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Pristavec T, Luth EA. Informal Caregiver Burden, Benefits, and Older Adult Mortality: A Survival Analysis. J Gerontol B Psychol Sci Soc Sci 2020; 75:2193-2206. [PMID: 31903481 PMCID: PMC7664316 DOI: 10.1093/geronb/gbaa001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Informal caregivers are crucial to maintaining older adults' health, but few studies examine how caregiving receipt is associated with older person longevity. In a nationally representative sample, we prospectively explore whether and how having an informal caregiver is associated with older adult overall mortality, and how caregivers' burden and benefits perceptions relate to care recipient mortality. METHODS We match six National Health and Aging Trends Study waves (2011-2016) with 2011 National Study of Caregiving data, conducting survival analysis on 7,369 older adults and 1,327 older adult-informal caregiver dyads. RESULTS Having an informal caregiver is associated with 36% (p < .001) higher mortality risk over 6-year follow-up, adjusting for demographic, economic, and health factors. Older adults whose caregivers perceive only burden have 38% higher (p < .05) mortality risk than those with caregivers reporting neither burden nor benefits. This risk is reduced from 38% higher to 5% higher (p < .001) for older adults with caregivers reporting benefits alongside burden, compared to those with caregivers reporting neither perception. DISCUSSION Having a caregiver may signal impending decline beyond known mortality factors. However, interventions to increase caregivers' benefit perceptions and reduce their burden may decrease mortality risk for older adults with declining health and functional ability.
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Affiliation(s)
- Teja Pristavec
- Social and Decision Analytics Division, Biocomplexity Institute and Initiative, University of Virginia, Arlington
| | - Elizabeth A Luth
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, New York
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Abstract
Family members are the primary source of support for older adults with chronic illness and disability. Thousands of published empirical studies and dozens of reviews have documented the psychological and physical health effects of caregiving, identified caregivers at risk for adverse outcomes, and evaluated a wide range of intervention strategies to support caregivers. Caregiving as chronic stress exposure is the conceptual driver for much of this research. We review and synthesize the literature on the impact of caregiving and intervention strategies for supporting caregivers. The impact of caregiving is highly variable, driven largely by the intensity of care provided and the suffering of the care recipient. The intervention literature is littered with many failures and some successes. Successful interventions address both the pragmatics of care and the emotional toll of caregiving. We conclude with both research and policy recommendations that address a national agenda for caregiving.
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Affiliation(s)
- Richard Schulz
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA; .,University Center for Social and Urban Research, University of Pittsburgh, Pittsburgh, Pennsylvania 15260, USA
| | - Scott R Beach
- University Center for Social and Urban Research, University of Pittsburgh, Pittsburgh, Pennsylvania 15260, USA
| | - Sara J Czaja
- Center on Aging and Behavioral Research, Weill Cornell Medicine, Cornell University, New York, NY 10065, USA
| | - Lynn M Martire
- College of Health and Human Development, Pennsylvania State University, University Park, Pennsylvania 16802, USA
| | - Joan K Monin
- School of Public Health, Yale University, New Haven, Connecticut 06520, USA
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Jenkins Morales M, Robert SA. Black-White Disparities in Moves to Assisted Living and Nursing Homes Among Older Medicare Beneficiaries. J Gerontol B Psychol Sci Soc Sci 2020; 75:1972-1982. [PMID: 31665513 PMCID: PMC7566960 DOI: 10.1093/geronb/gbz141] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Investigate black-white disparities in older adults' moves to assisted living and nursing homes and draw from the Andersen Healthcare Utilization Model to test explanations for any disparities. METHODS Data are from a nationally representative sample of older community-dwelling Medicare beneficiaries from the 2015 (N = 5,212) National Health and Aging Trends Study (NHATS). We use stepwise multinomial logistic regression to examine black-white disparities in moves out of community housing to assisted living or a nursing home over 2 years, before and after adjusting for predisposing (age, gender), enabling (income, housing tenure, Medicaid, living arrangement) and need (activities of daily living [ADL] limitation, physical capacity, self-rated health, and dementia) factors. RESULTS Black older adults are less likely to move to assisted living and are more likely to move to a nursing home compared to white older adults. Black-white disparities in moves to nursing homes are explained by black-white differences in enabling and need factors, whereas black-white disparities in moves to assisted living remain even after adjusting for enabling and need factors. DISCUSSION Unmeasured factors related to systemic racism (e.g., residential racial segregation, racial discrimination) and/or black-white differences in care preferences might further explain black-white disparities in moves to assisted living and warrant further investigation.
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Marfeo EE, Ni P, Keeney T, Jette A. Measuring Activity Limitations Within the National Health and Aging Trends Study (NHATS). THE GERONTOLOGIST 2020; 60:e11-e19. [PMID: 30889237 DOI: 10.1093/geront/gnz010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND AND OBJECTIVES To better understand the disablement process among older adults, improved measures of activity limitations are needed. Traditional population-level measures lack the ability to distinguish precise gradations of activity limitation and are unable to detect degrees of differences over a wide range of ability levels. Therefore, we used contemporary measurement methods to improve upon current methodologies for characterizing activity limitations within the National Health and Aging Trends Study (NHATS) . RESEARCH DESIGN AND METHODS We used the NHATS Round 1 cohort to assess the feasibility of constructing an Activity Limitations scale using Rasch item response theory methods. Factor analysis was used to develop the scale from a set of existing items in the NHATS Mobility, Self-Care, and Household Activity domains. Psychometric properties of the scale were evaluated and the scale was used to examine change in activity limitations among the sample from 2011 to 2015. RESULTS Results supported an 18-item scale (N = 7,609). Rasch infit and outfit statistics were within acceptable range for all items (Cronbach's alpha = 0.95; sample score reliability = 0.83). From 2011 to 2015, 5.88% older adults demonstrated increase in function, 15% showed decrease in function, and 78% of the sample showed no change (did not exceed ± MDC90). DISCUSSION AND IMPLICATIONS Findings demonstrate that a unidimensional, interval scale of activity limitations can be constructed using traditional survey measures nested within the NHATS. Results revealed concerns regarding ceiling effects within the current self-report items of activity limitations suggesting future work is needed to expand the range of ability currently represented in the NHATS Activity Limitation items.
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Affiliation(s)
- Elizabeth E Marfeo
- Department of Occupational Therapy, Tufts University Graduate School of Arts and Sciences, Medford, Massachusetts
| | - Pengsheng Ni
- Department of Health Law, Policy & Management, Boston University School of Public Health, Massachusetts
| | - Tamra Keeney
- Center for Gerontology and Health Care Research, Brown University School of Public Health, Providence, Rhode Island
| | - Alan Jette
- Department of Rehabilitation Sciences and Physical Therapy, MGH Institute of Health Professions, Boston, Massachusetts
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Brenner AB, Skolarus LE, Perumalswami CR, Burke JF. Understanding End-of-Life Preferences: Predicting Life-Prolonging Treatment Preferences Among Community-Dwelling Older Americans. J Pain Symptom Manage 2020; 60:595-601.e3. [PMID: 32376264 PMCID: PMC7483277 DOI: 10.1016/j.jpainsymman.2020.04.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 04/03/2020] [Accepted: 04/05/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To determine how demographic, socioeconomic, health, and psychosocial factors predict preferences to accept life-prolonging treatments (LPTs) at the end of life (EOL). METHODS This is a retrospective cohort study of a nationally representative sample of community-dwelling older Americans (N = 1648). Acceptance of LPT was defined as wanting to receive all LPTs in the hypothetical event of severe disability or severe chronic pain at the EOL. Participants with a durable power of attorney, living will, or who discussed EOL with family were determined to have expressed their EOL preferences. The primary analysis used survey-weighted logistic regression to measure the association between older adult characteristics and acceptance of LPT. Secondarily, the associations between LPT preferences and health outcomes were measured using regression models. RESULTS Approximately 31% of older adults would accept LPT. Nonwhite race/ethnicity (odds ratio [OR] 0.54; 95% CI 0.41, 0.70; white vs. nonwhite), self-realization (OR 1.34; 95% CI 1.01, 1.79), attendance of religious services (OR 1.44; 95% CI 1.07, 1.94), and expression of preferences (OR 0.54; 95% CI 0.40, 0.72) were associated with acceptance of LPT. LPT preferences were not independently associated with mortality or disability. CONCLUSIONS Approximately one-third of older Americans would accept LPT in the setting of severe disability or severe chronic pain at the EOL. Adults who discussed their EOL preferences were more likely to reject LPT. Conversely, minorities were more likely to accept LPT. Sociodemographics, physical capacity, and health status were poor predictors of acceptance of LPT. A better understanding of the complexities of LPT preferences is important to ensuring patient-centered care.
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Affiliation(s)
- Allison B Brenner
- Survey Research Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Lesli E Skolarus
- Population Health Research Director, Cascadia Behavioral Healthcare, Portland, Oregon, USA; Department of Neurology, Stroke Program, Institute for Healthcare Policy and Innovation, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Chithra R Perumalswami
- Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - James F Burke
- Department of Neurology, Stroke Program, Institute for Healthcare Policy and Innovation, University of Michigan Medical School, Ann Arbor, Michigan, USA.
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Ge ML, Carlson MC, Bandeen-Roche K, Chu NM, Tian J, Kasper JD, Xue QL. U.S. National Profile of Older Adults with Cognitive Impairment Alone, Physical Frailty Alone, and Both. J Am Geriatr Soc 2020; 68:2822-2830. [PMID: 32860219 DOI: 10.1111/jgs.16769] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 07/13/2020] [Accepted: 07/17/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND/OBJECTIVES To obtain national and regional estimates of prevalence of frailty with or without cognitive impairment, and cognitive impairment with or without frailty among older adults in the United States, and to identify profiles of characteristics that distinguish their joint versus separate occurrence. DESIGN Cross-sectional. SETTING Community or non-nursing home residential care settings. PARTICIPANTS A U.S. nationally representative sample of 7,497 older adults aged 65 and older from the National Health and Aging Trends Study. MEASUREMENTS Frailty was measured by the physical frailty phenotype. Cognitive impairment was assessed by cognitive performance testing of executive function and memory or by proxy reports. Multinomial logistic regression was used to identify profiles of demographic, socioeconomic, health, behavioral, and psychosocial characteristics that distinguish four subgroups: not-frail and cognitively intact ("neither"), not-frail and cognitively impaired ("Cog. only"), frail and cognitively intact ("frailty only"), and frail and cognitively impaired ("both"). RESULTS The prevalence of "Cog. only," "frailty only," and "both" was 25.5%, 5.6%, and 8.7%, respectively. Individuals with"frailty only" had the highest prevalence of obesity, current smoking, comorbidity, lung disease, and history of surgery. The "both" group had the highest prevalence of dementia, depression, cardiovascular diseases, and disability. No significant differences were found between the "Cog. only" group and the "neither" group with respect to history of surgery and comorbidity burden. The prevalence of dementia in the "Cog. only" was less than half of that in the "both" group. CONCLUSION The finding of sizable subgroups having physical frailty but not cognitive impairment, and vice versa, suggests that the two cannot be considered necessarily as antecedent or sequela of one another. The study provided empirical data supporting the prioritization of comorbidity, obesity, surgery history, and smoking status in clinical screening of frailty and cognitive impairment before formal diagnostic assessments.
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Affiliation(s)
- Mei-Ling Ge
- The Center of Gerontology and Geriatrics (National Clinical Research Center for Geriatrics), West China Hospital, Sichuan University, Chengdu, China
| | - Michelle C Carlson
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Center on Aging and Health, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Karen Bandeen-Roche
- Center on Aging and Health, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.,Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Nadia M Chu
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jing Tian
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Judith D Kasper
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Qian-Li Xue
- Center on Aging and Health, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.,Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Department of Medicine, Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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57
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Xu F, Earp JE, Greene GW, Cohen SA, Lofgren IE, Delmonico MJ, Greaney ML. Temporal Association between Abdominal Weight Status and Healthy Aging: Findings from the 2011-2018 National Health and Aging Trends Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17165656. [PMID: 32764442 PMCID: PMC7459859 DOI: 10.3390/ijerph17165656] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 07/27/2020] [Accepted: 08/01/2020] [Indexed: 11/21/2022]
Abstract
Background/objectives: The longitudinal effect of abdominal weight status (AWS) defined by waist circumference (WC) on healthy aging has not yet been comprehensively examined. Therefore, the purpose of the present study was to examine the temporal association between WC-defined AWS and a comprehensive assessment for healthy aging. Subjects/methods: This study utilized data from 5211 respondents aged 65+ who participated in the National Health and Aging Trends Study from 2011 to 2018. Mixed effects regression models were used to examine the association between baseline AWS and the annual change rate in healthy aging score (HAS) via interaction terms (AWS*round) adjusting for confounding effects. Further multiple mixed models examined the relationship of AWS and HAS over an 8-year period. Results: There were no annual change rate differences in HAS by baseline AWS, regardless of sex. However, males with abdominal obesity were more likely to have a lower HAS than males with normal AWS (β = −0.20, 95% CI: −0.30, −0.10, p < 0.001) but no difference in HAS was observed between males with overweight and normal AWS. A similar pattern was observed among females. Conclusions: Study results indicate that AWS was associated with HAS but it did not modify annual HAS change rate over time.
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Affiliation(s)
- Furong Xu
- Department of Kinesiology, University of Rhode Island, Independence Square II, Kingston, RI 02881, USA; (J.E.E.); (M.J.D.)
- Correspondence: ; Tel.: +1-401-874-2412
| | - Jacob E. Earp
- Department of Kinesiology, University of Rhode Island, Independence Square II, Kingston, RI 02881, USA; (J.E.E.); (M.J.D.)
| | - Geoffrey W. Greene
- Department of Nutrition and Food Sciences, University of Rhode Island, Fogarty Hall, Kingston, RI 02881, USA; (G.W.G.); (I.E.L.)
| | - Steven A. Cohen
- Department of Health Studies, University of Rhode Island, Independence Square II, Kingston, RI 02881, USA; (S.A.C.); (M.L.G.)
| | - Ingrid E. Lofgren
- Department of Nutrition and Food Sciences, University of Rhode Island, Fogarty Hall, Kingston, RI 02881, USA; (G.W.G.); (I.E.L.)
| | - Matthew J. Delmonico
- Department of Kinesiology, University of Rhode Island, Independence Square II, Kingston, RI 02881, USA; (J.E.E.); (M.J.D.)
| | - Mary L. Greaney
- Department of Health Studies, University of Rhode Island, Independence Square II, Kingston, RI 02881, USA; (S.A.C.); (M.L.G.)
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Singh T, Bélanger E, Thomas K. Is Fear of Falling the Missing Link to Explain Racial Disparities in Fall Risk? Data from the National Health and Aging Trends Study. Clin Gerontol 2020; 43:465-470. [PMID: 29764333 PMCID: PMC6202265 DOI: 10.1080/07317115.2018.1468377] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVES Emerging research suggests Black older adults experience a 30% decreased risk for falls compared with their White U.S. counterparts, and this is mediated neither by physical performance nor activity. Fear of falling (FOF) is a significant risk factor for falls, yet we know little about how FOF varies by race/ethnicity. The purpose of this original research brief was to investigate the relationship between race/ethnicity and FOF among older adults. METHODS 4,981 community-dwelling Medicare beneficiaries from the National Health and Aging Trends Study (NHATS) who had not self-reported a fall in the past 12 months were analyzed. Logistic regression analyses were conducted to examine the association between race/ethnicity and fear of falling, controlling for sex, age, total annual income, and mobility assistance. RESULTS FOF differed significantly across racial groups. Black, non-Hispanic older adults were less likely to have FOF (OR = .87, 95% CI = .71,1.07) compared with their White, non-Hispanic counterparts. In the fully adjusted model, this difference persisted and became stronger (adjusted OR = .75, 95%CI = .61, .93). CONCLUSION The decreased risk for falls in Black older adults could be explained by lower FOF in this group. CLINICAL IMPLICATIONS These findings should inform public health fall prevention initiatives among community-dwelling older adults.
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Affiliation(s)
- Tanvee Singh
- Center for Gerontology & Healthcare Research, Department of Health Services, Policy, and Practice, School of Public Health, Brown University , Providence, Rhode Island, USA
| | - Emmanuelle Bélanger
- Center for Gerontology & Healthcare Research, Department of Health Services, Policy, and Practice, School of Public Health, Brown University , Providence, Rhode Island, USA
| | - Kali Thomas
- Center for Gerontology & Healthcare Research, Department of Health Services, Policy, and Practice, School of Public Health, Brown University , Providence, Rhode Island, USA.,Center of Innovation for Long-term Services and Supports at the Providence VA Medical Center, Brown University , Providence, Rhode Island, USA
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Stamm BJ, Burke JF, Lin CC, Price RJ, Skolarus LE. Disability in Community-Dwelling Older Adults: Exploring the Role of Stroke and Dementia. J Prim Care Community Health 2020; 10:2150132719852507. [PMID: 31185786 PMCID: PMC6563403 DOI: 10.1177/2150132719852507] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Objectives: We sought to determine the relative contributions of stroke, dementia, and their combination to disability and racial differences in disability among community-dwelling older adults. Methods: We performed a cross-sectional study of 6848 community-dwelling older adults. We evaluated the associations of stroke, dementia, and their combination with activities of daily living (ADL) limitations (range 0-7). We then explored the impact of stroke and dementia on race differences in ADL limitations using Poisson regression after accounting for sociodemographics and comorbidities. Results: After full adjustment, ADL limitations differed among older adults with stroke and dementia. Older adults without stroke or dementia had 0.32 (95% CI 0.29-0.35) ADL limitations compared to 0.64 (95% CI 0.54-0.73) with stroke, 1.36 (95% CI 1.20-1.53) with dementia and 1.84 (95% CI 1.54-2.15) with stroke and dementia. Overall, blacks had 0.27 (95%CI 0.19-0.36) more ADL limitations than whites. Models accounting for stroke led to a 3.7% (95%CI 2.98%-4.43%) reduction in race differences, while those for dementia led to a 29.26% (95%CI 28.53%-29.99%) reduction and the stroke-dementia combination -1.48% (95%CI -2.21% to -0.76) had little impact. Discussion: Older adults with stroke and dementia have greater disability than older adults with either of these conditions alone. However, the amount of disability experienced by older adults with stroke and dementia is less than the sum of the contributions from stroke and dementia. Dementia is likely a key contributor to race differences in disability.
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Affiliation(s)
| | - James F Burke
- 2 University of Michigan, Ann Arbor, MI, USA.,3 Ann Arbor VA, Ann Arbor, MI, USA
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Chu NM, Bandeen-Roche K, Tian J, Kasper JD, Gross AL, Carlson MC, Xue QL. Hierarchical Development of Frailty and Cognitive Impairment: Clues Into Etiological Pathways. J Gerontol A Biol Sci Med Sci 2020; 74:1761-1770. [PMID: 31120105 DOI: 10.1093/gerona/glz134] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Frailty and cognitive impairment (CI) are associated and often coexist in older adults. Whether temporal patterns of occurrence reflect different etiologies remain unknown. METHODS Participants from the National Health and Aging Trends Study were assessed annually (2011-2016) for frailty (Fried's criteria) and CI (bottom quintile of clock drawing test or immediate and delayed recall; proxy-report of dementia diagnosis or AD8 ≥ 2). We used the Fine & Gray model to identify correlates of frailty onset before CI, CI onset before frailty, and frailty-CI co-occurrence, accounting for death as a competing risk. RESULTS Of 3,848 free of frailty, CI, and dementia at baseline, 2,183 (61.2%) developed neither frailty nor CI during the 5-year follow-up; 343 (8.3%) developed frailty first; 1,014 (24.4%) developed CI first; and 308 (6.0%) developed frailty-CI co-occurrence. Incident dementia, as a marker of underlying neuropathologies, was associated with greater likelihood of CI onset first (subdistribution hazard ratios [SHR] = 2.60, 95% confidence interval [ci] 2.09 to 3.24), and frailty-CI co-occurrence (SHR = 8.77, 95% ci 5.79 to 13.28), but lower likelihood of frailty onset first (SHR = 0.38, 95% ci 0.21 to 0.68). Number of comorbidities was only associated with frailty occurrence first (1 comorbidity: SHR = 2.51, 95% ci 1.15 to 5.47; 4+ comorbidities: SHR = 6.48, 95% ci 2.78 to 15.48). CONCLUSIONS Different patterns of frailty and CI occurrence exist, and dementia-related pathologies and comorbidities may be important correlates of order of emergence, potentially reflecting different etiologies. Future investigation into relationships between these patterns and dementia subtypes and related pathologies is needed to elucidate etiologic pathways and to provide new targets for prevention, intervention, and risk screening.
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Affiliation(s)
- Nadia M Chu
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Karen Bandeen-Roche
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Center on Aging and Health, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Jing Tian
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Center on Aging and Health, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Judith D Kasper
- Department of Health Policy and Management, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Alden L Gross
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Center on Aging and Health, Johns Hopkins Medical Institutions, Baltimore, Maryland.,Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Michelle C Carlson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Center on Aging and Health, Johns Hopkins Medical Institutions, Baltimore, Maryland.,Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Qian-Li Xue
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Center on Aging and Health, Johns Hopkins Medical Institutions, Baltimore, Maryland.,Department of Medicine, Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Kim J, Lee HY, Won CR, Barr T, Merighi JR. Older adults' technology use and its association with health and depressive symptoms: Findings from the 2011 National Health and Aging Trends Study. Nurs Outlook 2020; 68:560-572. [PMID: 32527596 PMCID: PMC7205676 DOI: 10.1016/j.outlook.2020.05.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 04/27/2020] [Accepted: 05/03/2020] [Indexed: 12/27/2022]
Abstract
Background Information and communication technology (ICT) provides older adults with access to information and resources that benefit their health. Purpose To explore ICT use among older adults and examine the influence of information technology (IT), communication technology (CT), or ICT use on older adults' self-rated health status and depressive symptoms. Method A sample of community-dwelling Medicare beneficiaries aged 65 and older in the United States (N = 4,976) from the 2011 National Health and Aging Trends Study. Findings Older adults who embraced ICT and used this technology for a variety of purposes were more likely to report better health status, and were less likely to experience major depressive symptoms than nonusers. Discussion In accordance with the Health Information Technology for Economic and Clinical Health Act, nursing professional can play an important role by responding to older adults' diverse technology preferences and effectively incorporating them into nursing practice.
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Affiliation(s)
- Jeehoon Kim
- Department of Sociology, Social Work, and Criminology, Idaho State University, Pocatello, ID.
| | - Hee Yun Lee
- School of Social Work, University of Alabama, Tuscaloosa, AL
| | - Cho Rong Won
- School of Social Work, University of Alabama, Tuscaloosa, AL
| | - Tina Barr
- Department of Social Work, University of North Carolina at Pembroke, Pembroke, NC
| | - Joseph R Merighi
- School of Social Work, University of Minnesota, Twin Cities, St. Paul, MN
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Skolarus LE, Feng C, Burke JF. Exploring Factors Contributing to Race Differences in Poststroke Disability. Stroke 2020; 51:1813-1819. [PMID: 32404036 DOI: 10.1161/strokeaha.119.027700] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose- Cross sectional analyses have found large race differences in poststroke disability, yet these analyses do not account for prestroke disability, hospitalization factors, postacute care, transitions, or mortality. In this context, we explore mortality, nursing home placement, and disability in a longitudinal analysis of older stroke survivors who survived at least 90 days poststroke. Methods- A prospective cohort of black or white stroke survivors from the National Health and Aging Trends Study (2009-2016) linked to Medicare were used. Disability was assessed during in-person interviews with validated scales (0-7). We used cox proportional hazards models to separately assess mortality and nursing home admission adjusting for age, sex, sociodemographics (marital status, education, income, insurance status, social network size), comorbidities, hospitalization factors, postacute care, and 90-day readmissions. To estimate racial differences in disability, we used a multilevel linear regression model initially adjusting for age and sex and then compared with a model adjusted for sociodemographics, comorbidities, hospitalization factors, postacute care, and 90-day readmissions. Results- There were 282 stroke survivors, of which 76 (12.6%) were black. There were no race differences in long-term mortality (hazard ratio for black, 1.2 [95% CI, 0.7-2.2]; P=0.5) or nursing home placement (hazard ratio for black, 0.7 [95% CI, 0.2-2.4]; P=0.5). The largest race differences in disability were observed immediately prestroke, estimated age- and sex-adjusted activity limitations were (2.6 [2.0-3.2] in blacks versus 1.4 [1.0-1.8] in whites, mean difference, 1.2 [0.5-1.9], P<0.001) and immediately poststroke (2.6 [2.0-3.3] in blacks versus 1.7 [1.2-2.1] in whites, mean difference, 1.0 [0.2-1.7], P<0.01). Full adjustment did not substantially change the associations between race and disability. Conclusions- Race differences in nursing home placement, long-term mortality, sociodemographics, comorbidities, hospitalization factors, postacute care, and readmissions are unlikely to be large contributors to race differences in poststroke disability. Further research is needed to understand the drivers of race differences in poststroke disability.
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Affiliation(s)
- Lesli E Skolarus
- From the Department of Neurology, University of Michigan, Ann Arbor (L.E.S., C.F., J.F.B.)
| | - Chunyang Feng
- From the Department of Neurology, University of Michigan, Ann Arbor (L.E.S., C.F., J.F.B.)
| | - James F Burke
- From the Department of Neurology, University of Michigan, Ann Arbor (L.E.S., C.F., J.F.B.).,Department of Neurology, Ann Arbor VA, MI (J.F.B.)
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Abstract
IMPORTANCE Assessment of functional outcomes is currently limited by a lack of large data sets. Functional assessments are included in Medicare rehabilitation assessment files, yet the validity of these measures in routine care is unknown. OBJECTIVE To evaluate the validity of individual-level routine care functional assessments in Medicare rehabilitation settings compared with criterion-standard National Health and Aging Trends Study (NHATS) research assessments obtained no more than 90 days later. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study of individuals aged 65 years and older used the 2011 to 2015 NHATS linked with Medicare assessment files. Individuals with a discharge assessment from inpatient rehabilitation facilities, skilled nursing facilities, or home health agencies and a criterion-standard NHATS assessment were included. Data analysis was performed June 2019 to November 2019. MAIN OUTCOMES AND MEASURES Summary functional assessment based on independence with eating, toilet hygiene, bathing, dressing, transfers, and mobility or walking. Linear regression was used to assess agreement between the 2 scales, adjusting for time between assessments and rehabilitation setting. RESULTS A total of 1036 adults aged 65 years and older (671 [64.8%] aged ≥80 years; 670 [64.7%] women; 685 [66.1%] white participants) met the study criteria. The correlation of the assessments was 0.63 (95% CI, 0.59 to 0.66; mean [SD] rehabilitation score, 27.5 [7.2]; mean [SD] NHATS score, 30.5 [10.1]). The correlation increased to 0.66 (95% CI, 0.60 to 0.71) for assessments no more than 30 days apart. The linear regression model adjusting for rehabilitation setting and days between evaluations found the assessments were strongly correlated (β = 1.00 [95% CI, 0.93 to 1.08]; intercept, 0.72 [95% CI, -1.79 to 3.24]; R2 = 0.42). Differences in scores were generally small (mean [SD] of NHATS - rehabilitation score, 2.96 [7.91]), and only 59 assessments (5.7%) differed by more than 2 SDs of the mean difference. Rehabilitation service scores were typically higher than NHATS scores in individuals with lower mean scores; however, the population with lower mean scores was small (156 [15.1%]). CONCLUSIONS AND RELEVANCE In this large sample of older US adults, routine care rehabilitation facility functional assessments had overall moderate correlation with criterion-standard research assessments.
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Affiliation(s)
- Kevin A. Kerber
- Department of Neurology, University of Michigan, Ann Arbor
- Department of Neurology, Ann Arbor Veteran’s Affairs, Ann Arbor, Michigan
| | | | - Chunyang Feng
- Department of Neurology, University of Michigan, Ann Arbor
| | - James F. Burke
- Department of Neurology, University of Michigan, Ann Arbor
- Department of Neurology, Ann Arbor Veteran’s Affairs, Ann Arbor, Michigan
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Freedman VA, Kasper JD. Cohort Profile: The National Health and Aging Trends Study (NHATS). Int J Epidemiol 2020; 48:1044-1045g. [PMID: 31237935 DOI: 10.1093/ije/dyz109] [Citation(s) in RCA: 132] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2019] [Indexed: 11/15/2022] Open
Affiliation(s)
- Vicki A Freedman
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Judith D Kasper
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
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65
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Engelberg Anderson JK, Jain P, Wade AJ, Morris AM, Slaboda JC, Norman GJ. Indicators of potential health-related social needs and the association with perceived health and well-being outcomes among community-dwelling medicare beneficiaries. Qual Life Res 2020; 29:1685-1696. [PMID: 31907869 DOI: 10.1007/s11136-019-02410-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/24/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE Health-related social needs (HRSNs) can make older adults' more vulnerable and impact their health, well-being, and ability to age-in-place. The current study assessed the prevalence of potential HRSNs (pHRSNs) across several domains (e.g., transportation, social isolation) and explored the associations with health and well-being outcomes in a sample of Medicare beneficiaries. METHODS Cross-sectional analyses were conducted with a representative sample of community-dwelling Medicare beneficiaries (N = 5758) from the 2012 National Health and Aging Trends Study. Binary indicators of pHRSNs were created for five domains: medical and utility financial needs (MUFN), housing, nutrition, social isolation, and transportation. Outcomes were depression/anxiety, self-rated health, meaning/satisfaction, perceived control/adaptability. Variables were weighted, and multivariate regression models assessed associations between pHRSN variables and outcomes, controlling for sociodemographics and health conditions. RESULTS Of the estimated 32 million community-dwelling beneficiaries, approximately 13.3 million were positive for ≥ 1 pHRSN and 11.4 million for ≥ 2 pHRSNs. The prevalence by domain was 7% for housing, 8% for transportation, 12% for UMFN and nutrition, and 33% for social isolation. Each domain, except for housing, was significantly (p < .05) associated with at least two of the four outcomes, where being positive for a pHRSN was associated with greater depression/anxiety and poorer self-rated general health. CONCLUSIONS Over 40% of Medicare beneficiaries had ≥ 1 pHRSN indicators, which means they are more vulnerable and that may limit their ability to age-in-place. Given the growing aging population, better measures and methods are needed to identify, monitor, and address HRSNs. For example, leveraging existing community-based services through coordinated care may be an effective strategy to address older adults' HRSNs.
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Affiliation(s)
| | - Purva Jain
- West Health Institute, 10350 N Torrey Pines Rd, La Jolla, CA, 92037, USA
| | - Amy J Wade
- West Health Institute, 10350 N Torrey Pines Rd, La Jolla, CA, 92037, USA
| | - Andrea M Morris
- West Health Institute, 10350 N Torrey Pines Rd, La Jolla, CA, 92037, USA
| | - Jill C Slaboda
- West Health Institute, 10350 N Torrey Pines Rd, La Jolla, CA, 92037, USA
| | - Gregory J Norman
- University of California San Diego, 9500 Gilman Dr, La Jolla, CA, 92093, USA.
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66
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Abstract
OBJECTIVE Despite the high prevalence of late-life depression and anxiety at threshold and subthreshold levels, their joint role in the disablement process remains unclear. This study aims to examine the association of comorbid occurring depression and anxiety across the full spectrum of symptom severity with disability onset in older adults. METHODS The study included 3663 participants from the 2011 National Health and Aging Trends Study, who reported no limitations in self-care and mobility activities at baseline. Disability onset was defined as a report of receiving help from another person in any of the activities for 3 consecutive months. Depression and anxiety symptoms were measured using the four-item Patient Health Questionnaire, grouped into low, mild, and moderate/severe symptom groups. Cox proportional hazards models were used to estimate relative risks for disability onset over a 5-year period by depression/anxiety symptom groups. RESULTS A total of 1047 participants developed disability (24.6%; 6.0 per 1000 person-months). At baseline, one-fifth of the sample reported symptoms that were mild (n = 579 [14.9%]; 31.6% with disability onset) or moderate/severe (n = 156 [4.2%]; 38.1% with disability onset). After adjustment for sociodemographics, there was a dose-response relationship between depression/anxiety symptom groups and disability onset (mild versus low: hazard ratio [HR] = 1.43, 95% confidence interval [CI] = 1.20-1.70; moderate/severe versus low: HR = 1.94, 95% CI = 1.45-2.59). The increased risk remained significant after adjustment for health status variables for the mild symptom group (HR = 1.26, 95% CI = 1.07-1.49), but not for the moderate/severe symptom group (HR = 1.30, 95% CI = 0.94-1.79), possibly reflecting lower statistical power. CONCLUSIONS Findings suggest that the full spectrum of depression and anxiety symptoms are associated with increased risk for disability in late life. Their role in the disablement process warrants further investigation.
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67
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Dong L, Freedman VA, Sánchez BN, Mendes de Leon CF. Racial and Ethnic Differences in Disability Transitions Among Older Adults in the United States. J Gerontol A Biol Sci Med Sci 2019; 74:406-411. [PMID: 29562316 DOI: 10.1093/gerona/gly052] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Racial and ethnic differences in disability persist and are possibly widening in recent years, but evidence is limited for racial and ethnic differences in disability progression through the entire disablement process and potential influential factors. The objective of this study is to examine racial and ethnic differences in patterns of late-life disability transitions, using a new disability spectrum that incorporates successful accommodation with assistive devices in response to capacity limitations to prolong independence. METHODS The study cohort consisted of a nationally representative sample of Medicare beneficiaries aged 65 and older in the United States who were enrolled in the 2011 National Health and Aging Trends Study and followed up annually until 2015 (n = 6,198). First-order Markov transition models were used to determine racial/ethnic differences in transitions among three stages of self-care and mobility limitations (fully able, successful accommodation, difficulty/assistance) and death. RESULTS After adjustment for age and sex, non-Hispanic Black and Hispanic respondents had higher probabilities of unfavorable transitions and lower probabilities of remaining in the successful accommodation stage than non-Hispanic White respondents. The racial and ethnic differences in probabilities of maintaining successful accommodation remained statistically significant after adjustment for socioeconomic and health factors (Black: 0.56, 95% CI = 0.52-0.60; Hispanic: 0.53, 95% CI = 0.44-0.61; White: 0.63, 95% CI = 0.61-0.65). CONCLUSIONS Successful accommodation with assistive devices may provide possibilities for implementing interventions to enhance older adults' capacities and reducing racial/ethnic differences in late-life disability.
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Affiliation(s)
- Liming Dong
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Vicki A Freedman
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan
| | - Brisa N Sánchez
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Carlos F Mendes de Leon
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan
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68
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The Social Context of Sedentary Behaviors and Their Relationships With Health in Later Life. J Aging Phys Act 2019; 27:797-806. [PMID: 30859891 DOI: 10.1123/japa.2018-0109] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This study examined sedentary behaviors among older adults and explored associations with social context and health measures using cross-sectional data from the National Health and Aging Trends Study (N = 1,687). Multivariate models were estimated to explore associations of time in six sedentary behaviors (i.e., television watching, sitting and talking, hobbies, computer use, driving, and resting) with sociodemographic characteristics and level of social engagement and with health status. Results indicated substantial variability in sedentary behaviors, with television watching being the most frequent and resting the least frequent activities. Sedentary behaviors varied by sociodemographic characteristics, including age, race/ethnicity, and education, as well as by level of social engagement. Television watching and resting, but not other behaviors, were associated with poorer health. These findings help to unpack the role of social context in sedentary behaviors and could inform public health interventions aimed at reducing time spent in behaviors that are adversely associated with health.
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69
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Keeney T, Jette AM. Individual and Environmental Determinants of Late-Life Community Disability for Persons Aging With Cardiovascular Disease. Am J Phys Med Rehabil 2019; 98:30-34. [PMID: 30095448 DOI: 10.1097/phm.0000000000001011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of the study was to estimate the prevalence of late-life community disability for adults 65 yrs and older with cardiovascular disease versus those without. This study also investigated the contributions of environmental and individual risk factors on late-life community disability for persons with cardiovascular disease. DESIGN This is a secondary data analysis of the 2016 round of the National Health and Aging Trends Study. The study sample included community-dwelling Americans with cardiovascular disease (n = 1490) and without (n = 4819). Logistic regression was used to estimate associations between individual risk factors, environmental factors, and community disability for those with cardiovascular disease. RESULTS Individuals with cardiovascular disease had a significantly higher prevalence of late-life community disability than those without (44.8% vs. 29.0%). For persons with cardiovascular disease, lack of transportation, home modification, and needing assistance with mobility increased the odds of community disability. Younger age and lower comorbidity were associated with decreased odds of community disability. When accounting for environmental factors in multivariate analyses, sex, race, and education were not significantly associated with community disability. CONCLUSION Late-life community disability is highly prevalent for persons aging with cardiovascular disease. Intervention strategies to deter late-life community disablement should focus on improving access to transportation and improving the community environment in which older adults live.
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Affiliation(s)
- Tamra Keeney
- From the MGH Institute of Health Professions, Boston, Massachusetts
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70
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Price RJ, Brenner AB, Lin CC, Burke JF, Skolarus LE. Two million stroke survivors utilize medical visit companions: The other person in the room? Neurology 2019; 93:899-901. [PMID: 31619484 DOI: 10.1212/wnl.0000000000008465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 08/20/2019] [Indexed: 11/15/2022] Open
Affiliation(s)
- Rory J Price
- From the School of Public Health (R.J.P.), University of Michigan, Ann Arbor; Department of Neurology (A.B.B., C.C.L., J.F.B., L.E.S.), Health Services Research Program, University of Michigan Medical School, Ann Arbor; Institute for Social Research (A.B.B.), University of Michigan, Ann Arbor; and Department of Neurology (J.F.B.), Ann Arbor VA, MI
| | - Allison B Brenner
- From the School of Public Health (R.J.P.), University of Michigan, Ann Arbor; Department of Neurology (A.B.B., C.C.L., J.F.B., L.E.S.), Health Services Research Program, University of Michigan Medical School, Ann Arbor; Institute for Social Research (A.B.B.), University of Michigan, Ann Arbor; and Department of Neurology (J.F.B.), Ann Arbor VA, MI
| | - Chun Chieh Lin
- From the School of Public Health (R.J.P.), University of Michigan, Ann Arbor; Department of Neurology (A.B.B., C.C.L., J.F.B., L.E.S.), Health Services Research Program, University of Michigan Medical School, Ann Arbor; Institute for Social Research (A.B.B.), University of Michigan, Ann Arbor; and Department of Neurology (J.F.B.), Ann Arbor VA, MI
| | - James F Burke
- From the School of Public Health (R.J.P.), University of Michigan, Ann Arbor; Department of Neurology (A.B.B., C.C.L., J.F.B., L.E.S.), Health Services Research Program, University of Michigan Medical School, Ann Arbor; Institute for Social Research (A.B.B.), University of Michigan, Ann Arbor; and Department of Neurology (J.F.B.), Ann Arbor VA, MI
| | - Lesli E Skolarus
- From the School of Public Health (R.J.P.), University of Michigan, Ann Arbor; Department of Neurology (A.B.B., C.C.L., J.F.B., L.E.S.), Health Services Research Program, University of Michigan Medical School, Ann Arbor; Institute for Social Research (A.B.B.), University of Michigan, Ann Arbor; and Department of Neurology (J.F.B.), Ann Arbor VA, MI.
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71
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Meng H, Peterson LJ, Feng L, Dobbs D, Hyer K. The Use of Mobility Devices and Personal Assistance: A Joint Modeling Approach. Gerontol Geriatr Med 2019; 5:2333721419885291. [PMID: 31696144 PMCID: PMC6820176 DOI: 10.1177/2333721419885291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 09/30/2019] [Accepted: 10/04/2019] [Indexed: 11/15/2022] Open
Abstract
Objective: To examine whether mobility device use substitutes for personal assistance among U.S. older adults. Method: Using the National Health and Aging Trends Study, we identified 3,211 community-living older adults (aged 65 and older) who reported mobility difficulties at baseline. We used recursive bivariate probit models to simultaneously estimate the effect of covariates on the likelihood of using (a) mobility devices and (b) personal assistance to accommodate mobility difficulty. Independent variables included age, gender, race, physical/mental health status, cognition, and comorbidities. Results: Predictors of the use of personal assistance and mobility devices exhibit important similarities and differences. Device use reduced the odds of receiving personal assistance by 50% (odds ratio [OR] = 0.50, 95% confidence interval [CI] = [0.29, 0.86]). Discussion: Findings suggest device use substitutes for personal assistance. Practitioners and policymakers should promote the appropriate use of mobility devices while recognizing the importance of assistance with some groups and the potential of increasing mobility device use.
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72
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Magaziner J, Mangione KK, Orwig D, Baumgarten M, Magder L, Terrin M, Fortinsky RH, Gruber-Baldini AL, Beamer BA, Tosteson ANA, Kenny AM, Shardell M, Binder EF, Koval K, Resnick B, Miller R, Forman S, McBride R, Craik RL. Effect of a Multicomponent Home-Based Physical Therapy Intervention on Ambulation After Hip Fracture in Older Adults: The CAP Randomized Clinical Trial. JAMA 2019; 322:946-956. [PMID: 31503309 PMCID: PMC6737521 DOI: 10.1001/jama.2019.12964] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
IMPORTANCE Disability persists after hip fracture in older persons. Current rehabilitation may not be sufficient to restore ability to walk in the community. OBJECTIVE To compare a multicomponent home-based physical therapy intervention (training) with an active control on ability to walk in the community. DESIGN, SETTING, AND PARTICIPANTS Parallel, 2-group randomized clinical trial conducted at 3 US clinical centers (Arcadia University, University of Connecticut Health Center, and University of Maryland, Baltimore). Randomization began on September 16, 2013, and ended on June 20, 2017; follow-up ended on October 17, 2017. Patients aged 60 years and older were enrolled after nonpathologic, minimal trauma hip fracture, if they were living in the community and walking without human assistance before the fracture, were assessed within 26 weeks of hospitalization, and were not able to walk during daily activities at the time of enrollment. A total of 210 participants were randomized and reassessed 16 and 40 weeks later. INTERVENTIONS The training intervention (active treatment) (n = 105) included aerobic, strength, balance, and functional training. The active control group (n = 105) received transcutaneous electrical nerve stimulation and active range-of-motion exercises. Both groups received 2 to 3 home visits from a physical therapist weekly for 16 weeks; nutritional counseling; and daily vitamin D (2000 IU), calcium (600 mg), and multivitamins. MAIN OUTCOMES AND MEASURES The primary outcome (community ambulation) was defined as walking 300 m or more in 6 minutes at 16 weeks after randomization. The study was designed to test a 1-sided hypothesis of superiority of training compared with active control. RESULTS Among 210 randomized participants (mean age, 80.8 years; 161 women [76.7%]), 197 (93.8%) completed the trial (187 [89.0%] by completing the 6-minute walk test at 16 weeks and 10 [4.8%] by adjudication of the primary outcome). Among these, 22 of 96 training participants (22.9%) and 18 of 101 active control participants (17.8%) (difference, 5.1% [1-sided 97.5% CI, -∞ to 16.3%]; 1-sided P = .19) became community ambulators. Seventeen training participants (16.2%) and 15 control participants (14.3%) had 1 or more reportable adverse events during the intervention period. The most common reportable adverse events reported were falls (training: 6 [5.7%], control: 4 [3.8%]), femur/hip fracture (2 in each group), pneumonia (training: 2, control: 0), urinary tract infection (training: 2, control: 0), dehydration (training: 0, control: 2), and dyspnea (training: 0, control: 2). CONCLUSIONS AND RELEVANCE Among older adults with a hip fracture, a multicomponent home-based physical therapy intervention compared with an active control that included transcutaneous electrical nerve stimulation and active range-of-motion exercises did not result in a statistically significant improvement in the ability to walk 300 m or more in 6 minutes after 16 weeks. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01783704.
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Affiliation(s)
- Jay Magaziner
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
| | - Kathleen K. Mangione
- Department of Physical Therapy, College of Health Sciences, Arcadia University, Glenside, Pennsylvania
| | - Denise Orwig
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
| | - Mona Baumgarten
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
| | - Laurence Magder
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
| | - Michael Terrin
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
| | | | - Ann L. Gruber-Baldini
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
| | - Brock A. Beamer
- Gerontology Research, Education and Clinical Center (GRECC) at Baltimore Veterans Affairs Medical Center, Baltimore, Maryland
- Division of Gerontology and Geriatric Medicine, University of Maryland School of Medicine, Baltimore
| | - Anna N. A. Tosteson
- Department of Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Anne M. Kenny
- Department of Medicine, UConn Health, Farmington, Connecticut
| | - Michelle Shardell
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
- National Institute on Aging, National Institutes of Health, Baltimore, Maryland
| | - Ellen F. Binder
- Division of Geriatrics and Nutritional Science, Washington University School of Medicine, St Louis, Missouri
| | - Kenneth Koval
- Department of Orthopaedic Surgery, Orlando Regional Medical Centre, Orlando, Florida
| | | | - Ram Miller
- Novartis Institutes for BioMedical Research, Cambridge, Massachusetts
| | - Sandra Forman
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
| | | | - Rebecca L. Craik
- Department of Physical Therapy, College of Health Sciences, Arcadia University, Glenside, Pennsylvania
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Wu S, Mulcahy J, Kasper JD, Kan HJ, Weiner JP. Comparing Survey-Based Frailty Assessment to Medicare Claims in Predicting Health Outcomes and Utilization in Medicare Beneficiaries. J Aging Health 2019; 32:764-777. [PMID: 31148491 DOI: 10.1177/0898264319851995] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: To assess two models for the prediction of health utilization and functions using standardized in-person assessments of frailty and administrative claims-based geriatric risk measures among Medicare fee-for-service beneficiaries aged 65 years and above. Methods: Outcomes of hospitalizations, death, and functional help were investigated for participants in the 2011 National Health and Aging Trends Study. For each outcome, multivariable logistic regression model was used to investigate claims-based geriatric risk and survey-based frailty. Results: Both claims-based and survey-based models showed moderate discrimination. The c-statistic of the standardized frailty models ranged from 0.67 (for any hospitalization) to 0.84 (for any IADL [instrumental activities of daily living] help). Models using administrative data ranged from 0.71 (for any hospitalization) to 0.81 (for any IADL help). Discussion: Models based on existing administrative data appear to be as discriminate as survey-based models. Health care providers and insurance plans can effectively apply existing data resources to help identify high-risk individuals for potential care management interventions.
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Affiliation(s)
- Shannon Wu
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - John Mulcahy
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Judith D Kasper
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Hong J Kan
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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74
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Valluru G, Yudin J, Patterson CL, Kubisiak J, Boling P, Taler G, De Jonge KE, Touzell S, Danish A, Ornstein K, Kinosian B. Integrated Home- and Community-Based Services Improve Community Survival Among Independence at Home Medicare Beneficiaries Without Increasing Medicaid Costs. J Am Geriatr Soc 2019; 67:1495-1501. [PMID: 31074846 DOI: 10.1111/jgs.15968] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 02/25/2019] [Accepted: 02/28/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To determine the effect of home-based primary care (HBPC) for frail older adults, operating under Independence at Home (IAH) incentive alignment on long-term institutionalization (LTI). DESIGN Case-cohort study using HBPC site, Medicare administrative data, and National Health and Aging Trends Study (NHATS) benchmarks. SETTING Three IAH-participating HBPC sites in Philadelphia, PA, Richmond, VA, and Washington, DC. PARTICIPANTS HBPC integrated with long-term services and supports (LTSS) cases (n = 721) and concurrent comparison groups (HBPC not integrated with LTSS: n = 82; no HBPC: n = 573). Cases were eligible if enrolled at one of the three HBPC sites from 2012 to 2015. Independence at Home-qualified (IAH-Q) concurrent comparison groups were selected from Philadelphia, PA; Richmond, VA; and Washington, DC. INTERVENTION HBPC integrated with LTSS under IAH demonstration incentives. MEASUREMENTS Measurements include LTI rate and mortality rates, community survival, and LTSS costs. RESULTS The LTI rate in the three HBPC programs (8%) was less than that of both concurrent comparison groups (IAH-Q beneficiaries not receiving HBPC, 16%; patients receiving HBPC but not in the IAH demonstration practices, 18%). LTI for patients at each HBPC site declined over the three study years (9.9%, 9.4%, and 4.9%, respectively). Costs of home- and community-based services (HCBS) were nonsignificantly lower among integrated care patients ($2151/mo; observed-to-expected ratio = .88 [.68-1.09]). LTI-free survival in the IAH HBPC group was 85% at 36 months, extending average community residence by 12.8 months compared with IAH-q participants in NHATS. CONCLUSION HBPC integrated with long-term support services delays LTI in frail, medically complex Medicare beneficiaries without increasing HCBS costs.
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Affiliation(s)
- Girish Valluru
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jean Yudin
- Division of Geriatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,Independence at Home Learning Collaborative, American Academy of Home Care Medicine, Chicago, Illinois
| | | | | | - Peter Boling
- Division of Geriatrics, Virginia Commonwealth University, Richmond, Virginia.,Independence at Home Learning Collaborative, American Academy of Home Care Medicine, Chicago, Illinois
| | - George Taler
- Independence at Home Learning Collaborative, American Academy of Home Care Medicine, Chicago, Illinois.,MedStar House Call Program, MedStar Health, Washington, DC.,School of Medicine, Georgetown University, Washington, DC
| | - Karl Eric De Jonge
- Independence at Home Learning Collaborative, American Academy of Home Care Medicine, Chicago, Illinois.,MedStar House Call Program, MedStar Health, Washington, DC.,School of Medicine, Georgetown University, Washington, DC
| | - Steve Touzell
- Philadelphia Corporation for Aging, Philadelphia, Pennsylvania
| | - Ann Danish
- Philadelphia Corporation for Aging, Philadelphia, Pennsylvania
| | - Katherine Ornstein
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Bruce Kinosian
- Division of Geriatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,Independence at Home Learning Collaborative, American Academy of Home Care Medicine, Chicago, Illinois.,Geriatrics and Extended Care Data Analysis Center, Cpl Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania.,Center for Health Equity Research and Policy, Cpl Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania.,Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
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75
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Van Ness PH, MacNeil Vroomen J, Leo-Summers L, Vander Wyk B, Allore HG. Chronic Conditions, Medically Supportive Care Partners, And Functional Disability Among Cognitively Impaired Adults. Innov Aging 2019; 3:igz018. [PMID: 31286072 PMCID: PMC6604743 DOI: 10.1093/geroni/igz018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND AND OBJECTIVES To assess whether medically supportive care partners modify the associations of symptomatic chronic conditions with the number of functional disabilities in a cohort of multimorbid older adults with cognitive impairment. RESEARCH DESIGN AND METHODS The research design is a prospective study of a nationally representative cohort of Medicare beneficiaries. National Health and Aging Trends Study (NHATS) data were linked with Medicare claims for years 2011-2015. Participants were aged 65 or older and had cognitive impairment with at least 2 chronic conditions (N = 1,003). Annual in-person interviews obtained sociodemographic information at baseline and time-varying variables for caregiving, hospitalization, and 6 activities of daily living (ADL); these variables were merged with Center for Medicare and Medicaid Services data to ascertain 16 time-varying chronic conditions. A care partner was defined as a person who sat with their care recipient during doctor visits in the past year and/or who helped them with prescribed medications in the last month. Chronic condition associations and their potential effect modifications by care partner status were assessed using weighted generalized estimating equations accounting for the complex survey design of the longitudinal analytical sample. RESULTS Chronic kidney disease, depression, and heart failure were associated with an increased number of functional disabilities. Among these, only the association of chronic kidney disease with the number of functional disabilities (interaction p value = .001) was weakened by the presence of a care partner. DISCUSSION AND IMPLICATIONS The presence of care partners showed limited modification of the associations of symptomatic chronic conditions with functional disability.
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Affiliation(s)
- Peter H Van Ness
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Janet MacNeil Vroomen
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Department of Internal Medicine, Section of Geriatric Medicine, Academic University Medical Center, Amsterdam, The Netherlands
| | - Linda Leo-Summers
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Brent Vander Wyk
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Heather G Allore
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut
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76
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Whitney DG, Dutt-Mazumder A, Peterson MD, Krishnan C. Fall risk in stroke survivors: Effects of stroke plus dementia and reduced motor functional capacity. J Neurol Sci 2019; 401:95-100. [PMID: 31075685 DOI: 10.1016/j.jns.2019.04.035] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 04/24/2019] [Accepted: 04/25/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Despite extensive research on falls among individuals with stroke, little is known regarding the impact of neurological conditions with comorbid diagnoses and motor functional capacity on the risk of falls in these individuals. Hence, the purpose of this study was to determine the fall risk and the contribution of reduced motor functional capacity to fall risk in individuals with stroke, dementia, and stroke plus dementia. METHODS Data from the National Health and Aging Trends Study (NHATS), a nationally-representative sample of Medicare beneficiaries, were analyzed for this cross-sectional study. The odds of self-reported falls within the past month in three subgroups of neurological conditions [stroke (n = 751), dementia (n = 369), and stroke plus dementia (n = 141)] were evaluated with a reference group of individuals with no stroke/dementia [i.e., controls (n = 6337)] using logistic regression models. RESULTS The prevalence of a recent fall was significantly higher (P < .05) in the three neurological disorder groups compared with controls. After adjusting for sociodemographics, mobility device use, and other comorbidities (i.e., chronic disease, vision impairment, and major surgery), the odds of a recent fall were significantly elevated in individuals with stroke (odds ratio [OR] = 1.45), dementia (OR = 2.45), and stroke plus dementia (OR = 2.64) compared with controls. After further adjustment for the lower motor functional capacity, the elevated odds in individuals with stroke were attenuated (OR = 1.16); however, the odds remained significantly elevated in individuals with dementia (OR = 1.67) and stroke plus dementia (OR = 1.82). CONCLUSION Findings indicate that the odds for falls in stroke survivors are elevated in the presence of comorbid dementia. Further, lower motor functional capacity accounted for increased likelihood of a fall in individuals with stroke, but it was not sufficient to account for the increased likelihood of a fall in individuals with dementia or stroke plus dementia. Thus, interventions focusing on secondary prevention of dementia and improving motor functional capacity may reduce fall risk in individuals with stroke.
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Affiliation(s)
- Daniel G Whitney
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, Ann Arbor, MI, USA
| | - Aviroop Dutt-Mazumder
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, Ann Arbor, MI, USA
| | - Mark D Peterson
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, Ann Arbor, MI, USA
| | - Chandramouli Krishnan
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, Ann Arbor, MI, USA; Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA; Michigan Robotics Institute, University of Michigan, Ann Arbor, MI, USA; School of Kinesiology, University of Michigan, Ann Arbor, MI, USA.
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77
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Ratnapradipa KL, Wang J, Berg-Weger M, Schootman M. Coming Out of "Retirement"-Predictors of Driving Resumption Among Older Drivers. Innov Aging 2018; 2:igy030. [PMID: 30480149 PMCID: PMC6208715 DOI: 10.1093/geroni/igy030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background and Objectives Predictors and consequences of driving cessation in older adults have been studied extensively. This study sought to establish the extent to which former drivers resume driving and identify associated factors. Research Design and Methods Descriptive analysis of the 2011–2015 National Health and Aging Trends Study data (Round 1: n = 6,680; Round 5: n = 3,409) characterized the extent of driving resumption through 2015 by baseline driving status (driver, former driver, never driver). Weighted multivariate logistic regression and multilevel longitudinal models examined predictors of driving resumption. Results Among drivers who stopped driving during the study, 17%–28% resumed driving. Age, vehicle ownership, stroke, hospitalization, memory, and perceived transportation barriers were associated with resumption in regression analysis. In multilevel analysis stratified by baseline driving status, poor word recall (OR = 0.62; 95% CI = 0.40, 0.95) and use of public transportation (OR = 9.74; 95% CI = 1.54, 61.77) were significantly associated with driving resumption for baseline drivers, while use of taxi (OR < 0.001; 95% CI = <0.001, 0.02) was negatively associated with resumption for baseline former drivers. Discussion and Implications This study highlights several factors associated with driving resumption. Uncertainty about the underlying causes for resumption remains, so results should be interpreted with caution. However, predictive factors may help to identify individuals in need of additional mobility transition counseling. Ongoing transportation assessment may be warranted among former drivers.
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Affiliation(s)
- Kendra L Ratnapradipa
- Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Jing Wang
- Department of Graduate Nursing, College of Nursing & Health Innovation, University of Texas at Arlington
| | - Marla Berg-Weger
- School of Social Work, College for Public Health and Social Justice, Saint Louis University, Missouri
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78
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Gell NM, Patel KV. Rehabilitation Services Use of Older Adults According to Fall-Risk Screening Guidelines. J Am Geriatr Soc 2018; 67:100-107. [PMID: 30295320 DOI: 10.1111/jgs.15625] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Revised: 08/26/2018] [Accepted: 08/27/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To characterize rehabilitation services use of older adults according to fall-risk classification based on screening guidelines. DESIGN Cross-sectional analysis of 2015 National Health and Aging Trends Study. SETTING Study participants' homes. PARTICIPANTS National sample of 7,440 community-dwelling Medicare beneficiaries. MEASUREMENTS In-person interviews and functional assessments. Based on Centers for Disease Control and Prevention Stopping Elderly Accidents, Deaths and Injuries criteria, participants were classified as low, moderate, or high fall risk. RESULTS Twenty-three percent of older adults classified as moderate fall-risk (n = 2602) and 40.6% of those at high fall-risk (n = 940) reported rehabilitation services use in the past year. Among older adults who reported rehabilitation services in the past year (n = 1,505), treatment to address falls was reported by 2.8%, 12.6%, and 34.7% of those classified with low, moderate, and high fall-risk, respectively (p < 0.001). Older adults with high fall-risk who did not receive rehabilitation services had significantly better self-reported physical capacity (p = 0.02) but comparable physical performance (all p's > 0.05) relative to those who received rehabilitation. CONCLUSION Older adults at high risk for falls were significantly more likely to report rehabilitation services use compared to those with low and moderate risk of falling. The findings also indicate that there is low adherence to national clinical recommendations for rehabilitation services use in older adults vulnerable to falls-related injury. Among the high fall-risk group, those who did not receive rehabilitation services had similarly low physical function as compared with those who received rehabilitation, indicating potential unmet need to address physical impairments related to fall-risk. J Am Geriatr Soc 67:100-107, 2019.
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Affiliation(s)
- Nancy M Gell
- Department of Rehabilitation and Movement Science, University of Vermont, Burlington, Vermont
| | - Kushang V Patel
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington.,Division of Gerontology and Geriatric Medicine, University of Washington, Seattle, Washington
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79
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Zhao Y(L, Alderden J, Lind BK, Kim H. A Comprehensive Assessment of Risk Factors for Falls in Community-Dwelling Older Adults. J Gerontol Nurs 2018; 44:40-48. [DOI: 10.3928/00989134-20180913-04] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Accepted: 07/23/2018] [Indexed: 11/20/2022]
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80
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Abstract
GOALS We aimed to assess use of colorectal cancer screening (CRCS) as per United States Preventive Task Force guidelines among people with mobility disability using a nationally representative data set. BACKGROUND Individuals with mobility disability have decreased access to health care services, but the impact of mobility disability on CRCS has not been investigated. STUDY Data from the 2013 National Health Interview Survey were used to estimate sociodemographic characteristics of adults with mobility disability, prevalence of CRCS, and odds of CRCS given mobility disability among Americans aged 50 to 75. RESULTS In total, 56.8% of the entire sample (n=81,953,585) were up-to-date with CRCS. Mobility disability was not associated with CRCS status on univariable analysis but was significantly associated after adjustment for covariates including age and comorbidities, with an inverse relationship between the degree of mobility disability and odds of CRCS. Odds ratio for CRCS given progressively severe disability were 0.78 (0.66 to 0.93), 0.71 (0.53 to 0.94), 0.65 (0.31 to 1.19). CONCLUSIONS The present study indicates reduced CRCS among people with mobility disability and highlights the need for CRCS to be especially targeted toward this group. Future research should identify the specific systemic, social, and/or physical barriers to CRCS for this subgroup so that they can be addressed.
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81
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Amjad H, Roth DL, Sheehan OC, Lyketsos CG, Wolff JL, Samus QM. Underdiagnosis of Dementia: an Observational Study of Patterns in Diagnosis and Awareness in US Older Adults. J Gen Intern Med 2018; 33:1131-1138. [PMID: 29508259 PMCID: PMC6025653 DOI: 10.1007/s11606-018-4377-y] [Citation(s) in RCA: 215] [Impact Index Per Article: 35.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 12/28/2017] [Accepted: 02/08/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Many older adults living with dementia have not been formally diagnosed. Even when clinicians document the diagnosis, patients and families may be unaware of the diagnosis. Knowledge of how individual characteristics affect detection and awareness of dementia is limited. OBJECTIVE To identify characteristics associated with dementia diagnosis and awareness of diagnosis. DESIGN Cross-sectional observational study. PARTICIPANTS Five hundred eighty-five adults aged ≥ 65 in the National Health and Aging Trends Study who met assessment-based study criteria for probable dementia in 2011 and had 3 years of continuous, fee-for-service Medicare claims prior to 2011. MAIN MEASURES Using multivariable logistic regression, we compared participants with undiagnosed versus diagnosed dementia (based on Medicare claims) on demographic, social/behavioral, functional, medical, and healthcare utilization characteristics. Among those diagnosed, we compared characteristics of participants unaware versus aware of the diagnosis (based on self or proxy report). KEY RESULTS Among older adults with probable dementia, 58.7% were either undiagnosed (39.5%) or unaware of the diagnosis (19.2%). In adjusted analyses, individuals who were Hispanic (OR 2.48, 95% CI 1.19, 5.14), had less than high school education (OR 0.54 for at least high school education, 95% CI 0.32, 0.91), attended medical visits alone (OR 1.98, 95% CI 1.11, 3.51), or had fewer functional impairments (OR 0.79 for each impairment, 95% CI 0.69, 0.90) were more likely to be undiagnosed. Similarly, among those diagnosed, having less education (OR 0.42), attending medical visits alone (OR 1.97), and fewer functional impairments (OR 0.72) were associated with unawareness of diagnosis (all ps < 0.05). CONCLUSIONS The majority of older adults with dementia are either undiagnosed or unaware of the diagnosis, suggesting shortcomings in detection and communication of dementia. Individuals who may benefit from targeted screening include racial/ethnic minorities and persons who have lower educational attainment, any functional impairment, or attend medical visits alone.
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Affiliation(s)
- Halima Amjad
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD, USA. .,Johns Hopkins University Center on Aging and Health, Baltimore, MD, USA.
| | - David L Roth
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Johns Hopkins University Center on Aging and Health, Baltimore, MD, USA
| | - Orla C Sheehan
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Johns Hopkins University Center on Aging and Health, Baltimore, MD, USA
| | - Constantine G Lyketsos
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jennifer L Wolff
- Johns Hopkins University Center on Aging and Health, Baltimore, MD, USA.,Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Quincy M Samus
- Johns Hopkins University Center on Aging and Health, Baltimore, MD, USA.,Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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82
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Freedman VA, Kasper JD, Jette A. Can Older Adults Accurately Report Their Use of Physical Rehabilitation Services? Arch Phys Med Rehabil 2018; 99:1507-1513. [PMID: 29653109 DOI: 10.1016/j.apmr.2018.03.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 01/30/2018] [Accepted: 03/17/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To explore the accuracy of rehabilitation service use reports by older adults as well as variation in accuracy by demographic characteristics, time since use, duration, and setting (inpatient, outpatient, home). DESIGN Longitudinal observational study. SETTING Participants' homes. PARTICIPANTS Community-dwelling adults ages 65 and older (N=4228) in the 2015 National Health and Aging Trends Study who were enrolled in Medicare Parts A and B for 12 months before their interview. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Respondents were asked whether they received rehabilitation services in the past year and the duration and location of services. Healthcare Common Procedure Coding System codes and Revenue Center codes were used to identify Medicare-eligible rehabilitation service. RESULTS Survey-based reports and Medicare claims yielded similar estimates of rehabilitation use over the past year. Self-reported measures had high sensitivity (77%) and positive predictive value (80%) and even higher specificity and negative predictive value (approaching 95%). However, in adjusted models, sensitivity was lower for black enrollees, the very old, and those with lower education levels. CONCLUSIONS Survey-based measures of rehabilitation accurately captured use over the past year, but differential reporting should be considered when characterizing rehabilitation use in certain subgroups of older Americans.
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Affiliation(s)
- Vicki A Freedman
- Institute for Social Research, University of Michigan, Ann Arbor, MI.
| | - Judith D Kasper
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Alan Jette
- Center for Interprofessional Studies & Innovation, MGH Institute of Health Professions, Boston, MA
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83
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Potter AJ. Factors Associated With Caregivers' Use of Support Services and Caregivers' Nonuse of Services Sought. J Aging Soc Policy 2018; 30:155-172. [PMID: 29293072 DOI: 10.1080/08959420.2017.1414539] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Informal caregivers may face barriers accessing services like respite care, training, and support groups. Using multinomial logistic regression, I modeled caregivers' probability of using all services sought ("all services used") and nonuse of any services sought ("any unused services") as a function of caregiver and care-recipient characteristics. Care-recipient health and function, especially dementia and need for medical task assistance, were associated with all services used and any unused services, and any unused services were more likely among adult children caring for their parents, caregivers of Black and Hispanic older adults, caregivers providing intensive care, caregivers living in metropolitan areas, and residents of states that spend more on increasing access to caregiver services under the National Family Caregiver Support Program. Regularly scheduled caregiving was associated with higher likelihood of all services used, but not with any unused services. Steps should be taken to increase access for caregivers who provide intensive care, care to dementia patients, or assistance with medical tasks and for Hispanic families.
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Affiliation(s)
- Andrew J Potter
- a Department of Health Management and Policy , University of Iowa , Iowa City , Iowa , USA.,b Department of Political Science and Criminal Justice , California State University Chico , Chico , California , USA
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84
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Urbanek JK, Spira AP, Di J, Leroux A, Crainiceanu C, Zipunnikov V. Epidemiology of objectively measured bedtime and chronotype in US adolescents and adults: NHANES 2003-2006. Chronobiol Int 2017; 35:416-434. [PMID: 29283283 DOI: 10.1080/07420528.2017.1411359] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND We propose a method for estimating the timing of in-bed intervals using objective data in a large representative US sample, and quantify the association between these intervals and age, sex, and day of the week. METHODS The study included 11,951 participants 6 years and older from the National Health and Nutrition Examination Survey (NHANES) 2003-2006, who wore accelerometers to measure physical activity for seven consecutive days. Participants were instructed to remove the device just before the nighttime sleep period and put it back on immediately after. This nighttime period of non-wear was defined in this paper as the objective bedtime (OBT), an objectively estimated record of the in-bed interval. For each night of the week, we estimated two measures: the duration of the OBT (OBT-D) and, as a measure of the chronotype, the midpoint of the OBT (OBT-M). We estimated day-of-the-week-specific OBT-D and OBT-M using gender-specific population percentile curves. Differences in OBT-M (chronotype) and OBT-D (the amount of time spent in bed) by age and sex were estimated using regression models. RESULTS The estimates of OBT-M and their differences among age groups were consistent with the estimates of chronotype obtained via self-report in European populations. The average OBT-M varied significantly by age, while OBT-D was less variable with age. In the reference group (females, aged 17-22 years), the average OBT-M across 7 days was 4:19 AM (SD = 30 min) and the average OBT-D was 9 h 19 min (SD = 12 min). In the same age group the average OBT-D was 18 minutes shorter for males than for females, while the average OBT-M was not significantly different between males and females. The most pronounced differences were observed between OBT-M of weekday and weekend nights. In the reference group, compared to the average OBT-M of 3:50 am on Monday through Thursday nights, there was a 57-minute delay in OBT-M on Friday nights (entering the weekend), a 69-minute delay on Saturday nights (staying in the weekend), and a 23-minute delay on Sunday night (leaving the weekend). For both OBT-M and OBT-D, in most age groups and for most days of the week, there were no statistically significant differences between males and females, except for OBT-D on Wednesdays and Thursdays, with males having 31 (p-value < 0.05) and 45 (p-value < 0.05) minutes shorter OBT-D, respectively. CONCLUSIONS The proposed measures, OBT-D and OBT-M, provide useful information of time in bed and chronotype in NHANES 2003-2006. They identify within-week patterns of bedtime and can be used to study associations between the bedtime and the large number of health outcomes collected in NHANES 2003-2006.
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Affiliation(s)
- Jacek K Urbanek
- a Department of Medicine , Johns Hopkins University School of Medicine , Baltimore , Maryland , US
| | - Adam P Spira
- b Department of Mental Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , Maryland , US.,c Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, 21287 Johns Hopkins Center on Aging and Health , Baltimore , Maryland , US
| | | | - Andrew Leroux
- d Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health , Baltimore , Maryland , US
| | - Ciprian Crainiceanu
- d Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health , Baltimore , Maryland , US
| | - Vadim Zipunnikov
- d Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health , Baltimore , Maryland , US
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85
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Lee HY, Kim J, Sharratt M. Technology use and its association with health and depressive symptoms in older cancer survivors. Qual Life Res 2017; 27:467-477. [PMID: 29128998 DOI: 10.1007/s11136-017-1734-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2017] [Indexed: 12/21/2022]
Abstract
PURPOSE Acknowledging the expanding influence of technology in the promotion of health and wellness, this study assessed the role of information and communication technology (ICT) use in the lives of older cancer survivors. METHODS A community sample of cancer survivors aged 65 and older (N = 1411) was extracted from a 2011 U.S. National Health and Aging Trends Study dataset. Weighted multiple regression and multinomial logistic regression analyses were performed to explore the relationships between survey respondents' ICT use and their self-rated health status and depressive symptoms. RESULTS The majority of respondents reported rarely or never engaging in ICT use. Greater use of communication technology such as emailing or texting was associated with decreased risk for severe depressive symptoms and higher self-rated health status. Information technology use was not associated with depressive symptoms and self-rated health status. CONCLUSIONS Investigation into reasons behind older cancer survivors' apparent low rates of engagement with ICT is warranted, particularly the examination of access as a potential barrier. Findings indicated that frequent use of communication technology was positively linked with mental and physical wellness. The nature of the relationships between communication technology use and physical and mental health merits further research, helping to determine whether community-based educational efforts to improve technology access and skills may benefit the growing population of older cancer survivors.
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Affiliation(s)
- Hee Yun Lee
- School of Social Work, University of Minnesota, Twin Cities, 105 Peters Hall, 1404 Gortner Avenue, St. Paul, MN, 55108, USA.
| | - Jeehoon Kim
- Department of Sociology, Social Work, and Criminology, Idaho State University, Pocatello, ID, USA
| | - Monica Sharratt
- School of Social Work, University of Minnesota, Twin Cities, 105 Peters Hall, 1404 Gortner Avenue, St. Paul, MN, 55108, USA
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86
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Brenner AB, Clarke PJ. Difficulty and independence in shopping among older Americans: more than just leaving the house. Disabil Rehabil 2017; 41:191-200. [PMID: 29117730 DOI: 10.1080/09638288.2017.1398785] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND The built, social and economic environments are associated with disability, but knowledge of how these environmental characteristics simultaneously influence older adults' ability to shop independently is limited. OBJECTIVE We investigated cross-sectional associations between the outdoor home, local neighborhood and macrosocioeconomic levels of the environment and shopping difficulty and interactions between environmental factors and shopping difficulty. METHODS Using nationally representative data from a study of Medicare-eligible adults, we conducted a cross-sectional secondary data analysis to examine associations between the environment and difficulty shopping (N = 5504). RESULTS Sidewalk conditions, broken steps, neighborhood social cohesion and neighborhood socioeconomic disadvantage were associated with more difficulty shopping, although health factors partially accounted for associations between broken steps and disadvantage and shopping difficulty. The association between social cohesion and shopping difficulty also depended on the degree of socioeconomic disadvantage in the neighborhood. CONCLUSIONS Overall, results suggest that factors in the outdoor and local neighborhood environment influence the ability to shop independently for older adults, but that it also may depend on the socioeconomic context of the neighborhood. Interventions aimed at improving the built environment directly outside of older adults' homes and helping increase social cohesion among neighbors, has the potential to reduce difficulty in carrying out this important activity. Implications for rehabilitation Built features of the outdoor home environment including sidewalks and broken steps influence whether older adults are able to safely leave their home to conduct daily activities such as shopping, so it is important that clinicians and rehabilitation professionals are aware of these challenges when helping their patients resume daily activities such as shopping. The physical condition and safety of the immediate outdoor home and neighborhood environment is critical for maintaining independence and well-being for older adults, which is critical for physical rehabilitation as well as maintenance of essential activities such as shopping. Living in more socially cohesive neighborhoods may aid in physical rehabilitation efforts by helping older adults feel more comfortable and able to shop independently in neighborhoods with social and economic disadvantages.
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Affiliation(s)
- Allison B Brenner
- a Survey Research Center at the Institute for Social Research , University of Michigan , Ann Arbor , MI , USA
| | - Philippa J Clarke
- a Survey Research Center at the Institute for Social Research , University of Michigan , Ann Arbor , MI , USA
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87
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Gell NM, Mroz TM, Patel KV. Rehabilitation Services Use and Patient-Reported Outcomes Among Older Adults in the United States. Arch Phys Med Rehabil 2017; 98:2221-2227.e3. [DOI: 10.1016/j.apmr.2017.02.027] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 02/06/2017] [Accepted: 02/27/2017] [Indexed: 10/19/2022]
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88
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Deane AM, Hodgson CL, Young P, Little L, Singh V, Poole A, Young M, Mackle D, Lange K, Williams P, Peake SL, Chapman MJ, Iwashyna TJ. The rapid and accurate categorisation of critically ill patients (RACE) to identify outcomes of interest for longitudinal studies: a feasibility study. Anaesth Intensive Care 2017; 45:476-484. [PMID: 28673218 DOI: 10.1177/0310057x1704500411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The capacity to measure the impact of an intervention on long-term functional outcomes might be improved if research methodology reflected our clinical approach, which is to individualise goals of care to what is achievable for each patient. The objective of this multicentre inception cohort study was to evaluate the feasibility of rapidly and accurately categorising patients, who were eligible for simulated enrolment into a clinical trial, into unique categories based on premorbid function. Once a patient met eligibility criteria a rapid 'baseline assessment' was conducted to categorise patients into one of eight specified groups. A subsequent 'gold standard' assessment was made by an independent blinded assessor once patients had recovered sufficiently to allow such an assessment to occur. Accuracy was predefined as agreement in >80% of assessments. One hundred and twenty-two patients received a baseline assessment and 104 (85%) were categorised to a unique category. One hundred and six patients survived to have a gold standard assessment performed, with 100 (94%) assigned to a unique category. Ninety-two patients had both a baseline and gold standard assessment, and these agreed in 65 (71%) patients. It was not feasible to rapidly and accurately categorise patients according to premorbid function.
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Affiliation(s)
| | | | | | | | - V Singh
- The Australian & New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University Melbourne, Victoria
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89
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Zahuranec DB, Skolarus LE, Feng C, Freedman VA, Burke JF. Activity limitations and subjective well-being after stroke. Neurology 2017; 89:944-950. [PMID: 28733341 PMCID: PMC5577967 DOI: 10.1212/wnl.0000000000004286] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 06/06/2017] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE As limitations in activities of daily living are major components of many stroke outcome scales, we examined how well activity limitations predicted subjective well-being among stroke survivors in a nationally representative survey. METHODS Individuals with a self-reported history of stroke were identified from the National Health and Aging Trends Study. Subjective well-being (primary outcome) was assessed with a validated 7-item measure (higher = greater well-being) assessing emotions (cheerful, bored, full of life, and upset) and self-realization (purpose in life, self-acceptance, and environmental mastery). Activity limitations were defined by the receipt of help in any of 11 activities of daily living/instrumental activities of daily living. Multivariable linear regression assessed predictors of well-being including medical, physical, cognitive, psychological, and environmental factors. RESULTS A total of 738 stroke survivors age 65 or older were included (57% female, 9% African American, 6% Hispanic). Activity limitations were modestly associated with well-being after adjusting for demographic characteristics and availability of assistance (estimate -0.49, 95% confidence interval -0.61 to -0.37). However, in the fully adjusted model (R2 = 0.28), neither activity limitations nor physical capacity was associated with subjective well-being. Predictors of lower well-being in the final model included depressive symptoms, chewing/swallowing problems, pain that limited activity, and restricted participation in valued life activities. Income and executive function were modestly associated with improved well-being, while comorbidities and communication technology access were not associated. CONCLUSIONS Activity limitations were not associated with stroke survivors' subjective well-being after adjustment for other factors. While some predictors of well-being after stroke were identified, the determinants of well-being remained largely unexplained.
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Affiliation(s)
- Darin B Zahuranec
- From the Stroke Program, Department of Neurology (D.B.Z., L.E.S., C.F., J.F.B.), and Institute for Social Research (V.A.F.), University of Michigan, Ann Arbor.
| | - Lesli E Skolarus
- From the Stroke Program, Department of Neurology (D.B.Z., L.E.S., C.F., J.F.B.), and Institute for Social Research (V.A.F.), University of Michigan, Ann Arbor
| | - Chunyang Feng
- From the Stroke Program, Department of Neurology (D.B.Z., L.E.S., C.F., J.F.B.), and Institute for Social Research (V.A.F.), University of Michigan, Ann Arbor
| | - Vicki A Freedman
- From the Stroke Program, Department of Neurology (D.B.Z., L.E.S., C.F., J.F.B.), and Institute for Social Research (V.A.F.), University of Michigan, Ann Arbor
| | - James F Burke
- From the Stroke Program, Department of Neurology (D.B.Z., L.E.S., C.F., J.F.B.), and Institute for Social Research (V.A.F.), University of Michigan, Ann Arbor
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90
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Berridge C, Mor V. Disparities in the Prevalence of Unmet Needs and Their Consequences Among Black and White Older Adults. J Aging Health 2017; 30:1427-1449. [PMID: 28737106 DOI: 10.1177/0898264317721347] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE We document differential prevalence of need for assistance with personal, instrumental, and mobility tasks and adverse consequences of unmet needs, nursing home relocation, and mortality among Black and White older adults. METHOD Data are from the National Health and Aging Trends Study. Using logistic and multinomial logistic regression, we determine whether race is predictive of reporting need or adverse consequence and test the role of race as a moderator of the relationship between baseline need and three 1-year outcomes. RESULTS Black older adults are more likely to experience a consequence of unmet need (35.33% vs. 29.97%, p = .028) in unadjusted models. In adjusted models, we find no moderating effect of race on baseline need on nursing home placement (0.00, 95% confidence interval [CI] = [-2.43, 2.42], p = .991), mortality (0.73, 95% = [-1.58, 0.11], p = .089), or a Round 2 consequence of unmet (-0.51, 95% CI = [-1.15, 0.14], p = .121). DISCUSSION This work highlights the complex relationship between race, need, unmet need, mortality, and nursing home entry.
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Affiliation(s)
| | - Vincent Mor
- 2 Brown University, Providence, RI, USA.,3 Providence VAMC Health Services Research Service
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91
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Freedman VA, Kasper JD, Spillman BC. Successful Aging Through Successful Accommodation With Assistive Devices. J Gerontol B Psychol Sci Soc Sci 2017; 72:300-309. [PMID: 27522088 DOI: 10.1093/geronb/gbw102] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 07/25/2016] [Indexed: 11/14/2022] Open
Abstract
Objectives To provide a profile of older adults who successfully accommodate declines in capacity by using assistive devices. Method Using the National Health and Aging Trends Study, we provide national estimates of prevalent, incident, and persistent successful accommodation of mobility and self-care activity limitations. For incident and persistent accommodation groups, we describe their subjective wellbeing and participation restrictions, health and functioning, demographic and socioeconomic characteristics, and acquisition of assistive devices and environmental features. We estimate regression models predicting incident and persistent successful accommodation and the extent of wellbeing and participation restrictions for incident and persistent groups (vs. those who are fully able). Results Nearly one-quarter of older adults have put in place accommodations that allow them to carry out daily activities with no assistance or difficulty. In adjusted models, incident and persistent successful accommodation is more common for those ages 80-89, those with more children, and those living in homes with environmental features already installed; wellbeing levels for these groups are similar and participation restrictions only slightly below those who are fully able. Discussion A focus on facilitating successful accommodation among those who experience declines in capacity may be an effective means of promoting participation and wellbeing in later life.
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Affiliation(s)
- Vicki A Freedman
- Institute for Social Research, University of Michigan, Ann Arbor
| | - Judith D Kasper
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
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92
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Cohen SA, Cook SK, Sando TA, Brown MJ, Longo DR. Socioeconomic and Demographic Disparities in Caregiving Intensity and Quality of Life in Informal Caregivers: A First Look at the National Study of Caregiving. J Gerontol Nurs 2017; 43:17-24. [PMID: 28253411 DOI: 10.3928/00989134-20170224-01] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 01/23/2017] [Indexed: 07/13/2024]
Abstract
Informal caregiving is an integral component of the health care system, saving the national economy more than $522 billion annually. The current study examined how the association between caregiving intensity and caregiver quality of life varies by sociodemographic factors through a secondary analysis of the National Study of Caregiving. Generalized linear models assessed the associations among four aspects of caregiving intensity, three aspects of caregiver quality of life, and key sociodemographic factors. Compared to White individuals, Black individuals had higher levels of overall caregiving intensity (β = 0.293, 95% confidence interval [CI] [0.140, 0.447]), number of instrumental activities of daily living performed (β = 0.060, 95% CI [0.030, 0.090]), and hours spent caregiving per month (β = 0.025, 95% CI [0.002, 0.049]), yet experienced significantly fewer negative impacts on quality of life. Understanding how informal caregiving affects caregiver quality of life is critical to inform public health policies and programs designed to support caregivers and protect this critical component of the U.S. health care system. [Journal of Gerontological Nursing, 43(6), 17-24.].
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93
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Does economic vulnerability moderate the association between transportation mode and social activity restrictions in later life? AGEING & SOCIETY 2017. [DOI: 10.1017/s0144686x17000411] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
ABSTRACTTransportation is critical to older adults’ ability to participate in social activities in their community. We examined the association between modes of transportation and restrictions in social activity (i.e.visiting with others, religious attendance, clubs and organised activities, and going out for enjoyment), with particular attention to the moderating effects of economic vulnerability. We used logistic regression to analyse data from 7,197 community-dwelling older adults from the 2011 wave of the National Health and Aging Trends Study, a representative sample of adults aged 65 and over in the United States of America. Economic vulnerability moderated the association between transportation mode and social activity restrictions. Findings suggest that even when economically vulnerable older adults have access to driving, walking or public transit, they may be at a higher risk for social exclusion than their counterparts with more financial resources.
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94
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Frochen S, Mehdizadeh S. Functional Status and Adaptation: Measuring Activities of Daily Living and Device Use in the National Health and Aging Trends Study. J Aging Health 2017; 30:1136-1155. [DOI: 10.1177/0898264317707299] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: The objective of this study is to evaluate the functional status and adaptation of older Americans and discover the factors that contribute to device use. Method: Using the community participants’ portion of the first round of National Health and Aging Trends Study (NHATS), we demonstrate the prevalence of device use and reduction in activities, creating a multilevel measure of activities of daily living (ADL) functionality as compared with Katz’s dichotomous measure. In determining whether adaptation is universal irrespective of age, sex, race, living arrangement, and income, or dependent on these variables, we create a measure of device use, performing a path analysis of the device use measure and sociodemographic variables, with disability score as an intervening measure. Results: ADL functionality becomes more nuanced between the Katz-ADL and NHATS-ADL. Age, sex, and living arrangement were predictors of device use; income was indirectly, whereas race was not. Discussion: When assessors design service plans, consideration should be given to older adults’ ability, capacity, and resources to adapt.
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95
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Zeki Al Hazzouri A, Mayeda ER, Elfassy T, Lee A, Odden MC, Thekkethala D, Wright CB, Glymour MM, Haan MN. Perceived Walking Speed, Measured Tandem Walk, Incident Stroke, and Mortality in Older Latino Adults: A Prospective Cohort Study. J Gerontol A Biol Sci Med Sci 2017; 72:676-682. [PMID: 27549992 PMCID: PMC5964741 DOI: 10.1093/gerona/glw169] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 07/18/2016] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Walking speed is associated with functional status and all-cause mortality. Yet the relationship between walking speed and stroke, also a leading cause of disability, remains poorly understood, especially in older Latino adults who suffer from a significant burden of stroke. METHODS A total of 1,486 stroke-free participants from the Sacramento Area Latino Study on Aging, aged 60 and older at baseline in 1998-1999, were followed annually through 2010. Participants reported their usual walking speed outdoors which was classified into slow, medium, or fast. We also assessed timed tandem walk ability (unable or eight or more errors vs less than eight errors). We ascertained three incident stroke endpoints: total stroke, nonfatal stroke, and fatal stroke. Using Cox proportional hazards models, we estimated hazard ratios (HRs) for stroke at different walking speed and timed tandem walk categories. RESULTS Over an average of 6 years of follow-up (SD = 2.8), the incidence rate of total strokes was 23.2/1,000 person-years for slow walkers compared to 15.6/1,000 person-years for medium walkers, and 7.6/1,000 person-years for fast walkers. In Cox models adjusted for sociodemographics, cardiovascular risk, cognition and functional status, and self-rated health, the hazard of total stroke was 31% lower for medium walkers (HR: 0.69, 95% confidence interval [CI]: 0.47, 1.02) and 56% lower for fast walkers (HR: 0.44, 95% CI: 0.24, 0.82) compared with slow walkers. We found similar associations with timed tandem walk ability (fully adjusted HR: 0.66, 95% CI: 0.45, 0.98). CONCLUSIONS Our findings suggest perceived walking speed captures more than self-rated health alone and is a strong risk factor for stroke risk in Latino older adults.
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Affiliation(s)
- Adina Zeki Al Hazzouri
- Division of Epidemiology, Department of Public Health Sciences, University of Miami, Florida
| | - Elizabeth Rose Mayeda
- Department of Epidemiology & Biostatistics, School of Medicine, University of California San Francisco
| | - Tali Elfassy
- Division of Epidemiology, Department of Public Health Sciences, University of Miami, Florida
| | - Anne Lee
- Department of Epidemiology & Biostatistics, School of Medicine, University of California San Francisco
| | - Michelle C Odden
- College of Public Health and Human Sciences, Oregon State University, Corvallis
| | - Divya Thekkethala
- College of Public Health and Human Sciences, Oregon State University, Corvallis
| | - Clinton B Wright
- Department of Neurology, Miller School of Medicine and
- Evelyn F. McKnight Brain Institute, Miller School of Medicine, University of Miami, Florida
| | - Maria M Glymour
- Department of Epidemiology & Biostatistics, School of Medicine, University of California San Francisco
| | - Mary N Haan
- Department of Epidemiology & Biostatistics, School of Medicine, University of California San Francisco
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96
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The role of the environment in falls among stroke survivors. Arch Gerontol Geriatr 2017; 72:1-5. [PMID: 28482268 DOI: 10.1016/j.archger.2017.04.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 04/10/2017] [Accepted: 04/28/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND Stroke survivors' risk of falls may be particularly sensitive to the environment due to deficits such as visuospatial neglect or homonymous hemianopia. We sought to identify the prevalence of falls among stroke survivors and investigate the possible role of the environment in falling. MATERIALS AND METHODS Data from the National Health and Aging Trends Study (NHATS), a nationally representative population of community-dwelling adults over 65, were used. We compared the prevalence of falling in the past month between stroke survivors and demographic and comorbidity matched controls using sequential Poisson regression models. RESULTS The proportion of stroke survivors reporting a fall in the previous month was 18.8% compared to 10.8% among matched controls (PR: 1.74; 95% CI: 1.36-2.25). These differences were attenuated after adjusting for known confounders, mediators and aspects of the environment (PR: 1.17; 95% CI: 0.86-1.60). Indoor tripping hazards were associated with falls (PR: 1.24; 95% CI: 1.01-1.53). The association between stroke and falls was modified by neighborhood social disorder, such that in areas of low social disorder, falls in the previous month were more common in stroke survivors compared to non-stroke controls. CONCLUSIONS The difference in falls among stroke survivors and matched controls is largely explained by known risk factors and physical capacity. Indoor tripping hazards were associated with falls among stroke survivors and matched controls. Explanations of why the association between stroke and falls was protective in areas of high social disorder are unclear, but may warrant additional research.
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97
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Skolarus LE, Freedman VA, Feng C, Burke JF. African American Stroke Survivors: More Caregiving Time, but Less Caregiving Burden. Circ Cardiovasc Qual Outcomes 2017; 10:CIRCOUTCOMES.116.003160. [PMID: 28228451 DOI: 10.1161/circoutcomes.116.003160] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 12/22/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Blacks have higher stroke incidence and experience greater poststroke disability than whites. To optimize care for stroke survivors, it is important to understand the amount of care that they receive and the implications for stroke caregivers. METHODS AND RESULTS Data from 2 nationally representative, population-based studies, the NHATS (National Health and Aging Trends Study) linked to the NSOC (National Study of Caregiving), were used to identify elderly stroke survivors and their caregivers. We compared hours of care received and unmet activity need among the 581 white and 225 black stroke survivors. We then performed racial comparisons of positive and negative aspects of caregiving reported by caregivers of black and white stroke survivors. Black stroke survivors were more likely than white stroke survivors to have a caregiver (62.5% versus 49.7%; P<0.01) and received on average more hours of help per week (31.7 versus 20.5; P<0.01). There was little racial difference in unmet need for assistance. Caregivers of black stroke survivors reported more positive aspects of caregiving than caregivers of white stroke survivors (6.8 versus 6.0; P<0.01). There was no racial difference in negative aspects of caregiving, depression, or anxiety. CONCLUSIONS Black stroke survivors received an average of ≈11 more hours of care than white stroke survivors without substantial differences in unmet need. Despite providing more hours of care, caregivers of black stroke were more positive about their caregiver role than caregivers of white stroke survivors.
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Affiliation(s)
- Lesli E Skolarus
- From the Stroke Program, Department of Neurology (L.E.S., C.F., J.F.B.) and Institute for Social Research (V.A.F.), University of Michigan, Ann Arbor; and Center for Clinical Management and Research, Ann Arbor VA, MI (J.F.B.).
| | - Vicki A Freedman
- From the Stroke Program, Department of Neurology (L.E.S., C.F., J.F.B.) and Institute for Social Research (V.A.F.), University of Michigan, Ann Arbor; and Center for Clinical Management and Research, Ann Arbor VA, MI (J.F.B.)
| | - Chunyang Feng
- From the Stroke Program, Department of Neurology (L.E.S., C.F., J.F.B.) and Institute for Social Research (V.A.F.), University of Michigan, Ann Arbor; and Center for Clinical Management and Research, Ann Arbor VA, MI (J.F.B.)
| | - James F Burke
- From the Stroke Program, Department of Neurology (L.E.S., C.F., J.F.B.) and Institute for Social Research (V.A.F.), University of Michigan, Ann Arbor; and Center for Clinical Management and Research, Ann Arbor VA, MI (J.F.B.)
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98
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Brenner AB, Clarke PJ. Understanding Socioenvironmental Contributors to Racial and Ethnic Disparities in Disability Among Older Americans. Res Aging 2016; 40:103-130. [PMID: 27909061 DOI: 10.1177/0164027516681165] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Our understanding of the mechanisms through which racial/ethnic disparities in disability in older adults develop and are maintained is limited. We examined the role of physical impairment, socioeconomic factors and health for racial/ethnic disparities in activities of daily living (ADL), and the modifying role of the indoor home environment. Data come from the National Health and Aging Trends Study ( N = 5,640), and negative binomial regression models were specified separately for men and women. Blacks and Hispanics reported more ADL difficulty than Whites. Living in homes with clutter was associated with higher rates of ADL difficulty, but it was not related to racial/ethnic disparities. Racial/ethnic differences were explained by physical impairment for men, but not for women. Socioeconomic factors and health accounted for remaining disparities for Black, but not for Hispanic women. Attention to individual and environmental factors is necessary to fully understand and address race/ethnic disparities in disability in older Americans.
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Affiliation(s)
- Allison B Brenner
- 1 Survey Research Center at the Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Philippa J Clarke
- 1 Survey Research Center at the Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
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99
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Brenner AB, Burke JF, Skolarus LE. Moving Toward an Understanding of Disability in Older U.S. Stroke Survivors. J Aging Health 2016; 30:75-104. [PMID: 27605555 DOI: 10.1177/0898264316666125] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVES We test a comprehensive model of disability in older stroke survivors and determine the relative contribution of neighborhood, economic, psychological, and medical factors to disability. METHOD The sample consisted of 728 stroke survivors from the National Health and Aging Trends Study (NHATS), who were 65 years and older living in community settings or residential care. Confirmatory factor analysis and structural equation modeling were used to test relationships between neighborhood, socioeconomic, psychological, and medical factors, and disability. RESULTS Economic and medical context were associated with disability directly and indirectly through physical impairment. Neighborhood context was associated with disability, but was only marginally statistically significant ( p = .05). The effect of economic and neighborhood factors was small compared with that of medical factors. DISCUSSION Neighborhood and economic factors account for a portion of the variance in disability among older stroke survivors beyond that of medical factors.
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100
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Iwashyna TJ, Deane AM. Individualizing endpoints in randomized clinical trials to better inform individual patient care: the TARGET proposal. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2016; 20:218. [PMID: 27485596 PMCID: PMC4971746 DOI: 10.1186/s13054-016-1388-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 06/14/2016] [Indexed: 01/11/2023]
Abstract
In practice, critical care practitioners individualize treatments and goals of care for each patient in light of that patient’s acute and chronic pathophysiology, as well as their beliefs and values. Yet critical care researchers routinely measure one endpoint for all patients during randomized clinical trials (RCTs), eschewing any such individualization. More recent methodology work has explored the possibility that enrollment criteria in RCTs can be individualized, as can data analysis plans. Here we propose that the specific endpoints of a RCT can be individualized—that is, different patients within a single RCT might have different secondary endpoints measured. If done rigorously and objectively, based on pre-randomization data, such individualization of endpoints may improve the bedside usefulness of information obtained during a RCT, while perhaps also improving the power and efficiency of any RCT. We discuss the theoretical underpinnings of this proposal in light of related innovations in RCT design such as sliding dichotomies. We discuss what a full elaboration of such individualization would require, and outline a pragmatic initial step towards the use of “individualized secondary endpoints” in a large RCT evaluating optimal enteral nutrition targets in the critically ill.
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Affiliation(s)
- Theodore J Iwashyna
- Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia. .,Department of Internal Medicine, University of Michigan, 2800 Plymouth Road, NCRC Bldg 16, Room 326 W, Ann Arbor, MI, 48109, USA. .,Center for Clinical Management Research, VA Ann Arbor Health System, Ann Arbor, MI, USA.
| | - Adam M Deane
- Department of Critical Care Services, Royal Adelaide Hospital, Adelaide, Australia.,Discipline of Acute Care Medicine, The University of Adelaide, Adelaide, Australia.,National Health and Medical Research Council of Australia, Centre for Research Excellence in Translating Nutritional Science to Good Health, Adelaide, Australia
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