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Diverse strategies are needed to reduce frailty. This study evaluated the effects of two behavioural interventions targeting outdoor walking on reducing the level of frailty among community-dwelling older adults with mobility limitations. Data from two participant cohorts of the Getting Older Adults Outdoors (GO-OUT) study were analyzed. After baseline evaluations, 190 participants were invited to a one-day educational workshop and were then randomized to either a 10-week supervised outdoor walk group (n = 98) or a 10-week telephone weekly reminders group (n = 92). Frailty was assessed using Fried's frailty index at 0, 3, and 5.5 months. Mixed-effects linear and ordinal regression models were used to evaluate change in frailty score and phenotype over time after accounting for age, sex, study site, participation on own or with a partner, and cohort. At baseline, participant mean age was 74.5 ± 7.1 years; 73% were female, 7% were frail, and 59% were pre-frail. Total frailty scores decreased, on average, by 0.13 points (b = -0.13, 95% CI: -0.26 to -0.01; p = .036) across all participants from 0 to 3 months (immediately post-intervention). Participants were 55% less likely to progress to more severe frailty phenotypes at 3 months compared to baseline (OR=0.45; 95% CI: 0.25 to 0.81; p = .008). No significant between-group differences or long-term effects were observed. A short-term reduction in frailty was observed in older adults with mobility limitations following participation in behavioural interventions aimed at improving outdoor walking; neither intervention was superior. Supervised outdoor walk group and telephone weekly reminder interventions to increase outdoor walking may have the potential to mitigate frailty in older adults with mobility limitations.

The Getting Older Adults Outdoors (GO-OUT) randomized trial showed that a 10-week outdoor walk group (OWG) program was not superior to 10 weekly phone reminders in increasing physical and mental health; however, OWG attendance varied. This study examined whether dose-response relationships existed between OWG attendance and improvement in physical and mental health among older adults with mobility limitations. We analyzed data from 76 OWG participants with pre- and post-intervention scores on at least one of seven measures of health outcomes (walking endurance, comfortable and fast walking speed, balance, lower extremity strength, walking self-efficacy, and emotional well-being). Participants were classified as attending 0-9, 10-15, and 16-20 OWG sessions based on attendance tertiles. We adjusted for participant sex and study site in regression analyses. Among the 76 participants, mean age was 74.9 ± 6.6 years and 72% were female. Compared to those attending 0-9 OWG sessions, participants attending 16-20 sessions exhibited a 56.3-meter greater improvement in walking endurance (95% CI: 17.3, 95.4, p = 0.005); 0.15-meter/second greater improvement in comfortable walking speed (95% CI: 0.01, 0.29, p = 0.034); and 0.18-meter/second greater improvement in fast walking speed (95% CI: 0.03, 0.34, p = 0.020). Higher attendance was associated with greater odds of improvement in comfortable walking speed (OR = 7.1; 95% CI: 1.1, 57.8, p = 0.047) and fast walking speed (OR = 10.1, 95% CI: 1.8, 72.0, p = 0.014). No significant dose-response relationships for the remaining outcomes were observed. Higher attendance in a park-based, supervised, task-oriented and progressive OWG program is associated with greater improvement in walking endurance and walking speed among older adults with mobility limitations. Attendance likely impacted walking capacity and not balance, lower extremity strength, walking self-efficacy or emotional well-being due to task-specificity of training. This study highlights the importance of attendance when designing and implementing OWG programs to enhance walking endurance and speed among older adults.

Individuals aging with HIV may experience disability that is multidimensional and evolving over time. Our aims were to characterize the longitudinal trajectories of disability and to investigate how intrinsic and extrinsic contextual factors influence dimensions of disability over an eight-month period among adults aging with HIV. We analyzed longitudinal observational data from a community-based study in Toronto, Canada, where adults aging with HIV completed self-reported questionnaires over eight months (five time points). We measured disability using the Short-Form HIV Disability Questionnaire (SF-HDQ), which included six dimensions: physical, cognitive, mental-emotional health challenges, uncertainty, difficulties with day-to-day activities, and challenges to social inclusion. Higher SF-HDQ scores (range: 0-100) indicate greater severity of disability. We assessed intrinsic (age, gender, education, living status, number of comorbidities, mastery) and extrinsic (stigma, social support) contextual factors using baseline self-reported questionnaires. Latent class growth analysis was performed to identify distinct disability trajectories within each of the six dimensions. Multinomial logistic regression models were used to assess the influence of contextual factors on the disability trajectories. Of 108 participants, 89% identified as men with a mean age of 50.6 years (standard deviation ±10.9). We identified three disability trajectories: low, medium, and high disability severity in the physical, mental-emotional, and day-to-day activities dimensions. Four trajectories: low, medium-low, medium-high, and high disability severity were in the cognitive, uncertainty, and social inclusion dimensions. Factors such as higher self-mastery and social support were associated with lower disability trajectories, whereas greater number of comorbidities and stigma were associated with more severe disability trajectories over time. Disability experiences among adults aging with HIV included three or four distinct trajectories with considerable heterogeneity over time. Information on contextual factors may be helpful for informing interventions and supports that mitigate disability among adults aging with HIV.

Background Advances in treatment and care have extended the life expectancy of people living with HIV. Nevertheless, comorbidities are common and may result in health-related challenges, known as disability, in everyday life. Rehabilitation strategies such as physical activity may help to mitigate disability. Our aim was to characterize comorbidity profiles and examine their relationship with disability and physical activity among a cohort of older adults living with HIV in Canada. Methods We conducted a cross-sectional analysis of data collected from older adults living with HIV aged 65 years and older and enrolled in the Correlates of Healthy Aging in Geriatric HIV (CHANGE HIV) study. We examined the presence of 14 individual comorbidities and their combinations. Hierarchical linear regression was used to assess the associations between number of comorbidities, disability (Stanford Health Assessment Questionnaire Disability Index), and physical activity (Rapid Assessment of Physical Activity Aerobic Scale) while sequentially adjusting for intrinsic (personal attributes) and extrinsic (perceived HIV stigma and social support) contextual factors. Results Among the 516 participants (median age = 69 years, 25th − 75th percentiles: 67–73), most were identified as male (90%) and White (77%). Participants reported a median of two comorbidities (25th − 75th percentiles: 1–4) in addition to HIV. The most common comorbidities included dyslipidemia (51%), hypertension (45%), cancer (28%), diabetes (23%), and arthritis (21%). Various combinations of coexisting comorbidities were also observed. A greater number of comorbidities was associated with more severe disability scores ( ρ  = 0.25, p  < 0.001). However, higher levels of physical activity attenuated the impact of each additional comorbidity on disability scores, and this moderating effect remained robust after accounting for the influence of intrinsic and extrinsic contextual factors. Conclusions Comorbidities are prevalent among older adults living with HIV in Canada and are associated with disability. Physical activity attenuated the negative association between comorbidity and disability, highlighting that older adults living with HIV who are physically active may experience better functional outcomes. Routine screening and management of chronic conditions, coupled with tailored physical activity interventions, may have a role in addressing disability among older adults living with HIV. Trial registration Clinical trial not applicable.

IntroductionWhile group, task-oriented, community-based exercise programs (CBEPs) delivered in-person can increase exercise and social participation in people with mobility limitations, challenges with transportation, cost and human resources, threaten sustainability. A virtual delivery model may help overcome challenges with accessing and delivering in-person CBEPs. The study objective is to estimate the short-term effect of an 8-week, virtual, group, task-oriented CBEP called TIME™ (Together in Movement and Exercise) at Home compared with a waitlist control on improving everyday function in community-dwelling adults with mobility limitations.Methods and analysisA randomised controlled trial incorporating a type 1 effectiveness-implementation hybrid design is being conducted in four Canadian metropolitan centres. We aim to stratify 200 adults with self-reported mobility limitations by site, participation alone or with a partner, and functional mobility level, and randomise them using REDCap software to either TIME™ at Home or a waitlist control group. During TIME™ at Home classes (2 classes/week, 1.5 hours/class), two trained facilitators stream a 1-hour exercise video and facilitate social interaction prevideo and postvideo using Zoom. A registered healthcare professional at each site completes three e-visits to monitor and support implementation. Masked evaluators with physical therapy training evaluate participants and their caregivers at 0, 2 and 5 months using Zoom. The primary outcome is the change in everyday function from 0 to 2 months, measured using the physical scale of the Subjective Index of Physical and Social Outcome. The study is powered to detect an effect size of 0.4, given α=0.05, power=80% and a 15% attrition rate. Secondary outcomes are mobility, well-being, reliance on walking aids, caregiver assistance, caregiver mood, caregiver confidence in care-recipient balance and cost-effectiveness. A multimethod process evaluation is proposed to increase understanding of implementation fidelity, mechanisms of effect and contextual factors influencing the complex intervention. Qualitative data collection immediately postintervention involves interviewing approximately 16 participants and 4 caregivers from the experimental group, and 8 participants and 4 caregivers from the waitlist control group, and all healthcare professionals, and conducting focus groups with all facilitators to explore experiences during the intervention period. A directed content analysis will be undertaken to help explain the quantitative results.Ethics and disseminationTIME™ at Home has received ethics approval at all sites. Participants provide verbal informed consent. A data safety monitoring board is monitoring adverse events. We will disseminate findings through lay summaries, conference presentations, reports and journal articles.Trial registration numberNCT06245135.

Abstract Background and Objectives Falls, the leading cause of death and disability among older adults, occur in daily life when the demands of daily activities surpass the ability to maintain balance. An estimated 30% of older adults misestimate their physical function, placing them at greater risk of falling. This study examined how experiences of physical function are linked to awareness of fall risk in daily life. Research Design and Methods For 30 consecutive days following a fall-risk assessment, 41 older adults (observations = 1,135; 56% women; age: 65–91) self-assessed objective and subjective fall risk using a custom smartphone application. Alignment of objective and subjective fall risk was indexed as awareness of fall risk. Postural sway was measured by the application. Physical and mobility symptoms and fear of falling were reported daily. Results At baseline, 49% of participants misestimated their fall risk. Awareness of fall risk varied from day to day and fall risk was misestimated on 40% of days. Multilevel multinomial models showed individual differences in the level of daily symptoms to increase the tendency to misestimate fall risk. Daily symptoms and fear of falling increased awareness of high fall risk, but daily symptoms threatened awareness of low fall risk. Discussion and Implications Findings suggest that misestimation of fall risk is common in older adulthood and informed by appraisals of physical function. Fall prevention strategies could support older adults in understanding their everyday physical function and provide tools to adjust the demands of activities in daily life.

Abstract In the United States, the trends of disabilities among older adults have been largely stable over the past decade. However, the impact of disabilities on health and quality of life remains substantial and requires continued research. Along with a set of compensatory strategies, assistive technologies play a promising role in augmenting individuals' capacity and reducing environmental demands in daily activities. Using data from the five survey rounds of the National Health and Aging Trends Study (2015‒2019), we aimed to investigate the longitudinal associations between disabilities, assistive technologies, and subjective well-being among older adults. A multi-class hierarchical spectrum was constructed to capture the state of disability and assistive technology use. Overall, results showed that subjective well-being decreased progressively along the spectrum. Additionally, assistive technologies were found to differentiate the associations between disabilities and well-being outcomes. Discussions focused on the insights and implications for successful accommodation to disabilities in later life.

Abstract Relationship research has suggested that health among spouses is interdependent and should be considered jointly. Using data from the 2008/2010 and 2016/2018 waves of the Health and Retirement Study (3858 qualified couples; age=67.0±9.6), we investigated the joint influence of married partners' individual and shared cumulative biological risk on future health outcomes. Two risk indicators were constructed to indicate biological health in different domains. Individual grip strength, walk speed, lung function, and cystatin-C were biomarkers selected to construct frailty risk whereas blood pressure, pulse, waist circumference, C-reactive protein, glycohemoglobin, high-density lipoprotein cholesterol, and total cholesterol were biomarkers used to construct cardiometabolic risk. Shared risk was calculated as the number of risks the partners shared. We employed multilevel Poisson regression models to nest partners within couples and examine the effects of individual and shared cumulative risks on future functional limitations. Heckman correction was performed to correct potential selection bias. Our unadjusted models showed individual (frailty: b=0.22, p<.001; cardiometabolic: b=0.10, p<.001) and shared (frailty: b=0.17, p<.001; cardiometabolic: b=0.08, p<.01) risks are associated with greater future functional limitations. Further, shared cardiometabolic risk moderated the effect of individual risk (b=-0.01, p<.05). In the adjusted models, the direct associations between shared risks and future functional limitations were explained by indicators of partner selection and shared experiences. In the fully adjusted model, the cross-level interaction for frailty risk became statistically significant. The unique set of dynamics shown in our study offered new insights into understanding how couples influence one another in the context of multisystem biological health.

Abstract Falls are the leading preventable cause of death and disability in older adulthood. Subjective experiences of aging could facilitate fall prevention and adaptation to post-falls life. We use data from the 2008-2018 waves of the Health and Retirement Study to follow self-perceptions of aging (SPA), health-domain control (HDC), and physical activity (PA) in 12,000+ adults (Mage=69.09; 59% women; 83% white) to examine trajectories of subjective experiences and health behaviors preceding and following a fall. In total, 57% experienced falling. Both SPA and HDC were lower among fallers. Spline growth models showed that HDC, SPA, and PA significantly decreased over time. Additionally, the rate of decline in HDC and PA increased following the fall. After falling, the protective effect of HDC amplified, while positive SPA dampened change in PA. Our study illustrates the importance of subjective experiences of aging on adaptation and recovery in the context of falling.

As individuals with HIV live longer, many now face the health consequences of aging and multimorbidity, known as disability. Exercise can mitigate disability; however, engagement in exercise among adults living with HIV varies. Technology-based interventions, such as telerehabilitation, may help mitigate geographical, financial, and time barriers to community-based exercise (CBE). However, little is known about the experiences with technology uptake and usage among adults living with HIV. Understanding these experiences is essential to inform the design of inclusive, accessible, and sustainable online interventions. This study aimed to describe experiences with technology uptake and usage among adults aging with HIV participating in a 6-month online CBE intervention and explore how these experiences changed over time, from baseline to postintervention. We conducted a longitudinal qualitative descriptive study and secondary analysis using interview data from adults living with HIV who were engaged in a CBE intervention study in Toronto, Canada. Participants engaged in a 6-month online CBE intervention consisting of thrice-weekly exercise supervised biweekly through online personal coaching sessions, weekly group exercise classes, and monthly self-management education sessions (via Zoom). The technology used included Zoom software and a webcam, as well as the Sweat for Good YMCA app and the YMCA Virtuagym website; participants wore a wireless physical activity monitor (Fitbit Inspire 2) throughout. Participants completed interviews at baseline and postintervention. We conducted a group-based content analysis of interview transcripts, focusing on digital access, setup, usage, and perceptions of technology. Questionnaire data describing digital literacy and access to technology provided additional context to the interview data. Eleven participants completed at least one interview. We analyzed 19 interview transcripts from 11 participants (women: n=6, 55%; men: n=5, 45%; median age 52, IQR 45-60 y). Experiences with technology uptake and usage among adults aging with HIV were characterized by four components: (1) preparations for technology (technology setup), (2) interactions with technology (preferences for different types of technology, preferences for mode of delivery, and ease of usage), (3) facilitators and satisfaction with technology (facilitators to technology uptake and usage and satisfaction with technology), and (4) challenges and frustrations with technology (barriers to technology uptake and usage and frustrations with technology). Experiences with technology across participants were influenced by intrinsic contextual factors (prior exposure to technology) and extrinsic contextual factors (COVID-19 pandemic and technological and social support). Experiences with technology among adults aging with HIV engaging in an online CBE intervention varied from increasing ease of use to increasingly burdensome over time. Results highlight the need to incorporate personal preferences and ongoing technological support when implementing online CBE with adults aging with HIV.