A multilevel analysis of change in neighborhood walking activity in older adults

The article reports on a multilevel analysis conducted to examine change in neighborhood walking activity over a 12-month period in a community-based sample of 28 neighborhoods of 303 older adults age 65 and over. The study employed a multilevel (residents nested within neighborhoods) and longitudinal (4 repeated measures over 1 year) design and a multilevel analysis of change and predictors of change in neighborhood walking activity. Results indicated a significant neighborhood effect, with neighborhood-level walking characterized by a downward trajectory over time. Inclusion of baseline variables using selected perceived neighborhood-level social- and physical-environment measures indicated that neighborhoods with safe walking environments and access to physical activity facilities had lower rates of decline in walking activity. The findings provide preliminary evidence of neighborhood-level change and predictors of change in walking activity in older adults. They also suggest the importance of analyzing change in physical activity in older adults from a multilevel or macrolevel framework.     

Perceived barriers to walking in the neighborhood environment: a survey of middle-aged and older adults

The authors investigated whether low levels of walking among older adults in the UK were associated with demographic and health characteristics, as well as perceived environmental attributes. Survey data were obtained from self-administered standard questionnaires given to 680 people age 50+ (mean age 64.4 yr) attending nationally led walking schemes. Items concerned with demographic characteristics and perceived barriers to neighborhood walking were analyzed using multiple logistic regression. Citing more than 1 environmental barrier to walking, versus not, was associated with significantly reduced levels of (leisure) walking (MET/hr) in the preceding week (Z = -2.35, p = .019), but physical activity levels overall did not differ significantly (Z = -0.71, p = .48). Citing a health-related barrier to walking significantly adversely affected overall physical activity levels (Z = -2.72, p = .006). The authors concluded that, among older people who favor walking, health problems might more seriously affect overall physical activity levels than perceived environmental barriers.     

The effect of weather on walking behavior in older adults

In this article, the authors examine how temperature and precipitation affect the probability that a retired American between the ages of 65 and 90 walks at least 2.5 hr/wk, using longitudinal data on walking frequency from the Consumption and Activities Mail Survey, a subpanel in the Health and Retirement Survey. Walking behavior is linked with monthly temperature and precipitation data from weather-station reports. The authors found that higher temperatures were associated with a higher probability of walking at least 2.5 hr/wk for women. In contrast, higher temperatures are associated with a lower probability of walking at least 2.5 hr/wk among men. Precipitation is not significantly associated with walking behavior for either gender.     

Promoting walking among older adults living in retirement communities

The authors tested the feasibility and acceptability, and explored the outcomes, of 2 walking interventions based on ecological models among older adults living in retirement communities. An enhanced intervention (EI) was compared with a standard walking intervention (SI) among residents in 4 retirement facilities (N = 87 at baseline; mean age = 84.1 yr). All participants received a walking intervention including pedometers, printed materials, and biweekly group sessions. EI participants also received phone counseling and environmental-awareness components. Measures included pedometer step counts, activities of daily living, environment-related variables, physical function, depression, cognitive function, satisfaction, and adherence. Results indicated improvements among the total sample for step counts, neighborhood barriers, cognitive function, and satisfaction with walking opportunities. Satisfaction and adherence were high. Both walking interventions were feasible to implement among facility-dwelling older adults. Future studies can build on this multilevel approach.     

Natural neighborhood networks — Important social networks in the lives of older adults aging in place

Neighborhoods are important places of aging and meaningful contexts of life for many older people. The overall aim of this study was to explore the public life of older people aging in place in order to understand neighborhoods as the material places where public life occurs, networks as the social places of public life, and to examine how these neighborhoods and networks influence the experience of aging and wellbeing. Adopting a friendly visiting methodology, data was collected over an 8-month period using participant observation, visual methods and an innovative interview technique called the “go along method”. Data were analyzed using grounded theory and a coding strategy that integrated textual, visual, and auditory data. Results provide insights into the micro-territorial functioning of neighborhoods and highlight third places and transitory zones as significant sites for older residents. Embedded within these places is a natural neighborhood network — a web of informal relationships and interactions that enhance well being and shape the everyday social world of older adults aging in place.     

Neighborhood and individual factors in activity in older adults: results from the neighborhood and senior health study

This study examined whether features of the built environment and residents' perceptions of neighborhood walkability, safety, and social cohesion were associated with self-reported physical activity (PA) and community-based activity among a sample of 190 older adults (mean age 74) residing in 8 Denver neighborhoods. Neighborhood walking audits were conducted to assess walkability and social capital. In multilevel analyses, a few walkability variables including curb cuts, crosswalks, and density of retail predicted greater frequency of walking for errands (p < .05), but mean frequency of walking for errands for this sample was low (<1/wk). Contrary to expectations, total PA and community-based activity were highest in neighborhoods with fewer walkability variables but higher respondent perceptions of safety and social cohesion (p < .01). For seniors, the importance of characteristics of the built environment in promoting PA and general activity engagement might be secondary to attributes of the social environment that promote safety and social cohesion.     

The impact of unsupervised regular walking on health: a sample of Turkish middle-aged and older adults

Regular walking is one of the most recommended and popular physical activity worldwide. This study (1) detected the effects of unsupervised regular walking on physical and cognitive functioning, emotional status, and quality of life in middle-aged and older adults and (2) compared the results with inactive controls. Forty middle-aged and older adults with a mean age of 56.30 ± 4.85 years (range 40–70) walking for at least 1 year, at least three times a week, and at least 45 min a day and 40 inactive participants with a mean age of 55.15 ± 5.64 years (range 40–70) participated. Before testing, sociodemographics of the participants were recorded. Body mass index and waist–hip ratio were calculated. The two groups were evaluated and compared in terms of physical functioning (handgrip strength, balance performance, cardio-vascular endurance, flexibility, muscular endurance and coordination), cognitive functioning (Mini Mental Test), emotional status (Beck Depression Inventory), and health related quality of life (CDC HRQOL- 4). The results obtained from this study showed that there were significant differences in terms of all outcome measurements between the groups (p < 0.05). The regular walking group had better scores in most parameters than the inactive controls. The results indicate that unsupervised regular walking improves health and is also a safe, cheap, and can easily be adapted into daily life. Therefore, it can be recommended to improve physical and cognitive functioning, emotional status, and quality of life of middle-aged and older adults.     

The influence of familiarization sessions on the stability of ramp and ballistic isometric torque in older adults

Ramp isometric contractions determine peak torque (PT) and neuromuscular activation (NA), and ballistic contractions can be used to evaluate rate of torque development (RTD) and electrical mechanical delay (EMD). The purposes of this study were to assess the number of sessions required to stabilize ramp and ballistic PT and to compare PT and NA between contractions in older adults. Thirty-five older men and women (age 63.7 ± 3.7 yr, body mass 64.3 ± 10.7 kg, height 159.2 ± 6.6 cm) performed 4 sessions of unilateral ramp and ballistic isometric knee extension, 48 hr apart. PT significantly increased (main time effect p < .05) from the first to the third session, with no further improvements thereafter. There was a trend toward higher PT in ballistic than in ramp contractions. No difference between contraction types on EMG values was observed. Therefore, the authors suggest that 3 familiarization sessions be performed to correctly assess PT. In addition, PT, NA, RTD, and EMD can be assessed with ballistic contraction in older adults.     

Schizophrenia in older adults

Although the number of people older than 55 with schizophrenia is expected to double during the next 20 years, the research data on older adults with schizophrenia are limited. This appears to be because until the middle of the 20th century, it was assumed that mental illness in older adults was a part of the aging process and because older adults are often excluded from research investigations. Nursing research is needed to explore how people with schizophrenia learn to manage their problems as they age, as well as how those who are first diagnosed with schizophrenia in later life adapt to their illness. Mental health nurses need to be cautious in assigning premature labels to older adults with mental illness that may lead to unsubstantiated assumptions about levels of disability. Instead, nurses should realize individual potential regarding undiscovered strengths and should attempt to create interventions that recognize and foster personal development for older adults with schizophrenia.     

Power mobility and the built environment: the experiences of older Canadians

In this article, we employ data from qualitative interviews with 15 men and 14 women aged 51–92 to examine older Canadian adults’ experiences of utilizing power wheelchairs and motorized scooters in the context of the built environment. When functioning properly and utilized within accessible spaces, power mobility devices provided many of the participants with the autonomy they desired. However, the features and functionality of power mobility equipment also constrained participants’ abilities to negotiate their surroundings and maintain valued social roles and physical activities. Participants’ experiences of power mobility technology as enabling or disabling were further complicated by the organization of the built environment, as the men and women described encountering various barriers to mobility within both public and private spaces. We discuss our findings in relation to the extant literature concerning the social and spatial construction of disability.     

Chronic pain in older adults

Despite the sophisticated pharmaceutical agents and technologies available today, many people, including older adults, continue to experience chronic pain. Inadequately treated chronic pain can seriously affect one's quality of life. Health care providers are only beginning to understand the structural and functional changes that occur in older adults with chronic pain, but recent research suggests that nurses and other health professionals need to become aware of the unique needs of older adults who live with chronic pain. When health professionals lack specific knowledge of pain management in older adults, patients may suffer needlessly.     

Health literacy in older adults

Health literacy is a critical goal for nurses to address. Consider the patient who stated: They told me I was taking double the medication I was supposed to. I had two bottles, and I was taking one from each bottle, but it turned out they were the same medication. But since I didnt know how to read. I didn't know. (University of Virginia Health Systems, 2003). Many older adults struggle daily to manage their health care problems; compounding these dificulties with low literacy skills can be devastating. They need our help.     

Understanding hoarding in older adults

Compulsive hoarding is a debilitating disorder that is only recently becoming understood. Hoarding has been studied primarily in the general population, with only a few researchers focusing on hoarding in older adults, even though the prevalence and severity of the disorder appears to increase with aging. Hoarding seriously affects the quality of one's life and can also cause safety and health problems for individuals and the community. Established treatments for hoarding are relatively new and often need to be extended over a long period of time. Nurses can play an important role in helping identify the problem of hoarding in older adults, determining the types of safety and health hazards that need to be addressed, and contacting the appropriate community agencies.     

Prospective analysis of time out-of-home and objectively measured walking duration during a week in a large cohort of older adults

Background

Physical activity is considered an effective measure to promote health in older people. There is evidence that the number of outdoor trips increases physical activity by increasing walking duration. The objective of this study was to analyse the relationship between daily time out-of-home and walking duration. Furthermore, predictors for walking duration and time out-of-home were evaluated.

Methods

Walking duration was measured prospectively over a 1 week period by a body-fixed sensor and the time out-of-home was assessed by a questionnaire at the same days. Seven thousand, two hundred and forty-three days from 1289 older people (mean age 75.4 years) with both sensor-based measures and completed questionnaires were included in the analyses. To account for several observation days per participant multilevel regression analyses were applied. Analyses were stratified according to the time out-of-home (more or less than 100 min/day).

Results

In the group with less than 100 min out-of-home, each additional minute out-of-home added 20 s to overall walking duration. If the time exceeded 100 min the additional increase of walking duration was only moderate or weak. Leaving the home once added 40 min of walking, the following trips 15 to 20 min. Increasing age, lower gait speed, comorbidities, low temperature, rain and specific week days (Sunday) decreased both the time out-of-home and walking duration. Other variables like gender (female), isolation or living with a spouse reduced the time out-of-home without affecting walking duration.

Conclusions

Being out-of-home increases daily walking duration. The association is strongest if the time out-of-home is 100 min or less.

     

Racial/ethnic differences in asthma prevalence: the role of housing and neighborhood environments

This article examines the prevalence of asthma among New York City households from 10 racial/ethnic groups, and it explores whether differential exposure to potentially adverse housing and neighborhood conditions helps to mediate observed disparities. After adjusting for household size, Puerto Rican households exhibit the highest levels of asthma, followed by other Hispanic and black households. Mexican, Chinese, and Asian Indian households exhibit the lowest levels of asthma. Results from multilevel logistic regression models indicate that exposure to deteriorated housing conditions and perceptions of low social cohesion in the neighborhood significantly elevate the odds of asthma. Controlling for these conditions along with household characteristics reduces the disproportionately high levels of asthma among Puerto Rican and black households, although they remain significantly higher than the level among white households.     

Computer acceptance of older adults

Even though computers play a massive role in everyday life of modern societies, older adults, and especially older women, are less likely to use a computer, and they perform fewer activities on it than younger adults. To get a better understanding of the factors affecting older adults' intention towards and usage of computers, the Unified Theory of Acceptance and Usage of Technology (UTAUT) was applied as part of a more extensive study with 52 users and non-users of computers, ranging in age from 50 to 90 years. The model covers various aspects of computer usage in old age via four key constructs, namely performance expectancy, effort expectancy, social influences, and facilitating conditions, as well as the variables gender, age, experience, and voluntariness it. Interestingly, next to performance expectancy, facilitating conditions showed the strongest correlation with use as well as with intention. Effort expectancy showed no significant correlation with the intention of older adults to use a computer.     

Measuring influence in command games

In the paper, we study a relation between command games proposed by Hu and Shapley and an influence model. We show that our framework of influence is more general than the framework of the command games. We define several influence functions which capture the command structure. These functions are compatible with the command games, in the sense that each commandable player for a coalition in the command game is a follower of the coalition under the command influence function. Some of the presented influence functions are equivalent to the command games, that is, they are compatible with the command games, and additionally each follower of a coalition under the command influence function is also a commandable player for that coalition in the command games. For some influence functions we define the equivalent command games. We show that not for all influence functions the compatible command games exist. Moreover, we propose a more general definition of the influence index and show that under some assumptions, some power indices, which can be used in the command games, coincide with some expressions of the weighted influence indices. Both the Shapley–Shubik index and the Banzhaf index are equal to a difference between the weighted influence indices under some influence functions, and the only difference between these two power indices lies in the weights for the influence indices. An example of the Confucian model of society is broadly examined. The authors wish to gratefully thank two anonymous referees for useful suggestions concerning this paper.     

Representations of older adults in television advertisements

The purpose of the present study was to examine a comprehensive set of television advertisements, across networks and times of day, to determine how older adults are portrayed. Older adults appeared in 15% of advertisements, and in those ads, older women were underrepresented relative to men, and older adults appeared less frequently on youth-oriented networks and during the evening. Older adults tended to play incidental roles in the advertisements and to promote a circumscribed, stereotyped set of products and services. Moreover, their characters portrayed overwhelmingly positive attributes and traits. Results from the current study suggest ways in which portrayals in television advertisements might shape attitudes that viewers have about older adults and aging.