Association of oral care with periodontitis and glycemic control among US adults with diabetes.

BACKGROUND: Studies indicate that treating periodontitis may benefit glycemic control among people with diabetes. It is unclear whether oral self-care such as flossing may reduce risk for periodontitis and improve glycemic control among people with diabetes. The purpose of this study was to examine associations between oral care, specifically, flossing and preventive dental care, with periodontitis and glycemic control, among US dentate adults with diabetes. METHODS: We analyzed data from the National Health and Nutrition Examination Survey 2011-2014 for 892 participants aged 30 years and older with diabetes who completed the periodontal examination and lab test for hemoglobin A1c (HbA1c). Sampling weights were applied. Multivariable logistic regression and multivariable linear modeling were performed to examine the associations of flossing and preventive dental services on periodontal health and HbA1c levels, respectively, controlling for sociodemographic characteristics, health behaviors, and other risk factors. RESULTS: Among U.S. dentate adults with diabetes, 52.1% of flossers and 72.1% of non-flossers had periodontitis (p < 0.001). Flossers were 39% less likely to have periodontitis (Adj. OR 0.61, 95% CI 0.43-0.88) compared to non-flossers. Flossers had an average HbA1c reading 0.30% (95% CI 0.02%-0.58%) lower than non-flossers, adjusted for covariates (p = 0.037). Preventive dental visits were associated with reduced risk for periodontitis (Adj. OR 0.54, 95%CI, 0.38-0.75) but not glycemic control. CONCLUSION: Flossing was associated with periodontal health and glycemic control among US adults with diabetes. Although further research is needed, the findings support that oral self-care may be particularly beneficial for adults with diabetes.

Defining and Measuring Preclinical Mobility Limitation: An Expert Consensus Exercise Informed by a Scoping Review.

BACKGROUND: Early change in function in older adults has been termed preclinical disability (PCD). PCD has been understudied compared to other stages of disability because it is unlikely to receive comparative priority in clinical settings. It has major implications for prevention and population health as it may be the optimal time to intervene to prevent further decline. A standardized approach to research in PCD, including a common definition and measurement approaches, is needed to advance this work. METHODS: The process to establish how PCD should be defined and measured was undertaken in 2 stages: (1) a scoping review of the literature, which was used to inform (2) a web-enabled consensus meeting with content experts. RESULTS: The scoping review and the consensus meeting support the use of the term preclinical mobility limitation (PCML) and that it should be measured using both patient-reported and performance-based measures. It was agreed that the definition of PCML should include modification of frequency and/or method of task completion, without overt disability, and that requisite mobility tasks include walking (distance and speed), stairs, and transfers. CONCLUSIONS: Currently, there are few standardized assessments that can identify PCML. PCML is the term that most clearly describes the stage where people experience a change in routine mobility tasks, without a perception of disability. Further evaluation into the reliability, validity, and responsiveness of outcome measures is needed to advance research on PCML.

Is Tai Chi beneficial for multisite pain syndrome in older adults?

Chronic musculoskeletal pain is prevalent and undertreated in older adults. In particular, multisite pain is associated with serious functional consequences and falls and appears to be a novel geriatric syndrome. The causes of multisite pain are often multifactorial, and emerging evidence supports a complex pathway whereby multisite pain leads to cognitive problems, mobility decline, fear of falling, falls, and reduced participation in life roles. A few pharmacologic approaches are safe and effective for older adults with chronic multisite pain and evidence for effectiveness of non-pharmacologic treatments for this common condition is very limited. Compared to light physical exercise, mind-body exercise may prove to be more beneficial for older adults living with chronic pain. Tai Chi, as a movement-based mind-body exercise, can relieve pain symptoms, improve cognition and physical function, and lower risk for falls in older adults. However, little is known about the potential benefits of Tai Chi for older adults with multisite pain syndrome. Future large-scale randomized-controlled trials are needed to investigate the effectiveness of Tai Chi in alleviating pain and lowering fall risk in older adults with multisite pain, and the biological mechanisms that underlie its potential benefits to chronic pain, physical and cognitive functions, and falls in this at-risk population.

Characterizing Fall Circumstances in Community-Dwelling Older Adults: A Mixed Methods Approach.

BACKGROUND: Understanding fall circumstances can help researchers better identify causes of falls and develop effective and tailored fall prevention programs. This study aims to describe fall circumstances among older adults from quantitative data using conventional statistical approaches and qualitative analyses using a machine learning approach. METHODS: The MOBILIZE Boston Study enrolled 765 community-dwelling adults aged 70 years and older in Boston, MA. Occurrence and circumstances of falls (ie, locations, activities, and self-reported causes of falls) were recorded using monthly fall calendar postcards and fall follow-up interviews with open- and close-ended questions during a 4-year period. Descriptive analyses were used to summarize circumstances of falls. Natural language processing was used to analyze narrative responses from open-ended questions. RESULTS: During the 4-year follow-up, 490 participants (64%) had at least 1 fall. Among 1 829 falls, 965 falls occurred indoors and 804 falls occurred outdoors. Commonly reported activities when the fall occurred were walking (915, 50.0%), standing (175, 9.6%), and going down stairs (125, 6.8%). The most commonly reported causes of falls were slip or trip (943, 51.6%) and inappropriate footwear (444, 24.3%). Using qualitative data, we extracted more detailed information on locations and activities, and additional information on obstacles related to falls and commonly reported scenarios such as "lost my balance and fell." CONCLUSIONS: Self-reported fall circumstances provide important information on both intrinsic and extrinsic factors contributing to falls. Future studies are warranted to replicate our findings and optimize approaches to analyzing narrative data on fall circumstances in older adults.

Pilot studies of recruitment and feasibility of remote Tai Chi in racially diverse older adults with multisite pain.

BACKGROUND: Multisite musculoskeletal pain is highly prevalent among older adults yet undertreated. Studies support the promise of Tai Chi for managing pain and lowering fall risk. Since the COVID-19 pandemic, effective alternatives to classroom-based exercise programming are warranted. AIMS: To recruit 100 racially diverse older adults with multisite pain and increased fall risk, who are interested in participating in a future Tai Chi clinical trial, and to evaluate the feasibility and acceptability of a short-term, remotely delivered home-based Tai Chi program. METHODS: A random sample of adults aged 65 years or older living in diverse Boston neighborhoods were sent mailed invitations to participate in a telephone screening survey. Eligible adults were invited to join a 4-week Tai Chi program offered online via Zoom. Primary outcomes were class attendance, experience, and program safety. RESULTS: Among 334 survey respondents, 105 were eligible for the intervention. Average age of eligible participants was 74 years, 75% were women, and 62% were Black. We assigned 32 participants to 4 Tai Chi or 2 light exercise groups conducted via Zoom; of these, 24 (75%) completed the program and 79% attended ≥6 of 8 classes. There were no adverse events reported. Two-thirds reported it was very easy to join the online classes and 88%, very easy to see the instructor. CONCLUSION: Mailed invitations were effective for recruiting a racially diverse sample. Remote exercise programming delivered online via live Zoom sessions is safe and feasible for diverse older adults who have multisite pain and risk of falls.

Association of Parental Cardiovascular Health With Disability-Adjusted Life Years in the Offspring: Results From the Framingham Heart Study.

BACKGROUND: Disability-adjusted life years (DALYs) are used to evaluate the relative burden of diseases in populations to help set prevention or treatment priorities. The impact of parental cardiovascular health (CVH) on healthy life years lost from cardiovascular disease (CVD) in adult offspring is unknown. We compared parent-offspring CVD DALYs trends over the life course and examined the association of parental CVH with offspring CVD DALYs. METHODS: Using data from the Framingham Heart Study, 4814 offspring-mother-father trios were matched for age at selected baseline exams. CVH score was computed from the number of CVH metrics attained at recommended levels: poor (0-2), intermediate (3-4), and ideal (5-7). CVD DALYs were defined as the sum of years of life lost and years lived with CVD. Age-sex-standardized life expectancy and disability weights were derived from the actuarial life tables and Global Burden of Disease study, respectively. Multivariable-adjusted linear regression was used to investigate the association of parental CVH with offspring CVD DALYs. RESULTS: Over an equal 47-year follow-up, parents lost nearly twice the number of CVD DALYs compared to their offspring (23 234 versus 12 217). However, age-adjusted CVD DALYs were higher at younger ages and similar along the life course for parents and offspring. One-unit increase in parental CVH was associated with 5 healthy life months saved in offspring. Offspring of mothers with ideal versus poor CVH had 3 healthy life years saved (ß=-3.0 DALYs [95% CI, -5.6 to -0.3]). No statistically significant association was found between paternal CVH categories and offspring CVD DALYs. CONCLUSIONS: Higher maternal and paternal CVH were associated with increased healthy life years in offspring; however, the association was strongest between mothers and offspring. Investment in CVH promotion along the life course has the potential to reduce the burden of CVD in the current and future generation of adults.

Multiple Chronic Diseases Associated With Tooth Loss Among the US Adult Population.

Background: Half of US adults aged 20-64 years have lost at least one permanent tooth; one in six adults aged 65 and over in the USA is edentulous. Tooth loss and edentulism interfere with nutritional intake and quality of life. Although selected chronic diseases (e.g., diabetes) have been identified as possible risk factors for tooth loss, data on multiple chronic diseases and on having two or more concurrent chronic diseases (multimorbidity) in relation to tooth loss are lacking. Therefore, this study aimed to assess the association between multiple chronic diseases, multimorbidity, and tooth loss in US adults. Methods: We performed a secondary data analysis using the US 2012 Behavioral Risk Factor Surveillance System (BRFSS), a national cross-sectional telephone survey studying health conditions and health behaviors among US adults (≥18 years) who are non-institutionalized residents. Variables were derived from the BRFSS Standard Core Questionnaire. Descriptive analysis including means, standard deviations (SDs), and percentages was calculated. Sample weights were applied. The stepwise multinomial logistic regression method was used to examine the relationship between several chronic diseases and tooth loss. Separate multinomial logistic regression models were used to examine the relationship between multimorbidity and tooth loss among all adults aged more than 18 years, adults aged 18-64 years, and adults aged more than 65 years, respectively. Results: Among the samples (n = 471,107, mean age 55 years, 60% female), 55% reported losing no tooth loss, 30% reported losing one to five teeth, 10% reported losing six or more but not all teeth, and 5% reported losing all teeth. After adjusting for demographic characteristics, socioeconomic status, smoking, BMI, and dental care, chronic diseases that were associated with edentulism were chronic obstructive pulmonary disease (COPD) [adjusted risk ratio (adj. RR) 2.18, 95% confidence interval (CI) 2.08-2.29]; diabetes (adj. RR 1.49, 95% CI 1.44-1.56); arthritis (adj. RR 1.49, 95% CI 1.44-1.54); cardiovascular disease (adj. RR 1.38, 95% CI 1.30-1.45); stroke (adj. RR 1.31, 95% CI 1.24-1.40); kidney disease (adj. RR 1.16, 95% CI 1.08-1.25); cancer (adj. RR 1.05, 95% CI 1.01-1.11); and asthma (adj. RR 1.07, 95% CI 1.02-1.12). For those who reported losing six or more teeth, the association remained significant for all the chronic diseases mentioned, albeit the magnitude of association appeared to be comparative or smaller. In addition, adults with multimorbidity were more likely to have tooth loss (loss of one to five teeth: adj. RR 1.17, 95% CI 1.14-1.19; loss of six or more teeth: adj. RR 1.78, 95% CI 1.73-1.82; edentulous: adj. RR 2.03, 95% CI 1.96-2.10). Conclusions: Multiple chronic diseases were associated with edentulism and tooth loss. People with multimorbidity are more likely to be edentulous than those with one or no chronic disease. The findings from this study will help to identify populations at increased risk for oral problems and nutritional deficits, thus the assessment of oral health should be evaluated further as an important component of chronic illness care.

Brief Pain Inventory Pain Interference Subscale: Assessing Interference With Daily Living Activities in Older Adults With Multisite Musculoskeletal Pain.

Objectives: This study aims to determine domains of pain interference in daily routines assessed using the Brief Pain Inventory, in relation to multisite musculoskeletal pain among older adults living in the community. Design: The MOBILIZE Boston Study is a population-based study of 749 adults aged 70 and older. Measurements: Chronic musculoskeletal pain was assessed using a joint pain questionnaire and grouped as: no pain, single-site and multisite pain. The Brief Pain Inventory pain interference (PI) sub-scale assessed level of pain interference (0-10 rating) in 7 domains including general activity, mood, walking, work, relationships with people, sleep, and enjoyment of life. Interference ratings were grouped as: none (0), mild (>0 and ≤ 2), and moderate to severe (>2) PI. Results: PI was more common among women and those with less education compared to others. Older adults with chronic conditions such as osteoarthritis, depression, spinal stenosis, peripheral artery disease, and asthma/lung disease were more likely than their peers to report PI (p < 0.05). Multisite musculoskeletal pain was strongly associated with pain interference in all domains (p < 0.05). More than half of older adults with multisite musculoskeletal pain reported moderate to severe PI with general activity and walking. The highest prevalence of moderate to severe PI (score >2) in general activity was seen in participants with depression (62%), knee and hand osteoarthritis (71%) and peripheral artery disease (65%). Conclusion: Greater attention to PI and PI domains such as general activity and walking, could aid in efforts to reduce the overall impact of multisite musculoskeletal pain among older adults.

Fall risk assessment through a synergistic multi-source DNN learning model.

Falls are a complex problem and play a leading role in the development of disabilities in the older population. While fall detection systems are important, it is also essential to work on fall preventive strategies, which will have the most significant impact in reducing disability in the elderly. In this work, we explore a prospective cohort study, specifically designed for examining novel risk factors for falls in community-living older adults. Various types of data were acquired that are common for real-world applications. Learning from multiple data sources often leads to more valuable findings than any of the data sources can provide alone. However, simply merging features from disparate datasets usually will not produce a synergy effect. Hence, it becomes crucial to properly manage the synergy, complementarity, and conflicts that arise in multi-source learning. In this work, we propose a multi-source learning approach called the Synergy LSTM model, which exploits complementarity among textual fall descriptions together with people's physical characteristics. We further use the learned complementarities to evaluate fall risk factors present in the data. Experiment results show that our Synergy LSTM model can significantly improve classification performance and capture meaningful relations between data from multiple sources.

Predictors of Online Patient Portal Use Among a Diverse Sample of Emerging Adults: Cross-sectional Survey.

BACKGROUND: Health self-management is increasingly being influenced by emerging health information technologies (IT), especially online patient portals. Patient portals provide patients with direct access to their health information, electronic tools to manage their health, and additional opportunities to engage with their care team. Previous studies have found that patient portal use is highest among patients with high eHealth literacy, the ability to find health information from electronic sources and apply the knowledge gained to solve a health problem. The role of eHealth literacy on patient portal use appears to be especially strong among older adults with chronic diseases. The use of patient portals among emerging adults (ages 18-29) is much less understood. Although generally healthy, emerging adults are more regular IT users and just beginning to independently navigate the health care system. A good understanding of how emerging adults are using online patient portals and what factors, including eHealth, impact portal use is lacking. OBJECTIVE: The aim of this study is to describe patient portal use and explore the predictors of portal use among a diverse sample of emerging adults. METHODS: A cross-sectional survey study that used convenience sampling was conducted at two universities. Data on demographics, health care encounters, eHealth literacy, patient engagement, and use of patient portal features (administrative and clinical) were obtained via self-report and summarized. Logistic regression models were used to examine factors associated with portal use. RESULTS: Of the 340 emerging adults, 257 (76%) were female, 223 (65%) White, 156 (47%) low income, and 184 (54%) reported having patient portal access. Of those reporting access, 142 (77%) used at least 1 portal feature and 42 (23%) reported using none. Significant predictors were patient engagement (odds ratio [OR] 1.08, 95% CI 1.04-1.13, P=.001) and total encounters (OR 1.23, 95% CI 1.05-1.44, P=.009) but not eHealth literacy. Hispanic and Asian emerging adults were more likely to be frequent users of clinical portal features than White emerging adults (Hispanic: OR 2.97, 95% CI 1.03-8.52, P=.04; Asian: OR 4.28, 95% CI 1.08-16.89, P=.04). CONCLUSIONS: We found that about half of emerging adults had access to a patient portal. Among those with access, a majority reported using at least one portal feature. Factors associated with increased portal use included increased patient engagement and total clinical encounters. Self-reported eHealth literacy was not associated with patient portal use in this diverse sample of emerging adults. This may have been due to high overall eHealth literacy levels in this population of frequent IT users. There may also be racial/ethnic differences that are important to consider, as we found Hispanic and Asian emerging adults reported more frequent portal use than White emerging adults. Interventions to promote patient portal use among emerging adults should include strategies to increase awareness of portal access and engagement among patients with fewer clinical encounters, with a focus on preventative health management.

Chronic pain and circumstances of falls in community-living older adults: an exploratory study.

BACKGROUND: Chronic pain is a risk factor contributing to mobility impairment and falls in older adults. Little is known about the patterns of circumstances of falls among older adults with chronicpain. OBJECTIVE: To examine the relationship between chronic pain and circumstances of falls including location, activities at the time of falls and self-reported causes of falls in older adults. DESIGN: Prospective cohort study. SETTING: Communities in/around Boston, Massachusetts. SUBJECTS: The MOBILIZE Boston Study enrolled 765 adults aged ≥70 years. METHODS: Pain severity, fall occurrence and fall circumstances were recorded using monthly calendar postcards and fall follow-up interviews during a 4-year follow-up period. Generalised estimating equation models were performed to examine the relation between monthly pain ratings and circumstances of the first fall in the subsequent month. RESULTS: Compared to fallers without chronic pain, fallers with moderate-to-severe pain had around twice the likelihood of reporting indoor falls (aOR = 1.93, 95%CI: 1.32-2.83), falls in living or dining rooms (aOR = 2.06, 95%CI: 1.27-3.36), and falls due to health problems (aOR = 2.08, 95%CI: 1.16-3.74) or feeling dizzy or faint (aOR = 2.10, 95%CI: 1.08-4.11), but they were less likely to report falls while going down stairs (aOR = 0.48, 95%CI: 0.27-0.87) or falls due to a slip or trip (aOR = 0.67, 95%CI: 0.47-0.95) in the subsequent month. CONCLUSIONS: Given the exploratory nature of the study, these findings should be interpreted with caution. Future studies may investigate whether better pain management and tailored fall prevention in older people with chronic pain could lead to fewer falls.

Parental cardiovascular health predicts time to onset of cardiovascular disease in offspring.

BACKGROUND: Cardiovascular disease (CVD) risk factors are transmitted from parents to children. We prospectively examined the association between parental cardiovascular health (CVH) and time to onset of CVD in the offspring. METHODS AND RESULTS: The study consisted of a total of 5967 offspring-mother-father trios derived from the Framingham Heart Study. Cardiovascular health score was defined using the seven American Heart Association's CVH metrics attained at ideal levels: poor (0-2), intermediate (3-4), and ideal CVH (5-7). Multivariable-adjusted Cox proportional hazards regression models, Kaplan-Meier plots, and Irwin's restricted mean were used to examine the association and sex-specific differences between parental CVH and offspring's CVD-free survival. In a total of 71 974 person-years of follow-up among the offspring, 718 incident CVD events occurred. The overall CVD incidence rate was 10 per 1000 person-years [95% confidence interval (CI) 9.3-10.7]. Offspring of mothers with ideal CVH lived 9 more years free of CVD than offspring of mothers with poor CVH (P < 0.001). Maternal poor CVH was associated with twice as high hazard of early onset of CVD compared with maternal ideal CVH (adjusted Hazard Ratio 2.09, 95% CI 1.50-2.92). No statistically significant association was observed in the hazards of CVD-free survival by paternal CVH categories. CONCLUSIONS: We found that offspring of parents with ideal CVH had a greater CVD-free survival. Maternal CVH was a more robust predictor of offspring's CVD-free survival than paternal CVH, underscoring the need for clinical and policy interventions that involve mothers to break the intergenerational cycle of CVD-related morbidity and mortality.

Frontline healthcare workers' mental distress, top concerns, and assessment on hierarchy of controls in response to COVID-19: a cross-sectional survey study.

BACKGROUND: The existing studies showed that frontline healthcare workers during an epidemic experienced unusual stressors and mental distress which even lasted for years after the crisis. It is important to learn about their concerns early to mitigate the negative impact as well as to evaluate disease control from experiences on the front lines for improving responses to the outbreak. The study aimed to provide insights on how to strengthen public health responses to protect healthcare workers both physically and mentally, and effectively control the disease in light of hierarchy of controls. METHODS: A cross-sectional survey was distributed online via Qualtrics to frontline healthcare workers during the COVID-19 through a university's nursing program and received 267 valid responses from 103 certificated nursing assistants, 125 nurses, and 39 other health professionals. A descriptive data analysis with a Chi-square test at a two-sided 0.05 level of significance was performed on factors that potentially affected mental health of healthcare workers and effectiveness of disease control at workplace in five domains. The themes were summarized on open-ended questions. RESULTS: About 30% of the respondents showed the symptom of depression and needed a further investigation. The influencing factors in five domains were examined. Engineering and administrative controls, as well as PPE were widely used in response to COVID-19. The respondents assessed the state and workplace responses to COVID-19 better than the federal government responses. The workplace responses were considered most effective. Multiple factors with a statistically significant correlation with effectiveness of the disease control at workplace were identified. CONCLUSIONS: The study suggested that timely responses at policy level will be more effective than other measures in early prevention and control of the pandemic, mental distress should be addressed in addition to PPE, and nursing programs should consider providing a situation-specific career coaching or counseling for students. A longitudinal study at a larger scale is warranted to capture the variation of time change with the disease control evolvement and across geographic regions.

Factors associated with nutrition risk among community-dwelling older adults in Thailand.

This study was to investigate socio-demographic, chronic conditions and health factors associated with nutrition risk among Thai community-dwelling older adults. This was a cross-sectional study, involving 330 participants aged ≥ 60 years living in low-income suburban Chiang Mai, Northern Thailand. Of the 330 participants, 54.8% were at nutritional risk based on the Mini Nutritional Assessment. Multivariate analysis indicated factors significantly associated with nutritional risk were: aged ≥80 years (OR:8.59, 95% CI = 2.94-25.11), low income (OR: 2.35, 95% CI = 1.15-4.78), living alone (OR: 2.02, 95% CI = 0.20-0.78), moderate to severe pain (OR: 5.88, 95% CI = 2.30-15.02), dyslipidemia (OR: 5.12, 95% CI = 2.23-11.77), osteoarthritis (OR: 2.49, 95% CI = 1.14-5.48), poor physical performance (OR: 1.49, 95% CI = 1.70-3.15), and ≥1 fall in the previous year (OR: 2.22, 95% CI = 1.21-4.07). Results point to the need for multifactorial interventions to reduce risk for geriatric nutrition problems. Further studies are needed to determine effective solutions to the problem of malnutrition among older adults.

Disparities in Preventive Oral Health Care and Periodontal Health Among Adults With Diabetes.

INTRODUCTION: People with diabetes are more vulnerable to periodontal disease than those without; thus, practicing preventive oral health care is an important part of diabetes self-care. Our objective was to examine disparities in preventive oral health care among US adults with diabetes. METHODS: We performed a secondary analysis of data from the National Health and Nutrition Examination Survey (NHANES) 2011-2016. Periodontal examinations were conducted in adults aged 30 and older. We compared the weighted prevalence of periodontal disease and the practice of preventive oral health care, including practicing dental interproximal cleaning (flossing or using other interproximal cleaning devices) and use of preventive dental services, among people with and without diabetes. Multivariable logistic regressions were performed to examine the relationship between the presence of diabetes, periodontal disease, and preventive oral health care practices. RESULTS: Weighted prevalence of periodontal disease in the US population was higher among adults with diabetes than those without (58.0% vs 37.6%). This difference persisted after controlling for sociodemographic characteristics and smoking status. People with diabetes were more likely to have periodontal disease (adjusted odds ratio [aOR] 1.39; 95% CI, 1.17-1.65), less likely to practice daily interproximal cleaning (aOR 0.85; 95% CI, 0.75-0.95), and less likely to visit a dentist for preventive care in the past year (aOR 0.86; 95% CI, 0.76-0.96) than people without diabetes. CONCLUSION: Adults with diabetes reported suboptimal preventive oral health care behaviors in use of preventive dental services and interproximal dental cleaning than people without diabetes, despite their health disparity related to periodontal disease. Educating people to improve their preventive oral health care is essential for good oral health and diabetes self-management.

Participation in cognitive activities is associated with foot reaction time and gait speed in older adults.

BACKGROUND: Given the evidence of the links between cognition and mobility, participation in cognitive activities may benefit neuromotor performance and mobility in older adults. AIMS: To examine the association between participation in cognitive activities and foot reaction time (RT) and gait speed in community-dwelling older adults. METHODS: The MOBILIZE Boston Study II (MBSII) re-enrolled 354 community-dwelling older adults aged ≥ 70 years from the original MBS cohort. Of these, 310 completed the performance testing and we excluded three participants who had Parkinson's disease. Cognitive Activities Scale (CAS) assessed participation in 17 cognitive activities. Simple and Choice foot RT (SRT, CRT, msec) and gait speed (m/s) were measured using a sensored GAITRite® gait mat. RESULTS: The average age of the 307 participants was 84 years; 79% were white and 65% were women. The average CAS score was 25.5 ± 11.7, indicating participation in approximately 26 activities per week on average. The average foot SRT was 245 ± 57msec and average CRT was 323 ± 85msec. Usual-paced gait speed was 0.9 ± 0.3 m/s on average. More frequent participation in cognitive activities was associated with shorter SRT (ß = - 0.759, p = 0.015) and CRT (ß = - 1.125, p = 0.013), and faster gait speed (ß = 0.003, p = 0.026), after adjusting for potential confounders. DISCUSSION: Participation in cognitively stimulating activities may be beneficial for neuromotor performance and mobility in older adults. CONCLUSIONS: Prospective and intervention studies are needed to determine whether participation in cognitive activities may prevent mobility decline over time, and thus reduce fall risk.

Chronic Musculoskeletal Pain and Foot Reaction Time in Older Adults.

This cross-sectional study examines the association between chronic musculoskeletal pain and foot reaction time (RT) among older community-living adults. Participants were 307 adults aged 71 years and older in the MOBILIZE Boston Study II. Pain severity, interference, and location were measured by the Brief Pain Inventory and a joint pain questionnaire. With participants seated, simple foot reaction time was measured as self-selected foot response time to an intermittent light, and choice foot reaction time was measured as response time to the light on the corresponding side of the sensored gait mat. We performed multivariable linear regression to determine associations of pain and foot RT, adjusted for sociodemographic and health characteristics, and serially adjusted for cognitive function (MMSE or Trail Making A). Pain severity and interference were associated with slower simple foot reaction time (P < .05). Pain severity and knee pain were associated with slower choice foot reaction time (P < .05). Adjustment for cognitive measures had little impact on the pain-RT relationship. This significant relationship was only observed among participants with less education. These results support the idea that chronic pain may lead to slower foot RT, thus could represent a fall hazard in older adults. Neuromotor mechanisms underlying the pain-fall relationship warrant further investigation. PERSPECTIVE: This study provides insights on the mechanisms underlying the pain-fall relationship. Chronic pain may contribute to slower foot RT thus increase fall risk in older adults. This may help inform interventions such as stepping training to reduce fall risk in older adults living with chronic pain.

Chronic Pain and Risk of Injurious Falls in Community-Dwelling Older Adults.

BACKGROUND: Fall injuries are a leading cause of death in older adults. The potential impact of chronic pain characteristics on risk for injurious falls is not well understood. This prospective cohort study examined the relationship between chronic pain and risk for injurious falls in older adults. METHOD: The MOBILIZE Boston Study enrolled 765 community-dwelling adults aged 70 years and older living in and around Boston, Massachusetts. Chronic pain characteristics, including pain severity, pain interference, and pain distribution, were measured at baseline using the Brief Pain Inventory subscales and a joint pain questionnaire. Occurrence of falls and fall-related injuries were recorded using monthly fall calendar postcards and fall follow-up interviews during the 4-year follow-up period. RESULTS: Negative binomial regression models showed that pain interference and pain distribution, but not pain severity, independently predicted injurious falls adjusting for potential confounders. Participants in the highest third of pain interference scores had a 61% greater risk of injurious falls compared to those reporting little or no pain interference. Compared to no pain, multisite pain was associated with a 57% greater risk of injurious falls. Stratified by gender, the association was only significant in women. In the short term, moderate-to-severe pain in a given month was associated with increased risk of injurious falls in the subsequent month. CONCLUSIONS: Global pain measures are associated with increased risk of injurious falls in older adults. Pain assessment should be incorporated into fall risk assessments. Interventions are needed to prevent fall injuries among elders with chronic pain.

The Short Physical Performance Battery (SPPB): A Quick and Useful Tool for Fall Risk Stratification Among Older Primary Care Patients.

OBJECTIVES: Evaluate fall risk with the Short Physical Performance Battery (SPPB) and examine its application within the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) tool advocated by the Centers for Disease Control and Prevention. DESIGN: Prospective longitudinal cohort study. SETTING AND PARTICIPANTS: 417 community-dwelling adults aged ≥65 years at risk for mobility decline, recruited from 9 primary care practices. METHODS: The SPPB, a 3-part performance-based test (gait time, chair stand, and balance), was assessed at baseline. Previously established cutpoints were used to categorize participant scores into 3 groups: low, middle, and best performers. Self-reported falls were assessed in-person at baseline and via phone interviews quarterly for 4 years. Multivariable negative binomial regression models were used to evaluate the relationship of the SPPB and each of its 3 components with fall rates over 1 and 4 years of follow-up. Additional analysis were stratified by fall risk screen status (+/-) based on self-reported fall history and balance self-efficacy using an adapted STEADI model. RESULTS: Participants had median age 76 years (interquartile range 70-82) and were 67.2% female with mean baseline SPPB 8.7 ± 2.3. Poor performance on the SPPB and on each of its 3 components independently predicted higher fall risk in the first year. After 4 years, the low total baseline SPPB [rate ratio (RR) 1.53, confidence interval (CI) 1.09-2.17] and gait time performances (RR 1.61, CI 1.07-2.41) predicted higher fall risk. After stratifying the sample according to the STEADI model, we observed the highest 1-year fall risk among those with a (+) fall risk screen who also scored lowest on the SPPB. CONCLUSIONS AND IMPLICATIONS: The SPPB is a performance measure with clinical utility for fall risk stratification over 1 and 4 years of follow-up among older adults. It shows promise as a complement to the STEADI guidelines, but its full benefits should be confirmed within a larger study.

Validation of a brief scale to assess ambulatory patients' perceptions of reading visit notes: a scale development study.

OBJECTIVES: To develop and evaluate the validity of a scale to assess patients' perceived benefits and risks of reading ambulatory visit notes online (open notes). DESIGN: Four studies were used to evaluate the construct validity of a benefits and risks scale. Study 1 refined the items; study 2 evaluated underlying factor structure and identified the items; study 3 evaluated study 2 results in a separate sample; and study 4 examined factorial invariance of the developed scale across educational subsamples. SETTING: Ambulatory care in three large health systems in the USA. PARTICIPANTS: Participants in three US health systems who responded to one of two online surveys asking about benefits and risks of reading visit notes: a psychometrics survey of primary care patients, and a large general survey of patients across all ambulatory specialties. Sample sizes: n=439 (study 1); n=439 (study 2); n=500 (study 3); and n=250 (study 4). PRIMARY AND SECONDARY OUTCOME MEASURES: Questionnaire items about patients' perceived benefits and risks of reading online visit notes. RESULTS: Study 1 resulted in the selection of a 10-point importance response option format over a 4-point agreement scale. Exploratory factor analysis (EFA) in study 2 resulted in two-factor solution: a four-item benefits factor with good reliability (alpha=0.83) and a three-item risks factor with poor reliability (alpha=0.52). The factor structure was confirmed in study 3, and confirmatory factor analysis of benefit items resulted in an excellent fitting model, X2(2)=2.949; confirmatory factor index=0.998; root mean square error of approximation=0.04 (0.00, 0.142); loadings 0.68-0.86; alpha=0.88. Study 4 supported configural, measurement and structural invariance for the benefits scale across high and low-education patient groups. CONCLUSIONS: The findings suggest that the four-item benefits scale has excellent construct validity and preliminary evidence of generalising across different patient populations. Further scale development is needed to understand perceived risks of reading open notes.