Exploring Barriers And A Potential Solution For Physical Therapists Prescribing Physical Activity To Patients 50 Years And Older

Insufficient levels of physical activity (PA) can lead to an increased risk of poor quality of life, morbidity, and mortality. Therefore, it is essential that healthcare providers, such as physical therapists, implement regular PA promotion and prescriptions. Yet, according to research performed primarily outside of the United States, physical therapists are not providing regular PA promotion and prescriptions. Our ethnographic and mixed-method studies identified that these findings are similar among United States-based physical therapists treating patients 50 years and older. Previous research and our results indicated that a barrier to promoting and prescribing PA is the lack of tools, including a multifactorial assessment tool of PA participation barriers. Therefore, we developed and validated the Inventory of Physical Activity Barriers (IPAB), a 27-item scale examining PA participation barriers. The IPAB provides physical therapists with a structured method of identifying PA participation barriers, an essential step of providing individualized PA interventions. The mixed-method study participants endorsed the IPAB as a potentially appropriate, acceptable, feasible, and adoptable assessment tool of PA participation barriers. Another tool identified to possibly address the PA promotion and prescription barriers is a step-by-step guide for addressing insufficient PA, such as a PA toolkit. The mixed-method study also provided insight into the PA toolkit components that may be beneficial for physical therapists. With the insight gained from these studies, we will finalize the PA toolkit, which we hypothesize will address PA promotion and prescription barriers, such as lack of time, knowledge, and skills. Additional PA promotion and prescription barriers revealed by our data were related to the following factors: personal, patient, professional, work, community, healthcare policies, and COVID-19. Further research is needed to identify solutions that address these barriers

Falls and Risk for Malnutrition among Older Adults Residing in a Rural State

Vermont continues to have one of the nation’s highest fall rates and its rurality may be a contributing factor. The purpose of our study was to compare fall history and nutritional risk (a fall risk factor also associated with rurality) in participants from rural and metropolitan areas. We collected data at statewide community-based fall risk screenings. During the events, nutritional data was collected using the DETERMINE Your Nutritional Health Screening Tool Questionnaire. We used descriptive statistics (chi2) to examine the relationship between fall history, nutritional risk, and rurality. From 123 subjects, 67% were classified as rural residents. There was no relationship between fall history and nutritional risk (p=0.6). Compared to rural residents, a significantly higher percentage of those living in metropolitan areas reported falls (54% versus 35% p=0.05). However, metropolitan residents were not at higher nutritional risk (49% versus 54%, p=0.61). National nutritional risk rates are lacking, but food insecurity is associated with nutritional risk. Our overall reported high nutritional risk (20%) is higher than the prevalence of food insecurity, both nationally (11%) and in Vermont (9%). In conclusion, we did not identify a relationship between fall history and nutritional risk. We did find a higher percentage of metropolitan residents reporting falls. Furthermore, we identified that DETERMINE is a feasible nutritional screening tool to use at fall risk screenings. It can be used to identify community dwelling older adults at nutritional risk, but it may not have the sensitivity to identify an association between nutritional risk and falls. Objectives: After attending the poster session individuals will be able to define 1) outcomes of using the DETERMINE Your Nutritional Health Screening Tool in community-based fall risk screenings. 2) the relationship between falls, nutritional risk, and rurality. References: 1. Determine Your Nutritional Health. Am Fam Physician. 2007. http://nutritionandaging.org/wp-content/uploads/2017/01/DetermineNutritionChecklist.pdf.Nash L, Bergin N. Nutritional strategies to reduce falls risk in older people. Nursing Older People (2014+); London. 2018;30(3):20. doi:http://dx.doi.org/10.7748/nop.2018.e1016 2. Holben DH, Marshall MB. Position of the Academy of Nutrition and Dietetics: food insecurity in the United States. J Acad Nutr Diet. 2017;117(12):1991-2002. 3. Singh GK, Daus GP, Allender M, et al. Social Determinants of Health in the United States: Addressing Major Health Inequality Trends for the Nation, 1935-2016. Int J MCH AIDS. 2017;6(2):139-164. doi:10.21106/ijma.236 4. Torres MJ, Féart C, Samieri C, et al. Poor nutritional status is associated with a higher risk of falling and fracture in elderly people living at home in France: the Three-City cohort study. Osteoporos Int. 2015;26(8):2157-2164. doi:10.1007/s00198-015-3121-2 5. Vermont Department of Health PHS. Vermont Behavioral Risk Factor Surveillance System 2016 Data Summary. 2017:72. 6. Ziliak J, Gundersen C. The State of Senior Hunger in America 2016: An Annual Report. Feeding America and the National Foundation to End Senior Hunger. 2018. 7. Zoltick ES, Sahni S, McLean RR, Quach L, Casey VA, Hannan MT. Dietary protein intake and subsequent falls in older men and women: The Framingham Study. J Nutr Health Aging. 2011;15(2):147-152

The Inventory of Physical Activity Barriers: Development and Preliminary Validation

The level of inactivity among community-dwelling adults 50 years and older is a healthcare concern, particularly when examining the association between increasing age, inactivity, and risk of non-communicable diseases. To confront this concern, healthcare providers need to address the reasons for inactivity. Unfortunately, limited tools exist to address barriers to physical activity (PA). The purpose of our study was to develop and psychometrically evaluate a PA barrier scale for adults 50 years and older. The Inventory of Physical Activity Barriers (IPAB) scale was developed, refined, and evaluated using a cross-sectional and a modified Delphi study. We had two groups of participants: First, 39 adults (50 years and older) provided survey pilot data for psychometric evaluation and then nine interprofessional PA experts assisted with finalizing the scale. Participants completed a demographic questionnaire, Physical Activity Vital Sign questionnaire, and the IPAB. The IPAB’s refinement was guided by item-scale correlations, descriptive statistics, and consensus among the PA experts. Construct validity was examined by comparing mean IPAB scores of inactive and active participants via independent t-test. Internal consistency was assessed via Cronbach Alpha. The IPAB was refined from 172 items to 40 items and found to be internally consistent (α=.97) and able to differentiate individuals who do and do not meet the recommended 150 minutes of PA (p=0.01). The IPAB is a reliable assessment of PA barriers for adults 50 years and older. Preliminary analyses are promising for the scale’s construct validity and support further psychometric evaluation of the tool

Combined Physical and Mental Health Interventions on Physical Functioning in Older Adults: A Scoping Review

Purpose of this scoping review is to synthesize the knowledge and available literature of existing randomized controlled trials (RCTs) testing combined physical and psychological intervention components on physical functioning outcomes in older adults

Suicide and Non-Suicidal Self-Injury among Vermont High School Students: An Analysis of Associated Health-Behavior Variables

Objectives: To determine the prevalence of suicidal ideation (SI) and non-suicidal self-injury (NSSI) among Vermont high schoolers and examine their relationship with health-behavior and demographic variables. Methods: We used responses to the 2019 Centers for Disease Control and Prevention Youth Risk Behavior Surveillance survey from Vermont high schoolers (n = 18 613) to perform bivariate logistic regression analyses of variables thought to predict SI and NSSI. Results: In 2019, 14.8% of Vermont high schoolers reported SI in the past year, and 18.9% reported NSSI. Lower grade level, LGBT identity, self-perception as over- or underweight, being bullied, alcohol use, smoking, and female sex were all associated with higher odds of reporting SI and NSSI. Conclusions: SI and NSSI are prevalent problems among adolescents that would be amenable to school-based public health interventions. Certain groups face higher risk for SI and NSSI, such as girls and LGBT adolescents

Integrating STEADI for Falls Prevention in Outpatient Rehabilitation Clinics: An Outcomes Evaluation Using the RE-AIM Framework.

BACKGROUND AND OBJECTIVES: The RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework was used to describe implementation of the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) Initiative (years 2018-2021) for screening and assessing all older adults \u3e 65 years for falls risk across 34 outpatient rehabilitation clinics within a large health system. RESEARCH DESIGN AND METHODS: We described the Implementation process and strategies. Using Electronic Health Records (EHR), we identified Reach, Adoption, and Maintenance of screenings and physical assessments to identify fall risk among older adults. RESULTS: STEADI Implementation strategies included health system mandates, EHR revisions, email instructions, educational sessions and resources, clinical leads and champions, and chart audits. Reach: 76.4% (50,023) had a completed screening, and 44.1% screened at-risk for falls. Adoption: Clinic-level adoption varied, with most performing screenings. Profession-level adoption was highest for physical therapists (PTs) (94.2% initiated, 80.6% completed) and lowest for speech-language pathologists (SLPs; 79.8% initiated, 55.9% completed). Reach and Adoption of functional outcomes measures (FOM): PTs completed aFOM on 59.5% of at-risk patients, occupational therapists on 11.6%, and SLPs on 7.9%. Maintenance: All measures declined 1-10% annually between 2018-2021. DISCUSSION AND IMPLICATIONS: STEADI screening and FOMs were implemented system-wide in 34 outpatient rehabilitation clinics, reaching over 50,000 older adults. Screening adoption rates varied by clinic. PTs had the highest adoption rate. All adoption rates declined over time. Future research should consider an implementation science approach with input from key partners before implementation to identify barriers and develop strategies to support STEADI in outpatient rehabilitation

Community-Dwelling Older Adults and Physical Activity Recommendations: Patterns of Aerobic, Strengthening, and Balance Activities.

Though it is known that most older adults do not meet the recommended physical activity (PA) guidelines, little is known regarding their participation in balance activities or the full guidelines. Therefore, we sought to describe PA patterns among 1,352 community-dwelling older adult participants of the Adult Changes in Thought study, a longitudinal cohort study exploring dementia-related risk factors. We used a modified version of the Community Healthy Activities Model Program for Seniors questionnaire to explore PA performed and classify participants as meeting or not meeting the full guidelines or any component of the guidelines. Logistic regression was used to identify factors associated with meeting PA guidelines. Despite performing 10 hr of weekly PA, only 11% of participants met the full guidelines. Older age, greater body mass index, needing assistance with instrumental daily activities, and heart disease were associated with decreased odds of meeting PA guidelines. These results can guide interventions that address PA among older adults

The cost and cost-effectiveness of gender-responsive interventions for HIV: a systematic review.

INTRODUCTION: Harmful gender norms and inequalities, including gender-based violence, are important structural barriers to effective HIV programming. We assess current evidence on what forms of gender-responsive intervention may enhance the effectiveness of basic HIV programmes and be cost-effective. METHODS: Effective intervention models were identified from an existing evidence review ("what works for women"). Based on this, we conducted a systematic review of published and grey literature on the costs and cost-effectiveness of each intervention identified. Where possible, we compared incremental costs and effects. RESULTS: Our effectiveness search identified 36 publications, reporting on the effectiveness of 22 HIV interventions with a gender focus. Of these, 11 types of interventions had a corresponding/comparable costing or cost-effectiveness study. The findings suggest that couple counselling for the prevention of vertical transmission; gender empowerment, community mobilization, and female condom promotion for female sex workers; expanded female condom distribution for the general population; and post-exposure HIV prophylaxis for rape survivors are cost-effective HIV interventions. Cash transfers for schoolgirls and school support for orphan girls may also be cost-effective in generalized epidemic settings. CONCLUSIONS: There has been limited research to assess the cost-effectiveness of interventions that seek to address women's needs and transform harmful gender norms. Our review identified several promising, cost-effective interventions that merit consideration as critical enablers in HIV investment approaches, as well as highlight that broader gender and development interventions can have positive HIV impacts. By no means an exhaustive package, these represent a first set of interventions to be included in the investment framework