The Association of Pain Levels and Low Physical Activity among Older Women.

There is an integral research gap regarding whether there is a relationship between pain levels and low physical activity among older women. This is a secondary analysis of a longitudinal cohort study, the Women's Health and Aging Study (WHAS) II. Our analyses included 436 community-dwelling women between the ages of 70 and 79, who were followed for 10.5 years. We employed marginal structural modeling, which controls for time-dependent confounding, with the aim of assessing the potential direct association between pain levels and low physical activity and assess a graded relationship. Compared to women with no pain, those with widespread pain were nearly half as likely to be moderately active versus low active (aOR: 0.46, 95% confidence interval (CI): 0.22, 0.96). A graded association was observed across the four pain levels (no pain or mild pain, other pain, moderate or severe lower extremity pain, and widespread pain) on low physical activity. Our findings indicate that reducing chronic widespread pain in older women may increase moderate physical activity, and therefore reduce the downstream health risks of low physical activity, including morbidity and mortality risk.

Ideal Vial Size for Infliximab in the Treatment of Inflammatory Bowel Disease: An Analysis of Pharmaceutical Waste and Physician Opinions.

Background: Infliximab is a weight-based prescription for multiple autoimmune diseases and is dispensed only in single-use, 100mg vials. We aim to compute the quantity of infliximab waste at our site and in an ideal world where weight-based prescribing practices are followed. We estimate hypothetical waste reduction and cost-savings if a smaller vial is dispensed. We also surveyed gastroenterologists to study prescription rounding practices for infliximab. Methods: A pre-existing registry of 426 inflammatory bowel disease patients identified 112 individuals who had received a total of 1003 infliximab administrations from December 2013 to May 2019. We calculated infliximab wastage per administration for the real world and an ideal (weight-based) world. Analysis of potential waste reduction and cost-savings was computed with the hypothetical creation of 50 and 25mg vials. Infliximab-prescribing gastroenterologists completed an online survey, determining reasons for rounding of weight-based prescription, rounding practices, and biosimilar use. Results: At our site, the total value of infliximab wasted was between $112738.08 and $243209.50. Utilizing 50 and 25mg vials would reduce this waste by 92.2% and 99.4%, respectively. If prescriber guidelines were followed precisely, the total value of waste was between $132781.08 and $286448.19. Utilizing 50 and 25mg vials would reduce waste by 50.39% and 75.34%, respectively. The physician survey revealed that 68.1% rounded doses while only 31.9% prescribed exact weight-based doses. Conclusions: Infliximab-prescribing gastroenterologists considered reducing drug waste as a common reason in their rounding practices. Our analysis demonstrates significant waste reduction and cost-savings are possible with the introduction of 50 and 25mg vials.

Erratum: Creation of the Person-Centered Wellness Home in Older Adults.

[This corrects the article DOI: 10.1093/geroni/igz055.].

Creation of the Person-Centered Wellness Home in Older Adults.

BACKGROUND AND OBJECTIVES: Extending the Patient-Centered Medical Home (PCMH) model into the community may address the poor linkage between medical clinics and underserved communities. Our first of three objectives was to determine if peer leaders and wellness coaches can be the relationship center of wellness care. We evaluated the Self-management Resource Center Small Group Programs (SMRCSGP), plus wellness coaching, as a booster intervention in older adults with chronic diseases. Second, we evaluated the role of personal health records (PHR) prototype as the linkage between the clinic and community. Using input from these two objectives, we lay the groundwork for the Person-centered Wellness Home (PCWH). RESEARCH DESIGN AND METHODS: Participants enrolled from five South Bronx New York City Housing Authority communities. We conducted a pragmatic, randomized controlled trial using two arms (n = 121): (1) SMRCSGP and (2) SMRCSGP plus wellness coaching initiated as a booster after SMRCSGP completion. Adjusted individual growth models compared the slope differences for outcomes. We conducted a social networking analysis on the ties between wellness coaches and participants. PCMH-certified physicians completed in-depth interviews on the PHR prototype. An adaptation from the consensus-workshop model summarized the priority PCWH items. RESULTS: There was an improvement in self-reported physical functioning (2.0 T-score units higher, p = .03) by the wellness coaching group, but the groups did not differ on physical activity. From the social networking analysis, connections were stable over time with wellness-coaches and participants. The Consensus Conference identified eight major components of the PCWH. DISCUSSION AND IMPLICATIONS: Wellness coaching post-SMRCSGP was a booster to physical function, an upstream outcome for physical activity. During the Consensus-Conference, community-based prevention marketing and personal navigators for connecting to a PCMH emerged as novel components. This supports future work in training community health workers as peer leaders to provide evidence-based programs and other PCWH components.

Reduced Lower Extremity Functioning Is Associated With an Increased Rate of Being a Nondriver: The National Health and Aging Trends Study.

BACKGROUND: Driving a motor vehicle is an important aspect of mobility for older adults. Limited lower extremity functioning performance, as measured by the Short Physical Performance Battery (SPPB), has been associated with various negative health outcomes, but little is known about the association of SPPB scores with driving status. OBJECTIVE: The purpose of this study was to evaluate whether lower (poorer) SPPB scores are associated with an increased rate for being a current nondriver among a nationally representative sample of community-dwelling older adults. DESIGN: The National Health and Aging Trends Study is a longitudinal cohort study. METHODS: A population of 5935 participants, surveyed annually from 2011 to 2014 for the National Health and Aging Trends Study, was used to examine the relationship between SPPB and driving status. Using weighted data, multivariable Poisson regression with generalized estimating equations was used to calculate the rate ratios, adjusting for covariates and clustering due to the complex survey design. RESULTS: Participants with a low (poor) SPPB score (0-5) had a rate for being a current nondriver 2.01 times the rate (or 101% increase) of those with a high (good) SPPB score (10-12) (adjusted 95% confidence interval = 1.78-2.26). LIMITATIONS: Current nondrivers were not asked whether they planned to resume driving if they had not driven in the previous year. CONCLUSIONS: Unlike other factors, such as cognitive decline, lower SPPB scores (poorer lower extremity functioning) are significantly associated with an increased rate of being a current nondriver and are a modifiable risk factor. Further research is needed to examine whether optimum exercises and other physical therapist interventions focused on improving lower extremity strength and balance ultimately improve driving outcomes.

Rehabilitation Utilization for Falls Among Community-Dwelling Older Adults in the United States in the National Health and Aging Trends Study.

OBJECTIVE: To determine the characteristics of community-dwelling older adults receiving fall-related rehabilitation. DESIGN: Cross-sectional analysis of the fifth round (2015) of the National Health and Aging Trends Study (NHATS). Fall-related rehabilitation utilization was analyzed using weighted multinomial logistic regression with SEs adjusted for the sample design. SETTING: In-person interviews of a nationally representative sample of community-dwelling older adults. PARTICIPANTS: Medicare beneficiaries from NHATS (N=7062). INTERVENTIONS: Not applicable. MAIN OUTCOMES MEASURES: Rehabilitation utilization categorized into fall-related rehabilitation, other rehabilitation, or no rehabilitation. RESULTS: Fall status (single fall: odds ratio [OR]=2.96; 95% confidence interval [CI], 1.52-5.77; recurrent falls: OR=14.21; 95% CI, 7.45-27.10), fear of falling (OR=3.11; 95% CI, 1.90-5.08), poor Short Physical Performance Battery scores (score 0: OR=6.62; 95% CI, 3.31-13.24; score 1-4: OR=4.65; 95% CI, 2.23-9.68), and hip fracture (OR=3.24; 95% CI, 1.46-7.20) were all associated with receiving fall-related rehabilitation. Lower education level (less than high school diploma compared with 4-y college degree: OR=.21; 95% CI, .11-.40) and Hispanic ethnicity (OR=.37; 95% CI, .15-.87) were associated with not receiving fall-related rehabilitation. CONCLUSIONS: Hispanic older adults and older adults who are less educated are less likely to receive fall-related rehabilitation. Recurrent fallers followed by those who fell once in the past year were more likely to receive fall-related rehabilitation than are older adults who have not had a fall in the past year.

Select physical performance measures and driving outcomes in older adults.

BACKGROUND: Improving physical functioning may be a future intervention to keep older adults driving safely longer as it can help maintain both physical and cognitive health longer. This systematic review assesses the evidence on the association between three physical functioning measures: the Short Physical Performance Battery, the Timed Up-and-Go test, and the Rapid Pace Walk with driving outcomes in older adults. METHODS: Older adult studies published between 1994 and 2015 that included the Short Physical Performance Battery, the Timed Up-and-Go test, or the Rapid Pace Walk as a measure of physical functioning and included a driving-related outcome were identified through a comprehensive search and reviewed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS: Thirteen studies involving 5,313 older adults met the inclusion criteria. Lower Short Physical Performance Battery scores were associated with reduced driving exposure and increased cessation in all three Short Physical Performance Battery studies. The Timed Up-and-Go test was not associated with the driving outcomes (cessation, ability, crashes, and citations) in either of the two Timed Up-and-Go studies. Poorer Rapid Pace Walk scores were associated with decreased driving ability in two studies and with reduced driving exposure in one study, but not associated with driving ability, crashes, citations, or cessation in the remaining five Rapid Pace Walk studies. CONCLUSIONS: The Timed Up-and-Go test measure appears not to be a useful measure of physical functioning for the driving outcomes included here. The Rapid Pace Walk may be useful in studies of driving ability and exposure. More driving studies should consider using the Short Physical Performance Battery to determine if it may be useful as a risk factor assessment for identifying individuals at risk of certain driving outcomes.

Association between baseline frailty and driving status over time: a secondary analysis of The National Health and Aging Trends Study.

BACKGROUND: Continued automobile driving is important for the wellbeing and independence of older adults. Frailty has been associated with a variety of negative health outcomes, but studies are lacking on the potential association between frailty and driving status. The present study uses data from The National Health and Aging Trends Study (NHATS) to assess if the presence of frailty is associated with being a current non-driver. METHODS: NHATS is a nationally representative cohort study of Medicare beneficiaries (aged ≥65) that have been followed since 2011. We examined frailty status at baseline (Fried's frailty phenotype) and driving status over 4 years (from 2011 to 2014) excluding never drivers at baseline. Multivariable Poisson regression was used to obtain incidence rate ratios, adjusting for covariates and clustering. To account for the repeated measures in the data collection, generalized estimating equations (GEE) were employed. RESULTS: A significant association between baseline frailty and driving status was observed at all four time points. At T4, frail participants at baseline had an incidence rate for becoming a current non-driver 1.80 times (or an 80% increase) that of non-frail participants at baseline (adjusted 95% confidence interval (CI) 1.56-2.07). CONCLUSIONS: Frailty was associated with an increased rate of being a current non-driver. Based on this association, we posit that screening for and intervening on frailty may help certain older adults who are at risk for becoming a current non-driver to remain on the road longer.

Predictors of and health- and fall-related program outcomes resulting from complete and adequate doses of a fall risk reduction program.

Falls are dangerous and costly for older adults. The A Matter of Balance/Volunteer Lay Leader (AMOB/VLL) program is an evidence-based fall risk reduction program that could help reduce this burden. This study introduced a door-through-door transportation program to improve program delivery (N = 126). Characteristics predicting completion of all eight AMOB/VLL sessions were identified using logistic regression. Individual growth models were employed to determine the immediate, intermediate, and long-term goal outcomes resulting from receiving an adequate dose of the program (five to eight sessions). Self-restriction of activities due to fear of falling (OR 5.04, 95 % CI 1.86-13.69) and a lower frequency of moderate and vigorous physical activity (OR 1.14, 95 % CI 1.04-1.27) were significantly predictive of receiving a complete dose. Three outcome goals were significant, including (1) immediate-improved self-efficacy of managing medications and treatments, (2) intermediate-reduced activity limitations, and (3) intermediate-reduced physical disability. Self-restriction of activities due to a fear of falling and physical activity levels may be simple and effective screening questions to prevent AMOB/VLL attrition. In our study, those who did receive the program improved on a specific type of self-efficacy and on self-reported physical functioning.

Relationship Between Falls and Complementary and Alternative Medicine Use Among Community-Dwelling Older Adults.

OBJECTIVES: The objective of this study was to examine the potential relationship between different forms of complementary and alternative medicine (CAM) use and falls among older adults in New York City (NYC). DESIGN: This cross-sectional study of data from the NYC Health Indicators Project survey used modified questionnaire items from several national surveys. SETTINGS: Participants were recruited from 56 senior centers located in the 5 boroughs of NYC. PARTICIPANTS: There were 1273 participants aged 60 years or older included in the final analysis. OUTCOME MEASURES: Of particular interest to the researchers was a dichotomous outcome variable for falls, indicating that an individual had experienced no falls during the past year or one or more falls. Also of interest in the analyses were five CAM therapy types: alternative medical systems, biologically based therapies, manipulative and body-based therapies, mind-body therapies, and movement therapies. RESULTS: Prevalence of falls in NYC was 26.8%, which is consistent with the national average. Prevalence of CAM use was 92%. Participants who had tried manipulative and body-based therapies were more likely to report falling in the past 12 months (odds ratio, 1.65; 95% confidence interval, 1.26-2.15), after adjustment for age and sex. This observed association may reflect older adults with chronic pain who are already at risk for falling and are seeking therapy for this pain. None of the other CAM types were significantly associated with falls. CONCLUSIONS: Because of the growing popularity of CAM use within this population, CAM practitioners should be included in falls prevention strategies. Particular attention should be taken to include practitioners who provide manipulative and body-based therapies (e.g., chiropractors, osteopaths, physical and massage therapists) because of the high risk for falls observed among individuals who use these therapies.