What Accounts for Physical and Emotional Health? Influence of Health, Personality, and Health Activation

Abstract The purpose of this study was to identify associations among health personality, health activation, and emotional and physical health, and to identify direct and indirect effects. Participants in the study consisted of 3907 older adults, 65 years of age and older. Measures used in the analyses were the Health Personality Assessment, the Consumer Health Activation Index, and The Veterans RAND 12-Item Health Survey. Structural equation modeling with bootstrap sampling estimation was conducted to examine direct and indirect effects. The measurement model, X2(307)=2142.34, CFI=0.96, RMSEA=0.04, and structural model, X2(313)=2167.36, CFI=0.96, RMSEA=0.04 yielded an acceptable fit. Significant direct paths were observed between health personality factors and health activation, and in turn health activation to emotional and physical health. The results indicate that older adults with lower levels of Health Neuroticism, lower Health Openness, higher Health Agreeableness, and higher Health Conscientiousness had higher levels of health activation. In addition, older adults with higher levels of health activation had higher emotional and physical health. Also, direct paths from health personality to emotional and physical health were observed. Lastly, significant indirect effects were health activation had a significant positive indirect effect on physical health through Health Agreeableness. Health activation had a significant negative indirect effect on emotional health through Health Neuroticism and Health Openness. The implication of this study is that health activation has a significant role in the emotional and physical health of older adults through health personality dispositions. In addition, health personality factors directly influence the emotional and physical health of older adults.

particular concern for older African Americans, who are at increased risk for obesity and type 2 diabetes and for whom weight loss interventions can be less effective. However, obesity interventions have been under-studied in this population; little is known about potential differences in motivation for change by race. The ongoing Eggs PreDiabetes Intervention Trial (EGGSPDITe) is a randomized controlled trial of expedited weight loss in older (60+ years) Black and White adults with prediabetes. Participants completed both the Stages-and Processes of Change questionnaires in Weight Management (S-Weight and P-Weight) at baseline and end of 4-month intervention. Preliminary combined-group analysis indicates that, while White participants reported a higher average stage of change at baseline, there was no difference by race (ps < 0.05) in changes for body weight, fat mass, and hemoglobin A1c at endpoint. Reductions in weight consequences evaluation (WCE) and increases in weight management actions (WMA) subscales were observed in both races (ps < 0.05), with a trend toward decreased emotional re-evaluation (EmR; p = 0.06). Of the processes of change subscales, only WCE differed by race (p < 0.05), with White participants showing ≈13.5% higher utilization, relative to Black participants, at both time points. These preliminary findings suggest that weight loss interventions can be equally effective among black and white older adults, although motivations for weight loss may differ by race. The purpose of this study was to identify associations among health personality, health activation, and emotional and physical health, and to identify direct and indirect effects. Participants in the study consisted of 3907 older adults, 65 years of age and older. Measures used in the analyses were the Health Personality Assessment, the Consumer Health Activation Index, and The Veterans RAND 12-Item Health Survey. Structural equation modeling with bootstrap sampling estimation was conducted to examine direct and indirect effects. The measurement model, X2(307)=2142.34, CFI=0.96, RMSEA=0.04, and structural model, X2(313)=2167.36, CFI=0.96, RMSEA=0.04 yielded an acceptable fit. Significant direct paths were observed between health personality factors and health activation, and in turn health activation to emotional and physical health. The results indicate that older adults with lower levels of Health Neuroticism, lower Health Openness, higher Health Agreeableness, and higher Health Conscientiousness had higher levels of health activation. In addition, older adults with higher levels of health activation had higher emotional and physical health. Also, direct paths from health personality to emotional and physical health were observed. Lastly, significant indirect effects were health activation had a significant positive indirect effect on physical health through Health Agreeableness. Health activation had a significant negative indirect effect on emotional health through Health Neuroticism and Health Openness. The implication of this study is that health activation has a significant role in the emotional and physical health of older adults through health personality dispositions. In addition, health personality factors directly influence the emotional and physical health of older adults. Older adults with chronic obstructive pulmonary disease (COPD) are at risk for physical and cognitive impairment. Cognitive function is associated with falls in older adults however it is unknown if a relationship exists between cognitive function and falls in COPD. The aim of this study was to examine the relationships between cognitive function and balance and mobility in older adults with COPD. A secondary analysis was performed using data from the 2010 wave of the Health and Retirement Study (HRS) (N=4051). Cognitive (immediate and delayed recall, executive function) and physical (gait speed, tandem balance time) measure data was extracted from older adults with COPD (N=382) and an age matched control group without COPD (N=382) who met inclusion/exclusion criteria. Multivariate linear regression modeling was performed to examine associations between cognitive function and mobility or balance while controlling for age, gender, BMI, grip strength, and education. We found that in COPD, immediate word recall, delayed word recall, orientation, and executive function (β ranging from 0.004-0.02) were significantly associated with gait speed while only delayed word recall (β = 0.122, p < .05) was associated with tandem balance. These same associations did not exist in those without COPD. In older adults with COPD, cognitive function is associated with balance and mobility. Screening for cognitive function, specifically delayed recall, should be a part of the management of falls in this population.

CLINICAL SCREENING FOR LOWER LIMB MUSCLE WEAKNESS IN COMMUNITY-DWELLING OLDER WOMEN
Daniela Abreu, 1 and Jaqueline Porto, 2 1. University of Sao Paulo,Ribeirao Preto,Sao Paulo,Brazil,2

. Ribeirão Preto School of Medicine of the University of São Paulo, Ribeirão Preto, Sao Paulo, Brazil
The objective of the present study was to evaluate the ability of the five times sit to stand test (5TSST), grip strength (GS) and step test (ST) to detect older women with reduced lower-limb muscle strength (LLMS), and to investigate the clinical usefulness of the combination of such tests. One hundred and nineteen older women were submitted to the 5TSST, GS, ST and lower limb peak torque by an isokinetic dynamometer. The capacity of the clinical tests to detect older women with reduced LLMS was measured using the ROC curve, followed by calculation of posttest probability (PoTP). The results show that a ST score of 0.24 cm per cm of participant's height shows the best PoTP for a positive test (72%). However, the combination of the ST and 5TSST enhances the accuracy from 48% (prevalence of weakness in the population) to 82.6% if both tests are positive, and decreases the PoTP from 48% to 11.4% if both tests are negative. The inclusion of GS provided additional benefits of small magnitude. In conclusion, the ST performed alone or in combination with 5TSST could be an alternative for clinical screening of LLMS reduction in older women. The early identification of impairment of lower-limb muscle strength in independent older adults may favor early intervention and prevention of negative outcomes such as falls and functional limitations.

DIETARY QUALITY AMONG OLDER OVERWEIGHT OR OBESE VETERANS WITH DYSMOBILITY
Elizabeth Parker, 1 Lauren Bergamo, 2 Will Perez, 2 Leslie Katzel, 2 Alice Ryan, 2 Steven Prior, 3 Monica Serra, 4 and Odessa Addison, 5 1. University of Maryland School of Medicine,Baltimore,Maryland,United States,2. Baltimore VA Medical Center,Baltimore,Maryland,United States,3. University of Maryland School of Public Health,College Park,Maryland,United States,4. UTHSCSA,San Antonio,Texas,United States,5. University of Maryland School of Medicine,Glen burnie,Maryland,United States Older adults have unique dietary challenges due to a myriad of factors including age-related taste and smell changes and lack of nutrition knowledge that increase the risk for poor dietary quality. Healthier dietary quality is associated with higher muscle mass, strength and physical performance which may reduce the development of frailty and disability later in life; however, few studies have examined dietary quality among older Veterans with limited physical functioning. The purpose of this study was to examine overall dietary quality among older, overweight/obese veterans with dysmobility. Habitual dietary intake was assessed at baseline using three, nonconsecutive 24-hour recalls and used to calculate healthy eating index (HEI-2015; higher scores indicate higher diet quality). Twentyeight participants were included in analysis: 93% male; 54% black; aged=69.5±7.0 years; BMI=35.5±5.4 kg/m2. Means and standard deviations were calculated for average intake of total daily energy (2184±645 kcals) and protein (0.89±0.3g/kg), daily servings of fruits (0.84±0.94) and vegetables (1.3±0.87), and HEI-2015 (52.8±13.4). Overall, 96% consumed fewer than the recommended 5 daily servings of fruits and vegetables and 68% consumed <1.0g/kg/d of protein (1.0-1.3g/kg/d recommended for older adults). Mean HEI-2015 was below the US national average for adults >65 years (2015-2016 NHANES 65+ years: 64.0), suggesting poor dietary quality among our sample. This pilot study suggests that dietary intake quality is suboptimal in older, obese Veterans with disability and highlights the need to identify strategies that improve dietary intake quality of older Veterans who may benefit from obesity and disability management.

DISABILITY AND SYMPTOM BURDEN AMONG THE VERY OLD: COMPARISON OF SURVIVORS AND DECEDENTS
Xinran Liu, and Steven Albert, University of Pittsburgh, Pittsburgh, Pennsylvania, United States