Making decisions about simple interventions: older people's use of walking aids

BACKGROUND: Walking difficulty is common in old age. Simple and inexpensive interventions, such as walking aids, provide considerable assistance. However, older people's views on walking aids are likely to affect their uptake, and we have little knowledge about older people's motivations for using walking aids. AIM: To explore older people's views on their use of walking aids. METHODS: Longitudinal qualitative study comprising in-depth interviews with a purposive sample of 24 men and women recruited from a UK national cross-sectional population survey of older people. Participants were 69-90 years old at the first interview, 15 were followed up a year later, and 12 were followed up again a year after that. Analysis was conducted using constant comparison methods. RESULTS: Of the 24 people interviewed at the start of the study, 12 used walking aids, mainly walking sticks. These aids came from a range of sources, including informal ones. Over the course of the study, some participants adopted walking aids or changed the types of aids that they used. As time passed, participants' initial misgivings about the use of aids subsided, and walking aids were described as improving confidence and facilitating activity and participation. Decisions to start using walking aids were influenced by both gradual and sudden changes in ability and by culturally informed views about ageing. Views on ageing initially acted as barriers to the use of aids but then acted as facilitators to use. CONCLUSIONS: Walking aids enable continued activity and participation and it is likely that they provide benefits of health and well being. Health care providers can draw on the knowledge about the impact of beliefs about ageing to help them reach shared decisions with older patients about the use of walking aids.     

The experience and management of HIV stigma among HIV-negative adults in heterosexual serodiscordant relationships in New York City

Despite treatment advances that have improved the health and life expectancy of HIV-positive people and contribute to the prevention of HIV transmission, HIV stigma is still frequently experienced by HIV-infected individuals and those close to them. This study investigated the types of HIV-related stigma experienced by HIV-negative adults in serodiscordant heterosexual relationships when their partner’s HIV-positive status was revealed to family and friends and their strategies to manage such stigma. In-depth interviews were conducted in New York City with 56 men and 44 women who were HIV negative and had been in a relationship for at least six months with an HIV-positive partner of the opposite sex. Those who had disclosed the HIV status of their partner to family or friends experienced four main types of stigmatizing behaviours: distancing (avoidance of the participant or his/her partner for fear of infection), depreciation of the partner (being told their partner is not worthy of them), violation of privacy (people spreading the information that the partner is HIV positive), or accusations (being told that it was wrong to be in a relationship with HIV-positive people or to try to conceive with them). Participants described four main ways of managing actual or anticipated stigma: secrecy (not disclosing the HIV status of their partner to anyone), avoidance (breaking ties with people who held stigmatizing views), seeking support from their partner or the HIV-positive community (e.g., HIV-related organizations or their partner’s family or friends), or education (informing family or friends about HIV treatment and prevention). Findings show that HIV-related “courtesy” stigma is frequently experienced by HIV-negative people in serodiscordant relationships but often can be managed. Offering support to individuals in serodiscordant relationships can improve the quality of life of HIV-positive people and their HIV-negative partners and potentially reduce HIV stigma.     

Walking difficulty, walking speed, and age as predictors of self-rated health: the women's health and aging study

BACKGROUND: Older persons reporting disability are more likely to report poor self-rated health, but little work has been done to assess the independent relationships of reported walking difficulty and measured walking performance with self-rated health. This study examines the associations of walking difficulty, walking speed, and age with self-rated health in older women. METHODS: The data are from the baseline of the Women's Health and Aging Study. Difficulty walking one quarter mile was used as a measure of mobility in the representative population aged 65 and older screened for the study (n = 3841) and in the one third most disabled study group (n = 1002). Maximal walking speed was measured in the study sample. RESULTS: Increasing severity of walking difficulty (in the screened population and in the disabled study group), slower walking speed (in the study group), and younger age were all associated with fair or poor self-rated health, after simultaneous adjustment for these and other objective measures of physical performance and health. The associations of both measures of walking with self-rated health weakened with age. CONCLUSIONS: Both walking difficulty and walking speed are independent determinants of self-rated health. Adjusted for health and functioning, self-rated health tends to improve with age.     

Neurological examination findings to predict limitations in mobility and falls in older persons without a history of neurological disease

PURPOSE: To estimate the prevalence of neurological signs and their association with limitations in mobility and falls in a sample of older persons without known neurological disease. METHODS: A neurologist examined 818 participants from the InCHIANTI study who were aged > or =65 years and who did not have cognitive impairment, treatment with neuroleptics, and a history of neurological disease. Mobility was assessed as walking speed and self-reported ability to walk at least 1 km without difficulty. Participants were asked to report falls that had occurred in the previous 12 months. RESULTS: Less than 20% (160/818) of participants had no neurological signs. Neurological signs were more prevalent in older participants and those with impaired mobility. When all neurological signs were included in sex-and age-adjusted multivariate models, 10 were mutually independent correlates of poor mobility. After adjusting for age and sex, the number of neurological signs was associated with progressively slower walking speed (P <0.001), a higher probability of reported inability to walk 1 km (P <0.001), and a history of falls (P <0.05). CONCLUSION: Neurological signs are independent correlates of limitations in mobility and falls in older persons who have no clear history of neurological disease.     

Walking Ability and Its Relationship to Self-Rated Health in Later Life

This study investigated the relationship between self-assessed overall health (SRH) and walking ability among older adults (n?=?239) gauged using three well-established measures of walking ability (“normal” and “fast” walking speeds, and perceived walking difficulty). Logistic regression models adjusted for health, behavioral, and sociodemographic variables were used to estimate the relationship between the three measures of walking ability and SRH. Walking ability was significantly associated with SRH; notably, only normal walking speed discriminated between participants in all three SRH comparisons (good versus poor/bad, good versus fair, or excellent versus good). Health care providers, family, and friends should be attentive to reduced walking speed or complaints about difficulty walking because these are harbingers of health decline.     

Life in a retirement village: implications for contact with community and village friends

BACKGROUND: Friends provide acceptance, companionship, emotional support, and are important to mental health. One reason that older adults give for seeking alternative accommodations is to reduce their loneliness and isolation. OBJECTIVE: The purpose of this study was to investigate whether older adults living in a retirement village have varying amounts of contact with friends who live within the retirement village or in the wider community. METHODS: Three hundred and twenty-three independently living residents of 25 retirement village sites were interviewed. Participants were asked a range of open and closed questions about the amount and kind of contact they had with co-resident friends and community-based friends. RESULTS: Residents engaged in several weekly visits with village friends and maintained regular contact with community friends through telephone calls. Few residents engaged in community outings or participated in village activities with either village or community friends. CONCLUSION: The nature of living in close proximity with other people, influences the amount of informal contact they have with friends. For those older individuals who seek alternative accommodation due to isolation or loneliness, re-location to congregate-style accommodation may increase their social contacts and have a positive impact on their well-being.     

Use of a cane for ambulation: marker and mitigator of impairment in older people who report no difficulty walking

OBJECTIVES: To measure disability, patients are often asked whether they have difficulty performing daily tasks. However, recent work suggests that functional problems may be detected earlier by inquiring about modifications in the way tasks are performed. We sought to describe the characteristics of older people who deny difficulty walking but nevertheless have modified the manner in which they walk, by use of a cane. We also tested the hypothesis that, among older people who deny difficulty walking, those using a cane have more mobility problems and are at greater risk for future mobility problems than those not using a cane. DESIGN: Longitudinal survey study, with measures at baseline and 2-year follow-up. SETTING: Population-based survey of urban older people. PARTICIPANTS: One thousand two hundred fifty-one community-dwelling older persons without severe cognitive impairment who reported no difficulty walking at baseline. MEASUREMENTS: Self-reported health, activities of daily living (ADL), and mobility status. RESULTS: Among older people who denied difficulty walking, those who used a cane at baseline (7 of subjects) were older and more likely to have taken medication for a heart condition or arthritis, to have an ADL deficit, and to have been hospitalized in the past year. They were less likely to have walked for pleasure in the past month and more likely to report difficulty crossing roads or intersections. Moreover, those using a cane at baseline were more likely to develop new mobility problems at follow-up. For example, 15 of those who used a cane at baseline reported new difficulty walking at follow-up, compared with 2 of those who did not use a cane. CONCLUSION: Older people who deny difficulty walking but who use a cane are at greater risk than those who do not use a cane for the development of difficulty walking and other new mobility problems. Asking patients about task modification rather than difficulty alone may be a more sensitive way to detect early or mild functional problems.     

Preclinical mobility disability predicts incident mobility disability in older women

BACKGROUND: Physical disability and dependency are serious, and frequent, adverse health outcomes associated with aging and resulting from chronic disease. Reasoning has suggested that there might be a preclinical, intermediate phase of disablement which might develop in parallel with progression of underlying disease and precede and predict disability. Definition of this stage could provide a basis for screening and early intervention to prevent disability. The objective of this study was to determine preclinical functional predictors of incident mobility difficulty and provide evidence for a preclinical stage of disability. METHODS: A prospective, population-based cohort study was carried out in Baltimore, Maryland, with two evaluations 18 months apart. The participants were 436 community-dwelling women, 70-80 years of age at baseline, not cognitively impaired, and reporting difficulty in no areas, or only one area, of physical function (primarily mobility), who were participating in the Women's Health and Aging Study II. Participants were recruited from a population-based, age-stratified random sample. Incident mobility disability was studied in the subset without such disability at baseline. The main outcome measure was self-reported incident difficulty walking 1/2 mile or climbing up 10 steps. RESULTS: At baseline, 69.3% of the cohort reported no difficulty with mobility. After 18 months, 16.0 and 11.7% of this group reported incident difficulty walking 1/2 mile or climbing up 10 steps, respectively. Those reporting baseline task modification due to underlying health problems, our measure of preclinical disability, were at three- to fourfold higher odds of progressing to difficulty than were those without such modification. In multivariate logistic regression analyses, this self-report measure, task modification without difficulty, and objective measures of performance were independently and jointly predictive of incident mobility difficulty. Specifically, for incident difficulty walking 1/2 mile, self-reported task modification odds ratio (OR) = 3.67, walking speed (.5 m/s difference) OR = 2.16; for incident difficulty climbing up 10 stairs, OR for task modification = 3.84, for stair climb speed (1/3 step/s difference) = 2.08 (95% CI did not include 1 for any). Covariates, age, living alone, number of chronic diseases, depression score, knee strength, and balance by functional reach, were not significant predictors in either model. CONCLUSIONS: Two indicators of functional changes in older women without mobility difficulty, self-report of modification of method of doing a task in the absence of difficulty and performance measures, are independent and strong predictors of risk of incident mobility disability. The self-report measure provides substantial strength in predicting risk of incident disability across the full range of performance, and may identify a vulnerable point at which other risk factors act to cause transitions to disability. Together, the preclinical indicators identify a subset of high-functioning older women who are at high risk of mobility disability, and provide a potential basis for screening for disability risk and targeting interventions to prevent mobility disability.     

Older People's Perceptions of Their General Practitioner

Objective : As part of a larger study into the health and well‐being of older people, their relationships with health and community service providers were explored. This paper focuses on how older people viewed their relationship with their general practitioner (GP). Method : 49 older people in metropolitan Melbourne were interviewed using qualitative research, via in‐depth interviews. Results : Most participants described their relationship with their GP as being very important to them. Many described their GP as a friend and key components of the relationship were faith and trust. Good communication skills, on the part of the GP, were important. Consumerist attitudes were generally not apparent and many of the older people interviewed would find the expectation to behave as a consumer very threatening. Conclusions : Similar to previous studies, most of the older people preferred a very strong trusting relationship with their GP, and it was one of the most important relationships in their lives.     

Use of self-report to predict ability to walk 400 meters in mobility-limited older adults

Objectives: To determine whether the ability to walk 400 m could be predicted from self‐reported walking habits and abilities in older adults and to develop an accurate self‐report measure appropriate for observational trials of mobility when functional measures are impractical to collect. Design: Cross‐sectional. Setting: University‐based human physiology laboratory. Participants: One hundred fifty community‐dwelling older men and women (mean age±standard error= 79.8±0.3). Measurements: An 18‐item questionnaire assessing walking habits and ability was administered to each participant, followed by a 400‐m walk test. Ninety‐eight (65%) volunteers were able to complete the 400‐m walk; 52 (35%) were unable. Logistic regression was performed using response items from a questionnaire as predictors and 400‐m walk as the outcome. Results: Three questions (Do you think you could walk one‐quarter of a mile now without sitting down to rest. Because of a health or physical problem, do you have difficulty walking 1 mile? Could you walk up and down every aisle of a grocery store without sitting down to rest or leaning on a cart?) were predictive of 400‐m walking ability and were included in the model. If participants answered all three questions compatible with the inability to walk 400 m, there was a 91% probability that they were unable to walk 400 m, with a sensitivity of 46% and a specificity of 97%. Conclusion: A three‐item self‐report developed in the study was able to accurately predict mobility disability. The utility of this instrument may be in evaluating self‐reported mobility in large observational trials on mobility when functional mobility tasks are impractical to collect.     

Retirement and Flow: Can the Casual Leisure Pursuits of Older Adults in Retirement Create the Experience of Flow?

ABSTRACT

This study examines the casual leisure activities of older adults and their potential to create flow experiences. Using a qualitative approach, the study found that participants often choose leisure activities based on the perceived enjoyment and potential benefits; maintaining physical and mental health, altruism, or maintaining relationships with friends and family. Analysis revealed that flow-like experiences were facilitated by participants’ purposeful choices and focusing their attention on the immediate task. If participants do not achieve flow, their leisure activities were chosen to contribute positively to their well-being and quality of life.     

Performance tests and disability: developing an objective index of mobility-related limitation in older populations

BACKGROUND: Disability reflects physiological limitations, social and environmental barriers, and "sickness" behavior. Being able to measure these influences separately would greatly assist interpretation of disability comparisons over time or between populations. This study aimed to identify an index of mobility-related limitations composed of physiological measures that are most closely associated with reported mobility disability in elders. METHODS: Data from the Third National Health and Nutrition Examination Survey (NHANES III) were used. Participants aged 60 and older were included in this analysis. Participants included 6596 respondents who were interviewed in their homes, and 5724 (87%) of these attended a further examination. Domains of measurements included body measurements, bone densitometry, physical examination, spirometry, fundus photography, and physical performance measures. Multivariate models were developed on a random half subsample of the data and were validated on the other half. Receiver operating characteristic (ROC) areas and logit rank slopes were used to evaluate sets of measures. RESULTS: In weighted logistic regression models, six and five measures were significantly associated with difficulty and inability in walking a quarter of a mile, respectively. These mainly included measures of lower extremity and lung function. A relatively minimal loss of sensitivity and specificity occurred from using more economical models, employing a subset of the identified measures. CONCLUSIONS: Subsets of measures associated with reported mobility disability could provide objective indices of mobility-related limitation for comparing populations or long-term population health monitoring.     

Reasons People Give for Using (or Not Using) Condoms

Study participants (N = 348) were asked about 46 reasons that have been suggested for why people use or do not use condoms. Participants were asked which of these reasons motivated them when they were deciding whether to use condoms in 503 sexual relationships. Participants were classified into one of three roles based on their HIV status and the status of each sexual partner: HIV+ people with HIV? partners; HIV? people with HIV+ partners; and HIV? people with HIV? partners. Motivations were looked at in the context of each of these roles. Of the 46 reasons, only 15 were selected by at least 1/3 of the participants, and only seven were selected by at least half. Frequently reported reasons primarily concern protecting self and partner from STDs including HIV. Less frequently reported reasons involved social norms, effects of condoms on sex, and concern for the relationship. These findings have implications for clinical interventions.     

Theories on coping with loss: the impact of social support and self-esteem on adjustment to emotional and social loneliness following a partner's death in later life

OBJECTIVES: This longitudinal study focused on the role of self-esteem and social support in adjustment to loneliness experienced by bereaved elderly persons. This study also examined the contributions of a general and a specific coping theory toward explaining loneliness. A distinction has been made between emotional loneliness and social loneliness/perceived support. The theory of mental incongruity predicts that the presence of more favorable conditions, such as higher self-esteem or more social support, results in less loneliness (i.e., less incongruity). According to the theory of relational loneliness, the partner's death leads to a loss of identity, thus increasing emotional loneliness, and social support does not mitigate emotional loneliness following a loss. METHODS: In total, 101 participants, aged 55-89 years, were interviewed before and after their partners' deaths. RESULTS: Findings were ambiguous with regard to both theories. As hypothesized, partner loss lowered self-esteem, resulting in higher emotional loneliness and social loneliness, that is, perception of less support. Supportive personal relations reduced emotional loneliness. The presence of close friends, however, seemed to increase emotional and social loneliness (i.e., decrease perceived support) in the long term, particularly among bereaved participants with lower self-esteem. DISCUSSION: The findings highlight the need to integrate theoretical concepts. In explaining adjustment to a partner's death, attention should be paid to underlying mechanisms relevant to the restoration process (e.g., identity change) and the ways in which the adjustment process can be improved (e.g., intimate relationships) or impeded (e.g., dependency-sustaining relationships).     

Close Relationships and Social Support in Coping with HIV: A Test of Sensitive Interaction Systems Theory

This study tested sensitive interaction systems theory, and examined how persons with HIV seek and receive social support in relationships with peers versus parents and the association between different kinds of support-receiving behaviors and depressive symptoms. The participants were men and women with HIV in southeastern Virginia who completed a self-administered questionnaire about their relations with parents, an intimate partner, and a close friend. Participants reported using more Ask behaviors (a direct form of support seeking) with a friend and an intimate partner than with parents. They also reported receiving more Approach (Solve/Solace) forms of support from a friend and an intimate partner than from parents and less Avoidance (Escape/Dismiss) from a close friend than from parents. As a support-seeking behavior Ask was most likely to be associated with Approach forms of support providing from all types of relationship partners. Avoidance from parents, an intimate partner, or a friend was positively associated with depressive symptoms. Counselors should discuss with clients the social support process and how different forms of support seeking and support providing may be more or less useful in coping with HIV.     

Determinants of HIV Serostatus Disclosure to Sexual Partner Among HIV-Positive Alcohol Users in Haiti

This study examined the relationship between antiretroviral therapy use, participants’ knowledge of partner’s HIV serostatus, number of sex partners, perceived infectivity and HIV disclosure to a main sexual partner among 258 HIV-positive Haitian alcohol users. Only 38.6 % had disclosed their HIV serostatus to sexual partners. Logistic regression analyses revealed that participants who self-reported having an HIV-negative partner (OR = 0.36, 95 % CI 0.13–0.97) or a partner of unknown HIV status (OR = 0.09, 95 % CI 0.04–0.22) were less likely to disclose their HIV serostatus than participants who self-reported having an HIV-positive partner. Participants who had more than one sexual partner in the past 3 months (OR = 0.41, 95 % CI 0.19–0.90) were also less likely to disclose than participants who had one partner. These findings suggest the need for couples-based programs to assist people living with HIV (PLWH) with the disclosure process, especially among PLWH who have more than one sexual partner and/or are in serodiscordant relationships.     

Strategies for coping with fatigue among HIV-positive individuals fifty years and older

Fatigue, a common symptom among persons living with HIV/AIDS, is often underreported and undertreated. However, given fatigue's pervasive effects on well-being and functioning, the identification of its physiologic and psychological causes and strategies to alleviate it are important to patients' quality of life. As part of a study to understand better how HIV-positive middle-aged and older adults (50+) manage common symptoms, 49 participants discussed in depth their experience with fatigue. Most engaged in both self-care activities and sought the assistance of a health care professional. Frequent strategies included dietary changes, vitamins, modification of routines, rest, exercise, and prescribed medications for anemia, Vitamin B(12) deficiency, or testosterone deficiency. Complementary and alternative medicine (e.g., acupuncture, massage, herbal remedies, special juices) was also commonly used. Participants often used multiple strategies to alleviate their fatigue, possibly because of their tendency to attribute it to multiple causes. These HIV-positive older adults were also apt to view fatigue as an indirect indicator of their overall health status and immune functioning. This may explain why many of the coping strategies they used could be considered approaches to improving their overall health status as a means to increasing their energy levels. Health care professionals can play an important role in helping HIV-positive individuals manage their fatigue. The majority of participants tried to implement the coping suggestions offered by health care professionals, as well as those from family, friends, and support group members.     

Heterosexual relationship characteristics, condom use and safe sex practices

It was examined whether sexual relationship characteristics were associated with condom use and safe sex practices against HIV. Characteristics investigated were: (1) age difference between sexual partners, (2) previous knowledge of partner, (3) type of relationship, (4) duration, and (5) exclusiveness. Safe sex practices (risky, non-safe, safe) were defined by condom use consistency, previous knowledge of partner and monogamy. Participants (N = 458, were Greek, sexually active and between 18-25 years old) responded to a questionnaire on sexual and condom use practices in their sexual relationships of the past 12 months, condom use negotiation and variables a-e. Only age difference between partners was found to differentiate consistent from inconsistent condom use. Inconsistent condom use was more frequent among partners whose age difference was over two years. Safe sex practices (risky, non-safe, safe) varied across different relationships of 36% and remained consistently non-safe or risky across those of 40%. Risky practices occurred more frequently in relationships where the man was older than the woman. When condoms had not been used, they had not been negotiated in 80% of the cases. These findings reconfirm the importance of negotiation in condom use, call attention to the neglected role of age differences between partners in safe sex and bring forward the issue of studying actual variation of safe sex practices across relationships as an indication of people's response to health campaign messages of risk reduction.