Arthroscopic transglenoid multiple suture repair: 2 to 8 year results in 150 shoulders

Although treatment for hypertension is readily available, poor control of hypertension is a major health problem frequently manifested in late life. Researchers believe that one of the major causes of uncontrolled hypertension is failure to take medication as directed. In this preliminary study, the medication-taking behaviors of 48 adults diagnosed with hypertension, ranging in age from 35 to 87, were recorded for 2 months with credit card-sized bar-code scanners. The social-cognitive model (Park, 1992) for understanding medication adherence, which proposes that medication adherence is governed by both beliefs and cognitive factors, was used as a basis for this research. Therefore, measures of health behaviors, attitudes about health and medication taking, and cognitive function were recorded, as well as blood pressure readings. The main findings were that (a) the oldest-old and groups of middle-aged adults were the most nonadherent, whereas the young-old were more likely to adhere than the other age groups; (b) high blood pressure readings predicted adherence to antihypertensive medications; and (c) medication beliefs influenced adherence in some situations.     

Changes in functional health, changes in medication beliefs, and medication adherence.

Objective: Medication adherence often lies below recommendations although it is crucial for effective therapies, particularly in older adults with multiple illnesses. Medication beliefs are important factors for individual adherence, but little is known about their origin. We examine whether changes in functional health predict changes in medication beliefs, and whether such changes in beliefs predict subsequent medication adherence. Design: At three points in time over a 6-month period, 309 older adults (65–85 years) with multiple illnesses were assessed. Latent true change modeling was used to explore changes in functional health and medication beliefs. Adherence was regressed on changes in beliefs. Main Outcome Measures: Medication beliefs were measured by the Beliefs About Medicines Questionnaire; medication adherence by the Reported Adherence to Medication Scale. Results: Functional health and medication beliefs changed over time. Increasing physical limitations predicted increases in specific necessity and specific concern beliefs, but not in general beliefs. Changes in specific necessity beliefs predicted intentional adherence lapses, changes in general overuse beliefs predicted unintentional adherence lapses. Conclusions: Medication beliefs partly depend on health-related changes, and changes in beliefs affect individual adherence, suggesting to target such beliefs in interventions and to support older adults in interpreting health changes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychosocial Mediators of Antiretroviral Nonadherence in HIV-Positive Adults With Substance Use and Mental Health Problems.

This study used data from 1,889 HIV-positive patients on antiretroviral (ARV) medications who participated in the HIV Cost and Services Utilization Study to investigate whether nonadherence to ARV medications among patients with mental health and substance use problems could be explained by difficulty getting and negative attitudes toward ARV medications, poor fit of the regimen with lifestyle, lack of instruction and cues for remembering the regimen from a health care provider, and poor support from others for taking ARV medications. Difficulty getting ARV medications and poor fit with lifestyle were significant mediators of nonadherence for patients with a probable psychiatric disorder. Difficulty getting medication was a mediator for heavy drinkers, and poor fit with lifestyle was a mediator for drug users who drank heavily. Further research is needed to identify and address the barriers to adherence in these populations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The temporal relationship between alcohol consumption and HIV-medication adherence: A multilevel model of direct and moderating effects.

Previous studies documenting an association between alcohol use and HIV medication nonadherence, have been unable to distinguish between-persons characteristics from within-person characteristics representing the temporally linked effects of alcohol. Hierarchical Linear Modeling (HLM) explored within- and between-person predictors of adherence during the past 14 days, as well as factors that moderate the event-level effects of alcohol consumption among 272 HIV-positive men and women with alcohol problems. On days in which participants drank, they had almost 9 times higher odds of medication nonadherence, with each drink increasing the odds by 20%. The cognitive and alcohol factors had significant between-person effects on adherence. Individuals with strong and rigid beliefs about the importance of strict medication adherence were significantly more affected by each dose of alcohol, while individuals with more alcohol use and problems were less affected by each drink. Regimen complexity increased the effects of having 1 or more drinks. These results highlight the importance of promoting medication adherence among alcohol-using adults, especially among patients with complex regimens or with high confidence and positive attitudes toward HIV medication. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Well- and ill-defined measures of everyday cognition: Relationship to older adults' intellectual ability and functional status.

The present study examined 2 approaches to the measurement of everyday cognition in older adults. Measures differing in the degree of structure offered for solving problems in the domains of medication use, financial management, and food preparation and nutrition were administered to a sample of 130 community-dwelling older adults ranging in age from 60 to 90 (M=73 years, SD=7.02 years). Well-defined and ill-defined everyday problem-solving measures, which varied in the amount of means--end-related information provided to participants, were used. The study found that (a) well- and ill-defined measures were moderately interrelated, (b) the 2 approaches were differentially related to basic cognitive abilities, and (c) together the 2 approaches explained over half of the variance in older adults' everyday instrumental functioning and were in fact better predictors of everyday functioning than traditional psychometric cognitive measures. Discussion focuses on the differential importance of both methods for assessing older adults' everyday cognitive functioning. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Medication Adherence and Diabetes Control in Urban African Americans With Type 2 Diabetes.

In 181 urban African Americans with Type 2 diabetes, medication adherence was assessed using a measure designed specifically for an urban, impoverished sociodemographic population. Hemoglobin A1c, blood pressure and cholesterol levels, medication-related beliefs, and depression were assessed. Seventy-four percent of the sample reported adherence to diabetes medication. Adherence, adjusted for age, was associated with lower hemoglobin A1c. The specific behaviors associated with poorer diabetes control were forgetting to take medications and running out of medications. Knowledge of blood glucose goals differed for adherers and nonadherers. Blood pressure and cholesterol medication adherence rates were not associated with actual levels of blood pressure or lipids, respectively. These data suggest that specific medication-taking behaviors are important to diabetes control and constitute logical targets for interventions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Adrenergic stimulation of Na/K pump current in adult rat cardiac myocytes in short-term culture

This research examined self-perception and the perception of age groups by young and elderly adults from the perspective of social identity theory and social categorization theory. Respondents rated either themselves or unfamiliar stimulus persons from three age categories in adulthood: young, middle-aged, and elderly. As expected, an ingroup bias was found in the evaluation of elderly adults. Specifically, compared to ratings made by younger adults, older adults evaluated elderly persons more favorably. Moreover, as predicted, elderly adults' self-evaluations and those of young adults asked to imagine themselves as elderly were more positive than the ratings made by respondents who evaluated an unfamiliar older adult (e.g., elderly woman, elderly man). Both cognitive and motivational processes were discussed as contributing to the phenomenon of self-other discrepancy in beliefs about and attitudes toward older adults.     

Use it or lose it: Engaged lifestyle as a buffer of cognitive decline in aging?

Data from the Victoria Longitudinal Study were used to examine the hypothesis that maintaining intellectual engagement through participation in everyday activities buffers individuals against cognitive decline in later life. The sample consisted of 250 middle-aged and older adults tested 3 times over 6 years. Structural equation modeling techniques were used to examine the relationships among changes in lifestyle variables and an array of cognitive variables. There was a relationship between changes in intellectually related activities and changes in cognitive functioning. These results are consistent with the hypothesis that intellectually engaging activities serve to buffer individuals against decline. However, an alternative model suggested the findings were also consistent with the hypothesis that high-ability individuals lead intellectually active lives until cognitive decline in old age limits their activities. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sociodemographic variations in the sense of control by domain: Findings from the MacArthur studies of midlife.

Past research has focused on general control beliefs with little attention to whether control beliefs vary across domains. Also, most age-comparative studies have examined control beliefs in younger and older adults but not in middle-aged adults. This study examined assessments of control in 7 domains for a large probability sample of adults 25–75 years in age. Results revealed differential age patterns across domains: Increases in control by age were found for control over work, finances, and marriage, whereas decreases were found for control over relationship with children and sex life. Control beliefs in some domains also varied by gender and education, but the age patterns were consistent across these sociodemographic groups. Domain-specific control beliefs were significantly related to a variety of domain-relevant experiences and outcomes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Age-associated predictors of medication adherence in HIV-positive adults: Health beliefs, self-efficacy, and neurocognitive status.

Objective: Although most agree that poor adherence to antiretrovirals is a common problem, relatively few factors have been shown to consistently predict treatment failure. In this study, a theoretical framework encompassing demographic characteristics, health beliefs/attitudes, treatment self-efficacy, and neurocognitive status was examined in relationship to highly active antiretroviral therapy adherence. Design: Prospective, cross-sectional observational design. Main Outcome Measures: Neuropsychological test performance, health beliefs and attitudes, and medication adherence tracked over a 1-month period using electronic monitoring technology (Medication Event Monitoring System caps). Results: The rate of poor adherence was twice as high among younger participants than with older participants (68% and 33%, respectively). Results of binary logistic regression revealed that low self-efficacy and lack of perceived treatment utility predicted poor adherence among younger individuals, whereas decreased levels of neurocognitive functioning remained the sole predictor of poor adherence among older participants. Conclusion: These data support components of the health beliefs model in predicting medication adherence among younger HIV-positive individuals. However, risk of adherence failure in those ages 50 years and older appears most related to neurocognitive status. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Randomized, double-blind placebo-controlled trial of coenzyme Q10 in patients with acute myocardial infarction

Adherence with inhaled beta-agonists and corticosteroids in 24 asthmatic children was tracked over 3 months utilizing the metered-dose inhaler chronolog (MDIC). Patients seldom took all of their medications as prescribed, and failed to take any inhaled corticosteroid doses on a median of 41.8% of days or inhaled beta-agonists on 28.1% of days despite prescribed daily use. Medication nonadherence was correlated with lower levels of asthma knowledge (Asthma Knowledge Questionnaire) and family dysfunction (Family Assessment Device), but not child behavior disorder (Child Behavior Checklist). Patients tended to dramatically over-report medication use. Improved identification of the markers of nonadherence can directly facilitate more efficient targeting of behavioral interventions, resulting in improved adherence, better illness control, and less requirement of urgent medication intervention.     

Glycerol gangliotomy of the second dorsal cervical root in rats: an experimental study to evaluate a minimal invasive approach for the treatment of the chronic cervicogenic headache

The purpose of this integrated literature review (1980-1997) is to describe and summarize specific nursing interventions that have been devised to aid community-dwelling older adults with self-administration of prescribed medications. Interventions that combine patient education with written information or follow-up phone calls produce the most positive results. By using interventions supported by research, nurses will provide more effective and efficient care to older adults managing medications at home.     

Personal theories, intellectual ability, and epistemological beliefs: Adult age differences in everyday reasoning biases.

Age-related differences in everyday reasoning biases were explored. In each of 2 social domains, examination of theoretical beliefs and biases along 2 dimensions of scientific reasoning, involving the law of large numbers and the evaluation of experimental evidence, revealed that, across age groups, scientific reasoning was used to reject evidence that contradicted prior beliefs; relatively cursory reasoning was used to accept belief-consistent evidence. Biased reasoning was more common among middle-aged and older adults than among young adults. Dispositions to engage in analytic processing were negatively related to biases, but intellectual abilities and bias were not related. The findings support a 2-process view of adult cognitive development and suggest that the tendency to rely on heuristic information processing increases with age. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Chronological age and age-related cognitive deficits are associated with an increase in multiple types of driving errors in late life.

Objective: Older driver research has mostly focused on identifying that small proportion of older drivers who are unsafe. Little is known about how normal cognitive changes in aging affect driving in the wider population of adults who drive regularly. We evaluated the association of cognitive function and age with driving errors. Method: A sample of 266 drivers aged 70 to 88 years were assessed on abilities that decline in normal aging (visual attention, processing speed, inhibition, reaction time, task switching) and the UFOV?, which is a validated screening instrument for older drivers. Participants completed an on-road driving test. Generalized linear models were used to estimate the associations of cognitive factors with specific driving errors and number of errors in self-directed and instructor navigated conditions. Results: All error types increased with chronological age. Reaction time was not associated with driving errors in multivariate analyses. A cognitive factor measuring speeded selective attention and switching was uniquely associated with the most errors types. The UFOV? predicted blind-spot errors and errors on dual carriageways. After adjusting for age, education, and gender, the cognitive factors explained 7% of variance in the total number of errors in the instructor-navigated condition and 4% of variance in the self-navigated condition. Conclusion: We conclude that among older drivers, errors increase with age and are associated with speeded selective attention, particularly when that requires attending to the stimuli in the periphery of the visual field, task switching, errors inhibiting responses, and visual discrimination. These abilities should be the target of cognitive training. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Oral staphylococcus in older subjects with rheumatoid arthritis

OBJECTIVE: To determine if Staphylococcus aureus and Staphylococcus epidermidis, etiologic bacterial agents to late prosthetic joint infections (LPJI), are more prevalent in the oral flora of older individuals with rheumatoid arthritis (RA) than in an age and gender-matched nonarthritic control population (NA). DESIGN: Cultures were obtained from the nares, oropharynx, saliva, tongue, and gingival crevice, and the results were compared between older patients with RA and controls. SETTING: University of Michigan Medical Center, Ann Arbor, VA Medical Center, and University of Michigan School of Dentistry. PARTICIPANTS: A total of 111 community-dwelling subjects with a diagnosis of RA and 83 gender-matched control subjects. MEASUREMENTS: Colistin nalidixic acid agar plates with 5% sheep's blood were inoculated and incubated. Isolates were speciated using the API Staph Trac micro method and catalase and coagulase tests. MAIN RESULTS: Individuals with RA had a higher prevalence of S. aureus isolated from the oral cavity. However, only the oropharynx and tongue revealed higher rates; all other sites were insignificant. The presence of oral S. aureus was associated with xerostomia. Staphylococcus epidermidis was not detected from any of the oral sites sampled. Sixty-two percent (10/16) of the S. aureus isolates from the RA subjects were resistant to penicillin and ampicillin, whereas none were resistant to a cephalosporin. CONCLUSIONS: These findings suggest that rheumatoid arthritis may be a risk factor for LPJI in older prosthetic joint patients undergoing invasive dental procedure in the posterior oral cavity. This increased risk is caused, in part, by a higher prevalence of S. aureus in the posterior oral cavity. The prevalence and the antibiotic resistance of S. aureus must be considered when determining the need for chemoprophylaxis.     

Effect of formula supplemented with docosahexaenoic acid and gamma-linolenic acid on fatty acid status and visual acuity in term infants

This study identified factors associated with exercise participation and adherence in a sample of 102 sedentary, functionally limited, community-dwelling adults aged 60 to 94 years who participated in a home-based resistance training program. Stepwise regression analyses revealed that baseline physical factors (i.e., higher levels of mobility, weaker muscle strength, and fewer numbers of new medical conditions) were associated with higher rates of participation in the home program. Positive attitudes and a sense of control toward exercise, lower levels of confusion and depressive moods, and the development of fewer new medical problems during the program were related to higher levels of adherence to the program. Findings revealed that although physical health variables were the primary indicators of an older person's overall participation in the program, it was the psychological factors that were most important to adherence to this home-based program.     

Perceptions of the cognitive compensation and interpersonal enjoyment functions of collaboration among middle-aged and older married couples.

Perceptions of cognitive compensation and interpersonal enjoyment of collaboration were examined in three hundred middle-aged and older couples who completed measures of perceptions of collaboration, cognitive ability, marital satisfaction, an errand task and judged their spouse's affiliation. Older adults (especially men) endorsed cognitive compensation and interpersonal enjoyment and reported using collaboration more frequently than middle-aged adults. Greater need for cognitive compensation was related to lower cognitive ability only for older wives. Greater marital satisfaction was associated with greater interpersonal enjoyment. These two functions related to reports of more frequent use of collaboration and perceptions of spousal affiliation in a collaborative task. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Relapse as a model of nonadherence to dietary treatment of diabetes.

Tested the generality of G. A. Marlatt and J. R. Gordon's (1980, 1985) model of dietary lapse. 46 adults with insulin-dependent diabetes mellitus (IDDM) and 43 obese adults with non-IDDM were interviewed regarding dietary violations. Most episodes occurred in a limited range of high-risk situations. Although the 2 groups lapsed in similar situations, there was a tendency for the IDDM Ss to report a larger proportion of lapses in situations characterized by negative emotions. Approximately 27% of the lapses occurred when the S was busy with a competing activity or had no choice, and these lapses did not fit into Marlatt and Gordon's coding schema. Violations usually were errors of omission rather than errors of commission. Results suggest that most instances of nonadherence were intermittent lapses that did not develop into full-blown relapses. (PsycINFO Database Record (c) 2010 APA, all rights reserved)