Search

The growing population of older adults has attracted concern from policymakers due in part to the fact that they are at higher risk of costly and potentially injurious falls. Responding to this concern, this study investigated fall-related hospitalizations among those aged 65 and older. Hospitalizations rose from 49,299 to 58,931, with charges and costs (estimated based on charges) increasing from $2.5 billion to $3.6 billion and under $900 million to over $1.1 billion, respectively. The intraclass correlation coefficients from linear mixed-effect models (with charges and costs serving as dependent variables) indicated differences in hospitals accounted for nearly half or more of medical cost variation among older adults suffering a fall-related hospitalization. Nonmetropolitan residence, being aged 65-69 (versus older), and higher risk-of-mortality on admission indicated higher costs. Identifying trends of fall-related hospitalizations over time allows for key stakeholders to not only track the burden of falls among older adults but to also use this information to attract funding for fall prevention strategies from policy makers at various levels (e.g., locally, at the state). Further, identifying characteristics of individuals (e.g., age, race, sex) and places (e.g., rural areas) that carry a higher relative cost can serve to inform the targeted allocation of finite resources including local, state, or federal funding, but also existing evidence-based practices such as community and clinical interventions.

The growing population of older adults has attracted concern from policymakers due in part to the fact that they are at higher risk of costly and potentially injurious falls. Responding to this concern, this study investigated fall-related hospitalizations among those aged 65 and older. Hospitalizations rose from 49,299 to 58,931, with charges and costs (estimated based on charges) increasing from $2.5 billion to $3.6 billion and under $900 million to over $1.1 billion, respectively. The intraclass correlation coefficients from linear mixed-effect models (with charges and costs serving as dependent variables) indicated differences in hospitals accounted for nearly half or more of medical cost variation among older adults suffering a fall-related hospitalization. Nonmetropolitan residence, being aged 65-69 (versus older), and higher risk-of-mortality on admission indicated higher costs. Identifying trends of fall-related hospitalizations over time allows for key stakeholders to not only track the burden of falls among older adults but to also use this information to attract funding for fall prevention strategies from policy makers at various levels (e.g., locally, at the state). Further, identifying characteristics of individuals (e.g., age, race, sex) and places (e.g., rural areas) that carry a higher relative cost can serve to inform the targeted allocation of finite resources including local, state, or federal funding, but also existing evidence-based practices such as community and clinical interventions.

Despite many interventions to promote medication adherence in older adults, we know little about how medication adherence has improved as a result of such interventions. The purpose of this study was to examine the long-term program impacts on medication adherence from participating in the Chronic Disease Self-Management Program (CDSMP). Secondary data used for this study included the CDSMP participants' sociodemographic characteristics and their baseline and 6- and 12-month follow-up assessments on health-related indicators, including medication adherence, self-rated health, depression, and patient communication skills. This study included those who were 65 years or older, had one or more chronic conditions, and attended at least the first or second session. Linear mixed models were used to analyze the impacts of short-term (6 months) changes in health-related indicators on long-term (12 months) changes in medication nonadherence. The subset analyses were performed among participants with self-rated major depression at baseline. This study included 687 participants. Self-reported medication adherence did not improve significantly at 6-month follow-up assessment but significantly improved at 12-month follow-up assessment. Among those with self-reported major depression at baseline assessment, the short-term improvements in depression and self-rated health were associated with long-term changes in medication adherence. The long-term impacts of the CDSMP on medication adherence were influenced by the short-term program impacts on health-related indicators. More targeted interventions are needed for patients with major depression, and programs such as the CDSMP can be particularly helpful among the population.

IntroductionCost-related medication nonadherence (CRN) can negatively affect chronic disease prevention and management in an aging population. Limited data are available on the interacting influences among such factors as availability of financial resources, attitudes and beliefs of patients, and CRN. The objective of this study was to examine the causal paths among financial resource availability, patient attitudes and beliefs, and CRN.MethodsWe used a nationally representative sample (n = 4,818) from the 2015 National Health Interview Survey; selected respondents were aged 65 or older, had a diagnosis of hypertension or diabetes or both, and were prescribed medication for at least 1 of these conditions. We performed structural equation modeling to examine whether perceived medication affordability, access to health care, and patient satisfaction influenced the effects of financial resource availability on CRN (skipped doses, took less medicine, or delayed filling a prescription to save money).ResultsSix percent of respondents reported CRN in the previous 12 months. The model showed a good to fair fit, and all paths were significant (P < .05) except for age. The effects of financial resource availability on CRN was mediated through perceived medication affordability, access to health care, and patient satisfaction with health care services.ConclusionThis study suggests that patients' attitudes and beliefs can mediate the effects of financial resource availability on CRN. We call for senior-friendly public health interventions that can address these modifiable barriers to reduce CRN among older adults with chronic conditions.

Objectives. Translating efficacious interventions into practice within community settings is a major public health challenge. We evaluated the effects of 2 evidence-based physical activity interventions on self-reported physical activity and related outcomes in midlife and older adults. Methods. Four community-based organizations implemented Active Choices, a 6-month, telephone-based program, and 5 implemented Active Living Every Day, a 20-week, group-based program. Both programs emphasize behavioral skills necessary to become more physically active. Participants completed pretest and posttest surveys. Results. Participants (n = 838) were aged an average of 68.4 [+ or -] 9.4 years, 80.6% were women, and 64.1% were non-Hispanic White. Seventy-two percent returned posttest surveys. Intent-to-treat analyses found statistically significant increases in moderate-to-vigorous physical activity and total physical activity, decreases in depressive symptoms and stress, increases in satisfaction with body appearance and function, and decreases in body mass index. Conclusions. The first year of Active for Life demonstrated that Active Choices and Active Living Every Day, 2 evidence-based physical activity programs, can be successfully translated into community settings with diverse populations. Further, the magnitudes of change in outcomes were similar to those reported in the efficacy trials. (doi: 10.2105/AJPH.2005. 074690)

Background: The role of parents' perceptions of the neighborhood environment in determining children's active commuting to and from school (ACS) is understudied. This study examined the association between parents' perceptions of neighborhood social cohesion, perceived neighborhood safety, and their children's ACS. Methods: This cross-sectional analysis (n = 857 from 81 elementary schools in Texas) examined baseline data from the Texas Childhood Obesity Prevention Policy Evaluation project. Participants had a mean age of 9.6 (0.6) years, and 50% were girls. Mixed effects logistic regression models were used to assess gender-stratified associations between parent's perceived social cohesion and children's ACS and their perception of neighborhood safety. Results: A positive significant association was observed between levels of perceived social cohesion and children's ACS for boys (P = 0.047); however, an inverse significant association was observed among girls (P = 0.033). Parents of boys living in neighborhoods with medium to high social cohesion were more likely to perceive their neighborhood as safe compared with parents living in neighborhoods with low social cohesion, though nonsignificant. Perceived neighborhood safety for walking and biking was associated with greater ACS among boys (P = 0.003). Conclusions: Our study findings indicate that both social and physical environments are important factors in determining ACS among boys. [ABSTRACT FROM AUTHOR]

Background: Several environmental audit instruments have been developed for assessing streets, parks and trails, but none for schools. This paper introduces a school audit tool that includes 3 subcomponents: 1) street audit, 2) school site audit, and 3) map audit. It presents the conceptual basis and the development process of this instrument, and the methods and results of the reliability assessments. Methods: Reliability tests were conducted by 2 trained auditors on 12 study schools (high-low income and urban-suburban-rural settings). Kappa statistics (categorical, factual items) and ICC (Likert-scale, perceptual items) were used to assess a) interrater, b) test-retest, and c) peak vs. off-peak hour reliability tests. Results: For the interrater reliability test, the average Kappa was 0.839 and the ICC was 0.602. For the test-retest reliability, the average Kappa was 0.903 and the ICC was 0.774. The peak-off peak reliability was 0.801. Rural schools showed the most consistent results in the peak-off peak and test-retest assessments. For interrater tests, urban schools showed the highest ICC, and rural schools showed the highest Kappa. Conclusions: Most items achieved moderate to high levels of reliabilities in all study schools. With proper training, this audit can be used to assess school environments reliably for research, outreach, and policy-support purposes. [ABSTRACT FROM AUTHOR]

Despite many interventions to promote medication adherence in older adults, we know little about how medication adherence has improved as a result of such interventions. The purpose of this study was to examine the long-term program impacts on medication adherence from participating in the Chronic Disease Self-Management Program (CDSMP). Secondary data used for this study included the CDSMP participants' sociodemographic characteristics and their baseline and 6- and 12-month follow-up assessments on health-related indicators, including medication adherence, self-rated health, depression, and patient communication skills. This study included those who were 65 years or older, had one or more chronic conditions, and attended at least the first or second session. Linear mixed models were used to analyze the impacts of short-term (6 months) changes in health-related indicators on long-term (12 months) changes in medication nonadherence. The subset analyses were performed among participants with self-rated major depression at baseline. This study included 687 participants. Self-reported medication adherence did not improve significantly at 6-month follow-up assessment but significantly improved at 12-month follow-up assessment. Among those with self-reported major depression at baseline assessment, the short-term improvements in depression and self-rated health were associated with long-term changes in medication adherence. The long-term impacts of the CDSMP on medication adherence were influenced by the short-term program impacts on health-related indicators. More targeted interventions are needed for patients with major depression, and programs such as the CDSMP can be particularly helpful among the population. [ABSTRACT FROM AUTHOR]

The primary focus of the 2013 Texas Health Perception Survey was to assess the knowledge, attitudes, and perceptions about obesity prevention and control measures of legislators from the 83rd Texas legislative session. The purpose of this manuscript is to present insights gained in surveying and interviewing Texas politicians. Initial steps in conducting the survey included formation of an Advisory Committee to guide the process, development of a survey instrument, and organizing a list of legislators and appropriate staff. Hard copy and online versions of the survey were developed. Administration of the survey required initial and follow-up visits and contact via email, phone, and in person. Lessons learned included methods to work effectively with partners as well as techniques to survey and interview legislators and their aides. Policy research work gives researchers, practitioners, and advocates opportunities to tailor future communications, refi ne and advance a childhood obesity policy agenda, and galvanize existing partnerships. [ABSTRACT FROM AUTHOR]

The article focuses on the community-based physical activity program called Active for Life that was established by the Robert Wood Johnson Foundation® to address the health issue among older people. The Active For Life National Program Office was created at the Texas A&M Health Science Center School of Rural Public Health to better clarify the processes and outcomes of converting research-based physical activity programs into community programs for sedentary adult age 50 and above.

Background: Most evidence-based programs are never translated into community settings and thus never make a public health impact. Design: Active for Life (AFL) was a 4-year translational initiative using a pre–post, quasi-experimental design. Data were collected from 2003 to 2007. Analyses were conducted in 2005 and 2008. Setting/participants: Nine lead organizations at 12 sites participated. Active Choices participants (n=2503) averaged 65.8 years (80% women, 41% non-Hispanic white). Active Living Every Day (ALED) participants (n=3388) averaged 70.6 years (83% women, 64% non-Hispanic white). Intervention: In AFL, Active Choices was a 6-month telephone-based and ALED a 20-week group-based lifestyle behavior change program designed to increase physical activity, and both were grounded in social cognitive theory and the transtheoretical model. The interventions were evaluated in Years 1, 3, and 4. An adapted shortened ALED program was evaluated in Year 4. Main outcome measure: Moderate- to vigorous-intensity physical activity, assessed with the CHAMPS self-reported measure. Results: Posttest survey response rates were 61% for Active Choices and 70% for ALED. Significant increases in moderate- to vigorous-intensity physical activity, total physical activity, and satisfaction with body appearance and function, and decreases in BMI were seen for both programs. Depressive symptoms and perceived stress, both low at pretest, also decreased over time in ALED. Results were generally consistent across years and sites. Conclusions: Active Choices and ALED were successfully translated across a range of real-world settings. Study samples were substantially larger, more ethnically and economically diverse, and more representative of older adult''s health conditions than in efficacy studies, yet the magnitude of effect sizes were comparable. [Copyright &y& Elsevier]

Background: Several environmental audit instruments have been developed for assessing streets, parks and trails, but none for schools. This paper introduces a school audit tool that includes 3 subcomponents: 1) street audit, 2) school site audit, and 3) map audit. It presents the conceptual basis and the development process of this instrument, and the methods and results of the reliability assessments., Methods: Reliability tests were conducted by 2 trained auditors on 12 study schools (high-low income and urban-suburban-rural settings). Kappa statistics (categorical, factual items) and ICC (Likert-scale, perceptual items) were used to assess a) interrater, b) test-retest, and c) peak vs. off-peak hour reliability tests., Results: For the interrater reliability test, the average Kappa was 0.839 and the ICC was 0.602. For the test-retest reliability, the average Kappa was 0.903 and the ICC was 0.774. The peak-off peak reliability was 0.801. Rural schools showed the most consistent results in the peak-off peak and test-retest assessments. For interrater tests, urban schools showed the highest ICC, and rural schools showed the highest Kappa., Conclusions: Most items achieved moderate to high levels of reliabilities in all study schools. With proper training, this audit can be used to assess school environments reliably for research, outreach, and policy-support purposes.