Topical Collection "Aging and Public Health"

Editors

Prof. Dr. Matthew Lee Smith
Website
Collection Editor
Center for Population Health and Aging, Texas A&M University, 212 Adriance Lab Road, TAMU 1266, College Station, TX 77843, USA
Department of Environmental and Occupational Health, Texas A&M School of Public Health, 212 Adriance Lab Road, TAMU 1266, College Station, TX 77843, USA
Special Issues and Collections in MDPI journals
Prof. Dr. Marcia G. Ory
Website
Collection Editor
Center for Population Health and Aging, Texas A&M University, 212 Adriance Lab Road, TAMU 1266, College Station, TX 77843, USA
Strategic Partnerships and Initiatives, Texas A&M Health Science Center, College Station, TX 77843, USA Department of Environmental and Occupational Health, Texas A&M School of Public Health, College Station, TX 77843, USA

Topical Collection Information

Dear Colleagues,

With the world-wide growth of the older adult population, there is increased concern about the impact of aging-related consequences on health and healthcare utilization. While individuals can encounter many problems as they age, two of the most pressing issues facing older adults are falls and chronic disease. The direct and indirect costs of these public health issues are enormous and growing. Many of the known risks for falls are associated with inadequate disease management (e.g., physical activity, medication, communication with healthcare providers), which makes strategies to address these issues highly interrelated. Over the past decade, there has been an emergence of large initiatives to reduce the burden of falls and chronic conditions that draw upon evidence-based programs (EBP) and practices in community, clinical, and industry settings. Often these efforts are translational in nature and integrate technology. Additional research is needed to document the reach and effectiveness of these interventions and advance their implementation, dissemination, and sustainability. 

This Topical Collection features a spectrum of articles about health among older adults. Articles being solicited include those that address: (1) health-related risk factors; (2) physical, mental, and social aspects of health and well-being; (3) interventions and programs influencing health status, functioning, and quality of life; and (4) strategies to engage older adults in healthy behaviors, enhance the delivery of EBP, develop infrastructure and networks to support healthy aging. 

This Topical Collection will advance healthy aging by contributing to what is known about health risk among older adults and opportunities to promote population health and aging. Further, this Topical Collection will inform practice, policy, and research needed to develop and nurture systems of support for evidence-based programs and strategies.

Prof. Dr. Matthew Lee Smith
Prof. Dr. Marcia G. Ory
Collection Editors

Manuscript Submission Information

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2000 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Aging
  • Public health
  • Behavioral intervention
  • Fall prevention
  • Physical activity
  • Mental health
  • Medication management
  • Aging-in-place
  • Built environment
  • Technology
  • Translational research
  • Dissemination
  • Implementation
  • Evidence-based programs
  • Quality of life
  • Chronic disease management

Published Papers (71 papers)

2020

Jump to: 2019, 2018, 2017

Open AccessArticle
A Brief Intervention for Malnutrition among Older Adults: Stepping Up Your Nutrition
Int. J. Environ. Res. Public Health 2020, 17(10), 3590; https://doi.org/10.3390/ijerph17103590 - 20 May 2020
Abstract
Despite a multitude of nutritional risk factors among older adults, there is a lack of community-based programs and activities that screen for malnutrition and address modifiable risk among this vulnerable population. Given the known association of protein and fluid consumption with fall-related risk [...] Read more.
Despite a multitude of nutritional risk factors among older adults, there is a lack of community-based programs and activities that screen for malnutrition and address modifiable risk among this vulnerable population. Given the known association of protein and fluid consumption with fall-related risk among older adults and the high prevalence of falls among Americans age 65 years and older each year, a brief intervention was created. Stepping Up Your Nutrition (SUYN) is a 2.5 h workshop developed through a public/private partnership to motivate older adults to reduce their malnutrition risk. The purposes of this naturalistic workshop dissemination were to: (1) describe the SUYN brief intervention; (2) identify participant characteristics associated with malnutrition risk; and (3) identify participant characteristics associated with subsequent participation in Stepping On (SO), an evidence-based fall prevention program. Data were analyzed from 429 SUYN participants, of which 38% (n = 163) subsequently attended SO. As measured by the SCREEN II®, high and moderate malnutrition risk scores were reported among approximately 71% and 20% of SUYN participants, respectively. Of the SUYN participants with high malnutrition risk, a significantly larger proportion attended a subsequent SO workshop (79.1%) compared to SUYN participants who did not proceed to SO (65.8%) (χ2 = 8.73, p = 0.013). Findings suggest SUYN may help to identify malnutrition risk among community-dwelling older adults and link them to needed services like evidence-based programs. Efforts are needed to expand the delivery infrastructure of SUYN to reach more at-risk older adults. Full article
Open AccessArticle
Ageism, Healthy Life Expectancy and Population Ageing: How Are They Related?
Int. J. Environ. Res. Public Health 2020, 17(9), 3159; https://doi.org/10.3390/ijerph17093159 - 01 May 2020
Abstract
Evidence shows that ageism negatively impacts the health of older adults. However, estimates of its prevalence are lacking. This study aimed to estimate the global prevalence of ageism towards older adults and to explore possible explanatory factors. Data were included from 57 countries [...] Read more.
Evidence shows that ageism negatively impacts the health of older adults. However, estimates of its prevalence are lacking. This study aimed to estimate the global prevalence of ageism towards older adults and to explore possible explanatory factors. Data were included from 57 countries that took part in Wave 6 of the World Values Survey. Multilevel Latent Class Analysis was performed to identify distinct classes of individuals and countries. Individuals were classified as having high, moderate or low ageist attitudes; and countries as being highly, moderately or minimally ageist, by aggregating individual responses. Individual-level (age, sex, education and wealth) and contextual-level factors (healthy life expectancy, population health status and proportion of the population aged over 60 years) were examined as potential explanatory factors in multinomial logistic regression. From the 83,034 participants included, 44%, 32% and 24% were classified as having low, moderate and high ageist attitudes, respectively. From the 57 countries, 34 were classified as moderately or highly ageist. The likelihood of an individual or a country being ageist was significantly reduced by increases in healthy life expectancy and the proportion of older people within a country. Certain personal characteristics—younger age, being male and having lower education—were significantly associated with an increased probability of an individual having high ageist attitudes. At least one in every two people included in this study had moderate or high ageist attitudes. Despite the issue’s magnitude and negative health impacts, ageism remains a neglected global health issue. Full article
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Open AccessArticle
Association between Daily Living Walking Speed and Walking Speed in Laboratory Settings in Healthy Older Adults
Int. J. Environ. Res. Public Health 2020, 17(8), 2707; https://doi.org/10.3390/ijerph17082707 - 15 Apr 2020
Abstract
Although there is evidence on the predictors of adverse health outcomes in older individuals, walking speed has typically been measured in laboratory settings (LWS); LWS may be distinct from individuals’ actual walking speed in their daily lives (DWS). We examined whether DWS differs [...] Read more.
Although there is evidence on the predictors of adverse health outcomes in older individuals, walking speed has typically been measured in laboratory settings (LWS); LWS may be distinct from individuals’ actual walking speed in their daily lives (DWS). We examined whether DWS differs from LWS among older adults, and its association with physical frailty. Participants were 90 community-dwelling older adults. A five-meter normal (LWSnor) and maximum (LWSmax) walking speed was measured with a stopwatch. DWS was measured using a global positioning system-related smartphone application for one month during their daily lives. DWSavr, DWSmax, and DWSsd were defined as the average, maximum, and standard deviation of walking speed for one month. Participants’ mean DWSavr and DWSmax were 1.28 m/s and 2.14 m/s, respectively, significantly slower than the mean LWSnor (1.42 m/s) and LWSmax (2.24 m/s); the intraclass correlation coefficient between DWS and LWS were 0.188 to 0.341. DWS was significantly correlated with grip strength, one-legged stance, and LWS. The area under the receiver operating characteristic curve of DWSsd concerning pre-frailty was largest among DWSs, at 0.615, while that of LWSnor was 0.643. The findings suggest that DWS differs from LWS and is associated with physical function and pre-frailty. Full article
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Open AccessArticle
Sexually Transmitted Infection Knowledge among Older Adults: Psychometrics and Test–Retest Reliability
Int. J. Environ. Res. Public Health 2020, 17(7), 2462; https://doi.org/10.3390/ijerph17072462 - 03 Apr 2020
Abstract
Sexually transmitted infections (STI) among older adults have dramatically increased in recent years, especially among those who are widowed and divorced. The purposes of this study were to: (1) identify STI-related knowledge among older adults; (2) report the psychometric properties of a tool [...] Read more.
Sexually transmitted infections (STI) among older adults have dramatically increased in recent years, especially among those who are widowed and divorced. The purposes of this study were to: (1) identify STI-related knowledge among older adults; (2) report the psychometric properties of a tool commonly used to assess STI-related knowledge among younger populations using data from adults 65 years and older; and (3) determine test-retest reliability of the tool. Data were analyzed from 43 adults, aged 65–94 years, using the 27-item Sexually Transmitted Disease Knowledge Questionnaire (STD-KQ). Participants completed identical instruments on two separate days with approximately two weeks between. After responses were coded for correctness, composite scores were created. Cronbach’s reliability coefficients were calculated to determine response consistency, and Pearson’s r coefficients were used to assess test–retest reliability. Of 27 possible correct answers, participants reported an average of 11.47 (±6.88) correct responses on Day 1 and 11.67 (±7.33) correct responses on Day 2. Cronbach’s alpha coefficients for the 27-item composite scale were high for both days (0.905 and 0.917, respectively), which indicates strong response consistency. Pearson’s r coefficients were high between responses for the 27-item composite scale on Days 1 and 2 (r = 0.882, P < 0.01), which indicates strong test–retest reliability. Pearson’s r coefficients were high between responses for all but three of the 27 items when assessed separately. Findings suggest the utility of the STD-KQ to assess STI knowledge among older adults. However, the consistently low knowledge scores highlight the need for educational interventions among this population. Full article
Open AccessArticle
Cognitive Function and Mortality: Results from Kaunas HAPIEE Study 2006–2017
Int. J. Environ. Res. Public Health 2020, 17(7), 2397; https://doi.org/10.3390/ijerph17072397 - 01 Apr 2020
Abstract
Background: The purpose of the study is to evaluate the association between cognitive function and risk of all-cause and cardiovascular disease mortality during 10 years of the follow-up. Methods: 7087 participants were assessed in the baseline survey of the Health Alcohol Psychosocial Factors [...] Read more.
Background: The purpose of the study is to evaluate the association between cognitive function and risk of all-cause and cardiovascular disease mortality during 10 years of the follow-up. Methods: 7087 participants were assessed in the baseline survey of the Health Alcohol Psychosocial Factors in Eastern Europe (HAPIEE) study in 2006–2008. During 10 years of follow-up, all-cause and CVD mortality risk were evaluated. Results: During 10 years of follow-up, 768 (23%) men and 403 (11%) women died (239 and 107 from CVD). After adjustment for sociodemographic, biological, lifestyle factors, and illnesses, a decrease per 1 standard deviation in different cognitive function scores increased risk for all-cause mortality (by 13%–24% in men, and 17%–33% in women) and CVD mortality (by 19%–32% in men, and 69%–91% in women). Kaplan-Meier survival curves for all-cause and CVD mortality, according to tertiles of cognitive function, revealed that the lowest cognitive function (1st tertile) predicts shorter survival compared to second and third tertiles (p < 0.001). Conclusions: The findings of this follow-up study suggest that older participants with lower cognitive functions have an increased risk for all-cause and CVD mortality compared to older participants with a higher level of cognitive function. Full article
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Open AccessArticle
Reference Values and Correlations for Multiple Physical Performance Measures: A Cross-Sectional Study among Independently Mobile Older Men in Japan
Int. J. Environ. Res. Public Health 2020, 17(7), 2305; https://doi.org/10.3390/ijerph17072305 - 30 Mar 2020
Abstract
Purpose: Japan is one of few countries with a male life expectancy over 80 years. The gap between the healthy life span and the total life expectancy is large, highlighting the importance of maintaining physical performance. The present study aims to establish reference [...] Read more.
Purpose: Japan is one of few countries with a male life expectancy over 80 years. The gap between the healthy life span and the total life expectancy is large, highlighting the importance of maintaining physical performance. The present study aims to establish reference values for multiple physical performance measures among high-functioning oldest-old Japanese men and to investigate the correlations among these measurements to understand how these variables are related. Methods: This study was conducted with 120 Japanese males aged 80 years or older who were able to walk independently. Seven measures of physical performance were assessed: handgrip strength, quadriceps strength, static balance ability (one-legged stance), dynamic balance ability (Functional Reach Test; FRT), walking ability (5-m walking time test), combined movement ability (Timed Up & Go test), and bone quality. Cognitive function was also measured (Mini-Mental State Examination; MMSE). Results: Specific reference values are reported for each physical performance measurement explored in this study. Only six participants were classified as cognitively impaired, and 16 had mild cognitive impairment. There were significant correlations of varying levels among all of the measures of physical performance. Age was significantly correlated with all performance measures except FRT, and there was no correlation between age and MMSE. MMSE was weakly correlated with FRT and unrelated to the other performance measures. Conclusions: The reference ranges can be used by older men who have not yet reached 80 years and their health care providers as physical performance targets to facilitate the maintenance of independent mobility in later life. Full article
Open AccessArticle
Association of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) with Muscle Strength in Community-Dwelling Elderly with Knee Osteoarthritis
Int. J. Environ. Res. Public Health 2020, 17(7), 2260; https://doi.org/10.3390/ijerph17072260 - 27 Mar 2020
Abstract
Purpose: The purpose of this study was to evaluate the correlation between muscle strength and knee symptoms (pain, stiffness, and functional limitation) regardless of the presence of radiologic knee osteoarthritis (RKOA) in community-dwelling elderly. Patients and methods: This cross-sectional study used data from [...] Read more.
Purpose: The purpose of this study was to evaluate the correlation between muscle strength and knee symptoms (pain, stiffness, and functional limitation) regardless of the presence of radiologic knee osteoarthritis (RKOA) in community-dwelling elderly. Patients and methods: This cross-sectional study used data from the Namgaram-2 cohort. The Namgaram-2 cohort consisted of participants living in three rural communities. Such participants were included for studies on activity limitation due to age-related musculoskeletal disorders including knee osteoarthritis, osteoporosis, and sarcopenia. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), a health assessment tool for patients with arthritis in lower extremities, was used to assess health-related quality of life (HRQOL). Muscle strengths were measured by knee strength (by using the isokinetic dynamometer) and hand grip strength. Results: The WOMAC pain of Kallgren–Lawrence (K/L) grade < 2 was correlated with age, grip strength, nutrition status, and knee extension 180 peak torque. The WOMAC pain of K/L grade ≥ 2 was correlated with age, nutrition status, and knee extension 60 peak torque. The WOMAC stiffness of K/L grade < 2 was correlated with having a spouse, nutrition status, and knee extension 60 peak torque. The WOMAC stiffness of K/L grade ≥ 2 was correlated with knee extension 60 peak torque. The WOMAC function of K/L grade < 2 was correlated with age, grip strength, osteoporosis, nutrition status, and knee extension 180 peak torque. The WOMAC function of K/L grade ≥ 2 was correlated with age, nutrition status, and knee extension 60 peak torque. Conclusion: Muscle strength as measured by grip strength and knee extension was statistically significantly correlated with the WOMAC scores in patients with knee symptoms regardless of whether radiologic signs of knee osteoarthritis were observed. Full article
Open AccessArticle
Knee Osteoarthritis Grade Does Not Correlate with Quadriceps Muscle Strength or Bone Properties of the Calcaneus in Men Aged 80 Years or More Who Can Walk Independently
Int. J. Environ. Res. Public Health 2020, 17(5), 1709; https://doi.org/10.3390/ijerph17051709 - 05 Mar 2020
Abstract
Purpose: Muscle weakness and bone deterioration in the elderly are related to falls and fractures, resulting in decreased mobility. Knee osteoarthritis also may contribute to falls and fractures and thereby affect mortality rates. The Kellgren–Lawrence (KL) classification is widely used in the radiographic [...] Read more.
Purpose: Muscle weakness and bone deterioration in the elderly are related to falls and fractures, resulting in decreased mobility. Knee osteoarthritis also may contribute to falls and fractures and thereby affect mortality rates. The Kellgren–Lawrence (KL) classification is widely used in the radiographic evaluation of knee osteoarthritis. Aims: This study aimed to evaluate the quadriceps strength and bone properties of the calcaneus for each KL grade, and to clarify the impact of knee osteoarthritis grade on quadriceps strength and bone properties. Methods: This prospective cross-sectional study included data on 108 male patients (213 knees), aged ≥80 years, who could walk independently. A handheld dynamometer was used to measure quadriceps strength. Bone properties were evaluated using broadband ultrasound attenuation with a portable bone densitometer. Weight-bearing standing knee radiographs were evaluated using KL classification. Quadriceps strength and bone properties were evaluated for each KL grade and the correlations between the grade and quadriceps strength and bone properties were assessed simultaneously. Results: The numbers of participants in KL grades I–IV were 46, 102, 45, and 20, respectively. There were no differences among grades for either quadriceps strength or bone properties. Conclusions: Participants exhibited good quadriceps strength and bone properties regardless of their KL grade. Relatively high mechanical loading of muscle and bone incurred while walking independently, likely explaining this result. Clinically, this study demonstrated the absence of correlations between KL grade and quadriceps strength and bone properties, as was previously reported in studies showing the absence of a correlation between KL grade and pain. Full article
Open AccessArticle
Heuristic Evaluation of an IoMT System for Remote Health Monitoring in Senior Care
Int. J. Environ. Res. Public Health 2020, 17(5), 1586; https://doi.org/10.3390/ijerph17051586 - 01 Mar 2020
Cited by 1
Abstract
This paper presents the usability assessment of the design of an Internet of Medical Things (IoMT) system for older adults; the evaluation, using heuristics, was held early on the design process to assess potential problems with the system and was found to be [...] Read more.
This paper presents the usability assessment of the design of an Internet of Medical Things (IoMT) system for older adults; the evaluation, using heuristics, was held early on the design process to assess potential problems with the system and was found to be an efficient method to find issues with the application design and led to significant usability improvements on the IoMT platform. Full article
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Open AccessArticle
External Validation of the ‘PHYT in Dementia’, a Theoretical Model Promoting Physical Activity in People with Dementia
Int. J. Environ. Res. Public Health 2020, 17(5), 1544; https://doi.org/10.3390/ijerph17051544 - 28 Feb 2020
Abstract
Physical activity is beneficial for people with dementia. We previously developed a theoretical model to explain behaviour change in physical activity in dementia (PHYT-in-dementia). This study aimed to externally validate the model. Validation occurred through the process evaluation of a programme promoting activity [...] Read more.
Physical activity is beneficial for people with dementia. We previously developed a theoretical model to explain behaviour change in physical activity in dementia (PHYT-in-dementia). This study aimed to externally validate the model. Validation occurred through the process evaluation of a programme promoting activity in people with dementia (PrAISED 2). Twenty participants with dementia and their carers were interviewed to investigate their experience of the programme. The data were analysed through content analysis. The original constructs of the model were used as initial codes and new codes were generated, if elicited from the data. The constructs were also ranked, based on their frequency in the interviews. All of the original model constructs were validated and two novel constructs created: ‘personal history’ and ‘information/knowledge’. Certain constructs (e.g., support) were more frequently mentioned than others (e.g., personal beliefs). We suggested modifications and integrated them into a revised model. The PHYT-in-dementia recognised that dementia has an impact on motivation to initiate and maintain behaviour change over time. The model advocates that interventions adopt a more holistic approach than traditional behaviour change strategies. The suggested revisions require further validation to accurately predict behaviour change in physical activity in people with dementia. Full article
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Open AccessArticle
Relationship between Cortisol Changes during the Night and Subjective and Objective Sleep Quality in Healthy Older People
Int. J. Environ. Res. Public Health 2020, 17(4), 1264; https://doi.org/10.3390/ijerph17041264 - 16 Feb 2020
Abstract
The aim of this study was to investigate whether the nighttime cortisol release was associated with subjective and objective sleep quality and the discrepancy between them. Forty-five healthy older adults (age range from 56 to 75 years) collected salivary samples immediately before sleep [...] Read more.
The aim of this study was to investigate whether the nighttime cortisol release was associated with subjective and objective sleep quality and the discrepancy between them. Forty-five healthy older adults (age range from 56 to 75 years) collected salivary samples immediately before sleep and immediately after awakening on two consecutive nights. Actigraphy was used to assess objective sleep quality and quantity. A sleep diary was used to assess subjective sleep quality. Linear mixed models were performed using subjective and objective sleep quality data from 76 nights to investigate between-subject associations. We observed that larger changes in cortisol levels between sleep onset and awakening, reflecting a healthier circadian rhythm of the Hypothalamic-Pituitary-Adrenal (HPA) axis, were associated with better subjective sleep quality, but not with objective sleep quality. Moreover, smaller changes in nighttime cortisol were associated with lower subjective sleep quality relative to objective sleep quality. All these results were observed even after controlling for important confounders such as sleep quantity, age, sex, subjective socioeconomic status, stress perception, depression, physical activity, and adherence to the salivary sampling protocol. This study demonstrates that subjective sleep quality in older people may be explained, to some extent, by the activity of the HPA axis. Full article
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2019

Jump to: 2020, 2018, 2017

Open AccessArticle
Twelve Weeks of Combined Resistance and Aerobic Exercise Improves Cardiometabolic Biomarkers and Enhances Red Blood Cell Hemorheological Function in Obese Older Men: A Randomized Controlled Trial
Int. J. Environ. Res. Public Health 2019, 16(24), 5020; https://doi.org/10.3390/ijerph16245020 - 10 Dec 2019
Cited by 2
Abstract
The present study examined the effect of a 12-week combined resistance and aerobic exercise training program on cardiometabolic biomarkers and red blood cell (RBC) hemorheological function in 20 obese older men (mean age: 68.8 ± 0.9 years). Subjects were randomly divided into two [...] Read more.
The present study examined the effect of a 12-week combined resistance and aerobic exercise training program on cardiometabolic biomarkers and red blood cell (RBC) hemorheological function in 20 obese older men (mean age: 68.8 ± 0.9 years). Subjects were randomly divided into two groups (exercise intervention [EXP; n = 10] and control [CON; n = 10]). The EXP subjects performed resistance and aerobic exercise training program three times per week for 12 weeks, and the CON subjects maintained their regular lifestyle during the intervention period. Body composition was estimated using bioelectrical impedance analysis equipment. Cardiometabolic biomarkers (glucose, insulin, homeostasis model assessment-estimated insulin resistance (HOMA-IR), HOMA β-cell function, and leptin) and RBC hemorheological parameters (RBC deformability and aggregation) were analyzed. Percent body fat decreased significantly in the EXP group during the intervention period but increased significantly in the CON group. Insulin increased significantly in the CON group over the 12-week period and both insulin and HOMA-IR were significantly higher in the CON group than in the EXP group at post-test. RBC deformability (RBC EI_3Pa) and aggregation (RBC AI_3Pa) improved significantly only in the EXP group. The present study suggests that combined exercise training can be useful for improving cardiometabolic biomarkers and RBC hemorheological parameters in obese older men and may help prevent metabolic syndrome and cardiovascular diseases. Full article
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Open AccessArticle
Does Loneliness Predict Subsequent Use of Flu Vaccination? Findings from a Nationally Representative Study of Older Adults in Germany
Int. J. Environ. Res. Public Health 2019, 16(24), 4978; https://doi.org/10.3390/ijerph16244978 - 07 Dec 2019
Cited by 1
Abstract
There is a lack of studies investigating whether loneliness predicts subsequent use of flu vaccination. Therefore, we aimed to clarify this relationship. Data were drawn from two waves (second wave took place in 2002, third wave took place in 2008) of a nationally [...] Read more.
There is a lack of studies investigating whether loneliness predicts subsequent use of flu vaccination. Therefore, we aimed to clarify this relationship. Data were drawn from two waves (second wave took place in 2002, third wave took place in 2008) of a nationally representative cohort of community-dwelling individuals in Germany. The sample was restricted to individuals ≥60 years for whom flu vaccination is recommended. Loneliness was quantified using the De Jong Gierveld Loneliness Scale (second wave). Flu vaccination in the past 12 months was assessed (third wave). Consequently, older individuals that participated in the second wave and reported flu vaccination in the third wave were included (n = 970). The other waves (e.g., first wave) were excluded for reasons of data availability. Increased loneliness was associated with subsequent decreased use of the flu vaccine. Moreover, the probability of flu vaccination in the third wave was positively associated with being retired (ref.: employed), having a lower income, and the number of physical illnesses in the second wave. Findings stressed the importance of loneliness in the decreased use of the flu vaccine. Preventing loneliness may also help to increase flu vaccination rates. Full article
Open AccessArticle
Happiness and Cognitive Impairment Among Older Adults: Investigating the Mediational Roles of Disability, Depression, Social Contact Frequency, and Loneliness
Int. J. Environ. Res. Public Health 2019, 16(24), 4954; https://doi.org/10.3390/ijerph16244954 - 06 Dec 2019
Abstract
Background: Understanding the lower level of happiness among older adults with cognitive impairment has been a largely neglected issue. This study (1) reports on the level of happiness among older adults in Singapore and (2) examines the potential mediating roles of depression, disability, [...] Read more.
Background: Understanding the lower level of happiness among older adults with cognitive impairment has been a largely neglected issue. This study (1) reports on the level of happiness among older adults in Singapore and (2) examines the potential mediating roles of depression, disability, social contact frequency, and loneliness in the relationship between cognitive scores and happiness. Methods: Data for this study were extracted from the Well-being of the Singapore Elderly (WiSE) study: a cross-sectional; comprehensive single-phase survey conducted among Singapore citizens and permanent residents that were aged 60 years and above (n = 2565). The Geriatric Mental State examination (GMS) was administered to the participants. Questions pertaining to socio-demographic characteristics; happiness; loneliness; social contact; depression; and, disability were utilized in this study. Logistic regression analyses and mediation analyses were used to explore the correlates of happiness and potential mediating factors. Results: Overall, 96.2% of older adults in Singapore reported feeling either fairly happy or very happy. In the regression analysis, individuals of Malay descent, those who were married/cohabiting, or had higher education levels were more likely to report feeling happy. After controlling for socio-demographic factors, higher cognitive scores were associated with higher odds of reporting happiness. We found that the positive association between cognition and happiness was fully mediated by disability, depression, loneliness, and frequency of contact with friends. Conclusion: The majority of the older adult population reported feeling fairly or very happy. While cognitive impairment has shown limited reversibility in past studies, unhappiness among older adults with cognitive impairment might be potentially mitigated through interventions addressing accompanying issues of social isolation, disability, and depression Full article
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Open AccessArticle
Impaired Eating and Swallowing Function in Older Adults in the Community: The Kurihara Project
Int. J. Environ. Res. Public Health 2019, 16(20), 4040; https://doi.org/10.3390/ijerph16204040 - 22 Oct 2019
Cited by 1
Abstract
Introduction: Older adults with dementia often develop aspiration pneumonia as a complication due to deterioration of swallowing function. Herein, we report our findings of eating and swallowing-related functions in elderly local residents. Methods: The subjects were 229 elderly residents in Kurihara [...] Read more.
Introduction: Older adults with dementia often develop aspiration pneumonia as a complication due to deterioration of swallowing function. Herein, we report our findings of eating and swallowing-related functions in elderly local residents. Methods: The subjects were 229 elderly residents in Kurihara City, including 97 healthy (Clinical Dementia Rating (CDR): 0), 108 with mild cognitive impairment (MCI) (CDR: 0.5), and 24 with dementia (CDR: 1 or higher: CDR 1+). We analyzed the relationships between the findings, eating, and swallowing, based on the database of the Kurihara Project performed from 2008 to 2010. Results: In the CDR 0.5 group, some deterioration in oral condition, oral function and swallowing function was confirmed. In the CDR 0.5 group, tooth staining, decrease in oral diadochokinesis (oral motion velocity), increased number of points below the cut-off value in a repetitive saliva swallowing test and the questionnaire, and prolonged water swallowing time were confirmed. In the CDR 1+ group, bad breath, elimination of the pharyngeal reflex, increase in disturbed soft palate elevation, and prolonged jelly swallowing time were confirmed. Conclusions: Deterioration of swallowing function was confirmed, even in subjects with mild dementia, in addition to development of problems related to food intake. Full article
Open AccessArticle
The Association between Frailty Indicators and Blood-Based Biomarkers in Early-Old Community Dwellers of Thailand
Int. J. Environ. Res. Public Health 2019, 16(18), 3457; https://doi.org/10.3390/ijerph16183457 - 17 Sep 2019
Cited by 1
Abstract
Thailand has officially reached the status of an “aged society” and become the developing country with the 2nd largest proportion of senior citizens in Southeast Asia. A cross-sectional study of 526 early-old community dwellers was conducted for the Fried frailty phenotype assessment, This [...] Read more.
Thailand has officially reached the status of an “aged society” and become the developing country with the 2nd largest proportion of senior citizens in Southeast Asia. A cross-sectional study of 526 early-old community dwellers was conducted for the Fried frailty phenotype assessment, This included five indicators: Weakness, slowness, physical activity, exhaustion, and weight loss. C-reactive protein (CRP), interleukin-6 (IL-6), insulin-like growth factor-1, and CD4+:CD8+ Ratio which serve as blood-based biomarkers of frailty. The prevalence of frailty and pre-frail in this population was found to be 15% and 69.6% respectively and was higher among women than men. Frail (n = 58) and non-frail (n = 60) participants were evaluated for the associations between the frail indicators and the blood-based biomarkers. Serum levels of IL-6 and CRP from frail group were significantly elevated when compared with the non-frail counterparts (p = 0.044 and 0.033, respectively), and were significantly associated with the frailty status with an Odd RatioIL-6 [OR] of 1.554-fold (95% confidence interval [CI], 1.229–1.966) and an ORCRP of 1.011-fold (95 CI, 1.006–1.016). Decreased hand-grip strength was the only frailty indicator that was significantly associated with both inflammatory biomarkers, (ORIL-6 of 1.470-fold and ORCRP of 1.008-fold). Our study is the first to assess the frailty status among the early-old population in Thailand. These findings will encourage general practitioners to combine frailty indicators and serum biomarkers as early detection tools for at-risk older adults to achieve the goal of healthy aging. Full article
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Open AccessArticle
Recreational Centres’ Facilities and Activities to Support Healthy Ageing in Singapore
Int. J. Environ. Res. Public Health 2019, 16(18), 3343; https://doi.org/10.3390/ijerph16183343 - 10 Sep 2019
Abstract
Objective: This study examined the physical and social environment (facilities and activities) of Singapore’s Recreational Centres (RCs) and female patrons’ (>50 years) perception of the RC facilities and activities. Materials and Methods: A total of 100 RCs were audited, and 22 face-to-face interviews [...] Read more.
Objective: This study examined the physical and social environment (facilities and activities) of Singapore’s Recreational Centres (RCs) and female patrons’ (>50 years) perception of the RC facilities and activities. Materials and Methods: A total of 100 RCs were audited, and 22 face-to-face interviews were undertaken. Results: Physical activity classes were the main activity offered (mean = eight classes per month), with walking (29.8%) and aerobics sessions (17.5%) being the most frequent. Nutrition classes and social activities were offered less often (mean = one class per month). The activities were well received by patrons, offering opportunities to interact while participating in physical activity and nutrition classes. However, the need for staff training, consideration of patron’s abilities and the desire to engage in alternative activities were expressed. Conclusion: Overall, RCs’ facilities and activities were well liked by the patrons but opportunities for improvements were identified. Regular reviews of facilities and activities through consultation with the RC patrons and managers are needed to ensure that the facilities and activities remain relevant and practical to the patrons. This will help to support active lifestyles and healthy eating practices among older adults residing within the community. Full article
Open AccessArticle
The Association Between Loneliness and Cognitive Impairment among Older Men and Women in China: A Nationwide Longitudinal Study
Int. J. Environ. Res. Public Health 2019, 16(16), 2877; https://doi.org/10.3390/ijerph16162877 - 12 Aug 2019
Cited by 3
Abstract
We aimed to investigate the association between loneliness and cognitive impairment among older men and women in China. Data for 6898 eligible participants aged 65 years and older were derived from the latest two waves (2008/2009 and 2011/2012) of the Chinese Longitudinal Healthy [...] Read more.
We aimed to investigate the association between loneliness and cognitive impairment among older men and women in China. Data for 6898 eligible participants aged 65 years and older were derived from the latest two waves (2008/2009 and 2011/2012) of the Chinese Longitudinal Healthy Longevity Survey. A logistic regression analysis was performed to determine whether the association between loneliness at baseline and the risk of cognitive impairment at follow-up varied by sex, with adjustment for social-demographic variables, social isolation, lifestyles, and health status. The rates of baseline loneliness and follow-up cognitive impairment were both higher among women than men. Loneliness at baseline was significantly associated with cognitive impairment at follow-up among elderly men (OR = 1.30; 95% CI 1.01–1.69), even after adjusting for potential confounding variables; however, a similar association was not observed among elderly women (OR = 0.98; 95% CI 0.81–1.19). Multiple imputations were applied to address missing data. Although elderly women more frequently reported feelings of loneliness, the impact of loneliness on cognitive impairment was significant among elderly men but not elderly women. Interventions designed to decrease the incidence of loneliness may be particularly beneficial for the reduction of cognitive impairment among elderly Chinese men. Full article
Open AccessArticle
Changes in Cognitive Function and Risk Factors for Cognitive Impairment of the Elderly in China: 2005–2014
Int. J. Environ. Res. Public Health 2019, 16(16), 2847; https://doi.org/10.3390/ijerph16162847 - 09 Aug 2019
Cited by 3
Abstract
Background: The cognitive function of the elderly has become a focus of public health research. Little is known about the changes of cognitive function and the risk factors for cognitive impairment in the Chinese elderly; thus, the purposes of this study are as [...] Read more.
Background: The cognitive function of the elderly has become a focus of public health research. Little is known about the changes of cognitive function and the risk factors for cognitive impairment in the Chinese elderly; thus, the purposes of this study are as follows: (1) to describe changes in cognitive function in the Chinese elderly from 2005–2014 and (2) to explore risk factors for cognitive impairment of the Chinese elderly. Design and setting: A total of 2603 participants aged 64 years and above participated in the Chinese Longitudinal Healthy Longevity Survey (CLHLS) and were followed up from 2005 to 2014. Cognitive function and cognitive impairment were assessed using the Chinese version of the Mini-Mental State Examination (MMSE). Binary logistic regression analysis was used to estimate the odds ratio (OR) and 95% confidence intervals (CI) of cognitive impairment. Results: Results revealed that the cognitive function of the Chinese elderly shows diversified changes: deterioration (55.09%), unchanged (17.21%) and improvement (27.70%). In addition, there are significant demographic differences in gender, age, education, marriage and other aspects when it comes to the changes of cognitive function in Chinese elderly. In the binary logistic regression analysis, female, increased age, lower education level, no spouse, less income, worse PWB (psychological well-being), less fresh fruit and vegetable intake, more activities of daily living (ADL) limitations, lower social engagement were significantly associated with higher odds for cognitive impairment. Conclusions: Various interventions should be implemented to maintain cognitive function in Chinese elderly. Full article
Open AccessArticle
Body Fat Mass and Risk of Cerebrovascular Lesions: The PRESENT (Prevention of Stroke and Dementia) Project
Int. J. Environ. Res. Public Health 2019, 16(16), 2840; https://doi.org/10.3390/ijerph16162840 - 08 Aug 2019
Abstract
Obesity is known to increase the risk of stroke. It is unclear whether high absolute fat mass (FM) increases the risk of stroke independently. We studied the correlation between FM and silent brain infarction/white matter change (SI/WMC) using brain computed tomography. We selected [...] Read more.
Obesity is known to increase the risk of stroke. It is unclear whether high absolute fat mass (FM) increases the risk of stroke independently. We studied the correlation between FM and silent brain infarction/white matter change (SI/WMC) using brain computed tomography. We selected subjects from the local government health promotion project. We randomly selected a target population that had never been diagnosed with stroke or dementia. FM was measured by bioelectrical impedance analysis (BIA). We divided the subjects into three groups according to the FM (gender-specific tertiles [GTx]). Seven hundred and twenty-two subjects (321 men) between 50 and 75 years of age were recruited. The overall odds ratio (OR) of SI/WMC was 2.23 (95% confidence interval (CI), 1.34–3.71; p = 0.002) times higher in the 37th to 100th percentiles (GT3) than in the first to 32nd percentiles (GT1). When men and women were separated, the OR of GT3 was 1.35 (CI, 0.62–2.94; p = 0.45) in men and 3.2 (CI, 1.60–6.40; p = 0.001) in women. The findings were not found to be statistically significant after adjusting for the well-known stroke risk factors. When the subjects were divided into a high FM (HFMG, GT3) and low FM group (LFMG, GT1 + GT2), the HFMG showed an increased OR of SI/WMC in women. Similar results were seen after adjusted (overall: OR, 1.38; CI, 0.85–2.25, p = 0.198; men: OR, 0.93; CI, 0.422–2.051; p = 0.86; women: OR, 2.02; CI, 1.06–3.86; p = 0.03). The findings suggest that high FM may be an independent risk factor for ischemic stroke among adults free from stroke and dementia, especially in women. Full article
Open AccessArticle
Community-Based Cognitive Social Capital and Self-Rated Health among Older Chinese Adults: The Moderating Effects of Education
Int. J. Environ. Res. Public Health 2019, 16(15), 2741; https://doi.org/10.3390/ijerph16152741 - 31 Jul 2019
Cited by 2
Abstract
This study investigated the moderating role of education on the association between community-based cognitive social capital and self-rated health among older adults in urban Chinese communities. Data were derived from a community survey conducted in Suzhou, China, in November 2015. A sample of [...] Read more.
This study investigated the moderating role of education on the association between community-based cognitive social capital and self-rated health among older adults in urban Chinese communities. Data were derived from a community survey conducted in Suzhou, China, in November 2015. A sample of 456 respondents aged 60 or older completed interviews. Multiple-group analysis from a structural equation modeling perspective was adopted to examine the proposed model. The measurement model of community-based cognitive social capital featured four trust and reciprocity indicators. Measurement invariance was established across high and low education groups. Education was found to have a moderating effect on the association between community-based cognitive social capital and self-rated health, but only in the high education group. Education should be considered an important factor in future social capital policy and intervention plans. Policy and intervention implications are discussed. Full article
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Open AccessArticle
Associations Among Health Insurance Type, Cardiovascular Risk Factors, and the Risk of Dementia: A Prospective Cohort Study in Korea
Int. J. Environ. Res. Public Health 2019, 16(14), 2616; https://doi.org/10.3390/ijerph16142616 - 23 Jul 2019
Cited by 2
Abstract
Due to an aging population, dementia incidence has rapidly increased in South Korea, heaping psychological and economic burdens upon families and the society. This study was aimed at investigating the associations of health insurance type and cardiovascular risk factors with the risk of [...] Read more.
Due to an aging population, dementia incidence has rapidly increased in South Korea, heaping psychological and economic burdens upon families and the society. This study was aimed at investigating the associations of health insurance type and cardiovascular risk factors with the risk of dementia. The study was performed using data from 15,043 participants aged 60 years and above, enrolled in the Seoul Dementia Management Project in 2008 and followed up until 2012. Factors such as demographic data, health insurance type, lifestyle factors, and cardiovascular risk factors were subjected to Cox proportional hazard regression analysis to identify their associations with dementia incidence. During the follow-up, 495 participants (3.3%) developed dementia. Medical Aid beneficiaries were associated with an increase in the risk of dementia (hazard ratio [HR] 1.77, 95% confidence interval [CI] 1.421–2.215). Upon analyzing a composite cardiovascular risk score derived from all five cardiovascular risk factors, the risk for dementia incidence in participants increased from 1.56 for the presence of three risk factors to 2.55 for that of four risk factors (HR 2.55, 95% CI 1.174–5.546), compared with those who had no risk factors. The Medical Aid beneficiaries of health insurance type and the presence of multiple cardiovascular risk factors were found to be associated with a higher risk of dementia incidence. Full article
Open AccessArticle
Correlations between Forgetfulness and Social Participation: Community Diagnosing Indicators
Int. J. Environ. Res. Public Health 2019, 16(13), 2426; https://doi.org/10.3390/ijerph16132426 - 08 Jul 2019
Cited by 1
Abstract
We analyzed the relationships between forgetfulness and social participation, social contact, and social support by municipality to develop community diagnosing indicators. The analysis subjects included 105 municipalities that agreed to provide data for the 2013 Survey of Needs in Spheres of Daily Life [...] Read more.
We analyzed the relationships between forgetfulness and social participation, social contact, and social support by municipality to develop community diagnosing indicators. The analysis subjects included 105 municipalities that agreed to provide data for the 2013 Survey of Needs in Spheres of Daily Life in Japan (n = 338,659 people). Forgetfulness as a risk factor for dementia was used as the dependent variable. The variables of social environment factors were (1) social participation, (2) social contact, and (3) social support. The ratio of people responding that they experienced forgetfulness differed among municipalities, with a mean of 19.0% (7.1–35.6%). Higher levels of social participation, social contact, and social support were associated with lower levels of forgetfulness, even after adjusting for age and regional variables. The results of the present study suggest that it is appropriate to use forgetfulness and social participation at least a few times a year in any social activity as community diagnosing indicators. Municipalities could encourage their inhabitants to participate by developing and providing engaging social activities. Full article
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Open AccessArticle
Estimation of Prevalence of Osteoporosis Using OSTA and Its Correlation with Sociodemographic Factors, Disability and Comorbidities
Int. J. Environ. Res. Public Health 2019, 16(13), 2338; https://doi.org/10.3390/ijerph16132338 - 02 Jul 2019
Cited by 1
Abstract
Osteoporosis is a growing concern for an aging society. The study aimed to estimate the prevalence of older adults who were at risk of osteoporosis and explore factors associated with osteoporosis. The relationship between the risk of osteoporosis, chronic conditions and disability was [...] Read more.
Osteoporosis is a growing concern for an aging society. The study aimed to estimate the prevalence of older adults who were at risk of osteoporosis and explore factors associated with osteoporosis. The relationship between the risk of osteoporosis, chronic conditions and disability was also explored. We hypothesized that respondents with high risk index of osteoporosis would be associated with greater disability. Participants aged 60 years and above (N = 2565) who were representative of Singapore’s multiethnic population were recruited. The Osteoporosis Self-Assessment Tool for Asians (OSTA) was used to classify the risk of osteoporosis. Information on sociodemographic details and chronic diseases were collected, while severity of disability was measured using the World Health Organization Disability Assessment Schedule 2.0. The overall prevalence of the respondents who were at risk of osteoporosis was 52%. Those belonging to an older age, Chinese, female, never married or widowed, lower education and retired were associated with a higher risk of osteoporosis. A diagnosis of diabetes or hypertension was a protective factor against the risk of osteoporosis. High risk of osteoporosis was not associated with disability. Our findings highlighted specific factors associated with the risk of osteoporosis that could be useful for the prevention of osteoporosis and fractures. Full article
Open AccessArticle
Survival to Age 90 in Men: The Tromsø Study 1974–2018
Int. J. Environ. Res. Public Health 2019, 16(11), 2028; https://doi.org/10.3390/ijerph16112028 - 06 Jun 2019
Abstract
The 738 oldest men who participated in the first survey of the population-based Tromsø Study (Tromsø 1) in Norway in 1974 have now had the chance to reach the age of 90 years. The men were also invited to subsequent surveys (Tromsø 2–7, [...] Read more.
The 738 oldest men who participated in the first survey of the population-based Tromsø Study (Tromsø 1) in Norway in 1974 have now had the chance to reach the age of 90 years. The men were also invited to subsequent surveys (Tromsø 2–7, 1979–2016) and have been followed up for all-cause deaths. This study sought to investigate what could be learned from how these men have fared. The men were born in 1925–1928 and similar health-related data from questionnaires, physical examination, and blood samples are available for all surveys. Survival curves over various variable strata were applied to evaluate the impact of individual risk factors and combinations of risk factors on all-cause deaths. At the end of 2018, 118 (16.0%) of the men had reached 90 years of age. Smoking in 1974 was the strongest single risk factor associated with survival, with observed percentages of men reaching 90 years being 26.3, 25.7, and 10.8 for never, former, and current smokers, respectively. Significant effects on survival were also found for physical inactivity, low income, being unmarried, high blood pressure, and high cholesterol. For men with 0–4 of these risk factors, the percentages reaching 90 years were 33.3, 24.9, 12.4, 14.4, and 1.5, respectively. Quitting smoking and increasing physical activity before 55 years of age improved survival significantly. Men should refrain from smoking and increase their physical activity, especially those with low income, those who are unmarried, and those with high blood pressure and high cholesterol. Full article
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Open AccessArticle
Self-Rated Health and Social Exclusion: Does Gardening Moderate This Relation? Evidence from the German Ageing Survey
Int. J. Environ. Res. Public Health 2019, 16(10), 1834; https://doi.org/10.3390/ijerph16101834 - 23 May 2019
Cited by 1
Abstract
The aim of the present study was to examine whether the association between self-rated health and social exclusion can be moderated by the frequency of gardening in the total sample and stratified by sex. Cross-sectional data employed in this study came from the [...] Read more.
The aim of the present study was to examine whether the association between self-rated health and social exclusion can be moderated by the frequency of gardening in the total sample and stratified by sex. Cross-sectional data employed in this study came from the fifth wave of the German Ageing Survey (n = 5048), a nationally representative sample comprising non-institutionalized individuals aged 40 and above. A single-item measure was used to quantify self-rated health (ranging from 1 = very good to 5 = very bad). An established scale developed by Bude and Lantermann was used to assess social exclusion. Moreover, individuals reported the frequency of work in the garden (daily; several times a week; once a week; 1-3 times a month; less often; never). Poorer self-rated health was associated with feelings of social exclusion. The frequency of gardening significantly moderated the association between these factors in women. This cross-sectional study emphasizes the moderating role of gardening in the relation between self-rated health and social exclusion in women. Longitudinal studies are required to validate the present findings. Full article
Open AccessArticle
The Evolutionary Trends of Health Behaviors in Chinese Elderly and the Influencing Factors of These Trends: 2005–2014
Int. J. Environ. Res. Public Health 2019, 16(10), 1687; https://doi.org/10.3390/ijerph16101687 - 14 May 2019
Cited by 1
Abstract
As China is now facing the severe challenge of rapid population ageing, the health behaviors in Chinese elderly people are of great significance for realizing the goal of “Healthy Ageing” and the construction of a “Healthy China”. Little is known about the evolutionary [...] Read more.
As China is now facing the severe challenge of rapid population ageing, the health behaviors in Chinese elderly people are of great significance for realizing the goal of “Healthy Ageing” and the construction of a “Healthy China”. Little is known about the evolutionary trends of health behaviors in the Chinese elderly and about the factors influencing these trends; thus, the purposes of this paper are: (1) To describe the classes and evolutionary trends of health behaviors in the Chinese elderly; and (2) to explore the factors that influence the changes in the health behaviors in the elderly in China. Latent class analysis (LCA) is applied in this study to analyze the classes of health behaviors in the Chinese elderly. Growth mixture modelling (GMM) is employed to describe the evolutionary trends of the health behaviors in elderly people in China. In addition, the Bivariate analysis model is adopted to identify the influencing factors of the evolution of health behaviors. The data were derived from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) from 2005 to 2014. The results reveal that the health behaviors in the Chinese elderly can be grouped into five classes: Negative, relatively negative, fair, relatively positive, and positive. Approximately 77.2% of the health behaviors in the Chinese elderly have the characteristics of “modified”, with a positive tendency. Moreover, approximately 22.8% of the health behaviors in Chinese elderly people have the characteristics of “non-modified”, with a negative tendency or remaining unchanged. The evolution of the health behaviors in the elderly in China is more affected by economic factors such as timely medical treatment during childhood, pension, occupations before the age of 60 and family income, as well as by self-rated health (SRH) and demographic characteristics such as household registration, age, and education level. Hence, various possible interventions should be made to improve the health behaviors in elderly people. Full article
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Open AccessArticle
Explaining the Use of Social Network Sites as Seen by Older Adults: The Enjoyment Component of a Hedonic Information System
Int. J. Environ. Res. Public Health 2019, 16(10), 1673; https://doi.org/10.3390/ijerph16101673 - 14 May 2019
Cited by 6
Abstract
Previous studies suggest that older adults are living increasingly alone and without the company of their close relatives, which cause them depression problems and a detriment to their health and general wellbeing. The use of social network sites (SNS) allows them to reduce [...] Read more.
Previous studies suggest that older adults are living increasingly alone and without the company of their close relatives, which cause them depression problems and a detriment to their health and general wellbeing. The use of social network sites (SNS) allows them to reduce their isolation, improve their social participation, and increase their autonomy. Although the adoption of various information technologies by older adults has been studied, some assumptions still predominate, for example, that older adults use SNS only for utilitarian purposes. However, considering SNS as hedonic information systems, and in order to extend the theoretical explanation of the intention to use hedonic systems to their actual use, this study aims to determine the influence of perceived enjoyment, perceived usefulness, and perceived ease of use on the use of SNS by elders in Concepción, Chile. Two hundred fifty-three older adults participated in the cross-sectional study. The results indicate that perceived ease of use is the variable that has the greatest total effect in explaining the use of SNS and that by adding the perceived enjoyment construct, the explanatory power of the model increases significantly. Therefore, advancement in user acceptance models, especially in the use of SNS by elders, can be made by focusing on the type of system, hedonic or utilitarian. Full article
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Open AccessArticle
Ageism in an Aging Society: The Role of Knowledge, Anxiety about Aging, and Stereotypes in Young People and Adults
Int. J. Environ. Res. Public Health 2019, 16(8), 1329; https://doi.org/10.3390/ijerph16081329 - 13 Apr 2019
Cited by 4
Abstract
The progressive aging of society, caused by profound demographic changes, brings with it the necessity of confronting the subject of biases against the elderly. Ageism, in fact, can influence society’s attitudes regarding this population, in addition to impacting the self-perception of elderly people. [...] Read more.
The progressive aging of society, caused by profound demographic changes, brings with it the necessity of confronting the subject of biases against the elderly. Ageism, in fact, can influence society’s attitudes regarding this population, in addition to impacting the self-perception of elderly people. This, in turn, has consequences for positive outcomes during the aging process. The current research aims to investigate the simultaneous relationships between knowledge, age, anxiety about aging, and stereotypes toward the elderly, as well as their predictive roles with respect to ageism. A self-report questionnaire was administered to 886 participants, with an average age of 35.8 years (Standard Deviation—SD = 14.2), predominantly female (64.8%). Descriptive and correlational analyses were performed, along with structural equation modeling. Based on the analyses conducted, anxiety about aging and knowledge are antecedents for stereotypes, which in turn, together with the other variables, influence ageism. Increased education about the aging process could help reduce anxiety and stereotypes against the aging among those who are most responsible for prejudice against the elderly. Knowledge of the antecedents of prejudice toward the elderly is fundamental to promoting positive attitudes toward them. Full article
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Open AccessArticle
Rural-Urban Variation in Weight Loss Recommendations Among US Older Adults with Arthritis and Obesity
Int. J. Environ. Res. Public Health 2019, 16(6), 946; https://doi.org/10.3390/ijerph16060946 - 16 Mar 2019
Abstract
Purpose: Weight loss is advantageous for individuals with obesity and arthritis. Therefore, this study was conducted to determine if there are differences by rural-urban status among older adults with these conditions who reported being advised by a health care provider to lose [...] Read more.
Purpose: Weight loss is advantageous for individuals with obesity and arthritis. Therefore, this study was conducted to determine if there are differences by rural-urban status among older adults with these conditions who reported being advised by a health care provider to lose weight for arthritis or to ameliorate arthritis symptoms. Methods: A cross-sectional analysis of 2011 Behavioral Risk Factor Surveillance System (BRFSS) data. Respondents reported if they had been diagnosed with arthritis and if they received a provider weight loss recommendation (WLR). The analytic sample was limited to older adults aged 60–79 living in the five states that administered the examined BRFSS arthritis module who had body mass index ≥ 30 kg/m2 and reported having arthritis (n = 2920). The respondent’s county of residence was linked to the corresponding county-level population density from the US Decennial Census to determine rural-urban status. A generalized linear model examined the association between receipt of a WLR and population density, controlling for demographics. Results: The sample was 83.6% white, 57.8% female, and 63.2% received a WLR. Respondents from more urban counties were more likely to receive a WLR (p value for trend <0.001). Additionally, older respondents, men, individuals with less than a high school education, and whites had a decreased likelihood of receiving a WLR. Conclusions: The analysis identified notable rural-urban differences with respondents in more urban counties being more likely to receive a WLR. Furthermore, there were differences in those who received a WLR by age, sex, and education. Reasons for these differences should be explored. Full article
Open AccessArticle
What Matters Most for Community Social Capital among Older Adults Living in Urban China: The Role of Health and Family Social Capital
Int. J. Environ. Res. Public Health 2019, 16(4), 558; https://doi.org/10.3390/ijerph16040558 - 15 Feb 2019
Cited by 5
Abstract
The present study investigated individual-level determinants of community social capital among older adults in urban China, with a particular emphasis on health and family social capital. A quota sampling method was used to select 456 adults aged 60 or older from 16 local [...] Read more.
The present study investigated individual-level determinants of community social capital among older adults in urban China, with a particular emphasis on health and family social capital. A quota sampling method was used to select 456 adults aged 60 or older from 16 local communities in the city of Suzhou in 2015. Multiple indicators and multiple courses in structural equation modeling were used to examine the proposed model. Latent constructs of community social capital (i.e., cognitive social capital and structural social capital) were established. The results showed that family social capital and instrumental activities of daily living were the most influential determinants of cognitive social capital, whereas activities of daily living and socioeconomic status were the most important determinants of structural social capital. We demonstrate the application of social capital theory in an urban Chinese context. Future policy development and social work interventions should use a more comprehensive social capital latent constructs and health indicators as screening instruments. The promotion of family social capital could play an important role in enhancing cognitive social capital among older adults. Full article
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Open AccessArticle
Denture Wearing Moderates the Association between Aspiration Risk and Incident Pneumonia in Older Nursing Home Residents: A Prospective Cohort Study
Int. J. Environ. Res. Public Health 2019, 16(4), 554; https://doi.org/10.3390/ijerph16040554 - 14 Feb 2019
Abstract
Aspiration is increasingly recognized as a major risk for pneumonia, but a potential link between wearing dentures and incident pneumonia with aspiration risk is unclear. The aim of this study was to investigate whether denture wearing moderates the association between aspiration risk and [...] Read more.
Aspiration is increasingly recognized as a major risk for pneumonia, but a potential link between wearing dentures and incident pneumonia with aspiration risk is unclear. The aim of this study was to investigate whether denture wearing moderates the association between aspiration risk and incident pneumonia in older adults. We used prospective cohort data of 156 residents aged >70 years from eight nursing homes in Aso, Japan. Aspiration risk was evaluated using the modified water swallowing test. During a 1-year follow-up (2014 to 2015), information on incident pneumonia was obtained from nursing home medical records. During follow-up, pneumonia developed in 7.1% of participants. In the multivariate-adjusted Cox proportional hazards model, after adjusting for potential confounders, aspiration risk was independently associated with a 4.4-fold higher hazard ratio (HR) of incident pneumonia (95% confidence interval, CI, 1.16–16.43). The difference in the risk of incident pneumonia between subjects with aspiration risk who were wearing dentures and those not at risk of aspiration was not significant, whereas those with aspiration risk without dentures had a 7.3-fold higher HR of incident pneumonia than those not at risk of aspiration (95% CI, 1.02–52.63). Denture wearing might partially moderate the increased risk of incident pneumonia associated with aspiration risk. Full article
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Open AccessArticle
Study on Lifestyle Evaluation Systems for the Health of Chinese Elderly
Int. J. Environ. Res. Public Health 2019, 16(2), 284; https://doi.org/10.3390/ijerph16020284 - 21 Jan 2019
Abstract
Background/Objective: China is now faced with a serious population aging challenge, and the health of the Chinese elderly is becoming an imminent concern. Consequently, it is critical to establish a lifestyle evaluation system for promoting the health of the Chinese elderly. Methods [...] Read more.
Background/Objective: China is now faced with a serious population aging challenge, and the health of the Chinese elderly is becoming an imminent concern. Consequently, it is critical to establish a lifestyle evaluation system for promoting the health of the Chinese elderly. Methods: Interviews with experts and questionnaire surveys were conducted. Factor analysis, analytic hierarchy process, and statistical analyses were also adopted in this study. Results: Besides evaluation metrics and standards, a two-level category system including 50 indices and associated weights from three level 1 categories (physical and mental health and social wellbeing) and thirteen level 2 categories were obtained. Discussion and Conclusions: Based on the confirmatory factor analysis and Cronbach’s test, such an evaluation system excels in effectiveness and reliability, and is ready to be popularized in Chinese society. We expect that the Chinese elderly will benefit from our system and that it will lead to a healthy lifestyle accordingly. Full article
Open AccessArticle
Social Engagement and Elderly Health in China: Evidence from the China Health and Retirement Longitudinal Survey (CHARLS)
Int. J. Environ. Res. Public Health 2019, 16(2), 278; https://doi.org/10.3390/ijerph16020278 - 18 Jan 2019
Cited by 9
Abstract
This study examines the impact of social engagement on elderly health in China. A two-stage residual inclusion (2SRI) regression approach was used to examine the causal relationship. Our dataset comprises 9253 people aged 60 or above from the China Health and Retirement Longitudinal [...] Read more.
This study examines the impact of social engagement on elderly health in China. A two-stage residual inclusion (2SRI) regression approach was used to examine the causal relationship. Our dataset comprises 9253 people aged 60 or above from the China Health and Retirement Longitudinal Survey (CHARLS) conducted in 2011 and 2013. Social engagement significantly improved the self-rated health of the elderly and reduced mental distress, but had no effect on chronic disease status. Compared with the rural areas, social engagement played a more important role in promoting the elderly health status in urban areas. Social engagement could affect the health status of the elderly through health behavior change and access to health resources. To improve the health of the elderly in China and promote healthy aging, the government should not only improve access to effective medical care but also encourage greater social engagement of the elderly. Full article
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Open AccessArticle
The Association between Social Support and Incident Dementia: A 10-Year Follow-Up Study in Japan
Int. J. Environ. Res. Public Health 2019, 16(2), 239; https://doi.org/10.3390/ijerph16020239 - 16 Jan 2019
Cited by 5
Abstract
Social support is important for the health of elderly populations. However, its longitudinal effect on incident dementia is unclear. We used the Aichi Gerontological Evaluation Study (AGES) project data to investigate the longitudinal effect of social support on dementia onset. Functionally independent older [...] Read more.
Social support is important for the health of elderly populations. However, its longitudinal effect on incident dementia is unclear. We used the Aichi Gerontological Evaluation Study (AGES) project data to investigate the longitudinal effect of social support on dementia onset. Functionally independent older people at baseline (n = 14,088) in 10 municipalities were followed from 2003 to 2013 using National Long-term Care Insurance System data. Social support was assessed by the following support sources: co-residing family, family or relatives living apart, and friends or neighbors. Cumulative incidence of dementia was 14.6% and 18.7% for men and women, respectively. Cox proportional hazard models were employed by gender to investigate the association between social support and dementia onset adjusting for age, health status, health behaviors, subjective cognitive complaints, depression, and other socioeconomic factors. Gender differences were observed in the association between social support and incident dementia. Support from co-residing family members was protective among men, whereas among women, no effect of social support on dementia was observed. Among other social factors, community engagement was protective for women, while for men, being married was associated with lower incidence of dementia. The association between social support and dementia seems to differ by gender. When we design programs to promote social interactions among the elderly, we need to take into account such gender differences. Full article
Open AccessArticle
Waist Circumference and All-Cause Mortality among Older Adults in Rural Indonesia
Int. J. Environ. Res. Public Health 2019, 16(1), 116; https://doi.org/10.3390/ijerph16010116 - 03 Jan 2019
Cited by 2
Abstract
Waist circumference, a measure of abdominal obesity, is associated with all-cause mortality in general adult population. However, the link between abdominal obesity with all-cause mortality in the studies of older adults is unclear. This study aims to determine the association between waist circumference [...] Read more.
Waist circumference, a measure of abdominal obesity, is associated with all-cause mortality in general adult population. However, the link between abdominal obesity with all-cause mortality in the studies of older adults is unclear. This study aims to determine the association between waist circumference and all-cause mortality in older adults in Indonesia. The association between waist circumference and all-cause mortality was examined in 10,997 men and women aged 50 years and older, in the World Health Organization (WHO) and International Network of field sites for continuous Demographic Evaluation of Populations and their Health in developing countries (INDEPTH) collaboration Study on global AGEing and adult health (SAGE) in Purworejo District Central Java, Indonesia during 2007–2010. Multivariate Cox regression analysis with restricted cubic splines was used to assess the non-linear association between waist circumference and all-cause mortality. During the 3-year follow-up, a total of 511 men and 470 women died. The hazard ratio plot shows a pattern of U-shape relationship between waist circumference and all-cause mortality among rich women, though the result was significant only for women in the lower end of waist circumference distribution (p < 0.05). Poor men with a low waist circumference (5th percentile) have a two times higher mortality risk (HR = 2.1; 95% CI = 1.3, 3.3) relative to those with a waist circumference of 90 cm. Poor women with a low waist circumference (25th percentile) have a 1.4 times higher mortality risk (HR = 1.4; 95% CI = 1.1, 1.8) relative to those with a waist circumference of 80 cm. This study shows a significant association between low waist circumference measure and mortality, particularly among poor men and women. Though the association between large waist circumference and mortality was not significant, we observed a trend of higher mortality risk particularly among rich women with large waist circumference measure. Public health intervention should include efforts to improve nutritional status among older people and promoting healthy lifestyle behaviours including healthy food and active lifestyle. Full article
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Open AccessArticle
Evaluating the Effectiveness of the Health Management Program for the Elderly on Health-Related Quality of Life among Elderly People in China: Findings from the China Health and Retirement Longitudinal Study
Int. J. Environ. Res. Public Health 2019, 16(1), 113; https://doi.org/10.3390/ijerph16010113 - 03 Jan 2019
Cited by 3
Abstract
The world’s rapidly aging population brings serious challenges which could be addressed by changes in behaviour and policy that promote good health in older age. However, these cheap and simple interventions are not available in many countries. China is one of the fastest-ageing [...] Read more.
The world’s rapidly aging population brings serious challenges which could be addressed by changes in behaviour and policy that promote good health in older age. However, these cheap and simple interventions are not available in many countries. China is one of the fastest-ageing countries in the world. The health management programs for the elderly in basic public health services was introduced by the government to promote the health of the elderly in China and address the challenges related to ageing. However, the effectiveness of the program is uncertain. So, we use a propensity score matching difference-in-difference (PSM-DID) model to analyse the causal effect of the health management program for the elderly in basic public health services on the health-related quality of life (HRQoL) of the elderly in China. The result shows that the program has improved the physical health of the elderly but has had no significant impact on mental health. Expanding the program to cover mental health could further benefit the HRQoL of the elderly. The program is a cost-effective approach to tackle the challenges of ageing and is a good example for other developing countries facing the same ageing challenges. Full article
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Open AccessArticle
Gender Differences in the Prevalence and Correlates of Elder Abuse in a Community-Dwelling Older Population in Korea
Int. J. Environ. Res. Public Health 2019, 16(1), 100; https://doi.org/10.3390/ijerph16010100 - 01 Jan 2019
Cited by 5
Abstract
Background: We examined gender differences in the prevalence estimates and correlates of elder abuse in a community-dwelling older population in Korea. Methods: We analyzed responses from the Living Profiles of Older People Survey (LPOPS), which comprises a nationally representative sample of non-institutionalized Korean [...] Read more.
Background: We examined gender differences in the prevalence estimates and correlates of elder abuse in a community-dwelling older population in Korea. Methods: We analyzed responses from the Living Profiles of Older People Survey (LPOPS), which comprises a nationally representative sample of non-institutionalized Korean older adults living in the community. A total of 10,184 older persons (4179 men and 6005 women) were included in the analysis. Results: The overall rate of elder abuse was 9.9%, and emotional elder abuse was the most frequent type. Of the men and women subjects, 8.8 and 10.6%, respectively, had experienced elder abuse. We observed significant gender differences in the correlates of elder abuse. Educational attainment was significantly associated with elder abuse in men but not in women. Poor self-rated health was significantly associated with elder abuse in women but not in men. Household income and relationship with children were significantly associated with elder abuse in both men and women. Conclusion: Our results suggest that the factors that make elderly persons vulnerable to elder abuse may differ by gender. A better understanding of the risk factors for elder abuse across genders will facilitate the development of elder abuse prevention strategies, practices, and policies. Full article

2018

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Open AccessArticle
A Data-Driven Assessment of the Metabolic Syndrome Criteria for Adult Health Management in Taiwan
Int. J. Environ. Res. Public Health 2019, 16(1), 92; https://doi.org/10.3390/ijerph16010092 - 31 Dec 2018
Cited by 1
Abstract
According to the modified Adult Treatment Panel III, five indices are used to define metabolic syndrome (MetS): waist circumference (WC), high blood pressure, fasting glucose, triglycerides (TG), and high-density lipoprotein cholesterol. Our work evaluates the importance of these indices. In addition, we attempted [...] Read more.
According to the modified Adult Treatment Panel III, five indices are used to define metabolic syndrome (MetS): waist circumference (WC), high blood pressure, fasting glucose, triglycerides (TG), and high-density lipoprotein cholesterol. Our work evaluates the importance of these indices. In addition, we attempted to identify whether trends and patterns existed among young, middle-aged, and older people. Following the analysis, a decision tree algorithm was used to analyze the importance of the five criteria for MetS because the algorithm in question selects the attribute with the highest information gain as the split node. The most important indices are located on the top of the tree, indicating that these indices can effectively distinguish data in a binary tree and the importance of this criterion. That is, the decision tree algorithm specifies the priority of the influence factors. The decision tree algorithm examined four of the five indices because one was excluded. Moreover, the tree structures differed among the three age groups. For example, the first key index for middle-aged and older people was TG whereas for younger people it was WC. Furthermore, the order of the second to fourth indices differed among the groups. Because the key index was identified for each age group, researchers and practitioners could provide different health care strategies for individuals based on age. High-risk middle-aged and healthy older people maintained low values of TG, which might be the most crucial index. When a person can avoid the first and second indices provided by the decision tree, they are at lower risk of MetS. Therefore, this paper provides a data-driven guideline for MetS prevention. Full article
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Open AccessArticle
Factors Associated with Discharge to a Skilled Nursing Facility after Transcatheter Aortic Valve Replacement Surgery
Int. J. Environ. Res. Public Health 2019, 16(1), 73; https://doi.org/10.3390/ijerph16010073 - 28 Dec 2018
Cited by 1
Abstract
An assumption regarding transcatheter aortic valve replacement (TAVR), a minimally invasive procedure for treating aortic stenosis, is that patients remain at, or near baseline and soon return to their presurgical home to resume activities of daily living. However, this does not consistently occur. [...] Read more.
An assumption regarding transcatheter aortic valve replacement (TAVR), a minimally invasive procedure for treating aortic stenosis, is that patients remain at, or near baseline and soon return to their presurgical home to resume activities of daily living. However, this does not consistently occur. The purpose of this study was to identify preoperative factors that optimally predict discharge to a skilled nursing facility (SNF) after TAVR. Delineation of these conditions is an important step in developing a risk stratification model to assist in making informed decisions. Data was extracted from the American College of Cardiology (ACC) transcatheter valve therapy (TVT) registry and the Society of Thoracic Surgeons (STS) database on 285 patients discharged from 2012–2017 at a tertiary referral heart institute located in the southeastern region of the United States. An analysis of assessment, clinical and demographic variables was used to estimate relative risk (RR) of discharge to a SNF. The majority of participants were female (55%) and white (84%), with a median age of 82 years (interquartile range = 9). Approximately 27% (n = 77) were discharged to a SNF. Age > 75 years (RR = 2.3, p = 0.0026), female (RR = 1.6, p = 0.019), 5-meter walk test (5MWT) >7 s (RR = 2.0, p = 0.0002) and not using home oxygen (RR = 2.9, p = 0.0084) were identified as independent predictive factors for discharge to a SNF. We report a parsimonious risk-stratification model that estimates the probability of being discharged to a SNF following TAVR. Our findings will facilitate making informed treatment decisions regarding this older patient population. Full article
Open AccessArticle
Gender Differences in Quality of Life and Health Services Utilization among Elderly People in Rural Vietnam
Int. J. Environ. Res. Public Health 2019, 16(1), 69; https://doi.org/10.3390/ijerph16010069 - 28 Dec 2018
Cited by 3
Abstract
As in much of the world, the elderly population in Vietnam is growing rapidly with two-thirds of them currently living in rural areas. Besides limited access to quality healthcare services, they also have unique health profiles and needs due to various factors, including [...] Read more.
As in much of the world, the elderly population in Vietnam is growing rapidly with two-thirds of them currently living in rural areas. Besides limited access to quality healthcare services, they also have unique health profiles and needs due to various factors, including the highly skewed sex ratio of more women residing in rural areas. However, the relationship between gender, health-seeking behaviors, and health outcomes in this under-served population has not been well characterized. This study sought to explore the associations of gender with health-related quality of life and health-seeking behavior among the elderly in Soc Son, a rural district of Hanoi, Vietnam. A cross-sectional design was used; elderly individuals were surveyed across the domains of socioeconomic information, health status, and healthcare service utilization. We found that overall, women had poorer health and quality of life even though gender difference did not appear to significantly influence their levels of health services utilization. A greater understanding of the systemic, sociocultural, and psychological factors underlying such differences may help better inform future healthcare service delivery strategies targeting this growing population in rural areas. Full article
Open AccessArticle
Relationship between the Well-Being of Elderly Men and Cohabiting with Women Who Have Had Experience as a Health Promotion Volunteer in Japan: A Cross-Sectional Study
Int. J. Environ. Res. Public Health 2019, 16(1), 65; https://doi.org/10.3390/ijerph16010065 - 27 Dec 2018
Cited by 1
Abstract
In Japan, there are traditionally many health promotion volunteer activities. However, the effects these activities have on the volunteers’ families are not clear. This study examined whether the well-being of Japanese elderly men was affected by cohabiting with women who have had experience [...] Read more.
In Japan, there are traditionally many health promotion volunteer activities. However, the effects these activities have on the volunteers’ families are not clear. This study examined whether the well-being of Japanese elderly men was affected by cohabiting with women who have had experience as a health promotion volunteer. The study area was Suzaka City, where more than 7500 women have been elected and served as health promotion volunteers for over 60 years. A cross-sectional survey targeting all residents aged 65 years or over was conducted in 2014 using a self-administered questionnaire and 10,758 (77.7%) residents participated. Of those, married men who lived with married women were analyzed (n = 2370). Functional capacity and depressive symptoms were analyzed as outcomes respectively. Of the 2370 men, 1434 (60.5%) lived with women who had experience as a health promotion volunteer in the past. Modified Poisson regression analysis adjusting for covariates showed that living with women who had this experience was inversely associated with depressive symptoms (adjusted Prevalence Ratio; 0.84, 95% Confidence Interval; 0.73–0.97), but not with low functional capacity. These results suggest that living with women who had the experience as health promotion volunteer might affect depressive symptoms of elderly men. Full article
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Open AccessArticle
Shifts in Traditional Methods of Coping Among Elderly Bedouin Men
Int. J. Environ. Res. Public Health 2019, 16(1), 4; https://doi.org/10.3390/ijerph16010004 - 20 Dec 2018
Abstract
Elderly Bedouin men in southern Israel are a unique traditional population living in remote unrecognized villages and experiencing rapid social transition, in addition to deep poverty and political tension. In this study, we aimed to explore stressful events, as self-defined by the participants, [...] Read more.
Elderly Bedouin men in southern Israel are a unique traditional population living in remote unrecognized villages and experiencing rapid social transition, in addition to deep poverty and political tension. In this study, we aimed to explore stressful events, as self-defined by the participants, and the ways in which these men have coped with those stressful events. This study involved 12 men, aged 69–74, who participated in in-depth narrative interviews during which they were asked about transformative stressful events in their lives and how they had managed, understood, and utilized human capital, meaning-making, and other methods of coping. Analysis of the interviews revealed several themes: (a) the definition of stressful events within the cultural context, (b) the use of human capital to overcome those events, (c) the transformation of experience from hindsight into a didactic narrative that can be used to assign meaning to past events, which can then be passed on to the next generation, and (d) cultural transition as a catalyst for the creation of new understandings of events. This paper sheds new light on how elderly indigenous Bedouin men self-define stressful situations within a complex and unstable cultural context. This specific context, can help us to gain insight into how indigenous impoverished older men in similar contexts may self-define their stress and coping, based on the types of generalization accepted in qualitative research. The methodological contribution of this work lies in its use of narrative to culturally contextualize phenomenological meaning structures. Its theoretical contribution lies in its examination of the concept of stress within a specific cultural context. Full article
Open AccessArticle
Delivery of Fall Prevention Interventions for At-Risk Older Adults in Rural Areas: Findings from a National Dissemination
Int. J. Environ. Res. Public Health 2018, 15(12), 2798; https://doi.org/10.3390/ijerph15122798 - 10 Dec 2018
Cited by 7
Abstract
Falls incidence rates and associated injuries are projected to increase among rural-dwelling older adults, which highlights the need for effective interventions to prevent falls and manage fall-related risks. The purpose of this descriptive study was to identify the geospatial dissemination of eight evidence-based [...] Read more.
Falls incidence rates and associated injuries are projected to increase among rural-dwelling older adults, which highlights the need for effective interventions to prevent falls and manage fall-related risks. The purpose of this descriptive study was to identify the geospatial dissemination of eight evidence-based fall prevention programs (e.g., A Matter of Balance, Stepping On, Tai Chi, Otago Exercise Program) across the United States (U.S.) in terms of participants enrolled, workshops delivered, and geospatial reach. These dissemination characteristics were compared across three rurality designations (i.e., metro areas; non-metro areas adjacent to metro areas; and, non-metro areas not adjacent to metro areas). Data were analyzed from a national repository of 39 Administration for Community Living (ACL) grantees from 2014–2017 (spanning 22 states). Descriptive statistics were used to assess program reach, delivery-site type, and completion rate by rurality. Geographic information systems (GIS) geospatially represented the collective reach of the eight interventions. Of the 45,812 participants who attended a fall prevention program, 12.7% attended workshops in non-metro adjacent areas and 6.6% attended workshops in non-metro non-adjacent areas. Of the 3755 workshops delivered (in over 550 unique counties), most were delivered in senior centers (26%), residential facilities (20%), healthcare organizations (13%), and faith-based organizations (9%). On average, the workshop attendance/retention rates were consistent across rurality (~70%). Findings highlight the need to diversify the delivery infrastructure for fall prevention programs to adequately serve older adults in rural areas. Ongoing efforts are needed to offer sustainable technical assistance and to develop scalable clinical-community referral systems to increase fall prevention program participation among rural-dwelling older adults. Full article
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Open AccessArticle
Gender Differences in the Impact of Cognitive Function on Health Literacy among Older Adults with Heart Failure
Int. J. Environ. Res. Public Health 2018, 15(12), 2711; https://doi.org/10.3390/ijerph15122711 - 01 Dec 2018
Cited by 2
Abstract
Heart failure (HF)-related cognitive decline is a common condition and may be associated with health literacy. However, gender differences in this context have not been explored fully. This secondary data analysis aimed to identify gender differences in the impact of cognitive function on [...] Read more.
Heart failure (HF)-related cognitive decline is a common condition and may be associated with health literacy. However, gender differences in this context have not been explored fully. This secondary data analysis aimed to identify gender differences in the impact of cognitive function on health literacy among older patients with HF. A total of 135 patients (75 men and 60 women) with a mean age of 73.01 ± 6.45 years were recruited. Older women with HF had higher cognitive impairment (15%) and inadequate health literacy (56.7%) compared to men. Cognitive function was the strongest predictor of health literacy in men (β = 3.668, p < 0.001) and women (β = 2.926, p = 0.004). Notably elderly women are likely to face double the burden of the influence of cognitive function on health literacy in comparison with men. It is necessary to assess cognitive function and health literacy during HF illness trajectories on a regular basis. Healthcare professionals working with patients with HF should be aware of gender differences in cognitive function and health literacy and the importance of assessing these factors. Full article
Open AccessArticle
Correlates of Mild Cognitive Impairment of Community-Dwelling Older Adults in Wuhan, China
Int. J. Environ. Res. Public Health 2018, 15(12), 2705; https://doi.org/10.3390/ijerph15122705 - 30 Nov 2018
Abstract
Mild cognitive impairment (MCI) is an early stage of Alzheimer’s disease or other forms of dementia that occurs mainly in older adults. The MCI phase could be considered as an observational period for the secondary prevention of dementia. This study aims to assess [...] Read more.
Mild cognitive impairment (MCI) is an early stage of Alzheimer’s disease or other forms of dementia that occurs mainly in older adults. The MCI phase could be considered as an observational period for the secondary prevention of dementia. This study aims to assess potential differences in the risk of MCI among different elderly groups in Wuhan, China, and to further identify the most vulnerable populations using logistic regression models. A total of 622 older adults participated in this study, and the prevalence of MCI was 34.1%. We found that individuals aged 80–84 (odds ratio, OR = 1.908, 95% confidence interval, 95% CI 1.026 to 3.549) or above (OR = 2.529, 95% CI 1.249 to 5.122), and those with two chronic diseases (OR = 1.982, 95% CI 1.153 to 3.407) or more (OR = 2.466, 95% CI 1.419 to 4.286) were more likely to be diagnosed with MCI. Those with high school degrees (OR = 0.451, 95% CI 0.230 to 0.883) or above (OR = 0.318, 95% CI 0.129 to 0.783) and those with a family per-capita monthly income of 3001–4500 yuan (OR = 0.320, 95% CI 0.137 to 0.750) or above (OR = 0.335, 95% CI 0.135 to 0.830) were less likely to experience MCI. The results also showed that those aged 80 or above were more likely to present with cognitive decline and/or reduced activities of daily living (ADL) function, with the odds ratios being 1.874 and 3.782, respectively. Individuals with two, or three or more chronic diseases were more likely to experience cognitive decline and/or reduced ADL function, with odds ratios of 2.423 and 2.631, respectively. Increased risk of suffering from either MCI and/or decline in ADL functioning is strongly positively associated with older age, lower educational levels, poorer family economic status, and multiple chronic diseases. Our findings highlight that the local, regional, and even national specific MCI-related health promotion measures and interventions must target these vulnerable populations. Full article
Open AccessArticle
Associations between Body Mass Index and Subjective Health Outcomes among Older Adults: Findings from the Yilan Study, Taiwan
Int. J. Environ. Res. Public Health 2018, 15(12), 2645; https://doi.org/10.3390/ijerph15122645 - 26 Nov 2018
Cited by 2
Abstract
Previous findings on the associations between body mass index (BMI) and subjective health outcomes among older adults are inconsistent. The aims of this study were to explore the associations of BMI with health-related quality of life (HRQoL), self-rated health (SRH) and happiness among [...] Read more.
Previous findings on the associations between body mass index (BMI) and subjective health outcomes among older adults are inconsistent. The aims of this study were to explore the associations of BMI with health-related quality of life (HRQoL), self-rated health (SRH) and happiness among older adults. This study was part of the Yilan study, which was a community-based survey conducted in the Yilan city in Taiwan. A total of 3722 older adults were randomly recruited during 2012–2016. HRQoL was measured using the Short Form-12 Health Survey physical component summary (PCS) and mental component summary (MCS) scores and SRH and happiness were also evaluated. By hierarchical regression, after adjusting for covariates, compared with normal-weight participants, overweight did not have significantly different PCS scores (B = 0.20, 95% confidence interval [CI]: −0.45 to 0.85, p = 0.546) but obese had significantly lower PCS scores (B = −0.97, 95% CI: −1.68 to −0.26, p < 0.0001); overweight and obese participants had significantly better MCS scores (B = 1.00, 95% CI: 0.40 to 1.61, p = 0.001 and B = 1.22, 95% CI: 0.60 to 1.88, p < 0.0001, respectively); overweight participants had significantly higher SRH scores (B = 1.08, 95% CI: 0.16 to 2.00, p = 0.022) but underweight had significantly lower SRH scores (B = −2.88, 95% CI: −4.81 to −0.95, p = 0.003); overweight and obese participants had better happiness scores (B = 1.55, 95% CI: 0.45 to 2.66, p = 0.006 and B = 1.68, 95% CI: 0.49 to 2.88, p = 0.006, respectively). In conclusion, compared with normal-weight individuals, overweight individuals had better mental HRQoL, SRH and happiness but underweight older people reported poorer SRH and obese reported poorer physical HRQOL but better mental HRQoL and self-rated happiness. Full article
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Open AccessArticle
The Effectiveness of Home Services in Taiwan: A People-Centered Approach
Int. J. Environ. Res. Public Health 2018, 15(11), 2605; https://doi.org/10.3390/ijerph15112605 - 21 Nov 2018
Cited by 2
Abstract
Among available home and community-based services in Taiwan, there should be a focus on providing people with people-centered, value-based services. This study aims to follow up the people-centered health outcomes of care recipients and to examine the factors associated with to feedback for [...] Read more.
Among available home and community-based services in Taiwan, there should be a focus on providing people with people-centered, value-based services. This study aims to follow up the people-centered health outcomes of care recipients and to examine the factors associated with to feedback for policy and practice in long-term care. A total of 9889 persons from the long-term care dataset were followed up for two years (T0–T4). The Cox Proportional Hazard Regression analyses to analyze mortality and the mixed effect models for health outcomes were used. Three classes among the care recipients were identified. Health profiles (HR = 1.46 and 2.56 for FI and FD compared with RI, p < 0.001), subsidy gap (HR = 1.01), and living status (HR = 0.88 for those living with spouse only) had a significant impact on mortality. The overall dropout rate was 52.3% at two years, and the health profiles at baseline significantly influenced the health outcome’s change. The health heterogeneity matters and influences subsequent outcomes. To reach the goal of the HCBS, regular and exact monitoring of care recipients is crucial, while feedback regarding health outcomes and a greater focus on providing person-centered and responsive services in the community are also required. Full article
Open AccessArticle
Intensity-Dependent Effects of a Six-Week Balance Exercise Program in Elderly Women
Int. J. Environ. Res. Public Health 2018, 15(11), 2564; https://doi.org/10.3390/ijerph15112564 - 16 Nov 2018
Cited by 1
Abstract
The objective of this study was to gain a better understanding of the mechanisms underlying falls in the elderly. The results were based on a group of 28 women in a control group (CON) and 16 women in an experimental group (EXP), aged [...] Read more.
The objective of this study was to gain a better understanding of the mechanisms underlying falls in the elderly. The results were based on a group of 28 women in a control group (CON) and 16 women in an experimental group (EXP), aged 60–70. Participants took part in the six-weeks Elderly Recreation Movement Program (ERMP) with the only difference that the EXP group practiced twice as often as the CON group. The measurement of variations in the index called limits of stability (LOS) was performed by application of Kistler force plate and the coactivation index (CI) was registered by means of sEMG. The results demonstrate the existence of statistically significant differences in terms of the principal outcome of the exercise time in the measurements of LOS (F(1.42) = 10.0, p = 0.003), and CI (F(1.42) = 10.5, p = 0.002). The effect of the program was associated with an increase the level of the maximum LOS, and a decrease of the CI level, especially in the experimental group. Hence, the implementation of an innovative ERMP exercise program results in the improvement of the physical capabilities of senior subjects. Full article
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Open AccessArticle
The Effect of Nordic Walking Training Combined with Vitamin D Supplementation on Postural Control and Muscle Strength in Elderly People—A Randomized Controlled Trial
Int. J. Environ. Res. Public Health 2018, 15(9), 1951; https://doi.org/10.3390/ijerph15091951 - 07 Sep 2018
Cited by 3
Abstract
Nordic Walking (NW) and Vitamin D concentration (Vit D) alone have been shown to contribute to the health and performance of elderly people. However, the interaction between these two factors has yet to be explored. In this study 42 women over 60 years [...] Read more.
Nordic Walking (NW) and Vitamin D concentration (Vit D) alone have been shown to contribute to the health and performance of elderly people. However, the interaction between these two factors has yet to be explored. In this study 42 women over 60 years of age (69.02 ± 5.56 years) were recruited and divided in two NW groups: a high-intensity interval training group (HI-NW) and a moderate-intensity continuous training group (MI-NW). Individuals from each group completed a 12-week NW training program (3 times a week/2 hours) combined with randomized Vitamin D supplementation (HD = high dose: 4000 IU/day or LD = low dose: 800 IU/day). Body composition, postural control, muscle strength and Vitamin D serum concentration were measured twice; before and after the intervention. To investigate the interaction between supplementation and training a mixed-design analysis of variance (ANOVA) was performed. The HI-NW group, regardless of supplementation dose, increased their Vit D and elbow torque performance. On the other hand, in the MI-NW group the same Vit D outcome was seen only with HD supplementation and was also associated with increased leg muscle mass. In conclusion, beneficial effects of both HI-NW and MI-NW training regimes were seen. The impact of the dose supplementation on Vit D and body composition was related to the type of NW training. Full article
Open AccessArticle
Associations among Elder Abuse, Depression and PTSD in South Korean Older Adults
Int. J. Environ. Res. Public Health 2018, 15(9), 1948; https://doi.org/10.3390/ijerph15091948 - 06 Sep 2018
Abstract
Increasing attention is being placed on the prevalence of elder abuse and its impact on mental health. This study conducted a survey of 172 elderly people in South Korea to determine the prevalence of elder abuse and the relationships involving elder abuse, depression [...] Read more.
Increasing attention is being placed on the prevalence of elder abuse and its impact on mental health. This study conducted a survey of 172 elderly people in South Korea to determine the prevalence of elder abuse and the relationships involving elder abuse, depression and posttraumatic stress disorder (PTSD). Participants completed a battery of self-report questionnaires, which included the Korean Geriatric Depression Screening Scale (KGDS) and Impact of Event Scale-Revised Korean version (IES-R-K). Descriptive analyses were conducted to examine the frequency of specific forms of abuse. Logistic regression models were estimated to identify the factors that contributed to risk of abuse exposure and the relationship between exposure and PTSD or depression. The results indicated around 22% of the participants reported abuse exposure, which most commonly included being refused physical contact, verbal threats, and/or being excluded from decision-making about personal issues. Low education and being unmarried, separated or divorced was associated with an increased risk of abuse exposure. There were strong associations between elder abuse and PTSD symptoms, while comparable relationships with depression were weaker and were not robust to the inclusion of control variables. The findings provided empirical support for the relationship between abuse experiences of the elderly and poor mental health and raise important issues for the mental health care of the elderly. Full article
Open AccessArticle
Use of an E2SFCA Method to Measure and Analyse Spatial Accessibility to Medical Services for Elderly People in Wuhan, China
Int. J. Environ. Res. Public Health 2018, 15(7), 1503; https://doi.org/10.3390/ijerph15071503 - 17 Jul 2018
Cited by 16
Abstract
Current studies on measuring the accessibility of medical services for the elderly (AMSE) have ignored the potential competition among supply and demand and the distance decay laws. Hence, an enhanced two-step floating catchment area (E2SFCA) method (i.e., the road network-based Gaussian 2SFCA method) [...] Read more.
Current studies on measuring the accessibility of medical services for the elderly (AMSE) have ignored the potential competition among supply and demand and the distance decay laws. Hence, an enhanced two-step floating catchment area (E2SFCA) method (i.e., the road network-based Gaussian 2SFCA method) is proposed to calculate AMSE scores after considering different types of roads, including urban rail transit, freeways, major roads, minor roads and rural roads. Based on the first National Geographic Conditions Monitoring (NGCM) data, this study took Wuhan, China, as a case study and assessed the variation of AMSE using two different threshold times (i.e., Platinum Ten and Golden Hour). Next, global (i.e., sensitivity and hot spot analysis) and local analyses (i.e., three regional area internal comparisons) of AMSE scores were conducted to accurately identify details in the variation of spatial accessibility. It was observed that the E2SFCA method could be easily applied to measure AMSE. The results showed that 48.63% of the elderly population in Wuhan had a higher or the highest level of medical accessibility in “Platinum Ten”, while 72.97% had a higher or the highest level in the “Golden Hour”, and hot spots of AMSE scores were located in central urban areas and presented an enclosure structure using both threshold travel times, which could provide guidance to governments or planners on issues of spatial planning and identifying elderly medical services shortage areas. Full article
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Open AccessArticle
Effect of a Positive Photo Appreciation Program on Depressive Mood in Older Adults: A Pilot Randomized Controlled Trial
Int. J. Environ. Res. Public Health 2018, 15(7), 1472; https://doi.org/10.3390/ijerph15071472 - 12 Jul 2018
Cited by 2
Abstract
Safer and more effective programs are required to cope with an increasing number of older people with depression. Hence, we developed the Positive Photo Appreciation (PPA) program. A three-month pilot randomized controlled trial was conducted with healthy Japanese individuals aged 65–84 years, assigned [...] Read more.
Safer and more effective programs are required to cope with an increasing number of older people with depression. Hence, we developed the Positive Photo Appreciation (PPA) program. A three-month pilot randomized controlled trial was conducted with healthy Japanese individuals aged 65–84 years, assigned to a PPA group (n = 28) or Photo Correspondence Education (PCE) (control group) (n = 27). We used the Center for Epidemiologic Studies Depression Scale (CES-D) score as the primary outcome measure. Secondary outcome measures, among others, were cognitive function and positive emotion. Data collected at baseline and post-intervention were analyzed using a linear mixed-effect model. Over 80% of the participants in the PPA group completed and were satisfied with the program. Compared with the PCE group, the CES-D score in the PPA group significantly improved (main effect of group: t = −4.30, p < 0.001; interaction effect of group by time: t = 4.39, p < 0.001), with an effect size of d = 1.23. Additionally, a positive significant interaction effect of group by time was found in the Positive and Negative Affect Schedule (t = −2.33, p = 0.024). The PPA program might be promising for mitigating depressive mood in older adults. Full article
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Open AccessArticle
A Cross-Disciplinary Successful Aging Intervention and Evaluation: Comparison of Person-to-Person and Digital-Assisted Approaches
Int. J. Environ. Res. Public Health 2018, 15(5), 913; https://doi.org/10.3390/ijerph15050913 - 04 May 2018
Abstract
Background: Successful aging has been the paradigm of old-age life. The purpose of this study was to implement and evaluate a cross-disciplinary intervention program using two approaches for community-based older adults in Taichung, Taiwan. Methods: The content of the intervention included [...] Read more.
Background: Successful aging has been the paradigm of old-age life. The purpose of this study was to implement and evaluate a cross-disciplinary intervention program using two approaches for community-based older adults in Taichung, Taiwan. Methods: The content of the intervention included successful aging concepts and preparation, physical activity, chronic disease and health management, dietary and nutrition information, cognitive training, emotional awareness and coping skills, family relationship and resilience, legal concepts regarding financial protection, and Internet use. The traditional person-to-person (P2P) intervention approach was implemented among participants at urban centers, and the personal-and-digital (P&D) intervention approach was implemented among participants at rural centers; before the P&D group received the intervention, participants were assessed as the control group for comparison. Results: Healthy behavior and nutrition improved for the P2P group, although not significantly. Strategies for adapting to old age and reducing ineffective coping were significantly improved in the P2P group. The ability to search for health information improved in the P&D group, and knowledge of finance-related law increased in the P2P group. Conclusion: A continuous, well-designed and evidence-based intervention program is beneficial for improving the health of older adults, or at least delaying its decline. Full article
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Open AccessArticle
The Relationship between Diabetes Mellitus and Respiratory Function in Patients Eligible for Coronary Artery Bypass Grafting
Int. J. Environ. Res. Public Health 2018, 15(5), 907; https://doi.org/10.3390/ijerph15050907 - 03 May 2018
Abstract
Introduction: Spirometry performed prior to surgery provides information on the types of lung disorders in patients. The purpose of this study was to look for a relationship between the prevalence of diabetes and spirometry parameters. Material and Methods: The study was conducted in [...] Read more.
Introduction: Spirometry performed prior to surgery provides information on the types of lung disorders in patients. The purpose of this study was to look for a relationship between the prevalence of diabetes and spirometry parameters. Material and Methods: The study was conducted in patients with coronary artery disease who were eligible for an isolated coronary artery bypass graft in 2013. The study group included 367 patients (287 men and 80 women) aged 68.7 ± 8.4 years. They were divided into those with diagnosed diabetes (group I, n = 138, 37.6%) and without diabetes (group II, n = 229, 62.4%). Spirometry tests were performed on the day of admission to the hospital. Results: Patients with diabetes (group I) had a significantly higher body mass index than those without diabetes (group II). Spirometry tests also showed that patients with diabetes had statistically significantly lower forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1.0). Both FVC and FEV1.0 were also statistically significantly lower for overweight and obese individuals in group I than those in group II. Conclusion: Patients with diabetes eligible for coronary artery bypass grafting with concurrent overweight or obesity are more likely to have lower spirometry parameters than those without diabetes. Full article
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Open AccessFeature PaperArticle
Impact of a Translated Disease Self-Management Program on Employee Health and Productivity: Six-Month Findings from a Randomized Controlled Trial
Int. J. Environ. Res. Public Health 2018, 15(5), 851; https://doi.org/10.3390/ijerph15050851 - 25 Apr 2018
Cited by 9
Abstract
Disease management is gaining importance in workplace health promotion given the aging workforce and rising chronic disease prevalence. The Chronic Disease Self-Management Program (CDSMP) is an effective intervention widely offered in diverse community settings; however, adoption remains low in workplace settings. As part [...] Read more.
Disease management is gaining importance in workplace health promotion given the aging workforce and rising chronic disease prevalence. The Chronic Disease Self-Management Program (CDSMP) is an effective intervention widely offered in diverse community settings; however, adoption remains low in workplace settings. As part of a larger NIH-funded randomized controlled trial, this study examines the effectiveness of a worksite-tailored version of CDSMP (wCDSMP [n = 72]) relative to CDSMP (‘Usual Care’ [n = 109]) to improve health and work performance among employees with one or more chronic conditions. Multiple-group latent-difference score models with sandwich estimators were fitted to identify changes from baseline to 6-month follow-up. Overall, participants were primarily female (87%), non-Hispanic white (62%), and obese (73%). On average, participants were age 48 (range: 23–72) and self-reported 3.25 chronic conditions (range: 1–16). The most commonly reported conditions were high cholesterol (45%), high blood pressure (45%), anxiety/emotional/mental health condition (26%), and diabetes (25%). Among wCDSMP participants, significant improvements were observed for physically unhealthy days (uΔ = −2.07, p = 0.018), fatigue (uΔ = −2.88, p = 0.002), sedentary behavior (uΔ = −4.49, p = 0.018), soda/sugar beverage consumption (uΔ = −0.78, p = 0.028), and fast food intake (uΔ = −0.76, p = 0.009) from baseline to follow-up. Significant improvements in patient–provider communication (uΔ = 0.46, p = 0.031) and mental work limitations (uΔ = −8.89, p = 0.010) were also observed from baseline to follow-up. Relative to Usual Care, wCDSMP participants reported significantly larger improvements in fatigue, physical activity, soda/sugar beverage consumption, and mental work limitations (p < 0.05). The translation of Usual Care (content and format) has potential to improve health among employees with chronic conditions and increase uptake in workplace settings. Full article
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Open AccessArticle
The Elderly Perceived Meanings and Values of Virtual Reality Leisure Activities: A Means-End Chain Approach
Int. J. Environ. Res. Public Health 2018, 15(4), 663; https://doi.org/10.3390/ijerph15040663 - 03 Apr 2018
Cited by 6
Abstract
This study uses means-end chain (MEC) techniques to examine the awareness, decision-making procedure, and personal values of the elderly with regard to virtual reality leisure activities. The results of the study show that elderly respondents value virtual reality leisure activities that are fun, [...] Read more.
This study uses means-end chain (MEC) techniques to examine the awareness, decision-making procedure, and personal values of the elderly with regard to virtual reality leisure activities. The results of the study show that elderly respondents value virtual reality leisure activities that are fun, safe, and easy. In terms of outcome benefits, elderly respondents value feeling physically and mentally healthy, firsthand experience, and satisfied curiosity. In value terms, elderly respondents hope that their chosen virtual reality leisure activities improve not only their relationships with others, but also their enjoyment, quality of life, and sense of belonging. The results show that, while consumers with different awarenesses of virtual reality leisure activities have different decision-making processes, they share creating “good memories” as the terminal value with the most significant effect. This presents a potential opportunity to promote virtual reality leisure activities. Relevant bodies or enterprises can seek to create good memories in consumers by developing activities that are safe and fun, promote good health, and provide good service, thereby attracting the interest of elderly consumers. Full article
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Open AccessArticle
The Effect of Leisure Activity Diversity and Exercise Time on the Prevention of Depression in the Middle-Aged and Elderly Residents of Taiwan
Int. J. Environ. Res. Public Health 2018, 15(4), 654; https://doi.org/10.3390/ijerph15040654 - 01 Apr 2018
Cited by 10
Abstract
Previous studies have confirmed that activity participation is beneficial to mental health, but few studies focus on older adults’ depression. Based on the theory of social integration, this study examined the effects of leisure activity diversity and exercise time on depression in late [...] Read more.
Previous studies have confirmed that activity participation is beneficial to mental health, but few studies focus on older adults’ depression. Based on the theory of social integration, this study examined the effects of leisure activity diversity and exercise time on depression in late adulthood. Subjects in the 2011 Survey of Health and Living Status of the Middle-Aged and Elderly in Taiwan were extracted. A series of logistic regressions were conducted to discern factors related to the odds of having depression. Among study subjects (N = 3727; age ≥ 58), 20.9% indicated an inclination of having depression (CESD-10 score ≥ 8). This study found that participating in diverse leisure activities and longer exercise time decreases older adults’ risk of having depression. Additionally, the results confirmed that depression is positively correlated with chronic diseases. Consequently, efforts should be continually spent on encouraging older adults’ participation in activities to reduce the prevalence of depression. Full article
Open AccessArticle
Importance of Footwear for Preventing Xerosis and Hyperkeratosis in Older People with Psychiatric Disorders Living in an Institution
Int. J. Environ. Res. Public Health 2018, 15(4), 584; https://doi.org/10.3390/ijerph15040584 - 24 Mar 2018
Cited by 1
Abstract
Few studies have focused on the relation between the use and characteristics of footwear and the presence of foot lesions in people with psychiatric disorders. This work analyzes the influence of different footwear habits on the presence of deformities and ungueal and dermal [...] Read more.
Few studies have focused on the relation between the use and characteristics of footwear and the presence of foot lesions in people with psychiatric disorders. This work analyzes the influence of different footwear habits on the presence of deformities and ungueal and dermal pathologies of the foot of institutionalized people with psychiatric disorders compared to people without these disorders. A transversal and observational study was conducted on 107 participants, divided into two groups who have used different types of shoes throughout their lives. The control group comprised 63 autonomous people who mainly use leather footwear and a study group of 44 institutionalized people with intellectual disabilities and psychiatric disorders who mainly use textile footwear. There were significant differences between populations. The group with psychiatric disorders presented more xerosis and hyperkeratosis. Footwear with inappropriate characteristics is a possible causal agent of skin alterations. Wearing footwear with quality textile uppers, e.g., fabric or felt, could influence the appearance of these alterations. Leather footwear is recommended for institutionalized people to reduce symptoms of xerosis and improve their quality of life. Full article
Open AccessArticle
Internet Use and Psychological Well-Being at Advanced Age: Evidence from the English Longitudinal Study of Aging
Int. J. Environ. Res. Public Health 2018, 15(3), 480; https://doi.org/10.3390/ijerph15030480 - 09 Mar 2018
Cited by 4
Abstract
This work explores the connection between psychological well-being and Internet use in older adults. The study is based on a sample of 2314 participants in the English Longitudinal Study of Aging. The subjects, aged 50 years and older, were interviewed every two years [...] Read more.
This work explores the connection between psychological well-being and Internet use in older adults. The study is based on a sample of 2314 participants in the English Longitudinal Study of Aging. The subjects, aged 50 years and older, were interviewed every two years over the 2006–2007 to 2014–2015 period. The connection between the use of Internet/Email and the main dimensions of psychological well-being (evaluative, hedonic and eudaimonic) was analyzed by means of three generalized estimating equation models that were fitted on 2-year lagged repeated measurements. The outcome variables, the scores on three well-being scales, were explained in terms of Internet/Email use, controlling for covariates that included health and socioeconomic indicators. The results support the existence of a direct relationship between Internet/Email use and psychological well-being. The connection between the main predictor and the score of the participants on the scale used to measure the eudaimonic aspect was positive and statistically significant at conventional levels (p-value: 0.015). However, the relevance of digital literacy on the evaluative and the hedonic components could not be confirmed (p-values for evaluative and hedonic dimensions were 0.078 and 0.192, respectively). Full article
Open AccessArticle
Community Readiness for the Promotion of Physical Activity in Older Adults—A Cross-Sectional Comparison of Rural and Urban Communities
Int. J. Environ. Res. Public Health 2018, 15(3), 453; https://doi.org/10.3390/ijerph15030453 - 06 Mar 2018
Cited by 3
Abstract
Communities can play an important role in delivering public health programs to older adults, but they differ in the provision of local structures and resources. The community readiness (CR) approach applies a stage model of change to the community level and analyzes structures [...] Read more.
Communities can play an important role in delivering public health programs to older adults, but they differ in the provision of local structures and resources. The community readiness (CR) approach applies a stage model of change to the community level and analyzes structures and the degree of willingness to take action on a health issue. This study compared the CR regarding the promotion of physical activity as part of healthy ageing for older adults among urban and rural communities in North-West Germany. A cross-sectional CR assessment with key respondents in 23 municipalities (11 urban and 12 rural communities) was conducted using a semi-structured interview. Interviews were scored across the five CR dimensions and global CR score was calculated (scores between 1 = no awareness and 9 = professionalization). Wilcoxon rank-sum test and hierarchical regression models were used to compare urban and rural communities. In total, 118 interviews were conducted (response rate 69.8%). On average, the communities showed moderate CR scores (4.9 ± 0.3; Range: 4.3–5.4; preplanning or preparation phase). The global CR score was slightly higher in rural than in urban communities (regression coefficient = 0.29, 95% confidence interval (CI): −0.02–0.59). The rural communities showed significantly higher CR scores in the ‘Knowledge of efforts’ dimension (0.70, 95% CI: 0.26–1.14) and in the ‘Knowledge of the issue’ (0.37, 95% CI: 0.04–0.70). Rural communities display a slightly higher CR level than urban communities. In the next step, targeted capacity building activities will be initiated among communities with low CR levels. Full article
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Open AccessArticle
Evaluation of a Computer-Tailored Healthy Ageing Intervention to Promote Physical Activity among Single Older Adults with a Chronic Disease
Int. J. Environ. Res. Public Health 2018, 15(2), 346; https://doi.org/10.3390/ijerph15020346 - 15 Feb 2018
Cited by 8
Abstract
This study explores the effectiveness of the Active Plus65 intervention designed to stimulate physical activity among single older adults with a chronic physical impairment. A quasi-experimental pre-test post-test study was performed. The intervention group (n = 411; mean age = 76.75; SD [...] Read more.
This study explores the effectiveness of the Active Plus65 intervention designed to stimulate physical activity among single older adults with a chronic physical impairment. A quasi-experimental pre-test post-test study was performed. The intervention group (n = 411; mean age = 76.75; SD = 7.75) was assessed at baseline, three months, and six months. Data of comparable older adults who completed the original Active Plus intervention served as reference group (n = 87; mean age = 74.36; SD = 6.26). Multilevel regression analyses were applied: outcome measures were weekly minutes of moderate to vigorous physical activity (MVPA) and days per week with at least 30 min of MVPA. Although Active Plus65 did not outperform the original intervention, in itself Active Plus65 effectuated a significant increase in the weekly minutes of MVPA (B = 208.26; p < 0.001; Effect Size (ES) = 0.45) and in the days per week with sufficient MVPA (B = 1.20; p < 0.001; ES = 0.61) after three months. After six months, it effectuated a significant increase in the days per week with sufficient MVPA (B = 0.67; p = 0.001; ES = 0.34) but not for the weekly minutes of MVPA (p = 0.745). As Active Plus65 increased MVPA at three months with a higher ES than average interventions for this vulnerable target group, it potentially makes an interesting intervention. Further development should focus on long-term maintenance of effects. Full article
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Open AccessArticle
The Role of Motivation to Reduce Obesity among Elderly People: Response to Priming Temptation in Obese Individuals
Int. J. Environ. Res. Public Health 2018, 15(2), 244; https://doi.org/10.3390/ijerph15020244 - 01 Feb 2018
Cited by 1
Abstract
The risk of obesity-related disorders is increased among the elderly, so changing eating habits can be an important element of prevention. The main aim of this article is to consider whether looking at pictures that present either fattening food or healthy food may [...] Read more.
The risk of obesity-related disorders is increased among the elderly, so changing eating habits can be an important element of prevention. The main aim of this article is to consider whether looking at pictures that present either fattening food or healthy food may motivate elderly people to change their nutrition habits. Might priming different kinds of food influence the attractiveness of the food for people in late adulthood undergoing obesity therapy? Based on priming theories, we analysed the effects of the conscious processing of stimuli associated with dietary habits in individuals aged with BMI ≥ 30 kg/m2. Our experiments confirmed the influence of a higher-priority goal of “slimming” on the perception and internalization of nutrition-related stimuli. In response to such stimuli, individuals who are actively involved in weight reduction and health-oriented programs use strategies for resisting temptation and to effectively “slim”. We present our findings in the context of their theoretical background and practical application. Full article
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Open AccessArticle
Use of an Integrated Research-Practice Partnership to Improve Outcomes of a Community-Based Strength-Training Program for Older Adults: Reach and Effect of Lifelong Improvements through Fitness Together (LIFT)
Int. J. Environ. Res. Public Health 2018, 15(2), 237; https://doi.org/10.3390/ijerph15020237 - 31 Jan 2018
Cited by 7
Abstract
Only 17% of older adults meet the recommendations for two days of full body strength training that is associated with improved functional fitness; reduced risk of falls; and reduced morbidity and mortality rates. Community-based interventions are recommended as they provide supportive infrastructure to [...] Read more.
Only 17% of older adults meet the recommendations for two days of full body strength training that is associated with improved functional fitness; reduced risk of falls; and reduced morbidity and mortality rates. Community-based interventions are recommended as they provide supportive infrastructure to reach older adults and impact strength training behaviors. Scalability and sustainability of these interventions is directly linked with setting-level buy-in. Adapting an intervention through an integrated research–practice partnership may improve individual and setting-level outcomes. The purpose of this study was to evaluate the initial reach and effect of a locally adapted, health educator-led strength-training intervention; Lifelong Improvements through Fitness Together (LIFT). LIFT was compared to an evidence-based exercise program, Stay Strong; Stay Healthy (SSSH). Intervention dose and mode were the same for LIFT and SSSH, but LIFT included behavioral change strategies. Older adult functional fitness was assessed before and after the 8-week strength training intervention. Health educators who delivered LIFT and SSSH were able to reach 80 and 33 participants, respectively. Participants in LIFT were able to significantly improve in all functional fitness measures whereas SSSH participants were only able to significantly improve in 5 of the 7 functional fitness measures. In conclusion, this study provides preliminary evidence that the locally adapted program reached more individuals and had improvements in functional fitness. Full article
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Open AccessArticle
Effectiveness of a Lifestyle Intervention on Social Support, Self-Efficacy, and Physical Activity among Older Adults: Evaluation of Texercise Select
Int. J. Environ. Res. Public Health 2018, 15(2), 234; https://doi.org/10.3390/ijerph15020234 - 30 Jan 2018
Cited by 6
Abstract
Despite the well-recognized benefits of physical activity across the life course, older adults are more inactive than other age groups. The current study examines the effects of Texercise Select participation on self-reported sedentary, light, moderate, and vigorous physical activity. Secondarily, this study examined [...] Read more.
Despite the well-recognized benefits of physical activity across the life course, older adults are more inactive than other age groups. The current study examines the effects of Texercise Select participation on self-reported sedentary, light, moderate, and vigorous physical activity. Secondarily, this study examined intervention effects on two potential facilitators of physical activity: (1) self-efficacy for being more physically active and (2) social support received for physical activity. This study used a non-equivalent group design with self-reported surveys administered at baseline, three-month (immediate post for cases) and six-month follow-ups for the intervention (n = 163) and a comparison group (n = 267). Multivariable mixed model analyses were conducted controlling for age, sex, race, ethnicity, education, comorbid conditions, and site. Among the intervention group, the program had significant immediate effects on most primary outcomes (p < 0.05) at three months. Furthermore, significant improvements were observed for all physical activity intensity levels at six months (p < 0.05). The reduction in sedentary behavior and increases in all physical activity intensity levels were significantly greater from baseline to three-month and baseline to six-month follow-ups among intervention group participants relative to those in the comparison group. This study confirms the effectiveness of Texercise Select to reduce sedentary behavior and improve physicality, supporting the intervention’s robustness as a scalable and sustainable evidence-based program. It also counters negative stereotypes that older adults are not interested in attending multi-modal lifestyle intervention programs nor able to make health behavior changes that can improve health and overall functioning. Full article
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Open AccessArticle
Association between Social Activities and Cognitive Function among the Elderly in China: A Cross-Sectional Study
Int. J. Environ. Res. Public Health 2018, 15(2), 231; https://doi.org/10.3390/ijerph15020231 - 30 Jan 2018
Cited by 14
Abstract
Participation in social activities is one of important factors for older adults’ health. The present study aims to examine the cross-sectional association between social activities and cognitive function among Chinese elderly. A total of 8966 individuals aged 60 and older from the 2015 [...] Read more.
Participation in social activities is one of important factors for older adults’ health. The present study aims to examine the cross-sectional association between social activities and cognitive function among Chinese elderly. A total of 8966 individuals aged 60 and older from the 2015 China Health and Retirement Longitudinal Study were obtained for this study. Telephone interviews of cognitive status, episodic memory, and visuospatial abilities were assessed by questionnaire. We used the sum of all three of the above measures to represent the respondent’s cognitive status as a whole. Types and frequencies of participation in social groups were used to measure social activities. Multiple linear regression analysis was used to explore the relationship between social activities and cognitive function. After adjustment for demographics, smoking, drinking, depression, hypertension, diabetes, basic activities of daily living, instrumental activities of daily living, and self-rated health, multiple linear regression analysis revealed that interaction with friends, participating in hobby groups, and sports groups were associated with better cognitive function among both men and women (p < 0.05); doing volunteer work was associated with better cognitive function among women but not among men (p < 0.05). These findings suggest that there is a cross-sectional association between participation in social activities and cognitive function among Chinese elderly. Longitudinal studies are needed to examine the effects of social activities on cognitive function. Full article
Open AccessArticle
Restricted Social Engagement among Adults Living with Chronic Conditions
Int. J. Environ. Res. Public Health 2018, 15(1), 158; https://doi.org/10.3390/ijerph15010158 - 19 Jan 2018
Cited by 7
Abstract
Background: Social engagement is key to health and quality of life. Little is known about social engagement patterns of middle-aged and older adults who live with one or more chronic illnesses. This study investigated social engagement restrictions among middle-aged and older adults [...] Read more.
Background: Social engagement is key to health and quality of life. Little is known about social engagement patterns of middle-aged and older adults who live with one or more chronic illnesses. This study investigated social engagement restrictions among middle-aged and older adults with chronic conditions and factors associated with these restrictions. Methods: Cross-sectional representative data from the National Council on Aging Chronic Care Survey were examined for relationships between social engagement restrictions and chronic conditions, health status, support, quality of life implications, self-care barriers, caregiving, and demographics. Associations were tested using bivariate analyses and binary logistic regression. Results: Participants were 793 middle-aged (age 44–64) and older adults (age 65+) with one or more chronic conditions. Factors associated with social engagement restrictions included having higher education, receiving care, having more physician visits and hospitalizations, being disabled, being unemployed, and having higher Emotional and Physical Problems Scale scores. Conclusions: Findings reveal the prevalence of social engagement restrictions among middle-aged and older adults with chronic conditions. Results highlight the importance of promoting research, assessments, and interventions to increase social engagement among this aging population. Full article
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2017

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Open AccessArticle
Grip Strength as an Indicator of Health-Related Quality of Life in Old Age—A Pilot Study
Int. J. Environ. Res. Public Health 2017, 14(12), 1447; https://doi.org/10.3390/ijerph14121447 - 24 Nov 2017
Cited by 18
Abstract
Over the last century life expectancy has increased dramatically nearly all over the world. This dramatic absolute and relative increase of the old aged people component of the population has influenced not only population structure but also has dramatic implications for the individuals [...] Read more.
Over the last century life expectancy has increased dramatically nearly all over the world. This dramatic absolute and relative increase of the old aged people component of the population has influenced not only population structure but also has dramatic implications for the individuals and public health services. The aim of the present pilot study was to examine the impact of physical well-being assessed by hand grip strength and social factors estimated by social contact frequency on health-related quality of life among 22 men and 41 women ranging in age between 60 and 94 years. Physical well-being was estimated by hand grip strength, data concerning subjective wellbeing and health related quality of life were collected by personal interviews based on the WHOQOL-BREF questionnaires. Number of offspring and intergenerational contacts were not related significantly to health-related quality of life, while social contacts with non-relatives and hand grip strength in contrast had a significant positive impact on health related quality of life among old aged men and women. Physical well-being and in particular muscle strength—estimated by grip strength—may increase health-related quality of life and is therefore an important source for well-being during old age. Grip strength may be used as an indicator of health-related quality of life. Full article
Open AccessArticle
FRED: Exergame to Prevent Dependence and Functional Deterioration Associated with Ageing. A Pilot Three-Week Randomized Controlled Clinical Trial
Int. J. Environ. Res. Public Health 2017, 14(12), 1439; https://doi.org/10.3390/ijerph14121439 - 23 Nov 2017
Cited by 2
Abstract
Introduction: Frailty syndrome and advanced age may decrease the acceptance of illness and quality of life, and worsen patients’ existing health conditions, as well as leading to an increase in health care expenses. Purpose: The purpose of this study is to reduce frailty [...] Read more.
Introduction: Frailty syndrome and advanced age may decrease the acceptance of illness and quality of life, and worsen patients’ existing health conditions, as well as leading to an increase in health care expenses. Purpose: The purpose of this study is to reduce frailty risk via the use of a FRED game which has been expressly designed and put together for the study. Materials and methods: A total of 40 frail volunteers with a score of <10 points in the short physical performance battery (SPPB) took part in a feasibility study in order to validate the FRED game. Following randomisation, the study group (20 subjects) took part in nine sessions of 20 min each over a three-week period. The control group (19 subjects) continued to lead their daily lives in the course of which they had no physical activity scheduled; Results: After three weeks and having taken part in nine physical activity sessions with the FRED game, 60% of subjects from the study group (12/20) obtained a score of ≥10 points at the end of the study, i.e., less risk of evidencing frailty. This result proved to be statistically significant (p < 0.001). The degree of compliance with and adherence to the game was confirmed by 100% attendance of the sessions. Discussion: Our findings support the hypothesis that FRED, an ad hoc designed exergame, significantly reduced the presence and severity of frailty in a sample of sedentary elders, thus potentially modifying their risk profile. Conclusions: The FRED game is a tool that shows a 99% certain improvement in the degree of frailty in frail elderly subjects. The effectiveness of the design of ad hoc games in a certain pathology or population group is therefore evidenced. Full article
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Open AccessArticle
Comparison of Summer and Winter Objectively Measured Physical Activity and Sedentary Behavior in Older Adults: Age, Gene/Environment Susceptibility Reykjavik Study
Int. J. Environ. Res. Public Health 2017, 14(10), 1268; https://doi.org/10.3390/ijerph14101268 - 21 Oct 2017
Cited by 8
Abstract
In Iceland, there is a large variation in daylight between summer and winter. The aim of the study was to identify how this large variation influences physical activity (PA) and sedentary behavior (SB). Free living PA was measured by a waist-worn accelerometer for [...] Read more.
In Iceland, there is a large variation in daylight between summer and winter. The aim of the study was to identify how this large variation influences physical activity (PA) and sedentary behavior (SB). Free living PA was measured by a waist-worn accelerometer for one week during waking hours in 138 community-dwelling older adults (61.1% women, 80.3 ± 4.9 years) during summer and winter months. In general, SB occupied about 75% of the registered wear-time and was highly correlated with age (β = 0.36). Although the differences were small, more time was spent during the summer in all PA categories, except for the moderate-to-vigorous PA (MVPA), and SB was reduced. More lifestyle PA (LSPA) was accumulated in ≥5-min bouts during summer than winter, especially among highly active participants. This information could be important for policy makers and health professionals working with older adults. Accounting for seasonal difference is necessary in analyzing SB and PA data. Full article
Open AccessReview
Community Capacity Building for Physical Activity Promotion among Older Adults—A Literature Review
Int. J. Environ. Res. Public Health 2017, 14(9), 1058; https://doi.org/10.3390/ijerph14091058 - 13 Sep 2017
Cited by 5
Abstract
Community-based interventions to promote physical activity (PA) among older adults are of high interest in health promotion since they promise to be effective strategies to reach this population group. Community capacity building, that is, the local promotion of knowledge, skills, commitment, structures, and [...] Read more.
Community-based interventions to promote physical activity (PA) among older adults are of high interest in health promotion since they promise to be effective strategies to reach this population group. Community capacity building, that is, the local promotion of knowledge, skills, commitment, structures, and leadership, is among the recommended core strategies. However, little guidance is provided on how to achieve a high degree of community capacity. This study aims to identify practical strategies to enhance community capacities for PA promotion among older adults (50 years or older) and to evaluate their success. A literature review was conducted using scientific databases (PsycInfo and Web of Sciences) and grey literature (national and international project databases), and 14 studies (16 articles) were identified. Five groups of capacity building strategies emerged from the literature: (1) building community coalitions and networks, (2) training of professionals, (3) training of laypersons, (4) strengthening competence and awareness in the target population, and (5) allocation of financial resources. All studies used more than one strategy. Coalition building and strengthening competence and awareness were most frequently used. Feasibility and acceptability of the capacity building strategies were demonstrated. However, intervention effects on PA behavior and other relevant outcomes were inconsistent. The one study that systematically compared different capacity building approaches did not find any evidence for beneficial effects of intensified capacity building. More rigorous research evaluating the efficacy of specific strategies to enhance community capacities for PA promotion is needed. Full article
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