Sample Of Community-dwelling Adults Research Articles

The effects of neighborhood disadvantage and adverse childhood experiences on conditioned pain modulation in adults with chronic low back pain

Chronic low back pain (cLBP) remains a major health crisis worldwide. Current conceptualizations of cLBP utilize the biopsychosocial model, yet research on social factors remains limited. Adverse childhood experiences (ACEs) are a risk factor for a variety of chronic health problems, including cLBP. However, the extent to which socioeconomic context might influence associations between ACEs and cLBP remains unclear. Socioeconomic factors such as healthcare access and living conditions, which cluster at the neighborhood level, may affect how ACEs relate to cLBP in adulthood. This study examined (1) the relationship between ACEs and conditioned pain modulation (CPM), and (2) the moderating effect of area-level deprivation index (ADI) in a sample of community-dwelling adults with cLBP. 183 adults with cLBP (53% female, 62.8% non-Hispanic Black) reported on ACEs, ADI, sociodemographics, and completed experimental testing of conditioned pain modulation (CPM). Greater ACEs were associated with a less efficient CPM response for individuals residing in low neighborhood deprivation (p < 0.01). ACEs were not significantly associated with CPM for those residing in average (p = 0.31) or high deprivation (p = 0.15). Our findings suggest that a history of ACEs is associated with diminished ability to inhibit pain, especially among individuals living in less deprived neighborhoods. The association between ACEs and CPM was weakest for the portion of our sample residing in neighborhoods with the most deprivation. People from disadvantaged backgrounds may experience numerous psychosocial stressors that hinder CPM, making it difficult to assess the specific impact of ACEs on CPM. Trial registrationThis study utilized baseline data collected as part of a parent trial titled “Examining Racial and SocioEconomic Disparities in Chronic Low Back Pain” (ERASED - ClinicalTrials.gov ID: NCT03338192). PerspectiveThis study demonstrates that early life adversity is associated with abnormal endogenous pain modulation, particularly for participants who live in neighborhoods characterized by less deprivation.

WITHDRAWN: Mitochondrial oxygen respiration is associated with loneliness in a sample of community-dwelling adults

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MHealth to Support Outdoor Gym Resistance Training: The ecofit Effectiveness RCT

In Australia, 45% of adults meet the aerobic recommendations, and only 9%-30% meet the resistance training guidelines. Given the lack of at-scale community-based interventions promoting resistance training, the aim of this study was to assess the impact of an innovative mHealth intervention on upper- and lower-body muscular fitness, cardiorespiratory fitness, physical activity, and social-cognitive mediators among a sample of community-dwelling adults. Researchers evaluated the community-based ecofit intervention using a cluster RCT from September 2019 to March 2022 in 2 regional municipalities of New South Wales, Australia. Researchers recruited a sample of 245 participants (72% female, aged 53.4±13.9 years) who were randomized to the ecofit intervention group (n=122) or waitlist control (n=123) group. The intervention group received access to a smartphone application with standardized workouts tailored to 12 outdoor gym locations and an introductory session. Participants were encouraged to perform at least 2 ecofit workouts per week. Primary and secondary outcomes were assessed at baseline, 3 months, and 9 months. The coprimary muscular fitness outcomes were evaluated using the 90-degree push-up and the 60-second sit-to-stand test. Intervention effects were estimated using linear mixed models accounting for group-level clustering (participants could enroll in groups of up to 4). Statistical analysis was conducted in April 2022. Statistically significant improvements were observed in upper (1.4 repetitions, 95% CI=0.3, 2.6, p=0.018) and lower (2.6 repetitions, 95% CI=0.4, 4.8, p=0.020) body muscular fitness at 9 months but not at 3 months. Increases in self-reported resistance training, resistance training self-efficacy, and implementation intention for resistance training were statistically significant at 3 and 9 months. This study has shown that a mHealth intervention promoting resistance training using the built environment can improve muscular fitness, physical activity behavior, and related cognitions in a community sample of adults. This trial was preregistered with the Australian and New Zealand Clinical Trial Registry (ACTRN12619000868189).

Psychometric Validation of the Brief-COPE Scale in a Sample of Individuals with Multiple Sclerosis: A Brief Report

People with multiple sclerosis (MS) must often cope with high levels of stress, especially during the ongoing COVID-19 pandemic. The Brief-COPE is commonly used to assess how individuals use different coping strategies to deal with stressful life situations, but its application with people who have MS has not been validated. The purpose of this study was to assess the measurement structure and psychometric properties of the Brief-COPE in a sample of community-dwelling adults with multiple sclerosis, using exploratory factor analysis. Results revealed a three-factor measurement structure: (a) flexible coping, (b) succumbing coping, and (c) substance use coping. Correlations among these three factors and external measures of related concepts provided evidence of the validity of these factors. The Brief-COPE can be incorporated in rehabilitation counseling, mental health, and health care settings to assess coping strategies, assisting people with MS with managing stressful life events during and after the pandemic. Rehabilitation and health researchers can use it to assess the effectiveness of psychosocial interventions aimed to improve coping abilities and mental health of people with MS.

Relationship between physical frailty, nutritional risk factors and protein intake in community-dwelling older adults.

Physical frailty may compromise physical function and reduce self-reliance in community-dwelling older adults. We investigated if nutritional risk factors and protein intake were associated with physical frailty in community-dwelling adults. This cross-sectional study combined data from two studies in community-dwelling adults ≥65 years. Variables included physical frailty (SHARE-FI75+), nutritional risk factors (dysphagia, poor dental status, illness, unintentional weight loss, low and high BMI), chronic diseases, physical function, and protein intake (4-day food records). Logistic regression analyses were performed to investigate the association between physical frailty, number of nutritional risk factors and specific nutritional risk factors, and between physical frailty and protein intake. A total of 1430 participants were included in the study of these n=860 were ≥80 years. Having one, two or more nutritional risk factors increased odds of physical pre-frail/frail condition (adjusted OR 1.39 95% CI 1.07-1.80; OR 2.67 1.76-4.04, respectively). Unintentional weight loss, poor dental status, dysphagia, and high BMI independently increased odds of physical pre-frail/frail condition. In participants ≥80 years two or more nutritional risk factors were associated with physical pre-frail/frail condition (adjusted OR 2.56 95%CI 1.45-4.52) and high BMI increased odds of physical pre-frail/frail condition independently. Higher intakes of protein did not significantly reduce odds of physical pre-frail/frail condition (adjusted OR 0.23 95% CI 0.05-1.09) in this sample of community-dwelling adults ≥80 years. Nutritional risk factors were independently associated with physical pre-frail/frail condition in community-dwelling older adults. Tackling nutritional risk factors offers an opportunity in primary prevention of malnutrition and physical frailty.

Deinstitutionalization from the perspective of community-dwelling adults with a severe mental illness in Amsterdam: a cohort study protocol

BackgroundPeople with a severe mental illness (SMI) increasingly receive ambulatory forms of care and support. The trend of deinstitutionalization accelerated in the Netherlands from 2008 and onwards without sufficient understanding of its consequences. The study protocol herein focuses on deinstitutionalization from the perspective of adults with an SMI living within the community in Amsterdam and aims at delivering better insight into, amongst others, their recovery, quality of life, societal participation and needs for care and support.MethodsA cohort design will be used. A representative sample of community-dwelling adults with an SMI, including those in care (n = 650) and not in care (n = 150), will be followed over time. During a two-year time period, participants will be interviewed twice using a wide-ranging set of validated instruments. Interview data will be matched with administrative data about the care process, as retrieved from their patient files. Primary outcomes are changes over time in recovery, societal participation and quality of life, controlled for the occurrence of adverse life-events during follow-up. Additionally, prevalence estimates of and associations between social functioning, safety and discrimination, substance use and health indicators will be investigated.DiscussionThe study protocol aims at delivering a comprehensive insight into the needs of community-dwelling adults with an SMI based on which ambulatory care and support can best be provided to optimally promote their social recovery and well-being.

Epigenome-wide DNA methylation profiling of conditioned pain modulation in individuals with non-specific chronic low back pain

BackgroundThe pathoanatomic cause of chronic low back pain (cLBP) cannot be identified for up to 90% of individuals. However, dysfunctional processing of endogenous nociceptive input, measured as conditioned pain modulation (CPM), has been associated with cLBP and may involve changes in neuronal gene expression. Epigenetic-induced changes such as DNA methylation (DNAm) have been associated with cLBP.MethodsIn the present study, the relationship between CPM and DNAm changes in a sample of community-dwelling adults with nonspecific cLBP (n = 48) and pain-free controls (PFC; n = 50) was examined using reduced representation bisulfite sequencing. Gene ontology (GO) term enrichment and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis were applied to identify key pathways involved in efficient versus deficient CPM.ResultsBased on CPM efficiency, we identified 6006 and 18,305 differentially methylated CpG sites (DMCs) with q values < 0.01 among individuals with cLBP and PFCs, respectively. Most of the DMCs were hypomethylated and annotated to genes of relevance to pain, including OPRM1, ADRB2, CACNA2D3, GNA12, LPL, NAXD, and ASPHD1. In both cLBP and PFC groups, the DMCs annotated genes enriched many GO terms relevant to pain processing, including transcription regulation by RNA polymerase II, nervous system development, generation of neurons, neuron differentiation, and neurogenesis. Both groups also enriched the pathways involved in Rap1-signaling, cancer, and dopaminergic neurogenesis. However, MAPK-Ras signaling pathways were enriched in the cLBP, not the PFC group.ConclusionsThis is the first study to investigate the genome-scale DNA methylation profiles of CPM phenotype in adults with cLBP and PFCs. Based on CPM efficiency, fewer DMC enrichment pathways were unique to the cLBP than the PFCs group. Our results suggest that epigenetically induced modification of neuronal development/differentiation pathways may affect CPM efficiency, suggesting novel potential therapeutic targets for central sensitization. However, CPM efficiency and the experience of nonspecific cLBP may be independent. Further mechanistic studies are required to confirm the relationship between CPM, central sensitization, and nonspecific cLBP.

Relationship of smoking with current and future social isolation and loneliness: 12-year follow-up of older adults in England.

SummaryBackgroundSmoking is often colloquially considered “social”. However, the actual relationship of smoking with current and future social isolation and loneliness is unclear. We therefore examined these relationships over a 12-year follow-up.MethodsIn this cohort study, we used a nationally representative sample of community dwelling adults aged 50 years and over from the English Longitudinal Study of Ageing (N=8780) (45% male, mean(SD) age 67(10) years. We examined associations of self-reported smoking status at baseline assessment, with social isolation (low social contact, social disengagement, domestic isolation), and loneliness (3-item UCLA loneliness scale), measured at baseline, and follow-up at 4, 8 and 12 years, using ordinary least squares regression models.FindingsAt baseline, smokers were more likely to be lonely (coef.=0·111, 95% CI 0·025 – 0·196) and socially isolated than non-smokers, having less frequent social interactions with family and friends (coef.= 0·297, 95%CI 0·148 – 0·446), less frequent engagement with community and cultural activities (coef.= 0·534, 95%CI 0·421 – 0·654), and being more likely to live alone (Odds Ratio =1·400, 95%CI 1·209 – 1·618). Smoking at baseline was associated with larger reductions in social contact (coef.=0·205, 95%CI 0·053 – 0·356, to 0·297, 95%CI 0·140 – 0·455), increases in social disengagement (coef.=0·168, 95%CI 0·066 – 0·270, to coef.=0·197, 95%CI 0·087 – 0·307), and increases in loneliness (coef.=0·105, 95%CI 0·003 – 0·207), at 4-year follow-up) over time. No association was found between smoking and changes in cohabitation status. Findings were independent of all identified confounders, including age, sex, social class and the presence of physical and mental health diagnoses.InterpretationSmoking is associated with the development of increasing social isolation and loneliness in older adults, suggesting smoking is detrimental to aspects of psychosocial health. The idea that smoking might be prosocial appears a misconception.FundingUK Economic and Social Research Council & Imperial College London.

The Relationship between Social Isolation and Sense of Community among Older Adults in Puerto Rico

Psychological sense of community (SOC) is linked to key health and wellbeing outcomes for older adults and among Latin American populations. Prior research shows that social factors may affect SOC, but this has yet to be studied among Puerto Rican older adults. This study draws on Social Resource Theory to test the hypothesis that social isolation is associated with SOC among older adults in Puerto Rico. We collected data through face-to-face interviews in a non-probability sample of community dwelling adults aged 60+ throughout Puerto Rico in 2019-2020 (N = 154). We measured social isolation with the Spanish translation of the LSNS-6 (range 0-30, mean= 14.00, SD= 5.99), where higher scores indicate less isolation, and SOC with the Spanish translation of the Brief Sense of Community Scale (range 0-32, mean= 24.75, SD= 6.04). This cross-sectional study used multiple linear regression to test the association between social isolation and SOC, while controlling for gender, age, income and living arrangement. Higher scores on the LSNS-6 were associated with higher SOC (β=0.31, SE=0.08, p<0.001). Among the sociodemographic covariates, increased age was associated with higher SOC (β=0.12, SE=0.05, p<0.05). This study demonstrates that older adults in Puerto Rico who are more socially isolated have lower SOC, and that SOC increases with age. In order to promote SOC in this population, interventions should focus on reducing social isolation and may benefit from targeting young-old older adults. Future research should continue to examine these relationships and extend to other Latin American cultures.

Visual Impairment, Eye Disease, and 3-Year Cognitive Decline: The Canadian Longitudinal Study on Aging

ABSTRACT Purpose To examine the longitudinal association between vision-related variables and the 3-year change in cognitive test scores in a community-dwelling sample of adults and to explore whether sex, education, or hearing loss act as effect modifiers. Methods Data came from two waves of a 3-year population-based prospective cohort study (Canadian Longitudinal Study on Aging), which consisted of 30,097 randomly selected people aged 45–85 years from 7 Canadian provinces. Visual impairment (VI) was defined as binocular presenting visual acuity worse than 20/40. Participants were asked if they had ever had a diagnosis of age-related macular degeneration (AMD), glaucoma, or cataract. Cognitive change over 3 years was examined by calculating the difference between baseline and follow-up scores for the Rey Auditory Verbal Learning Test (RAVLT) and the RAVLT delayed test (memory tests), the Controlled Oral Word Association Test (COWAT) and the Animal Naming Test (ANT) (verbal fluency tests), and the Mental Alternation Test (MAT) (processing speed test). Multiple linear regression was used. Results VI, AMD, and cataract were not associated with 3-year changes on any of the 5 cognitive tests after adjusting for age, sex, ethnicity, education, income, smoking, diabetes, stroke, heart disease, and province. A report of glaucoma was associated with greater declines in MAT scores (β = -0.60, 95% CI -1.03, -0.18). No effect modification was detected. Conclusions Glaucoma was associated with worsening processing speed. Further research to confirm this finding and to understand the possible reason is necessary.

Attached to Virtual Dreams: The Mediating Role of Maladaptive Daydreaming in the Relationship Between Attachment Styles and Problematic Social Media Use.

Maladaptive daydreaming describes excessive fantasy activity that interferes with an individual's life. Surprisingly, the precursors of maladaptive daydreaming and its role in excessive involvement in virtual worlds have been scarcely investigated. In the current study, we examined the relationships among attachment styles, maladaptive daydreaming, and problematic social media use (PSMU) in a sample of community-dwelling adults. Eight hundred seventy-seven participants between 18 and 68 years old were recruited via an online survey and asked to fill out self-reported measures on attachment styles, maladaptive daydreaming, and PSMU. Mediation analyses showed that maladaptive daydreaming is a significant mediator in the relationships between preoccupied and fearful attachment styles and PSMU, suggesting that maladaptive daydreaming partly explains the established link between insecure attachment styles and excessive use of social media. Individuals with PSMU fostered by maladaptive daydreaming may benefit from clinical interventions that promote the use of adaptive regulatory strategies to develop feelings of security and self-confidence that may serve to reduce the excessive involvement in social media.

Factors Associated with Medication-Related Burden Quality of Life (MRB-QoL) in Community-Dwelling Adults with Long-Term Conditions: An Exploratory Study.

BackgroundThe Medication-Related Burden Quality of Life (MRB-QoL) tool has been developed to measure the burden of medications on functioning and wellbeing from a patient perspective. However, predictors of MRB-QoL were not reported in greater detail in the validation study. This study aimed to explore factors associated with MRB-QoL to see whether there is any new information that calls for further research.MethodsAnalysis of data from the MRB-QoL validation study was undertaken. Outcome variables were domains of the MRB-QoL (Routine and Regimen Complexity, Psychological Burden, Functional and Role Limitation, Therapeutic Relationship, and Social Burden). Explanatory variables were patient age; disease-related factors; and medication-related factors, such as number of medications, complexity of medication regimen (measured by the Medication Regimen Complexity Index [MRCI]), and exposure to medications with anticholinergic and sedative effects (measured by the Drug Burden Index [DBI]). Linear regression analyses were used to identify factors associated with the MRB-QoL.ResultsThe study included 367 participants (52.1% male), with a median age of 64 years. In multivariable regression analyses, an increase in the DBI was significantly associated with poorer Psychological wellbeing (β=−0.15, p<0.001) and Functional and Role Limitation (β=−1.79, p<0.001). Living with three or more medical conditions was significantly associated with poorer Psychological wellbeing (β=−0.21, p<0.001). Age was significantly associated with all domains of the MRB-QoL (β=0.28 to 0.55). Polypharmacy and MRCI were not associated with any of the MRB-QoL domains.ConclusionIn this sample of community-dwelling adults with multiple medications, the DBI was independently associated with the Psychological Burden and Functional and Role Limitation domains of the MRB-QoL. This study provides preliminary evidence on factors affecting medication-related quality of life outcomes from a patient perspective. Future longitudinal studies, along with further psychometric testing of the MRB-QoL measure, are warranted to better understand predictors of MRB-QoL.

A performance-based measure of emotion response control: A preliminary MRI study.

Identifying performance-based assessments of emotion regulation is needed for the study of myriad mood and neurological disorders. Color and form responses on the Rorschach Inkblot Method are valid measures of emotion response control, but have not been studied in relation to known neural correlations of emotion regulation. A discrepancy of color (CF+C) greater than form (FC) responses suggests low cognitive control over emotional responses. This preliminary report explores the discrepancy between form-color responses as a correlate of regional cortical thickness. A sample of community-dwelling adults were administered the Rorschach Inkblot Method and participated in a structural MRI scan. Greater middle frontal cortex thickness was associated with a positive discrepancy score [(CF+C) - FC], indicating less emotion response control (rs =0.48, p<0.05); a moderate, non-significant correlation was also observed with insula cortex (rs =0.42, p=0.07).The results provide evidence in support of the Rorschach Inkblot Method as a valid behavioral measure of emotion response control. More specifically, these results support the use of color-related variables included in contemporary evidence-based Rorschach methods. The results are discussed with implications for the study of emotion regulation in mood disorders and sensitivity analyses based on the observed effect sizes are reported to inform future study planning.

Is Smoking Social? The Relationship of Smoking with Current and Future Social Isolation and Loneliness: 12-Year Follow-Up of 8,780 Older Adults in England

Background: Smoking is often colloquially considered “social”. However, the relationship between smoking with current and future social isolation and loneliness is unclear. Therefore, we examined these relationships over a 12-year follow-up. Methods: In this cohort study, we used a nationally representative sample of community dwelling adults aged 50 years and over from the English Longitudinal Study of Ageing (N=8780) (45% male, mean age of 67 years, standard deviation of 10). We examined associations of self-reported smoking status at baseline assessment, with social isolation (low social contact, social disengagement, domestic isolation), and loneliness (3-item UCLA loneliness scale), measured at baseline, and follow-up at 4, 8 and 12 years after. Findings: At baseline, smokers were more likely to be lonely and socially isolated than non-smokers, having less frequent social interactions with family and friends, having less frequent engagement with community and cultural activities, and being more likely to live alone. Smoking at baseline was associated with larger reductions in social contact, increases in social disengagement, and loneliness over time. No evidence was found for the association between smoking and changes in cohabitation status. These findings were independent of all identified confounders, including age, sex, social class and the presence of physical and mental health diagnoses. Interpretation: Smoking is associated with the development of increasing social isolation and loneliness in older adults. The idea that smoking might be prosocial appears a misconception. The intersection of these public health priorities requires further attention. Funding: UK Economic and Social Research Council & Imperial College London. Declaration of Interests: All authors have completed the ICMJE uniform disclosure form and declare: support from the National Institute of Ageing, a consortium of UK government departments coordinated by the Economic and Social Research Council; Imperial College London; and the Wellcome Trust for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years, no other relationships or activities that could appear to have influenced the submitted work. Ethics Approval Statement: The study received ethical approval from the National Research Ethics Service and all participants provided informed consent.

Abstract 15085: Association Between Bone Mineral Density and Incident Heart Failure in a Biracial Cohort of Older Adults: The Health, Aging, and Body Composition Study

Background: Osteoporosis and heart failure (HF) are age-related disorders that share some pathogenetic features and may influence each other. Previous studies have suggested an association between bone mineral density (BMD) and HF risk, which may be race-dependent. We sought to further investigate race- and sex-specific associations of BMD with HF in a longitudinal study of older adults. Methods: We evaluated the relationship between BMD and HF in the Health, Aging, and Body Composition study, a sample of community-dwelling adults aged 70-79. BMD was measured by dual-energy X-ray absorptiometry (DXA) of the total hip and femoral neck, and in half the cohort by computed tomography of the spine. Analyses were stratified a priori by sex and race, and Cox models were used to estimate risk after adjustment for potential confounders. Results: Of 2835 participants, 572 (49% women, 42% black) developed HF during a median follow up of 12.2 years. Lower BMD of the total hip by DXA was associated with higher risk of HF in black women (adj. HR 1.84 [95% CI, 1.43 - 2.37] per SD decrement), with suggestion of lower risk in black men that was not significant (adj. HR 0.81 [0.64 - 1.02]). Corresponding analyses failed to reveal significant associations in white women (adj. HR 0.86 [0.71-1.04]) or white men (adj. HR 1.10 [0.93 - 1.30]). There were a significant interaction of total hip BMD by sex among blacks (p=0.002), but not whites (p=0.363), as well as by race among women (p=0.026) and men (p=0.049). Relationships of BMD of the femoral neck were similar in all groups. Likewise, lower volumetric BMD of the spine was associated with higher risk in black women (adj. HR 1.34 [1.02 - 1.77] per SD decrement), but there were no significant associations in black men (adj. HR 0.91 [0.78 - 1.18]), white women (adj. HR 0.83 [0.64 - 1.08]), or white men (adj. HR 1.17 [0.95 - 1.44]). Conclusions: Among a biracial cohort of older adults, lower BMD was associated with higher risk of HF in black women, with no clear evidence of an association in white women or in men of either race. Further research is needed to understand the factors that may account for the particular association in black women, and whether these can be leveraged for therapeutic intervention.

Patient Activation Among Community-Dwelling Persons Living With Chronic Obstructive Pulmonary Disease.

Vigilant self-management is associated with positive health outcomes in people living with chronic obstructive pulmonary disease (COPD), yet the predictors of activated self-managers are not well understood. The aims of the study were to identify and describe the predictors of patient activation among a sample of community-dwelling adults with COPD in the United States. A postal survey of demographic, mood, symptom, function, health perception, life quality measures, and the patient activation measure was completed by 64 participants. Descriptive and inferential statistics were used to examine and describe associations between personal characteristics, health outcomes, and patient activation measure scores (0-100). Multivariate, linear regression analysis was conducted to identify predictors of patient activation score. Patient activation was high among the sample. Multivariate analysis revealed positive affect, smoking pack-years, overall quality of life, and female gender collectively explained 45.4% of the variance in patient activation. Positive life view, gender, and lifestyle factors present novel predictors of high activation in self-managers of COPD that warrant explication through future research.

Who worries about specific phobias? – A population-based study of risk factors

Although specific phobia is one of the most prevalent lifetime anxiety disorders, little is known about the particular risk factors related to its development. The underlying goal of this study was to analyse the risk factors associated with worrying about specific phobias (SP) in a representative sample of community dwelling adults. The sample was composed of 8461 participants (mean age 47.68 years, range 18–85, 54.60% female), from the Australian National Mental Health Survey. A total of 188 participants (2.22%) reported worrying about SPs. Multivariate logistic regression analysis indicated that female sex (odds ratio (OR) = 1.98, p < 0.0001) and a comorbid diagnosis of lifetime major depression disorder (OR = 2.80, p < 0.0001) were the factors most strongly associated with worrying about SPs. Having experienced traumatic experiences involving significant others (OR = 1.18, p = 0.02), the number of chronic diseases (OR = 1.21, p < 0.01), and a comorbid diagnosis of substance use (OR = 2.80, p = 0.02) were also associated. Our results are in line with previous studies focusing on other anxiety disorders. We provide further evidence that substance dependence appears to serve as a unique risk factor for the subsequent onset of SP. Further empirical and clinical implications are discussed.

Factor structure and gender invariance of the Beck Depression Inventory – second edition (BDI-II) in a community-dwelling sample of adults

ABSTRACT Objective: The main purpose of this study was to investigate the factor structure of the Beck Depression Inventory – Second Edition (BDI-II) in a sample of adults. Specifically, we evaluated the BDI-II based on confirmatory factor analysis of different measurement models, and compared the optimal factor structure of the BDI-II by gender using measurement invariance analysis. Method: A cross-sectional survey with 717 community-dwelling adults was conducted. The Brazilian Portuguese version of the BDI-II was administered. Seven different models (one-, two-, three-factor models and their bifactor structures) were tested through CFA. CFA and multigroup analysis were executed with the software MPLUS (Weighted Least Squares Estimator – WLSMV). Results: Four bifactor models reached acceptable fit indices. A bifactor model with two specific factors (Cognitive–Affective, and Somatic-Affective) provided the best fit to the data. The multigroup analysis of this model demonstrated invariance by gender. Conclusions: Our findings support the use of the total BDI-II score to identify depressive symptoms, including gender comparisons. Since a bifactor structure fit the data better, the scores of the specific factors should not be used as the first choice, or at least should be used with caution. The analysis of the severity of depression, based on a total score, seems to be the most appropriate option.

WHY DON’T OLDER ADULTS USE SENIOR CENTERS? EVIDENCE FROM A SAMPLE OF MASSACHUSETTS ADULTS AGE 50 AND OLDER

Senior centers are an integral community resource, providing programs and services intended to meet the vast range of needs and interests of older adults. There is a growing literature describing senior center participants and benefits to participation, but little is known about those who choose not to participate at a local senior center. This presentation uniquely characterizes non-users of senior centers, based on a sample of community-dwelling adults aged 50+ from seven communities in Massachusetts (N = 9,462). To date, this is the largest data set that describes senior center usage. Most of the sample were women (60%) and in the 60-69 age group (36%). More than three quarters of the sample do not use the local senior center (77%). The most common reasons for non-usage were lack of interest (27%) and not feeling old enough (26%). There are significant differences in reasons of non-usage among age groups and gender (p < .001). Younger age groups’ (50-69) most popular reasons for non-usage were not feeling old enough, not having time, inconvenient senior center hours, and not knowing what is offered. In contrast, older age groups (80+) more frequently reported having no interest or using programs elsewhere. Men were more likely to report not being interested and not being familiar with what is offered. Women were more likely to report not having time, inconvenient hours of programming, and using programs elsewhere. Based on results from this study, this presentation will outline implications for the future of senior centers and their programming.

ASSOCIATION OF SENSORY AND COGNITIVE IMPAIRMENT WITH HEALTHCARE UTILIZATION AND COST IN MEDICARE BENEFICIARIES

The combination of sensory and cognitive impairment is increasingly prevalent among older adults and may be an important driver of healthcare cost due to functional disability and reduced self-care. This presentation focuses on the relationship between hearing and/or vision impairment and cognitive impairment with hospital admissions and healthcare cost using data from the Medicare Current Beneficiary Survey, a nationally representative sample of community-dwelling adults. We show that the presence of sensory impairment is associated with increased risk of hospitalization regardless of dementia status. In adjusted models, annual total healthcare costs were generally higher among those with sensory impairments compared to those without sensory impairments. We will also discuss work related to the development of a prognostic model that provides estimates of hospitalization risk among older adults with self-reported hearing and/or vision impairment. This model may help inform allocation of health care resources to those at highest risk for adverse outcomes.