Multi-cultural perspectives on group singing among diverse older adults.
Ontology highlight
ABSTRACT:
SUBMITTER: Allison TA
PROVIDER: S-EPMC7738424 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:BACKGROUND:Singing is a multimodal activity that requires physical, cognitive and psychosocial performance, with benefits to various domains of well-being and health in older adults. In recent years, research has increasingly studied group singing as an important cost-effective intervention to promote active and healthy aging. However, the specific factors responsible for these benefits need further experimental support, as most studies do not allow for causal inferences. This study responds to the need for further randomized controlled trials (RCT), with follow-up measurement, on the benefits of group singing in older adults from a low socioeconomic background. Also, while most studies often focus on specific outcome measure dimensions, in this study, the conjoint effect of several physical, psychosocial, psychoemotional and cognitive dimensions are analyzed, testing mediation effects of psychosocial and psychoemotional variables on the well-being and health of the participants. METHODS:We implement and measure the effects of a singing group program for older adults, with an RCT crossover design study, in a natural context, before and after the intervention and in a follow-up, 6 months after the intervention. PARTICIPANTS:140 retired older adults (>?60?years) users of a social support institution, will be invited to participate in a singing group program and randomly allocated to an experimental (n?=?70) and a control (n?=?70) group, which will enroll in the regular activities proposed by the institution. The intervention consists of 34 bi-weekly group singing sessions, of 2 h each, for 4 months. Measures on social and emotional well-being, cognitive function, and health indicators (e.g., blood pressure, glycemia, cholesterol, c-reactive protein, sedimentation rate, respiratory function, body balance, sleep quality, medication intake, and health services attendance) will be collected. Interviews will be conducted on the motivation and perceived benefits of participation. DISCUSSION:Significant improvements are expected in the outcome measures in the experimental group after the intervention, validating singing groups as a cost-effective intervention for healthy aging. Psychosocial and psychoemotional variables are expected to be mediators of the effects of the program in the cognitive function, well-being and health of the participants. TRIAL REGISTRATION:NCT03985917 . Registered 14th June 2019 (retrospectively registered).
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Project description:Psychology has become less WEIRD in recent years, marking progress toward becoming a truly global psychology. However, this increase in cultural diversity is not matched by greater attention to cultural biases in research. A significant challenge in culture-comparative research in psychology is that any comparisons are open to possible item bias and non-invariance. Unfortunately, many psychologists are not aware of problems and their implications, and do not know how to best test for invariance in their data. We provide a general introduction to invariance testing and a tutorial of three major classes of techniques that can be easily implemented in the free software and statistical language R. Specifically, we describe (1) confirmatory and multi-group confirmatory factor analysis, with extension to exploratory structural equation modeling, and multi-group alignment; (2) iterative hybrid logistic regression as well as (3) exploratory factor analysis and principal component analysis with Procrustes rotation. We pay specific attention to effect size measures of item biases and differential item function. Code in R is provided in the main text and online (see https://osf.io/agr5e/), and more extended code and a general introduction to R are available in the Supplementary Materials.
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Project description:Prognosis is critical in individualizing care for older adults with late life disability. Evidence suggests that preferences for prognostic information may be culturally determined. Yet little is known about the preferences of diverse elders for discussing prognosis.To determine the preferences for discussing prognosis of a diverse sample of older adults with late-life disability.We interviewed 60 older adults with mean age 78 and mean 2.5 Activities of Daily Living dependencies. Participants were recruited from San Francisco's On Lok program, the first Program of All-inclusive Care for the Elderly (PACE). Participants were interviewed in English, Spanish, and Cantonese, and responded to scenarios in which their doctors estimated they had 5 years and 1 year left to live. Open-ended questions explored the reasons for their responses. Results were analyzed qualitatively using grounded theory.Sixty-five percent of participants wanted to discuss the prognosis if their doctor estimated they had?<5 years to live and 75% if the estimate was?<1 year. Three themes were prominent among patients who wanted to discuss prognosis: to prepare, to make the most of the life they had left, and to make medical or health-related decisions. Those who preferred not to discuss prognosis described emotional difficulty, the uncertainty of prognosis, or that it would not be useful. Nearly all participants said that doctors should not make assumptions based on race or ethnicity, though differences between ethnic groups emerged.Most patients in this diverse sample of disabled elders were interested in discussing prognosis, while a substantial minority was not. Among those participants who preferred to discuss prognosis, many said that prognostic information would be important as they made difficult medical and personal decisions in late-life. Clinicians should inquire about preferences for discussing prognosis before sharing prognostic estimates.
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Project description:Background/objectivesGuideline-based management of cardiovascular disease often involves prescribing multiple medications, which contributes to polypharmacy and risk for adverse drug events in older adults. Deprescribing is a potential strategy to mitigate these risks. We sought to characterize and compare clinician perspectives regarding deprescribing cardiovascular medications across three specialties.DesignNational cross-sectional survey.SettingAmbulatory.ParticipantsRandom sample of geriatricians, general internists, and cardiologists from the American College of Physicians.MeasurementsElectronic survey assessing clinical practice of deprescribing cardiovascular medications, reasons and barriers to deprescribing, and choice of medications to deprescribe in hypothetical clinical cases.ResultsIn each specialty, 750 physicians were surveyed, with a response rate of 26% for geriatricians, 26% for general internists, and 12% for cardiologists. Over 80% of respondents within each specialty reported that they had recently considered deprescribing a cardiovascular medication. Adverse drug reactions were the most common reason for deprescribing for all specialties. Geriatricians also commonly reported deprescribing in the setting of limited life expectancy. Barriers to deprescribing were shared across specialties and included concerns about interfering with other physicians' treatment plans and patient reluctance. In hypothetical cases, over 90% of physicians in each specialty chose to deprescribe when patients experienced adverse drug reactions. Geriatricians were most likely and cardiologists were least likely to consider deprescribing cardiovascular medications in cases of limited life expectancy (all P < .001), such as recurrent metastatic cancer (84% of geriatricians, 68% of general internists, and 45% of cardiologists), Alzheimer dementia (92% of geriatricians, 81% of general internists, and 59% of cardiologists), or significant functional impairment (83% of geriatricians, 68% of general internists, and 45% of cardiologists).ConclusionsWhile barriers to deprescribing cardiovascular medications are shared across specialties, reasons for deprescribing, especially in the setting of limited life expectancy, varied. Implementing deprescribing will require improved processes for both physician-physician and physician-patient communication. J Am Geriatr Soc 68:78-86, 2019.
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Project description:INTRODUCTION:This study aimed to determine if later birth year influences trajectory of age-related cognitive decline across racial/ethnic groups and to test whether years of school, childhood socioeconomic status, and cardiovascular disease burden explain such secular trends. METHODS:We compared cognitive trajectories of global cognition and subdomains in two successive racially/ethnically and educationally diverse birth cohorts of a prospective cohort study. RESULTS:Later birth year was associated with higher initial cognitive levels for Whites and Blacks, but not Hispanics. Later birth year was also associated with less rapid rate of decline in all three racial/ethnic groups. More years of education, higher childhood socioeconomic status, and, to a smaller extent, greater cardiovascular disease burden accounted for higher intercepts in the later-born cohort, but did not account for attenuated slope of cognitive decline. DISCUSSION:Later birth year is related to a slower rate of age-related decline in some cognitive domains in some racial/ethnic groups. Our analyses suggest that racial/ethnic and social inequalities are part of the mechanisms driving secular trends in cognitive aging and dementia.
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Project description:BACKGROUND AND PURPOSE:Previously, we showed that internal cues (such as singing) produce similar motor benefits as external cues (such as listening to music) for people with Parkinson disease (PD). This study takes that research further by exploring how singing-either aloud or mentally-at different tempos can ameliorate gait, and it offers insight into how internal cueing techniques may enhance motor performance for older adults and people with PD. METHODS:Sixty participants aged 50 years and older (30 female) were recruited; 30 had PD and 30 were healthy age-matched controls. Participants completed walking trials involving internal and external cueing techniques at 90%, 100%, and 110% of preferred cadence. The effects of different cue types and rates were assessed in a repeated-measures cross-sectional study by comparing gait characteristics (velocity, cadence, stride length) and variabilities (coefficients of variation of stride length, stride time, single support time). RESULTS:All participants modified their cadence and stride length during cued conditions, resulting in changes in gait velocity closely reflecting expected changes based upon cue rate. External cues resulted in increased gait variability, whereas internal cues decreased gait variability relative to uncued walking. Variability decreases were more substantial during mental singing at tempos at or above preferred cadence. DISCUSSION AND CONCLUSIONS:Matching movement to one's own voice improves gait characteristics while reducing gait variability for older adults and people with PD. Optimizing the use of internal cues to facilitate movement is an important step toward more effectively meeting the needs of people with gait disorders related to aging or neurological disease.Video Abstract available for more insights from authors (see Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A286).
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Project description:Whereas the burgeoning population of older adults is intrinsically vulnerable to cardiovascular disease, the utility of many management precepts that were validated in younger adults is often unclear. Whereas biomarker- and imaging-based tests are a major part of cardiovascular disease care, basic assumptions about their use and efficacy cannot be simply extrapolated to many older adults. Biology, physiology, and body composition change with aging, with important influences on cardiovascular disease testing procedures and their interpretation. Furthermore, clinical priorities of older adults are more heterogeneous, potentially undercutting the utility of testing data that are collected. The American College of Cardiology and the National Institutes on Aging, in collaboration with the American Geriatrics Society, convened, at the American College of Cardiology Heart House, a 2-day multidisciplinary workshop, "Diagnostic Testing in Older Adults with Cardiovascular Disease," to address these issues. This review summarizes key concepts, clinical limitations, and important opportunities for research.
| S-EPMC7540920 | biostudies-literature
Project description:OBJECTIVES:Cross-sectional and longitudinal evidence from largely non-Hispanic White cohorts suggests that positive psychosocial factors, particularly self-efficacy and social support, may protect against late-life cognitive decline. Identifying potentially protective factors in racial/ethnic minority elders is of high importance due to their increased risk of Alzheimer's disease. The overall goal of this study was to characterize cross-sectional associations between positive psychosocial factors and cognitive domains among Black, Hispanic, and White older adults. METHODS:A total of 548 older adults (41% Black, 28% Hispanic, 31% White) in the Washington Heights-Inwood Columbia Aging Project completed cognitive and psychosocial measures from the NIH Toolbox and standard neuropsychological tests. Multiple-group regressions were used to compare cross-sectional associations between positive psychosocial factors and cognition across racial/ethnic groups, independent of demographics, depressive symptoms, and physical health. RESULTS:Positive associations between self-efficacy and language did not significantly differ across race/ethnicity, although the bivariate association between self-efficacy and language was not significant among Hispanics. Additional positive associations were observed for Whites and Blacks, but not Hispanics. Negative associations between emotional support and purpose in life and working memory were seen only in Hispanics. CONCLUSIONS:Results confirm and extend the link between self-efficacy and cognition in late life, particularly for White and Black older adults. Previous studies on positive psychosocial factors in cognitive aging may not be generalizable to Hispanics. Longitudinal follow-up is needed to determine whether negative relationships between certain psychosocial factors and cognition in Hispanics reflect reverse causation, threshold effects, and/or negative aspects of having a strong social network. (JINS, 2018, 24, 294-304).
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