Community exercise program for older adults recovering from hip fracture: a pilot study

Community-based rehabilitative exercise programs might be an effective means to improve functional outcomes for hip-fracture patients. The purpose of this study was to evaluate the effectiveness of a community exercise program (CEP) for older adults recovering from hip fracture. Twenty-five older adults (mean age 80.0 +/- 6.0 years; 24 women; 71 +/- 23 days post-hip fracture) participated in this pilot study (17 exercise, 8 control). The CEP involved functional stepping and lower extremity-strengthening exercises. Control participants received only standard outpatient therapy. Measures of functional mobility, balance confidence, falls efficacy, lower extremity strength, and daily physical activity were evaluated at baseline and at 16 weeks. Improvements for self-reported physical activity, mobility, balance, and knee-extensor strength were observed for the CEP group. This study demonstrated that a CEP is beneficial for community-dwelling older adults post-hip fracture.     

Motives for and barriers to physical activity among older adults with mobility limitations

The purpose of this study was to investigate what older adults with severe, moderate, or no mobility limitation consider motives for and barriers to engaging in physical exercise. Community-dwelling adults (N=645) age 75-81 years completed a questionnaire about their motives for and barriers to physical exercise and answered interview questions on mobility limitation. Those with severely limited mobility more often reported poor health, fear and negative experiences, lack of company, and an unsuitable environment as barriers to exercise than did those with no mobility limitation. They also accentuated disease management as a motive for exercise, whereas those with no or moderate mobility limitation emphasized health promotion and positive experiences related to exercise. Information about differences in motives for and barriers to exercise among people with and without mobility limitation helps tailor support systems that support engagement in physical activity among older adults.     

Adherence to exercise programs and determinants of maintenance in older adults with mild cognitive impairment

After a randomized controlled trial showing that improvement on some aspects of cognitive function was related to adherence to an exercise program, determinants of adherence and maintenance were further studied. Older adults with mild cognitive impairment were contacted 6 mo after the end of exercise programs for a telephone interview addressing patterns of adherence and determinants of maintenance. Mean adherence during the trial was 53%. About one third of participants had lapses during the trial but completed, one third had no lapses, and one third dropped out or never started. Practical barriers (time, location) were related to not starting and functional limitations to dropout. After the trial 25% of participants continued the programs, 14% reported intention to continue, and 61% quit. Maintenance was determined by fewer health complaints, higher satisfaction with the programs, and better adherence during the programs. Although maintenance was low, this study identified several reasons and barriers to adherence and maintenance that could be addressed.     

Evaluating Social Integration and Psychological Outcomes for Older Adults Enrolled at a University Intergenerational Program

Abstract

Intergenerational programs are proliferating. The basic assumption of such programs is that pairing older and younger people in various activities and contexts such as educational programs will produce positive developmental benefits for all participants. Educational programs appear to help adults to remain socially active and connected. The University of Valencia (Spain) initiated in 1999–2000 a “University Program for Seniors” for adults age 55 and over, entitled “Nau Gran.”The goal of this paper is to present baseline results on the benefits and impacts for older adults enrolled at the program during 2002. Results from a sample of 212 sophomore and junior older adult participants are presented. The questionnaire included socio-demographic information and items regarding health, social integration, and psychological outcomes. Results indicated that older adults attending courses at the University increased their level of social integration.     

Exercise intervention designed to improve strength and dynamic balance among community-dwelling older adults

Loss of balance and falling are critical concerns for older adults. Physical activity can improve balance and decrease the risk of falling. The purpose of this study was to evaluate a simple, low-cost exercise program for community-dwelling older adults. Sixteen senior adults were evaluated using the Senior Fitness Test for measures of functional strength, aerobic endurance, dynamic balance and agility, and flexibility. In addition, measures of height, weight, resting blood pressure, blood lipids, and cognitive function were obtained. Participants then attended a 10-week exercise class including stretching, strengthening, and balance-training exercises. At the completion of the program, significant improvements were observed in tests measuring dynamic balance and agility, lower and upper extremity strength, and upper extremity flexibility. The results indicate that exercise programs such as this are an effective, low-cost solution to improving health and factors that affect falling risk among older adults.     

Construct validity and physical performance of older adults in different hierarchical physical-disability level

The purpose of this study was to test the construct validity of the hierarchical levels of self-reported physical disability using health-related variables and physical-performance tests as criteria. The study participants were a community-based sample of 368 adults age 60 years or older. These older adults were grouped into 4 levels according to their physical-disability status (able, mildly disabled, moderately disabled, and severely disabled groups) based on their self-reported measures on the mobility, instrumented activity of daily living (IADL), and activities of daily living (ADL) domains. Health-related variables (body-mass index, number of comorbidities, depression status, mental status, and self-perceived health status) and eight performance-based tests demonstrated significant group differences. Self-reported measures of physical disability can be used to categorize older adults into different stages of physical functional decline.     

Motivational factors influencing older adults diagnosed with knee osteoarthritis to join and maintain an exercise program

In order to provide successful interventions to increase physical activity among inactive older adults, it is imperative to understand motivational factors influencing exercise. The authors present data from 191 (baseline) and 125 (12-month) community-dwelling men and women with mean ages of 68.71 (7.47) and 67.55 (7.55) years, respectively, from a strength-training trial. Approximately 53% had diagnosed knee osteoarthritis. Using a Likert scale, participants self-reported their degree of motivation from personal, social, and environmental factors. Using multivariate analyses, the authors evaluated demographic and clinical correlates of motivational factors to join and continue with exercise. The following results were reported: Knee osteoarthritis was positively related to motivation from an organized exercise opportunity and from efficacy/outcome expectations, and knee pain was positively related to motivation from social support and experience with the exercise task. Understanding these motivators might help in targeting recruitment efforts and interventions designed to increase physical activity in older adults with lower extremity arthritis.     

Misconceptions about strength exercise among older adults

The purposes of this study were to determine current opinions of strength exercise among older adults and whether knowledge of recommended protocols differs between strength-exercise participants and nonparticipants. One hundred twenty-nine older adults (77.5 +/- 8.6 years) responded to questions about their opinions, experiences, and knowledge of strength-exercise recommendations. Some misconceptions were identified in the sample, with 48.4% of participants responding "no" to "strength training increases muscle mass," 45% responding "no" to "increasing weight is more important than number of repetitions for building strength," and 37% responding that walking is more effective than lifting weights at building muscle strength. The number of correct responses was related to the number of years in school (semipartial r(2)= .046). More education is needed about the benefits and recommendations to ensure proper use of current strength-exercise protocols among older adults.     

Older patient-physician discussions about exercise

This cross-sectional observational study examined the frequency of older patient-physician discussions about exercise, who initiates discussions, and the quality of questioning, informing, and support about exercise. The study used a convenience sample of 396 follow-up visits at 3 community-based practice sites, with 376 community-dwelling older patients and 43 primary-care physicians. Audiotapes were analyzed using the Multi-Dimensional Interaction Analysis coding system. Results demonstrate that exercise was discussed in 13% of visits and the subject was raised equally by patients and physicians. Exercise was significantly more likely to be discussed in dyadic visits (14.7%) than in triadic visits (4.1%). Patient level of education, patient overall physical health, and the physician's being female were significant predictors of the occurrence of exercise discussion. Given the importance of exercise for maintaining health and independence in older adults, more clinical and research attention is needed to address barriers to effective discussions in this area.     

Dropout from exercise programs for seniors: a prospective cohort study

This study examines dropout incidence, moment of dropout, and switching behavior in organized exercise programs for seniors in the Netherlands, as determined in a prospective cohort study (with baseline measurements at the start of the exercise program and follow-up after 6 months; N = 1,725, response rate 73%). Participants were community-living individuals 50+ who participated in different forms of organized exercise programs. The average dropout incidence was 0.15 per 6 months, which is lower than that for the general population. The dropout incidence and the timing of dropout differed substantially between the exercise programs. In total, 31% of people who dropped out of one type of exercise program switched to another type of exercise. The type of program and exercise had a strong effect on differences in this switching behavior. It is recommended that switching behavior be monitored in future studies.     

An Approach to Community Outreach Practice in the 21st Century

ABSTRACT

This article presents the findings of a study about knowledge, attitudes and beliefs about AIDS held by older Hispanic adults. Members of the convenience sample provided responses that identify concerns about effective practice in outeach and information provision to older adults with regard to risky sexual practices. Intervention to prevent the spread of HIV/AIDS among older adults needs to be culturally competent and to be attuned to social practices, traditions, community concerns, and generational perspectives with regard to serious health problems related to sexual behavior. The sample composition was primarily Hispanic (97.4%); Catholic, (92.1%) and female (84.2%) with a mean age of 73.7 years. Approximately 28.2% of those surveyed stated that they felt that AIDS was an important problem for older adults. The majority, (76.3%) were aware of locations where health information and services were available if AIDS were a problem. Even though the majority indicated knowledge that AIDS is spread through sexual intercourse, more than one third, (36.8%) thought that sexually active adults 55 and over never use condoms. A discussion of the implications for disease prevention programs and community practice is presented emphasizing the importance of empowerment strategies in health promotion programs and the strengthening of multidisciplinary collaborative efforts to effect positive community health changes.     

A proposal for a new screening paradigm and tool called Exercise Assessment and Screening for You (EASY)

The Exercise Assessment and Screening for You (EASY) is a tool developed to help older individuals, their health care providers, and exercise professionals identify different types of exercise and physical activity regimens that can be tailored to meet the existing health conditions, illnesses, or disabilities of older adults. The EASY tool includes 6 screening questions that were developed based on an expert roundtable and follow-up panel activities. The philosophy behind the EASY is that screening should be a dynamic process in which participants learn to appreciate the importance of engaging in regular exercise, attending to health changes, recognizing a full range of signs and symptoms that might indicate potentially harmful events, and becoming familiar with simple safety tips for initiating and progressively increasing physical activity patterns. Representing a paradigm shift from traditional screening approaches that focus on potential risks of exercising, this tool emphasizes the benefits of exercise and physical activity for all individuals.     

The Phone-FITT: a brief physical activity interview for older adults

The purpose of this study was to develop a brief physical activity interview for older adults (Phone-FITT) and evaluate its test-retest reliability and validity. Summary scores were derived for household, recreational, and total PA. Reliability was evaluated in a convenience sample from a fall-prevention study (N = 43, 79.4 +/- 2.9 years, 51% male), and validity, in a random sample of individuals in older adult exercise programs (N = 48, 77.4 +/- 4.7 years, 25% male). Mean time to complete the Phone-FITT was 10 min for participants sampled from exercise programs. Evaluation of test-retest reliability indicated substantial to almost perfect agreement for all scores, with intraclass correlation coefficients (95% confidence intervals) ranging from .74 (.58-.85) to .88 (.8-.94). For validity, Spearman's rho correlations of Phone-FITT scores with accelerometer counts ranged from .29 (.01-.53) to .57 (.34-.73). Correlations of Phone-FITT recreational scores with age and seconds to complete a self-paced step test ranged from -.29 (-.53 to -.01) to -.45 (-.68 to -.14). This study contributes preliminary evidence of the reliability and validity of the Phone-FITT.     

Exercise behavior in older adults: a test of the transtheoretical model

The transtheoretical model (TTM) was developed as a guide for understanding behavior change. Little attention has been given, however, to the appropriateness of the TTM for explaining the adoption of exercise behavior in older adults. The purposes of this study were to determine the reliability of the TTM instruments and validate TTM predictions in 86 community-dwelling older adults (mean age 75.1 +/- 7.0 years, 87% women) who were participants in a 16-week walking program. TTM construct scales--self-efficacy, decisional balance (pros and cons), and processes of change (behavioral and cognitive)--were generally reliable (all>.78). Behavioral processes of change increased from baseline to follow-up, but pros, cons, and cognitive processes did not change among participants who became regular exercisers. Stage of change did not predict exercise adoption, but baseline self-efficacy predicted walking behavior. These results lend partial support to the TTM in predicting exercise behavior.     

Does yoga engender fitness in older adults? A critical review

Interest in yoga is growing, especially among older adults. This review critically summarizes the current literature to investigate whether physical fitness and function benefits are engendered through the practice of yoga in older adults. A comprehensive search yielded 507 studies; 10 studies with 544 participants (69.6 ± 6.3 yr, 71% female) were included. Large variability in yoga styles and measurement outcomes make it challenging to interpret results across studies. Studies reported moderate improvements for gait (ES = 0.54, 0.80), balance (ES = 0.25-1.61), upper/lower body flexibility (ES = 0.25, 0.70), lower body strength (ES = 0.51), and weight loss (ES = 0.73, 0.99).Yoga may engender improvements in some components of fitness in older adults. However, more evidence is needed to determine its effectiveness as an alternative exercise to promote fitness in older adults. Further investigation into yoga as an exercise activity for older adults is warranted.     

Motivational factors and physician advice for physical activity in older urban adults

This study aimed to ascertain by means of a new scale older adults' motives for engaging in physical activity, in a probability and representative sample of an older urban population. The sample size was 630 older adults, ranging from 65 to 94 years in age, randomly selected using multistage sampling. The participants completed a 17-item questionnaire, as well as answering questions on demographic variables, type of demand for physical activity, and physician's recommendation. A principal-component analysis was performed. The relationships among the four factors (physical health, social relationships, competence, and physician's advice) show a clearly motivational structure. Significant relationships have also been found between physician's recommendation and type of demand. The findings suggest that programs promoting physical activity in older adults should have different characteristics from those aimed at general adult populations.     

Older Adults’ Receipt of Financial Help: Does Personality Matter?

This study examined the role of personality traits in the receipt of financial help at older ages using the 2006 and 2008 waves of Health and Retirement Study data. An investigation of (1) how the five domains of personality traits (openness to experience, conscientiousness, extraversion, agreeableness, and neuroticism) are associated with the receipt of financial help among older adults and (2) the relationship between personality traits and the source of financial help received was examined. Three sets of probit analyses were conducted. The results indicated that personality can predict financial help and the source of financial help. Specifically, older adults who exhibited relatively higher levels of neuroticism and agreeableness were more likely to receive financial help, whereas those who exhibited relatively higher levels of conscientiousness were less likely to receive financial help regardless of the source. Furthermore, older adults who had relatively higher levels of neuroticism were more likely to help themselves with individual sources such as credit cards whereas agreeable older adults were more likely to receive financial help from family members. These findings have implications for financial counseling, planning and education professionals, public assistance program directors, and policy makers. Understanding the effect of personality on financial decision-making can help with financial planning throughout life and inform outreach efforts for those in need of financial help.     

Disparities in Access to Health Care Among Middle-Aged and Older Adults with Disabilities

Disability is increasing among middle-aged adults and, reversing earlier trends, increasing among older adults as well. Disability is experienced disproportionately by Black and lower socioeconomic status (SES) individuals. We used Medical Expenditure Panel Survey data to examine health care disparities in access to health care for middle-aged (31 to 64 years of age) and older (65+ years of age) adults with disabilities by race and ethnicity, education, and income (n = 13,174). Using logistic regression, we examined three measures of potential (e.g., usual source of care), and three measures of realized (e.g., counseling related to smoking) access. Middle-aged and older minority individuals with disabilities had lower relative risks of having usual sources of care and higher relative risks of having suboptimal usual sources of care (e.g., a place rather than a person) than White adults with disabilities. There were SES effects observed for middle-aged adults with disabilities across most measures that were, for certain measures, more pronounced than SES effects among older adults with disabilities. These findings are important, since health resources (e.g., a usual source of care) may mediate relations among disability, morbidity, and mortality. Policy actions that may mitigate the disparities we observed include financial incentives to support access to an optimal usual source of care and mechanisms to foster behavioral interventions related to smoking and exercise. Ensuring that these actions address the specific concerns of individuals with disabilities, such as physical accessibility and provider cultural competency, is essential.     

Item-response-theory analysis of two scales for self-efficacy for exercise behavior in people with arthritis

Benefits of physical activity for those with arthritis are clear, yet physical activity is difficult to initiate and maintain. Self-efficacy is a key modifiable psychosocial determinant of physical activity. This study examined two scales for self-efficacy for exercise behavior (SEEB) to identify their strengths and weaknesses using item response theory (IRT) from community-based randomized controlled trials of physical activity programs in adults with arthritis. The 2 SEEB scales included the 9-item scale by Resnick developed with older adults and the 5-item scale by Marcus developed with employed adults. All IRT analyses were conducted using the graded-response model. IRT assumptions were assessed using both exploratory and confirmatory factor analysis. The IRT analyses indicated that these scales are precise and reliable measures for identifying people with arthritis and low SEEB. The Resnick SEEB scale is slightly more precise at lower levels of self-efficacy in older adults with arthritis.