Perceived Balance, Balance Performance, and Falls Among Community-Dwelling Older Adults: A Retrospective, Cross-Sectional Study.

Objectives: To examine the extent to which older adults' perceived balance, a balance performance test, and fear of falling (FOF) were associated with falls in the last month. Methods: The Health Belief Model served as the theoretical framework. A retrospective, cross-sectional, secondary analysis using data from the National Health and Aging Trends Study was conducted (N = 7499). Results: Multiple logistic regression analysis revealed that the odds of reporting a fall in the past month were 3.3 times (p < .001) greater for participants who self-reported having a balance problem compared to those who did not. The Short Physical Performance Battery and FOF were not uniquely associated with falls. Discussion: Our findings support limited evidence suggesting that older adults' perceived balance is a better predictor of falls than balance performance. Assessing older adults' perceived balance may be a new way to assess older adults' fall risk to prevent future falls.

Behavioral activation for family caregiver connectedness: Adaptation of an evidenced based intervention.

Informal caregivers of older adults with chronic illness have unique barriers to social connection. As the older adult population increases, individualized interventions are urgently needed to address the social disconnection experienced across generations of informal caregivers. Adapting an evidenced-based intervention to target social connectedness and leverage technology-mediated communication may be a promising approach. This article describes the adaptation of the Brief Behavioral Activation Treatment for Depression-Revised intervention using elements of the Framework for Reporting Adaptations and Modifications-Enhanced. Facilitating the comprehensive documentation of modifications made, we discuss the (a) rationale for modifications, (b) timing and approach to modifications, (c) nature of context and content modifications, and (d) fidelity in modifications. The Behavioral Activation for Family Caregiver Connectedness intervention addresses unique barriers to caregiver social connection with individualized value-based plans. Modifications to content and delivery reflect the goal of improving intervention fit in the context of social connectedness experienced by informal caregivers.

Perceived balance and self-reported falls: A retrospective cross-sectional study using the National Health and Aging Trend Study.

AIMS: To examine how perceived balance problems are associated with self-reported falls in the past month after controlling for known correlates of falls among older adults. BACKGROUND: Approximately 30% of adults age 65 and older fall each year. Most accidental falls are preventable, and older adults' engagement in fall prevention is imperative. Limited research suggest that older adults do not use the term 'fall risk' to describe their risk for falls. Instead, they commonly use the term 'balance problems'. Yet, commonly used fall risk assessment tools in both primary and acute care do not assess older adults' perceived balance. DESIGN AND METHOD: The Health Belief Model and the concept of perceived susceptibility served as the theoretical framework. A retrospective, cross-sectional secondary analysis using data from the National Health and Aging Trends Study from year 2015 was conducted. The outcome variable was self-reported falls in the last month. RESULTS: A subsample of independently living participants (N = 7499) was selected, and 10.3% of the sample reported a fall. Multiple logistic regression analysis revealed that the odds of reporting a fall in the past month was 3.4 times (p < .001) greater for participants who self-reported having a balance problem compared to those who did not. In contrast, fear of falling and perceived memory problems were not uniquely associated with falls. Using a mobility device, reporting pain, poor self-rated health status, depression and anxiety scores were also associated with falling. CONCLUSION AND IMPLICATIONS: Older adults' perceived balance problem is strongly associated with their fall risk. Perceived balance may be important to discuss with older adults to increase identification of fall risk. Older adults' perceived balance should be included in nursing fall risk assessments and fall prevention interventions. A focus on balance may increase older adults' engagement in fall prevention.

Social isolation and health among family caregivers of older adults: Less community participation may indicate poor self-reported health.

Social isolation is associated with adverse health outcomes in the general older adult population, but little is known about indicators of social isolation in family caregiver populations. This cross-sectional study examined the prevalence of social isolation in the 2015 National Survey of Caregiving. Using the Convoy Model of social relations, a life-course social support framework, we also examined associations between social isolation and caregiver self-reported health. Using multiple ordinal logistic regression models, we examined social isolation - operationalised with a five-item summative measure and, alternatively, with each social isolation item - as a predictor of self-reported general health status. On the dichotomised summative measure, 24.74% (n = 2,175) were more isolated. Younger caregivers were more isolated (M = 56.77 years, SE = 0.76) compared with those who were not (M = 60.86 years, SE = 0.41). Self-reported general health was as follows: 4.93% poor; 15.67% fair; 25.62% good; 34.81% very good and 18.97% excellent. Less social isolation was associated with higher odds of better self-reported health (Adjusted odds ratio [AOR] = 1.19; CI = 1.05-1.35). Of the individual social isolation indicators, only a lack of community participation was associated with higher odds of worse self-reported health (AOR = 1.57; CI = 1.25-1.97). Social isolation and particularly community participation were associated with caregiver health status. It may be necessary for healthcare providers to consider these factors in caregiver health assessments. Future research is recommended to understand the consequences of various social isolation indicators in diverse samples including younger caregivers.

Falls and Social Isolation of Older Adults in the National Health and Aging Trends Study.

A longitudinal secondary analysis of 2 years of data from the National Health and Aging Trends Study was undertaken to determine the extent to which social isolation predicts falls in older adults. Social isolation during Year 1 (baseline) was operationalized as a multiple-indicator measure based on Social Network Index participation domains. Falling during the previous year was self-reported using Year 2 data. Logistic regression models revealed social isolation significantly predicted falls (odds ratio [OR] = 1.11; 95% confidence interval [CI] [1.05, 1.17]). The relationship remained significant after adjusting for age, gender, and education (OR = 1.08; 95% CI [1.02, 1.14]). The relationship weakened after adjusting for self-reported general health, depression risk, and worry about falling (OR = 1.02; 95% CI [0.96, 1.08]). Adjusting for Short Physical Performance Battery (SPPB), assistive mobility device, and activities of daily living further weakened the relationship (OR = 0.99; 95% CI [0.94, 1.04]). SPPB demonstrated the strongest correlation with social isolation (r = -0.42; p < 0.01). Fall prevention intervention studies specifically targeting social isolation may incorporate physical performance as a shorter-term and cost-effective proxy outcome for falls. [Res Gerontol Nurs. 2018; 11(2):61-70.].

Measuring Social Isolation in the National Health and Aging Trends Study.

The objectives of the current study were to describe the development of a social isolation measure based on Berkman and Syme's Social Network Index domains with data from the National Health and Aging Trends Study. A descriptive correlational design was used, establishing convergent and divergent validity of the measure with depression risk and well-being. Depression risk was measured with the Patient Health Questionnaire-2 and an ordinal well-being measure was developed based on measures in MIDUS-Midlife in the U.S.-A Study of National Health and Well-Being. Participants who scored ≥4 (cutoff point) on the social isolation measure represented 21.9% (N = 7,609) of the sample (95% confidence interval [20.6, 23.3]). Spearman's correlation with depression was 0.23 (p < 0.001) and -0.24 (p ≤ 0.001) with well-being. The weighted data complex samples general linear model with depression (R = 0.22, p ≤ 0.001) and well-being (R = -0.26, p ≤ 0.001) confirm the relationships. This measure offers conceptual clarity and measurement consistency for developing the components and targets for future social isolation intervention research. [Res Gerontol Nurs. 2017; 10(6):277-287.].