Self-Efficacy and Its Associations with Sweat Pro-Inflammatory Cytokine Interleukin-6 and Pre-Frailty/Frailty among Older Adults with Chronic Disease

Problem Statement Chronic disease affects over 117 million US adults1 and is more prevalent in older adults2. Likewise, 15% of community dwelling older adults are frail, which is a state of decreased physiologic reserve associated with many negative health outcomes. Self-management programs to aid in chronic disease and frailty management are commonly based on the concept of self-efficacy, which is the confidence to be successful at specific tasks or life domains. In the context of health and illness, higher self-efficacy is associated with healthier behaviors and positive health outcomes. Although inflammation is common in older adults with chronic diseases, not all have the same amount or degree of poor health outcomes from the inflammation or chronic diseases. Self-efficacy is integral to successful disease management but it is unclear if and how this relates to inflammation. The purpose of this study was to evaluate associations between self-efficacy and frailty as well as self-efficacy and Interleukin-6 (IL-6), which is an inflammatory cytokine highly associated with all-cause morbidity and mortality. Methods We conducted a two-visit cross-sectional study with 159 community dwelling adults ages 65 and older in Maryland. All participants had at least one chronic condition (e.g. hypertension, diabetes, arthritis, etc.) Those with a terminal illness diagnosis, active cancer treatment, cognitive impairment or progressive neurological conditions were excluded. Sweat IL-6, frailty status, self-efficacy, number of chronic diseases, social support and other socio-demographic data were collected. Sweat was collected using a non-invasive sweat patch worn for 72 hours by each participant. We used multiple linear regression and logistic regression to examine whether self-efficacy was associated with sweat IL-6 and frailty after controlling for co-variates. Results There was a significant relationship between social coping self-efficacy and IL-6 (β= -0.544, p=0.006) that remained significant after adjustment for age, sex, race, body mass index, number of chronic conditions and social support (β= -0.534, p=0.010). High self-efficacy was significantly related to lower IL-6. High self-efficacy was associated with an 91% reduction in the odds of pre-frailty/frailty after adjustment for age, race, co-morbidities, cardiovascular disease, heart rate, a life events count, illness intrusiveness, depressive symptoms and financial strain. High self-efficacy was associated with a more robust state. Conclusions Although preliminary, this could shed light on the mechanistic connection between psychological and physical states. Enhancing self-efficacy might also be a viable non-pharmacological treatment to lower or slow inflammatory burden or frailty status in older adults

Self-Efficacy and Its Associations with Sweat Pro-Inflammatory Cytokine Interleukin-6 and Pre-Frailty/Frailty among Older Adults with Chronic Disease

Problem Statement Chronic disease affects over 117 million US adults1 and is more prevalent in older adults2. Likewise, 15% of community dwelling older adults are frail, which is a state of decreased physiologic reserve associated with many negative health outcomes. Self-management programs to aid in chronic disease and frailty management are commonly based on the concept of self-efficacy, which is the confidence to be successful at specific tasks or life domains. In the context of health and illness, higher self-efficacy is associated with healthier behaviors and positive health outcomes. Although inflammation is common in older adults with chronic diseases, not all have the same amount or degree of poor health outcomes from the inflammation or chronic diseases. Self-efficacy is integral to successful disease management but it is unclear if and how this relates to inflammation. The purpose of this study was to evaluate associations between self-efficacy and frailty as well as self-efficacy and Interleukin-6 (IL-6), which is an inflammatory cytokine highly associated with all-cause morbidity and mortality. Methods We conducted a two-visit cross-sectional study with 159 community dwelling adults ages 65 and older in Maryland. All participants had at least one chronic condition (e.g. hypertension, diabetes, arthritis, etc.) Those with a terminal illness diagnosis, active cancer treatment, cognitive impairment or progressive neurological conditions were excluded. Sweat IL-6, frailty status, self-efficacy, number of chronic diseases, social support and other socio-demographic data were collected. Sweat was collected using a non-invasive sweat patch worn for 72 hours by each participant. We used multiple linear regression and logistic regression to examine whether self-efficacy was associated with sweat IL-6 and frailty after controlling for co-variates. Results There was a significant relationship between social coping self-efficacy and IL-6 (β= -0.544, p=0.006) that remained significant after adjustment for age, sex, race, body mass index, number of chronic conditions and social support (β= -0.534, p=0.010). High self-efficacy was significantly related to lower IL-6. High self-efficacy was associated with an 91% reduction in the odds of pre-frailty/frailty after adjustment for age, race, co-morbidities, cardiovascular disease, heart rate, a life events count, illness intrusiveness, depressive symptoms and financial strain. High self-efficacy was associated with a more robust state. Conclusions Although preliminary, this could shed light on the mechanistic connection between psychological and physical states. Enhancing self-efficacy might also be a viable non-pharmacological treatment to lower or slow inflammatory burden or frailty status in older adults

Preventing falls with the LIVE-LIFE program: Pilot outcomes of a multicomponent OT-led intervention addressing health-related and home-related fall risks in community-living older adults

Introduction: There are multiple contributors to falls in older adults. Both health-related (poor balance, polypharmacy, and poor vision), and home-related (home hazards). However, most fall risk interventions only address one or two. The successful Lifestyle Intervention Functional Exercise (LiFE) program could likely be developed into a multicomponent intervention. Objectives: The objectives were to expand the LIFE program into a multicomponent program (LIVE-LIFE) addressing health-related and home-related fall risks, test feasibility and acceptability, and explore the intervention’s effect on measures of balance, strength and falls efficacy.Methods: We did an open-label pilot (n=3) followed by a single-blinded randomized pilot trial. Community-living older adults, 70+ years, with a history of falls, were randomized to the intervention (n=25) or the control group (n=12). The intervention was led by an occupational therapist and included strength and balance training into daily habits over 12 weeks and US$500 in home safety changes, vision screening and, and medication screening. Data were collected at baseline and at 12 and 32 weeks, on the TUG, the 4-stage balance test, incidence of falls, fall efficacy, the number of home hazards, and medications. Program adherence and satisfaction were assessed as well.Results: The intervention had a large effect (1.1) for tandem stand, moderate (0.5) in falls efficacy, and small (0.1) in the TUG. Participant satisfaction and experiences will be presented in the presentation.Conclusion: The results support moving forward with an efficacy trial and we will discuss clinical implications for occupational therapists working at reducing falls in older adults

Preventing falls among older fallers : Study protocol for a two-phase pilot study of the multicomponent LIVE LiFE program

Background: Falls reflect sentinel events in older adults, with significant negative consequences. Although fall risk factors have been identified as intrinsic (e.g., muscle weakness, balance problems) and extrinsic (e.g., home hazards), most prevention programs target only intrinsic factors. We present the rationale and design of a home-based multicomponent fall prevention program - the LIVE LiFE program - for community-living older adults. The program adapts and expands the successful Lifestyle Intervention Functional Exercise (LiFE) program by adding home safety, vision contrast screening, and medication review. The specific aims of the study are to (1) adapt the LiFE program to a US context and expand it into a multicomponent program (LIVE LiFE) addressing intrinsic and extrinsic fall risks, (2) examine feasibility and acceptability, and (3) estimate program impact on multiple outcome measures to prepare for an efficacy trial. Methods: The study involves two phases: an open-label pilot, followed by a two-group, single-blinded randomized pilot trial. Eligible participants are community-living adults 70+ years reporting at least one injurious fall or two non-injurious falls in the previous year. Participants are randomized in a 2:1 ratio to the program group (LIVE LiFE, n = 25) or the control group (written fall risk assessment, n = 12). The open-label pilot participants (n = 3) receive the program without randomization and are assessed based on their experience, resulting in a stronger emphasis on the participant's personal goals being integrated into LIVE LiFE. Fall risk and balance outcomes are assessed by the Timed Up and Go and the 4-Stage Balance Test at 16 weeks. Additional outcomes are incidence of falls and near falls, falls efficacy, fear of falling, number of home hazards, and medications assessed at 16 weeks. Incidence of falls and near falls, program adherence, and satisfaction are assessed again at 32 weeks. Discussion: By expanding and adapting the evidence-based LiFE program, our study will help us understand the feasibility of conducting a multicomponent program and estimate its impact on multiple outcome measures. This will support moving forward with an efficacy trial of the LIVE LiFE program for older adults who are at risk of falling. Trial registration: ClinicalTrials.gov, NCT03351413. Registered on 22 November 2017

Pilot Outcomes of a Multicomponent Fall Risk Program Integrated Into Daily Lives of Community-Dwelling Older Adults

Objectives: To evaluate whether a fall prevention intervention reduces fall risk in older adults who have previously fallen. Design: Randomized controlled pilot trial. Setting: Participants’ homes. Intervention: LIVE-LiFE, adapted from Lifestyle-Intervention Functional Exercise (LiFE) integrates strength and balance training into daily habits in eight visits over 12 weeks. The adaptations to LiFE were to also provide (a) US$500 in home safety changes, (b) vision contrast screening and referral, and (c) medication recommendations. Control condition consisted of fall prevention materials and individualized fall risk summary. Measurement: Timed Up and Go (TUG) and Tandem stand. Falls efficacy, feasibility, and acceptability of the intervention. Results: Sample (N = 37) was 65% female, 65% White, and average 77 years. Compared with the control group, each outcome improved in the intervention. The LIVE-LiFE intervention had a large effect (1.1) for tandem stand, moderate (0.5) in falls efficacy, and small (0.1) in the TUG. Conclusion: Simultaneously addressing preventable fall risk factors is feasible

The major genetic determinants of HIV-1 control affect HLA class I peptide presentation.

Infectious and inflammatory diseases have repeatedly shown strong genetic associations within the major histocompatibility complex (MHC); however, the basis for these associations remains elusive. To define host genetic effects on the outcome of a chronic viral infection, we performed genome-wide association analysis in a multiethnic cohort of HIV-1 controllers and progressors, and we analyzed the effects of individual amino acids within the classical human leukocyte antigen (HLA) proteins. We identified >300 genome-wide significant single-nucleotide polymorphisms (SNPs) within the MHC and none elsewhere. Specific amino acids in the HLA-B peptide binding groove, as well as an independent HLA-C effect, explain the SNP associations and reconcile both protective and risk HLA alleles. These results implicate the nature of the HLA-viral peptide interaction as the major factor modulating durable control of HIV infection