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Purpose: Although increased participation in physical activity by older adults is a major public health goal, little is known about the supply and use of physical activity programs in the United States. Design and Methods: Seven academic centers in diverse geographic areas surveyed physical activity programs for older adults. Five sites conducted surveys by mail with telephone follow-up, and two administered surveys primarily by telephone. Reported program attendance rates were compared with local census data to assess unmet needs. Results: Of the 2,110 targeted facilities, 77% responded. Aerobic programs were offered by 73%, flexibility by 47%, and strength training by 26%. Commercial gyms or YMCAs, senior centers, park or recreation centers, and senior-housing facilities offered 90% of available programs. The 2000 Census enumerated 1,123,401 total older adults across the seven sites. Facilities reported 69,634 individuals as current weekly program participants, equaling 6% of the sites' total older-adult population. This percentage varied from 3% in Pittsburgh to 28% in Colorado. Implications: Based on conservative estimates of demand, the number of physical activity programs would have to increase substantially (by 78%) to meet the needs of older adults. The data also indicate the need to develop more strength-training programs and to engage a higher percentage of older adults in these programs. There is a clear need to stimulate demand for programs through health promotion.

PurposeGiven that emotional health is a critical component of healthy aging, we undertook a systematic literature review to assess whether current interventions can positively affect older adults' emotional health.MethodsA national panel of health services and mental health researchers guided the review. Eligibility criteria included community-dwelling older adult (aged ≥ 50 years) samples, reproducible interventions, and emotional health outcomes, which included multiple domains and both positive (well-being) and illness-related (anxiety) dimensions. This review focused on three types of interventions - physical activity, social support, and skills training - given their public health significance and large number of studies identified. Panel members evaluated the strength of evidence (quality and effectiveness).ResultsIn all, 292 articles met inclusion criteria. These included 83 exercise/physical activity, 25 social support, and 40 skills training interventions. For evidence rating, these 148 interventions were categorized into 64 pairings by intervention type and emotional health outcome, e.g., strength training targeting loneliness or social support to address mood. 83% of these pairings were rated at least fair quality. Expert panelists found sufficient evidence of effectiveness only for skills training interventions with health outcomes of decreasing anxiety and improving quality of life and self-efficacy. Due to limitations in reviewed studies, many intervention-outcome pairings yielded insufficient evidence.ConclusionSkills training interventions improved several aspects of emotional health in community-dwelling older adults, while the effects for other outcomes and interventions lacked clear evidence. We discuss the implications and challenges in moving forward in this important area.

Background: Research on walking and walkability has yet to focus on wayfinding, the interactive, problem-solving process by which people use environmental information to locate themselves and navigate through various settings. Methods: We reviewed the literature on outdoor pedestrian-oriented wayfinding to examine its relationship to walking and walkability, 2 areas of importance to physical activity promotion. Results: Our findings document that wayfinding is cognitively demanding and can compete with other functions, including walking itself. Moreover, features of the environment can either facilitate or impede wayfinding, just as environmental features can influence walking. Conclusions: Although there is still much to be learned about wayfinding and walking behaviors, our review helps frame the issues and lays out the importance of this area of research and practice. [ABSTRACT FROM AUTHOR]

Objective The challenges posed by people living with multiple chronic conditions are unique for people with dementia and other significant cognitive impairment. There have been recent calls to action to review the existing literature on co-occurring chronic conditions and dementia in order to better understand the effect of cognitive impairment on disease management, mobility, and mortality. Methods This systematic literature review searched PubMed databases through 2011 (updated in 2016) using key constructs of older adults, moderate-to-severe cognitive impairment (both diagnosed and undiagnosed dementia), and chronic conditions. Reviewers assessed papers for eligibility and extracted key data from each included manuscript. An independent expert panel rated the strength and quality of evidence and prioritized gaps for future study. Results Four thousand thirty-three articles were identified, of which 147 met criteria for review. We found that moderate-to-severe cognitive impairment increased risks of mortality, was associated with prolonged institutional stays, and decreased function in persons with multiple chronic conditions. There was no relationship between significant cognitive impairment and use of cardiovascular or hypertensive medications for persons with these comorbidities. Prioritized areas for future research include hospitalizations, disease-specific outcomes, diabetes, chronic pain, cardiovascular disease, depression, falls, stroke, and multiple chronic conditions. Conclusions This review summarizes that living with significant cognitive impairment or dementia negatively impacts mortality, institutionalization, and functional outcomes for people living with multiple chronic conditions. Our findings suggest that chronic-disease management interventions will need to address co-occurring cognitive impairment. Copyright © 2017 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background Dementia or other significant cognitive impairment (SCI) are often comorbid with other chronic diseases. To promote collaborative research on the intersection of these conditions, we compiled a systematic inventory of major data resources. Methods Large data sets measuring dementia and/or cognition and chronic conditions in adults were included in the inventory. Key features of the resources were abstracted including region, participant sociodemographic characteristics, study design, sample size, accessibility, and available measures of dementia and/or cognition and comorbidities. Results 117 study data sets were identified; 53% included clinical diagnoses of dementia along with valid and reliable measures of cognition. Most (79%) used longitudinal cohort designs and 41% had sample sizes greater than 5000. Approximately 47% were European-based, 40% were US-based, and 11% were based in other countries. Conclusions Many high-quality data sets exist to support collaborative studies of the effects of dementia or SCI on chronic conditions and to inform the development of evidence-based disease management programs. [ABSTRACT FROM AUTHOR]

Purpose: Description of study participants and documentation of the desired diversity in the Prevention Research Centers Healthy Aging Research Network's Workgroup on Promoting Cognitive Health large multisite study designed to examine attitudes about brain health, behaviors associated with its maintenance, and information-receiving preferences among a diverse group of older Americans, to provide a foundation for developing health promotion interventions. Design and Methods: Four hundred fifty older adults in 55 focus groups at 9 sites completed a common participant survey. Using descriptive statistics, the analysis compares participant characteristics (age, sex, and race/ethnicity; rural-urban location; income and education; social activity; physical activity, nutrition, and body mass index; and self-reported measures of cognitive function) across sites and with national data. Results: Comparisons across sites document the rich diversity of the sample. lmplications: The substantial representation of a variety of demographic groups suggests that the qualitative data obtained in the focus group research provide a useful basis for developing well-targeted communication interventions for promoting brain health in diverse populations. [ABSTRACT FROM AUTHOR]

Purpose: Evidence suggests that healthy lifestyles may help maintain cognitive health. The Prevention Research Centers Healthy Aging Research Network, 9 universities collaborating with their communities and the Centers for Disease Control and Prevention, is conducting a multiyear research protect, begun in 2005, to understand how to translate this knowledge into public health interventions. Design and Methods: This article provides an overview of the study purpose, design, methods, and processes. We examined the literature on promoting cognitive health, convened a meeting of experts in cognitive health and public health interventions, identified research questions, developed a common focus group protocol and survey, established quality control and quality assurance processes, conducted focus groups, and analyzed the resulting data. Results: We conducted 55 focus groups with 450 participants in 2005-2007, and an additional 20 focus groups and in-depth interviews in 2007-2008. Focus groups were in English, Spanish, Mandarin, Cantonese, and Vietnamese, with African Americans, American lndians, Asian Americans, Hispanics, non-Hispanic Whites, physicians and other health practitioners, rural and urban residents, individuals caring for family or Friends with cognitive impairment, and cognitively impaired individuals. ImpIications: The data provide a wealth of opportunities for designing public health interventions to promote cognitive health in diverse populations. [ABSTRACT FROM AUTHOR]

Community-based health care agencies are facing demands for improved outcomes, cost-effective programming, and higher customer satisfaction. Implementing evidence-based health interventions and programs can help to address these challenges. This article provides all overview of evidence-based health practice, including the definition and advantages of this approach, other key terms and concepts inherent to evidence-based practice, and the tasks and steps necessary to its implementation. The article concludes with a list of resources to help health care providers learn about, plan, and impalement evidence-based health interventions and programs. [ABSTRACT FROM AUTHOR]

Purpose: Although Increased participation in physical activity by older adults is a major public health goal, little is known about the supply and use of physical activity programs in the United States. Design and Methods: Seven academic centers in diverse geographic areas surveyed physical activity programs For older adults. Five sites conducted surveys by mail with telephone follow-up, and two administered surveys primarily by telephone. Reported program attendance rates were compared with local census data to assess unmet needs. Results: Of the 2,110 targeted facilities, 77% responded. Aerobic programs were offered by 73%, flexibility by 47%, and strength training by 26%. Commercial gyms or YMCAs, senior centers, park or recreation centers, and senior-housing facilities offered 90% of available programs. The 2000 Census enumerated 1,123,401 total older adults across the seven sites. Facilities reported 69,634 individuals as current weekly program participants, equaling 6% of the sites' total older-adult population. This percentage varied from 3% in Pittsburgh to 28% in Colorado. Implications: Based on conservative estimates of demand, the number of physical activity programs would have to increase substantially (by 78%) to meet the needs of older adults. The data also indicate the need to develop more strength-training programs and to engage a higher percentage of older adults in these programs. There is a clear need to stimulate demand for programs through health promotion. [ABSTRACT FROM AUTHOR]

The San Luis Valley Health and Aging Study, was designed to examine Hispanic versus non-Hispanic White differences in prevalence and incidence of aging-related outcomes in a rural population (1,358 community dwellers and 75 nursing home residents). Data presented here were gathered between 1993 and 1997 Previously reported analyses identified greater prevalence of functional dependence in daily living activities among Hispanic elderly, especially females, than among non-Hispanic White elderly. This analysis explored the degree to which incident changes explain these patterns. Comparisons of incidence, recovery, and mortality rates after 22 months revealed no significant ethnic differences, although trends were as hypothesized: greater Hispanic incidence, lower Hispanic recovery rates, and less Hispanic mortality. Overall age-adjusted incidence (activities of daily living = 9.5; instrumental activities of daily living = 15.1 per 100 person-years) exceeded reports from most other studies, while rates of recovery (activities of daily living = 14.5; instrumental activities of daily living = 9.9) and mortality (4.8 among community dwellers; 6.7 including nursing home residents) were similar to those of other reports. Patterns of new dependence, recovery, and mortality did not increase the previously observed disparity. Greater prevalent disability in the Hispanic cohort, especially in women, may reflect a reservoir accumulated during younger years and related to culture and socioeconomic status as well as to older age. [ABSTRACT FROM AUTHOR]

There is an urgent need to translate science into practice and help enhance the capacity of professionals to deliver evidence-based programming. We describe contributions of the Healthy Aging Research Network in building professional capacity through online modules, issue briefs, monographs, and tools focused on health promotion practice, physical activity, mental health, and environment and policy. We also describe practice partnerships and research activities that helped inform product development and ways these products have been incorporated into real-world practice to illustrate possibilities for future applications. Our work aims to bridge the research-to-practice gap to meet the demands of an aging population. [ABSTRACT FROM AUTHOR]