Independent-living Retirement Communities Research Articles

Weather, Built Environment, or Personal Factors: Predictors of Walking by Independent Living Residents With Frailty

Environmental factors influence older adult physical activity. However, the evidence about which factors lead to increased physical activity is mixed and few have studied how these factors affect those with frailty or living in retirement communities. This study investigated how environmental and weather factors influence physical activity among pre-frail and frail older adults residing in independent living retirement communities. We used ActivPal accelerometers to measure 7-day step counts among (n=108) pre-frail and frail residents in 9 independent living residences in metropolitan Chicago. We conducted environmental audits using the MAPS Abbreviated tool and collected National Weather Service Station data (temperature, precipitation, and daylight minutes) during the ActivPal periods. Participants were on average 80.0 years, 74% female, and average daily step count was 3,450 (range 151 - 11,663). Four buildings were in suburban areas and 5 in urban areas and four were private-pay residences while 5 offered subsidized rent. ANOVA results showed private-pay buildings had higher total MAPS scores than subsidized buildings (p=0.001), and urban buildings had higher total MAPS scores than suburban buildings (p < 0.000). Mean step differences were non-significant between different building types: (mean steps = 3,317 private-pay, 3,629 subsidized, 3,536 urban, 3,350 suburban). Pearson product-moment correlations showed a positive association between steps and MAPS positive streetscape features (p=0.011). Multiple regression analysis showed higher temperature days, precipitation, and more minutes of daylight were associated with higher step counts (p=.04). Given the dramatic variation in individual step counts, future research should investigate personal factors that contribute to activity among independent living residents.

Associations between inflammatory and neurological markers with quality of life and well-being in older adults.

Stressful experiences, poor self-rated health, and negative emotional states have been implicated with higher levels of inflammatory markers and lower levels of neurotrophic factors in some healthy adults and clinical populations, but these relationships are unclear in the elderly. This study aimed to identify the associations between systemic inflammatory and neurological markers with well-being and health-related quality of life (HR-QoL) in independently living elderly people. Cross-sectional study. A total of 268 men and women aged ≥65 years living independently in retirement communities in Melbourne, Australia. Questionnaires were used to assess HR-QoL [Short Form (SF)-36 version 2] and well-being (Personal Wellbeing Index). Serum inflammatory cytokines [interleukin (IL)-4, IL-6, IL-1β, IL-8, IL-10, tumor necrosis factor (TNF)-α, and high sensitive C-reactive protein (hs-CRP)] were standardised to Z-scores and used to calculate pro- and anti-inflammatory composite score and an overall composite inflammatory index. Plasma levels of the neurological markers amyloid β (1-40) and amyloid β (1-42), brain derived neurotrophic factor (BDNF), insulin-like growth factor-1 (IGF-1) and vascular endothelial growth factor (VEGF), were also assessed. No significant associations were found between any inflammatory or neurological marker with HR-OoL or well-being, with the exception that lower perceptions of the HR-QoL vitality subscale were associated with higher levels of hs-CRP [unstandardized beta-coefficient (β): -1.50; 95% CI: -2.53, -0.46; P = 0.004] and Z-scores in the pro-inflammatory composite score (β = -2.06; 95% CI: -3.49, -0.62; P = 0.005). In elderly people residing in independent living retirement communities, there was no consistent evidence indicating that circulating inflammatory or neurological markers were associated with the key physical or mental HR-QoL domains or overall well-being. This suggests that these biomarkers may not be effective predictors in relatively healthy communities, and may be more beneficial in frail or clinical populations. Clinical Trials registry: Australian New Zealand Clinical Trials Registry (ACTRN12613001161718). http://www.anzctr.org.au/.

RELATIONSHIP BETWEEN THE 8-FOOT UP-AND-GO AND POWER IN OLDER ADULTS

As people age, muscular power tends to decline to a greater extent than muscular strength. This may have a detrimental impact on balance and functionality. However, the relationship between vertical power and dynamic balance and agility are not completely understood. The purpose of this study was to determine whether power production during a chair stand is related to 8 Foot Up-and-Go (UPGO) time. METHODS: Participants included residents of an independent living retirement community (N=31, M=81 ± 6.81 years). The UPGO required participants to stand and walk around a cone 8 feet away and return to a seated position as quickly as possible. Muscular power was assessed using a Tendo Power Analyzer ™ during a maximum velocity chair stand conducted five times. A one minute rest period was given between each trial. RESULTS: After removal of an outlier, no relationship existed between the UPGO and average (r=-.04, p=.85) and peak (r=-.11, p=.57) power. CONCLUSION: The lack of a relationship between power production and the UPGO may indicate other factors are more influential in dynamic balance and agility performance. Differing movement angles of the tests may have also played a role in the results. Future research should evaluate the influence other factors, such as muscular strength or reaction time, might have on UPGO performance, as well as account for angular differences.

Museum programming and mood: Participant responses to an object-based reminiscence outreach program in retirement communities

Background: Previous research suggests that group reminiscence offers psychosocial benefits, but studies have focused on multi session programs. This study examines mood changes related to a single-session object-based museum outreach reminiscence program. Methods: Twelve independent-living retirement communities, with 114 total participants, participated. A pre-test/post-test design was used to collect survey data, and a repeated-measures t-test, linear regression and logistic regression were used to analyze the data. Results: Mood scores were found to be significantly higher after the program, and mood changes were significantly related to participants' interest in the program's topic. Findings related to participant reactions and survey administration were also presented. Conclusions: The results of this study support the use of object-based reminiscence in museum outreach to retirement communities, suggesting it may have significant short-term impact on mood. The findings also suggest that it is important to align program content with topical interests of participants. Directions for further research are discussed.

The Relationship between the LateLife Function and Disability Instrument (LLFDI) and Berg Balance Scale (BBS)

The BBS has been shown to be reliable for predicting fallers, however a limitation of the BBS is that it requires significant training and one on one supervision to administer the test which consists of 14 tasks that are scored from 0–4 for a total of 56. The LLFDI, developed to predict who is at risk for disability, provides a composite score of basic lower extremity function and advanced lower extremity function. Since it is a questionnaire, it requires less training and can be administered in a one to four ratio in most settings. For many retirement communities the cost to administer the BBS would prohibit its use, whereas the LLFDI could be administered at a much lower cost per resident. PURPOSE: To compare the baseline results of the BBS and LLFDI which were both utilized in an intervention study aimed at improving mobility and balance in older adults. METHODS: The BBS and the LLFDI were administered, by researchers appropriately trained to use both approaches, at baseline. Subjects (n=20: 1 male, 19 female) were residents of an independent living retirement community (age 67–91, mean 78). RESULTS: The mean score for the BBS at baseline was 46.3 (SD 7.9). The baseline LLFDI basic lower extremity function mean score was 57.95 (SD 8.6). The advanced lower extremity function mean score was 35.3 (SD 16.4). A moderate relationship was observed between the BBS and the basic lower extremity score from the LLFDI (r =.65, p =.002). The relationship was also moderate (r =.71, p =.0001), when comparing the BBS to the advanced lower extremity score for the LLFDI. CONCLUSION: These results suggest that the LLFDI may provide an alternative screening approach to the BBS, which can be more costly and time consuming to administer, for those considered at high fall risk and in need of a fall prevention program. Supported by funding from the NSCA Foundation Student Research Grant.

Telling It Like It Is: The Adaptive Function of Narratives in Coping With Loss in Later Life

As the population ages, caregivers and health care providers need more insight into how people experience old age and their attitudes and emotions about growing older. It is particularly critical to understand how communication processes change and how older adults communicate their concerns and feelings. This article proposes that some discursive activities may play a crucial role in successfully adapting to, and coping with, loss in later life. Thus, this study explored how older adults reflect on and express themselves concerning recent experiences of loss. A sample of 41 residents of 2 independent-living retirement communities wrote in journals about a recent significant loss. Participants wrote about their losses during brief lab sessions over the course of 3 consecutive days. Each set of 3 journals was content-analyzed to measure the frequency with which the participants employed emotional expression, factual recounting, account giving, religious-account giving, humor, intensifiers, and referential statements. The analysis indicates that, overall, participants shifted from a primarily factual mode (what the loss was, how the loss occurred, etc.) to more of a focus on the impact of this loss on their lives (e.g., handling new tasks and expressions of emotions) over the 3 sessions. In addition, most participants offered accounts of their losses; that is, they attempted to find some meaning in the loss and integrate the loss into an overall framework for their lives. Many of these accounts focused on religion. Final sections of the article discuss the implications of journaling as a mechanism for effective coping with loss, as a useful tool for expressing emotions, and as a means for older adults' caregivers and health care providers to better adapt their supportive messages.

Loneliness and depression in independent living retirement communities: risk and resilience factors

Socio-emotional selectivity theory posits that as individuals age, they desire less social stimulation and novelty, and tend to select close, reliable relationships to meet their emotional needs. Residence in congregate facilities affords social exposure, yet does not guarantee access to close relationships, so that loneliness may be a result. Further, the gerontology literature has suggested that loneliness in late life may be a risk factor for serious mental health concerns such as depression. This article examined data on loneliness and depressive symptoms from older adults aged 60–98, residing in two age-segregated independent living facilities. Overlap between those scoring in the depressed range on the Geriatric Depression Scale and those scoring more than one standard deviation above the mean on the UCLA Loneliness Scale was less than 50%, although zero-order correlation of the two continuous scores was moderately high. Potential risk and resilience factors were regressed on the continuous scores of the two scales in separate hierarchical multiple regression analyses. Depression was predicted by being older, number of chronic health conditions, grieving a recent loss, fewer neighbor visitors, less participation in organized social activities and less church attendance. Grieving a recent loss, receiving fewer visits from friends, and having a less extensive social network predicted loneliness. In addition, loneliness scores explained about 8% of the unique variance in depression scores, suggesting it is an independent risk factor for depressive symptoms. Loneliness scores were seen to be more widely dispersed in these respondents, with less variance explained by the available predictors. Suggestions are made for addressing loneliness in older adults as a means of preventing more serious mental health consequences.

EFFECT OF A CHAIR-BASED EXERCISE CLASS USING THERABANDS ON PHYSICAL PERFORMANCE MEASURES IN INDEPENDENT OLDER ADULTS

Finding practical cost effective ways to help maintain functional fitness in older adults is of utmost importance as it contributes significantly to preserving functional independence. PURPOSE To determine the impact of participation in a chair-based exercise class using 4-inch wide Therabands on physical performance in older adults. METHODS Upon entry to an independent living retirement community, residents have the option to participate in a variety of physical fitness activities, one of which is a chair-based exercise class using Therabands. Twenty residents (M Age = 88.78, Range = 81–95) participated in the 35-minute three times a week class for one year. Participants averaging at least 2 classes a week were included in the study. Class participants were compared using several different physical performance measures to 18 non-active residents of comparable age (M = 87.00, Range=79–99) and cognitive ability, as assessed by the Clock test and Digit Symbol Substitution test. All participants in the study were screened by their physician for participation. The use of canes and/or walkers was permitted during the assessment. The components of the assessment included Fullerton's functional fitness test (30-s chair stand, 30-s arm curl, 6-min walk, chair sit-and-reach, back scratch, 8-ft up-and-go), Guralnik's Lower Extremity Performance (LEP) evaluation (8-ft walk, tandem balance, and 5-time chair stand), and other fitness tests (4-m walk, total grip strength). RESULTS Results indicate significantly better performance for the exercise group in the 8-ft up-and-go (9.54s vs. 12.54s, p < .01), arm curl (14.35 vs 10.87, p < .01), 6-min walk (429.09yds vs 349.25yds, p < .01), LEP score (9.67 vs 6.94, p < .01), 4-m walk (3.56s vs 4.91s, p < .01) and total grip strength (41.81kg vs 30.56kg, p < .01). CONCLUSION Based on a variety of physical performance measures, this study shows that regular participation in a chair-based exercise class using Therabands is a practical and cost-effective way to keep older adults functionally fit.

Predictors of physical activity in older adults in an independent living retirement community.

This study was undertaken to examine potential predictors of physical activity in older adults in an independent living retirement community. Participants received a self-developed questionnaire that included questions regarding age, gender, educational attainment, physical activity habits, and physicians' physical activity counseling habits. One hundred nine of 150 questionnaires (72.7%) were completed and returned. Multivariate regression analyses revealed that younger age (p=0.013), higher educational attainment (p=0.003), positive attitude toward physical activity (p=0.030), and receiving advice from a physician to be physically active (p=0.001) were all positive predictors of increased physical activity. The results demonstrate that younger age, higher educational attainment, a positive attitude toward physical activity, and receiving advice from a physician to be physically active result in increased physical activity levels of older adults in an independent living retirement community.

The DIET Study: Long-term Outcomes of a Cognitive-behavioral Weight-control Intervention in Independent-living Elders

Objective to describe the long-term outcomes of a cognitive-behavioral weight-control intervention implemented in a community-based sample of independent-living, older adults. Design A quasi-experimental design was used to compare an intervention community with a wait-listed control community. Comparisons between the communities were made at 40 weeks ( J Am Diet Assoc. 1994;94:37-42). The controlled trial ended at 40 weeks; then both communities received 2 years of intervention. Two-year data from both communities were combined and are presented in this article. Three-year outcome data from the initial intervention community were available and are also presented. Subjects A total of 247 overweight (>4.5 kg of age-adjusted weight), older (mean age=71 years) adults in 2 independent-living retirement communities participated in the study. Intervention The Dietary Intervention: Evaluation of Technology (DIET) study consisted of an intensive 10-week psychoeducational approach focused on lifestyle change, followed by a less intensive 2-year phase focusing on relapse prevention and maintenance of lifestyle changes. Outcome measures Physiologic and behavioral variables were analyzed at baseline and at 2 years after baseline. This article reports the combined 2-year outcome data from both retirement communities. Results of an additional follow-up 1 year after intervention was withdrawn are reported for the initial intervention community. Statistical analysis A within-subjects repeated measures analysis of variance design was used to test for significant changes in weight and lipid values over time. Results At 2 years, 70% of those who started the intervention remained actively enrolled. This group showed significant decreases in body mass index (−1.2, P<.001) and glucose level (−0.80 mmol/L, P<.001). Although high-density lipoprotein cholesterol (HDL-C) levels had increased at 40 weeks after baseline, this was not maintained at 2 years. At the 3-year follow-up, changes in body mass index and glucose level were maintained. Applications/conclusions The purpose of this article was to describe the long-term outcomes of a community-based weight-reduction intervention for older adults. The findings may be of interest to clinicians who design community or worksite weight-reduction programs. Although the intervention was designed to be a low-intensity program, attrition over the length of the study was still problematic. Nevertheless, our follow-up study indicates that this intervention was efficacious in maintaining reductions in weight and glucose levels for overweight older adults for 3 years. J Am Diet Assoc. 1998;98:1276–1281.

Sex Comparisons in Life Satisfaction and Psychosocial Adjustment Scores with an Older Adult Sample: Examining the Effect of Sex Role Differences in Older Cohorts

ABSTRACT The present study examined how sex and other individual-difference factors (i.e., age level, locus of control orientation, and self-actualization subscale scores) relate to older adults' scores on life satisfaction and psychosocial adjustment. Seventy-eight older adults (n = 39 females) were recruited from independent-living retirement communities located in Pennsylvania. Results indicated that females in the sample were not significantly different in mean life satisfaction scores but were significantly lower in mean psychosocial adjustment scores than males in the sample. There were no significant age-level differences in mean scores. Qualitative data from unstructured post-testing interviews revealed that women were more likely to express regret and sometimes frustration toward perceived “missed opportunities” in life (e.g., career) due to expected social roles of being a wife and mother in the decades ranging from the 1920s through the 1960s; these feelings of regret or frustration were not expressed by any of the males in the study.

A Fatality Involving Zolpidem

An elderly woman residing in an independent-living retirement community was found dead in the bathtub. She had a history of depression and was prescribed Ambien (generic name zolpidem) for the treatment of insomnia. Two empty prescription bottles of Ambien were found; both were for 10-mg tablets with a total quantity of 60. A postmortem examination was conducted, and blood, urine, and gastric contents were submitted for toxicology screening. The cause of death was drowning. The only remarkable toxicology finding was zolpidem. Quantitative analysis by gas chromatography-mass spectrometry determined the following concentrations of zolpidem: blood, 7.9 micrograms/mL and urine, 4.1 micrograms/mL. A total of 7 mg unabsorbed zolpidem was found in the gastric contents. Our findings report the highest blood concentration of zolpidem reported to date and corroborate other studies that imply that death due solely to overdosage of zolpidem is an unlikely occurrence.