Purpose: First, we aimed to gain insight in older adults’ opinions towards mHealth interventions, more specifically the MyHealthPlan application. Second, we examined whether person-level factors (age, gender, educational level, BMI, familiarity with smartphone) were linked to actually performing the exercises suggested through MyHealthPlan.

Methods: 40 older adults (+65 years) participated and were visited twice at home. During the first home visit, person-level factors were assessed with a questionnaire and the MyHealthPlan application was installed on the participant’s smartphone (or a smartphone provided by the researchers). Participants were instructed to use MyHealthPlan for seven consecutive days. The application provided maximum 6 notifications/day with suggestions for stretch and strengthening exercises. Participants could indicate in the application whether they performed or skipped the exercise, and were asked for some feedback if they skipped the exercise. Additionally, participants wore a Fitbit Charge 2 activity monitor during the measurement period, as notifications were triggered according to the number of steps they had already taken on a given day. After one week, participants were re-visited and a semi-structured interview was conducted to gain insight into their experiences with the application and the Fitbit. Qualitative data were analyzed using deductive thematic analysis (NVivo 12). For the second research question, logistic regression analyses will be conducted.

Results: In total, 52.5% of the participants were female, 70% completed a non-tertiary education, mean age was 72.6 years (SD 5.6) and mean BMI was 26.6 kg/m² (SD 3.7). Seventy percent of the participants did not own a smartphone. The main themes emerging from the interviews were 1) opinions about smartphone notifications, including a) timing; b) number; c) keeping the smartphone with you, 2) suggested exercises, 3) providing feedback, 4) experiences with Fitbit, 5) overall suggestions for improvement. The content of these themes will be discussed during the presentation. At the conference, also the results of the second research question will be presented, as data analyses are currently ongoing.

Conclusions: This study provides valuable information to optimize the development of mHealth interventions that are tailored to older adults’ specific needs, and align with their perceptions on the digital transformation in health promotion.

Purpose: Greater acculturation to the US is associated with cardiovascular disease (CVD) risk among Latinx populations; however, less is known regarding associations between acculturation and modifiable CVD risk factors, such as physical activity (PA) and sedentary behavior (SB) among older Latinx adults. This secondary analysis of the COMPASS (Computerized Physical Activity Support for Seniors) trial aimed to determine whether baseline acculturation levels were predictive of 12-month moderate-to-vigorous PA (MVPA) and SB.
Methods: Acculturation levels were estimated from the Short Acculturation Scale for Hispanics, a 12-item questionnaire with a total acculturation score and three subscales assessing language use, media preference, and ethnic/social relations. Responses were on a five-point Likert scale (1= “Only Spanish,” 5=“Only English,” 3=“Both equally.”) Higher scores indicated more acculturation. We examined linear relations using multivariate regression (adjusted for baseline values of MVPA and SB, intervention arm, years in the US, gender, and income) plus non-linear relations using regression analysis for median scores defining low (< median score) and high (≥ median score) acculturation groups. Total MVPA min/week was measured using the CHAMPS questionnaire, with total min/week of SB assessed using a validated 1-week recall survey.
Results: Irrespective of intervention arm, every one-unit increase in total acculturation score was associated with a 12-mo. 159.2 min/week SB increase (95% CI:19.8, 298.5; p=0.02); every one-unit increase in the media preference subscale was marginally associated with a 12-mo. 101.5 min/week SB increase (95% CI:-2.9, 206.1; p=0.05), and every one-unit increase in the language use subscale was associated with a 12-mo. 148.8 min/week SB increase (95% CI: 39.3, 258.3; p = 0.008). No significant linear associations were observed between the four acculturation scores and 12-mo. MVPA. However, non-linear models revealed that compared to those with low overall acculturation, high acculturation participants had a 12-mo. 155.7 (95% CI:4.3, 307.1; p=0.04) min/week increase with a similar trend observed between MVPA and the acculturation subscales.
Conclusions: In this Latinx clinical trial, irrespective of assignment to PA advice by computer or human, higher acculturation scores predicted both increased SB and MVPA, with a potential threshold-based impact of acculturation on MVPA. Findings underscore the complexity of these relations and deserve further evaluation.

Purpose: Many older Americans exhibit a lack of practices that prevent the decline of overall health and well-being. This is, in part, due to limitations in technological proficiency and access to education, resources, and services. A program was created to study the impact of virtual diabetes education and medically-tailored meals on health outcomes and expenditures of older Americans with type 2 diabetes.
Methods: Referrals were received from Maryland-based healthcare providers for 200 adults, age 60 and over, with type 2 diabetes. All qualifying participants received non-randomized access to resources through simplified means of technology. Each participant was given a tablet to access nutrition and diabetes education resources and to enable connectivity with Registered Dietitians for virtual sessions of Medical Nutrition Therapy, as well as a virtual Diabetes Self Management Program. Those who were at risk for food insecurity also received (1) medically-tailored, shelf stable meals that adhered to diabetes and Maryland Department of Aging specifications, and (2) referrals to the Area Agencies on Aging for eligibility assessments on additional services.
Qualitative and quantitative measures were used to evaluate the effectiveness of materials, medically-tailored meals, delivery mechanisms, and health outcomes. All individuals were evaluated for social isolation pre- and post- program. Additionally, participants were assessed for food security and other underlying diagnoses.
Results: The person-centered access to education and meals generated more self-care among participants who completed the intervention, which in turn decreased their hospital visits and expenses. Preliminary data revealed that total hospital visits were reduced by 26% and hospital-related charges were reduced by 75% three-months post-program, as compared to three-months pre-program.
Conclusions: Inadequate access to healthcare, nutrition, and additional services can negatively impact health outcomes and expenses. The provision of medically-tailored meals and diabetes education is critical to improving the health and wellbeing of older adults with type 2 diabetes. The preliminary findings from our program suggest that these services empower individuals to become more assured and self-reliant, equipping them with the power to care better for themselves and lessening the impact of health burdens.

Purpose: The Mediterranean and Dietary Approaches to Stop Hypertension (DASH) diets may be protective against cognitive decline, but evidence remains inconsistent. In this cohort study, we examined the association between Mediterranean or DASH diet adherence in midlife and dementia in later life, and the modifying effects of cardiorespiratory fitness.
Methods: Data are from 9,095 adults seeking preventive care at the Cooper Clinic (1987-1999) who completed a 3-day dietary record. Alzheimer’s disease and related disorders or senile dementia (i.e., all-cause dementia) was identified from Medicare administrative claims (1999-2019). Illness-death models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between Mediterranean or DASH diet adherence and all-cause dementia, adjusted for demographic and clinical factors. Effect modification by cardiorespiratory fitness was also examined.
Results: The mean age at dietary assessment was 50.6 years, and 1449 cases of all-cause dementia were identified over a mean follow-up of 9.2 years. Neither Mediterranean nor DASH diet adherence was associated with dementia risk models (HR, per SD of continuous score, Mediterranean model: 1.00, 95% CI: 0.94, 1.05; HR, per SD of continuous score, DASH model: 1.02, 95% CI: 0.96, 1.02). Participants with higher fitness had a decreased hazard of dementia in fully adjusted models (HR, per metabolic equivalent of task [MET] increase, Mediterranean model: 0.95, 95% CI: 0.92, 0.98; HR, per MET increase, DASH model: 0.96, 95% CI: 0.92, 0.97), though fitness did not modify the association between diet and dementia.
Conclusions: Whereas adherence to a Mediterranean or DASH diet was not associated with all-cause dementia, fitness was a significant predictor. Fitness should be targeted by encouraging health promoting physical activity in multimodal interventions for dementia prevention.