Older Hispanics routinely exhibit unhealthy beliefs about “normal” aging trajectories, particularly related to exercise and physical function. We evaluated the prospective effects of age reattribution on physical function in older Hispanics. Participants ( n = 565, ≥60 years) were randomly assigned into (a) treatment group—attribution-retraining, or (b) control group—health education. Each group separately engaged in four weekly 1-hr group discussions and 1-hr exercise classes, followed by monthly maintenance sessions. The Short Physical Performance Battery (SPPB) measured physical function throughout the 24-month intervention. No significant difference in physical function between intervention arms was evident over time. However, both groups experienced significant improvements in physical function at 24 months (β = 0.43, 95% confidence interval [CI] = [0.16, 0.70]). Participating in the exercise intervention was associated with improvements in physical function, although no additional gains were apparent for age attribution-retraining. Future research should consider strengthening or modifying intervention content for age reattribution or dosage received.

Objectives We examined associations between three geographic areas (urban, suburban, rural) and cognition (memory, reasoning, processing speed) over a 10-year period. Methods: Data were obtained from 2539 participants in the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) trial. Multilevel, mixed-effects linear regression was used to estimate cognitive trajectories by geographical areas over 10 years, after adjusting for social determinants of health. Results: Compared to urban and suburban participants, rural participants fared worse on all cognitive measures—memory ( B = −1.17 (0.17)), reasoning ( B = −1.55 (0.19)), and processing speed ( B = 0.76 (0.19)) across the 10-year trajectory. Across geographic areas, greater economic stability, health care access and quality, and neighborhood resources were associated with better cognition over time. Discussion: Findings highlight the importance of geographical location when examining cognition later in life. More research examining place-based life experiences is needed to make the greatest impact on geographically diverse communities.

Background Treatment effect is typically summarized in terms of relative risk reduction or number needed to treat (“conventional effect summary”). Restricted mean survival time (RMST) summarizes treatment effect in terms of a gain or loss in event‐free days. Older adults' preference between the two effect summary measures has not been studied. Methods We conducted a mixed methods study using a quantitative survey and qualitative semi‐structured interviews. For the survey, we enrolled 102 residents with hypertension at five senior housing facilities (mean age 81.3 years, 82 female, 95 white race). We randomly assigned respondents to either RMST‐based (n = 49) or conventional decision aid (n = 53) about the benefits and harms of intensive versus standard blood pressure‐lowering strategies and compared decision conflict scale (DCS) responses (range: 0 [no conflict] to 100 [maximum conflict]; <25 is associated with implementing decisions). We used a purposive sample of 23 survey respondents stratified by both their random assignment and DCS from the survey. Inductive qualitative thematic analysis explored complementary perspectives on preferred ways of summarizing treatment effects. Results The mean (standard deviation) total DCS was 22.0 (14.3) for the conventional decision aid group and 16.7 (14.1) for the RMST‐based decision aid group (p = 0.06), but the proportion of participants with a DCS <25 was higher in the RMST‐based group (26 [49.1%] vs 34 [69.4%]; p = 0.04). Qualitative interviews suggested that, regardless of effect summary measure, older individuals' preference depended on their ability to clearly comprehend quantitative information, clarity of presentation in the visual aid, and inclusion of desired information. Conclusions When choosing a blood pressure‐lowering strategy, older adults' perceived uncertainty may be reduced with a time‐based effect summary, although our study was underpowered to detect a statistically significant difference. Given highly variable individual preferences, it may be useful to present both conventional and RMST‐based information in decision aids.

Background A claims-based frailty index (CFI) allows measurement of frailty on a population scale. Our objective was to examine the association of changes in CFI over 12 months with mortality and Medicare costs Methods We used a 5% sample of fee-for-service Medicare beneficiaries. We estimated CFI (range: 0 to 1; non-frail (&lt;0.20), mildly frail (0.20-0.29), moderately-to-severely frail (≥0.35)) on 1/1/2015 and 1/1/2016. Beneficiaries were categorized as having a large decrease (-&lt;0.045), small decrease (-≤0.045-0.015), stable (±0.015), small increase (&gt;0.015-0.045), or large increase (&gt;0.045). We used Cox proportional hazards model to estimate hazard ratio (HR) for mortality adjusting for age, sex, and 2015 CFI value and compared total Medicare costs from January 1, 2016 and December 31, 2016. Results The study population included 995,664 beneficiaries (mean age 77 years, 56.8% female). In non-frail (n=906,046), HR (95% confidence interval [CI]) ranged from 0.71 (0.67-0.75) for a large decrease to 2.75 (2.68-2.33) for a large increase. In moderate-to-severely frail beneficiaries (n=16,527), the corresponding HR (95% CI) ranged from 0.63 (0.57-0.70) to 1.21 (1.06-1.38). The mean total Medicare cost per member per year (standard deviation) was from $12,149 ($83,508) in non-frail beneficiaries to $61,155 ($345,904) in moderate-to-severely frail beneficiaries. Conclusion One-year changes in CFI are associated with elevated mortality risk and healthcare costs across all levels of frailty.