Antimicrobial Stewardship Practices Reported by California Hospitals Following New Legislative Requirements: Analysis of National Healthcare Safety Network Annual Survey Data, 2014-2015.

We analyzed California hospitals' National Healthcare Safety Network Annual Surveys to describe antimicrobial stewardship program (ASP) implementation progress following new state ASP legislation. The proportion of hospitals with all 7 Core Elements of Hospital ASP rose from 59.3% in 2014 to 69.2% in 2015 (P<.001). Infect Control Hosp Epidemiol 2017;38:1503-1505.

Risk Profiles for Falls among Older Adults: New Directions for Prevention.

OBJECTIVE: To address whether neighborhood factors, together with older adults' levels of health and functioning, suggest new combinations of risk factors for falls and new directions for prevention. To explore the utility of Grade-of-Membership (GoM) analysis to conduct this descriptive analysis. METHOD: This is a cross-sectional, descriptive study of 884 people aged ≥65 years from Alameda County, CA, Cook County, IL, Allegheny County, PA, and Wake and Durham counties, NC. Interviews focused on neighborhood characteristics, physical and cognitive function, walking, and falls and injuries. Four risk profiles (higher order interactions of individual and neighborhood factors) were derived from GoM analysis. RESULTS: Profiles 1 and 2 reflect previous results showing that frail older adults are likely to fall indoors (Profile 1); healthy older adults are likely to fall outdoors (Profile 2). Profile 3 identifies the falls risk for older with mild cognitive impairment living in moderately walkable neighborhoods. Profile 4 identifies the risk found for healthy older adults living in neighborhoods with low walkability. DISCUSSION: Neighborhood walkability, in combination with levels of health and functioning, is associated with both indoor and outdoor falls. Descriptive results suggest possible research hypotheses and new directions for prevention, based on individual and neighborhood factors.

Mobility Disability in Older Adults: At the Intersection of People and Places.

PURPOSE: Mobility disability is associated with poor lower body function among older adults. This study examines whether specific types of neighborhood characteristics moderate that association. DESIGN AND METHODS: This study is based on a cross-sectional sample of 884 people aged ≥ 65 years identified through service organizations in Alameda County, CA; Cook County, IL; Allegheny County, PA; and Wake and Durham counties, NC. In-person interviews focus on neighborhood characteristics, physical and cognitive function, depression, and walking. Functional capacity is tested using objective measures of lower body strength, balance, and walking speed. Mobility disability, the main study outcome, is measured as self-reported level of difficulty in walking 2-3 neighborhood blocks. Estimates of main and interactive effects are derived from logistic regression models. RESULTS: Among older adults with poor lower body function, those who report less proximity to goods and services and barriers to walking report more mobility disability than other older adults. In contrast, among older adults with good lower body function, there is a low prevalence of mobility disability and little association between perceptions of the neighborhood and mobility disability. IMPLICATIONS: In addition to more refined longitudinal studies, this research provides a foundation for innovative place-based rehabilitation and hospital discharge programs for older adults newly diagnosed and treated for chronic health conditions.

Neighborhood characteristics and depressive symptoms in an older population.

OBJECTIVES: We explored relationships between depressive symptoms and neighborhood environment measures including traffic safety, crime, social capital, and density of businesses in community-dwelling older adults from four different regions of the United States. METHOD: The Healthy Aging Research Network walking study is a cross-sectional study of 884 adults aged 65+, which included a 10-item Center for Epidemiologic Studies Depression scale of depressive symptoms, demographics, self-reported neighborhood perceptions, and objective neighborhood data. RESULTS: After adjusting for individual covariates, reports of neighborhood crime, unsafe traffic, and unwillingness of neighbors to help each other were significantly positively associated with depressive symptoms among participants. CONCLUSION: This research suggests an association between self-reported depressive symptoms and the social and built environment; examining causal association requires additional longitudinal research in diverse populations of older adults.

Availability and readability of emergency preparedness materials for deaf and hard-of-hearing and older adult populations: issues and assessments.

A major public health challenge is to communicate effectively with vulnerable populations about preparing for disasters and other health emergencies. People who are Deaf or Hard of Hearing (Deaf/HH) and older adults are particularly vulnerable during health emergencies and require communications that are accessible and understandable. Although health literacy studies indicate that the readability of health communication materials often exceeds people's literacy levels, we could find no research about the readability of emergency preparedness materials (EPM) intended for Deaf/HH and older adult populations. The objective of this study was to explore issues related to EPM for Deaf/HH and older adult populations, to assess the availability and readability of materials for these populations, and to recommend improvements. In two California counties, we interviewed staff at 14 community-based organizations (CBOs) serving Deaf/HH clients and 20 CBOs serving older adults selected from a stratified, random sample of 227 CBOs. We collected 40 EPM from 10 CBOs and 2 public health departments and 40 EPM from 14 local and national websites with EPM for the public. We used computerized assessments to test the U.S. grade reading levels of the 16 eligible CBO and health department EPM, and the 18 eligible website materials. Results showed that less than half of CBOs had EPM for their clients. All EPM intended for clients of Deaf/HH-serving CBOs tested above the recommended 4(th) grade reading level, and 91% of the materials intended for clients of older adult-serving CBOs scored above the recommended 6(th) grade level. EPM for these populations should be widely available through CBOs and public health departments, adhere to health literacy principles, and be accessible in alternative formats including American Sign Language. Developers should engage the intended users of EPM as co-designers and testers. This study adds to the limited literature about EPM for these populations.

Physical activity and functional limitations in older adults: the influence of self-efficacy and functional performance.

OBJECTIVES: Data from the Healthy Aging Network (HAN) study (Prohaska, T., Eisenstein, A., Satariano, W., Hunter, R., Bayles, C., Kurtovich, E., … Ivey, S. [2009]. Walking and the preservation of cognitive function in older populations. The Gerontologist, 49[Suppl. 1], S86-S93; and Satariano, W., Ivey, S., Kurtovich, E., Kealey, M., Hubbard, A., Bayles, C., … Prohaska, T. [2010]. Lower-body function, neighborhoods, and walking in an older population. American Journal of Preventive Medicine, 38, 419-428.) were used to examine the relationships among physical activity, self-efficacy, functional performance, and limitations. METHOD: Interviews were conducted within homes and senior centers in 4 geographic regions across the United States. Participants were 884 older adults (M age = 74.8; 77% female; 35% minority status) who completed measures of walking behavior, way-finding self-efficacy, walking self-efficacy, functional performance, functional limitations, and demographic characteristics. RESULTS: Path analysis within a covariance modeling framework revealed significant direct effects of walking on self-efficacy constructs, functional performance on functional limitations, and efficacy on limitations. Additionally, significant indirect effects were also found, including walking on limitations via walking self-efficacy and performance and walking self-efficacy on limitations via performance. Furthermore, we found support for invariance of the model across geographical grouping. DISCUSSION: Our findings provide further validation for an efficacy-based model of functional limitations. Walking-related efficacy may help reduce or possibly delay the onset of functional limitations.

Environmental correlates of overweight and obesity in community residing older adults.

OBJECTIVE: This study examines the role of environmental correlates of overweight and obesity among older adults independent of walking activity and lower body function. METHODS: In-person interviews were conducted with 789 adults aged 65 and older, residing in four areas in the U.S. Demographic information, general health, lower body function, walking behavior, and awareness of environmental infrastructure features using the modified Neighborhood Environment Walking Survey (NEWS) were obtained. Regression analyses examined the association between Body Mass Index (BMI) and environmental infrastructure features, adjusting for demographics and lower body function. RESULTS: Older adults who perceived their neighborhood as less safe from crime and had reduced access to services were more likely to have higher BMI. Controlling for demographic and functional characteristics, access to services remained significant. This association remained significant for those with lower functional status. DISCUSSION: This research suggests that neighborhood environment may have an influence on BMI above and beyond walking activity.

The California Neighborhoods Data System: a new resource for examining the impact of neighborhood characteristics on cancer incidence and outcomes in populations.

Research on neighborhoods and health has been growing. However, studies have not investigated the association of specific neighborhood measures, including socioeconomic and built environments, with cancer incidence or outcomes. We developed the California Neighborhoods Data System (CNDS), an integrated system of small area-level measures of socioeconomic and built environments for California, which can be readily linked to individual-level geocoded records. The CNDS includes measures such as socioeconomic status, population density, racial residential segregation, ethnic enclaves, distance to hospitals, walkable destinations, and street connectivity. Linking the CNDS to geocoded cancer patient information from the California Cancer Registry, we demonstrate the variability of CNDS measures by neighborhood socioeconomic status and predominant race/ethnicity for the 7,049 California census tracts, as well as by patient race/ethnicity. The CNDS represents an efficient and cost-effective resource for cancer epidemiology and control. It expands our ability to understand the role of neighborhoods with regard to cancer incidence and outcomes. Used in conjunction with cancer registry data, these additional contextual measures enable the type of transdisciplinary, "cells-to-society" research that is now being recognized as necessary for addressing population disparities in cancer incidence and outcomes.

Lower-body function, neighborhoods, and walking in an older population.

BACKGROUND: Poor lower-body capacity is associated with reduced mobility in older populations. PURPOSE: This study sought to determine whether neighborhood environments (e.g., land-use patterns and safety) moderate that association. METHODS: The study is based on a cross-sectional sample of 884 people aged > or =65 years identified through service organizations in Alameda County CA, Cook County IL, Allegheny County PA, and Wake and Durham counties NC. In-person interviews focused on neighborhood characteristics, physical and cognitive function, and physical activity and walking. Functional capacity was tested using measures of lower-body strength, balance, and walking speed. The main outcome was time spent walking in a typical week (<150 vs > or =150 minutes per week). Objective environmental measures were also included. Estimates of main and interaction effects were derived from regression models. RESULTS: Living in a residential area, compared to a mixed-use or commercial area, was associated with less time spent walking (<150 minutes per week; OR=1.57, 95% CI=1.04, 2.38). Living in a less-compact area (greater median block length) is also significantly associated with less walking for seniors, but only among those with excellent lower-body strength. CONCLUSIONS: Neighborhood type is associated with walking among older people, as it is among the general adult population. In individuals with poor lower-body function, no association was found between residence in a less-compact area and walking. For those people, the relationship between neighborhood characteristics and walking requires further study.

Walking and the preservation of cognitive function in older populations.

PURPOSE: This cross-sectional study takes a unique look at the association between patterns of walking and cognitive functioning by examining whether older adults with mild cognitive impairment differ in terms of the community settings where they walk and the frequency, intensity, or duration of walking. DESIGN AND METHODS: The sample was based on interviews with 884 adults aged 65 years and older, residing in 4 locations across the United States: Alameda County, California; Cook County, Illinois; Allegheny County, Pennsylvania; and Durham/Wake Counties, North Carolina. Cognitive function was assessed using a modified Mini-Mental State Examination (MMSE) and the Mental Alternation Test (MAT). Multiple linear regressions were conducted between self-reported walking activities and cognitive measures, controlling for psychosocial, demographic, health status, functional performance, and neighborhood characteristics. RESULTS: The community setting where people walk and the intensity of walking in their neighborhood were significantly associated with cognitive status. After controlling for individual and neighborhood characteristics, better MAT scores were significantly associated with brisk walking and walking fewer times per week. Compared with the MMSE, the MAT was more likely to be associated with patterns of walking among older adults. Older adults with lower MAT scores were more likely to walk in indoor shopping malls and less in parks, whereas those with higher cognitive function scores on the MMSE were less likely to walk in indoor gyms. IMPLICATIONS: This investigation provides insight into the extent to which walking is associated with preservation of cognitive health, setting the stage for future longitudinal studies and community-based interventions.