Physical Activity Programming for Older Adults in Assisted Living: Contextual Factors to Consider

Abstract Sedentary behavior may adversely affect physical and cognitive health of older adults in assisted living (AL). Replacing sedentary behavior with light physical activity (PA) could help them maintain functional abilities and independence. We interviewed AL residents to obtain their guidance regarding the implementation of an intervention to reduce sedentary behavior. Here we report the results of a thematic analysis exploring contextual factors that may influence intervention implementation. We interviewed 20 residents (mean age 83.1; 60% women) and identified 7 themes. The first was attitudes and beliefs about PA. Most residents believed PA was important, but some lacked motivation or confidence to perform PA. Another theme was attitudes and beliefs about aging, as some residents felt discouraged about aging and uncertainty about how much PA they could safely perform. Abilities of AL residents was seen as an important consideration. It was noted that residents have a wide range of abilities and this could present challenges in planning a PA program appropriate for all residents. Social influences for PA should be considered, as residents may find encouragement from family or other residents. Space for being active is another factor because it is typically limited within AL. We found that some residents wanted more challenging exercise classes than currently provided by their facility. Finally, residents described limited opportunities for PA due to the nature of the AL environment. This thematic analysis brings attention to important factors that could influence the implementation of PA interventions with the AL population.

Research, LLC/Synexus Clinical Research/AES, Woodstock, MD, USA,Rockville,Maryland,United States,5. AMR Kansas City,Kansas City,MO,USA,Kansas City,Missouri,United States,6. Janssen Vaccines & Prevention BV,Leiden,The Netherlands,Leiden,Netherlands Respiratory syncytial virus (RSV) may cause serious lower respiratory tract disease (LRTD) in older adults, and there is currently no licensed vaccine.CYPRESS (NCT03982199) is a randomized, double-blind, placebo-controlled Phase 2b proof-of-concept trial of an Ad26.RSV.preF-basedvaccine for the prevention of RSV-mediated LRTD in older adults.Adults aged ≥65 years were randomized 1:1 before the RSV season to receive Ad26.RSV.preF-basedvaccine or placebo.Acute respiratory infection symptoms were collected through a patient eDiary and/or clinician assessment until the end of the RSV season.The primary endpoint was the first occurrence of RTPCR-confirmed RSV-mediated LRTD according to any of 3 case definitions: (1) ≥3 symptoms of lower respiratory tract infection (LRTI), (2) ≥2 symptoms of LRTI, or (3) ≥2 symptoms of LRTI or ≥1 symptom of LRTI with ≥1 systemic symptom.Immunogenicity was assessed in a subset of approximately 200 participants.A total of 2891 participants in each study arm received study treatment.Vaccine efficacy was 80% (94.2% CI, 52.2-92.9%),75% (50.1-88.5%),and 69.8% (43.7-84.7%)for case definition 1, 2, and 3, respectively (all P <0.001).In the vaccine arm, geometric mean fold increase in antibody titers 14 days after vaccination was 13.5 for RSV neutralizing antibodies and 8.6 for RSV prefusion F-specific binding antibodies, and median frequency of RSV-F-specific INFγ T-cells increased from 34 to 444 SFC/10^6 PBMC; no relevant changes were observed in the placebo arm.The Ad26.RSV.preF-basedvaccine was highly effective against RSV-mediated LRTD through the first RSV season and elicited robust immune responses in older adults.

PHYSICAL ACTIVITY PROGRAMMING FOR OLDER ADULTS IN ASSISTED LIVING: CONTEXTUAL FACTORS TO CONSIDER Katelyn Webster, and Janet Larson, University of Michigan School of Nursing, Ann Arbor, Michigan, United States
Sedentary behavior may adversely affect physical and cognitive health of older adults in assisted living (AL).Replacing sedentary behavior with light physical activity (PA) could help them maintain functional abilities and independence.We interviewed AL residents to obtain their guidance regarding the implementation of an intervention to reduce sedentary behavior.Here we report the results of a thematic analysis exploring contextual factors that may influence intervention implementation.We interviewed 20 residents (mean age 83.1; 60% women) and identified 7 themes.The first was attitudes and beliefs about PA.Most residents believed PA was important, but some lacked motivation or confidence to perform PA.Another theme was attitudes and beliefs about aging, as some residents felt discouraged about aging and uncertainty about how much PA they could safely perform.Abilities of AL residents was seen as an important consideration.It was noted that residents have a wide range of abilities and this could present challenges in planning a PA program appropriate for all residents.Social influences for PA should be considered, as residents may find encouragement from family or other residents.Space for being active is another factor because it is typically limited within AL.We found that some residents wanted more challenging exercise classes than currently provided by their facility.Finally, residents described limited opportunities for PA due to the nature of the AL environment.This thematic analysis brings attention to important factors that could influence the implementation of PA interventions with the AL population.

PREDICTION OF COVID-19 STRESS AMONG COMMUNITY DWELLING OLDER ADULTS: THE ROLE OF ANXIETY AND RESILIENCY
Geffre Jean Francois, Dawn Carr, and Natalie Sachs-Ericsson, Florida State University, Tallahassee, Florida, United States Worldwide, the COVID-19 pandemic has been an unparalleled source of stress.Older adults with anxiety are vulnerable to higher levels of stress during the pandemic.However not all older adults with anxiety will experience severe stress; resiliency may decrease such negative outcomes.There have been few, if any, longitudinal studies that followed older adults before and during the pandemic.Our data of community dwelling older adults (aged 60-92) is unique in that it allowed for an investigation of psychological variables that increase and decrease negative outcomes during the pandemic.Our longitudinal study examined the influence of prepandemic anxiety and resiliency on the severity of COVID related stress.
Methods: The pre-pandemic data was obtained in September 2018, and the pandemic data was collected in June 2020.In the baseline survey we obtained measures of anxiety and resiliency.During the pandemic we measured the severity of COVID related stressors.We hypothesized that anxiety would predict higher level of COVID-stress, whereas resiliency would be associated with decreased severity of COVID-stress.Further we predicted that resiliency would attenuate the association between anxiety and COVID-stress.
Results: Using OLS regression, we found that anxiety predicted higher COVID-stress, whereas resiliency predicted lower COVID-stress.However, resiliency did not moderate the association between anxiety and COVID-stress.

Conclusion:
Older adults are subject to many unavoidable negative life events, such as death of family members and chronic health problems.Resiliency may help buffer against such adversities.Development of intervention programs to enhance resiliency may increase psychological resources and foster healthy aging.

PROBLEM-DRINKING ACROSS THE LIFESPAN: CROSS-SECTIONAL VERSUS LONGITUDINAL EFFECTS AMONG MIDLIFE AND OLDER ADULTS
Thomas Britton, 1 Annabel Kady, 2 Yimei Li, 3 Angelo DiBello, 3 and Matthew Lee, 3 , 1. Rutgers University, Piscataway, New York, United States, 2. Rutgers University, Baltimore, Maryland, United States, 3. Rutgers University, Piscataway, New Jersey, United States When considering problem drinking from a lifespandevelopmental perspective, an often-stated premise is that problem drinking escalates during adolescence, peaks around early young adulthood, and then declines throughout the remainder of the lifespan.However, while there is a strong empirical basis for such changes throughout adolescence and young adulthood, the notion of continued declines throughout midlife and older adulthood is less firmly established and based primarily on cross-sectional data.Thus, this study contrasted cross-sectional versus longitudinal age effects on problem-drinking changes across the lifespan, with particular focus on midlife and older adulthood.Analyses used data from a large, two-wave, U.S.-representative sample.We generated descriptive "porcupine figures" graphically depicting both cross-sectional and longitudinal age effects simultaneously, and we estimated mixed-ANOVAs to partition, test, and contrast cross-sectional versus longitudinal age effects.As expected, analyses confirmed the well-known rise and fall of problem drinking across young adulthood in both cross-sectional and longitudinal age effects.In contrast, in midlife and older adulthood, only cross-sectional age effects were consistent with the notion of continued age-related declines throughout these ages, whereas the longitudinal data showed a mixture of stability and escalation at these ages.Age-confounded cohort effects are one plausible explanation for how cross-sectional data can lead to spurious conclusions about developmental change.By potentially yielding a more accurate understanding of lifespan-developmental change in midlife and older adulthood, findings like ours could help guide lifespan-developmentally-informed interventions for midlife and older-adult problem drinkers; an objective of increasing importance in light of the ongoing aging of the U.S. population.

PSYCHOLOGICAL IMPACT OF COVID-19 PANDEMIC ON FRONTLINE RESPONDERS AND STUDENTS IN TRAINING
Andrew Revell, 1 and Mitchell Gauvin, 2 , 1. University of Massachusetts Dartmouth, University of Massachusetts Dartmouth, Massachusetts, United States, 2. University of Massachusetts Dartmouth, North Dartmouth, Massachusetts, United States Medical personnel have been in the frontlines of the pandemic leading to increased levels of stress and an impact on mental health.Risks may include, but are not limited to, pronounced burnout (Shechter et al., 2020), vicarious trauma, and post-traumatic stress disorder.The goal of this investigation was to gain insight on the psychological effects that the pandemic had on both frontline responders (EMTs and emergency room staff) and students in clinical training.Emerging adults and adult participants (N=150; ages 18-46; 70.4% ages 18-24) were recruited through the introductory psychology subject pool, community healthcare, and social media.Linear regression and means testing were employed to assess differences between current frontline workers and future workers on the Depression, Anxiety, and Stress Scale (DASS-21;Lovibond, 1995) on irritability, sleep, covid-19 positive presence, concentration, and other mental health factors.Hierarchical linear regression, controlling for age, indicated higher anxiety subscale scores (b=2.49,p=.008) and higher stress subscale scores (b=2.25,p=.035) were present on the DASS-21 for women.Dichotomous means testing indicated higher anxiety, stress, and depression levels for those who also reported a significant change in sleep habits (p <.001) and for those who reported being more irritable on their days off (p <.001) during the pandemic.Students in training (37.7%) indicated interest in considering a different career path (r = .302,p = .02).Future studies should examine these dynamic relationships among mental health factors among healthcare professionals and the implications for training the next generation.

PSYCHOSOCIAL PREDICTORS OF PSYCHOLOGICAL WELL-BEING DURING THE COVID-19 PANDEMIC
Yeon Ji Ryou, 1 Gina Lee, 1 Rotem Arieli, 1 Peter Martin, 1 Shinae Choi, 2 Jinmyoung Cho, 3 and Melinda Heinz, 4  People worldwide have been largely affected by the COVID-19 outbreak.In addition to worries about physical health, it also causes concerns about psychological and mental health.This research aims to explore predictors affecting psychological well-being during the pandemic using the 2018 Health and Retirement Study (HRS) RAND longitudinal data (N = 42,233) and the 2020 HRS COVID-19 module (N = 3,266).Demographics (i.e., gender, age, and education), psychosocial (i.e., personality traits), and health (i.e., comorbidity) variables were included in multivariate logistic and ordinary least square regression analyses predicting feeling "overwhelmed," "stressed," and "lonely" during the pandemic.Our results indicated that neuroticism was positively associated with all outcomes.Women were more likely to feel overwhelmed, stressed, and lonely compared to men.Age negatively predicted the overwhelmed and stressed feelings.Furthermore, the effect of depressive symptoms in 2012, 2014, 2016, and 2018 on psychological well-being was assessed by conducting a latent growth curve model.Findings indicate that initial level and increasing change of depressive symptoms over four-time points (waves 11-14) were positively related to psychological feelings.A higher level of depressive symptoms at the initial level of 2012 and increasing reports of depression symptoms predicted higher rates of being stressed, feeling overwhelmed, and lonely during the COVID-19 pandemic.The results have implications for future research and interventions that should target the emotional antecedents and consequences of pandemics.