Preventive Interventions for the Second Half of Life: A Systematic Review

Introduction to the Special Issue: Toward a Lifespan Prevention Science - A Focus on Middle and Late Adulthood

The interdisciplinary field of prevention science was founded on the premise of a lifespan developmental model. Prevention scientists have developed a strong set of tools and intervention technologies for understanding and potentially modifying risk and protective factors through early adulthood. However, there is a demographic imperative to apply prevention science principles to health issues in middle and late adulthood. The articles in this special issue utilize a variety of methods to investigate important scientific questions about how theories, methodologies, and interventions applied in the science of prevention can be usefully integrated into the study of health and wellness in middle and late adulthood. More specifically, contributions (1) highlight current empirical research that draws on lifespan developmental science to address the unique prevention and intervention needs in middle and late adulthood, (2) illustrate the opportunities and challenges of a lifespan approach to prevention science with special attention to middle and late adulthood, and (3) identify additional areas that prevention science can contribute to advancements in middle and late adulthood. These articles provide a glimpse into the challenges and opportunities at the intersection of prevention science and gerontology. As a field, we have much room to grow in leveraging innovative tools, approaches, and efforts to best support older adults' physical, mental, and social health, particularly for diverse and under-served populations.

Influence of Alpine Skiing on Health-Related Quality of Life and Physical Self-Concept in Physically Active Adults over 55 Years of Age

Background: Older adults have the highest rates of a sedentary lifestyle. Alpine skiing could be considered a suitable activity to encourage continued sports practice and improve the health of this population in winter. The aim of this study was to analyse the relationship between the practice of alpine skiing and health-related quality of life (HRQoL), physical self-concept (PSC), and sport motivation. Methods: The study design was cross-sectional and descriptive, involving 280 Spanish adults aged over 55 years and physically active (75.35% skiers). To assess physical activity, PSC, HRQoL, and sport motivation, we used the Rapid Assessment of Physical Activity Questionnaire (RAPA-Q), the Physical Self-Perception Profile (PSPP 30), the Health-Related Quality of Life (SF-36), and the Sport Motivation Scale (SMS) questionnaires, respectively. Results: In the skier’s group, higher values were found for PSC (p < 0.001; d = 0.64), the physical component of HRQoL (p < 0.001, d = 0.48), physical function (p < 0.001, d = 61), and intrinsic motivation (p < 0.001; d = 0.85). The practice of alpine skiing was associated with higher levels of the physical health component (ORadj = 2.13, 95% CI 1.18−3.95, p = 0.013), PSC (ORadj = 2.92, 95% CI 1.58−5.52, p < 0.001), and intrinsic motivation (ORadj = 2.24, 95% CI 1.22−4.23, p = 0.010). Conclusions: The practice of alpine skiing is positively associated with higher values of HRQoL, PSC, and intrinsic motivation, and based on the above, it seems that alpine skiing can contribute to healthy ageing and improve the quality of life of older adults.

Development of a Frailty Detection Model Using Machine Learning with the Korean Frailty and Aging Cohort Study Data

OBJECTIVES

This paper aimed to use machine learning to identify a new group of factors predicting frailty in the elderly population by utilizing the existing frailty criteria as a basis, as well as to validate the obtained results.

METHODS

This study was conducted using data from the Korean Frailty and Aging Cohort Study (KFACS). The KFACS participants were classified as robust or frail based on Fried's frailty phenotype and excluded if they did not properly answer the questions, resulting in 1,066 robust and 165 frail participants. We then selected influential features through feature selection and trained the model using support vector machine, random forest, and gradient boosting algorithms with the prepared dataset. Due to the imbalanced distribution in the dataset with a low sample size, holdout was applied with stratified 10-fold and cross-validation for estimating the model performance. The reliability of the constructed model was validated using an unseen test set. The model was then trained with hyperparameter optimization.

RESULTS

During the feature selection process, 27 features were identified as meaningful factors for frailty. The model was trained based on the selected features, and the weighted average F1-score reached 95.30% with the random forest algorithm.

CONCLUSIONS

The results of the study demonstrated the possibility of adopting machine learning to strengthen existing frailty criteria. As the method analyzes questionnaire responses in a short time, it can support higher volumes of data on participants' health conditions and alert them regarding potential risks in advance.

Adherence to a Mediterranean Diet Pattern, Physical Activity, and Physical Self-Concept in Spanish Older Adults

Background: The aging world population is accelerating rapidly. Physical self-concept (PSC) is one of the psychosocial factors with the greatest influence on an individual’s well-being and health. The traditional Mediterranean dietary pattern (MDP) is considered one of the healthiest dietary models, as it is nutritionally complete and easy to follow. Objective: To assess the adherence to MDP and its association with the practice of physical activity (PA) and PSC levels in the older adult Spanish population. Methods: A cross-sectional study was conducted on a representative sample of Spanish older adults (n = 342; older than 55 years old). Their PSC was assessed using a previously validated PSC questionnaire. Adherence to an MDP was assessed using a validated Mediterranean Diet Adherence Screener questionnaire. Their PA was measured using the Spanish version of the Rapid Assessment of Physical Activity Questionnaire. Data on age, sex, hypertension, cholesterol or diabetes suffered in the last 12 months, as well as weight, height, and BMI, were collected. Results: At the lowest levels of PSC, the percentage of individuals who were non-active and non-adhering to the MDP was lower compared to the highest levels (75.0% vs. 19.6; p = 0.001; Cramer’s V = 0.414, and 83.3% vs. 57.9%; p = 0.001; Cramer’s V = 0.221, respectively). This sample showed an abandonment of the most classic habits of the MDP, such as the consumption of olive oil, vegetables, fruits, nuts and fish. Conclusions: Non-adherence to the MDP and low levels of PA are associated with low levels of PSC in older adults.

Physical Self-Concept Changes in Adults and Older Adults: Influence of Emotional Intelligence, Intrinsic Motivation and Sports Habits

Lifespan is increasing globally as never before, and leading to an aging world population. Thus, the challenge for society and individuals is now how to live these years in the best possible health and wellbeing. Despite the benefits of physical activity for both are well documented, older people are not active enough. Physical self-concept is correlated with high levels of sports practice, although its evolution across one’s life span is not clear. The aim of this research has been to analyze the physical self-concept in older adults and its relationship with emotional intelligence, motivation and sports habits. The sample of 520 adults aged between 41 and 80 was clustered in ranges of age; 70.96% were men (n = 369; 57.34 years (SD: 7.97)) and 29.04% women (n = 151; age = 55.56 years (SD: 9.12)). Questionnaires adapted to Spanish were used to measure physical self-concept (Physical Self-Perception Profile), motivation (Sport Motivation Scale), and emotional intelligence (Trait Meta-Mood Scale). Regarding physical self-concept, the youngest group obtained the highest mean values and the oldest group the lowest. Physical self-concept correlated positively with emotional regulation and intrinsic motivation. Initiation to sports in childhood, the practice of sports activities for more than 150’ per week, and the practice of three or more sports, were associated with a higher score of physical self-concept. The findings reveal that physical self-concept declines in older adults, slightly at first, and sharply between 71 and 80 years, being intrinsic motivation, emotional regulation, and sports habits, factors to consider in favoring a positive physical self-concept and adherence to sporting activities.

Clustering and Healthcare Costs With Multiple Chronic Conditions in a US Study

Objective: To investigate healthcare costs and contributors to costs for multiple chronic conditions (MCCs), common clusters of conditions and their impact on cost and utilization. Methods: This was a cross-sectional analysis of US financial claims data representative of the US population, including Medicare, Medicaid, and Commercial insurance claims in 2015. Outcome measures included healthcare costs and contributors; ranking of clusters of conditions according to frequency, strength of association and unsupervised (k-means) analysis; the impact of clustering on costs and contributors to costs. Results: Of 1,878,951 patients, 931,045(49.6%) had MCCs, 56.5% weighted to the US population. Mean age was 53.0 years (SD16.7); 393,121(42.20%) were male. Mean annual healthcare spending was $12,601, ranging from $4,385 (2 conditions) to $33,874 (11 conditions), with spending increasing by 22-fold for inpatient services, 6-fold for outpatient services, 4.5-fold for generic drugs, and 4.2-fold for branded drugs. Cluster ranking using the 3 methodologies yielded similar results: highest ranked clusters included metabolic syndrome (12.2% of US insured patients), age related diseases (7.7%), renal failure (5.6%), respiratory disorders (4.5%), cardiovascular disease(CVD) (4.3%), cancers (4.1-4.3%), mental health-related clusters (1.0-1.5%), and HIV/AIDS (0.2%). Highest spending was in HIV/AIDS clusters ($48,293), mental health-related clusters ($38,952-$40,637), renal disease ($38,551), and CVD ($37,155); with 89.9% of spending on outpatient and inpatient care combined, and 10.1% on medication. Conclusion and Relevance: Over 57% of insured patients in the US may have MCCs. MCC Clustering is frequent and is associated with healthcare utilization. The findings favor health system redesign toward a multiple condition approach for clusters of chronic conditions, alongside other cost-containment measures for MCCs.

Determinants of systemic hypertension in older adults in Africa: a systematic review

BACKGROUND

An estimated 55% of older adults in Africa have systemic hypertension, a major risk factor for stroke, heart failure and dementia in the region. The risk factors associated with hypertension in this population group in Africa have not been systematically evaluated. We, therefore, undertook a systematic review to identify these risk factors.

METHODS

We searched for population-based studies of adults aged ≥50 years living in Africa and reporting an estimate of hypertension and associated risk factors. We included articles published in any language between January 1980 and May 2018 using a comprehensive search strategy. We extracted data including the sample characteristics, prevalence of hypertension and risk factors with their effect sizes.

RESULTS

From an initial 10,719 records, we retained 63 eligible full text articles for review out of which we analyzed 23 studies made up of 19 primary and four multiple publications which had data on risk factors from bivariate or multivariable analysis. The primary studies, published from 2010 to 2018, involved a total of 30,500 participants in 12 different countries with mean ages ranging from 62.7 ± 9 years to 76.9 ± 8.4 years. Through narrative synthesis, we found consistent determinants of hypertension (overweight/obesity and history of stroke), less consistent but frequent determinants (including older age group, female sex and urban residence), inconsistent determinants (including education, wealth index, alcohol intake and physical activity) and nonsignificant covariates (marital status and having health insurance). Overall, the highest adjusted odds ratios were those associated with obesity and history of stroke.

CONCLUSION

The key determinants of systemic hypertension in older adults in Africa are older age group, overweight/obesity, history of stroke and female sex. Health programmes should promote weight reduction throughout the life course, including during the middle and older age of African adults.