Physical Activity, Blood Pressure, and Community Dining Sites: a Cohort Study of Older Black Adults Who Participate in the Congregate Meal Program.

Elevated blood pressure has been inconsistently associated with cognitive performance in older adults. Black adults experience higher rates of elevated blood pressure and cognitive impairment than White adults. This study investigated whether blood pressure measurements were associated with cognitive performance on the NIH Toolbox Cognition Battery (NIHTB-CB) in older Black adults. 77 older Black adults 65+ years of age (M=72.6, SD=4.9) with subjective cognitive decline were administered the NIHTB-CB, a battery of computer-based cognitive tests. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured before and after cognitive testing and a cognitive task-based EEG/ERP. Average SBP, DBP, and pulse pressure (PP) were calculated. Difference scores from pre- to post-EEG/ERP served as a reactivity index following cognitive task engagement. A ratio of the difference scores to the baseline measures controlled for resting blood pressure. Bayesian correlations examined the relations between blood pressure measurements and NIHTB-CB performance. Data analysis used fully corrected T scores from the NIHTB-CB subtests. Average SBP, SBP difference scores, and baseline SBP were not associated with NIHTB-CB performance on any measurement (all BF10 < 3.0). Similarly, DBP and PP were unrelated to NIHTB-CB performance. Systolic and diastolic blood pressure were not associated with any NIHTB-CB measure. Additionally, blood pressure reactivity was not related to cognitive performance. Future research may investigate the relationship between SBP reactivity and cognitive performance across multiple measurement periods. Antihypertensive medication and duration of hypertension among hypertensive individuals may also be an important consideration in future studies.

This clinical advisory statement from the Coordinating Committee of the National High Blood Pressure Education Program is intended to advance and clarify the recommendations of the Sixth Report of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI, 1997).1 The advisory addresses several interrelated issues about blood pressure (BP) that affect people approaching the later decades of life. On the basis of the wealth of currently available evidence, the committee now recommends a major paradigm shift in urging that systolic BP become the major criterion for diagnosis, staging, and therapeutic management of hypertension, particularly in middle-aged and older Americans. Several lines of strong evidence support the initiative to emphasize systolic BP. Pathophysiologically, there are strong associations among aging, increased stiffness of large arteries, increased systolic BP, increased pulse pressure, and the prevalence of cardiac and vascular disease. Epidemiologically, isolated systolic hypertension is the most common form of hypertension and is present in approximately two thirds of hypertensive individuals >60 years of age. Diagnostically, classification and staging of hypertension are more precise when systolic rather than diastolic BP is used as the principal criterion. Risk stratification for major complications of hypertension (stroke, myocardial infarction, heart failure, and kidney failure) is actually confounded by the use of diastolic BP; in older people with systolic hypertension, diastolic BP is inversely related to cardiovascular risk. Clinical benefits of treatment of isolated systolic hypertension include reductions in stroke, myocardial infarction, heart failure, kidney failure, and overall cardiovascular disease morbidity and mortality. Currently, only 1 in 4 Americans with hypertension falls below JNC VI–recommended values of 140/90 mm Hg in uncomplicated hypertension or 130/85 mm Hg in individuals with kidney disease or diabetes. Hypertension control rates are poorest in older people, primarily as a result of inadequate …

Associations of perceived health and social and physical activities with end-of-life (EOL) issues have been rarely studied, not to mention racial disparities in such associations. To address this gap, this study examined racial differences in the associations of perceived health and levels of social and physical activities with advance care planning, EOL concerns, and knowledge of hospice care among community-dwelling older adults in Alabama. Data from a statewide survey of 1044 community-dwelling older adults on their long-term care needs were analyzed using descriptive statistics and logistic and linear regressions. Results showed that black older adults were less likely to know about or document advance care planning and to have accurate knowledge of hospice care; however, despite their poorer perceived health, black older adults reported fewer EOL concerns. Higher levels of perceived health and social and physical activities were associated with knowledge about advance care planning among white older adults but not among black older adults. Both black and white older adults with poorer perceived health and lower levels of social and physical activities tended to have more EOL concerns and less knowledge of hospice care. These findings suggest that interventions to address suboptimal levels of perceived health and social and physical activities among black older adults may increase knowledge of advance care planning. Also, supportive services to address EOL concerns should be targeted at older adults with poorer perceived health and limited participation in social and physical activities.

A cross-sectional population-based survey employing a cluster sampling method and household visits by trained health teams investigated hypertension prevalence in the Kingdom among 13,700 individuals of both sexes in all age groups. The World Health Organization (WHO) definition of hypertension of = 160/95 mmHg was used; it was found that 9.1% and 8.7% of the total sample investigated were systolic and diastolic hypertensives, respectively. However, 12.4% and 7.9% of children younger than 18 years were systolic and diastolic hypertensive. Among adults aged 18 years and above, 5.3% were systolic and 7.3% were diastolic hypertensives; 87.5% of systolic and 79.4% of diastolic hypertensives were aged 40 years and over. Females had statistically significant elevated systolic hypertension compared with males (P < 0.01). However, if blood pressure = 140/90 mmHg is used as a criterion for hypertension definition, the prevalence among the latter age groups would be 20.4% for systolic and 25.9% for diastolic hypertension. The prevalence of Isolated Systolic Hypertension (ISH), Isolated Diastolic Hypertension (IDH) and Systolic Diastolic Hypertension (SDH) among adults above 18 years was 1.8%, 3.8% and 3.5% respectively. ISH was higher among females compared with males (2% vs 1.4%), while IDH was higher among males than females (4.4% vs 3.4%). There is a need for tracking childhood hypertension, which could provide long-term analysis for risk of adult hypertension.

Acute beetroot juice reduces blood pressure in young Black and White males but not females

Many of the most damaging life events are more prevalent among Black older adults. Black people have been found to have higher amounts of adverse childhood experiences (ACEs), which are linked to detrimental life impacts. Additionally, bereavement occurs at a higher rate among Black people and older adults. Despite these challenges, Black older adults have been repeatedly cited overcoming these challenges. Accordingly, the present study sought to investigate whether Black middle to older aged adults who encountered two of life’s most difficult challenges (i.e. bereavement and ACEs) would still maintain positivity. 103 middle to older Black adults (M=44.72, SD=5.48, 67% male) from a larger online grief study were probed about factors including time since loss, positive outlook, and ACES. A linear regression and mediation analysis were used to analyze the data. ACES were found to significantly predict positive outlook among bereaved middle to older Black adults (F=11.46, p=.001), such that as the number of ACES increased, so did positivity in spite of bereavement. Notably, this association was not mediated by time since loss. Results from this study provide evidence that even when faced with some of life’s most difficult events, Black middle to older adults were still able to reframe their situation with a positive focus. The ability for Black middle to older aged adults to reframe their tragedies into positivity could provide a basis for the use of Positive Psychological techniques specifically within this population. Additionally, this study provides further evidence that Black people exhibit exceeding resilience.

Cardiovascular risk of systolic versus diastolic blood pressure in Western and non-Western countries

Greater difficulty in controlling blood pressure (BP) and adverse lifestyle practices such as higher salt intake or less physical activity may account for some of the differences between BP control rates in Black vs White adults, thereby exposing Black adults to a higher risk of vascular events. To determine whether a lifestyle coaching intervention or an enhanced pharmacotherapy protocol is more effective than usual care in improving BP control rates in Black adults treated within an integrated health care delivery system. Shake, Rattle & Roll, a cluster randomized clinical trial, was conducted from June 5, 2013, to June 11, 2018, in a large integrated health care delivery system. Enrollment was completed during a 12-month period and interventions were implemented for 12 months. Follow-up lasted 48 months after enrollment. Panels of Black adult members of the health care delivery system with BP of at least 140/90 mm Hg from 98 adult primary care physicians were randomly assigned at the primary care physician level to usual care (UC group [n = 1129]), enhanced pharmacotherapy monitoring (EP group [n = 346]) of current BP management protocol, or diet and lifestyle coaching consisting of photographs, stories, and recipes, for example, that are appropriate for Black adults (LC group [n = 286]) focused on the Dietary Approaches to Stop Hypertension (DASH) diet. Data were analyzed from June 1, 2016, to March 25, 2022. The UC group received care per customary protocol. The EP group was contacted by a research nurse and/or a clinical pharmacist to discuss barriers to hypertension control, and drug therapy emphasized the use of thiazide diuretic intensification and addition of spironolactone as needed. The LC group received as many as 16 telephone sessions with a lifestyle coach and an emphasis on implementing reduction of sodium intake and the DASH diet. Intention-to-treat analysis of BP control rates at end of the 12-month intervention. Among the 1761 participants, the mean (SD) age was 61 (13) years, and 1214 (68.9%) were women. At the end of the 12-month intervention period, there was no significant difference in BP control rate among study groups (UC, 61.8% [95% CI, 58.8%-64.9%]; EP, 64.5% [95% CI, 59.0%-69.4%]; LC, 67.8% [95% CI, 62.1%-73.2%]; LC vs EP, P = .07). However, greater BP control was present in the LC group vs UC at 24 months (UC, 61.2% [95% CI, 57.3%-64.7%]; EP, 67.6% [95% CI, 61.9%-72.8%]; LC, 72.4% [95% CI, 66.9%-78.1%]; LC vs UC, P = .001), and 48 months (UC, 64.5% [95% CI, 61.6%-67.2%]; EP, 66.5% [95% CI, 61.3%-71.3%]; LC, 73.1% [95% CI, 67.6%-77.9%]; LC vs UC, P = .006) after enrollment. The contribution of BP medication adherence to explain group differences was inconclusive. In this cluster randomized clinical trial including Black adults with persistent uncontrolled hypertension, a 12-month LC intervention was more effective at controlling BP than UC at 24 and 48 months after enrollment. Further research is needed to explore the potential implementation of this intervention into clinical practice. ClinicalTrials.gov Identifier: NCT01892592.

The Rapid Assessment of Physical Activity (RAPA) was developed to provide an easily administered and interpreted means of assessing levels of physical activity among adults older than 50 years. A systematic review of the literature, a survey of geriatricians, focus groups, and cognitive debriefings with older adults were conducted, and an expert panel was convened. From these procedures, a nine-item questionnaire assessing strength, flexibility, and level and intensity of physical activity was developed. Among a cohort of 115 older adults (mean age, 73.3 years; age range, 51-92 years), half of whom were regular exercisers (55%), the screening performance of three short self-report physical activity questionnaires--the RAPA, the Behavioral Risk Factor Surveillance System (BRFSS) physical activity questions, and the Patient-centered Assessment and Counseling for Exercise (PACE)--was compared with the Community Healthy Activities Model Program for Seniors (CHAMPS) as the criterion. Compared with the BRFSS and the PACE, the RAPA was more positively correlated with the CHAMPS moderate caloric expenditure (r = 0.54 for RAPA, r = 0.40 for BRFSS, and r = 0.44 for PACE) and showed as good or better sensitivity (81%), positive predictive value (77%), and negative predictive value (75%) as the other tools. Specificity, sensitivity, and positive predictive value of the questions on flexibility and strength training were in the 80% range, except for specificity of flexibility questions (62%). Mean caloric expenditure per week calculated from the CHAMPS was compared between those who did and those who did not meet minimum recommendations for moderate or vigorous physical activity based on these self-report questionnaires. The RAPA outperformed the PACE and the BRFSS. The RAPA is an easy-to-use, valid measure of physical activity for use in clinical practice with older adults.

Late-life suicide is a complex public health issue, and older adults have a higher risk threshold than the national average (Drapeau & McIntosh, 2020). Most late-life suicide research focuses on elevated risk of older white males, and less is known about risk factors among Black older adults (Joe et al., 2014). Although fewer Black older adults die by suicide than White older adults, forms of suicidality do not differ between Black and White older adults (Cohen et al., 2008). Suicide risk factors, such as psychological distress (Watkins & Johnson, 2018) and chronic pain (Bazargan et al., 2016), are prevalent among Black older adults. According to the Interpersonal Theory of Suicide (IPTS; Van Orden et al., 2016), thwarted belongingness and perceived burdensomeness inform the development of suicidal desire. These findings have been corroborated among older adult samples, though lacking racial diversity. To better understand how the IPTS functions for older adults, and probe whether suicide risk pathways operate differently depending on race, we used data from over 400 homebound older adults residing in a U.S. metropolitan area to clarify if this suicide risk pathway is similar for Black and White older adults. Race moderated the relationship between physical and psychological pain and thwarted belongingness and perceived burdensomeness, with pain among Black older adults having a greater impact on their sense of belonging and burdensomeness. Findings illuminate the need for culturally nuanced understandings of suicidality in older adulthood. The presenters will demonstrate these results and discuss implications for cross-cultural suicide prevention frameworks.

With the burgeoning older adult population, there will be an increased demand for neighborhood environments that are conducive to successful aging. For example, the need for affordable and usable housing developments for older adults that provide greater opportunities for social engagement, social services, and convenience to neighborhood resources (e.g., grocery stores, healthcare) will continue to rise. Several initiatives have sought to develop age-friendly neighborhoods, which focused on improving accessibility and affordability of community resources. However, limited effort has focused on the health and cognitive effects of neighborhood-level socioeconomic disadvantage, with respect to neighborhood income, education, employment, and housing quality. This symposium will include presentations from two studies that explored how neighborhood disadvantage (measured by the Area Deprivation Index) relates to health and cognition. The objectives of the proposed symposium are the following: (1) discuss how neighborhood disadvantage relates to subjective and objective measures of physical health; and (2) discuss how neighborhood disadvantage relates to cognitive functioning. Allan and colleagues explored the association between neighborhood disadvantage as it relates to changes in self-reported health and objective measures (i.e., blood pressure) of health among older Black adults. Wright and colleagues explored the association between neighborhood disadvantage and measures of subclinical cardiovascular disease in older Black and White adults. Aiken-Morgan and colleagues examined associations between neighborhood disadvantage and cognitive functioning among Black older adults. Lastly, McCain and colleagues explored associations between neighborhood disadvantage and mobility among Black older adults.

Physical activity and social engagement protect older adults against functional decline and improve their quality of life. Physical inactivity poses an increased risk for noncommunicable diseases. Globally, one in four adults is physically inactive. Enhancing the physical activity of older adults is crucial not only for increasing their life expectancy but also for improving their functional status and quality of life. This study aimed to evaluate the physical activity, functional status, and quality of life of older adults attending the medical outpatient department of a tertiary care hospital in Chennai, Tamil Nadu, India. The study adopted a descriptive cross-sectional research design. A total of 100 female and male patients above 65 years of age with comorbid conditions attending the medical outpatient department participated in the study. The sociodemographic and clinical characteristics of these patients were assessed. In addition, the Rapid Assessment of Physical Activity, Katz Index of Independence in Activities of Daily Living, Lawton Instrumental Activities of Daily Living Scale, and Older People Quality of Life Questionnaire were used to measure the physical activity, functional status, and quality of life of patients. The data were analyzed using descriptive and inferential statistics. Among the participants, only 17% were active, and 35% were underactive for regular light activities. Approximately 81% did not perform any activity to improve their muscle strength or flexibility. In 56% of the participants, disability was present. The majority mentioned that they experienced difficulties in preparing food and shopping. Regarding the quality of life of the participants, the mean ± standard deviation score was 77.38 ± 9.03. Significant results were found in the domains of independence, control over life, and freedom. The overall quality of life was not related to leisure and activities, financial circumstances, the Instrumental Activities of Daily Living Scale score, the Rapid Assessment of Physical Activity 2 score, and the Rapid Assessment of Physical Activity 1 score. The quality of life was weakly related to emotional and psychological well-being, control over life, home and neighborhood, freedom, independence, and social relationships. Limited physical activity and poor functional status impact the quality of life of older adults. Therefore, educational and physical interventions should be implemented at the hospital and community levels to improve the physical activity, functional status, and quality of life of older adults.

An Evidence-Based Review of Exercise and Metabolic Syndrome

Using Pedometers to Promote Physical Activity Among Clinical Populations

Background: High blood pressure is one of the most common health conditions experienced by US older adults. Hypertension leads to heart disease, CVD incidence, stroke, and death. In older adults, community based physical activity (PA) interventions have been shown to significantly decrease systolic and diastolic blood pressure. The American Heart Association Physical Activity Guidelines recommend that adults accumulate at least 150 minutes of moderate-vigorous intensity physical activity (MVPA) per week in order to obtain substantial health benefits. It is not clear whether accumulation of total minutes of physical activity is more important for significant changes in cardiovascular health, including reductions in blood pressure levels, or whether the intensity of the physical activity is important. New physical activity assessment techniques allow us to assess daily minutes of intensity outside of the clinic environment. Study Objectives: The objective of this study was to assess the effects of total accumulation of PA, independent of time spent in MVPA, on changes in blood pressure in older adults participating in a 6-month physical activity intervention. Methods: Study data are from a multilevel physical activity intervention (MIPARC) for older adults. Residents over the age of 65 years (N=307, mean age 84) were recruited from 11 retirement communities in San Diego. Study evaluation included collection of blood pressure measures and 6 day hip-worn accelerometry data. Change in blood pressure (dependent variable) and PA (intensity and total) from baseline to 6 months and 6 months to 12 months were examined. To account for within person and within group clustering, hierarchical longitudinal mixed effect models were used. Results: Increases in total PA counts was related to significant decreases in systolic blood pressure over the 12-month intervention period, after adjusting for minutes of time spent in MVPA (p&lt;.005). Conclusions: Evidence is mixed on the intensity of PA needed for older adults to experience significant health benefits, including reducing blood pressure. The results of this study suggest that for older adults, the total accumulation of PA at any intensity, is more important than PA at moderate to vigorous intensities. These findings have important implications for the design of PA interventions and PA prescriptions for older adults. More research is needed in older adult populations to examine if MVPA is beneficial to older adults, or if the relationship varies by an individual’s cardiovascular health.