International Journal of Environmental Research and Public Health

Editorial

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Open AccessEditorial

What If Healthy Aging Is the ‘New Normal’?

by Marcia G. Ory and Matthew Lee Smith

Int. J. Environ. Res. Public Health 2017, 14(11), 1389; https://doi.org/10.3390/ijerph14111389 - 15 Nov 2017

Cited by 8 | Viewed by 4276

Abstract

We dedicate this special issue to our colleague, Dr. Lucinda Bryant (1941–2016).[...] Full article

(This article belongs to the Special Issue Aging and Health Promotion)

Research

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Open AccessArticle

A 10-Year Follow-Up Study of Social Ties and Functional Health among the Old: The AGES Project

by Chiyoe Murata, Tami Saito, Taishi Tsuji, Masashige Saito and Katsunori Kondo

Int. J. Environ. Res. Public Health 2017, 14(7), 717; https://doi.org/10.3390/ijerph14070717 - 3 Jul 2017

Cited by 17 | Viewed by 5043

Abstract

In Asian nations, family ties are considered important. However, it is not clear what happens among older people with no such ties. To investigate the association, we used longitudinal data from the Aichi Gerontological Evaluation Study (AGES) project. Functionally independent older people at [...] Read more.

In Asian nations, family ties are considered important. However, it is not clear what happens among older people with no such ties. To investigate the association, we used longitudinal data from the Aichi Gerontological Evaluation Study (AGES) project. Functionally independent older people at baseline (N = 14,088) in 10 municipalities were followed from 2003 to 2013. Social ties were assessed by asking about their social support exchange with family, relatives, friends, or neighbors. Cox proportional hazard models were employed to investigate the association between social ties and the onset of functional disability adjusting for age, health status, and living arrangement. We found that social ties with co-residing family members, and those with friends or neighbors, independently protected functional health with hazard ratios of 0.81 and 0.85 among men. Among women, ties with friend or neighbors had a stronger effect on health compared to their male counterparts with a hazard ratio of 0.89. The fact that social ties with friends or neighbors are associated with a lower risk of functional decline, independent of family support, serves to underscore the importance of promoting social ties, especially among those lacking family ties. Full article

(This article belongs to the Special Issue Aging and Health Promotion)

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Open AccessFeature PaperArticle

Dissemination of Chronic Disease Self-Management Education (CDSME) Programs in the United States: Intervention Delivery by Rurality

by Matthew Lee Smith, Samuel D. Towne, Angelica Herrera-Venson, Kathleen Cameron, Kristie P. Kulinski, Kate Lorig, Scott A. Horel and Marcia G. Ory

Int. J. Environ. Res. Public Health 2017, 14(6), 638; https://doi.org/10.3390/ijerph14060638 - 14 Jun 2017

Cited by 44 | Viewed by 6496

Abstract

Background: Alongside the dramatic increase of older adults in the United States (U.S.), it is projected that the aging population residing in rural areas will continue to grow. As the prevalence of chronic diseases and multiple chronic conditions among adults continues to [...] Read more.

Background: Alongside the dramatic increase of older adults in the United States (U.S.), it is projected that the aging population residing in rural areas will continue to grow. As the prevalence of chronic diseases and multiple chronic conditions among adults continues to rise, there is additional need for evidence-based interventions to assist the aging population to improve lifestyle behaviors, and self-manage their chronic conditions. The purpose of this descriptive study was to identify the geospatial dissemination of Chronic Disease Self-Management Education (CDSME) Programs across the U.S. in terms of participants enrolled, workshops delivered, and counties reached. These dissemination characteristics were compared across rurality designations (i.e., metro areas; non-metro areas adjacent to metro areas, and non-metro areas not adjacent to metro areas). Methods: This descriptive study analyzed data from a national repository including efforts from 83 grantees spanning 47 states from December 2009 to December 2016. Counts were tabulated and averages were calculated. Results: CDSME Program workshops were delivered in 56.4% of all U.S. counties one or more times during the study period. Of the counties where a workshop was conducted, 50.5% were delivered in non-metro areas. Of the 300,640 participants enrolled in CDSME Programs, 12% attended workshops in non-metro adjacent areas, and 7% attended workshops in non-metro non-adjacent areas. The majority of workshops were delivered in healthcare organizations, senior centers/Area Agencies on Aging, and residential facilities. On average, participants residing in non-metro areas had better workshop attendance and retention rates compared to participants in metro areas. Conclusions: Findings highlight the established role of traditional organizations/entities within the aging services network, to reach remote areas and serve diverse participants (e.g., senior centers). To facilitate growth in rural areas, technical assistance will be needed. Additional efforts are needed to bolster partnerships (e.g., sharing resources and knowledge), marketing (e.g., tailored material), and regular communication among stakeholders. Full article

(This article belongs to the Special Issue Aging and Health Promotion)

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Open AccessArticle

Socioeconomic Disparity in Later-Year Group Trajectories of Depressive Symptoms: Role of Health and Social Engagement Change

by Hyunjoo Lee, Sojung Park, Eunsun Kwon and Joonyoung Cho

Int. J. Environ. Res. Public Health 2017, 14(6), 588; https://doi.org/10.3390/ijerph14060588 - 1 Jun 2017

Cited by 1 | Viewed by 3994

Abstract

This study explored heterogeneous change patterns of South Korean older adults’ depressive symptoms by poverty status, focusing on health status and social engagement changes. We used data from four waves (2006–2012) of the Korean Longitudinal Study of Aging (KLoSA). Our sample contained 2461 [...] Read more.

This study explored heterogeneous change patterns of South Korean older adults’ depressive symptoms by poverty status, focusing on health status and social engagement changes. We used data from four waves (2006–2012) of the Korean Longitudinal Study of Aging (KLoSA). Our sample contained 2461 poor and 1668 non-poor individuals. All were 65 years old or older at baseline. We used latent class growth analysis to identify trajectory groups’ depressive symptoms. Multinomial logistic regression was used to examine how a range of changes in health conditions and social engagement was associated with trajectories among poor and non-poor participants. Among the poor, five heterogeneous trajectories with clear patterns were identified: high-to-moderate, stable-high, slightly-increasing, steeply-increasing, and stable-low. Among non-poor, high-to-moderate, steeply-increasing, and stable-low groups were found. A decrease in health conditions was the most vulnerable subgroup’s (steeply-increasing) primary risk factor. Poor older adults who reduced participation in, or decreased contact with, social networks were likely to belong to the steeply-increasing group. Our study provides impetus for organizational and/or environmental support systems to facilitate social engagement among poor older adults. Future research should examine whether the significance of social engagement among poor elders applies in less-developed and developed countries. Full article

(This article belongs to the Special Issue Aging and Health Promotion)

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Open AccessArticle

Heterogeneous Trajectories of Physical and Mental Health in Late Middle Age: Importance of Life-Course Socioeconomic Positions

by Eunsun Kwon and Sojung Park

Int. J. Environ. Res. Public Health 2017, 14(6), 582; https://doi.org/10.3390/ijerph14060582 - 30 May 2017

Cited by 9 | Viewed by 4896

Abstract

Drawing on life course and cumulative disadvantage theory, this study examines heterogeneous trajectories of functional limitations and depressive symptoms among late middle-aged individuals. This study used prospective data from 6010 adults, 51 to 64 years old, collected over a 12-year-period from the Health [...] Read more.

Drawing on life course and cumulative disadvantage theory, this study examines heterogeneous trajectories of functional limitations and depressive symptoms among late middle-aged individuals. This study used prospective data from 6010 adults, 51 to 64 years old, collected over a 12-year-period from the Health and Retirement Study. Considering the empirical proposition that several physical and mental trajectories may exist, Latent Class Growth Modeling was used. Five heterogeneous patterns of joint trajectories (Relatively healthy, Moderately improving, Steadily deteriorating, Steeply deteriorating, and Persistently high comorbid) were identified. Early life adversity was related to an increasing risk of declines in physical and mental health. The Persistently high comorbid class was characterized by a concentration of disadvantages over the life course. The development of public health interventions could help reduce co-existing physical and mental health problems, especially during late middle-age. Full article

(This article belongs to the Special Issue Aging and Health Promotion)

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Open AccessArticle

Socioeconomic, Geospatial, and Geopolitical Disparities in Access to Health Care in the US 2011–2015

by Samuel D. Towne Jr.

Int. J. Environ. Res. Public Health 2017, 14(6), 573; https://doi.org/10.3390/ijerph14060573 - 29 May 2017

Cited by 36 | Viewed by 6656

Abstract

Individuals forgoing needed medical care due to barriers associated with cost are at risk of missing needed care that may be necessary for the prevention or maintenance of a chronic condition among other things. Thus, continued monitoring of factors associated with forgone medical [...] Read more.

Individuals forgoing needed medical care due to barriers associated with cost are at risk of missing needed care that may be necessary for the prevention or maintenance of a chronic condition among other things. Thus, continued monitoring of factors associated with forgone medical care, especially among vulnerable populations, is critical. National survey data (2011–2015) for non-institutionalized adults residing in the USA were utilized to assess forgone medical care, defined as not seeking medical care when the individual thought it was necessary because of cost in the past 12 months. Logistic regression was used to predict forgone medical care vs. sought medical care. Racial/ethnic minority working-age adults, those with lower incomes, those with lower educations, those residing in the South, and those residing in states that failed to participate in Medicaid Expansion in 2014 were more likely (p < 0.01) to forgo medical care due to cost in the past year. Policy makers seeking to reduce barriers to forgone medical care can use this information to tailor their efforts (e.g., mechanisms targeted to bridge gaps in access to care) to those most at-risk and to consider state-level policy decisions that may impact access to care. Full article

(This article belongs to the Special Issue Aging and Health Promotion)

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Open AccessArticle

The Influence of Neighbourhoods and the Social Environment on Sedentary Behaviour in Older Adults in Three Prospective Cohorts

by Richard J. Shaw, Iva Čukić, Ian J. Deary, Catharine R. Gale, Sebastien F. M. Chastin, Philippa M. Dall, Manon L. Dontje, Dawn A. Skelton, Laura Macdonald and Geoff Der

Int. J. Environ. Res. Public Health 2017, 14(6), 557; https://doi.org/10.3390/ijerph14060557 - 24 May 2017

Cited by 19 | Viewed by 7198

Abstract

Sedentary behaviour is an emerging risk factor for poor health. This study aimed to identify ecological determinants of sedentary behaviour, for which evidence is currently scarce. The study participants were community dwelling adults from, respectively, the Lothian Birth Cohort 1936 (n = 271, [...] Read more.

Sedentary behaviour is an emerging risk factor for poor health. This study aimed to identify ecological determinants of sedentary behaviour, for which evidence is currently scarce. The study participants were community dwelling adults from, respectively, the Lothian Birth Cohort 1936 (n = 271, mean age 79) and the 1930s (n = 119, mean age 83) and 1950s (n = 310, mean age 64) cohorts of the West of Scotland Twenty-07 study. The outcome measure, percentage of waking time spent sedentary (sedentary time), was measured using an activPAL activity monitor worn continuously for seven days. Potential determinants included objective and subjective neighbourhood measures such as natural space, crime, social cohesion and fear of crime. Other determinants included measures of social participation such as social support, social group membership and providing care. Results from multivariable regression analyses indicated that providing care was associated with reduced sedentary time in retired participants in all cohorts. Fear of crime and perceived absence of services were associated with increased sedentary time for retired 1950s cohort members. Higher crime rates were associated with increased sedentary time in all cohorts but this was not significant after adjustment for socio-demographic characteristics. Most other neighbourhood and social participation measures showed no association with sedentary time. Full article

(This article belongs to the Special Issue Aging and Health Promotion)

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Open AccessFeature PaperArticle

Cost-Effectiveness of a Community Exercise and Nutrition Program for Older Adults: Texercise Select

by Olufolake (Odufuwa) Akanni, Matthew Lee Smith and Marcia G. Ory

Int. J. Environ. Res. Public Health 2017, 14(5), 545; https://doi.org/10.3390/ijerph14050545 - 20 May 2017

Cited by 20 | Viewed by 7427

Abstract

The wide-spread dissemination of evidence-based programs that can improve health outcomes among older populations often requires an understanding of factors influencing community adoption of such programs. One such program is Texercise Select, a community-based health promotion program previously shown to improve functional [...] Read more.

The wide-spread dissemination of evidence-based programs that can improve health outcomes among older populations often requires an understanding of factors influencing community adoption of such programs. One such program is Texercise Select, a community-based health promotion program previously shown to improve functional health, physical activity, nutritional habits and quality of the life among older adults. This paper assesses the cost-effectiveness of Texercise Select in the context of supportive environments to facilitate its delivery and statewide sustainability. Participants were surveyed using self-reported instruments distributed at program baseline and conclusion. Program costs were based on actual direct costs of program implementation and included costs of recruitment and outreach, personnel costs and participant incentives. Program effectiveness was measured using quality-adjusted life year (QALY) gained, as well as health outcomes, such as healthy days, weekly physical activity and Timed Up-and-Go (TUG) test scores. Preference-based EuroQol (EQ-5D) scores were estimated from the number of healthy days reported by participants and converted into QALYs. There was a significant increase in the number of healthy days (p < 0.05) over the 12-week program. Cost-effectiveness ratios ranged from $1374 to $1452 per QALY gained. The reported cost-effective ratios are well within the common cost-effectiveness threshold of $50,000 for a gained QALY. Some sociodemographic differences were also observed in program impact and cost. Non-Hispanic whites experienced significant improvements in healthy days from baseline to the follow-up period and had higher cost-effectiveness ratios. Results indicate that the Texercise Select program is a cost-effective strategy for increasing physical activity and improving healthy dietary practices among older adults as compared to similar health promotion interventions. In line with the significant improvement in healthy days, physical activity and nutrition-related outcomes among participants, this study supports the use of Texercise Select as an intervention with substantial health and cost benefits. Full article

(This article belongs to the Special Issue Aging and Health Promotion)

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Open AccessArticle

A Study Protocol for Applying User Participation and Co-Learning—Lessons Learned from the eBalance Project

by Anna Cristina Åberg, Kjartan Halvorsen, Ingrid From, Åsa Bergman Bruhn, Lars Oestreicher and Anita Melander-Wikman

Int. J. Environ. Res. Public Health 2017, 14(5), 512; https://doi.org/10.3390/ijerph14050512 - 10 May 2017

Cited by 11 | Viewed by 6448

Abstract

The eBalance project is based on the idea that serious exergames—i.e., computer gaming systems with an interface that requires physical exertion to play—that are well adapted to users, can become a substantial part of a solution to recognized problems of insufficient engagement in [...] Read more.

The eBalance project is based on the idea that serious exergames—i.e., computer gaming systems with an interface that requires physical exertion to play—that are well adapted to users, can become a substantial part of a solution to recognized problems of insufficient engagement in fall-prevention exercise and the high levels of fall-related injuries among older people. This project is carried out as a collaboration between eight older people who have an interest in balance training and met the inclusion criteria of independence in personal activities of daily living, access to and basic knowledge of a computer, four staff working with the rehabilitation of older adults, and an interdisciplinary group of six research coordinators covering the areas of geriatric care and rehabilitation, as well as information technology and computer science. This paper describes the study protocol of the project’s initial phase which aims to develop a working partnership with potential users of fall-prevention exergames, including its conceptual underpinnings. The qualitative methodology was inspired by an ethnographical approach implying combining methods that allowed the design to evolve through the study based on the participants’ reflections. A participatory and appreciative action and reflection (PAAR) approach, accompanied by inquiries inspired by the Normalization Process Theory (NPT) was used in interactive workshops, including exergame testing, and between workshop activities. Data were collected through audio recordings, photos, and different types of written documentation. The findings provide a description of the methodology thus developed and applied. They display a methodology that can be useful for the design and development of care service and innovations for older persons where user participation is in focus. Full article

(This article belongs to the Special Issue Aging and Health Promotion)

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Open AccessArticle

Does an Empty Nest Affect Elders’ Health? Empirical Evidence from China

by Min Gao, Yanyu Li, Shengfa Zhang, Linni Gu, Jinsui Zhang, Zhuojun Li, Weijun Zhang and Donghua Tian

Int. J. Environ. Res. Public Health 2017, 14(5), 463; https://doi.org/10.3390/ijerph14050463 - 27 Apr 2017

Cited by 60 | Viewed by 7367

Abstract

The “empty-nest” elderly family has become increasingly prevalent among old people in China. This study aimed to explore the causality between empty nests and elders’ health using effective instrumental variables, including “whether old parents talk with their families when they are upset” and [...] Read more.

The “empty-nest” elderly family has become increasingly prevalent among old people in China. This study aimed to explore the causality between empty nests and elders’ health using effective instrumental variables, including “whether old parents talk with their families when they are upset” and “ownership of housing”. The results showed that empty nests had a significantly adverse influence on elders’ physical health, cognitive ability and psychological health. Furthermore, urban elders’ cognitive ability was more influenced by empty nests than that of rural elders. Additionally, the effects of an empty nest on elders” health were more significant among female, single elders and senior rural elders. “Living resources”, “availability of medical treatment” and “social activity engagement” were found to be significant mediators between empty nests and elders’ health, accounting for 35% of the total effect. Full article

(This article belongs to the Special Issue Aging and Health Promotion)

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Open AccessArticle

Assessing Diabetes and Factors Associated with Foregoing Medical Care among Persons with Diabetes: Disparities Facing American Indian/Alaska Native, Black, Hispanic, Low Income, and Southern Adults in the U.S. (2011–2015)

by Samuel D. Towne, Jane Bolin, Alva Ferdinand, Emily Joy Nicklett, Matthew Lee Smith and Marcia G. Ory

Int. J. Environ. Res. Public Health 2017, 14(5), 464; https://doi.org/10.3390/ijerph14050464 - 26 Apr 2017

Cited by 30 | Viewed by 16308

Abstract

Objective: Identify individual- and place-based factors associated with diagnosed diabetes and forgone medical care among those diagnosed with diabetes. Background: Diabetes affects millions of individuals globally. In the U.S. alone the prevalence rate of diagnosed diabetes has more than doubled over [...] Read more.

Objective: Identify individual- and place-based factors associated with diagnosed diabetes and forgone medical care among those diagnosed with diabetes. Background: Diabetes affects millions of individuals globally. In the U.S. alone the prevalence rate of diagnosed diabetes has more than doubled over the past 20 years (4.2% in 1994 to 10% in 2014). Methods: The Behavioral Risk Factor Surveillance System (2011–2015) was used to identify factors associated with self-reported diabetes diagnoses (ever diagnosed) among U.S. adults. Logistic regression modeled: (1) the likelihood of having diabetes; (2) the likelihood of forgone medical care among those with diabetes, given appropriate medical care has been linked to preventing complications associated with diabetes. Results: Rates of diabetes remained relatively stable from 2011 to 2015. The likelihood of diabetes was higher (p < 0.01) among racial and ethnic minority groups, men, those with lower incomes and those with lower education. Place-based disparities indicating a higher likelihood of having a diagnosis of diabetes were found for those living in rural areas (urban versus rural, unadjusted OR = 0.844–0.908; p < 0.01) and those living in the South (North, Midwest, and Western/Pacific regions versus the South, unadjusted OR = 0.794–0.889; p < 0.01). Similar results were found with forgone medical care among those diagnosed with diabetes being more likely in the South (North, Midwest, and Western/Pacific regions versus the South, unadjusted OR = 0.542–0.819). In fully-adjusted analyses, the prevalence of diabetes and forgone medical care among those diagnosed with diabetes was higher for those with lower incomes, from several racial/ethnic minority groups, and in the South versus most other regions. Conclusions: Identifying at-risk groups informs targets for prevention and assists efforts to address chronic disease self-management among those already diagnosed with diabetes. Full article

(This article belongs to the Special Issue Aging and Health Promotion)

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Open AccessArticle

Life Course Trajectories of Later-Life Cognitive Functions: Does Social Engagement in Old Age Matter?

by Sojung Park, Eunsun Kwon and Hyunjoo Lee

Int. J. Environ. Res. Public Health 2017, 14(4), 393; https://doi.org/10.3390/ijerph14040393 - 7 Apr 2017

Cited by 31 | Viewed by 5945

Abstract

This study identified differential patterns of later-life cognitive function trajectories and examined to what extent life course factors and social engagement are associated with group trajectories. Data came from seven waves of the Health and Retirement Study (HRS 1998–2010; n = 7374; Observations [...] Read more.

This study identified differential patterns of later-life cognitive function trajectories and examined to what extent life course factors and social engagement are associated with group trajectories. Data came from seven waves of the Health and Retirement Study (HRS 1998–2010; n = 7374; Observations = 41,051). Latent class growth analysis identified cognitive function trajectory groups, and multinomial logistic regression was used to examine the factors associated with group trajectories. Five heterogeneous trajectories were identified: stable high, stable moderate, stable low, high-to-moderate, and moderate-to-low. Findings suggest that, after adjusting for life course factors, individuals who became volunteers were more likely to belong to one of the two least vulnerable trajectories, stable high or high-to-moderate. Our findings suggest that, despite the cumulative life course factors evident in cognitive decline, social engagement in old age may serve as a potential protective resource. Full article

(This article belongs to the Special Issue Aging and Health Promotion)

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Open AccessFeature PaperArticle

Relative Association of Multi-Level Supportive Environments on Poor Health among Older Adults

by Nelda Mier, Marcia G. Ory, Samuel D. Towne and Matthew Lee Smith

Int. J. Environ. Res. Public Health 2017, 14(4), 387; https://doi.org/10.3390/ijerph14040387 - 6 Apr 2017

Cited by 8 | Viewed by 5427

Abstract

Background: The aging of the United States population poses significant challenges to American healthcare and informal caregiving systems. Additional research is needed to understand how health promotion programs and policies based on a socio-ecological perspective impact the health and well-being of older [...] Read more.

Background: The aging of the United States population poses significant challenges to American healthcare and informal caregiving systems. Additional research is needed to understand how health promotion programs and policies based on a socio-ecological perspective impact the health and well-being of older persons. The purpose of this study was to investigate personal characteristics and supportive environments associated with poor health among older individuals aged 65 and over. Methods: This study used a cross-sectional design and was guided by a conceptual framework developed by the authors to depict the relationship between personal characteristics and environments associated with poor health status. Environment types included in this study were family, home, financial, neighborhood, and healthcare. The sample was comprised of 1319 adults aged 65 years and older residing in Central Texas. From a random selection of households, participants were administered a mail-based survey created by a community collaborative effort. Descriptive statistics and three binary logistic regression models were fitted to examine associations with poor health status (i.e., physical, mental, and combined physical/mental). Results: Two personal characteristics (number of chronic conditions and educational level) were consistently related (p < 0.05) to health outcomes. Supportive family, home, financial, neighborhood, and health care environmental factors were shown to be related (p < 0.05) to various aspects of physical or mental health outcomes. Conclusions: Multidimensional factors including personal characteristics and protective environments are related to health status among older individuals. The unique roles of each environment can help inform public health interventions to create and enhance support for older adults to engage in healthful activities and improve their physical and mental health. Full article

(This article belongs to the Special Issue Aging and Health Promotion)

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Open AccessArticle

Variation in Older Adult Characteristics by Residence Type and Use of Home- and Community-Based Services

by Heidi H. Ewen, Tiffany R. Washington, Kerstin G. Emerson, Andrew T. Carswell and Matthew Lee Smith

Int. J. Environ. Res. Public Health 2017, 14(3), 330; https://doi.org/10.3390/ijerph14030330 - 22 Mar 2017

Cited by 27 | Viewed by 6618

Abstract

Background: The majority of older adults prefer to remain in their homes, or to “age-in-place.” To accomplish this goal, many older adults will rely upon home- and community-based services (HCBS) for support. However, the availability and accessibility of HCBS may differ based on [...] Read more.

Background: The majority of older adults prefer to remain in their homes, or to “age-in-place.” To accomplish this goal, many older adults will rely upon home- and community-based services (HCBS) for support. However, the availability and accessibility of HCBS may differ based on whether the older adult lives in the community or in a senior housing apartment facility. Methods: This paper reports findings from the Pathways to Life Quality study of residential change and stability among seniors in upstate New York. Data were analyzed from 663 older adults living in one of three housing types: service-rich facilities, service-poor facilities, and community-dwelling in single-family homes. A multinomial logistic regression model was used to examine factors associated with residence type. A linear regression model was fitted to examine factors associated with HCBS utilization. Results: When compared to community-dwelling older adults, those residing in service-rich and service-poor facilities were more likely to be older, report more activity limitations, and provide less instrumental assistance to others. Those in service-poor facilities were more likely to have poorer mental health and lower perceived purpose in life. The three leading HCBS utilized were senior centers (20%), homemaker services (19%), and transportation services (18%). More HCBS utilization was associated with participants who resided in service-poor housing, were older, were female, and had more activity limitations. More HCBS utilization was also associated with those who received instrumental support, had higher perceived purpose in life, and poorer mental health. Conclusions: Findings suggest that older adults’ residential environment is associated with their health status and HCBS utilization. Building upon the Person–Environment Fit theories, dedicated efforts are needed to introduce and expand upon existing HCBS available to facility residents to address physical and mental health needs as well as facilitate aging-in-place. Full article

(This article belongs to the Special Issue Aging and Health Promotion)

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Open AccessArticle

Is the Association between Park Proximity and Recreational Physical Activity among Mid-Older Aged Adults Moderated by Park Quality and Neighborhood Conditions?

by Jelle Van Cauwenberg, Ester Cerin, Anna Timperio, Jo Salmon, Benedicte Deforche and Jenny Veitch

Int. J. Environ. Res. Public Health 2017, 14(2), 192; https://doi.org/10.3390/ijerph14020192 - 14 Feb 2017

Cited by 26 | Viewed by 6249

Abstract

Previous studies have reported mixed findings on the relationship between park proximity and recreational physical activity (PA), which could be explained by park quality and the surrounding neighborhood environment. We examined whether park quality and perceptions of the neighborhood physical and social environment [...] Read more.

Previous studies have reported mixed findings on the relationship between park proximity and recreational physical activity (PA), which could be explained by park quality and the surrounding neighborhood environment. We examined whether park quality and perceptions of the neighborhood physical and social environment moderated associations between park proximity and recreational PA among mid-older aged adults. Cross-sectional self-reported data on park proximity, park quality, neighborhood physical and social environmental factors, recreational walking and other moderate- to vigorous-intensity recreational physical activity (MVPA) were collected among 2700 Australian adults (57–69 years) in 2012. Main effects between park proximity and measures of recreational PA were non-significant. Park proximity was positively related to engagement in recreational walking among participants who reported average and high social trust and cohesion, but not among those reporting low social trust and cohesion. No other moderating effects were observed. Current findings suggest synergistic relationships between park proximity and social trust and cohesion with mid-older aged adults’ recreational walking. More research is needed to unravel the complex relationship between parks, recreational PA and the social context of neighborhoods. Full article

(This article belongs to the Special Issue Aging and Health Promotion)

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Open AccessArticle

The Uncommon Impact of Common Environmental Details on Walking in Older Adults

by Katherine Brookfield, Catharine Ward Thompson and Iain Scott

Int. J. Environ. Res. Public Health 2017, 14(2), 190; https://doi.org/10.3390/ijerph14020190 - 14 Feb 2017

Cited by 36 | Viewed by 7428

Abstract

Walking is the most common form of physical activity amongst older adults. Older adults’ walking behaviors have been linked to objective and perceived neighborhood and street-level environmental attributes, such as pavement quality and mixed land uses. To help identify components of walkable environments, [...] Read more.

Walking is the most common form of physical activity amongst older adults. Older adults’ walking behaviors have been linked to objective and perceived neighborhood and street-level environmental attributes, such as pavement quality and mixed land uses. To help identify components of walkable environments, this paper examines some of these environmental attributes and explores their influence on this population’s walking behaviors. It draws on focus group and interview data collected from 22 purposively sampled older adults aged 60 years and over. These participants presented a range of functional and cognitive impairments including stroke and dementia. In line with past research, we detail how various everyday aspects of urban environments, such as steps, curbs and uneven pavements, can, in combination with person-related factors, complicate older adults’ outdoor mobility while others, such as handrails and benches, seem to support and even encourage movement. Importantly, we delineate the influence of perceptions on mobility choices. We found that, in some instances, it is the meanings and possibilities that older adults derive from aspects of the environment, such as street cameras and underpasses, rather than the aspects per se, which shape behavior. The implications for policy and practice are considered. Full article

(This article belongs to the Special Issue Aging and Health Promotion)

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Open AccessArticle

Neighborhood Environment and Falls among Community-Dwelling Older Adults

by Emily Joy Nicklett, Matthew C. Lohman and Matthew Lee Smith

Int. J. Environ. Res. Public Health 2017, 14(2), 175; https://doi.org/10.3390/ijerph14020175 - 10 Feb 2017

Cited by 50 | Viewed by 7320

Abstract

Background: Falls present a major challenge to active aging, but the relationship between neighborhood factors and falls is poorly understood. This study examined the relationship between fall events and neighborhood factors, including neighborhood social cohesion (sense of belonging, trust, friendliness, and helpfulness) [...] Read more.

Background: Falls present a major challenge to active aging, but the relationship between neighborhood factors and falls is poorly understood. This study examined the relationship between fall events and neighborhood factors, including neighborhood social cohesion (sense of belonging, trust, friendliness, and helpfulness) and physical environment (vandalism/graffiti, rubbish, vacant/deserted houses, and perceived safety walking home at night). Methods: Data were analyzed from 9259 participants over four biennial waves (2006–2012) of the Health and Retirement Study (HRS), a nationally representative sample of adults aged 65 and older in the United States. Results: In models adjusting for demographic and health-related covariates, a one-unit increase in neighborhood social cohesion was associated with 4% lower odds of experiencing a single fall (odds ratio (OR): 0.96, 95% confidence interval (CI): 0.93–0.99) and 6% lower odds of experiencing multiple falls (OR: 0.94, 95% CI: 0.90–0.98). A one-unit increase in the physical environment scale was associated with 4% lower odds of experiencing a single fall (OR: 0.96, 95% CI: 0.93–0.99) and with 5% lower odds of experiencing multiple falls (OR: 0.95, 95% CI: 0.91–1.00) in adjusted models. Conclusions: The physical and social neighborhood environment may affect fall risk among community-dwelling older adults. Findings support the ongoing need for evidence-based fall prevention programming in community and clinical settings. Full article

(This article belongs to the Special Issue Aging and Health Promotion)

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Open AccessArticle

Non-Emergency Medical Transportation Needs of Middle-Aged and Older Adults: A Rural-Urban Comparison in Delaware, USA

by Matthew Lee Smith, Thomas R. Prohaska, Kara E. MacLeod, Marcia G. Ory, Amy R. Eisenstein, David R. Ragland, Cheryl Irmiter, Samuel D. Towne and William A. Satariano

Int. J. Environ. Res. Public Health 2017, 14(2), 174; https://doi.org/10.3390/ijerph14020174 - 10 Feb 2017

Cited by 22 | Viewed by 9226

Abstract

Background: Older adults in rural areas have unique transportation barriers to accessing medical care, which include a lack of mass transit options and considerable distances to health-related services. This study contrasts non-emergency medical transportation (NEMT) service utilization patterns and associated costs for [...] Read more.

Background: Older adults in rural areas have unique transportation barriers to accessing medical care, which include a lack of mass transit options and considerable distances to health-related services. This study contrasts non-emergency medical transportation (NEMT) service utilization patterns and associated costs for Medicaid middle-aged and older adults in rural versus urban areas. Methods: Data were analyzed from 39,194 NEMT users of LogistiCare-brokered services in Delaware residing in rural (68.3%) and urban (30.9%) areas. Multivariable logistic analyses compared trip characteristics by rurality designation. Results: Rural (37.2%) and urban (41.2%) participants used services more frequently for dialysis than for any other medical concern. Older age and personal accompaniment were more common and wheel chair use was less common for rural trips. The mean cost per trip was greater for rural users (difference of $2910 per trip), which was attributed to the greater distance per trip in rural areas. Conclusions: Among a sample who were eligible for subsidized NEMT and who utilized this service, rural trips tended to be longer and, therefore, higher in cost. Over 50% of trips were made for dialysis highlighting the need to address prevention and, potentially, health service improvements for rural dialysis patients. Full article

(This article belongs to the Special Issue Aging and Health Promotion)

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Open AccessArticle

Neighborhood Factors and Fall-Related Injuries among Older Adults Seen by Emergency Medical Service Providers

by Sungmin Lee, Chanam Lee and Susan Rodiek

Int. J. Environ. Res. Public Health 2017, 14(2), 163; https://doi.org/10.3390/ijerph14020163 - 8 Feb 2017

Cited by 12 | Viewed by 6664

Abstract

Falls are serious health problems among older adults, and are the leading cause of fatal and nonfatal injuries treated by emergency medical services (EMS). Although considerable research has examined the risk factors of falls at the individual level, relatively few studies have addressed [...] Read more.

Falls are serious health problems among older adults, and are the leading cause of fatal and nonfatal injuries treated by emergency medical services (EMS). Although considerable research has examined the risk factors of falls at the individual level, relatively few studies have addressed the risk factors at the neighborhood level. This study examines the characteristics of neighborhood environments associated with fall injuries reported to EMS providers. A total of 13,163 EMS records from 2011 to 2014 involving adults aged 65 and older in the city of San Antonio (TX, USA) were analyzed at the census tract level (n = 264). Negative binomial regression was used to identify significant census tract-based neighborhood environmental variables associated with the count of fall injuries in each census tract. Adjusting for exposure variable and the size of the census tract, neighborhoods with higher residential stability, captured as the percent of those who lived in the same house as the previous year were associated with decreased count of fall injuries. Neighborhoods with higher residential density and having a higher vacancy rate were associated with increased count of fall injuries. The study highlights the importance of stable and safe neighborhoods in reducing fall risks among older adults, which should be considered a prerequisite for promoting age-friendly environments. Full article

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Open AccessArticle

Older People’s Experiences of Mobility and Mood in an Urban Environment: A Mixed Methods Approach Using Electroencephalography (EEG) and Interviews

by Sara Tilley, Chris Neale, Agnès Patuano and Steve Cinderby

Int. J. Environ. Res. Public Health 2017, 14(2), 151; https://doi.org/10.3390/ijerph14020151 - 4 Feb 2017

Cited by 109 | Viewed by 19181

Abstract

There are concerns about mental wellbeing in later life in older people as the global population becomes older and more urbanised. Mobility in the built environment has a role to play in improving quality of life and wellbeing, as it facilitates independence and [...] Read more.

There are concerns about mental wellbeing in later life in older people as the global population becomes older and more urbanised. Mobility in the built environment has a role to play in improving quality of life and wellbeing, as it facilitates independence and social interaction. Recent studies using neuroimaging methods in environmental psychology research have shown that different types of urban environments may be associated with distinctive patterns of brain activity, suggesting that we interact differently with varying environments. This paper reports on research that explores older people’s responses to urban places and their mobility in and around the built environment. The project aim was to understand how older people experience different urban environments using a mixed methods approach including electroencephalography (EEG), self-reported measures, and interview results. We found that older participants experience changing levels of “excitement”, “engagement” and “frustration” (as interpreted by proprietary EEG software) whilst walking between a busy built urban environment and an urban green space environment. These changes were further reflected in the qualitative themes that emerged from transcribed interviews undertaken one week post-walk. There has been no research to date that has directly assessed neural responses to an urban environment combined with qualitative interview analysis. A synergy of methods offers a deeper understanding of the changing moods of older people across time whilst walking in city settings. Full article

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Changes in Depressive Symptoms among Older Adults with Multiple Chronic Conditions: Role of Positive and Negative Social Support

by SangNam Ahn, Seonghoon Kim and Hongmei Zhang

Int. J. Environ. Res. Public Health 2017, 14(1), 16; https://doi.org/10.3390/ijerph14010016 - 26 Dec 2016

Cited by 36 | Viewed by 7304

Abstract

Depression severely affects older adults in the United States. As part of the social environment, significant social support was suggested to ameliorate depression among older adults. We investigate how varying forms of social support moderate depressive symptomatology among older adults with multiple chronic [...] Read more.

Depression severely affects older adults in the United States. As part of the social environment, significant social support was suggested to ameliorate depression among older adults. We investigate how varying forms of social support moderate depressive symptomatology among older adults with multiple chronic conditions (MCC). Data were analyzed using a sample of 11,400 adults, aged 65 years or older, from the 2006–2012 Health and Retirement Study. The current study investigated the moderating effects of positive or negative social support from spouse, children, other family, and friends on the association between MCC and depression. A linear mixed model with repeated measures was used to estimate the effect of MCC on depression and its interactions with positive and negative social support in explaining depression among older adults. Varying forms of social support played different moderating roles in depressive symptomatology among older adults with MCC. Positive spousal support significantly weakened the deleterious effect of MCC on depression. Conversely, all negative social support from spouse, children, other family, and friends significantly strengthened the deleterious effect of MCC on depression. Minimizing negative social support and maximizing positive spousal support can reduce depression caused by MCC and lead to successful aging among older adults. Full article

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Open AccessArticle

Older Adults’ Outdoor Walking: Inequalities in Neighbourhood Safety, Pedestrian Infrastructure and Aesthetics

by Razieh Zandieh, Javier Martinez, Johannes Flacke, Phil Jones and Martin Van Maarseveen

Int. J. Environ. Res. Public Health 2016, 13(12), 1179; https://doi.org/10.3390/ijerph13121179 - 25 Nov 2016

Cited by 69 | Viewed by 9957

Abstract

Older adults living in high-deprivation areas walk less than those living in low-deprivation areas. Previous research has shown that older adults’ outdoor walking levels are related to the neighbourhood built environment. This study examines inequalities in perceived built environment attributes (i.e., safety, pedestrian [...] Read more.

Older adults living in high-deprivation areas walk less than those living in low-deprivation areas. Previous research has shown that older adults’ outdoor walking levels are related to the neighbourhood built environment. This study examines inequalities in perceived built environment attributes (i.e., safety, pedestrian infrastructure and aesthetics) and their possible influences on disparities in older adults’ outdoor walking levels in low- and high-deprivation areas of Birmingham, United Kingdom. It applied a mixed-method approach, included 173 participants (65 years and over), used GPS technology to measure outdoor walking levels, used questionnaires (for all participants) and conducted walking interviews (with a sub-sample) to collect data on perceived neighbourhood built environment attributes. The results show inequalities in perceived neighbourhood safety, pedestrian infrastructure and aesthetics in high- versus low-deprivation areas and demonstrate that they may influence disparities in participants’ outdoor walking levels. Improvements of perceived neighbourhood safety, pedestrian infrastructure and aesthetic in high-deprivation areas are encouraged. Full article

(This article belongs to the Special Issue Aging and Health Promotion)

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Open AccessArticle

A Robot-Based Tool for Physical and Cognitive Rehabilitation of Elderly People Using Biofeedback

by Leire Lopez-Samaniego and Begonya Garcia-Zapirain

Int. J. Environ. Res. Public Health 2016, 13(12), 1176; https://doi.org/10.3390/ijerph13121176 - 24 Nov 2016

Cited by 26 | Viewed by 5591

Abstract

This publication presents a complete description of a technological solution system for the physical and cognitive rehabilitation of elderly people through a biofeedback system, which is combined with a Lego robot. The technology used was the iOS’s (iPhone Operating System) Objective-C programming language [...] Read more.

This publication presents a complete description of a technological solution system for the physical and cognitive rehabilitation of elderly people through a biofeedback system, which is combined with a Lego robot. The technology used was the iOS’s (iPhone Operating System) Objective-C programming language and its XCode programming environment; and SQLite in order to create the database. The biofeedback system is implemented by the use of two biosensors which are, in fact, a Microsoft band 2 in order to register the user’s heart rate and a MYO sensor to detect the user’s arm movement. Finally, the system was tested with seven elderly people from La Santa y Real Casa de la Misericordia nursing home in Bilbao. The statistical assessment has shown that the users are satisfied with the usability of the system, with a mean score of 79.29 on the System Usability Scale (SUS) questionnaire. Full article

(This article belongs to the Special Issue Aging and Health Promotion)

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Open AccessArticle

Using Virtual Street Audits to Understand the Walkability of Older Adults’ Route Choices by Gender and Age

by Katherine Brookfield and Sara Tilley

Int. J. Environ. Res. Public Health 2016, 13(11), 1061; https://doi.org/10.3390/ijerph13111061 - 28 Oct 2016

Cited by 31 | Viewed by 6746

Abstract

Walking for physical activity can bring important health benefits to older adults. In this population, walking has been related to various urban design features and street characteristics. To gain new insights into the microscale environmental details that might influence seniors’ walking, details which [...] Read more.

Walking for physical activity can bring important health benefits to older adults. In this population, walking has been related to various urban design features and street characteristics. To gain new insights into the microscale environmental details that might influence seniors’ walking, details which might be more amenable to change than neighbourhood level factors, we employed a reliable streetscape audit tool, in combination with Google Street View^™, to evaluate the ‘walkability’ of where older adults choose to walk. Analysis of the routes selected by a purposive sample of independently mobile adults aged 65 years and over living in Edinburgh, UK, revealed a preference to walk in more walkable environments, alongside a willingness to walk in less supportive settings. At times, factors commonly considered important for walking, including wayfinding and legibility, user conflict, kerb paving quality, and lighting appeared to have little impact on older adults’ decisions about where to walk. The implications for policy, practice, and the emerging technique of virtual auditing are considered. Full article

(This article belongs to the Special Issue Aging and Health Promotion)

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l-Arginine Enhances Resistance against Oxidative Stress and Heat Stress in Caenorhabditis elegans

by Heran Ma, Yudan Ma, Zhixian Zhang, Ziyuan Zhao, Ran Lin, Jinming Zhu, Yi Guo and Li Xu

Int. J. Environ. Res. Public Health 2016, 13(10), 969; https://doi.org/10.3390/ijerph13100969 - 29 Sep 2016

Cited by 21 | Viewed by 5694

Abstract

The antioxidant properties of l-arginine (l-Arg) in vivo, and its effect on enhancing resistance to oxidative stress and heat stress in Caenorhabditis elegans were investigated. C. elegans, a worm model popularly used in molecular and developmental biology, was used [...] Read more.

The antioxidant properties of l-arginine (l-Arg) in vivo, and its effect on enhancing resistance to oxidative stress and heat stress in Caenorhabditis elegans were investigated. C. elegans, a worm model popularly used in molecular and developmental biology, was used in the present study. Here, we report that l-Arg, at a concentration of 1 mM, prolonged C. elegans life by 26.98% and 37.02% under oxidative and heat stress, respectively. Further experiments indicated that the longevity-extending effects of l-Arg may be exerted by its free radical scavenging capacity and the upregulation of aging-associated gene expression in worms. This work is important in the context of numerous recent studies that concluded that environment stresses are associated with an increased population death rate. Full article

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Relationships of Community and Individual Level Social Capital with Activities of Daily Living and Death by Gender

by Haruhiko Imamura, Tsuyoshi Hamano, Takehiro Michikawa, Fujimi Takeda-Imai, Takahiro Nakamura, Toru Takebayashi and Yuji Nishiwaki

Int. J. Environ. Res. Public Health 2016, 13(9), 860; https://doi.org/10.3390/ijerph13090860 - 29 Aug 2016

Cited by 19 | Viewed by 6303

Abstract

This study determined whether there is an association between social capital and a composite outcome of decline in Activities of Daily Living (ADL) and death by gender. A prospective 3.5 year cohort study was conducted in a rural town in Japan. The study [...] Read more.

This study determined whether there is an association between social capital and a composite outcome of decline in Activities of Daily Living (ADL) and death by gender. A prospective 3.5 year cohort study was conducted in a rural town in Japan. The study participants were 984 individuals aged 65 years and older with not impaired on ADL at 2010 baseline survey. Social participation and generalized trust were measured as social capital. The individual level responses were dichotomized and aggregated into the community level (eight areas). Multilevel logistic regression adjusting for covariates revealed that social participation at the individual level was significantly associated with higher odds of composite outcome (OR of “not participate” = 1.97, 95% CI = 1.38–2.81). Regarding generalized trust, only in men, there was an inverse association at the community level (OR of “low” = 0.55, 95% CI = 0.32–0.96), and a positive association at the individual level (OR of “tend to be careful” = 2.22, 95% CI = 1.27–3.90). These results suggest that social capital were associated with a decline in ADL and death and that the association may differ by gender. Full article

(This article belongs to the Special Issue Aging and Health Promotion)

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Comprehensive Comparison between Empty Nest and Non-Empty Nest Elderly: A Cross-Sectional Study among Rural Populations in Northeast China

by Ye Chang, Xiaofan Guo, Liang Guo, Zhao Li, Hongmei Yang, Shasha Yu, Guozhe Sun and Yingxian Sun

Int. J. Environ. Res. Public Health 2016, 13(9), 857; https://doi.org/10.3390/ijerph13090857 - 27 Aug 2016

Cited by 35 | Viewed by 6373

Abstract

This study aimed to comprehensively compare the general characteristics, lifestyles, serum parameters, ultrasonic cardiogram (UCG) parameters, depression, quality of life, and various comorbidities between empty nest and non-empty nest elderly among rural populations in northeast China. This analysis was based on our previous [...] Read more.

This study aimed to comprehensively compare the general characteristics, lifestyles, serum parameters, ultrasonic cardiogram (UCG) parameters, depression, quality of life, and various comorbidities between empty nest and non-empty nest elderly among rural populations in northeast China. This analysis was based on our previous study which was conducted from January 2012 to August 2013, using a multistage, stratified, random cluster sampling scheme. The final analyzed sample consisted of 3208 participants aged no less than 60 years, which was further classified into three groups: non-empty nest group, empty nest group (living as a couple), and empty nest group (living alone). More than half of the participants were empty nest elderly (60.5%). There were no significant statistical differences for serum parameters, UCG parameters, lifestyles, dietary pattern, and scores of Patient Health Questionnaire-9 (PHQ-9) and World Health Organization Quality of Life questionnaire, abbreviated version (WHOQOL-BREF) among the three groups. Empty nest elderly showed no more risk for comorbidities such as general obesity, abdominal obesity, hyperuricemia, hyperhomocysteinemia, diabetes, dyslipidemia, left atrial enlargement (LAE), and stroke. Our study indicated that empty nest elderly showed no more risk for depression, low quality of life and comorbidities such as general obesity, abdominal obesity, hyperuricemia, hyperhomocysteinemia, diabetes, dyslipidemia, LAE, and stroke among rural populations in northeast China. Full article

(This article belongs to the Special Issue Aging and Health Promotion)

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by Simiao Tian, Béatrice Morio, Jean-Baptiste Denis and Laurence Mioche

Int. J. Environ. Res. Public Health 2016, 13(8), 821; https://doi.org/10.3390/ijerph13080821 - 13 Aug 2016

Cited by 24 | Viewed by 7122

Abstract

This study assessed age-related changes in body composition (specifically in trunk fat and appendicular lean masses), with consideration of body mass index (BMI) at age 20 years (BMI reference age, “BMIref”), ethnicity and lifetime weight change history. A cross-sectional dual-energy X-ray absorptiometry-based dataset [...] Read more.

This study assessed age-related changes in body composition (specifically in trunk fat and appendicular lean masses), with consideration of body mass index (BMI) at age 20 years (BMI reference age, “BMIref”), ethnicity and lifetime weight change history. A cross-sectional dual-energy X-ray absorptiometry-based dataset was extracted from the U.S. National Health and Nutrition Examination Survey (NHANES) 1999–2004. Only European-American and African-American subjects were used (2705 men, 2527 women). For each gender and ethnicity, 6 analytic cases were considered, based on three BMIref categories (normal, overweight and obese, being 22, 27 and 30 kg/m², respectively) and two weight contexts (stable weight or weight gain across the lifespan). A nonparametric model was developed to investigate age-related changes in body composition. Then, parametric modelling was developed for assessing BMIref- and ethnicity-specific effects during aging. In the stable weight, both genders’ and ethnicities’ trunk fat (TF) increased gradually; body fat (BF) remained stable until 40 years and increased thereafter; trunk lean (TL) remained stable, but appendicular lean (APL) and body lean (BL) declined from 20 years. In the weight gain context, TF and BF increased at a constant rate, while APL, TL and BL increased until 40–50 years, and then declined slightly. Compared with European-American subjects of both genders, African-American subjects had lower TF and BF masses. Ethnic differences in body composition were quantified and found to remain constant across the lifespan. Full article

(This article belongs to the Special Issue Aging and Health Promotion)

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