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The purpose of this research is to identify the effectiveness of primary care-based interventions designed to increase older adults’ physical activity (PA). Primary care was defined as a patient’s main source of health care. Standardized mean difference effect size (ES) was calculated related to changes in PA levels in adults’ ≥65. Moderator analysis was performed to explore the relationship between participant characteristics, interventions, interventionists, and ES. Overall mean ES 0.27 (95% confidence interval [0.15, 0.39], p

This systematic review explores gender differences in adverse psychosocial and role-related outcomes of family caregivers of older adults with chronic illnesses. Data sources for the systematic review included CINAHL, PubMed, PsycINFO, and Google Scholar. Eligible primary research focused on examining gender-based differences in psychological and emotional outcomes (e.g., burden, depression, stress) among family caregivers of an older adult with chronic illness. In total, 16 studies were included in the review with most studies using a cross-sectional design and conducted outside of the United States. Studies reported on gender differences in health outcomes such as burden, stress, and anxiety. Women caregivers had overall higher negative outcomes, but men may have more intense difficulty during the initial caregiver transition phase. Resources to address caregiver health should consider the caregiver’s gender. As the older adult population grows, more caregiver research is needed and future studies to include more male caregivers.

We aimed to summarize the evidence on the effectiveness of audio care for managing chronic conditions (except diabetes) when used to replace in-person or video-based care or to supplement other usual care, and to assess differences for populations at risk for disparities.

Background Home health clinicians report a need for family caregiver assistance during the majority of skilled home health care episodes. Since 2018, the Medicare Conditions of Participation has required home health agencies to provide training to family caregivers. However, little is known regarding current practices of family caregiver assessment and training during home health care. Methods Qualitative research relying on semistructured key informant interviews with registered nurses and physical therapists (n = 19), hereafter "clinicians," from four home health agencies. Interviews were recorded and transcribed, then analyzed using directed content analysis to identify relevant themes and concepts. Results Three agencies were not-for-profit and one was for-profit; three were urban and one was rural; two operated on a local scale, one on a regional scale, and one on a national scale. Key informants had an average of 9.3 years of experience in home health care and an average age of 45.0 years. Clinicians described a cyclic process of family caregiver training including four major phases: initial assessment, education, reassessment, and adjustment. Initial assessment was informal and holistic; education was delivered via demonstration and teach-back; reassessment was used to evaluate caregiver progress and inform adjustments to the care plan. Clinicians noted that their perceptions regarding the success of family caregiver training efforts influenced decisions relating to clinical practice, including the number of visits provided and whether to discharge the patient. Conclusions Caregiver training is currently integrated into clinician workflows in home health care and helps determine visit intensity and discharge timing, but clinicians face a lack of structured assessment instruments or training materials. Efforts by policymakers and home health agencies to facilitate clinicians' training efforts could positively affect the cost and quality of Medicare-funded home health care.

Caregivers of older adults with chronic illnesses often face challenges that harm their health and well-being. Evidence-based strategies are needed to address such outcomes. The current study aims to synthesize interventions designed to improve the health and well-being of caregivers of older adults with chronic illnesses. Search strategies included investigating four databases (e.g., PubMed, CINAHL), as well as conducting bibliographic, hand, and author searches. Eligible studies were randomized controlled trials conducted between 2009 and 2019 that included family caregivers of older adults with chronic illnesses aged ≥65 and that reported care-giver health or well-being outcomes. Data from 24 eligible studies were extracted, analyzed, and narratively synthesized. Although intervention characteristics were diverse (e.g., strategies, interventionists), most improved health and well-being. Thus, providers have an array of interventions available to them to help caregivers. Future caregiver research should examine theory-driven interventions among diverse samples, clearly report intervention dose, and measure physical health. [ Journal of Gerontological Nursing, 47 (5), 45–51.]

The global COVID-19 pandemic has driven innovations in methods to sustain initiatives for the design, development, evaluation, and implementation of clinical support technology in long-term care settings while removing risk of infection for residents, family members, health care workers, researchers and technical professionals. We adapted traditional design and evaluation methodology for a mobile clinical decision support app - designated Mobile Application Information System for Integrated Evidence ("MAISIE") - to a completely digital design methodology that removes in-person contacts between the research team, developer, and nursing home staff and residents. We have successfully maintained project continuity for MAISIE app development with only minor challenges while working remotely. This digital design methodology can be implemented in projects where software can be installed without in-person technical support and remote work is feasible. Team skills, experience, and relationships are key considerations for adapting to digital environments and maintaining project momentum.

The global COVID-19 pandemic has driven innovations in methods to sustain initiatives for the design, development, evaluation, and implementation of clinical support technology in long-term care settings while removing risk of infection for residents, family members, health care workers, researchers and technical professionals. We adapted traditional design and evaluation methodology for a mobile clinical decision support app – designated Mobile Application Information System for Integrated Evidence (“MAISIE”) – to a completely digital design methodology that removes in-person contacts between the research team, developer, and nursing home staff and residents. We have successfully maintained project continuity for MAISIE app development with only minor challenges while working remotely. This digital design methodology can be implemented in projects where software can be installed without in-person technical support and remote work is feasible. Team skills, experience, and relationships are key considerations for adapting to digital environments and maintaining project momentum.

Unmet needs for family caregiver assistance threaten patient outcomes during Medicare home health care (HHC). Sepsis survivors represent a growing proportion of the HHC patient population, but little is known regarding their risk for unmet caregiving needs. We describe prevalence and underlying cause of unmet caregiving needs for sepsis survivors receiving HHC, using HHC patient assessment data for 85,851 older sepsis survivors receiving post-acute HHC in 2013–2014. Unmet caregiving needs were most common for assistance with Activities of Daily Living (ADLs) (28%) and medication administration (27%). Caregivers’ need for training accounted for more than three-fourths of all unmet caregiving needs. Those who experienced decline/no improvement in cognitive function were more likely to experience unmet caregiving needs. Findings highlight the potential value of expanding family caregiver training to improve HHC outcomes for sepsis survivors and indicate that caregivers of sepsis survivors with poor cognitive function may benefit most.

Family caregivers often manage complex medical and nursing tasks (MNTs) for older adults transitioning from hospital to home. To explore caregivers’ experiences managing MNTs in the postacute home health care (HHC) setting, we interviewed by phone 20 caregivers of older adults who received HHC following a hospitalization. Interviews were recorded, transcribed, and analyzed using directed content analysis. Caregivers highlighted the technical complexity and emotional impact of performing MNTs, as well as social (e.g., family, friends) and environmental (e.g., neighborhood, housing) resources they leveraged to meet the older adults’ care needs. Caregivers also identified challenges coordinating care and services within HHC and the larger health care system. Caregiver engagement in the postacute HHC setting should incorporate tailored training and support, assessments of socioenvironmental context and resources, and facilitated navigation of the health care system. Future research should elucidate factors associated with successful collaborative relationships among HHC providers, older adults, and their caregivers in the postacute HHC setting.

This study examined sedentary behaviors among older adults and explored associations with social context and health measures using cross-sectional data from the National Health and Aging Trends Study (N = 1,687). Multivariate models were estimated to explore associations of time in six sedentary behaviors (i.e., television watching, sitting and talking, hobbies, computer use, driving, and resting) with sociodemographic characteristics and level of social engagement and with health status. Results indicated substantial variability in sedentary behaviors, with television watching being the most frequent and resting the least frequent activities. Sedentary behaviors varied by sociodemographic characteristics, including age, race/ethnicity, and education, as well as by level of social engagement. Television watching and resting, but not other behaviors, were associated with poorer health. These findings help to unpack the role of social context in sedentary behaviors and could inform public health interventions aimed at reducing time spent in behaviors that are adversely associated with health.

Background: Post-acute home health-care (HHC) services provide a unique opportunity to train and support family caregivers of older adults returning home after a hospitalization. To enhance family-focused training and support strategies, we must first understand caregivers’ experiences. Objective: To explore caregivers’ experiences regarding training and support for managing older adults’ physical functioning (PF) needs in the post-acute HHC setting. Method: We conducted a qualitative descriptive study using semi-structured telephone interviews of 20 family caregivers. Interviews were recorded, transcribed, and analyzed using conventional content analysis. Results: We identified the following primary categories: facilitators to learning (eg, past experience, learning methods), barriers to learning (eg, learning on their own, communication, timing/logistics, preferred information and timing of information delivery), and interactions with HHC providers (eg, positive/negative interactions, provider training and knowledge). Conclusion: Caregivers were responsive to learning strategies to manage older adults’ PF needs and, importantly, voiced ideas to improve family-focused training and support. HHC providers can use these findings to tailor training and support of family caregivers in the post-acute HHC setting.

Trust is important to family caregivers of older adults receiving home health care (HHC). Caregivers rely extensively on nurses, home health aides, and other providers to manage complex care tasks. The current study examined how family caregivers conceive of trust in HHC providers. Directed content analysis methods were applied to 40 qualitative interviews conducted with caregivers of HHC patients aged ≥65 years. Results indicated that caregivers invested trust in providers who displayed competencies in caring for patients with chronic conditions and functional difficulties, willingness to foster frequent and open communication with room for questions and feedback, confidence in their ability to be present and alert for patients, and fidelity to a variety of tasks contributing to holistic care. Caregivers' conceptions of trust in providers are affected by interpersonal aspects of their interactions with providers as well as the broader systems of care within which they participate. [ Research in Gerontological Nursing, 14 (4), 200–210.]

Physiological and behavioral sensors on consumer-grade wearable devices have great potential to inform augmented cognition applications in everyday living. However, lack of understanding of usability and function of new devices when embedded within larger technical systems is a barrier to their implementation in translational research. Practical evaluation methods are needed to overcome this fundamental barrier in a rapidly changing consumer-grade device landscape. We describe a stepwise evaluation methodology developed in our lab that is designed to rapidly evaluate and position consumer-grade sensors for use in larger studies.

Background Physical inactivity in the older adult is associated with functional decline, increased fall risk, and threatens the ability of the older adult to live independently. Nurse practitioners, with their expertise in health promotion and chronic disease management, are well positioned to provide physical activity (PA) counseling. However, there is a gap in the literature describing a practical formula for providing PA counseling and PA prescriptions for clinical practice. Objective The objective of this integrative review was to synthesize the literature related to counseling interventions designed to increase PA among older adults and provide practical recommendations for incorporating recommendations into practice. Data sources Five different databases were searched along with ancestry searching of relevant articles. Eligible studies tested methods of recommending PA for adults age ≥65 years, including in-person counseling, phone calls, written information, and exercise prescriptions. Conclusions Health care providers are able to motivate older adults to increase PA in the short term. Diverse health care disciplines are efficacious at motivating older adults to increase PA. Various counseling interventions can be used with varying amounts of time investment. Implications for practice Physical activity counseling is an underused but effective intervention for increasing PA in older adults. Older adults respond well to advice to increase their PA especially with the addition of a written exercise prescription. Basing PA counseling interventions on a theoretical construct such as social cognitive theory or transtheoretical stages of change theory improves the efficacy of the interventions.

Few studies have explored racial/ethnic differences in health care outcomes among patients receiving home health care (HHC), despite known differences in other care settings. We conducted a retrospective cohort study examining racial/ethnic disparities in rehospitalization and emergency room (ER) use among post-acute patients served by a large northeastern HHC agency between 2013 and 2014 ( N = 22,722). We used multivariable binomial logistic regression to describe the relationship between race/ethnicity and health care utilization outcomes, adjusting for individual-level factors that are conceptually related to health service use. Overall rates of rehospitalization and ER visits were 10% and 13%, respectively. African American and Hispanic patients experienced higher odds of ER visits or rehospitalization during their HHC episode. Racial/ethnic differences in utilization were mediated by enabling factors, such as caregiver availability, and illness-level factors, such as illness severity, functional status, and symptoms. Intervention targets may include early risk assessment, proactive management of clinical conditions, rehabilitative therapy, and caregiver training.

Caregivers of older adults with chronic illness provide essential care that benefits individuals and society. Many factors influence health outcomes related to the caregiving role. The purpose of this review is to explore how caregiver health outcomes may vary by gender. Data sources include CINAHL, Google Scholar, Google and PsychINFO. Eligible studies focused on gender-based differences in psychological and emotional outcomes of primary informal or familial caregivers (ie, spouses, children, grandchildren, nieces, nephews, neighbors, and friends) of an older adult with chronic illness. The Caregiver Identity Theory (CIT) guided this study. Twelve studies were eligible for this review. Consistent with the CIT, negative outcomes are associated with changing role identity throughout the care recipient’s disease progression, and these outcomes differ between genders. Women tended to experience higher overall burden, stress, anxiety, shame and role strain; however, some studies found that men may be affected more during the initial transition into the caregiver role. Methodological limitations of primary research in this area included the use of cross-sectional design, poor generalization to US populations since most studies were conducted outside of the US, and disproportionately fewer male participants across studies. Overall, gender differences in health outcomes among caregivers exist, and other variables relating to gender, such as kinship and age, may also be important factors. Findings suggest health professionals should create individualized engagement, communication, and training strategies with considerations for gender differences in design. Future studies including more male caregivers and more diverse participants is warranted.

The purpose of this systematic review and meta-analysis was to determine the effects of supervised resistance and/or aerobic training physical activity interventions on performance-based measures of physical functioning among community-dwelling older adults, and to identify factors impacting intervention effectiveness. Diverse search strategies were used to identify eligible studies. Standardized mean difference effect sizes (d, ES) were synthesized using a random effects model. Moderator analyses were conducted using subgroup analyses and meta-regression. Twenty-eight studies were included. Moderator analyses were limited by inconsistent reporting of sample and intervention characteristics. The overall mean ES was 0.45 (k = 38, p ≤ .01), representing a clinically meaningful reduction of 0.92 s in the Timed Up and Go for treatment versus control. More minutes per week (p < .01) and longer intervention session duration (p < .01) were associated with larger effects. Interventions were especially effective among frail participants (d = 1.09). Future research should clearly describe sample and intervention characteristics and incorporate frail populations.

Hospitalization can negatively affect mobility among older adults. Early detection of older patients most at risk for mobility decline can lead to early intervention and prevention of mobility loss. This study’s purpose was to identify factors from the International Classification of Functioning, Disability, and Health associated with mobility decline among hospitalized elders. We conducted a secondary analysis of data from 959 hospitalized adults age 65 and older. We estimated the effects of health conditions and environmental and personal factors on mobility decline using logistic regression. Almost half of the sample declined in mobility function during hospitalization. Younger age, longer length of hospital stay, having a hearing impairment, and non-emergency admit type were associated with mobility decline, after adjusting for covariates. Findings may be used to develop an evidence-based, risk-determination tool for hospitalized elders. Future research should focus on individual, environmental, and policy-based interventions promoting physical activity in the hospital.

The purpose of the current study was to explore what hospitalized patients would like to know about post-acute care (PAC) services to ultimately help them make an informed decision when offered PAC options. Thirty hospitalized adults 55 and older in a Northeastern U.S. academic medical center participated in a qualitative descriptive study with conventional content analysis as the analytical technique. Three themes emerged: (a) r eceiving practical information about the services , (b) understanding “how it relates to me,” and (c) having opportunities to understand PAC options . Study findings inform clinicians what information should be included when discussing PAC options with older adults. Improving the quality of discharge planning discussions may better inform patient decision making and, as a result, increase the numbers of patients who accept a plan of care that supports recovery, meets their needs, and results in improved quality of life and fewer readmissions. [Res Gerontol Nurs. 2016; 9(4):175–182.]

BACKGROUND Despite the known benefits of medication therapy for secondary prevention of coronary artery disease (CAD), many patients do not adhere to prescribed medication regimens. Medication nonadherence is associated with poor health outcomes and higher healthcare cost. OBJECTIVE The purpose of this meta-analysis was to determine the overall effectiveness of interventions designed to improve medication adherence (MA) among adults with CAD. In addition, sample, study design, and intervention characteristics were explored as potential moderators to intervention effectiveness. METHODS Comprehensive search strategies helped in facilitating the identification of 2-group, treatment-versus-control-design studies testing MA interventions among patients with CAD. Data were independently extracted by 2 trained research specialists. Standardized mean difference effect sizes were calculated for eligible primary studies, adjusted for bias, and then synthesized under a random-effects model. Homogeneity of variance was explored using a conventional heterogeneity statistic. Exploratory moderator analyses were conducted using meta-analytic analogs for analysis of variance and regression for dichotomous and continuous moderators, respectively. RESULTS Twenty-four primary studies were included in this meta-analysis. The overall effect size of MA interventions, calculated from 18,839 participants, was 0.229 (P < .001). The most effective interventions used nurses as interventionists, initiated interventions in the inpatient setting, and informed providers of patients' MA behaviors. Medication adherence interventions tested among older patients were more effective than those among younger patients. The interventions were equally effective regardless of number of intervention sessions, targeting MA behavior alone or with other behaviors, and the use of written instructions only. CONCLUSIONS Interventions to increase MA among patients with CAD were modestly effective. Nurses can be instrumental in improving MA among these patients. Future research is needed to investigate nurse-delivered MA interventions across varied clinical settings. In addition, more research testing MA interventions among younger populations and more racially diverse groups is needed.

This systematic review applied meta-analytic procedures to integrate primary research that examined blood pressure outcomes of medication adherence interventions. Random-effects model analysis calculated standardized mean difference effect sizes. Exploratory dichotomous and continuous moderator analyses using meta-analytic analogues of ANOVA and regression were performed. Codable data were extracted from 156 reports with 60,876 participants. The overall weighted mean difference systolic effect size was 0.235 across 161 treatment versus control comparisons. The diastolic effect size was 0.189 from 181 comparisons. Effect sizes were significantly heterogeneous. Common risks of bias included lack of allocation concealment, unmasked data collectors, and absent intention-to-treat analyses. Exploratory moderator analyses suggested that habit-based interventions may be most effective. The largest effect sizes were for interventions delivered by pharmacists. The modest magnitude effect sizes suggest future research should explore novel higher dose interventions that might address multiple levels of influence on adherence behavior.

Family caregivers often manage complex medical/nursing tasks (MNTs) for older adults returning home after a hospitalization. The purpose of this qualitative study was to describe caregivers’ experiences leveraging diverse resources to manage MNTs for older adults receiving post-acute home health care services (HHC). In-depth telephone interviews were conducted with 20 caregivers of older adults who received HHC following hospitalization. Interviews were digitally audio-recorded, transcribed, and analyzed using directed content analysis. The Theory of Dependent-Care informed the analytical framework. We organized codes using three theoretical constructs related to managing older adults’ MNT care needs (“tasks related to the other”), accessing existing social/environmental resources (“tasks related to the situation of care”), and working with the healthcare system (“tasks related to the system of care”). Caregivers’ descriptions of MNTs included the complexity and socioemotional impact of assisting in these tasks (e.g., dependency, trust). When needed, caregivers’ accessed social (e.g., family, friends) and environmental (e.g., neighborhood, housing) resources to help address the older adults’ care needs. Caregivers also identified challenges and strategies for navigating and coordinating care and services within HHC and the larger healthcare system. Caregivers assisting with complex MNTs in the post-acute HHC setting need additional training and support. HHC providers can actively engage caregivers by tailoring training and support strategies, assessing social and environmental contexts and resources, and facilitating caregivers’ navigation of the healthcare system. Future research could elucidate social and environmental factors associated with successful collaborative relationships among providers, older adults and their caregivers in the post-acute HHC setting.

Home- and community-based services (HCBS) can reduce caregiver burden. We compared the prevalence of HCBS unmet needs among caregivers in rural and urban areas and identified factors associated with unmet HCBS needs. We used 2015-2018 Behavioral Risk Factor Surveillance System data, including the optional Caregiver Module, from 44 states, District of Columbia, and Puerto Rico. Caregivers were individuals providing care/assistance to a friend/family member with a long-term illness/disability during the past 30 days. Unmet needs were defined as needing, but not receiving, one or more of the following: caregiving classes, help accessing services, support groups, individual counseling, or respite care. “Rural” was defined as living outside Metropolitan Statistical Areas (available only for landline respondents). We calculated weighted estimates and used log-binomial regression to estimate adjusted prevalence ratios (PR). 19% of 25,180 caregivers lived in a rural area. Rural caregivers were less likely to report unmet HCBS needs (14.4% versus 20.6% urban, p

Interventions utilizing consumer-grade wearable and mobile devices may support older adult health and wellness. However, rapid technology change and short industry product release cycles limit timely incorporation of these devices. We developed a novel, multi-stage process to rapidly move from within-team evaluations to lab- and field-based participants studies based on small-sample technology testing methods from Human-Computer Interaction. We present findings from a first-stage evaluation of the Amazfit Bips smart watch for potential use in studies with older adults as part of the methodology validation. A four-person research team conducted evaluations using: 1) a wearables framework for user experience and feature availability; and 2) the System Usability Scale (SUS). Evaluators wore the watch seven days straight from the box. User experience checklists indicated high usability. However, corresponding comments identified challenges with downloading the mobile app, pairing the watch and phone, navigating watch and mobile interfaces, and privacy controls. Average SUS score was 65.6 indicating marginal usability (C grade). While meeting study goals, divergence in usability perceptions suggest the process could be improved by completing each set of instruments separately for the watch and mobile app rather than all at once. Given failures in pairing, app navigation challenges, and small screen size, the Amazfit Bips may be best suited for studies among older adults with a high degree of technical proficiency. For those with little technical experience or high disease burden, training materials and dedicated training with support may be required. Future steps are lab- and field-based tests with older adult participants.

Patients who are discharged to home health care (HHC) after a hospitalization for sepsis may experience high rates of readmission, functional decline, and mortality. The presence of one or more geriatric syndromes (GS) may exacerbate these negative outcomes. This purpose of this retrospective study was to identify the prevalence of GSs and describe their cumulative effects associated with healthcare utilization (rehospitalization, skilled nursing facility or sub-acute rehabilitation placement) and death in sepsis survivors recently discharged to HHC. Utilizing the Medicare administrative, Outcome and Assessment Information Set, and claims data from the Chronic Condition Warehouse for beneficiaries receiving HHC, six GSs (frailty, incontinence, falls, depression, pressure ulcers and functional decline) were identified. Overall, 91.6% of patients had one or more GSs. At 30 days post hospitalization, sepsis survivors with incontinence or pressure ulcers had a higher rate of rehospitalization and death than patients without these GSs. At seven days after discharge the rate of death was more than double for patients with a pressure ulcer (24.8%) when compared to those without (8.46%). However, risk of 30-day rehospitalization did not increase with increased number of GSs. Improvements in the assessment and identification of GSs in HHC are needed. Prompt and proper identification of GS can lead to early identification of at-risk older adults and timely, focused interventions to improve health outcomes.

Caregivers play important roles in managing the physical functioning (PF) needs of older adults transitioning home after a hospitalization. Training and support of caregivers in the post-acute home health care (HHC) setting should incorporate caregivers' perspectives. To explore caregivers' experiences managing PF needs in the post-acute HHC setting, semi-structured telephone interviews of 20 caregivers were conducted. Conventional content analysis revealed patient-, caregiving task–, caregiver-, and home environment–related themes consistent with the Theory of Dependent Care. Caregivers highlighted the dynamics and contributors of PF needs for older patients in the post-acute HHC setting and depicted the enormity of caregiving tasks needed to manage older patients' PF needs. Caregivers also described their perceived roles and challenges in managing PF deficits, including a sense of isolation when they were the sole caregiver. Findings from this research can guide nursing efforts to target caregiver training and support during this critical care transition. [Res Gerontol Nurs. 2019; 12(4):174–183.]

ABSTRACT BODY Sedentary behavior (SB) is associated with substantial health risks such as increased risk of cardiovascular mortality, diabetes, and cognitive and physical functioning decline. Older adults are particularly at risk as they are the most sedentary population. The purpose of this meta-analysis was to determine the overall effects of interventions designed to reduce SB among older adults. A comprehensive literature search of online databases, bibliographies, and author searches located published and unpublished studies. Included studies tested interventions to reduce SB time, were written in English, and focused on community-dwelling adults age 60 years or older. Data were extracted on sample, study design, and intervention characteristics using an investigator-developed tool. Study effect sizes were synthesized using a random effects model. Heterogeneity of effects across studies was examined; however, moderator analyses were not conducted due to the small number of included studies. Of the 2,408 reviewed citations, 22 reports were included representing 17 distinct studies, eight of which were included in the two-group post-test meta-analysis (n= 1,024 participants). Interventions overall modestly reduced SB time among older adults (d=-.25, 95% CI [-.50, .00], p=.05); however, significant heterogeneity of effect size was observed across studies (Q=22.34, p

Objective: To examine activities of daily living (ADL) disability outcomes among racially/ethnically diverse elders receiving home care (HC) after hospitalization. Method: We conducted a retrospective cohort analysis of single-agency, 2013-2014 Outcome and Assessment Information Set data from older adults who received post-hospitalization HC ( n = 20,674). We measured overall change in ADL disability by summing the difference of standardized admission and discharge scores from nine individual ADL. Associations between race/ethnicity and overall ADL change scores were modeled using general linear regression, adjusting for covariates consistent with the Disablement Model. Results: Overall, patients experienced improvement in ADL disability from HC admission to discharge. However, Asian, African American, and Hispanic patients experienced significantly less improvement compared with non-Hispanic Whites (all p < .001), even after controlling for covariates. Discussion: Racial/ethnic disparities exist in ADL disability improvement among HC patients. Research is needed to clarify mechanisms underlying these disparities. Disablement Model factors may be targets for clinical intervention.

BACKGROUND AND OBJECTIVES: To identify determinants of self-reported physical functioning (PF) among older adults new to long-term services and supports (LTSS). RESEARCH DESIGN AND METHOD: Using the International Classification of Function, Disability, and Health (ICF) framework, we conducted a secondary analysis of self-reported data on symptoms, basic/instrumental activities of daily living, quality of life, assistive devices, physical therapy needs, prior healthcare utilization, health status, and demographics from 470 older adults new to LTSS (Home/Community-Based n = 156; Assisted Living n = 156; Nursing Home n = 158). Multiple linear regression was used to identify associations between ICF constructs and self-reported PF (SF-12 Physical Composite Summary score [SF12PCS], lower scores indicate worse PF). RESULTS: LTSS recipients were mostly female (71%) and over age 80 (Mean: 80.9 years, SD: 8.7). LTSS recipients’ mean SF12PCS score was 37.3 (SD 11.0), indicating overall low self-reported PF. LTSS recipients living in their homes (b = −3.35, p = .003) or assisted living facilities (b = −2.93, p = .012) had significantly lower mean scores compared to recipients in nursing homes. Higher SF12PCS scores were associated with fewer activities of daily living deficits (p < .001), and better quality of life (p < .001). Lower scores were associated with more symptoms (p < .001), poorer nutrition (p = .013), ambulation aid use (p < .001), and physical therapy (p < .026). DISCUSSION AND IMPLICATIONS: Diverse health, activity, and environmental factors may facilitate early identification of new LTSS recipients most in need of interventions to optimize self-reported PF. Several health conditions may be targets for such interventions. Additional research is needed to evaluate and compare PF trajectories among older adults receiving LTSS in diverse settings.

Objective To profile the characteristics of growing numbers of sepsis survivors receiving home healthcare (HHC) by type of sepsis before, during, and after a sepsis hospitalization and identify characteristics significantly associated with 7-day readmission. Design Cross-sectional descriptive study. Data sources included the Outcome and Assessment Information Set (OASIS) and Medicare administrative and claims data. Setting and Participants National sample of Medicare beneficiaries hospitalized for sepsis who were discharged to HHC between July 1, 2013 and June 30, 2014 (N = 165,228). Methods We used an indicator distinguishing among 3 types of sepsis: explicitly coded sepsis diagnosis without organ dysfunction; severe sepsis with organ dysfunction; and septic shock. We compared these subgroups' demographic, clinical and functional characteristics, comorbidities, risk factors for rehospitalization, characteristics of the index hospital stay, and predicted 7-day hospital readmission. Results The majority (80.7%) had severe sepsis, 5.7% had septic shock, and 13.6% had sepsis without acute organ system dysfunction. The medical diagnoses recorded at HHC admission identified sepsis or blood infection only 7% of the time, potentially creating difficulty identifying the sepsis survivor in HHC. Among sepsis types, septic shock survivors had the greatest illness burden profile. This study describes 12 key variables, each of which individually raises the relative 7-day readmission risk by as much as 60%. Increased risk of 7-day rehospitalization was found among those with septic shock, 3 or more previous inpatient stays, index hospital length of stay of >8 days, dyspnea, >6 functional dependencies, and other risk factors. Conclusions and Implications Implications for practice include using our findings to identify sepsis survivors who are at risk for early readmission. Assessment for these factors may profile the at-risk patient, thereby triggering the call for additional acute care intervention such as delayed discharge, or post-acute intervention such as early home visit and outpatient follow-up.

Cardiovascular disease remains the leading cause of death in the United States today.1 Hyperlipidemia is a well-established risk factor for cardiovascular disease.1-3 Control of lipid levels is one of the key strategies for primary and secondary prevention of cardiovascular disease.2 While pharmacologic approaches to lipid management are available, non-pharmacological treatments are the preferred and first-line approach to managing hyperlipidemia, particularly for primary prevention.4 Exercise is any structured, planned, bodily movement to increase or maintain physical fitness.5 Exercise is a key health behavior intervention to improve lipid levels and lower cardiovascular disease risk. Many trials have examined exercise interventions to improve lipid outcomes, with varying results.6,7 While a link has been established between weight loss and improved lipid levels,8 more recent work indicates that exercise may improve lipid levels independent of weight loss.9,10 Even among healthy adults, too few individuals engage in regular physical exercise. Only 48.4% of persons age 18 years and older obtain the recommended amount of aerobic exercise.11 Even individuals considered as healthy are frequently not active enough to meet the recommended levels of exercise to reduce the risk of developing chronic disease. Health care providers should play a key role in assisting individuals, particularly those at greater risk for cardiovascular disease, to increase the quantity and quality of their exercise behavior. Supervised exercise interventions, where participants exercise at a specified location under the supervision of an interventionist (eg, exercise researcher, trainer), have been effective at improving exercise behavior among healthy adults.12 The lipid-lowering effect of supervised exercise programs for healthy adults, however, has not been conclusively established. Several recent literature syntheses have focused on the impact of exercise interventions on lipid outcomes.9,10,13-21 These studies have established the benefit of exercise overall as a component of lipid control for participants with cardiovascular and metabolic risk factors10,18,19,22 but the strength of the evidence for the effects of exercise on lipid outcomes for healthy adults is less clear. Published meta-analyses reporting lipid outcomes of exercise for healthy adults have mostly focused on specific sub-populations or limited intervention types. These meta-analyses have each synthesized small numbers of studies (ranging from 6 to 35 trials), and have had conflicting findings regarding the exercise characteristics associated with significant improvement in lipid levels. Finally, none of the meta-analyses identified in the past ten years examined the effect of supervised exercise on lipid outcomes of healthy adults. This systematic review and meta-analysis aims to synthesize the results of supervised exercise interventions in populations of healthy adults, and to conduct moderator analyses to determine whether particular sample, study, or intervention characteristics are associated with greater improvement in lipid outcomes.

Purpose of the Study: T o determine the overall effectiveness of interventions designed to increase physical activity (PA) behavior among community-dwelling older adults. Design and Methods: Comprehensi ve literature searching identified eligible PA inter vention studies among community-dwelling adults aged 65 and older, or sample mean age of 70. Diverse study characteristics were extracted and outcome data were duplicate coded. Overall mean effect sizes (ESs) were synthesized using a random-effects model. Heterogeneity of effects was analyzed using Q and I 2 statistics. Moderator analyses were conducted using meta-analytic analogues of ANOVA and regression for dichotomous and continuous moderators, respectively. Results: ESs were calculated from 1 3,829 primary study subjects. The overall mean ES for two-group posttest comparisons was 0.18 (95% CI 0.10–0.26, p < .001). This represents a difference of 620 steps/day or 73 min of P A/week between treatment and control groups. Significant moderators included the use of theory, how interventions were delivered, and cognitive plus behavioral-type intervention components. Non-significant moderators include the type of interventionist, delivery setting, and various measures of intervention dose. Implications: P A interventions significantly improved PA behavior among communitydwelling older adults. Effective PA interventions may be efficiently delivered using already available resources and personnel. Future PA intervention research should be theoretically based, incorporate more diverse subjects, and compare intervention delivery methods.

Sepsis is a growing national health crisis with many sepsis survivors being discharged to home with home healthcare (HHC) services. While the long-term consequences of sepsis have become evident, little is known about the health status of those receiving HHC. The purpose of this NIH-funded study (R01NR016014) was to illustrate sepsis survivors’ clinical profiles to enhance patient-centered care. Based on Medicare data of 165,228 sepsis survivors, we describe patient characteristics by sepsis severity and examine associations between illness severity and early HHC visits using descriptive statistics, bivariate analyses, and logistic regression. Overall, the illness profile for sepsis survivors entering HHC is severe. Sepsis survivors are a vulnerable group with significant health needs, as 89.8% took > ¬five medications, 48% were cognitively impaired, 42% had frailty indicators, and 26% had a history of falls. Health status of 39% was classified as fragile, 21% reported severe pain, and 79% reported dyspnea. The majority (88.4%) were dependent in >3 activities of daily living. Despite this profile, 43% were home for two or more days before the first HHC visit. Although septic shock survivors had the most severe illness profiles, they were 14% less likely to receive prompt nursing visits than other sepsis patients, and their 30-day readmissions were higher (25% versus 19%). Given the importance of timely visits for antibiotic stewardship, medication reconciliation, and infection monitoring, there is vast potential to improve sepsis survivors’ outcomes. Highlighting profiles of sepsis survivors can inform prioritization and tailoring of HHC interventions for this vulnerable group.

Sepsis survivors transitioning from hospital-to-home are clinically complex. Family caregivers can face challenges managing patients’ care needs; however, skilled home health care (HHC) can serve as an important resource during this care transition. This study’s purpose was to describe caregiving needs among older sepsis survivors receiving post-acute HHC, and identify sources of unmet caregiving needs. We conducted a retrospective analysis of a national dataset of Medicare beneficiaries starting a new HHC episode who were after hospital discharge for sepsis between 2013 and 2014 (n=165,228). All patients received at least one HHC visit the first week after hospital discharge. Caregiving activities included seven items from the start of care Outcome and Assessment Information Set. Descriptive statistics were used to examine types of caregiving activities and needs, demographics, and clinical information. Proportions of patients with unmet caregiving needs ranged from 9%-29%, with the largest proportion of unmet needs in activities of daily living (ADL) assistance (29%), medication administration (28%), and medical procedures/treatments (25%). Unmet caregiving needs across activities were largely due to a caregiver needing training/supportive services (75%-88%), suggesting that many sepsis survivors receiving HHC have caregivers who are available to help, but who lack the knowledge and skills to manage patients’ complex care needs. Thus, HHC providers should address caregiving training and support needs, especially related to assistance with ADLs, medication administration, and medical procedures/treatments. Future research is needed to determine specific educational strategies for caregiver training and support, especially related to skills and knowledge assessment, and training delivery and monitoring.

BACKGROUND Motivational physical activity (PA) interventions are effective in increasing PA behavior among healthy adults; however, the impact of these interventions on cardiorespiratory fitness (CRF) has not yet been examined. OBJECTIVE The purpose of this meta-analysis is to quantitatively synthesize CRF outcomes of motivational PA interventions among healthy adults. METHODS Comprehensive searching identified studies testing motivational PA interventions with CRF outcomes. Two independent coders extracted data. Data were synthesized using standardized mean difference effect sizes (ESs, d) under a random effects model. Heterogeneity was assessed, and moderator analyses were conducted using subgroup analyses and meta-regression. RESULTS Data were analyzed from 11,458 primary study subjects. The overall mean ES for CRF was 0.48 (p < .01), which corresponds to a difference in VO2 max of 2.5 mL/kg/min between treatment and control groups. Studies were significantly heterogeneous (Q = 133.29, p < .01). Significant moderators included age (β = -0.02, p = .01) and recommending endurance plus resistance exercises (d = 1.04) versus recommending only endurance exercise (d = 0.47). DISCUSSION Motivational interventions designed to increase PA can improve CRF among healthy adults. Clinicians should recommend endurance and resistance exercise to improve CRF in this population. Future primary research should test interventions longitudinally and across more diverse populations. Although other moderators examined in this study did not show a significant effect on ES, the number of comparisons available for moderator analyses was small.

Physical activity (PA) is important in the management of chronic illness among older adults worldwide. Researchers have conducted several intervention studies to increase PA behavior in this population. This review of the past 12 years of relevant PA intervention research among adults aged 60 years and older systematically summarized research findings, identified characteristics of successful interventions, and proposed areas of future research. There were 20 studies reviewed for this article, most employing a combination of cognitive-behavioral intervention design. Cognitive-based only and combination interventions were more successful in changing PA behavior; however, behavioral-based interventions demonstrated more long-term changes in PA behavior. Among theory-based interventions, self-efficacy was the most commonly operationalized construct. Findings from this review may inform future primary research to promote PA behavior among older adults, as well as gerontological clinical practice.

The most common post-acute care (PAC) services available to patients after hospital discharge include home care, skilled nursing facilities, nursing homes, inpatient rehabilitation, and hospice. Patients who need PAC and receive services have better outcomes, however almost one-third of those offered services decline. Little research exists on PAC decision-making and why patients may decline services. This qualitative descriptive study explored the responses of thirty older adults to the question: “Can you, from the patient point of view, tell me why someone would not want post hospital care?” Three themes emerged. Participants may decline due to 1) previous negative experiences with PAC, or 2) a preference to be home. Some participants stated, “I'd be there” and would not decline services. Participants also discussed 3) why other patients might decline PAC which included patients' past experiences, lack of understanding/preconceived ideas, and preferences. Clinical implications include assessing patients' knowledge and experience before providing recommendations.

Comparative effectiveness research seeks to identify the most effective interventions for particular patient populations. Meta-analysis is an especially valuable form of comparative effectiveness research because it emphasizes the magnitude of intervention effects rather than relying on tests of statistical significance among primary studies. Overall effects can be calculated for diverse clinical and patient-centered variables to determine the outcome patterns. Moderator analyses compare intervention characteristics among primary studies by determining whether effect sizes vary among studies with different intervention characteristics. Intervention effectiveness can be linked to patient characteristics to provide evidence for patient-centered care. Moderator analyses often answer questions never posed by primary studies because neither multiple intervention characteristics nor populations are compared in single primary studies. Thus, meta-analyses provide unique contributions to knowledge. Although meta-analysis is a powerful comparative effectiveness strategy, methodological challenges and limitations in primary research must be acknowledged to interpret findings.

Older adults who experience new or worsening difficulties performing activities of daily living (ADL) after hospitalization have poorer prognoses within a year after discharge. Past research suggests racial/ethnic disparities exist in the development and progression of ADL disability. However, little research exists examining ADL disability disparities among racially/ethnically diverse older adults after hospitalization. Understanding differences in ADL disability across racial/ethnic groups may lead to targeted interventions reducing disparities and promoting ADL performance. This study’s purpose was to determine if differences exist in ADL disability trajectories among racially/ethnically diverse adults age 65 years and older receiving home care following hospitalization. We used 2013–2014 Outcome and Assessment Information Set data (n=21,473) from a large non-profit home care agency to examine overall change in ADL disability, which was measured by summing the difference of admission and discharge scores from nine individual ADL. Associations between race/ethnic groups and overall ADL change scores were examined using general linear regression models, adjusting for personal, environmental, and health-related factors from the International Classification of Functioning, Disability and Health framework. On home care admission, Asians, African-Americans, and Hispanics had poorer individual ADL scores compared to Non-Hispanic Whites (all p

The aging adult population is growing, as well as the incidence of chronic illness among older adults. Physical activity (PA) has been demonstrated in the literature to be a beneficial component of self-management for chronic illnesses commonly found in the older adult population. Health sciences research seeks to develop new knowledge, practices, and policies that may benefit older adults’ management of chronic illness and quality of life. However, research with the older adult population, though beneficial, includes potential methodological challenges specific to this age group. This article discusses common methodological issues in research among older adults, with a focus on PA intervention studies. Awareness and understanding of these issues may facilitate future development of research studies devoted to the aging adult population, through appropriate modification and tailoring of sampling techniques, intervention development, and data measures and collection.

This systematic review applied meta-analytic procedures to synthesize medication adherence interventions that focus on adults with hypertension. Comprehensive searching located trials with medication adherence behavior outcomes. Study sample, design, intervention characteristics, and outcomes were coded. Random-effects models were used in calculating standardized mean difference effect sizes. Moderator analyses were conducted using meta-analytic analogues of ANOVA and regression to explore associations between effect sizes and sample, design, and intervention characteristics. Effect sizes were calculated for 112 eligible treatment-vs.-control group outcome comparisons of 34,272 subjects. The overall standardized mean difference effect size between treatment and control subjects was 0.300. Exploratory moderator analyses revealed interventions were most effective among female, older, and moderate- or high-income participants. The most promising intervention components were those linking adherence behavior with habits, giving adherence feedback to patients, self-monitoring of blood pressure, using pill boxes and other special packaging, and motivational interviewing. The most effective interventions employed multiple components and were delivered over many days. Future research should strive for minimizing risks of bias common in this literature, especially avoiding self-report adherence measures.

Considerable research has tested physical activity interventions to prevent and treat overweight and obesity. This comprehensive meta-analysis synthesized the anthropometric effects of supervised exercise interventions and motivational interventions to increase physical activity. Eligible intervention studies included healthy participants with reported anthropometric outcomes (e.g., body mass index). Extensive searching located 54,642 potentially eligible studies. We included data from 535 supervised exercise and 283 motivational interventions in our syntheses, which used random-effects analyses. Exploratory moderator analyses used meta-analytic analogues of ANOVA and regression. We synthesized data from 20,494 participants in supervised exercise and 94,711 undergoing motivational interventions. The overall mean effect sizes (ES, d) for treatment vs. control groups in supervised exercise interventions were 0.20 (treatment vs. control within-group comparison) and 0.22 (between-group comparison). The ES of 0.22 represents a post-intervention body mass index of 26.7 kg/m2 for treatment participants relative to 27.7 kg/m2 for controls. The corresponding mean ES for motivational interventions was significantly smaller (d = .09 for between group, d = 0.10 for treatment vs. control within-group). Control group within-group comparisons revealed slightly worsening anthropometric outcomes during study participation (d = −0.03 to d = −.04). Moderator analyses identified potential variables for future research. These findings document significant improvements in anthropometric effects from both supervised exercise and motivational interventions.