Depressive symptoms, chronic pain, and falls in older community-dwelling adults: The MOBILIZE Boston Study

Objectives To examine whether overall depressive symptoms and symptom clusters are associated with fall risk and to determine whether chronic pain mediates the relationship between depression and fall risk in aging. Design Prospective cohort study. Setting Boston, Massachusetts, and surrounding communities. Participants Older community-dwelling adults (N = 722, mean age 78.3). Measurements Depressive symptomatology was assessed at baseline using the 20-item Hopkins Revision of the Center for Epidemiologic Studies Depression Scale (CESDR) as overall depression and two separate domains: cognitive and somatic symptoms. Chronic pain was examined at baseline as number of pain sites (none, single site, or multisite), pain severity, and pain interference with activities of daily living. Participants recorded falls on monthly postcards during a subsequent 18-month period. Results According to negative binomial regression, the rate of incident falls was highest in those with the highest burden of depressive symptoms (according to total CESDR and the cognitive and somatic CESDR domains). After adjustment for multiple confounders and fall risk factors, fall rate ratios comparing the highest three CESDR quartiles with the lowest quartile were 1.91, 1.26, and 1.11, respectively. Similarly graded associations were observed according to the CESDR domains. Although pain location and interference were mediators of the relationship between depression and falls, adjustment for pain reduced fall risk estimates only modestly. There was no interaction between depression and pain in relation to fall risk. Conclusion Depressive symptoms are associated with fall risk in older adults and are mediated in part by chronic pain. Research is needed to determine effective strategies for reducing fall risk and related injuries in older people with pain and depressive symptoms. © 2012, The American Geriatrics Society

Physical Activity and Executive Function in Aging: the MOBILIZE Boston Study

OBJECTIVES: To determine the relationship between physical activity and cognition, specifically executive function, and the possible mediating role of factors such as cardiovascular disease (CVD) and CVD risk factors, chronic pain, and depressive symptoms. DESIGN: Cross-sectional study. SETTING: Population-based study of individuals aged 70 and older in the Boston area. PARTICIPANTS: Older community-dwelling adults (n=544; mean age 78, 62% female). MEASUREMENTS: Presence of heart disease (self-reported physician diagnosed), pain, and depressive symptomatology were assessed using interviewer-administered questions. Blood pressure was measured. Engagement in physical activity was determined using the Physical Activity Scale for the Elderly (PASE). Cognitive function was measured using a battery of neuropsychological tests. RESULTS: The older adults who engaged in more physical activity had significantly better performance on all cognitive tests, except for Letter Fluency and the memory test of delayed recall, after adjusting for age, sex, education, and total number of medications. With further adjustment for CVD and CVD risk factors (heart disease, diabetes mellitus, stroke, and hypertension), pain, and depressive symptoms, PASE score remained significantly associated with executive function tests. CONCLUSION: Even after multivariate adjustment, neuropsychological tests that were executive in nature were positively associated with physical activity participation in this cohort of older community-dwelling adults. In contrast, delayed recall of episodic memory was not associated with physical activity, supporting the idea that the relationship with executive function represents a specific biologically determined relationship. © 2009, The American Geriatrics Society

O perfil dos ingressantes de um programa de educação física para idosos e os motivos da adesão inicial The profile of the initiators in a physical education program for elderly and the reasons for the initial adherence

Numa sociedade em pleno envelhecimento, a Educação Física deverá desempenhar um importante papel. A cada ano, cresce a procura por programas supervisionados, como é o caso do Programa Autonomia para Atividade Física do Idoso - PAAF. Conhecer o idoso é fundamental para orientar as ações pedagógicas e atender suas expectativas. Assim, este trabalho destina-se a conhecer o perfil sócio-demográfico, a atividade física pregressa, verificar a saúde percebida e entender quais foram os motivos de adesão ao programa. Participaram desse estudo 54 pessoas (14 homens e 40 mulheres), com idade acima de 60 anos (66,45 ± 5,176 anos de idade), que ingressaram no PAAF-2002. Foram utilizados questionários, em que foram consideradas as seguintes variáveis: gênero, idade, nível de escolaridade, estado civil; saúde percebida do ingressante; a atividade profissional e a atividade física pregressa e o nível sócio-econômico. Para verificar os motivos da adesão inicial utilizamos tabela tipo Liekert e aplicamos o Índice de Consistência Interna de Liekert. Utilizamos o Coeficiente de Concordância de Kendall (W) e o Teste de Friedman (Xr²), com nível de significância (p = 0,05). A maioria dos alunos tinha entre 60 a 70 anos de idade, pertencia aos níveis sócio-econômico A e B e possuía alto nível de escolaridade. A maioria tinha pelo menos uma doença, porém, a saúde percebida era positiva. Os motivos de adesão relatados foram: aprender fazer exercícios físicos, melhorar condicionamento físico e prevenir problemas de saúde. Já, ocupar o tempo livre e fazer amigos foram motivos considerados menos importantes..<br>In an aging society, Physical Education has paramount importance. Each year the search for supervised programs expends, as in the Elderly Physical Activity Autonomy Program (PAAP) case. Understanding the elderly is important to orientate the pedagogic actions and to attend participants' needs. Therefore, the purpose of this study was to determine the social demographic characteristics, previous physical activity, perceived health of the elderly and to understand the reasons for their adherence in the PAAP. Fifty four individuals (14 male and 40 female, 66,45 ± 5,176 years old) that went into PAAP took part in this study. Questionnaires were used with the following variables: type, age, education level, marital status, perceived health, previous professional activity, previous physical activity and social-economic level. To check the reasons for the first adherence, we used the Liekert table and the Liekert Internal Consistence Index. To confirm the results, we applied the Kendall Concordance Coefficient (W) and the Friedman test (Xr²), adopting p = 0.05 as the significance level. The majority of the participants belonged to the A and B socio-economical classes and had a bachelor's degree. The majority had, at least, one disease, but the perceived health was positive. The adherence reasons reported were: learn how to perform physical exercises, to improve physical condition and to prevent health problems. Further, take up free time and to make friends were considered the less important reasons

Older Adults\u27 Experience of Health Promotion: A Theory for Nursing Practice

Understanding older adults\u27 experience of health promotion is essential in effectively preserving health and functional ability and thereby reducing health care costs among members of this rapidly expanding group. During 5 months of participant observation of 80 older adults (ages of 62-88), data from 31 semistructured interviews, as well as the Health Self-Determinism Index (HSDI) designed to measure intrinsic motivation for health (Cox, Miller, & Mull, 1987), were analyzed using methods common to grounded theory (Glaser & Strauss, 1967). Patterns central to maintaining health that provide essential theoretical grounding for health promotion practice with older adults were discovered