Mobility Disability in Older Adults: At the Intersection of People and Places

Mobility disability is associated with poor lower body function among older adults. This study examines whether specific types of neighborhood characteristics moderate that association

Regional variation in Ascaris lumbricoides and Trichuris trichiura infections by age cohort and sex: effects of market integration among the indigenous Shuar of Amazonian Ecuador

Background: Soil-transmitted helminth (STH) infection peaks during childhood and varies by sex. The impact of market integration (MI) (increasing production for and consumption from a market-based economy) on these infection patterns, however, is unclear. In this study, STH infection is examined by sex and age among indigenous Shuar inhabiting two regions of Amazonian Ecuador: (1) the modestly market-integrated Upano Valley (UV) and (2) the more traditional Cross-Cutucú (CC) region. Methods: Kato-Katz fecal smears were examined for parasite presence and infection intensity. Factorial ANOVAs and post hoc simple effects analyses were performed by sex to compare infection intensity between regions and age categories (infant/child, juvenile/adolescent, adult). Results: Significant age and regional differences in Ascaris lumbricoides and Trichuris trichiura infection were detected. Overall, infants/children and juveniles/adolescents displayed higher parasite loads than adults. CC females exhibited higher A. lumbricoides loads than UV females, while the opposite pattern was observed for T. trichiura infection in males. Conclusions: Regional infection patterns varied by sex and parasite species, perhaps due to MI-linked environmental and lifestyle changes. These results have public health implications for the identification of individuals at risk for infection and contribute to ongoing efforts to track changes and alleviate STH infection in indigenous populations undergoing MI

Physical Activity, Socioeconomic Status, and Perceptions of Neighborhood Safety in Older Adults

BackgroundMobility, "the ability to move oneself [e.g., by walking, by using assistive devices, or by using transportation) within community environments that expand from one's home, to the neighborhood, and to regions beyond" (Webber, Porter et al. 2010) ], is important to healthy aging. Walking, both for recreation and for transportation, has been suggested to be a particularly accessible, affordable, and safe way to be physically active. It is important to understand the barriers to and supports for walking in one's neighborhood for older adults. Neighborhood socioeconomic status and other neighborhood characteristics, such as perceived safety from crime, are associated with walking and physical activity. Health symptoms may also be important determinants of walking and physical activity for older adults. Objectives1. Determine to what extent objective and perceived neighborhood characteristics of older adults vary by the socioeconomic status of the neighborhood. Determine what objective neighborhood and personal characteristics are associated with perceived neighborhood safety in older adults. 2. Determine the leading health symptoms reported by older people as causing difficulty when walking outdoors.3. Determine the different physical activities engaged in by older men and women. Determine the association between both neighborhood socioeconomic status and perceived safety from crime and physical activity.MethodsThe study titled "Environmental Correlates of Physical Activity among Older Adults: A Healthy Aging Research Network (HAN) Collaboration" (referred to in this dissertation as the "HAN Walking Study") was designed to examine how the neighborhood environment may influence physical activity and walking behavior in older adults, and how this relationship may be modified by the functional capacity of older adults. Data were collected from 884 older adults at four sites across the country, from a diversity of physical environments. Data collection included in person interviews, lower-body functional capacity testing, accelerometers, walking diaries, and secondary GIS data. Results1. Participants living in neighborhoods of low socioeconomic status (low SES) have objectively shorter block lengths, higher housing density, and more businesses. Participants living in low SES neighborhoods perceive that they are less safe from crime and traffic. They also perceive that their neighborhood is more densely populated with greater percentages of apartments and condominiums. Perceived crime safety is associated with both neighborhood characteristics as well as the characteristics of the people who live there. 2. Most participants report multiple barriers to walking outside. Overall, 95.5% report at least one health symptom or other barrier to walking, with a range of 0-37 and a mean of 7.9 barriers.3. The most frequent types of activity reported by both women and men are light housework (93.0%) and shopping or running errands (93.0%), followed by walking at a normal or leisurely pace (77.7%). In a combined model, crime safety, but not neighborhood poverty or primary type of neighborhood housing, is associated with physical activity. ConclusionsWalking is engaged in by the majority of both older men and women in this study. However, they perceive multiple barriers to walking. Neighborhood determinants of walking may be one pathway through which neighborhood socioeconomic status influences health outcomes. Perceived safety from crime is possibly an important neighborhood determinant of walking and physical activity. Further research is needed to determine how changes in neighborhoods as well as other interventions may reduce barriers and lead to increased walking behavior in older adults

Risk Profiles for Falls among Older Adults: New Directions for Prevention

ObjectiveTo address whether neighborhood factors, together with older adults’ levels of health and functioning, suggest new combinations of risk factors for falls and new directions for prevention. To explore the utility of Grade-of-Membership (GoM) analysis to conduct this descriptive analysis.MethodThis is a cross-sectional, descriptive study of 884 people aged ≥65 years from Alameda County, CA, Cook County, IL, Allegheny County, PA, and Wake and Durham counties, NC. Interviews focused on neighborhood characteristics, physical and cognitive function, walking, and falls and injuries. Four risk profiles (higher order interactions of individual and neighborhood factors) were derived from GoM analysis.ResultsProfiles 1 and 2 reflect previous results showing that frail older adults are likely to fall indoors (Profile 1); healthy older adults are likely to fall outdoors (Profile 2). Profile 3 identifies the falls risk for older with mild cognitive impairment living in moderately walkable neighborhoods. Profile 4 identifies the risk found for healthy older adults living in neighborhoods with low walkability.DiscussionNeighborhood walkability, in combination with levels of health and functioning, is associated with both indoor and outdoor falls. Descriptive results suggest possible research hypotheses and new directions for prevention, based on individual and neighborhood factors

Availability and readability of emergency preparedness materials for deaf and hard-of-hearing and older adult populations: issues and assessments.

A major public health challenge is to communicate effectively with vulnerable populations about preparing for disasters and other health emergencies. People who are Deaf or Hard of Hearing (Deaf/HH) and older adults are particularly vulnerable during health emergencies and require communications that are accessible and understandable. Although health literacy studies indicate that the readability of health communication materials often exceeds people's literacy levels, we could find no research about the readability of emergency preparedness materials (EPM) intended for Deaf/HH and older adult populations. The objective of this study was to explore issues related to EPM for Deaf/HH and older adult populations, to assess the availability and readability of materials for these populations, and to recommend improvements. In two California counties, we interviewed staff at 14 community-based organizations (CBOs) serving Deaf/HH clients and 20 CBOs serving older adults selected from a stratified, random sample of 227 CBOs. We collected 40 EPM from 10 CBOs and 2 public health departments and 40 EPM from 14 local and national websites with EPM for the public. We used computerized assessments to test the U.S. grade reading levels of the 16 eligible CBO and health department EPM, and the 18 eligible website materials. Results showed that less than half of CBOs had EPM for their clients. All EPM intended for clients of Deaf/HH-serving CBOs tested above the recommended 4(th) grade reading level, and 91% of the materials intended for clients of older adult-serving CBOs scored above the recommended 6(th) grade level. EPM for these populations should be widely available through CBOs and public health departments, adhere to health literacy principles, and be accessible in alternative formats including American Sign Language. Developers should engage the intended users of EPM as co-designers and testers. This study adds to the limited literature about EPM for these populations

Availability and Readability of Emergency Preparedness Materials for Deaf and Hard-of-Hearing and Older Adult Populations: Issues and Assessments

A major public health challenge is to communicate effectively with vulnerable populations about preparing for disasters and other health emergencies. People who are Deaf or Hard of Hearing (Deaf/HH) and older adults are particularly vulnerable during health emergencies and require communications that are accessible and understandable. Although health literacy studies indicate that the readability of health communication materials often exceeds people’s literacy levels, we could find no research about the readability of emergency preparedness materials (EPM) intended for Deaf/HH and older adult populations. The objective of this study was to explore issues related to EPM for Deaf/HH and older adult populations, to assess the availability and readability of materials for these populations, and to recommend improvements. In two California counties, we interviewed staff at 14 community-based organizations (CBOs) serving Deaf/HH clients and 20 CBOs serving older adults selected from a stratified, random sample of 227 CBOs. We collected 40 EPM from 10 CBOs and 2 public health departments and 40 EPM from 14 local and national websites with EPM for the public. We used computerized assessments to test the U.S. grade reading levels of the 16 eligible CBO and health department EPM, and the 18 eligible website materials. Results showed that less than half of CBOs had EPM for their clients. All EPM intended for clients of Deaf/HH-serving CBOs tested above the recommended 4th grade reading level, and 91% of the materials intended for clients of older adult-serving CBOs scored above the recommended 6th grade level. EPM for these populations should be widely available through CBOs and public health departments, adhere to health literacy principles, and be accessible in alternative formats including American Sign Language. Developers should engage the intended users of EPM as co-designers and testers. This study adds to the limited literature about EPM for these populations

James R. Brune, Executive Director, Deaf Counseling, Advocacy and Referral Agency; PERRC National Advisory Board member presents at Preparedness and Emergency Response Research Center meeting at Centers for Disease Control and Prevention.

<p>James R. Brune, Executive Director, Deaf Counseling, Advocacy and Referral Agency; PERRC National Advisory Board member presents at Preparedness and Emergency Response Research Center meeting at Centers for Disease Control and Prevention.</p

Suitability Assessment of Materials Scores for Three Emergency Preparedness Materials.

<p>Suitability Assessment of Materials Scores for Three Emergency Preparedness Materials.</p

Readability Scores^* by Readability Test for Materials Collected from Websites of Local and National Organizations.

*<p>Scores estimate US grade reading level of the tested material.</p>1<p>The material was outside the Fry Graph’s range.</p