Atami O. Sagna’s research while affiliated with University of Texas at Austin and other places

Introduction: Poor self-management of heart failure (HF) has contributed to poor health outcomes with an annual loss of $32 billion. Our innovative sensor controlled digital game (SCDG) integrates data from weight scale and physical activity sensors to trigger rewards, progress, changes in avatar’s health status and feedback based on HF individuals’ real-time behaviors (Fig1). Hypothesis: Weight monitoring and physical activity by participants receiving both the SCDG app and sensors will be higher than participants receiving only the sensors (CG). Methods: English-speaking HF adults aged >55 years, own a smartphone, and walk unassisted were recruited from cardiac settings in Texas. Both SCDG and CG participants were given ‘Withings’ activity tracker and smart weight scale sensors to track behaviors for 12 weeks. Physical activity goal was tailored to the participant’s ability. Results: In early results over six weeks on 12 participants (58% women, white, and 65+ years age), the mean days with weight monitoring in the SCDG group was 34 and 27 in the CG. Daily average steps were 2195 (53% of goal) in SCDG group and 3187 in CG (75% of goal). 100% of participants found the SCDG easy and enjoyable to play. Study adaptations in response to the COVID19 crisis will allow us to present results on 30 participants at conference time. Conclusion: SCDG had trends of higher weight monitoring but lower physical activity among older adults with HF. Participants in the study continue to engage in weight-monitoring and physical activity even during the COVID19 crisis. This presents opportunities to tailor digital health interventions to remotely motivate self-management behaviors.

Background Poor self-management of heart failure (HF) has contributed to poor health outcomes. Sensor-controlled digital games (SCDGs) integrates data from behavior-tracking sensors to trigger progress, rewards, content, and positive feedback in a digital game to motivate real-time behaviors. Objectives To assess the usability of an SCDG prototype over a week of game-playing among 10 older adults with HF in their homes. Methods During initial play, participants' SCDG experiences were observed in their homes using a checklist based on the seven-item Serious Game User Evaluator (SeGUE) instrument. After a week of game-playing, participants completed a survey guided by the Intrinsic Motivation Inventory, to provide their perceptions of the SCDG's usability. Qualitative analysis via semistructured interview-derived themes on experiences playing the SCDG, perceptions regarding engaging with the SCDG, and any usability issues encountered. Results Ten HF participants (50% women and 50% White) played the SCDG for an average of 6 out of 7 days. Nine found the SCDG to be interesting, satisfying, and easy to play. The average step count over a week was 4,117 steps (range: 967–9,892). Average adherence with weight monitoring was 5.9 days in a week. Qualitative analysis yielded outcomes regarding attitudes toward SCDG, and barriers and facilitators that influenced participants' engagement with the SCDG. Conclusion To the best of the authors' knowledge, this usability and feasibility study is the first to report an SCDG designed to improve HF self-management behaviors of older adults in their homes. Future research should consider several issues, such as user profiles, prior game-playing experiences, and network conditions most suitable for connected health interventions for older adults living in the community.

Late-life suicide is a public health issue in the United States, and recent CDC data show that the number of deaths related to suicide in older adults continue to increase. Still, few researchers focus on a theoretical framework for the clinical assessment and care of older adults at risk for suicide. We performed a review and critical analysis of the Tidal Model, using Fawcett and DeSanto-Madeya’s framework, to increase our understanding of the clinical presentation of older adults with suicidal ideation and present strategies for caring for this population. The Tidal Model is a well-structured theory with relevant concepts and propositions founded on a highly patient-centered and pragmatic approach that facilitates its application in late-life suicidality. The model provides a framework for nursing and healthcare practice in psychiatry and mental health with goals and boundaries that help promote a better assessment of the clinical picture of older adults with suicidal ideation.

Objectives: This study examined (1) potential differences in life expectancy when suicide as a cause of death was discounted and (2) suicide's contributions to changes in life expectancy by age group and sex. Methods: Data were from the 2011 and 2015 National Violent Death Reporting System on all suicide decedents aged 10 years or older in 17 US states. Life tables were constructed based on the total population and all-cause mortality data from the Centers for Disease Control and Prevention. Differences in life expectancy were calculated using Arriaga's decomposition method. Results: The numbers of suicide deaths in both 2011 and 2015 were 3-4 times higher among males than females in all age groups. The highest impact for both males and females was in the 55-64 age group, with changes in life expectancy of 1.64 years in 2011 and 1.60 years in 2015 for men, and 1.30 years in 2011 and 1.27 years in 2015 for women. Between 2011 and 2015, the percent change in suicide mortality rates for all age groups was 7.44% in males and 15.72% in females. However, the groups that negatively impacted changes in life expectancy due to significant increases in suicide mortality were males aged 25-34 (22.80%) and 55-64 (15.45%) and females aged 15-19 (34.74%) and 55-64 (23.15%). Eliminating suicide as a cause of death would have increased life expectancy at birth by 1.92 years for males and 1.36 years for females from 2011 to 2015. Conclusions: This study updates information on suicide and adds to calls for more effective suicide prevention efforts, especially for older adolescent girls, young men, and middle-aged men and women.

Suicide has ranked as the 10th leading cause of death for all ages in the United States. Although Healthy People 2020’s target is to reduce suicide rates by 10.2 per 100,000 by 2020, it remains that suicide rates continue to increase, with suicide in older adults contributing substantially to this rise. Older adults have a higher risk for suicide, yet research in the area on positive psychological factors such as meaning in life and reasons for living is lacking. The purpose of this review is to investigate the associations among meaning in life, reasons for living and suicidal ideation in older adults (55+ years). Based on PRISMA guidelines, the PubMed, PsycINFO, PsycARTICLES, and CINAHL databases were systematically searched for relevant publications without date restrictions. Nine studies, qualitative and quantitative, are included in the review, showing a relationship among meaning in life, reasons for living and suicidal ideation in older adults. All the studies found that meaning in life and reasons for living were negatively associated with suicidal ideation in older adults. The findings of this review highlight the importance of including positive psychological factors in assessing suicide risk in older adults and in planning preventative measures and services for this high-risk group.

Polycystic ovary syndrome (PCOS) is highly prevalent and increasingly diagnosed during adolescence. This study explored the context and processes of self-management among adolescents, and parents of adolescents, who have PCOS. Adolescents with PCOS (n = 7) and their parents (n = 8) participated in a series of focus groups. Deductive thematic analysis was guided by the Individual and Family Self-Management Theory (IFSMT), and the patterns that were identified aligned with the contexts and processes described therein. A secondary inductive approach was employed as a novel contextual pattern emerged: psychological health and well-being. Study findings suggest that adolescents and their families have a desire to engage in optimal self-management, and particularly effective strategies may consider a holistic, family intervention approach that addresses psychological health and well-being in addition to behavior change. Study findings are the first to reflect the unique needs of adolescents with PCOS and their families.

As the fastest growing segment of the US population, older adults are at higher risk for suicide than any other age groups. More than 6,546 older adults in the 65–84 age group died by suicide in the US in 2016. The purpose of this study was to analyze the impact of late life suicide mortality in life expectancy in the 65+ age group. Data on suicide death counts for 17 US states came from the 2011 and 2015 National Violent Death Reporting System. Life tables were constructed based on the total population and all-cause mortality data from the National Center for Health Statistics (CDC-NCHS). Differences in life expectancies by gender and age group were calculated using Arriaga’s decomposition method. The findings show that the number of suicide deaths was 5 to 6 times higher among male older adults than females in both years. When suicide as a cause of death was discounted, the life expectancy for the 65+ age group would increase by 1.75 years (2011) and 1.70 years (2015) for males, and 1.36 (2011) and 1.37 (2015) for females. The highest impact was found in the 75+ age group for both genders, with potential years of life expectancy lost due to suicide being 2.16 years (2011) and 2.07 years (2015) for males and 1.58 years (2011) and 1.53 years (2015) for females. These findings highlight the effects of late life suicide mortality in life expectancy and add to the knowledge base regarding suicide prevention strategies at the population level.

Background: This study examined blood alcohol content (BAC) among suicide decedents aged 50+ and its associations with suicide precipitating/risk factors, means, and other drug toxicology. Methods: The National Violent Death Reporting System, 2005-2015, provided data (N = 56,118 for all suicide decedents and N = 29,115 with alcohol test results). We used logistic regression models, with BAC > 0.0 (BAC positive) and BAC > = 0.08 (intoxication) as the dependent variables. Results: Almost a third of decedents who were tested for alcohol were BAC positive, and almost two-thirds of those who were positive had a BAC > = 0.08. Alcohol problems prior to suicide (AOR = 6.71, 95% CI = 6.24-7.21), relationship problems (AOR = 1.53, 95% CI = 1.44-1.63), and death/suicide of family/friends (AOR = 1.22, 95% CI = 1.11-1.35) were associated with greater odds of a positive BAC, but suicide means were not significantly associated with a positive BAC. Alcohol problems (AOR = 2.98, 95% CI = 2.68-3.31), relationship problems (AOR = 1.18, 95% CI = 1.06-1.30), firearm use (AOR = 1.85, 95% CI = 1.59-2.16), and hanging/suffocation (AOR = 1.38, 95% CI = 1.16-1.64) were associated with greater odds of a BAC > = 0.08. A toxicology positive for antidepressants, marijuana, cocaine, or amphetamines was associated with greater odds of a positive BAC; however, a toxicology positive for antidepressants, opiates, or amphetamines was associated with lower odds of a BAC > = 0.08. BAC > = 0.08 rates increased over the study period. Conclusions: Alcohol intoxication may have contributed to using more violent suicide means. The significant association between relationship problems and intoxication before suicide calls for restricting access to alcohol and suicide means for individuals with these problems. Suicide prevention may require crisis counseling/support for acute life stressors and ongoing emotional support.

Background US suicide rates among older women have substantially increased over the past decade. We examined potential differences in sociodemographic and risk/precipitating factors among older female suicide decedents who died by drug overdose versus firearms, hanging/suffocation, and other means, and postmortem toxicology results by suicide means. Methods Data are from the 2005 to 2015 US National Violent Death Reporting System ( N = 12,401 female decedents aged 50 years and over). We used three logistic regression models, with overdose versus firearms, overdose versus hanging/suffocation, and overdose versus “other” means as the dependent variables, to examine associations between suicide means and sociodemographic and risk/precipitating factors. χ² tests were used to examine positive toxicology of prescription and illicit drugs by suicide means. Results Compared to firearm users, overdose users were younger and had higher odds of having had previous suicide attempts/intent disclosures, mental disorders (e.g. depression/dysthymia: AOR = 1.18, 95% CI = 1.05–1.34), and substance abuse other than alcohol, but lower odds of having had relationship problems and any crisis. Compared to hanging/suffocation, overdose declined (AOR = 0.95, 95% CI = 0.93–0.97) during the study period and was less prevalent among Hispanic and Asian women and those with job/finance/housing problems. Toxicology reports showed that 47%, 43%, and 45% of overdose users were antidepressant, opiate, and benzodiazepine positive, respectively. Firearm users had the lowest rates of positive toxicology results for these drugs. Conclusions Suicide prevention should include limiting access to large quantities of prescription medications and firearms for those at risk of suicide. More effective mental health/substance abuse treatment and chronic illness management support are also needed.