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Aim: The aim of this was to psychometrically adapt and evaluate the Tilburg Frailty Indicator to assess frailty among older people living in Slovenia's community and nursing home settings. Design: A cross- cultural adaptation and validation of instruments throughout the cross- sectional study. Methods: Older people living in the community and nursing homes throughout Slovenia were recruited between March and August 2021. Among 831 participants were 330 people living in nursing homes and 501 people living in the community, and all were older than 65 years. Results: All items were translated into the Slovene language, and a slight cultural adjustment was made to improve the clarity of the meaning of all items. The average scale validity index of the scale was rated as good, which indicates satisfactory content validity. Cronbach's α was acceptable for the total items and subitems. Conclusions: The Slovenian questionnaire version demonstrated adequate internal consistency, reliability, and construct and criterion validity. The questionnaire is suitable for investigating frailty in nursing homes, community dwelling and other settings where older people live. Impact: The Slovenian questionnaire version can be used to measure and evaluate frailty among older adults. We have found that careful translation and adaptation processes have maintained the instrument's strong reliability and validity for use in a new cultural context. The instrument can foster international collaboration to identify and manage frailty among older people in nursing homes and community-dwelling homes. Reporting Method: The Strengthening the Reporting of Observational Studies in Epidemiology checklist for reporting cross-sectional studies was used. No Patient or Public Contribution: No patient or public involvement in the design or conduct of the study. Head nurses from nursing homes and community nurses helped recruit older adults. Older adults only contributed to the data collection and were collected from nursing homes and community dwelling. [ABSTRACT FROM AUTHOR]

Background: Over the last decade, the inadequacy and unsustainability of current healthcare services for managing long-term co-morbid and multi-morbid diseases have become evident. Methods: This study, involving 426 adults with at least one non-communicable disease in Slovenia, aimed to explore the link between quality of life, life satisfaction, person-centred care, and non-communicable disease management. Results: Results indicated generally positive perceptions of quality of life, general health, and life satisfaction of individuals with non-communicable diseases. Participants assessed their physical health as the highest of the four quality of life domains, followed by the environment, social relations, and psychological health. Significant differences occurred in life satisfaction, general health, quality of life, and person-centred care for managing non-communicable diseases. But, there were no significant differences in person-centred care according to the living environment. The study revealed a positive association between person-centred care and effective non-communicable disease management, which is also positively associated with quality of life, general health, and life satisfaction. Conclusions: Person-centred care is currently the most compassionate and scientific practice conceived, representing a high ethical standard. However, implementing this approach in healthcare systems requires a cohesive national strategy led by capable individuals to foster stakeholder collaboration. Such an approach is crucial to address the deficiencies of existing healthcare services and ensure person-centred care sustainability in non-communicable disease management. [ABSTRACT FROM AUTHOR]

Background: Black smokers have earlier development of lung disease as well as poorer sleep health than whites.Research Question: In a sample of black smokers, to what extent does sleep health modify the association between smoking level and functional exercise capacity?Design and Methods: Cross-sectional data from 209 black smokers (≥ 1 cigarette in last month), aged 40 to 65 years with no evidence of sleep-disordered breathing (apnea-hypopnea index < 15) or severe COPD (FEV1 > 50%), were used for the current study. Self-reported smoking rate, objectively measured sleep efficiency (SE), total sleep time (TST), and the 6-min walk test (6MWT) for functional exercise capacity were the key assessments.Results: The mean age was 54.8 years (SD, 5.96), and mean cigarettes smoked per day (cpd) was 8.71 (SD, 6.78). Mean SE was 69.9% (SD, 12.3%), and mean TST was 307.99 min (SD 92.2). In adjusted linear regression models of the 6MWT (meters), TST (slope estimate, -0.14; P = .14) and SE (slope estimate, -1.0; P = .19) were negatively associated with 6MWT. The smoking rate × SE interaction was highly significant (slope estimate, 0.18; P = .007) such that in individuals who smoked ≥ 10 cpd, every additional percentage of SE garnered an additional distance of 0.83 to 6.62 m. Similarly, the smoking rate × TST interaction was significant (slope estimate, 0.019; P = .03) such that in smokers who smoked ≥ 10 cpd, every additional minute of TST garnered an additional distance of 0.04 to 0.60 m.Interpretation: Higher SE and, to a lesser extent, longer TST, in black adults who smoke ≥ 10 cpd is associated with better 6MWT performance.Clinical Trial Registration: ClinicalTrials.gov; No.: NCT03534076; URL: www.clinicaltrials.gov. [ABSTRACT FROM AUTHOR]

Background: African American adults experience a disproportionate burden and increased mortality for most solid tumor cancers and their adolescent children are negatively impacted by the illness experience. The purpose of this randomized clinical trial is to evaluate the efficacy of a culturally sensitive family-based intervention program developed for African American families coping with solid tumor parental cancer using an intention-to-treat approach. Primary outcome is adolescent depressive symptoms at end of treatment.Methods: A sample of 172 African American families will be enrolled from two diverse oncology centers (Helen Graham Cancer Center in Newark, DE, and Kimmel Cancer Center in Philadelphia, PA). Eligible families will be randomized either to a 5-session intervention Families Fighting Cancer Together (FFCT) or a 5-session parent-only psycho-educational (PED) program. Assessments will occur at weeks 0 (baseline), 8 (end-of-treatment), 24, and 52.Discussion: Treatments to help African American adolescents cope with the impact of parental cancer are scarce and urgently needed. If successful, this proposed research will change the nature of intervention support options available to African Americans, who are overrepresented and underserved by existing services or programs.Trial Registration: This project is registered with ClinicalTrials.gov (Protocol #: NCT03567330). [ABSTRACT FROM AUTHOR]

The aim of the present study was to examine the relationship between orthostatic changes in blood pressure (BP) and cognition, with consideration given to cardiovascular risk factors and lifestyle variables. The cross-sectional analysis included 961 community-dwelling participants of the Maine-Syracuse Longitudinal Study, for whom BP clinic measures (five sitting, five recumbent, and five standing) were obtained. Eighteen percent of participants had orthostatic hypotension (fall in systolic BP ≥20 mm Hg or diastolic BP ≥10 mm Hg upon standing) and 6% had orthostatic hypertension (rise in systolic BP ≥20 mm Hg). Orthostatic hypotension and hypertension defined using traditional criteria were unrelated to cognition with covariate adjustment. However, an examination of systolic and diastolic BP change independently revealed that participants with systolic orthostatic hypotension had poorer global cognition, verbal memory, and scanning and tracking scores than those with normal systolic BP change. The authors conclude that systolic orthostatic hypotension is significantly associated with reduced cognitive function. [ABSTRACT FROM AUTHOR]

The American Heart Association's ideal cardiovascular health score is based on 7 cardiovascular health metrics to measure progress toward their Impact Goal of reducing cardiovascular disease by 20 % before 2020. This study applied this construct to assess cardiovascular health in a sample of Asian Americans. Convenience sampling methods were used to enroll self-identified Asian American's over the age of 18 years who were attending community health fairs across the greater Philadelphia and urban areas of New Jersey. The heart health metrics of tobacco use, body mass index, physical activity, diet, blood pressure, and glucose were measured. In the greater sample (N = 541), 82 % were female, the mean age was 65.1 (SD = 15.5) years, 45 % were Vietnamese, 38 % were Chinese and 17 % were Korean. Prevalence of ideal heart health for the metrics of tobacco use (95 %) was high. Only 19.4 % achieved ideal levels of physical activity, 35.1 % for BMI, 28.9 % for glucose and 66 % for blood pressure. Dietary intake was ideal for 20.7 % of the sample. More years since migration and Korean race trended toward having a higher prevalence of poor health in some metrics. Most Asian Americans are not achieving ideal cardiovascular health for several of the metrics evaluated, with those residing in the United States for more than 13 years and Korean Americans being higher-risk groups. Targeted community based intervention approaches to improving and monitoring heart health in Asian American, and Asian American subgroups, are needed. [ABSTRACT FROM AUTHOR]

This study assessed adult patient's psychosocial support needs and treatment barriers in an urban diverse cancer center. A needs assessment was conducted with a convenience sample of adult oncology patients (n = 113; 71.7 % African American). Most patients were parenting school-age children and worried about them (96 %); 86.7 % would attend a family support program. Among patients who were married or partnered (68 %), 63.7 % were concerned about communication, coping, and emotional support; 53.9 % would attend a couple support program. Patients identified similar treatment barriers: transportation, babysitting for younger children, convenience of time/place, and refreshments. Findings suggest that behavioral health care providers should be available to screen cancer patients and improve access to appropriate psychosocial oncology support programs. [ABSTRACT FROM AUTHOR]

Objective: Evidence is lacking regarding effective weight control treatments in pregnancy for ethnic minority women with obesity. This study evaluated whether a technology-based behavioral intervention could decrease the proportion of African American women with overweight or obesity who exceeded Institute of Medicine (IOM) guidelines for gestational weight gain.Methods: We conducted a two-arm pilot randomized clinical trial. Participants were 66 socioeconomically disadvantaged African American pregnant women (12.5 ± 3.7 weeks' gestation; 36% overweight, 64% obesity) recruited from two outpatient obstetric practices at Temple University between 2013 and 2014. We randomized participants to usual care (n = 33) or a behavioral intervention (n = 33) that promoted weight control in pregnancy. The intervention included: (1) empirically supported behavior change goals; (2) interactive self-monitoring text messages; (3) biweekly health coach calls; and (4) skills training and support through Facebook.Results: The intervention reduced the proportion of women who exceeded IOM guidelines compared to usual care (37% vs. 66%, P = 0.033). Intervention participants gained less weight during pregnancy (8.7 vs. 12.3 kg, adjusted mean difference: -3.1 kg, 95% CI: -6.2 to -0.1). No group differences in neonatal or obstetric outcomes were found.Conclusions: The intervention resulted in lower prevalence of excessive gestational weight gain. [ABSTRACT FROM AUTHOR]

Purpose: This article expands on earlier analyses that assessed whether the recent recession influenced retirement expectations. Design and Methods: Acknowledging that planning for retirement is a complex process influenced by personal preferences, resources, economic factors, institutional policies, and social norms, we test more comprehensive models than those used in previous studies, using data from the 2006 and 2008 waves (Waves 8 and 9) of the Health and Retirement Study. Results: Our results confirm that economic changes impinge on retirement expectations, but they also show stronger influences of other factors such as debts and the work environment. Implications: As the baby boom cohorts approach retirement age, it will be important to better understand how workers consider macro factors such as the state of the economy and firm-level factors and personal finances when planning for retirement. [ABSTRACT FROM PUBLISHER]

Low serum concentrations of 25-hydroxyvitamin D (25(OH)D) have been associated with poor physical function in older adults, but few, if any, studies have examined this relationship in the very old. Therefore, the purpose of this study is to examine this relationship in the very old. Serum 25(OH)D concentrations were obtained from 194 centenarians and near centenarians (98 years and older). The associations between 25(OH)D concentrations and measures of physical function were evaluated with unadjusted and adjusted regression models. We found that 35% of centenarians had 25(OH)D concentrations less than 50nmol/L. Adjusted mean grip strength was lower for centenarians with 25(OH)D concentrations less than 75nmol/L than for centenarians with higher concentrations (P<0.05). However, there were no differences in the Georgia Centenarian Study (GCS) Composite Scale, a global measure of physical function, between those with higher and lower 25(OH)D concentrations. We conclude that low 25(OH)D concentrations are associated with poor grip strength, but not GCS Composite Scale, in the very old. Considering the high burden of poor physical function in older adults, understanding the relationship between vitamin D and different measures of physical function, including strength, becomes increasingly important. [ABSTRACT FROM PUBLISHER]

Centenarians represent a rare but rapidly growing segment of the oldest-old. This study presents item-level data from the Mini- Mental State Examination ( MMSE) in a cross-sectional, population-based sample of 244 centenarians and near-centenarians (aged 98-108, 16% men, 21% African-American, 38% community dwelling) from the Georgia Centenarian Study (2001-2008) according to age, education, sex, race, and residential status. Multiple- Indicator Multiple- Cause ( MIMIC) models were used to identify systematic domain-level differences in MMSE scores according to demographic characteristics in this age group. Indirect effects of age, educational attainment, race, and residential status were found on MMSE scores. Direct effects were limited to concentration for education and race and orientation for residential status. Mean levels of cognitive functioning in centenarians were low, with mean values below most commonly-used cutoffs. Overall scores on the MMSE differed as a function of age, education, race, and residential status, with differences in scale performance limited primarily to concentration and orientation and no evidence of interactions between centenarian characteristics. Adjusting for education was not sufficient to account for differences according to race, and adjusting for residential status was not sufficient to account for differences according to age. [ABSTRACT FROM AUTHOR]

Family caregiving research is increasingly contextual and dynamic, but few studies have examined prevalence and predictors of change in primary caregivers, those with the most frequent contact with healthcare professionals. We identified prevalence and predictors of 2-year change in primary adult-child caregivers. Data pooled from the 1992-2000 waves of the Health and Retirement Study (HRS) represent 1,068 parent-level care occasions and 3,616 child-level occasions. There is considerable 2-year stability in primary adult-child caregivers. Parents are more prone to experience a change in adult-child primary caregivers if they live by themselves and if they have more sons and daughters. As far as the adult children are concerned, daughters and children living closer to parents are more likely to remain primary caregivers. Results suggest that change in primary caregivers is more strongly associated with available alternatives and gender norms than burden and competing obligations. [ABSTRACT FROM AUTHOR]

Care-giving research has focused on primary care-givers and relied on cross-sectional data. This approach neglects the dynamic and systemic character of care-giver networks. Our analyses address changes in care-givers and care networks over a two-year period using pooled data from the US Health and Retirement Study, 1992–2000. Based on a matrix of specific adult-child care-givers across two consecutive time-points, we assess changes in any adult-child care-giver and examine the predictors of change. A change in care-giver occurred in about two-fifths of care-giving networks. Ability to provide care based on geographical proximity, availability of alternative care-givers, and gender play primary roles in the stability of care networks. Results underline the need to shift care-giving research toward a dynamic and systemic perspective. [ABSTRACT FROM PUBLISHER]

Background/Study Context: The goal of the study was to identify and characterize latent profiles (clusters) of cognitive functioning in centenarians and the psychometric properties of cognitive measures within them. Methods: Data were collected from cross-sectional, population-based sample of 244 centenarians (aged 98 to 108, 15.8% men, 20.5% African American, 38.0% community-dwelling) from 44 counties in northern Georgia participating in the Georgia Centenarian Study (2001-2008). Measures included the Mini-Mental State Examination (MMSE), Severe Impairment Battery (SIB), Wechsler Adult Intelligence Scale-III Similarities subtest (WAIS), Hand Tapping, Behavioral Dyscontrol Scale (BDS), Controlled Oral Word Association Test (COWAT), and Fuld Object Memory Evaluation (FOME). The Global Deterioration Rating Scale (GDRS) was used to independently evaluate criterion-related validity for distinguishing cognitively normal and impaired groups. Relevant covariates included directly assessed functional status for basic and instrumental activities of daily living (DAFS), race, gender, educational attainment, Geriatric Depression Scale Short Form (GDS), and vision and hearing problems. Results: Results suggest two distinct classes of cognitive performance in this centenarian sample. Approximately one third of the centenarians show a pattern of markedly lower cognitive performance on most measures. Group membership is independently well predicted (area under the curve [AUC]=.83) by GDRS scores (sensitivity 67.7%, specificity 82.4%). Membership in the lower cognitive performance group was more likely for individuals who were older, African Americans, had more depressive symptoms, lower plasma folate, carriers of the apolipoprotein E (APOE) c4 allele, facility residents, and individuals who died in the 2 years following interview. Conclusions: In a population expected to have high prevalence of dementia, latent subtypes can be distinguished via factor mixture analysis that provide normative values for cognitive functioning. The present study allows estimates for normative cognitive performance in this age group. [ABSTRACT FROM AUTHOR]

The primary objective of this study was to provide supplementary normative data on aging and cognition from an ongoing community-based study. This dementia- and stroke-free sample (age range = 70-89; mean = 77.5) consisted of 228 women and 155 men participating in the Maine-Syracuse Longitudinal Study at waves 6 to 7 (2001-2009). The authors employed a battery of 23 widely utilized clinical cognitive tests. In this cross-sectional study, the authors focus on subjects 70 to 79 (n = 248) and 80 to 89 (n = 135) years old, and provide preliminary data for a smaller number of subjects aged 90 to 98 years old (n = 14). More highly educated and younger participants exhibited better performance on cognitive tests. Education was not significantly associated with every cognitive outcome, nor was age cohort membership. The addition of cardiovascular disease (CVD)/health variables to a model including age, education, and gender main effects provided statistically significant increases in R² (range = .021-.084) of performance on some tests. Results are discussed in relation to this study's value with respect to determining cognitive impairment in individuals free from probable dementia or stroke. [ABSTRACT FROM AUTHOR]

Planning for future care needs is likely to be influenced by both policy and culture. We compared attitudes regarding the usefulness of planning ahead for future care needs, processes of preparation for these needs (becoming aware of the risk of future care needs, gathering information about available options, deciding on preferences, concrete planning), and outcomes of preparation (e.g., knowledge about services) in 294 East German, 288 West German, and 590 American seniors. American respondents had higher preparation scores. Compared to the size of national differences, differences between East and West German seniors were generally smaller. East Germans made fewer decisions on preferences and engaged in less concrete planning. Most of the national and regional differences in preparation for future care needs were reduced or eliminated by controlling for differences in the perceived usefulness of planning. [ABSTRACT FROM AUTHOR]

Although cross-sectional research has established the link between care demands and various indicators of caregiver adaptation, few studies have examined the impact of care recipients' problematic behavior over time. The present analysis determines the importance of behavior problems when predicting rates of change in subjective stressors (role overload and role captivity) and depression. Using 4-wave longitudinal data (N = 137) on dementia caregivers, the authors fit individual growth curve models for care demands (i.e., behavior problems, activities of daily living dependencies, and cognitive impairment), subjective stressors, and depression. Subsequent structural equation models found that increases in behavior problems were most likely to predict increases in role overload. The findings emphasize the deleterious long-term impact of behavior problems on individuals' emotional adaptation to caregiving. [ABSTRACT FROM AUTHOR]

Background: Cardiovascular disease is the number one cause of death in the United States and in most European countries. Cardiovascular health, as defined by the American Heart Association, is comprised of seven health metrics (smoking, body mass index, physical activity, diet, total cholesterol, blood pressure, and fasting plasma glucose). No studies have compared US data with data collected elsewhere, using this index of cardiovascular healthMethods: We performed comparative analyses of cardiovascular health status in participants from 2 study sites in 2 different countries: the Maine-Syracuse Study, conducted in Central New York, USA in 2001-2006 (n=673), and the Observation of Cardiovascular Risk Factors in Luxembourg, conducted in 2007-2009 (n=1145).Results: The Cardiovascular Health Score, the sum of the total number of metrics at ideal levels, was higher in the Luxembourg site than in the Central New York site. Ideal cardiovascular health levels for body mass index, smoking, physical activity, and diet were more prevalent in the Luxembourg site than the Central New York site. Ideal levels for blood pressure were more prevalent in Central New York. Differences between the two sites remained with control for age, gender and socioeconomic indicators.Conclusions: Cardiovascular health, as indexed by seven health metrics, was higher in the European study site than in the US study site. The largest differences were for the four lifestyle/behavior metrics, namely body mass index, smoking, physical activity, and diet. Preventative and intervention strategies will continue to be important for both countries in order to improve cardiovascular health. [ABSTRACT FROM AUTHOR]

Objective: To examine the feasibility, acceptability, and initial efficacy of a technology-based weight loss intervention for urban, low-income mothers. Methods: Eighteen obese, ethnic minority, socioeconomically disadvantaged mothers in the first year after childbirth were randomly assigned to either: 1) technology-based intervention, which included empirically supported behavior-change strategies, daily skills, and self-monitoring text messages with personalized feedback, biweekly counseling calls from a health coach, and access to a Facebook support group, or 2) usual-care control. Results: After 14 weeks of treatment, the technology-based intervention participants had significantly greater weight loss (−2.9 ± 3.6 kg) than usual care (0.5 ± 2.3 kg; adjusted mean difference: −3.2 kg, 95% confidence interval −6.2 to −0.1 kg, P = .04). One-third of intervention participants (3 of 9) and no control participants lost > 5% of their initial body weight at follow up. Conclusions and Implications: Results suggest the potential for using technology to deliver a postpartum weight loss intervention among low-income racial/ethnic minorities. [ABSTRACT FROM AUTHOR]

Serving larger portions of energy-dense foods has been shown to promote children's energy intake at meals. Whether larger portions increase children's intake of both fruits and vegetables (F&V) is less clear. A 2×2 within-subjects design systematically varied portion sizes of fruit (75 vs 150 g) and vegetable (75 vs 150 g) side dishes served at dinner. Children's F&V liking was measured using a validated tasting method. Thirty children aged 4 to 6 years were tested in a laboratory setting at 5:00 pm on weekdays from November 2008 through March 2009. Mixed linear models were used to determine effects of fruit portion size, vegetable portion size, and their interaction on food and energy intakes. Data are presented as model-based means±standard error unless otherwise indicated. When portions were doubled, children increased their vegetable intake by 37% (12±4 g; P<0.01) and their fruit intake by 70% (41±6 g; P<0.01). Vegetable portion size effects were not influenced by offering more fruit and vice versa. Portion size effects were limited to children who liked that particular food. Total meal energy intake did not vary by portion size condition. These results indicate that serving larger F&V portions at meals can be used to promote young children's intake of both foods without influencing total meal energy intake. Effects were not seen in children who disliked F&V, suggesting a need to combine increased F&V portions with strategies to increase their acceptance. [Copyright &y& Elsevier]