Search

This paper provides highlights from an expert meeting to explore opportunities to reduce cancer risk and promote health at older ages. Factors that increase cancer risk among older adults include exposure to carcinogens from multiple sources, chronic conditions such as obesity and diabetes, and unhealthy behaviors. Emerging research points to chronic social stressors – social isolation, loneliness, and financial hardship – as being linked to accelerated biological aging and increased cancer risk later in life. Older adults may disproportionately encounter these stressors as well as barriers to preventive health care services, accurate health information, and environments that promote health. Researchers can use existing cohort studies of older adults to deepen our understanding of the relative benefit of modifying specific behaviors and circumstances. The evidence points to the value of comprehensive, transdisciplinary approaches to promote health and reduce cancer risk across the entire lifespan, extending through older adulthood. Clinical encounters with older adults provide opportunities for psychosocial and behavioral screening and counseling. In the presence of multiple morbidities, preventive health services may offer greater health benefits than cancer-screening tests. Strategies that involve families and caregivers, promote positive attitudes about aging, and engage many different community sectors have the potential to prevent or delay the development of cancer at older ages.

Purpose Regular physical activity is a key component of healthy aging, but few older adults meet physical activity guidelines. Poor aging expectations can contribute to this lack of activity, since negative stereotypes about the aging process can be internalized and affect physical performance. Although prior cross-sectional studies have shown that physical activity and aging expectations are associated, less is known about this association longitudinally, particularly among traditionally underrepresented groups. It is also unclear whether different domains of aging expectations are differentially associated with physical activity. Design and Methods The number of minutes/week of physical activity in which Baltimore Experience Corps Trial participants (N = 446; 92.6% African American) engaged were measured using the CHAMPS questionnaire, while their aging expectations were measured using the ERA-12 survey. Linear mixed effects models assessed the association between physical activity and aging expectations over 2 years, both in full and sex-stratified samples. Separate models were also fit for different ERA-12 domains. Results We found that higher overall expectations regarding aging are associated with higher engagement in moderate- to high-intensity physical activity over a 2-year period of time for women only. When the ERA-12 domains were examined separately, only the physical domain was associated with physical activity, both in women and overall. Implications Low expectations regarding physical aging may represent a barrier to physical activity for older adults. Given that most older adults do not meet recommended physical activity guidelines, identifying factors that improve aging expectations may be a way to increase physical activity levels in aging populations.

Background and objectives Almost one-third of older adults report experiencing age discrimination. We hypothesized sequential links between older adults' everyday experiences of age discrimination and future health behaviors related to cancer risk through self-perceptions of aging (SPA). Research design and methods Participants were community-dwelling respondents (age: 51-96 years) from the 2008, 2012, and 2014 waves of the Health and Retirement Study (N = 4,467). Generalized path models estimated the immediate and enduring effects of age discrimination in 2008 on proximal SPA in 2012 and distal health behaviors in 2014. Results Age discrimination was associated with lower positive SPA and higher negative SPA in 2012. The effect of age discrimination on physical activity, smoking, and drinking in 2014 was mediated by positive and negative SPA in 2012. Through subsequent SPA, those who experienced age discrimination in 2008 were less likely to engage in regular moderate physical activity, more likely to smoke, and less likely to drink more than 3 times per week in 2014. Analysis of change in positive and negative SPA showed the effect of age discrimination on physical activity to be mediated by change in positive, but not negative, SPA. Discussion and implications The enduring effects of age discrimination were found through a reduction in positive SPA. Elevating positive SPA could be as important as reducing negative SPA for future health behaviors related to cancer risk.

BackgroundAs the population ages, older adults are seeking meaningful, and impactful, post-retirement roles. As a society, improving the health of people throughout longer lives is a major public health goal. This paper presents the design and rationale for an effectiveness trial of Experience Corps™, an intervention created to address both these needs. This trial evaluates (1) whether senior volunteer roles within Experience Corps™ beneficially impact children's academic achievement and classroom behavior in public elementary schools and (2) impact on the health of volunteers.MethodsDual evaluations of (1) an intention-to-treat trial randomizing eligible adults 60 and older to volunteer service in Experience Corps™, or to a control arm of usual volunteering opportunities, and (2) a comparison of eligible public elementary schools receiving Experience Corps™ to matched, eligible control schools in a 1:1 control:intervention school ratio.OutcomesFor older adults, the primary outcome is decreased disability in mobility and Instrumental Activities of Daily Living (IADL). Secondary outcomes are decreased frailty, falls, and memory loss; slowed loss of strength, balance, walking speed, cortical plasticity, and executive function; objective performance of IADLs; and increased social and psychological engagement. For children, primary outcomes are improved reading achievement and classroom behavior in Kindergarten through the 3rd grade; secondary outcomes are improvements in school climate, teacher morale and retention, and teacher perceptions of older adults.SummaryThis trial incorporates principles and practices of community-based participatory research and evaluates the dual benefit of a single intervention, versus usual opportunities, for two generations: older adults and children.

Purpose: Experience Corps Baltimore City (EC) is a product of a partnership between the Greater Homewood Community Corporation (GHCC) and the Johns Hopkins Center on Aging and Health (COAH) that began in 1998. EC recruits volunteers aged 55 and older into high-impact mentoring and tutoring roles in public elementary schools that are designed to also benefit the volunteers. We describe the evolution of the GHCC–COAH partnership through the “Courtship Model.” Design and Methods: We describe how community-based participatory research principals, such as shared governance, were applied at the following stages: (1) partner selection, (2) getting serious, (3) commitment, and (4) leaving a legacy. Results: EC could not have achieved its current level of success without academic–community partnership. In early stages of the “Courtship Model,” GHCC and COAH were able to rely on the trust developed between the leadership of the partner organizations. Competing missions from different community and academic funders led to tension in later stages of the “Courtship Model” and necessitated a formal Memorandum of Understanding between the partners as they embarked on a randomized controlled trial. Implications: The GHCC–COAH partnership demonstrates how academic–community partnerships can serve as an engine for social innovation. The partnership could serve as a model for other communities seeking multiple funding sources to implement similar public health interventions that are based on national service models. Unified funding mechanisms would assist the formation of academic–community partnerships that could support the design, implementation, and the evaluation of community-based public health interventions.

Objectives. We present a social marketing conceptual framework for Experience Corps Baltimore City (EC) in which the desired health outcome is not the promoted product or behavior. We also demonstrate the feasibility of a social marketing–based recruitment campaign for the first year of the Baltimore Experience Corps Trial (BECT), a randomized, controlled trial of the health benefits of EC participation for older adults. Methods. We recruited older adults from the Baltimore, MD, area. Participants randomized to the intervention were placed in public schools in volunteer roles designed to increase healthy behaviors. We examined the effectiveness of a recruitment message that appealed to generativity (i.e., to make a difference for the next generation), rather than potential health benefits. Results. Among the 155 participants recruited in the first year of the BECT, the average age was 69 years; 87% were women and 85% were African American. Participants reported primarily generative motives as their reason for interest in the BECT. Conclusions. Public health interventions embedded in civic engagement have the potential to engage older adults who might not respond to a direct appeal to improve their health.

Older adults with a high number of chronic conditions and who live in environments that do not promote physical activity have great difficulty initiating and adhering to exercise programs. Novel lifestyle activity interventions that can effectively increase physical activity may address disparities in health in these populations. This study evaluates the effects of the Baltimore Experience Corps program, a community-based volunteer program, on walking activity in older adults.The Baltimore Experience Corps Trial is a sex-stratified RCT that recruited participants from 2006 to 2009. Older adult participants aged ≥60 years (n=123) were from a nested objective physical activity trial within the larger Baltimore Experience Corps Trial. Participants randomized to the intervention group were placed as volunteers within the Baltimore public school system for 2 years. The primary study outcome was objectively measured total amount of walking activity measured in steps/day. Differences between intervention and control groups were measured at 12 and 24 months using linear mixed effects models. Data were analyzed in 2014.At 24 months, women, but not men, in the intervention group showed an increased amount of walking activity, averaging 1,500.3 (95% CI=77.6, 2,922.9) greater steps/day compared with the control group. Women in the control group showed a decline of 1,191.6 (95% CI=-2243.7, -139.5) steps/day at 24 months compared to baseline.A community-based volunteer intervention increased walking activity among older women, who were at elevated risk for both inactivity and adverse health outcomes.This study is registered at www.clinicaltrials.gov NCT00380562.

There is compelling evidence supporting the benefits of increased regular physical activity in older adults. The Experience Corps program in Baltimore MD was designed in part as a community based approach to increasing physical activity that would also appeal to older adults who have historically not utilized health promotion programs. The Baltimore Experience Corps program places older volunteers in public elementary schools for 15 h a week in roles designed to improve the academic outcomes of children and, simultaneously, increase the physical, cognitive and social activity of volunteers. This paper reports on the change in physical activity levels among older adults associated with participation in the Baltimore Experience Corps. In a pilot randomized controlled evaluation, older adults were randomly assigned to Experience Corps (EC participants) or a waiting list control group. Ages ranged from 59–86 years, 96% were African American, 94% were women, and 84% had annual incomes less than $15,000. EC participants were required to serve ≥15 h a week. At follow-up after 4–8 months, an analysis of 113 randomized volunteers revealed 53% of the EC participants were more active than the previous year by self-report, as compared to 23% of the controls (p

Recommended levels of physical activity may represent challenging targets for many older adults at risk for disability, leading to the importance of evaluating whether low-intensity activity is associated with health benefits. We examined the cross-sectional association between low-intensity walking activity (

To evaluate how accounting for driving status altered the relationship between volunteering and mortality in U.S. retirees.Observational prospective cohort.Nationally representative sample from the Health and Retirement Study in 2000 and 2002 followed to 2006.Retirees aged 65 and older (N=6,408).Participants self-reported their volunteering, driving status, age, sex, race or ethnicity, presence of chronic conditions, geriatric syndromes, socioeconomic factors, functional limitations, and psychosocial factors. Death by December 31, 2006, was the outcome.For drivers, mortality in volunteers (9%) and nonvolunteers (12%) was similar; for limited or non-drivers, mortality for volunteers (15%) was markedly lower than for nonvolunteers (32%). Adjusted results showed that, for drivers, the volunteering-mortality odds ratio (OR) was 0.90 (95% confidence interval (CI)=0.66-1.22), whereas for limited or nondrivers, the OR was 0.62 (95% CI=0.49-0.78) (interaction P=.05). The effect of driving status was greater for rural participants, with greater differences between rural drivers and rural limited or nondrivers (interaction P=.02) and between urban drivers and urban limited or nondrivers (interaction P=.81).The influence of volunteering in decreasing mortality seems to be stronger in rural retirees who are limited or nondrivers. This may be because rural or nondriving retirees are more likely to be socially isolated and thus receive more benefit from the greater social integration from volunteering.

Volunteer service opportunities for older adults may soon be expanded. Although volunteering is thought to provide health benefits for healthier older adults, it is not known whether older adults in less than very good health are suitable candidates for high-intensity volunteering and can derive health benefits. This manuscript presents a prospective analysis of 174 older adult volunteers serving in Experience Corps Baltimore®, a high-intensity senior volunteer program in Baltimore, Maryland. Volunteers served ≥15 h per week, for a full school year, in elementary schools helping children with reading and other skills between 1999 and 2002. Volunteers were assessed with standardized questionnaires and performance-based testing including grip strength, walking speed, chair stand speed, and stair-climbing speed prior to school volunteering and at the end of the school year. Results were stratified by health status. Among 174 volunteers, 55% initially reported “good” and 12% “fair” or “poor” health status. At baseline, those in fair health reported higher frequencies of disease and disability than volunteers in excellent or very good health. After volunteering, a majority of volunteers in every baseline health status category described increased strength and energy. Those in fair health were significantly more likely to display improved stair-climbing speed than those in good or excellent/very good health (100.0% vs. 53.4% vs. 37.5%, p = 0.05), and many showed clinically significant increases in walking speed of >0.5 m/s. Satisfaction and retention rates were high for all health status groups. Clinicians should consider whether their patients in fair or good health, as well as those in better health, might benefit from high-intensity volunteer programs. Productive activity such as volunteering may be an effective community-based approach to health promotion for older adults.

Experience Corps (EC) places older volunteers in public elementary schools in 20 cities across the country. The EC program in Baltimore is a health promotion intervention designed to improve the academic outcomes of children and increase older adult volunteer physical activity. We sought to determine if there were sustained increases in physical activity with participation in EC.Seventy-one African American women volunteers in the Baltimore EC were compared with 150 African American women in the Women's Health and Aging Studies (WHAS) I and II; all were aged 65-86 years with comparable Social Economic Status, frailty, and self-reported health status. Using a regression model, we evaluated physical activity adjusting for a propensity score and time of follow-up over 3 years.EC volunteers reported a sustained increase in physical activity as compared with the comparison cohort. Baseline physical activity for individuals with a median propensity score was 420 kcal/wk for both groups. At 36 months, EC volunteers reported 670 kcal/week compared with 410 kcal/week in WHAS (p = .04). Discussion These findings suggest that high-intensity senior service programs that are designed as health promotion interventions could lead to sustained improvements in physical activity in high-risk older adults, while simultaneously addressing important community needs.

OBJECTIVES:BTo examine the relationship between race and mortality in frail community-dwelling older people with access to a program providing comprehensive access and coordination of services. DESIGN:A longitudinal cohort study. SETTING:Twelve nationwide demonstration sites of the Program of All-Inclusive Care for the Elderly (PACE) from 1990 to 1996. PACE provides comprehensive medical and long-term care services for nursing home–eligible older people who live in the community. PARTICIPANTS:Two thousand two white patients and 859 black patients. MEASUREMENTS:Patients were followed after enrollment until death or the end of the follow-up period. Time from enrollment to death was measured with adjustment of the Cox proportional hazards model for comorbid conditions, functional status, site, and other demographic characteristics. RESULTS:Black patients were younger than white patients (mean age 77 vs 80, P < .001) but had worse functional status (mean activity of daily living (ADL) score 6.5 vs 7.2, P < .001) on enrollment. Survival for black and white patients was 88% and 86% at 1 year, 67% and 61% at 3 years, and 51% and 42% at 5 years, respectively (unadjusted hazard ratio (HR) for black patients = 0.77; 95% confidence interval (CI) = 0.67–0.89). After adjustment for baseline comorbid conditions, functional status, site, and demographic characteristics, black patients still had a lower mortality rate (HR = 0.77; 95% CI = .65–0.93). The survival advantage for black patients did not emerge until about 1 year after PACE enrollment (HR for first year after enrollment = 0.97; 95% CI = 0.72–1.31; HR after first year = 0.67; 95% CI = 0.54–0.85, P-value for time interaction < .001). During the first year of enrollment, black patients were more likely to improve and less likely to decline in ADL function than white patients (P < .001). CONCLUSION:In PACE, a system providing access to and coordination of comprehensive medical and long-term care services for frail older people, black patients have a lower mortality rate than white patients. This survival advantage, which emerges approximately 1 year after PACE enrollment, may be related to the comprehensive access and coordination of services provided by the PACE program. J Am Geriatr Soc 51:246–251, 2003.