Peggy M Cawthon
- California Pacific Medical Center, San Francisco, USA
- Department of Epidemiology and Biostatistics, University of California San Francisco, USA
| | - Jane A Cauley
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pennsylvania, USA
| | - Nancy W Glynn
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pennsylvania, USA
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10
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Allen HL, Gmelin T, Moored KD, Boudreau RM, Smagula SF, Cohen RW, Katz R, Stone K, Cauley JA, Glynn NW. Relationship Between Personality Measures and Perceived Mental Fatigability. J Aging Health 2022; 34:750-760. [PMID: 34821521 PMCID: PMC9130341 DOI: 10.1177/08982643211055032] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Examine the association between personality measures and perceived mental fatigability. METHODS We performed a cross-sectional analysis in N=1670 men, age 84.3±4.1 years. Multivariable linear regression models were used to examine the covariate adjusted association between personality measures (conscientiousness, optimism, goal reengagement, and goal disengagement) and perceived mental fatigability (measured with the validated 10-item Pittsburgh Fatigability Scale, PFS). RESULTS One standard deviation lower conscientiousness (β=-0.91, p<.0001) and optimism (β=-0.63, p<.0001), and higher goal reengagement (β=0.51, p=.01) scores were independently associated with higher PFS Mental scores adjusted for age, cognitive function, self-reported health status, depressive symptoms, sleep disturbance, physical activity, and goal disengagement. DISCUSSION Lower conscientiousness, optimism, and higher goal reengagement were linked with more severe perceived mental fatigability in older men. Personality traits may potentially contribute to early risk assessment for fatigability in later life. Future work should be longitudinal in nature and include personality assessments to confirm the temporality of the relationships observed.
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Affiliation(s)
- Hannah L. Allen
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - Theresa Gmelin
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - Kyle D. Moored
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - Robert M. Boudreau
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - Stephen F. Smagula
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Rebecca W. Cohen
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - Rain Katz
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - Katie Stone
- California Pacific Medical Center Research Institute, San Francisco, CA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA
| | - Jane A. Cauley
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - Nancy W. Glynn
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
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11
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Lin C, Glynn NW, Gmelin T, Wei YC, Chen YL, Huang CM, Shyu YC, Chen CK. Validation of the Traditional Chinese Version of the Pittsburgh Fatigability Scale for Older Adults. Clin Gerontol 2022; 45:606-618. [PMID: 33934690 PMCID: PMC10155380 DOI: 10.1080/07317115.2021.1914258] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES The Pittsburgh Fatigability Scale (PFS) is a self-administered 10-item tool to measure physical and mental fatigability in older adults. The aim of the current study was to validate the psychometric properties of the traditional Chinese version of PFS (TC-PFS). METHODS We recruited 114 community-dwellingolder adults, where 35 were diagnosed with late-life depression (LLD), 26 with mild cognitive impairment (MCI), and 53 were cognitively normal (CN) from a larger community study of older adults. Statistical analyses were done separately for TC-PFS Physical and Mental subscales. Factor analysis was used for reliability, Cronbach's alpha for internal consistency, Pearson's correlation for construct validity, and group comparison for discriminative validity. RESULTS Factor analysis revealed a two-factor structure for both the TC-PFS Physical and Mental subscales with high reliability (α = 0.89 and 0.89, respectively). Patients with LLD had the highest PFS scores, with 80.0% and 82.9% classified as having greater physical and mental fatigability. For concurrent validity, we found moderate associations with the vitality and physical functioning subscales of the 36-Item Short Form Health Survey. For convergent validity, TC-PFS showed moderate association with emotional-related psychometrics, particularly for the Physical subscale in those with LLD. In contrast, TC-PFS Mental subscale showed correlations with cognitive function, particularly in the MCI group. CONCLUSIONS Our results indicate that the TC-PFS is a valid instrument to measure perceived physical and mental fatigability in older Taiwanese adults.Clinical implications: Perceived fatigability reflects the underlying physical, mental or cognitive function in older adults with or without depression.
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Affiliation(s)
- Chemin Lin
- Department of Psychiatry, Keelung Chang Gung Memorial Hospital, Keelung City, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Nancy W Glynn
- Center for Aging and Population Health, Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Theresa Gmelin
- Center for Aging and Population Health, Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Yi-Chia Wei
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung, Taiwan.,Department of Neurology, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan.,Institute of Neuroscience, National Yang-Ming University, Taipei, Taiwan
| | - Yao-Liang Chen
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Chih-Mao Huang
- Department of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan
| | - Yu-Chiau Shyu
- Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Chih-Ken Chen
- Department of Psychiatry, Keelung Chang Gung Memorial Hospital, Keelung City, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung, Taiwan
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12
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Renner SW, Qiao Y(S, Gmelin T, Santanasto AJ, Boudreau RM, Walston JD, Perls TT, Christensen K, Newman AB, Glynn NW. Association of fatigue, inflammation, and physical activity on gait speed: the Long Life Family Study. Aging Clin Exp Res 2022; 34:367-374. [PMID: 34196949 PMCID: PMC8864668 DOI: 10.1007/s40520-021-01923-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [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: 01/24/2020] [Accepted: 06/20/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Fatigue, inflammation, and physical activity (PA) are all independently associated with gait speed, but their directionality is not fully elucidated. AIMS Evaluate the bidirectional associations amongst fatigue, inflammation, and PA on gait speed. METHODS This cross sectional study included probands (n = 1280, aged 49-105) and offspring (n = 2772, aged 24-88) in the Long Life Family Study. We assessed gait speed, fatigue with the question "I could not get going", inflammation using fasting interleukin-6 (IL-6) and high sensitivity C-reactive protein (CRP), and self-reported PA as walking frequency in the past two weeks. The two generations were examined separately using linear mixed modeling. RESULTS Lower fatigue, lower IL-6, and greater PA were all associated with faster gait speed in both generations (all p < 0.05); lower CRP was only associated with faster gait speed in the offspring. PA explained the association of fatigue and gait speed via a 16.1% (95% CI 9.7%, 26.7%) attenuation of the direct associations for the probands and 9.9% (95% CI 6.3%, 18.8%) in the offspring. In addition, IL-6 explained more of the association of fatigue and gait speed than the association between PA and gait speed, via a 14.9% (95% CI 9.2%, 23.4%) attenuation of the direct association in the offspring only. DISCUSSION Results revealed a potential directionality from fatigue to IL-6 to PA that may lead to faster gait speed. Future work should examine these relationships longitudinally to establish temporality and causality. CONCLUSIONS Our findings support a signal that lowering fatigue and inflammation and increasing physical activity may delay functional decline.
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Affiliation(s)
- Sharon W. Renner
- University of Pittsburgh, Graduate School of Public Health, Department of Epidemiology, Pittsburgh, Pennsylvania
| | - Yujia (Susanna) Qiao
- University of Pittsburgh, Graduate School of Public Health, Department of Epidemiology, Pittsburgh, Pennsylvania
| | - Theresa Gmelin
- University of Pittsburgh, Graduate School of Public Health, Department of Epidemiology, Pittsburgh, Pennsylvania
| | - Adam J. Santanasto
- University of Pittsburgh, Graduate School of Public Health, Department of Epidemiology, Pittsburgh, Pennsylvania
| | - Robert M. Boudreau
- University of Pittsburgh, Graduate School of Public Health, Department of Epidemiology, Pittsburgh, Pennsylvania
| | - Jeremy D. Walston
- Johns Hopkins School of Medicine, Division of Geriatrics and Gerontology, Baltimore, Maryland
| | - Thomas T. Perls
- Boston University School of Medicine, Department of Medicine, Geriatrics Section, Boston, Massachusetts
| | - Kaare Christensen
- University of Southern Denmark, Department of Public Health, Unit of Epidemiology, Biostatistics and Biodemography, Odense, Denmark
| | - Anne B. Newman
- University of Pittsburgh, Graduate School of Public Health, Department of Epidemiology, Pittsburgh, Pennsylvania
| | - Nancy W. Glynn
- University of Pittsburgh, Graduate School of Public Health, Department of Epidemiology, Pittsburgh, Pennsylvania
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13
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Agbalajobi OM, Gmelin T, Moon AM, Alexandre W, Zhang G, Gellad WF, Jonassaint N, Rogal SS. Characteristics of opioid prescribing to outpatients with chronic liver diseases: A call for action. PLoS One 2021; 16:e0261377. [PMID: 34919585 PMCID: PMC8682904 DOI: 10.1371/journal.pone.0261377] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 11/29/2021] [Indexed: 12/15/2022] Open
Abstract
Background Chronic liver disease (CLD) is among the strongest risk factors for adverse prescription opioid-related events. Yet, the current prevalence and factors associated with high-risk opioid prescribing in patients with chronic liver disease (CLD) remain unclear, making it challenging to address opioid safety in this population. Therefore, we aimed to characterize opioid prescribing patterns among patients with CLD. Methods This retrospective cohort study included patients with CLD identified at a single medical center and followed for one year from 10/1/2015-9/30/2016. Multivariable, multinomial regression was used identify the patient characteristics, including demographics, medical conditions, and liver-related factors, that were associated with opioid prescriptions and high-risk prescriptions (≥90mg morphine equivalents per day [MME/day] or co-prescribed with benzodiazepines). Results Nearly half (47%) of 12,425 patients with CLD were prescribed opioids over a one-year period, with 17% of these receiving high-risk prescriptions. The baseline factors significantly associated with high-risk opioid prescriptions included female gender (adjusted incident rate ratio, AIRR = 1.32, 95% CI = 1.14–1.53), Medicaid insurance (AIRR = 1.68, 95% CI = 1.36–2.06), cirrhosis (AIRR = 1.22, 95% CI = 1.04–1.43) and baseline chronic pain (AIRR = 3.40, 95% CI = 2.94–4.01), depression (AIRR = 1.93, 95% CI = 1.60–2.32), anxiety (AIRR = 1.84, 95% CI = 1.53–2.22), substance use disorder (AIRR = 2.16, 95% CI = 1.67–2.79), and Charlson comorbidity score (AIRR = 1.27, 95% CI = 1.22–1.32). Non-alcoholic fatty liver disease was associated with decreased high-risk opioid prescriptions (AIRR = 0.56, 95% CI = 0.47–0.66). Conclusion Opioid medications continue to be prescribed to nearly half of patients with CLD, despite efforts to curtail opioid prescribing due to known adverse events in this population.
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Affiliation(s)
- Olufunso M. Agbalajobi
- Department of General Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, United States of America
| | - Theresa Gmelin
- Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Andrew M. Moon
- Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Wheytnie Alexandre
- University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America
| | - Grace Zhang
- University of Pittsburgh School of Medicine, Pittsburgh, PA, United States of America
| | - Walid F. Gellad
- Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, United States of America
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, University Drive, Pittsburgh, PA, United States of America
| | - Naudia Jonassaint
- Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Shari S. Rogal
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, University Drive, Pittsburgh, PA, United States of America
- Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh, Pittsburgh, PA, United States of America
- * E-mail: ,
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14
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Katz R, Cohen R, Gmelin T, Moored K, Qiao Y(S, Slavin M, Glynn NW. Energy and Exhaustion May Explain Different Subdomains of Perceived Fatigability. Innov Aging 2021. [PMCID: PMC8970419 DOI: 10.1093/geroni/igab046.1432] [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: 11/14/2022] Open
Abstract
Fatigability is a more sensitive measure of one’s perception of fatigue. To identify an appropriate fatigue question when a fatigability measure is unavailable, we examined associations between widely used global fatigue questions and perceived physical and mental fatigability. Participants (N=896, age=74.7±6.6, 58.1% women) from two aging research registries completed the valid Pittsburgh Fatigability Scale (PFS, 0-50) and five global fatigue questions: energy level (0-10), running out of energy (0-5), feeling energetic (0-6), feeling tired (0-6), and feeling exhausted (0-6) over past four weeks. All fatigue measures were correlated (p<0.0001) with physical (|r| range=0.48-0.57) and mental fatigability (|r| range=0.31-0.39). “Energy level” and “feeling exhausted” had strongest associations with physical and mental fatigability, respectively, in age, sex, BMI-adjusted regression models (p’s<0.001), suggesting older adults can distinguish between physical and mental domains. Future work will explore how these constructs are distinct but related, and confirm the optimal proxy for the two fatigability subdomains.
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Affiliation(s)
- Rain Katz
- University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, United States
| | - Rebecca Cohen
- University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, United States
| | - Theresa Gmelin
- University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, United States
| | - Kyle Moored
- University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | | | - Maggie Slavin
- University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, United States
| | - Nancy W Glynn
- University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, United States
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15
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Moored K, Rosso A, Gmelin T, Qiao Y(S, Carlson M, Cawthon P, Cauley J, Glynn NW. Associations Between Perceived Physical and Mental Fatigability and Life Space Mobility in Older Men: The MrOS Study. Innov Aging 2021. [PMCID: PMC8970121 DOI: 10.1093/geroni/igab046.2161] [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: 11/12/2022] Open
Abstract
Abstract
Physical performance and fatigue can limit mobility within the larger environment (life-space mobility). It is unknown whether perceived fatigability, fatigue anchored to activity intensity and duration, is independently associated with life-space. We assessed this cross-sectionally in the Osteoporotic Fractures in Men Study (MrOS; N=1,681, Meanage=85±4.1). The Pittsburgh Fatigability Scale (PFS, range: 0-50) measured physical (Mean=16.2±9.5) and mental fatigability (Mean=7.5±8.0). Life Space Assessment scores (range: 0-120, higher=greater life-space) incorporated level, frequency, and assistance used for life-space mobility (Mean=84.3±22.0). Compared to the lowest fatigability strata (Physical: PFS 0-4; Mental: PFS 0-3, modeled separately), men in the two highest physical strata (PFS 20-24: B=-4.10±1.67; PFS≥25: B=-6.23±1.72; p’s≤.05) and men in the three highest mental strata reported significantly lower life-space mobility (PFS 13-15: B=-3.42±1.74; PFS 16-19: B=-5.38±1.83; PFS≥20: B=-7.96±1.66, p’s≤.05), adjusted for physical performance and health covariates. Our results provide evidence linking fatigability and real-world mobility, independent of physical health, in older men.
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Affiliation(s)
- Kyle Moored
- University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Andrea Rosso
- University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Theresa Gmelin
- University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, United States
| | | | | | - Peggy Cawthon
- California Pacific Medical Center, San Francisco, California, United States
| | - Jane Cauley
- University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Nancy W Glynn
- University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, United States
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16
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Gmelin T, Moored K, Lin F, Golub J, Wojczynski M, Boudreau R, Galvin A, Glynn NW. Worse Self-Reported Hearing Ability Is Associated With Greater Perceived Physical and Mental Fatigability. Innov Aging 2021. [PMCID: PMC8681938 DOI: 10.1093/geroni/igab046.595] [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: 11/14/2022] Open
Abstract
Abstract
Older adults with hearing loss often report higher fatigue due to effortful listening. We evaluated whether self-reported hearing ability is associated with perceived physical and mental fatigability (a more sensitive measure than fatigue) using the Pittsburgh Fatigability Scale (PFS). Older adults (N=2,558) from the Long Life Family Study Visit 2 (71.5±11.4 years; 54.8% women) completed PFS and self-reported hearing ability (worse=[fair,poor,very poor,deaf] or better=[good, excellent]). Age-adjusted PFS Physical and Mental scores were 2.3 and 2.5 lower, respectively, for worse vs. better hearing (p<.0001). Generalized estimating equations adjusted for family-relatedness, site, age, sex, cognitive function (Mini-Mental State Examination), education, and self-reported health. Compared to individuals with better hearing, those with worse hearing had a 42% and 44% greater odds of physical (≥15) (CI:1.12-1.80,p=0.0042) and mental(≥13) (CI:1.13-1.84,p=0.0034) fatigability, respectively. These observed associations may potentially be explained via complex psychosocial and cognitive aging pathways (e.g. effortful listening) to be examined in future work.
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Affiliation(s)
- Theresa Gmelin
- University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, United States
| | - Kyle Moored
- University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Frank Lin
- Johns Hopkins University, Johns Hopkins University, Maryland, United States
| | - Justin Golub
- Columbia University, New York, New York, United States
| | - Mary Wojczynski
- Washington University School of Medicine, Washington University School of Medicine, Missouri, United States
| | - Robert Boudreau
- University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Angeline Galvin
- University of Southern Denmark, Odense, Hovedstaden, Denmark
| | - Nancy W Glynn
- University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, United States
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17
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Glynn NW, Gmelin T, Renner SW, QiaoScM YS, Boudreau RM, Feitosa MF, Wojczynski MK, Cosentino S, Andersen SL, Christensen K, Newman AB. Perceived Physical Fatigability Predicts All-Cause Mortality in Older Adults. J Gerontol A Biol Sci Med Sci 2021; 77:837-841. [PMID: 34908118 PMCID: PMC8974332 DOI: 10.1093/gerona/glab374] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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] [Received: 09/17/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Perceived physical fatigability is highly prevalent in older adults and associated with mobility decline and other health consequences. We examined the prognostic value of perceived physical fatigability as an independent predictor of risk of death among older adults. METHODS Participants (N = 2,906), mean age 73.5 [SD, 10.4] years, 54.2% women, 99.7% white enrolled in the Long Life Family Study were assessed at Visit 2 (2014-2017) with 2.7 [SD, 1.0] years follow-up. The Pittsburgh Fatigability Scale (PFS), a 10-item, self-administered validated questionnaire (score range 0-50, higher=greater fatigability) measured perceived physical fatigability at Visit 2. Deaths post-Visit 2 through December 31, 2019 were identified by: family members notifying field centers, reporting during another family member's annual phone follow-up, an obituary, or Civil Registration System (Denmark). We censored all other participants at their last contact. Cox proportional hazard models predicted mortality by fatigability severity, adjusted for family relatedness and other covariates. RESULTS Age-adjusted PFS Physical scores were higher for those who died (19.1 [SE, 0.8]) compared to alive (12.2, [SE, 0.4]) overall, as well as across age strata (P<.001), except for those 60-69 years (P=.79). Participants with the most severe fatigability (PFS Physical scores ≥25) were over twice as likely to die (HR, 2.33 [95% CI, 1.65 to 3.28]) compared to those with less severe fatigability (PFS Physical scores <25) after adjustment. CONCLUSIONS This work underscores the utility of the PFS as a novel patient-reported prognostic indicator of phenotypic aging that captures both overt and underlying disease burden that predicts death.
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Affiliation(s)
- Nancy W Glynn
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Theresa Gmelin
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Sharon W Renner
- Department of Kinesiology and Health Sciences, Columbus State University, Columbus, GA, USA
| | - Yujia Susanna QiaoScM
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Robert M Boudreau
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Mary F Feitosa
- Department of Genetics, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Mary K Wojczynski
- Department of Genetics, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Stephanie Cosentino
- Department of Neurology, Columbia University Medical Center, New York, NY, USA
| | - Stacy L Andersen
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Kaare Christensen
- Unit of Epidemiology, Biostatistics, and Biodemography, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Anne B Newman
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
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18
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Ehrenkranz R, Rosso AL, Sprague BN, Tian Q, Gmelin T, Bohnen N, Simonsick EM, Glynn NW, Rosano C. Functional correlates of self-reported energy levels in the Health, Aging and Body Composition Study. Aging Clin Exp Res 2021; 33:2787-2795. [PMID: 33751489 PMCID: PMC8531104 DOI: 10.1007/s40520-021-01788-0] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 01/06/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Effects of fatigue on health in older age are well studied, yet little is known about the clinical relevance of energy perception. AIMS To explore cross-sectional associations of self-reported energy with physical and mental health metrics in the Health, Aging, and Body Composition Study. METHODS Participants rated their energy from 0 to 10; the outcome was energy dichotomized at the median (≥ 7 = higher energy). Four domains were assessed: depressive symptoms (Center for Epidemiologic Studies Depression Scale); physical performance (function: usual and rapid gait speed; fitness: 400-m walk time); physical activity (casual walking, walking for exercise, and intense exercise); and cognitive function (Modified Mini-Mental State Examination and Digit Symbol Substitution Test). Covariates bivariately associated with energy entered a multivariable logistic regression model, adjusted for demographics, chronic conditions, and strength. RESULTS Depressive symptoms, physical performance and activity, but not cognition, were bivariately associated with energy (p < 0.0005). Younger age, male sex, greater strength, and absence of chronic conditions predicted higher energy (p < 0.001). In a multivariable model, depressive symptoms [adjusted odds ratio (aOR) 95% CI 0.69 (0.62, 0.76)] and 400-m walk times [aOR = 0.81 (0.72, 0.91)] were inversely associated with energy; usual and rapid gait speed [aOR = 1.3 (1.2, 1.4); aOR = 1.2 (1.1-1.4)], and time spent in intense exercise [aOR = 1.4 (1.1-1.7)] were positively associated with energy. DISCUSSION In this cohort with a range of chronic conditions and fatigue, perceiving higher energy levels may reflect better emotional and physical health. CONCLUSION Energy should be considered in multidimensional clinical assessments of older age.
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Affiliation(s)
- Rebecca Ehrenkranz
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Andrea L Rosso
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Briana N Sprague
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Qu Tian
- Intramural Research Program, National Institute on Aging, Baltimore, MD, USA
| | - Theresa Gmelin
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Nicolaas Bohnen
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
| | - Eleanor M Simonsick
- Intramural Research Program, National Institute on Aging, Baltimore, MD, USA
| | - Nancy W Glynn
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Caterina Rosano
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
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19
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Qiao Y(S, Gmelin T, Renner SW, Boudreau RM, Martin S, Wojczynski MK, Christensen K, Andersen SL, Cosentino S, Santanasto AJ, Glynn NW. Evaluation of the Bidirectional Relations of Perceived Physical Fatigability and Physical Activity on Slower Gait Speed. J Gerontol A Biol Sci Med Sci 2021; 76:e237-e244. [PMID: 33170216 PMCID: PMC8436994 DOI: 10.1093/gerona/glaa281] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 07/10/2020] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Lower physical activity levels and greater fatigability contribute independently to slower gait speed in older adults. To fully understand the bidirectional relations between physical activity and fatigability, and to inform potential intervention strategies, we examined whether physical activity or fatigability explains more of the other factor's association on slower gait speed. METHODS Two generations (probands and offspring) of older adults (N = 2079, mean age 73.0 ± 10.0 years, 54.2% women, 99.7% White) enrolled in the Long Life Family Study were assessed at Visit 2 (2014-2017). Self-reported physical activity was measured with the Framingham Physical Activity Index and perceived physical fatigability using the Pittsburgh Fatigability Scale. Statistical mediation analyses were conducted separately by generation with linear mixed-effect models accounting for family relatedness and adjusted for demographics, health conditions, and field center. RESULTS Greater perceived physical fatigability explained the association of lower physical activity on slower gait speed via a 22.5% attenuation of the direct association (95% confidence interval [CI]: 15.0%-35.2%) for the probands and 39.5% (95% CI: 22.8%-62.6%) for the offspring. Whereas lower physical activity explained the association of greater perceived fatigability on slower gait speed via a 22.5% attenuation of the direct association (95% CI: 13.4%-32.8%) for the probands and 6.7% (95% CI: 3.8%-15.4%) for the offspring. CONCLUSIONS Our findings suggest that the impact of greater perceived physical fatigability on the association between lower physical activity and slower gait speed differs between younger-old and middle-to-oldest-old adults, indicating perceived physical fatigability as a potential mediator in the disablement pathway.
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Affiliation(s)
| | - Theresa Gmelin
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Sharon W Renner
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Robert M Boudreau
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Sarah Martin
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Mary K Wojczynski
- Department of Genetics, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Kaare Christensen
- Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Stacy L Andersen
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Stephanie Cosentino
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University Medical Center, New York, New York
| | - Adam J Santanasto
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Nancy W Glynn
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
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20
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Renner SW, Bear TM, Brown PJ, Andersen SL, Cosentino S, Gmelin T, Boudreau RM, Cauley JA, Qiao Y(S, Simonsick EM, Glynn NW. Validation of Perceived Mental Fatigability Using the Pittsburgh Fatigability Scale. J Am Geriatr Soc 2021; 69:1343-1348. [PMID: 33469914 PMCID: PMC8127403 DOI: 10.1111/jgs.17017] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [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: 08/06/2020] [Revised: 11/30/2020] [Accepted: 12/13/2020] [Indexed: 01/26/2023]
Abstract
OBJECTIVES Establish reliability, concurrent and convergent validity of the Pittsburgh Fatigability Scale (PFS) Mental subscale. DESIGN Cross-sectional. SETTING Older adults from two University of Pittsburgh registries, Baltimore Longitudinal Study of Aging (BLSA), and Long Life Family Study (LLFS). PARTICIPANTS PFS Mental subscale validation was conducted using three cohorts: (1) Development Sample (N = 664, 59.1% women, age 74.8 ± 6.4 years, PFS Mental scores 10.3 ± 9.1), (2) Validation Sample I-BLSA (N = 430, 51.9% women, age 74.5 ± 8.2 years, PFS Mental scores 9.4 ± 7.9), and (3) Validation Sample II-LLFS (N = 1,917, 54.5% women, age 72.2 ± 9.3 years, PFS Mental scores 7.5 ± 8.2). MEASUREMENTS Development Sample, Validation Sample I-BLSA, and Validation Sample II-LLFS participants self-administered the 10-item Pittsburgh Fatigability Scale. Validation Sample II-LLFS completed cognition measures (Trail Making Tests A and B), depressive symptomatology (Center for Epidemiologic Studies-Depression Scale, CES-D), and global fatigue from two CES-D items. RESULTS In the Development Sample and Validation Sample I-BLSA, confirmatory factor analysis showed all 10 items loaded on two factors: social and physical activities (fit indices: SRMSR = 0.064, RMSEA = 0.095, CFI = 0.91). PFS Mental scores had strong internal consistency (Cronbach's α = 0.85) and good test-retest reliability (ICC = 0.78). Validation Sample II-LLFS PFS Mental scores demonstrated moderate concurrent and construct validity using Pearson (r) or Spearman (ρ) correlations against measures of cognition (Trail Making Tests A (r = 0.14) and B (r = 0.17) time), depressive symptoms (r = 0.31), and global fatigue (ρ = 0.21). Additionally, the PFS Mental subscale had strong convergent validity, discriminating according to established clinical or cognitive testing cut points, with differences in PFS Mental scores ranging from 3.9 to 7.6 points (all P < .001). All analyses were adjusted for family relatedness, field center, age, sex, and education. CONCLUSIONS The validated PFS Mental subscale may be used in clinical and research settings as a sensitive, one-page self-administered tool of perceived mental fatigability in older adults.
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Affiliation(s)
- Sharon W. Renner
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Todd M. Bear
- Department of Behavioral and Community Health Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Patrick J. Brown
- Department of Psychiatry, New York State Psychiatric Institute and Columbia University College Physicians and Surgeons, New York, New York
| | - Stacy L. Andersen
- Geriatrics Section, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Stephanie Cosentino
- Department of Neurology, Columbia University Medical Center, New York, New York
| | - Theresa Gmelin
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Robert M. Boudreau
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jane A. Cauley
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Yujia (Susanna) Qiao
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Nancy W. Glynn
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
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21
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Cohen RW, Meinhardt AJ, Gmelin T, Qiao YS, Moored KD, Katz RD, Renner SW, Glynn NW. Prevalence and severity of perceived mental fatigability in older adults: The Long Life Family Study. J Am Geriatr Soc 2021; 69:1401-1403. [PMID: 33675035 DOI: 10.1111/jgs.17075] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 02/07/2021] [Indexed: 01/12/2023]
Affiliation(s)
- Rebecca W Cohen
- Center for Aging and Population Health, Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Alexa J Meinhardt
- Center for Aging and Population Health, Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Theresa Gmelin
- Center for Aging and Population Health, Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Yujia Susanna Qiao
- Center for Aging and Population Health, Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Kyle D Moored
- Center for Aging and Population Health, Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ryan D Katz
- Center for Aging and Population Health, Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Sharon W Renner
- Center for Aging and Population Health, Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Nancy W Glynn
- Center for Aging and Population Health, Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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22
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Gmelin T, Rosso A, Andersen S, Cosentino S, Wojczynski M, Christensen K, Boudreau R, Glynn N. Greater Perceived Physical Fatigability Is Associated with Lower Cognition: The Long Life Family Study. Innov Aging 2020. [PMCID: PMC7742523 DOI: 10.1093/geroni/igaa057.2831] [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: 11/14/2022] Open
Abstract
Greater perceived physical fatigability is associated with physical functional decline, but few studies have examined its relation with cognition. Adults ≥60 (mean±SD age 73.7±10.5, 54.7% female, 99.6% white) from the Long Life Family Study (n=2355) completed the Pittsburgh Fatigability Scale (PFS, 0-50, higher=greater fatigability) and a neurocognitive examination. Generalized estimating equations were used to account for family structure. Covariates included age, sex, field center, depressive symptoms (Center for Epidemiological Studies-Depression), education, and self-reported health. Each 1-point greater PFS was associated with lower: (1) global cognition (Mini-Mental Status Exam; β=-0.36,p<.0001), (2) verbal fluency (phonemic: β=-0.09,p=.029 and semantic: β=-0.14,p<.0001), (3) memory (Hopkins Verbal Learning Test-Revised: β=-0.06,p=.037), and (4) psychomotor speed (Digit Symbol Substitution Test: β=-0.10,p<.0001), after covariate adjustment. Greater perceived physical fatigability was significantly associated with lower memory and cognitive function in older adults, and may represent a promising new biomarker of biological aging reflecting declining brain reserve, resilience, and neurodegeneration.
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Affiliation(s)
- Theresa Gmelin
- University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Andrea Rosso
- School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Stacy Andersen
- Boston University School of Medicine, Boston, Massachusetts, United States
| | | | - Mary Wojczynski
- Washington University School of Medicine, St Louis, Missouri, United States
| | | | - Robert Boudreau
- University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Nancy Glynn
- University of Pittsburgh, Pittsburgh, Pennsylvania, United States
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23
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Sprague B, Zhu X, Ehrenkranz R, Tian Q, Gmelin T, Glynn N, Rosso A, Rosano C. Self-Reported Energy Trajectories Predict Adverse Health Outcomes in Older Adults. Innov Aging 2020. [PMCID: PMC7742776 DOI: 10.1093/geroni/igaa057.2880] [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: 11/14/2022] Open
Abstract
Declining energy may indicate homeostatic dysregulation and predict adverse health outcomes. We hypothesized that declining energy would predict greater frailty (1-10), greater mortality, and faster mood (CES-D) and cognition (3MS) decline over time. This observational cohort studies included 2,443 older adults (mean age=74.6, 62.5% White, 47.8% men) from the Health ABC Study with up to eight years of data. Energy was assessed using a single-item question about prior month’s energy (baseline mean=6.7, SD=1.7, range=0–10, lower=less energy). We used linear mixed models to create energy change scores (mean=-.07 points/year, SD=.05, range=-0.32-0.21, negative=decreased energy). In regression models adjusting for baseline outcome performance and energy and demographics, declining energy predicted greater frailty (β=-2.72, 95%CI = -3.39,-2.06), greater mortality (hazard ratio=.07, p<.001), and faster CES-D (β=-.93, 95%CI=-1.10,-0.75) but not 3MS decline. Energy changes are easy to assess and predict clinically-relevant outcomes. Future work should consider mechanisms of declining energy on disability-related outcomes. Part of a symposium sponsored by Brain Interest Group.
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Affiliation(s)
- Briana Sprague
- University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Xiaonan Zhu
- University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, United States
| | | | - Qu Tian
- National Institute on Aging, Bethesda, Maryland, United States
| | - Theresa Gmelin
- University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Nancy Glynn
- University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Andrea Rosso
- School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Caterina Rosano
- University of Pittsburgh, Pittsburgh, Pennsylvania, United States
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24
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Allen H, Gmelin T, Smagula S, Boudreau R, Cauley J, Glynn N. The Relationship Between Personality and Perceived Mental Fatigability. Innov Aging 2020. [PMCID: PMC7742329 DOI: 10.1093/geroni/igaa057.2832] [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: 11/26/2022] Open
Abstract
Several personality traits are known to be protective against global fatigue, however perceived mental fatigability (PMF, Pittsburgh Fatigability Scale 0-50) specifically measures an individual’s susceptibility to cognitive tiredness and is associated with mobility decline. We assessed whether optimism, conscientiousness, goal reengagement and goal disengagement contributed to greater PMF in 1,812 men (mean±SD age 84.4±4.2 years, 90.4% white) in the Osteoporotic Fractures in Men Study 4th visit (2014-2016). Covariates included demographic, psychological/behavioral factors, health conditions, physical activity and function. Prevalence of higher PMF (score ≥13) was 25% (n=448). In a covariate-adjusted regression model, each SD lower conscientiousness and lower optimism were associated with 0.93 and 0.61 SDs greater PMF, each p<0.01. Goal disengagement and goal reengagement were not associated with PMF. These findings warrant further investigation into how personality traits may help clinicians design targeted and effective interventions to reduce fatigability, and consequently lower the risk of adverse aging-related health outcomes.
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Affiliation(s)
- Hannah Allen
- University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, United States
| | - Theresa Gmelin
- University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Stephen Smagula
- University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Robert Boudreau
- University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Jane Cauley
- University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Nancy Glynn
- University of Pittsburgh, Pittsburgh, Pennsylvania, United States
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25
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Graves J, Gmelin T, Boudreau R, Albert S, Newman A, Venditti E, Glynn N. Perceived Physical Fatigability Improves After a Weight Management Intervention. Innov Aging 2020. [PMCID: PMC7742561 DOI: 10.1093/geroni/igaa057.3080] [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
The effects of a weight loss and physical activity (PA) intervention on improving perceived physical fatigability are unknown. We examined this question in a subset (n=79) of older adults who are obese enrolled in the 13-month Mobility and Vitality Lifestyle Program (mean□SD age 68.8±4.2 years, 83.5% female, 26.6% African American, body mass index 34.6±4.3 kg/m2). Accelerometer-assessed PA (mean/day vector magnitude) was measured with a wrist-worn triaxial GT3X+ ActiGraph for 7 full days. Perceived physical fatigability was measured using the 10-item self-administered Pittsburgh Fatigability Scale (PFS, 0-50; lower score= less fatigability). Baseline PFS was 18.7±8.5 with 69.6% having higher fatigability (PFS ≥15). At 13-months, PFS decreased by 15% (2.8 points) to 15.9±8.4 (p<0.01) and prevalence of higher fatigability declined to 60.8%. Concurrently, participants lost 6.2% of their body weight and PA increased by 2.4%. A lifestyle intervention may be effective at reducing fatigability, an important component in the age-related disablement pathway.
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Affiliation(s)
- Jessica Graves
- University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Theresa Gmelin
- University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Robert Boudreau
- University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Steven Albert
- University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Anne Newman
- University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | | | - Nancy Glynn
- University of Pittsburgh, Pittsburgh, Pennsylvania, United States
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26
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Ehrenkranz R, Rosso A, Sprague B, Tian Q, Simonsick E, Glynn N, Rosano C, Gmelin T. Functional Correlates of Self-Reported Energy in the Health, Aging, and Body Composition Study. Innov Aging 2020. [PMCID: PMC7740798 DOI: 10.1093/geroni/igaa057.558] [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: 11/29/2022] Open
Abstract
While fatigue in older age is well studied, the clinical relevance of maintaining higher energy late in life is less understood. We explored associations of self-reported energy with cognitive performance, depressive symptoms, and physical function in the Health, Aging and Body Composition study (n=2,529, mean age =75.9, 63.5% white, 44.9% men). Self-reported energy over the past month was recorded from 0-10 (least to most energy) and dichotomized at the median (≥7=high energy). Cognitive performance was measured using Modified Mini-Mental State Examination and Digit Symbol Substitution Test. Depressive symptoms were measured using the Center for Epidemiologic Studies Depression scale. Physical function was assessed via fitness (timed 400-meter walk), self-reported physical activity, and usual and rapid gait speed. Variables bivariately associated with energy entered a logistic regression model with higher energy as the outcome, adjusted for demographics, chronic conditions, strength, and body mass index (BMI). Overall, 58% of the sample reported high energy, and self-reported energy was greater for males and those without chronic conditions (p<0.05). Lower odds of higher self-reported energy were found for participants with more depressive symptoms (aOR 95% CI= 0.55 [0.50, 0.62]) and longer time to walk 400m (aOR = 0.79 [0.70, 0.89]). Increased odds of higher self-reported energy were found for participants with faster usual and rapid gait speeds (aOR = 1.3 [1.2, 1.5]; aOR = 1.2 [1.1 – 1.4], respectively). Associations with cognitive performance were not significant. Higher self-reported energy reflects fewer depressive symptoms and greater physical function independent of demographics, chronic conditions, strength, and BMI.
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Affiliation(s)
| | - Andrea Rosso
- School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Briana Sprague
- University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Qu Tian
- National Institute on Aging, Bethesda, Maryland, United States
| | | | - Nancy Glynn
- University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Caterina Rosano
- University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Theresa Gmelin
- University of Pittsburgh, Pittsburgh, Pennsylvania, United States
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LaSorda KR, Gmelin T, Kuipers AL, Boudreau RM, Santanasto AJ, Christensen K, Renner SW, Wojczynski MK, Andersen SL, Cosentino S, Glynn NW. Epidemiology of Perceived Physical Fatigability in Older Adults: The Long Life Family Study. J Gerontol A Biol Sci Med Sci 2020; 75:e81-e88. [PMID: 31828303 PMCID: PMC7494027 DOI: 10.1093/gerona/glz288] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [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: 08/20/2019] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Fatigability is a construct that measures whole-body tiredness anchored to activities of a fixed intensity and duration; little is known about its epidemiology and heritability. METHODS Two generations of family members enriched for exceptional longevity and their spouses were enrolled (2006-2009) in the Long Life Family Study (LLFS). At Visit 2 (2014-2017, N = 2,355) perceived physical fatigability was measured using the 10-item self-administered Pittsburgh Fatigability Scale (PFS), along with demographic, medical, behavioral, physical, and cognitive risk factors. RESULTS Residual genetic heritability of fatigability was 0.263 (p = 6.6 × 10-9) after adjustment for age, sex, and field center. PFS physical scores (mean ± SD) and higher physical fatigability prevalence (% PFS ≥ 15) were greater with each age strata: 60-69 (n = 1,009, 11.0 ± 7.6, 28%), 70-79 (n = 847, 12.5 ± 8.1, 37%), 80-89 (n = 253, 19.3 ± 9.9, 65.2%), and 90-108 (n = 266, 28.6 ± 9.8, 89.5%), p < .0001, adjusted for sex, field center, and family relatedness. Women had a higher prevalence of perceived physical fatigability compared to men, with the largest difference in the 80-89 age strata, 74.8% versus 53.5%, p < .0001. Those with greater body mass index, worse physical and cognitive function, and lower physical activity had significantly higher perceived physical fatigability. CONCLUSIONS Perceived physical fatigability is highly prevalent in older adults and strongly associated with age. The family design of LLFS allowed us to estimate the genetic heritability of perceived physical fatigability. Identifying risk factors associated with higher perceived physical fatigability can inform the development of targeted interventions for those most at risk, including older women, older adults with depression, and those who are less physically active.
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Affiliation(s)
- Kelsea R LaSorda
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Theresa Gmelin
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Allison L Kuipers
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Robert M Boudreau
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Adam J Santanasto
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Kaare Christensen
- Department of Public Health, Unit of Epidemiology, Biostatistics and Biodemography, University of Southern Denmark, Odense, Denmark
| | - Sharon W Renner
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Mary K Wojczynski
- Department of Genetics, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Stacy L Andersen
- Geriatrics Section, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts
| | - Stephanie Cosentino
- Department of Neurology, Columbia University Medical Center, New York, New York
| | - Nancy W Glynn
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
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Glynn NW, Gmelin T, Santanasto AJ, Lovato LC, Lange-Maia BS, Nicklas BJ, Fielding RA, Manini TM, Myers VH, de Rekeneire N, Spring BJ, Pahor M, King AC, Rejeski WJ, Newman AB. Impact of Baseline Fatigue on a Physical Activity Intervention to Prevent Mobility Disability. J Am Geriatr Soc 2019; 68:619-624. [PMID: 31867713 DOI: 10.1111/jgs.16274] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 10/02/2019] [Accepted: 11/04/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Our aim was to examine the impacts of baseline fatigue on the effectiveness of a physical activity (PA) intervention to prevent major mobility disability (MMD) and persistent major mobility disability (PMMD) in participants from the Lifestyle Interventions and Independence for Elders (LIFE) study. DESIGN Prospective cohort of individuals aged 65 years or older undergoing structured PA intervention or health education (HE) for a mean of 2.6 years. SETTING LIFE was a multicenter eight-site randomized trial that compared the efficacy of a structured PA intervention with an HE program in reducing the incidence of MMD. PARTICIPANTS Study participants (N = 1591) at baseline were 78.9 ± 5.2 years of age, with low PA and at risk for mobility impairment. MEASUREMENTS Self-reported fatigue was assessed using the modified trait version of the Exercise-Induced Feelings Inventory, a six-question scale rating energy levels in the past week. Responses ranged from 0 (none of the time) to 5 (all of the time). Total score was calculated by averaging across questions; baseline fatigue was based on the median split: 2 or higher = more fatigue (N = 856) and lower than 2 = less fatigue (N = 735). Participants performed a usual-paced 400-m walk every 6 months. We defined incident MMD as the inability to walk 400-m at follow-up visits; PMMD was defined as two consecutive walk failures. Cox proportional hazard models quantified the risk of MMD and PMMD in PA vs HE stratified by baseline fatigue adjusted for covariates. RESULTS Among those with higher baseline fatigue, PA participants had a 29% and 40% lower risk of MMD and PMMD, respectively, over the trial compared with HE (hazard ratio [HR] for MMD = .71; 95% confidence interval [CI] = .57-.90; P = .004) and PMMD (HR = .60; 95% CI = .44-.82; P = .001). For those with lower baseline fatigue, no group differences in MMD (P = .36) or PMMD (P = .82) were found. Results of baseline fatigue by intervention interaction was MMD (P = .18) and PMMD (P = .05). CONCLUSION A long-term moderate intensity PA intervention was particularly effective at preserving mobility in older adults with higher levels of baseline fatigue. J Am Geriatr Soc 68:619-624, 2020.
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Affiliation(s)
- Nancy W Glynn
- Center for Aging and Population Health, Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Theresa Gmelin
- Center for Aging and Population Health, Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Adam J Santanasto
- Center for Aging and Population Health, Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Laura C Lovato
- Department of Biostatistical Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Brittney S Lange-Maia
- Department of Preventive Medicine and Center for Community Health Equity, Rush University Medical Center, Chicago, Illinois
| | - Barbara J Nicklas
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Sticht Center on Aging, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Roger A Fielding
- Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts
| | - Todd M Manini
- Institute on Aging, Department of Aging and Geriatric Research, University of Florida, Gainesville, Florida
| | | | | | - Bonnie J Spring
- Department of Preventive Medicine, Northwestern University, Chicago, Illinois
| | - Marco Pahor
- Institute on Aging, Department of Aging and Geriatric Research, University of Florida, Gainesville, Florida
| | - Abby C King
- Department of Health Research & Policy, and the Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - W Jack Rejeski
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina
| | - Anne B Newman
- Center for Aging and Population Health, Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
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Gmelin T, Andersen SL, Boudreau RM, Christensen K, Wojczynski MK, Cosentino S, Glynn NW. ROLE OF COPING STYLES AND NEGATIVE LIFE EVENTS ON HIGHER PERCEIVED MENTAL FATIGABILITY IN OLDER ADULTS. Innov Aging 2019. [PMCID: PMC6845178 DOI: 10.1093/geroni/igz038.866] [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: 11/14/2022] Open
Abstract
Older adults are vulnerable to negative recent life events (RLE) which deplete attentional resources and leads to cognitive exhaustion. Adaptive coping styles reduce perceived stress severity but their role on cognitive tiredness is unknown. We examined RLE and coping styles on perceived mental fatigability (Pittsburgh Fatigability Scale (PFS), 0-50pts, higher=greater fatigability) in the Long Life Family Study (N=1464, age=74.7±12.6, female=57.7%, 43.9% ≥1 major RLE past 6 months, 27.8% higher mental fatigability≥13). All analyses adjusted for family structure, field center, age, and sex. PFS mental scores correlated with all NEO-FFI (60-item, 5-domain) personality traits representing maladaptive (neuroticism r=0.25 p<.0001) and adaptive (conscientiousness r=-0.18, extraversion r=-0.24, p<.00001) coping. Having ≥1RLE was associated with higher mental fatigability (OR=1.4, 95% CI:1.2,1.8, p=.0004); adjustment for neuroticism (OR=1.3, 95% CI:0.9,1.7, p=.06) attenuated the association. Education on adaptive coping may be a modifiable skill that allows older adults to maintain lower perceived mental fatigability despite stressful events.
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Affiliation(s)
- Theresa Gmelin
- University of Pittsburgh. Department of Epidemiology, Pittsburgh, Pennsylvania, United States
| | - Stacy L Andersen
- Boston University School of Medicine, Boston, Massachusetts, United States
| | | | | | - Mary K Wojczynski
- Washington University School of Medicine in St. Louis, St Louis, Missouri, United States
| | | | - Nancy W Glynn
- University of Pittsburgh, Pittsburgh, Pennsylvania, United States
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Meinhardt AJ, Gmelin T, Kuipers AL, Andersen SL, Cosentino S, Wojczynski MK, Christensen K, Glynn NW. PREVALENCE AND HERITABILITY OF PERCEIVED MENTAL FATIGABILITY IN THE LONG LIFE FAMILY STUDY. Innov Aging 2019. [PMCID: PMC6844858 DOI: 10.1093/geroni/igz038.865] [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: 11/25/2022] Open
Abstract
We examined the prevalence and heritability of perceived mental fatigability among older adults enrolled in the Long Life Family Study. Participants (N=2342; 55% female) self-administered the Pittsburgh Fatigability Scale (PFS; scores range 0-50; higher score=greater fatigability). Using the PFS mental subscale, we evaluated differences across age strata (adjusted for family structure and field center) and estimated genetic heritability using the variance covariance methods implemented in SOLAR to determine genetic heritability (adjusted for age, sex, and field center). PFS mental score (mean±SD) and prevalence of higher mental fatigability (PFS ≥13) was greater across age strata: 60-69 (N=996, 5.9± 6.5, 14.5%), 70-79 (N=830, 6.8 ±7.6, 18.7%), 80-89 (N=251, 11.7±10.8, 41.8%), and ≥90 (N=265, 20.2±13.6, 67.2%), p<0.0001. Only among those ≥90, females (21.7±13.5) had greater mental fatigability than males (18.0±13.5), p=0.03. Residual heritability of mental fatigability was 0.17, p<0.0001. Future analyses will evaluate correlates of mental fatigability to identify potential avenues for intervention.
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Affiliation(s)
- Alexa J Meinhardt
- University of Pittsburgh, Department of Epidemiology, Pittsburgh, Pennsylvania, United States
| | - Theresa Gmelin
- University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, United States
| | - Allison L Kuipers
- University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, United States
| | - Stacy L Andersen
- Boston University School of Medicine, Boston, Massachusetts, United States
| | - Stephanie Cosentino
- Columbia University Department of Neurology, New York, New York, United States
| | - Mary K Wojczynski
- Washington University School of Medicine in St. Louis Department of Genetics, St. Louis, Missouri, United States
| | | | - Nancy W Glynn
- University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, United States
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Qiao Y(S, Gmelin T, Boudreau RM, Andersen SL, Cosentino S, Christensen K, Wojczynski MK, Glynn NW. PHYSICAL ACTIVITY ATTENUATES AGE DIFFERENCES IN CHANGE IN PERCEIVED PHYSICAL FATIGABILITY. Innov Aging 2019. [PMCID: PMC6845019 DOI: 10.1093/geroni/igz038.3319] [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: 11/16/2022] Open
Abstract
Lower physical activity is cross-sectionally associated with greater fatigability; whether such a relationship holds for longitudinal changes in fatigability is under-studied. We examined this question in offspring (≥60 years, range 60-93y, 99.7% white; 53.2% female) enrolled in the Long Life Family Study, a two-generation cohort enriched for exceptional longevity and their spousal controls. At Visit 2 (2014-2017), we measured self-reported physical activity (PA) with the Framingham Physical Activity Index (dichotomized by median value: less active <37 MET-hrs/wk and more active ≥37 MET-hrs/wk). Perceived physical fatigability was assessed using the Pittsburgh Fatigability Scale (PFS, 0-50) at Visit 2 and repeated during a follow-up contact 2.7±0.92 years later. We constructed a repeated-measures linear mixed-effect model to examine the effect of PA on longitudinal change in PFS by median age (younger <70y; older ≥70y) adjusted for family structure, field center, follow-up time, sex, and self-rated health. We found a strong dose-response relationship of PFS scores across the four age/PA groups (ptrend<0.001). Specifically, older/less active (N=310) participants had the highest annual PFS increases of 0.37 points/yr (p<0.001) while those older/more active (N=340) had annual increases of 0.17 points/yr (p=0.03). Younger/less active (N=371) participants had annual PFS increases of 0.09 points/yr (p=0.008); those younger/more active (N=341) had annual decreases (improvement) of 0.18 points/yr (p<0.001). Although annual PFS changes were modest, our findings indicate physical activity attenuated age differences in these trajectories. Physical activity is emerging as a potential target for intervention aimed at reducing fatigability - an important risk factor in the disability pathway.
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Affiliation(s)
| | - Theresa Gmelin
- University of Pittsburgh. Department of Epidemiology, Pittsburgh, Pennsylvania, United States
| | | | - Stacy L Andersen
- Boston University School of Medicine, Boston, Massachusetts, United States
| | | | - Kaare Christensen
- Danish Aging Research Center, University of Southern Denmark, Odense C, Denmark
| | - Mary K Wojczynski
- Department of Genetics, Washington University in St. Louis, Saint Louis, Missouri, United States
| | - Nancy W Glynn
- University of Pittsburgh, Department of Epidemiology, Pittsburgh, Pennsylvania, United States
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Glynn NW, Gmelin T, Renner SW, Boudreau RM, Feitosa M, Andersen SL, Christensen K, Newman AB. PERCEIVED PHYSICAL FATIGABILITY PREDICTS ALL-CAUSE MORTALITY: THE LONG LIFE FAMILY STUDY. Innov Aging 2019. [PMCID: PMC6846352 DOI: 10.1093/geroni/igz038.3272] [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
Fatigability, the likelihood of fatigue with lower versus higher levels of exertion, is associated with declines in physical function and disability and related to fitness. Thus, fatigability may be a good predictor of mortality. We examined this relationship in the Long Life Family Study (LLFS), an international family cohort enriched for longevity and their spousal controls. We measured perceived physical fatigability at Visit 2 (2014-2017) using the Pittsburgh Fatigability Scale (PFS, 0-50 with higher score=greater fatigability). We identified deaths by family members notifying field centers, reporting during annual phone follow-up, or finding an obituary when unable to reach. Otherwise, we censored participants at most recent contact date when confirmed alive. Covariates included age, sex, and self-reported physical activity using the Framingham Physical Activity Index. We adjusted all analyses for field center and family structure. Participants alive ≥60 years (range 60-108, mean 73.6±10.5) and completed the PFS (N=2,326) at Visit 2 were predominantly white (99.5%) and female (55.1%). Post-Visit 2, 195 (8.4%) died during mean 2.5±1.0 years of follow-up. Age-adjusted PFS score was 7.7 points greater (p<.0001) for those who died (19.8) compared to alive (12.1). Using Cox Proportional-Hazard modeling, each 5-point greater PFS score was associated with 31% (HR: 1.31, 95% CI 1.18,1.43) higher all-cause mortality rate adjusted for covariates listed above. Further adjustment for comorbidities did not attenuate association. PFS’s perceived physical fatigability score may be a useful self-report clinical tool to predict higher risk of mortality among older adults when objective measures of fitness and function are unavailable.
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Affiliation(s)
- Nancy W Glynn
- University of Pittsburgh, Department of Epidemiology, Pittsburgh, Pennsylvania, United States
| | - Theresa Gmelin
- University of Pittsburgh, Department of Epidemiology, Pittsburgh, Pennsylvania, United States
| | - Sharon W Renner
- University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, United States
| | | | - Mary Feitosa
- Washington University School of Medicine, St Louis, Missouri, United States
| | - Stacy L Andersen
- Boston University School of Medicine, Boston, Massachusetts, United States
| | - Kaare Christensen
- Danish Aging Research Center, University of Southern Denmark, Odense C, Denmark
| | - Anne B Newman
- University of Pittsburgh, Pittsburgh, Pennsylvania, United States
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Wasson E, Rosso AL, Santanasto AJ, Rosano C, Butters MA, Rejeski WJ, Boudreau RM, Aizenstein H, Gmelin T, Glynn NW. Neural correlates of perceived physical and mental fatigability in older adults: A pilot study. Exp Gerontol 2018; 115:139-147. [PMID: 30528639 DOI: 10.1016/j.exger.2018.12.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [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: 08/06/2018] [Revised: 10/29/2018] [Accepted: 12/03/2018] [Indexed: 11/28/2022]
Abstract
This pilot work examined associations of brain grey matter volumes (GMV) with perceived fatigability in older adults to elucidate disablement mechanisms. A subsample (n = 29; age = 77.2 ± 5.5; 86% female) of participants from the Lifestyle Interventions and Independence for Elders (LIFE) Study was utilized to quantify GMV for regions of interest in the basal ganglia and limbic system normalized to intracranial volume. The Pittsburgh Fatigability Scale measured physical and mental fatigability (score 0-50; higher physical fatigability ≥ 15; higher mental fatigability ≥ 13). We used an exploratory alpha level of p < 0.1. Nineteen (66%) participants had higher physical fatigability, 19 (66%) had higher mental fatigability, of these, 17 (57%) had both. Right hippocampal volumes/ICV were smaller in participants with higher verses lower physical fatigability (0.261 ± 0.039 vs. 0.273 ± 0.022, p = 0.07); associations were similar for right putamen and bilateral thalamus. Higher mental fatigability was associated with smaller right hippocampus, thalamus, and posterior cingulum and bilateral amygdala. Higher fatigability in older adults may be associated with smaller volumes of the basal ganglia and limbic system, indicating mechanisms for further exploration.
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Affiliation(s)
- Emily Wasson
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, PA, United States
| | - Andrea L Rosso
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, PA, United States
| | - Adam J Santanasto
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, PA, United States
| | - Caterina Rosano
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, PA, United States
| | - Meryl A Butters
- Department of Psychiatry, University of Pittsburgh School of Medicine, University of Pittsburgh, PA, United States
| | - W Jack Rejeski
- Department of Health and Exercise Science, Wake Forest University, NC, United States
| | - Robert M Boudreau
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, PA, United States
| | - Howard Aizenstein
- Department of Psychiatry, University of Pittsburgh School of Medicine, University of Pittsburgh, PA, United States
| | - Theresa Gmelin
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, PA, United States
| | - Nancy W Glynn
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, PA, United States.
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Deal JA, Goman AM, Albert MS, Arnold ML, Burgard S, Chisolm T, Couper D, Glynn NW, Gmelin T, Hayden KM, Mosley T, Pankow JS, Reed N, Sanchez VA, Richey Sharrett A, Thomas SD, Coresh J, Lin FR. Hearing treatment for reducing cognitive decline: Design and methods of the Aging and Cognitive Health Evaluation in Elders randomized controlled trial. Alzheimers Dement (N Y) 2018; 4:499-507. [PMID: 30364572 PMCID: PMC6197326 DOI: 10.1016/j.trci.2018.08.007] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Hearing impairment is highly prevalent and independently associated with cognitive decline. The Aging and Cognitive Health Evaluation in Elders study is a multicenter randomized controlled trial to determine efficacy of hearing treatment in reducing cognitive decline in older adults. Clinicaltrials.gov Identifier: NCT03243422. METHODS Eight hundred fifty participants without dementia aged 70 to 84 years with mild-to-moderate hearing impairment recruited from four United States field sites and randomized 1:1 to a best-practices hearing intervention or health education control. Primary study outcome is 3-year change in global cognitive function. Secondary outcomes include domain-specific cognitive decline, incident dementia, brain structural changes on magnetic resonance imaging, health-related quality of life, physical and social function, and physical activity. RESULTS Trial enrollment began January 4, 2018 and is ongoing. DISCUSSION When completed in 2022, Aging and Cognitive Health Evaluation in Elders study should provide definitive evidence of the effect of hearing treatment versus education control on cognitive decline in community-dwelling older adults with mild-to-moderate hearing impairment.
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Affiliation(s)
- Jennifer A. Deal
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Adele M. Goman
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Marilyn S. Albert
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Michelle L. Arnold
- College of Science and Mathematics, University of South Florida Sarasota - Manatee, Sarasota, FL, USA
| | - Sheila Burgard
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Theresa Chisolm
- Department of Communication Sciences and Disorders, University of South Florida, Tampa, FL, USA
| | - David Couper
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Nancy W. Glynn
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - Theresa Gmelin
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kathleen M. Hayden
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Thomas Mosley
- The MIND Center, University of Mississippi Medical Center, Jackson, MS, USA
| | - James S. Pankow
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Nicholas Reed
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Victoria A. Sanchez
- Department of Otolaryngology-Head and Neck Surgery, University of South Florida, Tampa, FL, USA
| | - A. Richey Sharrett
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Josef Coresh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- George W. Comstock Center for Public Health Research and Prevention, Johns Hopkins Bloomberg School of Public Health, Hagerstown, MD, USA
- Department of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Frank R. Lin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Radovic A, Gmelin T, Hua J, Long C, Stein BD, Miller E. Supporting Our Valued Adolescents (SOVA), a Social Media Website for Adolescents with Depression and/or Anxiety: Technological Feasibility, Usability, and Acceptability Study. JMIR Ment Health 2018; 5:e17. [PMID: 29483067 PMCID: PMC5847821 DOI: 10.2196/mental.9441] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 01/08/2018] [Accepted: 01/08/2018] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Supporting Our Valued Adolescents (SOVA), a social media website for adolescents, was designed to increase mental health literacy and address negative health beliefs toward depression and/or anxiety diagnosis and treatment. This stakeholder-informed site underwent iterative user testing to evolve into its current version with daily blog posts, round-the-clock site moderation, and Web-based peer interaction to create an online support community. OBJECTIVE The aim of this study was to evaluate the technological feasibility (at least 100 users on the site, logging in 12 to 18 times in the first 6 weeks) and acceptability of the SOVA site determined by the System Usability Scale (SUS). METHODS Adolescents and young adults (aged 14-26 years) with a self-reported history of depressive and/or anxiety symptoms were recruited to access the research website (sova.pitt.edu). Participants were screened out if they reported active suicidality or a prior suicide attempt. Baseline survey measures included demographics, symptomatology using the Patient Health Questionnaire-9 modified for adolescents (PHQ-9A) and Screen for Child Anxiety Related Disorders (SCARED-C), and mental health treatment history. The 6-week follow-up measures taken in addition to the symptomatology, included feasibility (total number of log-ins), usability, and acceptability of SOVA using SUS. RESULTS Most of the 96 participants identified as female (75% [72/96]) and white (67% [64/96]). Most participants (73% [70/96]) reported having taken prior professional psychological help. The average PHQ-9A score was 11.8 (SD 5.5), and for SCARED-C, 85% (80/94) of the participants reported a score consistent with being susceptible to a diagnosed anxiety disorder. There were 46% (41/90) of eligible users who ever logged in. Out of the total users who ever logged in, the mean of total log-ins over the entire study was 4.1 (SD 6.9). Median number of users rated the user-friendliness of the site as "good." The average SUS score was 71.2% (SD 18.7), or a "C-grade," which correlated to an acceptable range. The participants reported to have liked the "easy-to-understand format" and "positive, helpful atmosphere," but they also reported a desire for greater social interaction. Iterative recruitment resulted in incremental improvements to the site. CONCLUSIONS The SOVA site met feasibility goals of recruiting almost 100 users and establishing acceptable usability. Subsequent interventions are planned to increase site engagement and to evaluate efficacy in increasing uptake of primary care-recommended depression and/or anxiety treatment.
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Affiliation(s)
- Ana Radovic
- Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Theresa Gmelin
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Jing Hua
- Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Cassandra Long
- Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Bradley D Stein
- Research and Development Corporation, Pittsburgh, PA, United States
| | - Elizabeth Miller
- Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
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Kazmerski TM, Gmelin T, Slocum B, Borrero S, Miller E. Attitudes and Decision Making Related to Pregnancy Among Young Women with Cystic Fibrosis. Matern Child Health J 2018; 21:818-824. [PMID: 27531009 DOI: 10.1007/s10995-016-2181-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [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: 12/27/2022]
Abstract
Introduction The number of female patients with CF able to consider pregnancy has increased with improved therapies. This study explored attitudes and decision making regarding pregnancy among young women with CF. Methods Twenty-two women with CF ages 18-30 years completed semi-structured, in-person interviews exploring experiences with preconception counseling and reproductive care in the CF setting. Interviews were audio-recorded, transcribed, and coded using a thematic analysis approach. Results Participants indicated CF is a major factor in pregnancy decision making. Although women acknowledged that CF influences attitudes toward pregnancy, many expressed confusion about how CF can affect fertility/pregnancy. Many perceived disapproval from CF providers regarding pregnancy and were dissatisfied with reproductive care in the CF setting. Discussion Young female patients with CF reported poor understanding of the effect of CF on fertility and pregnancy and limited preconception counseling in CF care. Improvements in female sexual and reproductive health care in CF are warranted.
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Affiliation(s)
- Traci M Kazmerski
- Children's Hospital of Pittsburgh of UPMC, Department of Pediatrics, University of Pittsburgh, 4401 Penn Ave. AOB 3rd Floor Suite 3300, Pittsburgh, PA, 15224, USA.
| | - Theresa Gmelin
- Children's Hospital of Pittsburgh of UPMC, Department of Pediatrics, University of Pittsburgh, 4401 Penn Ave. AOB 3rd Floor Suite 3300, Pittsburgh, PA, 15224, USA
| | - Breonna Slocum
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Sonya Borrero
- Department of Medicine, University of Pittsburgh and VA Pittsburgh Center for Health Equity Research and Promotion, Pittsburgh, PA, USA
| | - Elizabeth Miller
- Children's Hospital of Pittsburgh of UPMC, Department of Pediatrics, University of Pittsburgh, 4401 Penn Ave. AOB 3rd Floor Suite 3300, Pittsburgh, PA, 15224, USA
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Abebe KZ, Jones KA, Rofey D, McCauley HL, Clark DB, Dick R, Gmelin T, Talis J, Anderson J, Chugani C, Algarroba G, Antonio A, Bee C, Edwards C, Lethihet N, Macak J, Paley J, Torres I, Van Dusen C, Miller E. A cluster-randomized trial of a college health center-based alcohol and sexual violence intervention (GIFTSS): Design, rationale, and baseline sample. Contemp Clin Trials 2018; 65:130-143. [PMID: 29287667 PMCID: PMC5803349 DOI: 10.1016/j.cct.2017.12.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [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: 08/18/2017] [Revised: 12/09/2017] [Accepted: 12/20/2017] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Sexual violence (SV) on college campuses is common, especially alcohol-related SV. This is a 2-arm cluster randomized controlled trial to test a brief intervention to reduce risk for alcohol-related sexual violence (SV) among students receiving care from college health centers (CHCs). Intervention CHC staff are trained to deliver universal SV education to all students seeking care, to facilitate patient and provider comfort in discussing SV and related abusive experiences (including the role of alcohol). Control sites provide participants with information about drinking responsibly. METHODS Across 28 participating campuses (12 randomized to intervention and 16 to control), 2292 students seeking care at CHCs complete surveys prior to their appointment (baseline), immediately after (exit), 4months later (T2) and one year later (T3). The primary outcome is change in recognition of SV and sexual risk. Among those reporting SV exposure at baseline, changes in SV victimization, disclosure, and use of SV services are additional outcomes. Intervention effects will be assessed using generalized linear mixed models that account for clustering of repeated observations both within CHCs and within students. RESULTS Slightly more than half of the participating colleges have undergraduate enrollment of ≥3000 students; two-thirds are public and almost half are urban. Among participants there were relatively more Asian (10 v 1%) and Black/African American (13 v 7%) and fewer White (58 v 74%) participants in the intervention compared to control. CONCLUSIONS This study will offer the first formal assessment for SV prevention in the CHC setting. Clinical Trials #: NCT02355470.
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Affiliation(s)
- Kaleab Z Abebe
- Division of General Internal Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, PA, United States.
| | - Kelley A Jones
- Children's Hospital of Pittsburgh of UPMC, Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, PA, United States
| | - Dana Rofey
- Children's Hospital of Pittsburgh of UPMC, Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, PA, United States; Department of Psychiatry, University of Pittsburgh and Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Heather L McCauley
- Human Development & Family Studies, Michigan State University, East Lansing, MI, United States
| | - Duncan B Clark
- Department of Psychiatry, University of Pittsburgh and Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Rebecca Dick
- Children's Hospital of Pittsburgh of UPMC, Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, PA, United States
| | - Theresa Gmelin
- Children's Hospital of Pittsburgh of UPMC, Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, PA, United States
| | - Janine Talis
- Children's Hospital of Pittsburgh of UPMC, Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, PA, United States
| | - Jocelyn Anderson
- Children's Hospital of Pittsburgh of UPMC, Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, PA, United States
| | - Carla Chugani
- Children's Hospital of Pittsburgh of UPMC, Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, PA, United States
| | - Gabriela Algarroba
- Children's Hospital of Pittsburgh of UPMC, Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, PA, United States
| | - Ashley Antonio
- Children's Hospital of Pittsburgh of UPMC, Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, PA, United States
| | - Courtney Bee
- Children's Hospital of Pittsburgh of UPMC, Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, PA, United States
| | - Clare Edwards
- Children's Hospital of Pittsburgh of UPMC, Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, PA, United States
| | - Nadia Lethihet
- Children's Hospital of Pittsburgh of UPMC, Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, PA, United States
| | - Justin Macak
- Children's Hospital of Pittsburgh of UPMC, Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, PA, United States
| | - Joshua Paley
- Children's Hospital of Pittsburgh of UPMC, Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, PA, United States
| | - Irving Torres
- Children's Hospital of Pittsburgh of UPMC, Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, PA, United States
| | - Courtney Van Dusen
- Children's Hospital of Pittsburgh of UPMC, Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, PA, United States
| | - Elizabeth Miller
- Children's Hospital of Pittsburgh of UPMC, Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, PA, United States
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Gmelin T, Raible CA, Dick R, Kukke S, Miller E. Integrating Reproductive Health Services Into Intimate Partner and Sexual Violence Victim Service Programs. Violence Against Women 2017; 24:1557-1569. [DOI: 10.1177/1077801217741992] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
This study assessed the feasibility of integrating reproductive health services into intimate partner violence/sexual violence (IPV/SV) programs. After a training for victim service agencies on integration of health services, we conducted semistructured interviews with IPV/SV program leadership. Leadership reported advocates were more likely to recognize the need to refer clients to health services, and revealed challenges operationalizing partnerships with health care centers. Training to integrate basic health assessment into victim services may be one way to address women’s urgent health needs. Formal partnership agreements, protocols to facilitate referrals, and opportunities to cross-train are needed to nurture these cross-sector collaborations.
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Affiliation(s)
- Theresa Gmelin
- Children’s Hospital of Pittsburgh of UPMC, PA, USA
- Department of Epidemiology, University of Pittsburgh, PA, USA
| | | | - Rebecca Dick
- Children’s Hospital of Pittsburgh of UPMC, PA, USA
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Radovic A, DeMand AL, Gmelin T, Stein BD, Miller E. SOVA: Design of a stakeholder informed social media website for depressed adolescents and their parents. J Technol Hum Serv 2017; 35:169-182. [PMID: 29743822 PMCID: PMC5937703 DOI: 10.1080/15228835.2017.1347552] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Two moderated social media websites were designed for increasing likelihood for mental health treatment engagement for depressed adolescents (sova.pitt.edu) and for parents (wisesova.pitt.edu). This paper describes iterative stakeholder interviews conducted with adolescents, young adults, parents, advocates, and clinicians and use of human computer interaction techniques to inform major design changes which: (1) underscored the role of online interaction to provide emotional support and information; (2) importance of anonymity; (3) desire to share positive media; and (4) need for frequent moderation. Future studies will examine acceptability and effectiveness of revised websites in helping depressed adolescents and their parents engage with treatment.
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Affiliation(s)
- Ana Radovic
- Children’s Hospital of Pittsburgh of UPMC, Division of Adolescent and Young Adult Medicine, Oak-land Medical Building, 3420 Fifth Avenue Pittsburgh, PA 15213, 412.692.6677
- Department of Pediatrics, University of Pittsburgh School of Medicine
| | | | - Theresa Gmelin
- Department of Epidemiology, University of Pittsburgh School of Public Health
| | - Bradley D. Stein
- RAND Corporation, 4570 Fifth Avenue, Suite 600. Pittsburgh, Pennsylvania 15213, 412.683.2300,
| | - Elizabeth Miller
- Children’s Hospital of Pittsburgh of UPMC, Division of Adolescent and Young Adult Medicine, Oak-land Medical Building, 3420 Fifth Avenue Pittsburgh, PA 15213, 412.692.6677
- Department of Pediatrics, University of Pittsburgh School of Medicine
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Abstract
This qualitative study examined descriptions of social media use among 23 adolescents (18 female, 5 male) who were diagnosed with depression to explore how social media use may influence and be influenced by psychological distress. Adolescents described both positive and negative use of social media. Positive use included searching for positive content (i.e. for entertainment, humor, content creation) or for social connection. Negative use included sharing risky behaviors, cyberbullying, and for making self-denigrating comparisons with others. Adolescents described three types of use in further detail including "oversharing" (sharing updates at a high frequency or too much personal information), "stressed posting" (sharing negative updates with a social network), and encountering "triggering posts." In the context of treatment, these adolescents shifted their social media use patterns from what they perceived as negative to more positive use. Implications for clinicians counseling depressed adolescents on social media use are discussed.
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Affiliation(s)
- Ana Radovic
- Children's Hospital of Pittsburgh of UPMC, Division of Adolescent and Young Adult Medicine, Oakland Medical Building, 3420 Fifth Avenue, Pittsburgh, PA 15213, United States; Department of Pediatrics, University of Pittsburgh School of Medicine, United States.
| | - Theresa Gmelin
- Children's Hospital of Pittsburgh of UPMC, Division of Adolescent and Young Adult Medicine, Oakland Medical Building, 3420 Fifth Avenue, Pittsburgh, PA 15213, United States; Department of Pediatrics, University of Pittsburgh School of Medicine, United States.
| | - Bradley D Stein
- RAND Corporation, 4570 Fifth Avenue, Suite 600, Pittsburgh, PA 15213, United States.
| | - Elizabeth Miller
- Children's Hospital of Pittsburgh of UPMC, Division of Adolescent and Young Adult Medicine, Oakland Medical Building, 3420 Fifth Avenue, Pittsburgh, PA 15213, United States; Department of Pediatrics, University of Pittsburgh School of Medicine, United States.
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