Preventive Medicine via Lifestyle Medicine Implementation Practices Should Consider Individuals' Complex Psychosocial Profile.

Noncommunicable chronic diseases are associated with lifestyle behaviors. Psychological and social factors may influence the adoption of such behaviors. Being mentally and physically energized or fatigued may influence the intention-behavior gap of healthy lifestyle adoption accordingly. We investigated the associations of age, sex, lifestyle behaviors, mood, and mental and physical energy and fatigue at both the trait and state levels. The participants (N = 670) completed questionnaires assessing their sleep, mood, mental and physical state energy and fatigue, physical activity, mental workload, and diet. The ordinary least squares regression models revealed an overlap between the mental state and trait energy levels for males who consume polyphenols, have a high mental workload, and sleep well. Being younger, having a high stress level, bad sleep habits, and being confused and depressed were associated with high mental fatigue. Physical energy and fatigue shared the same commonalities with the previous results, with greater discrepancies observed between the state and trait indicators compared to that between mental energy and fatigue. Diet and stress management seem to be predictors of high physical energy, and females report higher physical fatigue levels. Health care professionals should consider this psychosocial complex profiling in their differential diagnosis and when one is implementing lifestyle behavioral changes to address the facets of preventive medicine, wellness, and health promotion.

Modifications of Traditional Formulas to Estimate and Project Dependency Ratios and Their Implications in a Developing Country, Bangladesh.

Traditional dependency ratios based on the United Nations' old age definition (≥ 65 years) appear to be an inappropriate indicator for many developing countries, including Bangladesh. Bangladesh, with a retirement age of 59 in many sectors, defines old age as ≥ 60 years, whereas the United Nations documents 60-64 years as working age. This study offers two modifications to the traditional formulas of dependency ratios and compares the modified measures against the traditional measures from 1975 to 2100. Using data from the United Nations and the World Bank, (i) we moved the cut-off for 'old age' to 60 instead of 65 years, considering 15-59 years as 'potentially working', and (ii) we used the economically active population instead of the entire working-age population. Using our modified calculations, the growth rate of older adults (≥ 60 years) will be at its peak (4.6%) between 2020 and 2030 and continue to increase until 2085, though we will observe a negative population growth after 2055, and 2020-2040 appears to be the best time for reaping the highest demographic dividend. Compared to our modification, the traditional formula undercounted the older adults substantially, predicting a much lower demographic and financial burden. The modifications and associated estimates are important in advancing our understanding of dependency ratios in Bangladesh and have policy and practical implications in preventing the inaccurate representation of demographic and financial issues, and they are useful for planning for geriatric care, social safety nets, and healthy aging. The modified formulas may also be applicable in other countries which adopt ≥ 60 years as an old-age threshold. Supplementary Information: The online version contains supplementary material available at 10.1007/s11113-022-09720-8.

Staying Connected: Alternative Transportation Use, Neighborhoods, and Social Participation Among Older Americans.

BACKGROUND AND OBJECTIVES: A wealth of empirical evidence documents improved health among older adults who participate in social activities. Alternative transportation can serve as a bridge linking older adults to social activities and improving person-environment fit. RESEARCH DESIGN AND METHODS: Using Waves 1-8 of the National Health and Aging Trends Study, this research examines whether alternative transportation use is associated with participation in diverse social activities among a sample of Medicare beneficiaries aged 65 or older. Additionally, this research explores whether the effect of transportation use varies across neighborhood environments. We analyzed individual trajectories of participation in social activities by estimating 2-level growth curve models. RESULTS: The use of public transportation, paratransit, getting a ride, or walking/using wheelchair/scooter to get places was associated with participating in more types of social activities. Respondents who used alternative transportation had less steep declines in participation. The effect of getting rides and using paratransit services was more pronounced among respondents living in disordered neighborhoods. DISCUSSION AND IMPLICATIONS: This research underscores the importance of alternative transportation use and the neighborhood context for participation among older adults. Age-friendly initiatives aimed at fostering greater community engagement should think broadly about the role of multiple forms of transportation.

Sleep quality and sex modify the relationships between trait energy and fatigue on state energy and fatigue.

The objective of this study was to identify the associations between trait energy and fatigue with state energy fatigue, as well as exploring if these relationships interacted with sex and/or sleep quality. The study population included a convenience sample of adults and college students (n ranges from 687 to 694). Key measures were state and trait mental and physical energy and fatigue scales, PSQI (a measure of sleep quality), and sex. Multiple regression models included age, polyphenol consumption, POMS scores, physical activity, mental load, and caffeine consumption as covariates. Analyses yielded a strong (r = .65) positive association between each trait and state variable. Overall, several statistically significant interactions were identified. First, the relationship between state and trait physical fatigue was particularly strong for women with high trait scores. There were also interactions with sleep quality. In the case of physical fatigue, poor sleep quality magnified the association between physical fatigue trait and state among those with low trait physical fatigue, while sleep quality did not make a difference for those with high trait physical fatigue. Conversely, in the case of physical energy and mental fatigue, good sleep quality was associated with both higher "highs" and lower "lows" of their respective traits; both interactions were present only among males. Our analyses suggest that sleep quality and sex could influence the effects of trait physical and mental energy and fatigue on state. Findings were more complex than initially assumed, suggesting that the interrelationship between trait and state may be modified by how males and females react and adapt to their trait.

Binary and Nonbinary Measures of Successful Aging: Do They Yield Comparable Conclusions?

Recently, some researchers have employed nonbinary measures of successful aging. Little has been done to determine whether these newer measures yield similar findings compared to traditional binary measures. To test for differences, three measures of successful aging were constructed within five waves of the Americans' Changing Lives data set. A number of demographic, behavioral, and psychosocial predictors were used to predict each outcome, examining whether estimates of effect sizes and statistical significance were similar across measures. Although many effect sizes were similar, conclusions regarding statistical significance were inconsistent. For instance, the binary measure downplayed income gradients, the ordinal measure found more racial disparities, and the continuous measure was most likely to detect effects for stressful life events. These differences may be due to the statistical techniques used to handle each outcome. Results imply that uneven application of operationalization approaches may complicate replication efforts, suggesting a need for consistent measurement standards.

Successful Present, Successful Future? Assessment of a Nonbinary Model of Successful Aging.

PURPOSE: Though many models of successful aging exist, there is a need for assessments of the empirical validity of these models and their measures. This study tests the validity of the multidimensional model of successful aging presented by Young and colleagues. DESIGN AND METHODS: Expanding on an earlier validation study, this analysis uses 1,211 respondents from the Americans' Changing Lives (ACL) study to determine predictive and discriminant validity. Respondents were surveyed in 1986, 1989, and 1994, providing an opportunity to assess if a baseline 5-point successful aging scale is associated with present and future outcomes. Validators include self-report items and interviewer recorded observations. In addition, a survival analysis of 24 years of ACL mortality data is conducted to confirm that baseline successful aging decreases risk of all-cause mortality. RESULTS: Results illustrate that, in some cases as far as 8 years in the future, low successful aging scores correspond with higher risk of future hospitalization and depressive episodes, interviewer observed difficulty moving around, low self-rated health, and decreased life satisfaction. Lowest scorers also had a 356% higher risk of mortality compared to individuals with the highest scores. IMPLICATIONS: These findings provide further evidence that Young and colleagues' successful aging construct is empirically valid and could be applied in future research and practice. Most respondents had middling scores, suggesting that future analyses should be cautious about concealing heterogeneity by operationalizing successful aging as a binary outcome.

Patient Satisfaction with Care After Coronary Revascularization.

OBJECTIVE: Bridging the Divides (Bridges), a Centers for Medicare and Medicaid Services-funded program, developed a post-hospitalization care management infrastructure integrating information technology-enabled informatics with patient care for ischemic heart disease patients. The objective of this study was to assess patient satisfaction with the Bridges program and determine the patient characteristics associated with higher satisfaction. METHODS: All adult English-speaking patients who underwent a percutaneous coronary intervention, coronary artery bypass grafting, or catheterization plus acute myocardial infarction and agreed to participate in the Bridges program were eligible. A survey instrument was administered to address patient satisfaction of care received, aspects of care that patients appreciated, and challenges faced. Descriptive statistics were calculated, and primary analyses included comparisons of overall patient satisfaction after discharge between procedure type, and according to age, sex, race, Elixhauser comorbidity count, and length of stay. RESULTS: Four hundred and sixty-seven (46%) had complete or partial response rates. There was a statistically significant difference in the overall satisfaction among patients undergoing percutaneous coronary intervention, coronary artery bypass grafting, or catheterization plus acute myocardial infarction (p = 0.023). There were significant procedure by sex (p = 0.052) and procedure by age (p = 0.039) interactions. There were no statistically significant differences in overall satisfaction according to age, sex, race, comorbidity count, or length of stay. CONCLUSIONS: This study identified several important components related to patient satisfaction for patients with ischemic heart disease. Results found that patients who underwent coronary artery bypass grafting were reportedly "very satisfied" when compared with patients who underwent percutaneous coronary intervention and catheterization plus acute myocardial infarction, as well as significant age and sex interactions between procedures.

Examining the Relationship Between Flexible Resources and Health Information Channel Selection.

This study examines how variations in flexible resources influence where individuals begin their search for health information. Access to flexible resources such as money, power, and knowledge can alter the accessibility of channels for health information, such as doctors, the Internet, and print media. Using the HINTS 3 sample, whether information channel utilization is predicted by the same factors in two groups with distinct levels of access to flexible resources, as approximated by high and low levels of education, is investigated. Differences in access to flexible resources are hypothesized to produce variations in channel utilization in bivariate analyses, as well as changes in coefficient strength and statistical significance in multivariate models. Multinomial logit models were used to assess how a number of variables influence the probability of using a specific information channel first in either flexible resource group. Results suggest that individuals with higher levels of education, a proxy for flexible resources, are more likely to report seeking information from the Internet first, which is consistent with research on the digital divide. It appears that diminished access to flexible resources is also associated with heightened utilization of offline channels, including doctors. A handful of differences in predictors were found between the low and high flexible resource groups when multivariate models were compared. Future research should take into account the distinctions between different offline channels while also seeking to further understand how social inequality relates to the utilization of different channels and corresponding health outcomes.

Gaps in knowledge: tracking and explaining gender differences in health information seeking.

Self-directed health information seeking has become increasingly common in recent years, yet there is a substantial body of evidence suggesting that females are more likely to engage in information seeking than males. Previous research has largely ignored the significance of this difference as both an empirical and a theoretical finding. The current study has two goals, seeking to track this sex gap over time and to test explanations for its existence. The three explanations tested are based in past findings of gendered division of childcare labor, gendered reactivity to illness, and gendered perceived risk of illness. These were tested using multiple dependent variables from both repeated cross sectional data and 2012 data from the Health Information Trends Survey (HINTS). Results show that females are significantly more likely to look for cancer information, information in general, and information over the Internet over time than males, though the gap may be closing in the case of cancer information. The three explanations also received little clear support though perceived risk of getting cancer acted as a mediator through which men may be less likely to look for cancer information. Based on this analysis it is clear that a sex gap in information seeking is present and theories of masculinity and health may hold promise in some contexts but additional explanations are needed.