Promoting the Congregate Meal Program to the Next Generation of Rural-Residing Older Adults

Despite a growing older adult population, Iowa Congregate Meal Program (CMP) participation has declined. Motivators and barriers to congregate mealsite participation and wellness programming preferences of baby boomers and older adults were examined to provide insight to how to revise and better promote the CMP for the next generation of older adults. Four focus group sessions were conducted with 27 primarily White, rural-residing adults, ages 48–88 years. Participation motivators included educational programs, food, and socialization while barriers included negative perceptions and stereotypes associated with congregate mealsites. Desired wellness programs were viewed as interactive and relevant. Healthcare was the leading wellness need with financial management and physical activity cited as the most-wanted topics of wellness programs. These results provide insight on factors, aside from funding, that may be adversely impacting CMP participation and identifies areas for further investigation.     

Physical activity resources and programming for substance use treatment in U.S. residential treatment programs

IntroductionRegular physical activity (PA) provides many physical and mental health benefits for people with substance use disorders (SUDs); however, multiple barriers exist integrating it into their treatment. This study examined the level of PA programming for adults in substance use residential treatment programs (RTPs) in the United States.MethodsUsing the Substance Abuse and Mental Health Services Administration's treatment locator, RTPs were identified and categorized by facility type (short-, long-term, or combined). In each state, 25% of RTPs from each facility type were randomly selected. A representative from each RTP was interviewed to identify equipment, time, space, and staff available for PA programming.ResultsOf the 193 RTPs interviewed, nearly all valued PA (89.1%) and believed their clients desired its inclusion in their treatment (89.6%). Most RTPs reported having space for PA programming (90.7%), had aerobic (52.9%) and strength training (54.9%) equipment, and included mandatory (57.0%) or optional (87.6%) time in the schedule for PA. Fewer RTPs reported having full- (24.3%) or part-time (56.8%) staff trained to lead PA programming. The most common organizational barriers were a lack of funding/resources (63.7%), space (31.6%), and staffing (11.9%). The most commonly perceived client barriers included a poor mindset/lack of motivation (55.4%), poor physical health (26.4%), client withdrawal/detoxification (14.5%), and general health issues (10.9%).ConclusionsRTPs valued PA and found unique ways to provide space, equipment, and time to offer PA programming. Future research should focus on strategies to overcome client barriers and increase staff qualified to lead PA programming.     

Criterion distances and environmental correlates of active commuting to school in children

Background

Data on barriers to physical activity in older adults in Germany are scarce. The aim of this study was to analyse barriers to physical activity in a cohort of older adults, allowing comparisons between men and women, and age groups.

Methods

1,937 older adults with a median age of 77 (range 72-93) years (53.3% female) took part in the 7-year follow-up telephone interviews of the getABI cohort. Participants who stated that they did not get enough physical activity were surveyed with respect to barriers to physical activity. Barriers were analysed for all respondents, as well as by sex and age group for cases with complete data. Multivariate logistic regression analysis was performed to evaluate differences between sexes and age groups. The level of significance (alpha < 0.05) was adjusted for multiple testing according to Bonferroni (p < .004).

Results

1,607 (83.0%) participants stated that they were sufficiently physically active. 286 participants rated their physical activity as insufficient and responded to questions on barriers to physical activity completely. The three most frequently cited barriers were poor health (57.7%), lack of company (43.0%), and lack of interest (36.7%). Lack of opportunities for sports or leisure activities (30.3% vs. 15.6%), and lack of transport (29.0% vs. 7.1%) were more frequently stated by female respondents than male respondents. These differences between men and women were significant (p = .003; p < .001) after adjustment for respondents' age. Analyses by age groups revealed that poor health was more frequently considered a barrier to physical activity by participants aged 80+ years compared to the younger age group (71.1% vs. 51.5%). This age-dependent difference was significant (p = .002) irrespective of the participants' sex.

Conclusions

The present study provides relevant data on barriers to physical activity in older adults. By revealing appreciable differences between men and women, and age groups, this study has implications for efforts to increase older adults' physical activity. Promotion and intervention strategies should consider the barriers and tailor measures to the specific needs of older adults in order to reduce their constraints to physical activity.     

Theory-based physical activity beliefs by race and activity levels among older adults

Objective. Given the benefits of physical activity and the high proportion of inactivity among older adults, the purpose was to elicit theory-based behavioral, normative, and control physical activity beliefs among 140 educationally and economically diverse older adults and compare their beliefs by race (Blacks vs. Whites) and physical activity levels (inactive/underactive vs. highly active individuals).Design. This was an elicitation study that took place in eight, mostly rural community settings in a Southeastern US state, such as Council of Aging Offices, retirement centers, and churches. Participants’ behavioral, normative, and control beliefs were elicited via in person interviews. A valid and reliable questionnaire was also used to assess their physical activity levels.Results. According to the content analysis, inactive/underactive participants reported fewer physical activity advantages than highly active participants. Common physical activity advantages between the two groups were overall health, emotional functioning, and physical functioning. Similar physical activity advantages were reported among Blacks and Whites with overall health being the most important advantage. The most common physical activity disadvantages and barriers for all four groups were falls, injuries, pain, and health issues. Inactive/underactive individuals and Blacks tended to report more disadvantages and barriers than their peers. Common physical activity supporters were family members, friends and peers, and health-care professionals.Conclusion. In their physical activity motivational programs, health promoters should reinforce physical activity benefits, social support, access to activity programs, and safety when intervening among older adults.     

Differential Programming Needs of College Students Preferring Web-Based Versus In-Person Physical Activity Programs

College students report several barriers to exercise, highlighting a need for university-based programs that address these challenges. In contrast to in-person interventions, several web-based programs have been developed to enhance program engagement by increasing ease of access and lowering the necessary level of commitment to participate. Unfortunately, web-based programs continue to struggle with engagement and less-than-ideal outcomes. One explanation for this discrepancy is that different intervention modalities may attract students with distinctive activity patterns, motivators, barriers, and program needs. However, no studies have formally evaluated intervention modality preference (e.g., web-based or in-person) among college students. The current study sought to examine the relationship between intervention modality preference and physical activity programming needs. Undergraduate students (n = 157) enrolled in psychology courses at an urban university were asked to complete an online survey regarding current activity patterns and physical activity program preferences. Participants preferring web-based physical activity programs exercised less (p = .05), were less confident in their abilities to exercise (p = .01), were less likely to endorse the maintenance stage of change (p < .01) and perceived more barriers to exercising (p < .01) than those who preferred in-person programming. Findings suggest that students preferring web-based programming may require programs that enhance self-efficacy by fostering goal-setting and problem-solving skills. A user-centered design approach may enhance the engagement (and therefore effectiveness) of physical activity promotion programs for college students.     

Promoting Sustainable Community Change in Support of Older Adult Physical Activity: Evaluation Findings from the Southeast Seattle Senior Physical Activity Network (SESPAN)

Researchers have identified as effective and worthy of broader dissemination a variety of intervention strategies to promote physical activity among older adults. This paper reports results of a community-organizing approach to disseminating evidence-based interventions in a sustainable way: The Southeast Seattle Senior Physical Activity Network (SESPAN). SESPAN was implemented in Southeast Seattle, a group of multicultural neighborhoods extending 8 miles southeast of downtown Seattle, with a population of 56,469 in 2000, with 12% (7,041) aged 65 and older. The SESPAN organizing strategy involved networking to: (1) make connections between two or more community organizations to create new senior physical activity programs; and (2) build coalitions of community groups and organizations to assist in making larger scale environmental and policy changes to increase senior physical activity. The SESPAN evaluation used an uncontrolled prospective design focusing on sustainable community changes, including new or modified programs, policies, and practices. Networking among organizations led to the creation of 16 ongoing exercise classes and walking groups, serving approximately 200 older adults in previously underserved Southeast Seattle communities. In addition, the project's health coalition is sustaining current activities and generating new programs and environmental changes. The success of the SESPAN organizing model depended on identifying and involving champions in partner organizations who provided support and resources for implementing programs.     

Neighborhood safety and the prevalence of physical inactivity--selected states, 1996

Physical inactivity is an important risk factor for premature morbidity and mortality, especially among high-risk populations. Although health-promotion programs have targeted high-risk groups (i.e., older adults, women, and racial/ethnic minorities), barriers exist that may affect their physical activity level. Identifying and reducing specific barriers (e.g., lack of knowledge of the health benefits of physical activity, limited access to facilities, low self-efficacy, and environmental issues [2-6]) are important for efforts designed to increase physical activity. Concerns about neighborhood safety may be a barrier to physical activity. To characterize the association between neighborhood safety and physical inactivity, CDC analyzed data from the 1996 Behavioral Risk Factor Surveillance System (BRFSS) in Maryland, Montana, Ohio, Pennsylvania, and Virginia. This report summarizes the results of this analysis, which indicate that persons who perceived their neighborhood to be unsafe were more likely to be physically inactive.     

Best-Practice Physical Activity Programs for Older Adults: Findings From the National Impact Study

Objectives. We assessed the impact of existing best-practice physical activity programs for older adults on physical activity participation and health-related outcomes.Methods. We used a multisite, randomized trial with 544 older adults (mean age 66 years) and measures at baseline, 5, and 10 months to test the impact of a multiple-component physical activity program compared with results for a control group that did not participate in such a program.Results. For adults who participated in a multiple-component physical activity program, we found statistically significant benefits at 5 and 10 months with regard to self-efficacy for exercise adherence over time (P < .001), adherence in the face of barriers (P = .01), increased upper- and lower-body strength (P = .02, P = .01), and exercise participation (P = .01).Conclusions. Best-practice community-based physical activity programs can measurably improve aspects of functioning that are risk factors for disability among older adults. US public policy should encourage these inexpensive health promotion programs.Moderate exercise 3 to 5 times per week for at least 30 minutes produces multiple health benefits for older adults at most levels of functional ability.¹ However, older adults are the most sedentary population in the United States,^2,3 with more than 60% failing to participate in regular physical activity.⁴A number of randomized controlled trials have tested specific exercise programs for older adults. To our knowledge, Wilcox et al. is the only study that has examined the impact of evidence-based programs adopted by community providers of physical activity programs for older adults.⁵ This study found that older adults who participated in 2 newly adopted programs experienced statistically significant benefits regarding physical activity participation, depression, stress, and body mass index. However, that study did not examine the impact of exercise programs already existing in the community. We sought to address this gap with our study.Community organizations like senior centers and YMCAs are the primary providers of physical activity programs for older adults in the United States. These providers strive to achieve a balance among the programs they offer, taking into consideration such factors as exercise science, older adults'' preferences, and real-world feasibility. In 2003, the Center for Healthy Aging of the National Council on Aging (NCOA) conducted a national competition to identify 10 best-practice physical activity programs operated by community organizations serving older adults. The competition was funded by the Robert Wood Johnson Foundation and was conducted in collaboration with the Center for Research on Health and Aging (CRHA) at the University of Illinois at Chicago. The Centers for Disease Control and Prevention''s Healthy Aging Research Network, the Active Aging Partnership, and nationally known physical activity experts helped NCOA develop best-practice criteria based on findings from the literature and expert judgment.Programs that participated in the national competition had to serve a large population of older adults, have a solid history of physical activity programming, and collect and evaluate outcomes data. The NCOA hosted application forms on its Web site, posted notices of the competition on Web sites and e-mail discussion lists, and networked with other national organizations to publicize the competition. More than 1100 competition applications were downloaded, and 83 were submitted. National experts scored the applications based on several criteria, including years of operation, numbers of clients served, types of instructors used, inservice education for instructors, and monitoring of participant attendance and outcomes. The top 29 applicants participated in telephone interviews that elicited more detailed information concerning each organization''s approach to program development and supervision, instructor training, collection and analysis of outcomes data, and sustainability. Finally, 10 programs were identified as national best-practice programs based on all of the above information. The NCOA awarded $1000 and a certificate of achievement to each of the 10 winning programs.A site visit team that included NCOA staff, researchers from the University of Illinois at Chicago, and other study partners visited the 10 best-practice sites to learn more about program elements, infrastructure support, partnership activities, and other factors that contributed to their success. During the visits, we assessed each site''s capacity to participate in the National Impact Study, which would assess the impact of site programs on participants. Based on findings from the site visits, we selected provider sites for participation in our study, recruited and enrolled study participants from those sites, and assessed the impact that participation in a multicomponent physical activity program had on those participants.     

Access barriers to and unmet needs for home- and community-based services among older korean americans

This cross-sectional survey study of 146 caregivers of older Korean Americans explored access barriers to and unmet needs for home- and community-based services (HCBS) programs (respite care, adult day care, personal care, home health, housekeeping, and transportation). Most often reported access barriers were lack of awareness and care recipient refusal. Predictors of unmet needs varied depending on the type of service, but included caregiver gender, relationship, education, caregiving duration, Medicaid coverage, English proficiency, caregiver self-efficacy, care recipient functional dependency, cognitive impairment, and caregiving hours. This study highlighted unmet needs for HCBS in Korean American communities, pointing to the pressing need for a collaborative effort to develop plans that modify and expand HCBS programs for older Korean Americans.     

Access Barriers to and Unmet Needs for Home- and Community-Based Services Among Older Korean Americans

This cross-sectional survey study of 146 caregivers of older Korean Americans explored access barriers to and unmet needs for home- and community-based services (HCBS) programs (respite care, adult day care, personal care, home health, housekeeping, and transportation). Most often reported access barriers were lack of awareness and care recipient refusal. Predictors of unmet needs varied depending on the type of service, but included caregiver gender, relationship, education, caregiving duration, Medicaid coverage, English proficiency, caregiver self-efficacy, care recipient functional dependency, cognitive impairment, and caregiving hours. This study highlighted unmet needs for HCBS in Korean American communities, pointing to the pressing need for a collaborative effort to develop plans that modify and expand HCBS programs for older Korean Americans.     

The Public Health Perspective in Health Promotion and Disability Prevention for Older Adults: The Role of the Centers for Disease Control and Prevention

As the United States federal public health agency, the role of the Centers for Disease Control and Prevention (CDC) in health promotion and disability prevention with older adults encompasses research, surveillance and program activities in aging. This article characterizes the objectives and context of prevention in later life and summarizes CDCs functions, collaborative partnerships with public health agencies and other organizations, and range of activities in older adult health. As a major focus of these efforts, chronic disease risk reduction is examined through CDC's efforts in the area of physical activity; a longitudinal investigation of osteoarthritis in an older biracial rural population; and chronic illness self-management programs as a prototype for secondary prevention. Other CDC activities highlighted include addressing the burden of vaccine-preventable diseases through CDC-funded programs to improve immunization coverage in older adults, and falls prevention interventions and resources. Future directions in aging at CDC are also outlined.     

Fitness facilities for adults: differences in perceived access and usage

BACKGROUND: Perceived access to places for physical activity may play an important role in influencing physical activity behavior. Little is known about the prevalence of perceived access to facilities for physical activity. METHODS: Cross-sectional analysis of a national sample of 27,894 adults from the 2002 National Health Interview Survey was performed to describe the characteristics of those who perceived that they have access to fitness facilities, and determine the prevalence of perceived access, reported use of fitness facilities, and reported barriers to the use of fitness facilities. Analyses were conducted in 2005 and 2006. RESULTS: Approximately 61% of adults reported having access to fitness facilities. Perceived access was highest among adults aged 34 and younger, non-Hispanic whites, those with a college education, among adults with a body mass index of less than 35 kg/m(2), and among those with higher physical activity levels. The most commonly reported perceived barrier to access was cost. Almost 21% of U.S. adults (37.0% of active, 19.9% of intermittently active, 6.0% of inactive) reported having used a health club, wellness program, or fitness facility at least ten times during the past year. CONCLUSIONS: Fitness facilities provide one option for increasing access to places to be physically active. Having access to fitness facilities is significantly associated with physical activity levels among U.S. adults.     

Health Opportunities with Physical Exercise (HOPE): social contextual interventions to reduce sedentary behavior in urban settings

Physical activity interventions targeting social and physical environments of the urban poor hold promise in improving health outcomes in underserved communities. This study randomly assigned overweight, sedentary, economically disadvantaged adults to one of three intervention conditions at The Hope and Healing Center, a large inner-city health facility providing numerous options for exercise. Within the tenets of Social Action Theory, the Health Opportunities with Physical Exercise (HOPE) trial will test the efficacy of two behavior change models, social support and patient-provider interaction, to increase physical activity. In addition to a standard care condition, in which patients have open access to Hope and Healing physical activity programming, patients were assigned to one of two behavior change interventions. Those assigned to patient-peer receive face-to-face, systematic and scheduled encouragement from study-trained 'peer' interventionists at the facility. Patients assigned to patient-provider receive face-to-face, systematic and scheduled encouragement provided by study-trained 'provider' interventionists also at the facility. The primary outcomes of change in exercise behavior will be documented by self-reported physical activity and confirmed by fitness testing at baseline, 6, 12 and 24 months during the 1 year of active intervention and 1 year of relapse prevention follow-up. Intervention conditions will be compared on psychosocial mediators including motivational appraisals, ratings of social support, rapport, problem solving and self-efficacy for overcoming barriers to increased physical activity. Novel aspects of this intervention include: (1) delivery of socially based physical activity interventions to an economically disadvantaged urban population, (2) reduction of environmental barriers to be physically active and (3) emphasis on social interactions influencing health habit change. Results of this study have the potential to identify mechanisms of behavior change that could be adopted by physical activity interventions aimed at reducing sedentary behavior and health disparities in high-risk, underserved populations.     

Threat-responsiveness and the decision to obtain free influenza vaccinations among the older adults in Taiwan

Background  

Although older adults are encouraged by government agencies to receive influenza vaccinations, many do not obtain them. In Taiwan, where universal health care coverage has significantly reduced the barriers of access to care, the health care system has provided free influenza vaccinations for people 65 years or older since 2001. Nevertheless, the numbers of people who use this service are much fewer than expected. The aim of this study was to explore major factors that might affect the decision to receive influenza vaccinations among older adults in Taiwan.     

A review of social and environmental barriers to physical activity for adults with intellectual disabilities

BackgroundThere is a higher prevalence of sedentary behavior among adults with intellectual disability (ID) compared to the general population. The majority of research on this topic has focused on assessing physical activity (PA) levels and there are relatively few studies addressing barriers to PA (including exercise) in this population.ObjectiveIt is important to analyze the PA barriers faced by adults with ID in order to develop and implement intervention programs.MethodsA systematic research review was conducted to analyze the barriers to PA for adults with ID. Original research articles published after 1980 with primary intention of identifying PA determinants of age 18+ adults with ID were included.ResultsIn total, 837 citations were returned, and after screening for repeated articles and inclusion criteria, 7 were included in the analysis. The primary barriers that reoccurred throughout the papers were transportation issues, financial limitations and lack of awareness of options. Other salient barriers included negative supports from caregivers and authority figures (e.g. teachers, coaches and parents) and lack of clear policies for engaging in regular activity in residential and day service programs.ConclusionThis study reveals clear barriers to PA to target. Of primary importance is the development of policies among agencies that serve individuals with ID that could help minimize transportation, financial, policy and educational barriers, which are more modifiable than negative supports.     

Assessing access as a first step toward improving the quality of care for very old adults

Understanding the barriers to obtaining care that the population of people age 80 and older (80+) experiences is one of the first steps toward developing organizational and clinical strategies aimed at improving care. This article reviews the data from the 80+ Project's survey to assess the prevalence of barriers to care and identify the characteristics that place the 80+ population at risk. Barriers to access for older adults occur on many levels. Ultimately, the ability to improve health outcomes through reducing barriers to care is dependent on the effectiveness and quality of care received. By recognizing the barriers to care that limit access, health care professionals can begin to develop strategies to eliminate these barriers and improve the health care of older adult patients.     

Factors associated with physical activity among older people--a population-based study

BACKGROUND: Regular physical activity improves survival and functional ability, and can improve quality of life. Few studies have examined factors associated with physical activity in older adults at a population level. This study examines factors associated with physical activity in the New South Wales (NSW) older population. METHODS: Data from a random survey of 8881 community-dwelling people aged 65+ years were examined. We used Cox's regression to analyze the influence of demographic, health, and social factors on physical activity. 'Adequate' physical activity was defined as at least 30 min of walking, moderate or vigorous activity on at least 5 days in the last week. Reported barriers to physical activity were also examined. RESULTS: Adequate physical activity was independently associated with sex (male), younger age, ability to travel independently, better physical functioning, lower psychological distress, rural residence, not having diabetes, adequate fruit and vegetable intake, and speaking a language other than English at home. No independent associations were found for good long distance eyesight, being a caregiver, living alone, age left school, employment status, fear of falling, or perception of neighborhood safety. Health problems were frequently reported barriers to physical activity. CONCLUSIONS: About half of older adults report adequate physical activity. These results will inform strategies to promote physical activity among older people.