Physical Activity and Local Blue/Green Space Access During the COVID-19 Pandemic.

PURPOSE: To examine whether local blue and green space access was associated with weekly physical activity frequency during the COVID-19 pandemic. DESIGN: Cross-sectional. SETTING: Population-based, nationally representative sample of U.S. adults (May and June 2021). SAMPLE: Adults, ages 18-94 (N = 1,771). MEASURES: Self-reported data included the presence of blue spaces (e.g., lakes, outdoor swimming pools, riverside trails) and green spaces (e.g., parks, forests, or natural trails) in their neighborhoods, and days of physical activity per week (e.g., running, swimming, bicycling, lifting weights, playing sports, or doing yoga). ANALYSIS: Multiple Poisson regression assessed relationships between blue and green spaces and physical activity, with coefficients transformed into incidence risk ratios (IRR). RESULTS: Among participants, 67.2% reported living near a blue space and 86.1% reported living near a green space. Racial/ethnic and socioeconomic disparities in access to blue and green spaces were observed, with less access among non-Hispanic Black participants and those with lower income and educational attainment. Living near blue (IRR = 1.23, 95% CI = 1.10, 1.39) or green space (IRR = 1.25, 95% CI = 1.02, 1.54) was significantly associated with more frequent weekly physical activity. CONCLUSION: Proximity to blue or green spaces is associated with more frequent physical activity during the COVID-19 pandemic. Health promotion efforts should include equitable strategies to improve accessibility to blue and green spaces.

Racial and Ethnic Differences in the Relationship Between Neighborhood Environment and Physical Activity Among Middle-Aged and Older Adults.

Objectives:To examine the associations between neighborhood environment-perceived neighborhood social cohesion and perceived neighborhood physical environment-and physical activity (PA) and whether these associations differ by race/ethnicity. Methods: We analyzed data from the Health and Retirement Study, a longitudinal study of US adults aged 50+ from 2006 to 2014 (N = 17,974), using multivariate mixed-effects linear models. PA was repeatedly measured using metabolic equivalent of task estimated values accounting for the vigor and frequency of self-reported PA. Results: In multivariate models, higher levels of PA were positively associated with higher rated neighborhood social cohesion and neighborhood physical environment scores. The effects of social cohesion were stronger among non-Hispanic Whites than among non-Hispanic Black and Hispanic/Latinx participants, while race/ethnicity did not moderate the association between PA and physical environment. Discussion: Intervention strategies that address social and physical barriers of neighborhoods could promote PA in older adults. Key implications for future research are discussed.

Using path analysis to model the process of change in HbA1c among African Americans and Latinos in a community health worker diabetes intervention.

OBJECTIVE: To examine which components of a culturally tailored community health worker (CHW) intervention improved glycemic control and intermediate outcomes among Latina/o and African American participants with diabetes. METHODS: The sample included 326 African American and Latina/o adults with type 2 diabetes in Detroit, MI. CHWs provided interactive group diabetes self-management classes and home visits, and accompanied clients to a clinic visit during the 6-month intervention period. We used path analysis to model the processes by which each intervention component affected change in diabetes self-efficacy, diabetes-related distress, knowledge of diabetes management, and HbA1c. RESULTS: The group-based healthy lifestyle component was significantly associated with improved knowledge. The group-based self-management section was significantly associated with reduced diabetes-related distress. Intervention class attendance was positively associated with self-efficacy. Diabetes self-management mediated the reductions in HbA1c associated with reductions in diabetes distress. CONCLUSIONS: Path analysis allowed each potential pathway of change in the intervention to be simultaneously analyzed to identify which aspects of the CHW intervention contributed to changes in diabetes-related behaviors and outcomes among African Americans and Latinas/os. PRACTICE IMPLICATIONS: Findings reinforce the importance of interactive group sessions in efforts to improve diabetes management and outcomes among Latina/o and African American adults with diabetes.

Food Access, Diet Quality, and Nutritional Status of Older Adults During COVID-19: A Scoping Review.

Background: COVID-19 has imposed challenges for older adults to access food, particularly in minority, lower income, and rural communities. However, the impact of COVID-19 on food access, diet quality, and nutrition of diverse older adult populations has not been systematically assessed. Objective: To examine changes in food access, diet quality, and nutritional status among older adults during the COVID-19 pandemic and the potential differential impacts of the COVID-19 pandemic on these nutrition-related outcomes using the framework of the socio-ecological model. Methods: An electronic search was conducted on 3 databases (PubMed, CINAHL, and Web of Science) on March 7, 2021. Original, peer-reviewed English-language studies published 10/1/2019-3/1/2021 were considered for which the mean age of participants was 50 years and older. In order to be considered, studies must have examined food access, food security, or nutrition constructs as an outcome. Results: The initial search yielded 13,628 results, of which 9,145 were duplicates. Of the remaining 4,483 articles, 13 articles were in scope and therefore selected in the final analysis, which can be characterized as descriptive (n = 5), analytical (n = 6), and correlational (n = 2). Studies were conducted among community-dwelling older adult populations (n = 7) as well as those temporarily residing in hospital settings (n = 6) in 10 countries. None of the in-scope studies examined the impact of food programs or specific public policies or disaggregated data by race/ethnicity. Conclusions: More research is needed to examine the impact of COVID-19 on food access/security and the differential barriers experienced by older adult populations.

Associations Between Diagnosis with Type 2 Diabetes and Changes in Physical Activity among Middle-Aged and Older Adults in the United States.

BACKGROUND AND OBJECTIVES: Physical activity (PA) is an effective strategy for diabetes self-management and is central to the diabetes regimen. Diagnostic events present an opportunity for health behavior change; however, many older adults with type 2 diabetes (T2D) do not engage in regular PA. The relationships between diagnosis events and subsequent changes in PA are not well understood. Drawing upon life-course theory, this is the first study to examine whether the diagnosis of T2D is followed by a change in PA, whether these changes are sustained, and the sociodemographic characteristics associated with these changes. RESEARCH DESIGN AND METHODS: We examined associations between T2D diagnosis and PA changes among 2,394 adults ages 51+ from the Health and Retirement Study (2004-2014). PA changes were measured using metabolic equivalents of task (METs) estimated values accounting for the vigor and frequency of self-reported PA. Using piecewise mixed models, we examined initial and sustained changes in METs over time and tested whether these changes were modified by race/ethnicity, educational level, gender, and age at diagnosis. RESULTS: Across participants, a significant postdiagnosis increase was observed in self-reported PA following the diagnostic event (ß: 0.54, 95% CI: 0.10, 0.97). The steepness of decline in PA participation over time did not change significantly following T2D diagnosis. Age at diagnosis and race/ethnicity significantly moderated these relationships: participants diagnosed at older ages were less likely to improve PA following diagnosis and non-Hispanic whites experienced relatively steeper rates of decline following diagnosis with T2D. DISCUSSION AND IMPLICATIONS: Modest diagnosis-related increases in PA were observed among participants overall. The usual rate of decline in PA appears unaffected by diagnosis overall. Age at diagnosis and race/ethnicity moderated these relationships. Key implications for future research and clinical practice are discussed.

Comparing Estimates of Fall-Related Mortality Incidence Among Older Adults in the United States.

BACKGROUND: Falls are the leading cause of injury-related mortality among older adults in the United States, but incidence and risk factors for fall-related mortality remain poorly understood. This study compared fall-related mortality incidence rate estimates from a nationally representative cohort with those from a national vital record database and identified correlates of fall-related mortality. METHODS: Cause-of-death data from the National Death Index (NDI; 1999-2011) were linked with eight waves from the Health and Retirement Study (HRS), a representative cohort of U.S. older adults (N = 20,639). Weighted fall-related mortality incidence rates were calculated and compared with estimates from the Centers for Disease Control and Prevention (CDC) vital record data. Fall-related deaths were identified using International Classification of Diseases (Version 10) codes. Person-time at risk was calculated from HRS entry until death or censoring. Cox proportional hazards models were used to identify individual-level factors associated with fall-related deaths. RESULTS: The overall incidence rate of fall-related mortality was greater in HRS-NDI data (51.6 deaths per 100,000; 95% confidence interval: 42.04, 63.37) compared with CDC data (42.00 deaths per 100,000; 95% confidence interval: 41.80, 42.19). Estimated differences between the two data sources were greater for men and adults aged 85 years and older. Greater age, male gender, and self-reported fall history were identified as independent risk factors for fall-related mortality. CONCLUSION: Incidence rates based on aggregate vital records may substantially underestimate the occurrence of and risk for fall-related mortality differentially in men, minorities, and relatively younger adults. Cohort-based estimates of individual fall-related mortality risk are important supplements to vital record estimates.

Correlates of Objective Social Isolation from Family and Friends among Older Adults.

This study examined the correlates of objective social isolation from extended family members and friends among older adults. The analysis is based on the older adult sub-sample of the National Survey of American Life (n = 1321). Multinomial logistic regression analyses examined race/ethnicity, demographics, functional health and family and friend network factors as correlates of objective isolation from family and friends. Only 4.47% of respondents were objectively isolated from both their extended family and friends, 10.82% were isolated from their friends, and 7.43% were isolated from their family members. Men were more likely to be objectively isolated from both family and friends and older adults who live with others were significantly more likely to be objectively isolated from their friends. When controlling for subjective social isolation, the two measures of functional health were significantly associated with objective social isolation. In particular, higher levels of self-care impairment decreased the risk of being objectively isolated from friends only, whereas higher mobility impairment was associated with an increased likelihood of being objectively isolated from friends only. Subjective evaluations of social isolation from family and friends were consistently associated with being objectively isolated from family and friends. There were no significant differences between African-Americans, Black Caribbeans and non-Hispanic Whites in objective isolation. These and other findings are discussed in detail.

Operationalisation and validation of the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) fall risk algorithm in a nationally representative sample.

BACKGROUND: Preventing falls and fall-related injuries among older adults is a public health priority. The Stopping Elderly Accidents, Deaths, and Injuries (STEADI) tool was developed to promote fall risk screening and encourage coordination between clinical and community-based fall prevention resources; however, little is known about the tool's predictive validity or adaptability to survey data. METHODS: Data from five annual rounds (2011-2015) of the National Health and Aging Trends Study (NHATS), a representative cohort of adults age 65 years and older in the USA. Analytic sample respondents (n=7392) were categorised at baseline as having low, moderate or high fall risk according to the STEADI algorithm adapted for use with NHATS data. Logistic mixed-effects regression was used to estimate the association between baseline fall risk and subsequent falls and mortality. Analyses incorporated complex sampling and weighting elements to permit inferences at a national level. RESULTS: Participants classified as having moderate and high fall risk had 2.62 (95% CI 2.29 to 2.99) and 4.76 (95% CI 3.51 to 6.47) times greater odds of falling during follow-up compared with those with low risk, respectively, controlling for sociodemographic and health-related risk factors for falls. High fall risk was also associated with greater likelihood of falling multiple times annually but not with greater risk of mortality. CONCLUSION: The adapted STEADI clinical fall risk screening tool is a valid measure for predicting future fall risk using survey cohort data. Further efforts to standardise screening for fall risk and to coordinate between clinical and community-based fall prevention initiatives are warranted.

Discrimination and psychiatric disorders among older African Americans.

OBJECTIVES: This study examined the impact of everyday discrimination (both racial and non-racial) on the mental health of older African Americans. METHODS: This analysis is based on the older African American subsample of the National Survey of American Life (NSAL) (n = 773). We examined the associations between everyday discrimination and both general distress and psychiatric disorders as measured by the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Six dependent variables were examined: lifetime mood disorders, lifetime anxiety disorders, any lifetime disorder, number of lifetime disorders, depressive symptoms as measured by the 12-item Center for Epidemiological Scale of Depression (CES-D), and serious psychological distress as measured by the Kessler 6 (K6). RESULTS: Overall, racial and non-racial everyday discrimination were consistently associated with worse mental health for older African Americans. Older African Americans who experienced higher levels of overall everyday discrimination had higher odds of any psychiatric disorder, any lifetime mood disorder, any lifetime anxiety disorder, and more lifetime DSM-IV disorders, in addition to elevated levels of depressive symptoms and serious psychological distress. These findings were similar for both racial discrimination and non-racial discrimination. CONCLUSIONS: This study documents the harmful association of not only racial discrimination, but also non-racial (and overall) discrimination with the mental health of older African Americans. Specifically, discrimination is negatively associated with mood and anxiety disorders as well as depressive symptoms and psychological distress. Copyright © 2016 John Wiley & Sons, Ltd.

An Exploratory Study of the Impact of Gender on Health Behavior Among African American and Latino Men With Type 2 Diabetes.

This study explores gender values and beliefs among Latino and African American men with diabetes and examines how these values and beliefs may influence their health behaviors. Participants were recruited from individuals who participated in one of three Racial and Ethnic Approaches to Community Health Detroit Partnership diabetes self-management interventions. One focus group was conducted with African American men ( n = 10) and two focus groups were conducted with Latino men ( n = 12) over a 3-month period. Sessions lasted 90 minutes, were audiotaped, and analyzed using thematic content analysis techniques. Two themes emerged that characterize gender identity and its relationship to health behavior in men: (a) men's beliefs about being men (i.e., key aspects of being a man including having respect for themselves, authority figures, and peers; fulfilling the role as breadwinner; being responsible for serving as the leader of the family; and maintaining a sense of chivalry) and (b) influence of gender values and beliefs on health behavior (i.e., the need to maintain a strong image to the outside world, and the need to maintain control of themselves served as barriers to seeking out and engaging in diabetes self-management behaviors). Results suggest that gender values and beliefs may have implications for how health behaviors among men with diabetes. Future research should study the direct impact masculine identity has on health behaviors among men with diabetes.

Access to Care and Diabetes Management Among Older American Indians With Type 2 Diabetes.

OBJECTIVE: To examine the relationship between health care access and diabetes management among a geographically diverse sample of American Indians (AIs) aged 50 and older with type 2 diabetes. METHOD: We examined the relationship between access to care and diabetes management, as measured by HbA1c, using 1998-1999 data from the Strong Heart Family Study. A series of bivariate and multivariate linear models examined the relationships between nine access-related variables and HbA1c levels. RESULTS: In bivariate analyses, out-of-pocket costs were associated with higher HbA1c levels. No other access-related characteristics were significantly associated with diabetes management in bivariate or in multivariate models. DISCUSSION: Access-related barriers were not associated with worse diabetes management in multivariate analyses. The study concludes with implications for clinicians working with AI populations to enhance opportunities for diabetes management.

Gardening Activities and Physical Health Among Older Adults: A Review of the Evidence.

Few studies have examined the health-related consequences of gardening among older adults. This scoping review summarizes and characterizes current research that examines the relationship between physical health and participation in planned gardening activities, including establishing, maintaining, or caring for plants. Six databases were searched. Eligible studies were published between 2000 and 2013, were published in English, and assessed different aspects of physical health (e.g., functional ability, energy expenditure, injury) for older adults who had participated in a planned gardening activity. Of the eight eligible studies identified with these criteria, four assessed energy expenditures and four assessed physical functioning. Studies assessing energy expenditures documented that the majority of gardening tasks were classified into low-to-moderate intensity physical activity. The current literature does not provide sufficient evidence of the physical functioning consequences of gardening. Future studies should consider how specific gardening interventions help older adults meet physical activity guidelines.

Social support from church and family members and depressive symptoms among older African Americans.

OBJECTIVE: This study examined the influence of church- and family-based social support on depressive symptoms and serious psychological distress among older African Americans. METHODS: The analysis is based on the National Survey of American Life. Church- and family-based informal social support correlates of depressive symptoms (CES-D) and serious psychological distress (K6) were examined. Data from 686 African Americans aged 55 years or older who attend religious services at least a few times a year are used in this analysis. RESULTS: Multivariate analysis found that social support from church members was significantly and inversely associated with depressive symptoms and psychological distress. Frequency of negative interactions with church members was positively associated with depressive symptoms and psychological distress. Social support from church members remained significant but negative interaction from church members did not remain significant when controlling for indicators of family social support. Among this sample of churchgoers, emotional support from family was a protective factor and negative interaction with family was a risk factor for depressive symptoms and psychological distress. CONCLUSION: This is the first investigation of the relationship between church- and family-based social support and depressive symptoms and psychological distress among a national sample of older African Americans. Overall, the findings indicate that social support from church networks was protective against depressive symptoms and psychological distress. This finding remained significant when controlling for indicators of family social support.

Too little, too late: Socioeconomic disparities in the experience of living with diabetes.

The purpose of this article is to examine whether or not subjective social status (SSS) contributes to diabetes diagnosis and disease discovery experiences. Eighteen diabetic women participated in semi-structured interviews. Interview transcripts were reviewed and coded using interpretative phenomenological analysis. Several general themes emerged from the data analysis: SSS shaped different experiences through (a) situations of diabetes discovery (including the circumstances and stage of diabetes at the time of diagnosis), (b) the degree to which participants considered diabetes to be manageable, (c) the extent of diabetes-related knowledge and experience before diagnosis, and (d) opportunities to gain knowledge shortly thereafter. Due to these constraints, lower SSS individuals had particularly adverse disease discovery experiences. The findings are consistent with the theory of constrained choices. Implications for practitioners and for future research are discussed.

Racial/Ethnic predictors of falls among older adults: the health and retirement study.

OBJECTIVE: The objective of this study was to examine racial/ethnic differences in the probability and frequency of falls among adults aged 65 and older. METHOD: Using data from the Health and Retirement Study (HRS) from 2000 to 2010, the authors conducted random-intercept logistic and Poisson regression analyses to examine whether race/ethnicity predicted the likelihood of a fall event and the frequency of falls. RESULTS: The analytic sample included 10,484 older adults. Baseline analyses showed no significant racial/ethnic differences in the probability or number of falls. However, in the longitudinal random-intercept models, African Americans had significantly lower odds (0.65) of experiencing at least one fall compared with non-Hispanic Whites. Among fallers, African Americans had significantly fewer falls (24%) than non-Hispanic Whites, controlling for health and sociodemographic covariates (all ps < .05). Latinos did not differ from non-Hispanic Whites in the likelihood or number of falls. DISCUSSION: African Americans are less likely to experience initial or recurrent falls than non-Hispanic Whites.

Direct social support and long-term health among middle-aged and older adults with type 2 diabetes mellitus.

OBJECTIVES: This study examined whether or not direct social support is associated with long-term health among middle-aged and older adults with diabetes mellitus. METHOD: Direct social support was assessed at baseline (2003) for 1,099 adults with type 2 diabetes mellitus from the Health and Retirement Study. Self-reported health status was examined at baseline and in 4 biennial survey waves (2003-2010). A series of ordinal logistic regression models examined whether or not the 7-item Diabetes Care Profile scale was associated with a subsequent change in health status over time. Additional analyses examined whether or not individual components of direct social support were associated with health status change. RESULTS: After adjusting for baseline covariates, greater direct social support as measured by the Diabetes Care Profile was associated with improved health outcomes over time; however, this trend was not significant (p = .06). The direct social support measures that were associated with improved health over follow-up were support for taking medicines (odds ratio [OR] = 1.22), physical activity (OR = 1.26), and going to health care providers (OR = 1.22; all p < .05). DISCUSSION: Interventions that specifically target improving specific aspects of diabetes social support may be more effective in improving long-term health than less targeted efforts.

Fruit and vegetable intake among older adults: a scoping review.

Older adults are the fastest growing segment of the world population. Older adults are also at heightened risk of chronic conditions (such as diabetes, heart disease, and cancer) and specific geriatric conditions (such as cognitive impairment, frailty, and falls). Research studies have examined the relationship between fruit and vegetable intake and subsequent health outcomes and the correlates of fruit and vegetable intake in the U.S. population. However, relatively few studies have specifically examined health impacts and correlates of fruit and vegetable intake among older adults, who have unique biophysical and socioeconomic circumstances. Evidence is reviewed to (1) describe findings related to consumption and chronic, geriatric, and other health outcomes among older adults and (2) describe patterns in fruit and vegetable consumption among older adults and how these patterns vary within and among populations. This review addresses specific barriers faced by older adults in obtaining and consuming fruits and vegetables in community settings. Recommendations for practice and policy are discussed.

Fruit and vegetable intake, physical activity, and mortality in older community-dwelling women.

OBJECTIVES: To examine the relationship between fruit and vegetable intake, physical activity, and all-cause mortality in older women. DESIGN: Six Cox proportional hazards models examined independent and additive relationships between physical activity, carotenoids, and all-cause mortality. Additional models tested whether physical activity and carotenoids were conjointly related to mortality. Models were adjusted for age, education, and race and ethnicity. SETTING: Baltimore, Maryland. PARTICIPANTS: Seven hundred thirteen women aged 70 to 79 participating in the Women's Health and Aging Studies. MEASUREMENTS: Total serum carotenoids, a marker of fruit and vegetable intake, and physical activity were measured at baseline. Physical activity was measured according to kilocalorie expenditure. RESULTS: During 5 years of follow-up, 82 (11.5%) participants died. Measured continuously, physical activity improved survival (HR = 0.52, 95% CI = 0.41-0.66, P < .001). The most active women were more likely to survive than the least physically active women (HR = 0.28, 95% CI = 0.13-0.59, P < .001). Continuous measures of carotenoids improved survival (HR = 0.67, 95% CI = 0.51-0.89, P = .01). Women in the highest tertile of total carotenoids were more likely to survive those in the lowest (HR = 0.50, 95% CI = 0.27-0.91, P = .03). When examined in the same model, continuous measures of physical activity (HR = 0.54, 95% CI = 0.42-0.68, P < .001) and carotenoids (HR = 0.76, 95% CI = 0.59-0.98, P = .04) predicted survival during follow-up. CONCLUSION: The combination of low total serum carotenoids and low physical activity, both modifiable risk factors, strongly predicted earlier mortality. These findings provide preliminary support that higher fruit and vegetable intake and exercise improve survival.

Socioeconomic status and race/ethnicity independently predict health decline among older diabetics.

BACKGROUND: There are pervasive racial and socioeconomic differences in health status among older adults with type 2 diabetes. The extent to which racial/ethnic and socioeconomic disparities unfold to differential health outcomes has yet to be investigated among older adults with diabetes. This study examines whether or not race/ethnicity and SES are independent predictors of steeper rates of decline in self-rated health among older adults in the U.S. with type 2 diabetes. METHODS: The study population was a subset of diabetic adults aged 65 and older from the Health and Retirement Study. Respondents were followed up to 16 years. Multilevel cumulative logit regression models were used to examine the contributions of socioeconomic indicators, race/ethnicity, and covariates over time. Health decline was measured as a change in self-reported health status over the follow-up period. RESULTS: Relative to whites, blacks had a significantly lower cumulative odds of better health status over time (OR: 0.61, p < .0001). Hispanics reported significantly lower cumulative odds better health over time relative to whites (OR: 0.59, p < .05). Although these disparities narrowed when socioeconomic characteristics were added to the model, significant differences remained. Including socioeconomic status did not remove the health effects of race/ethnicity among blacks and Hispanics. CONCLUSIONS: The author found that race/ethnicity and some socioeconomic indicators were independent predictors of health decline among older adults with diabetes.