Rural-dwelling Adults Research Articles

Body Mass Index Category Moderates the Relationship Between Depressive Symptoms and Diet Quality in Overweight and Obese Rural-Dwelling Adults.

This study was conducted to (1) compare diet quality among depressed and nondepressed overweight and obese rural-dwelling adults and (2) determine whether body mass index (BMI) category moderates the relationship between depressive symptoms and overall diet quality. Rural adults in Kentucky (n = 907) completed the 9-item Patient Health Questionnaire (PHQ-9) that assessed depressive symptoms and a food frequency questionnaire that generated 2005 Healthy Eating Index (HEI) scores. Participants were grouped into overweight (BMI 25-29.9 kg/m2 ) and obese (≥30 kg/m2 ), and nondepressed (PHQ-9 < 10) and depressed (PHQ-9 ≥ 10) groups. Bootstrapped ANCOVAs were used to compare diet quality among the 4 groups. Ordinary least-squares regression using PROCESS was used to determine whether BMI category (overweight vs obese) moderated the association between depressive symptoms and overall diet quality. Overall diet quality was poorer in the obese depressed group than in the obese nondepressed group. Intake of fruit and dark green/orange vegetables and legumes was lower in the obese depressed group than in the overweight nondepressed group. Depressive symptoms predicted poor overall diet quality (B = -0.287, P < .001) and the relationship was moderated by BMI category (coefficient of BMI category* depressive symptom interaction term = 0.355, P < .049). A significant inverse relationship between depressive symptoms and overall diet quality was observed in the overweight group but not in the obese group. Components of diet quality vary according to BMI category and depressive symptom status. The relationship between depressive symptoms and diet quality is influenced by BMI category.

Body mass index is inversely associated with arterial stiffness in Chinese adults with primary hypertension: results from the China Stroke Primary Prevention Trial (CSPPT)

ABSTRACTBackground: This study aimed to elucidate the relationship between body mass index (BMI) and the presence of arterial stiffness in rural-dwelling Chinese adults with primary hypertension. Methods: Primary hypertension patients (n = 19,375) receiving an average of 4.5 years of antihypertension therapy were selected from the Chinese Stroke Primary Prevention Trial (mean age: 64.7 ± 7.4 years, male: 37.8%). Anthropometric, demographic, hemodynamic, and biochemical data were obtained. Arterial stiffness was assessed using brachial-ankle pulse wave velocity (baPWV). Results: BMI was inversely associated with baPWV after adjusting for gender, age, smoking, alcohol consumption, center, pulse, SBP, DBP, FBG, TC, TG, HDL-C, BUN, Scr, UA, HCY, antidiabetes treatment, lipid-lowing treatment, and antihypertensive treatment (β (SE): –10.72 (0.69), P < 0.0001). Quintile1 (Q1) was used as a reference; Q2, Q3, Q4, and Q5 groups were all inversely associated with baPWV. The β increased with increasing BMI, β (SE) was –20.29 (6.74), –30.66 (7.01), –51.82 (7.27), and –103.1 (7.62), respectively, for Q2 – Q5, P < 0.05. BMI remained inversely correlated with baPWV across differences in gender, center, blood pressure, lipid levels, and the presence or absence of diabetes subgroups. Conclusion: Increased BMI is a positive factor against the development of arterial stiffness in Chinese rural-dwelling adults with primary hypertension undergoing antihypertension treatments, after adjusting for confounding factors.

Perceived Social Determinants of Health Among Older, Rural-Dwelling Adults with Early-Stage Cognitive Impairment.

Limited access to resources and delayed detection of subtle cognitive changes may negatively impact the long-term cognitive health of rural-dwelling adults. This study explored perceived social determinants of health among older, rural-dwelling adults with early-stage cognitive impairment. Semi-structured interviews were conducted with older, rural-dwelling adults with early-stage cognitive impairment and their care partners. Thematic content analysis was performed. Participants ( n = 9) were 73.7 ± 6.0 years of age with 14.2 ± 3.1 years of education; care partners ( n = 10) were 70.9 ± 7.4 years of age with 15.6 ± 2.3 years of education. Data analysis revealed six themes: Staying active, Eating well, Living with cognitive changes, Living rural, Connecting with neighbors and community, and Relying on children. Dyads' depictions of perceived social determinants of health focused on the adoption of a healthy lifestyle, description of relationships, and advantages of living in a rural area. Emergent themes may be used to promote adoption of self-management and prevention behaviors, particularly lifestyle changes.

Effects of Home-Delivered Cognitive Behavioral Therapy (CBT) for Depression on Anxiety Symptoms among Rural, Ethnically Diverse Older Adults

ABSTRACTBackground: We examined the effects of home-delivered cognitive-behavioral therapy (CBT) for depression on anxiety symptoms in an ethnically diverse, low resource, and medically frail sample of rural, older adults.Method: This was a secondary analysis of a randomized clincial trial with 134 rural-dwelling adults 65 years and older with decreased quality of life and elevated psychological symptomatology. Anxiety symptoms were assessed with the anxiety and phobic anxiety subscales of the Symptom Checklist-90-Revised (SCL-90-R).Results: Compared to a minimal support control condition, CBT for depression resulted in significantly greater improvements in symptoms of anxiety and phobic anxiety from pre-treatment to post-treatment.Conclusion: Home-delivered CBT for depression can be an effective treatment for anxiety in a hard-to-reach older populations.Clinical Implications: Additional research should explore integrated anxiety and depression protocols and other treatment modalities, including bibliotherapy or telehealth models of CBT, to reduce costs associated with its in home delivery. Flexibility in administration and adaptations to the CBT protocol may be necessary for use with vulnerable, rural older adults.

Differences in Benzodiazepine Receptor Agonist Use in Rural and Urban Older Adults.

BackgroundOlder adults are especially susceptible to adverse consequences of potentially inappropriate medications (PIMs), such as benzodiazepine receptor agonists (BZDRAs), due to age-related pharmacokinetic and pharmacodynamic changes. Although some risk factors for BZDRA use in older adults have been identified, the role of rural versus urban residence is less clear.ObjectiveTo describe BZDRA use in rural versus urban older adults using pharmaceutical claims from Pennsylvania’s Pharmaceutical Assistance Contract for the Elderly (PACE) program.MethodsThe sample consisted of older adults enrolled in Pennsylvania’s Healthy Steps for Older Adults and participated in Pennsylvania’s PACE program. Independent sample t tests and contingency tables were used to examine residence differences. Multivariate binary logistic modeling was performed.ResultsThe total sample (N = 426) was 305 (71.6 %) urban-dwelling adults and 121 (28.4 %) rural-dwelling adults. Rural participants were more likely to be male, white, married, and have less than a high school education compared with urban participants (p <.01). Specifically, 25 % of rural-dwelling adults received a BZDRA compared with 15 % of urban-dwelling adults (p = 0.02). Three variables reached statistical significance for predicting BZDRA use in a multivariate model: rural residence (OR 2.58, 95 % CI 1.39–4.79), history of anxiety/depression (OR 4.20, 95 % CI 2.39–7.46), and number of medications (OR 1.11, 95 % CI 1.02–1.21).ConclusionsBZDRA prescription differences in older, rural-dwelling adults further highlights the need for geriatric and mental health specialists to provide specialized care to this population. Rural healthcare professionals may be less aware of PIMs for older adults, and initiatives to support geriatric services and provide education for existing providers may be beneficial.

Effects of Telephone-Delivered Cognitive-Behavioral Therapy and Nondirective Supportive Therapy on Sleep, Health-Related Quality of Life, and Disability

The purpose of this study was to compare the effects of cognitive-behavioral therapy delivered by telephone (CBT-T) and telephone-delivered nondirective supportive therapy (NST-T) on sleep, health-related quality of life, and physical disability in rural older adults with generalized anxiety disorder. This was a secondary analysis of a randomized clinical trial on 141 rural-dwelling adults 60 years and older diagnosed with generalized anxiety disorder. Sleep was assessed with the Insomnia Severity Index. Health-related quality of life was assessed with the 36-item Short-Form Health Survey (SF-36). Physical disability was assessed with the Pepper Center Tool for Disability. Assessments occurred at baseline, 4 months, 9 months, and 15 months. Insomnia declined in both groups from baseline to 4 months, with a significantly greater improvement among participants who received CBT-T. Similarly, Mental and Physical Component Summaries of the SF-36 declined in both groups, with a differential effect favoring CBT-T. Participants in both interventions reported declines in physical disability, although there were no significant differences between the two interventions. Improvements in insomnia were maintained at the 15-month assessment, whereas between-group differences shrank on the Mental and Physical Component Summaries of the SF-36 by the 15-month assessment. CBT-T was superior to NST-T in reducing insomnia and improving health-related quality of life. The effects of CBT-T on sleep were maintained 1 year after completing the treatment.

Arsenic exposure, AS3MT polymorphism, and neuropsychological functioning among rural dwelling adults and elders: a cross-sectional study

BackgroundThe aim was to examine the link between low-level arsenic exposure and cognitive functioning, and the potential role of a single nucleotide polymorphism (SNP A35991G, rs10748835) of the AS3MT gene in modifying this link.MethodsData were analyzed on 526 participants from Project FRONTIER. Hierarchical linear regressions were created with neuropsychological raw index scores as the outcome variable and arsenic exposure and AS3MT SNP as different predictor variables.ResultsWithin the total sample, arsenic exposure was negatively associated with language (p < 0.001) and executive functioning (p < 0.001). Among those with the AA genotype of the AS3MT gene, arsenic levels were negatively associated with language (p < 0.001), attention (p = 0.01), and executive functioning (p = 0.04). Among those with the AG genotype, arsenic levels were positively associated with immediate (p = 0.04) and delayed memory (p < 0.001) and negatively associated with executive functioning (p = 0.03). Among those with the GG genotype, arsenic levels were negatively associated with visuospatial functioning (p = 0.02).ConclusionsLow-level arsenic exposure is associated with cognitive functioning; however, this association is modified by an AS3MT gene.

Web- vs telehealth-based delivery of cognitive behavioral therapy for insomnia: a randomized controlled trial

ObjectivesThe purpose of our study was to evaluate and compare two methods of service delivery (web-based and telehealth-based) for chronic insomnia with regard to patient preference, clinical effectiveness, and patient satisfaction. MethodsOur study was a randomized controlled trial with manualized telehealth- and web-based delivery conditions (nonblinded). The sample comprised 73 adults with chronic insomnia. Participants received web-based delivery from their homes or telehealth-based delivery from a nearby clinic. Both interventions consisted of identical psychoeducation, sleep hygiene and stimulus control instruction, sleep restriction treatment, relaxation training, cognitive therapy, mindfulness meditation, and medication-tapering assistance. ResultsUsing a linear mixed model analysis, results showed that both delivery methods produced equivalent changes in insomnia severity, with large effect sizes. Attendance patterns favored telehealth, whereas homework adherence and preference data favored web-based delivery. ConclusionsWeb- and telehealth-based delivery are both helpful in treating chronic insomnia in rural-dwelling adults.

The Influence of Rural Home and Neighborhood Environments on Healthy Eating, Physical Activity, and Weight

Despite the recognition that environments play a role in shaping physical activity and healthy eating behaviors, relatively little research has focused on rural homes and neighborhoods as important settings for obesity prevention. This study, conducted through community-based participatory research, used a social ecological model to examine how home and neighborhood food and physical activity environments were associated with weight status among rural-dwelling adults. Data were from a cross-sectional survey of White and African American adults (n = 513) aged 40-70years living in rural southwest Georgia. Data were analyzed using measured variable path analysis, a form of structural equation modeling. The results support a social ecological approach to obesity prevention. Physical activity had a direct effect on BMI; self-efficacy, family support for physical activity, and household inventory of physical activity equipment also had direct effects on physical activity. Neighborhood walkability had an indirect effect on physical activity through self-efficacy and family social support. Although neither fruit and vegetable intake nor fat intake had direct effects on BMI, self-efficacy and household food inventories had direct effects on dietary behavior. Perceived access to healthy foods in the neighborhood had an indirect effect on healthy eating and a direct effect on weight; neighborhood cohesion had an indirect effect on healthy eating through self-efficacy. Overall, individual factors and home environments tended to exhibit direct effects on behavior, and neighborhood variables more often exhibited an indirect effect.

The Efficacy of Using Self-Monitoring Diaries in a Weight Loss Program for Chronically Ill Obese Adults in a Rural Area

Self-monitoring is part of many weight-loss programs and is widely accepted as effective. However, there is a lack of research related to the efficacy of various self-monitoring instruments in meeting the needs of individuals with limited mobility or access to healthcare providers, especially those with limited education living in rural settings. This study examined the efficacy of using self-monitoring diaries in a weight loss program targeting chronically ill and obese rural-dwelling adults. A community-based intervention program using a pretest and posttest design examined the effect of using self-monitoring diaries on weight loss. Fifty participants were enrolled from the chronic disease clinic of a district health center with limited medical resources in a remote village in southwestern Taiwan. All participants were diagnosed with diabetes and/or hypertension, had body mass indices between 27 and 32 kg/m, and had a minimum educational level of junior high school. Mean participant age was 43.7 years. Participants were randomly assigned to the intervention or control group. All attended a mandatory 12-week weight loss program. The intervention group received instructions on how to record diet and exercise details in a structured, graphics-based diary provided by the researchers. Body weight and percentage of body fat were measured before and after the program, and data were analyzed by chi-square and ANCOVA. The intervention group significantly lost more weight than the control group (5.7 kg vs. 2.1 kg; p < .05). The participants of 88% in the intervention group lost 5% or more of their baseline weight greater than the 23% in the control group. Both groups achieved the mean of body fat reductions by comparing pretest and posttest. Self-monitoring diaries can have a significant impact on weight loss in individuals living in rural communities. Healthcare providers and health promotion agencies can use the suggested checklist method to improve weight loss promotion programs in isolated rural communities with limited medical resources.

Psychological symptoms and blood pressure among rural-dwellers.

Rural-dwelling adults face different health concerns and risks than do adults living in urban areas, with reduced assess to care. Studies examining the associations between anxiety and/or depression and blood pressure have yielded mixed results. This study addressed this by examining the association of these symptoms to blood pressure in men compared to women, and for differing racial groups in a rural population in the western United States. Analyses indicate the association between depression and blood pressure differs by race. Further, depressive symptoms were associated with higher diastolic blood pressure for participants at or above the mean of anxiety.

Higher Groundwater Selenium Exposure Is Associated with Better Memory: A Project FRONTIER Study

Background: Exposure to elements in groundwater (toxic or beneficial) is commonplace yet, outside of lead and mercury, little research has examined the impact of many commonly occurring exposures on mental abilities during the aging process. Selenium has antioxidant properties as part of the glutathione peroxidase system and may have protective effects on memory abilities. Objectives: To investigate the relationship of groundwater selenium exposure to neuropsychological status. Method: Analysis of data from 484 participants (148 men and 336 women) of Project FRONTIER, a community-based participatory research study of the epidemiology of health issues of rural-dwelling adults and elders. Results: Estimated selenium exposure (current and long-term) was specifically related to memory functioning without relation to other neurocognitive domains. The significant, positive link between selenium and memory (Immediate and Delayed) scores held regardless of APOE4 status as well as when the sample was restricted to only those without cognitive dysfunction. Current selenium was also associated with significantly reduced risk of cognitive decline prospectively. Conclusions: Higher selenium levels were associated with better memory functioning as well as reduced risk of cognitive decline among this community-based sample. Given the antioxidant properties of selenium, and the well-documented link between oxidative stress and the development of cognitive dysfunction and Alzheimer’s disease, additional research is necessary to determine the utility of groundwater selenium monitoring as a potential population-wide prevention effort against Alzheimer’s disease.

Assessing Health Literacy in Heart Failure Patients

Background Health literacy has important implications for health interventions and clinical outcomes. The Shortened Test of Functional Health Literacy in Adults (S-TOFHLA) is a timed test used to assess health literacy in many clinical populations. However, its usefulness in heart failure (HF) patients, many of whom are elderly with compromised cognitive function, is unknown. We investigated the relationship between the S-TOFHLA total score at the recommended 7-minute limit and with no time limit (NTL). Methods and Results We enrolled 612 rural-dwelling adults with HF (mean age 66.0 ± 13.0 years, 58.8% male). Characteristics affecting health literacy were identified by multiple regression. Percentage of correct scores improved from 71% to 86% (mean percent change 15.1 ± 18.1%) between the 7-minute and NTL scores. Twenty-seven percent of patients improved ≥1 literacy level with NTL scores ( P < .001). Demographic variables explained 24.2% and 11.1% of the variance in % correct scores in the 7-minute and the NTL scores, respectively. Female gender, younger age, higher education, and higher income were related to higher scores. Conclusion Patients with HF may be inaccurately categorized as having low or marginal health literacy when the S-TOFHLA time limits are enforced. New ways to assess health literacy in older adults are needed.

Long-term low-level arsenic exposure is associated with poorer neuropsychological functioning: a Project FRONTIER study.

Exposure to elements in groundwater (toxic or beneficial) is commonplace yet, outside of lead and mercury, little research has examined the impact of many commonly occurring environmental exposures on mental abilities during the aging process. Inorganic arsenic is a known neurotoxin that has both neurodevelopmental and neurocognitive consequences. The aim of this study was to examine the potential association between current and long-term arsenic exposure and detailed neuropsychological functioning in a sample of rural-dwelling adults and elders. Data were analyzed from 434 participants (133 men and 301 women) of Project FRONTIER, a community-based participatory research study of the epidemiology of health issues of rural-dwelling adults and elders. The results of the study showed that GIS-based groundwater arsenic exposure (current and long-term) was significantly related to poorer scores in language, visuospatial skills, and executive functioning. Additionally, long-term low-level exposure to arsenic was significantly correlated to poorer scores in global cognition, processing speed and immediate memory. The finding of a correlation between arsenic and the domains of executive functioning and memory is of critical importance as these are cognitive domains that reflect the earliest manifestations of Alzheimer’s disease. Additional work is warranted given the population health implications associated with long-term low-level arsenic exposure.

The differential impact of depressive symptom clusters on cognition in a rural multi-ethnic cohort: a Project FRONTIER study

To examine the differential impact of depressive symptom clusters on neuropsychological functioning in a rural-dwelling, multi-ethnic cohort. Data were analyzed for 184 participants (70% female, 46% Hispanic) who are part of an ongoing rural healthcare study, Project FRONTIER. Previously published factor scores of dysphoria, meaninglessness, apathy, and cognitive impairment from the GDS-30 were entered as predictor variables in linear regression models with RBANS Index raw scores as outcome variables. In the total sample, Dysphoria, Meaninglessness, and Cognitive Impairment were significantly associated with Immediate Memory, Language, Attention and Delayed Memory; Dysphoria was also significantly related to Visuospatial skills. When examined by gender and ethnicity, however, the findings varied with dysphoria being most related to cognitive status among men and dysphoria, meaninglessness, and cognitive impairment being most significantly related to cognitive status among women. When examined by ethnicity, dysphoria, meaninglessness, and cognitive impairment were most strongly associated with immediate and delayed memory in Hispanics. In this study of rural-dwelling adults and elders, depressive symptom clusters were differentially associated with poorer cognition with the most consistent findings being between depressive symptoms of dysphoria and meaninglessness and the cognitive domains of immediate and delayed memory.

Many Rural-dwelling Adults Are Not Meeting Physical Activity Guidelines upon Enrollment into a Long-Term Behavioral Weight Management Intervention

Many Rural-dwelling Adults Are Not Meeting Physical Activity Guidelines upon Enrollment into a Long-Term Behavioral Weight Management Intervention

Raising stroke awareness among rural dwellers with a Facts for Action to Stroke Treatment-based educational program

Stroke is the third leading cause of death in the United States with 780,000 new and/or recurrent strokes each year. Interventions aimed at the onset of stroke symptoms have been successful in decreasing long-term neurological deficits; however, providing the prompt medical interventions in rural areas involves unique challenges. To decrease time-to-treatment in rural areas, education about symptoms of stroke and the need for immediate medical attention are critical. The objective of this study was to measure the effectiveness of the Facts for Action to Stroke Treatment (FAST)-based educational intervention program focused on the improving knowledge about stroke of 402 rural-dwelling adults. Using a paired means t test, the participants had a significant increase in knowledge from pretest to posttest ( p = .000). Of those, 215 subjects participated in 2-month follow-up testing with the paired t test showing that the increased score from pretest to 2-month follow-up remained significant ( p = .000). The authors concluded that the FAST-based program was an effective tool to use when teaching recognition of stroke symptoms and the need for immediate medical intervention to rural adults.