Exploring the "Obesity Paradox" as a Correlate of Cognitive and Physical Function in Community-dwelling Black and White Older Adults.

Objective: The obesity paradox has been documented in aged populations, yet it remains unclear if this paradox persists for physical and cognitive outcomes in community-dwelling older adult populations. Our study examines associations between body mass index (BMI) classification, cognitive function, and physical function. We also investigate whether these associations are modified by race or age. Design: Cross-sectional study. Setting: Senior residential sites and community centers in Saint Louis, Missouri. Participants: Study participants included 331 adults, aged >55 years. Age was stratified into young-old (aged 55-74 years) and older (aged ≥75 years). Outcome Measures: Physical function was measured using the mini-Physical Performance Test (mini-PPT) and grip strength. Cognitive function was assessed with the Short Blessed Test (SBT) and the Trail Making Tests (TMT-A and TMT-B) performance. Results: Older adults who were obese had significantly better cognitive flexibility (TMT-B) performance than normal weight older adults (P=.02), and this association was not influenced by age or race. Adiposity was not associated with psychomotor speed (TMT-A), general cognition (SBT), or measures of physical function (Ps>.05). Conclusion: In a diverse sample of community-dwelling older adults, we found partial support for the controversial obesity paradox. Our results suggest excess adiposity may be protective for executive function processes. Future research is needed to examine the underlying physiological processes linking adiposity to executive function in older adults.

Fatigue in Older Adults Postmyocardial Infarction.

OBJECTIVE: The purpose of this study was to comprehensively examine putative factors that may independently contribute to fatigue and subsequent persistence of fatigue in elderly adults 6-8 months post-myocardial infarction (MI). Studies suggest cardiac function, comorbidities, daytime sleepiness, depression, anemia, interleukins, and social support are correlates of fatigue; however, no studies have systematically examined these factors 6 months post-MI in an aging population. METHODS: Study participants included 49 women and men (N = 98) ages 65-91 who were 6-8 months post-MI. Data collection included the demographic health status questionnaire (heart rate, blood pressure, body mass index, and medications), fatigue-related comorbidity scale, revised Piper fatigue scale, Epworth sleepiness scale, geriatric depression scale, social provisions scale, and venous blood tests (B-natriuretic peptide, hemoglobin, and interleukin-6). RESULTS: Fatigue persisted after MI in 76% of older men and women with no difference by sex. Only depression scores (P trend = 0.0004) and mean arterial pressure (P trend = 0.015) were found to be linearly independent predictors for fatigue, controlling for age, Il-6 levels, and body mass index. CONCLUSION: Post-MI depression and mean arterial blood pressure are important to assess when examining fatigue post-MI in older populations.

Predicting Heart Failure Readmissions.

OBJECTIVES: In this study, the effects of sociodemographic and clinical factors on heart failure (HF) readmission risk were examined. BACKGROUND: Hospitals now incur financial penalties for excessive HF readmission rates; therefore, identifying factors associated with risk is essential for designing risk-reduction strategies. METHODS: A retrospective cohort study using chart reviews compared HF inpatients (N = 245) who were readmitted with those who were not readmitted. RESULTS: The sample included mostly white (64%) elderly (mean [SD] age, 69.8 [15.1] years) men (49%) and women (51%). Using Cox regression, the number of comorbidities (3-4 or 5-8) and type of comorbidities, specifically renal insufficiency (readmission ratio [RR], 1.7; P = .003), atrial fibrillation (RR, 1.7; P = .005), cardiomyopathy (RR, 1.5; P = .020), followed by a history of myocardial infarction/coronary artery disease (RR, 1.4; P = .055), were the predictors of HF readmission. CONCLUSIONS: Targeting those with high-risk comorbidities is important in designing measures to prevent or delay readmission of HF patients.

Evaluation of concept mapping in an associate degree nursing program.

The purpose of this project was to evaluate concept mapping as a clinical teaching-learning activity that reflects critical thinking by promoting identification of nonlinear relationships among the components of the nursing process. The sample involved 28 associate degree nursing students from one graduating class. Students completed one map each in the second and fourth semesters and two maps in the fifth semester, for a total of four concept maps. The students' learning activity was to create a concept map on a blank sheet of paper describing the clients' physiological and psychosocial needs and nursing care and the relationships among concepts. As students progressed through the curriculum, there was a steady increase in the mean scores and the average number of cross-links in their concept maps. Cross-links indicated students' ability to use nonlinear thinking to identify relationships among concepts. The results of this study support the use of concept maps as an effective teaching-learning activity and support concept mapping as an evidence-based nursing education strategy.