Developing a One-Stop Platform Transportation Planning Service to Help Older Adults Move Around in Their Community Where, When, and How They Wish: Protocol for a Living Lab Study

Background

 Multiple mobility-related challenges frequently appear with aging. As a result, many older adults have difficulty getting around, to go, for example, to doctors’ appointments or leisure activities. Although various means of transportation are currently available, older adults do not necessarily use them, partly because they do not know which ones are adapted to their needs and preferences. To foster older adults’ autonomy and freedom in their decision-making about transportation, it is crucial to help them make informed decisions about the means that suit them best.

Objective

Our aim is to develop Mobilainés, a one-stop platform transportation planning service combining different transport modes and services to help older adults move around in their community where, when, and how they wish. More specifically, we aim to (1) define older adults’ mobility needs and preferences in order to conceptualize a one-stop platform; (2) cocreate a prototype of the one-stop platform; and (3) test the prototype with users in a real-life context.

Methods

This ongoing study uses a “Living Lab” co-design approach. This approach differs from traditional research on aging by facilitating intersectoral knowledge sharing and innovative solutions by and with older adults themselves. A steering committee of 8 stakeholders from the public, scientific, and private sectors, as well as older citizens, will meet quarterly throughout the study. The design comprises three phases, each with several iterative subphases. Phase 1 is exploration: through co-design workshops and literature reviews, members of the intersectoral committee will define older adults’ mobility needs and preferences to support the conceptualization of the one-stop platform. Phase 2 is experimentation: 4 personas will be produced that reflect the different needs and preferences of typical older adult end users of the platform; for development of a prototype, scenarios and mockups (static designs of the web application) will be created through co-design sessions with older adults (N=12) embodying these personas. Phase 3 is evaluation: we will test the usability of the prototype and document changes in mobility, such as the ability to move around satisfactorily and to participate in meaningful activities, by and with older adults (N=30) who use the prototype. The steering committee will identify ways to support the adoption, implementation, and scaling up of Mobilainés to ensure its sustainability. Qualitative and quantitative data will be triangulated according to each subphase objective.

Results

 The first phase began in September 2019. The study is scheduled for completion by mid-2023.

Conclusions

 This innovative transportation planning service will merge existing transportation options in one place. By meeting a wide variety of older adults’ needs and preferences, Mobilainés will help them feel comfortable and safe when moving around, which should increase their participation in meaningful activities and reduce the risk of social isolation.

International Registered Report Identifier (IRRID)

DERR1-10.2196/33894

Assessment of the American Heart Association's "Life's simple 7" score in French-speaking adults from Québec

BACKGROUND AND AIMS

The "Life's Simple 7" (LS7) metrics were developed by the American Heart Association (AHA) to assess and promote cardiovascular health in the American population. The purpose of this study was to assess the overall cardiovascular health of French-speaking adults from the Province of Quebec using the LS7 score.

METHODS AND RESULTS

A total of 777 age and sex-representative participants of five different administrative regions in the Province of Quebec (387 men and 390 women; mean age ± SEM: 41.9 ± 0.1 years) were included in these analyses. Metrics of the LS7 score (smoking, physical activity, diet, body mass index, blood pressure, fasting total cholesterol and blood glucose) were analysed to generate a final score ranging from 0 to 7. Only 0.5% of participants met all criteria for ideal cardiovascular health. The diet metric showed the lowest prevalence of "ideal" scores (4.8%) whereas not smoking was the metric with the highest prevalence (88.1%). Women had a higher LS7 score than men, while age and education level (negative and positive association, respectively; p < 0.0001) were also associated with the LS7 score.

CONCLUSION

Consistent with studies conducted among other populations, very few French-speaking adults from the Province of Quebec achieve an ideal cardiovascular health. These data indicate that further public health efforts aimed at promoting the LS7 metrics, focusing primarily on diet, are urgently needed. Specific groups, including older adults and those with lower levels of education, should be targeted when developing cardiovascular health promotion interventions.

Exploring women's beliefs and perceptions about healthy eating blogs: a qualitative study

Background

Chronic diseases are the leading cause of death (63%) worldwide. A key behavioral risk factor is unhealthy eating. New strategies must be identified and evaluated to improve dietary habits. Social media, such as blogs, represent a unique opportunity for improving knowledge translation in health care through interactive communication between health consumers and health professionals. Despite the proliferation of food and lifestyle blogs, no research has been devoted to understanding potential blog readers’ perceptions of healthy eating blogs written by dietitians.

Objective

To identify women’s salient beliefs and perceptions regarding the use of healthy eating blogs written by dietitians promoting the improvement of their dietary habits.

Methods

We conducted a qualitative study with female Internet users living in the Quebec City, QC, area with suboptimal dietary habits. First, the women explored 4 existing healthy eating blogs written in French by qualified dietitians. At a focus group 2-4 weeks later, they were asked to discuss their experience and perceptions. Focus group participants were grouped by age (18-34, 35-54, and 55-75 years) and by their use of social media (users/nonusers). Using a questionnaire based on the Theory of Planned Behavior, participants were asked to identify salient beliefs underlying their attitudes (advantages/disadvantages), subjective norms (what people important to them would think), and perceptions of control (facilitators/barriers) regarding the use of a healthy eating blog written by a dietitian to improve dietary habits. Discussion groups were audiotaped, transcribed verbatim, coded, and a deductive content analysis was performed independently by 2 individuals using the NVivo software (version 10).

Results

All participants (N=33) were Caucasian women aged between 22 to 73 year. Main advantages perceived of using healthy eating blogs written by a dietitian were that they provided useful recipe ideas, improved lifestyle, were a credible source of information, and allowed interaction with a dietitian. Disadvantages included increased time spent on the Internet and guilt if recommendations were not followed. Important people who would approve were family, colleagues, and friends. Important people who could disapprove were family and doctors. Main facilitators were visually attractive blogs, receiving an email notification about new posts, and finding new information on the blog. Main barriers were too much text, advertising on the blog, and lack of time.

Conclusions

The women in this study valued the credibility of healthy eating blogs written by dietitians and the contact with dietitians they provided. Identifying salient beliefs underlying women’s perceptions of using such blogs provides an empirically supported basis for the design of knowledge translation interventions to help prevent chronic diseases.

Cognitive frailty: rational and definition from an (I.A.N.A./I.A.G.G.) international consensus group

The frailty syndrome has recently attracted attention of the scientific community and public health organizations as precursor and contributor of age-related conditions (particularly disability) in older persons. In parallel, dementia and cognitive disorders also represent major healthcare and social priorities. Although physical frailty and cognitive impairment have shown to be related in epidemiological studies, their pathophysiological mechanisms have been usually studied separately. An International Consensus Group on "Cognitive Frailty" was organized by the International Academy on Nutrition and Aging (I.A.N.A) and the International Association of Gerontology and Geriatrics (I.A.G.G) on April 16th, 2013 in Toulouse (France). The present report describes the results of the Consensus Group and provides the first definition of a "Cognitive Frailty" condition in older adults. Specific aim of this approach was to facilitate the design of future personalized preventive interventions in older persons. Finally, the Group discussed the use of multidomain interventions focused on the physical, nutritional, cognitive and psychological domains for improving the well-being and quality of life in the elderly. The consensus panel proposed the identification of the so-called "cognitive frailty" as an heterogeneous clinical manifestation characterized by the simultaneous presence of both physical frailty and cognitive impairment. In particular, the key factors defining such a condition include: 1) presence of physical frailty and cognitive impairment (CDR=0.5); and 2) exclusion of concurrent AD dementia or other dementias. Under different circumstances, cognitive frailty may represent a precursor of neurodegenerative processes. A potential for reversibility may also characterize this entity. A psychological component of the condition is evident and concurs at increasing the vulnerability of the individual to stressors.

Couple dissatisfaction and eating profile: a mediation effect of coping style

Individuals' ways of coping with psychological stress have often been associated with body weight regulation through their impact on eating behaviours. In particular, emotion-oriented and distraction-oriented coping styles have been steadily related to disordered eating. Couple dissatisfaction may be experienced as an important psychological stressor and could therefore affect eating behaviours through the use of inadequate coping strategies. The study proposes 1) to compare women reporting a low vs a high level of couple satisfaction, and 2) to test mediational models including couple satisfaction, coping styles, and eating variables. Analyses were performed among 65 overweight/obese premenopausal women who reported being weight-preoccupied. Women exhibiting couple dissatisfaction (34.8%) showed a higher level of EDE-Q restraint, more intense concerns about eating and shape, a higher level of disinhibition and susceptibility to hunger and endorsed more often a distraction-oriented coping style, independently of their body weight. Furthermore, distraction- oriented coping style seemed to be a valid mediator of the relation between couple dissatisfaction and eating behaviours. Since non-normative eating behaviours, namely disinhibition and susceptibility to hunger, have been particularly linked to a higher body weight status, it is relevant to extend the scope of interest to more distal contributing factors, such as couple dissatisfaction.

Using restrictive messages to limit high-fat foods or nonrestrictive messages to increase fruit and vegetable intake: what works better for postmenopausal women?

BACKGROUND/OBJECTIVES

To compare the effects of two dietary approaches on changes in dietary intakes and body weight: (1) an approach emphasizing nonrestrictive messages directed toward the inclusion of fruits and vegetables (HIFV) and (2) another approach using restrictive messages to limit high-fat foods (LOFAT).

SUBJECTS/METHODS

A total of 68 overweight-obese postmenopausal women were randomly assigned to one of the two dietary approaches. The 6-month dietary intervention included three group sessions and ten individual sessions with a dietitian. Dietary food intake and anthropometric variables were measured at baseline, at 3 months and at 6 months.

RESULTS

Energy density decreased in both groups after the intervention compared with baseline (HIFV, -0.3+/-0.2 kcal/g; LOFAT, -0.3+/-0.3 kcal/g; P<0.0001). Although body weight decreased significantly in both groups after the intervention compared with baseline (HIFV, -1.6+/-2.9 kg; LOFAT, -3.5+/-2.9 kg; P<0.0001), women in the LOFAT group lost significantly more body weight than women in the HIFV group (P=0.01). In the HIFV group, the decrease in energy density was found to be an independent predictor of body weight loss.

CONCLUSIONS

The LOFAT approach induces more weight loss than does the HIFV approach in our sample of overweight-obese postmenopausal women.

Defined weight expectations in overweight women: anthropometrical, psychological and eating behavioral correlates

OBJECTIVE

To examine associations between defined weight expectations and anthropometric profile and to identify psychological and eating behavioral factors that characterize women having more realistic weight expectations.

METHODS

A nonrandom sample of 154 overweight/obese women completed the 'Goals and Relative Weight Questionnaire', which assessed four weight expectations: (1) dream weight (whatever wanted to weight); (2) happy weight (would be happy to achieve); (3) acceptable weight (could accept even if not happy with it); and (4) disappointed weight (would not view as a successful achievement). Psychological assessments evaluated dysphoria, self-esteem, satisfaction with one's body (i.e., body esteem) and weight-related quality of life. The 'Three-Factor Eating Questionnaire' assessed eating behaviors: (1) cognitive dietary restraint (control of food intake), (2) disinhibition (overconsumption of food with a loss of control), and (3) susceptibility to hunger (food intake in response to feelings and perceptions of hunger).

RESULTS

Women's expectations for their dream (60.6+/-6.0 kg), happy (65.2+/-6.4 kg) and acceptable (67.9+/-6.8 kg) weights corresponded to higher percentages of weight loss (24.2+/-6.6% or 19.8+/-7.1 kg, 18.6+/-5.8% or 15.2+/-6.0 kg and 15.2+/-5.7% or 12.6+/-5.8 kg, respectively) than goals recommended for overweight individuals. Defined weight expectations were positively associated with current weight and body mass index (BMI; 0.37 < or = r < or = 0.85; P<0.0001). When women were matched one by one for their current BMI, but showing different happy BMI, women with a more realistic happy BMI were older (P=0.03) and were characterized by a greater satisfaction towards body weight (P=0.04), a higher score for flexible restraint (P=0.003) and a lower score for susceptibility to hunger (P=0.02) than women with a less realistic happy BMI.

CONCLUSION

These findings suggest that having more realistic weight expectations is related to healthier psychological and eating behavioral characteristics.

Disinhibition, as assessed by the Three-Factor Eating Questionnaire, is inversely related to psychological well-being in postmenopausal women

Psychological correlates of obesity remain under controversy. As eating behaviors and dieting history have been previously related to obesity status, these dietary variables may contribute to identify overweight and obese individuals who are at higher risk of having an impaired psychological well-being.

OBJECTIVE

The main purpose of this cross-sectional study was to verify the hypothesis of a relationship between weight status and psychological well-being, and to examine whether cognitive dietary restraint, disinhibition, susceptibility to hunger and dieting history could be related to psychological well-being.

DESIGN AND SUBJECTS

In a sample of 101 postmenopausal women, we performed anthropometric measurements (weight, height and body mass index (BMI)), and measured psychological well-being (PER Questionnaire). The Three-Factor Eating Questionnaire (TFEQ) and a questionnaire about dieting history (dieters: had already been on a diet; non-dieters: had never been on a diet) were also administrated.

RESULTS

A trend for a significant relationship was observed between BMI and psychological well-being (r=-0.17; P=0.08). Significant negative relationships were observed for disinhibition, susceptibility to hunger and all their subscales with psychological well-being (-0.28</=r</=-0.48), whereas no significant differences in psychological well-being were observed between dieters and non-dieters. Finally, women displaying a higher score for habitual susceptibility to disinhibition (which is the subscale of TFEQ that was the most closely related to psychological well-being) had a lower level of psychological well-being, regardless of their weight status.

CONCLUSION

These results show that, as well as being related to weight status, TFEQ-factors are also related to psychological well-being. More specifically, individuals who display higher levels of disinhibition may be at higher risk of having an impaired psychological well-being.

Do 6-y changes in eating behaviors predict changes in body weight? Results from the Québec Family Study

OBJECTIVE

This study was performed to examine changes in eating behaviors as assessed by the three-factor eating questionnaire (TFEQ) and to quantify the potential associations between these eating behaviors and body weight changes in a 6-follow-up study.

DESIGN AND SUBJECTS

Prospective study performed in men and women who were tested twice (Visit 1=1989-1995 and Visit 2=6 y later) in the Québec Family Study (QFS).

RESULTS

Women were more restrained and less hungry than men. To reduce food intake, women relied more on strategic dieting behavior and avoided more fattening food. However, they had higher emotional and situational susceptibility to eat than men. Significant decreases in the disinhibition score were noted over time in women (P<0.01), which resulted from a decrease in habitual susceptibility behavior to increase food intake. In men, we observed an increase in the avoidance of fattening food (P<0.05). In both genders, we found that the 6-y change in restraint behavior was negatively correlated with body weight changes (P<0.05). In women, a high restraint behavior seems to promote weight gain, whereas in men, it is associated with the opposite trend.

CONCLUSION

These results suggest that variables reflecting some eating behaviors are associated with body weight changes in a free-living context. However, these behaviors are expressed differently between men and women. These behaviors should be considered in clinical interventions for individuals seeking a better body weight control.