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Jiroumaru T, Hyodo Y, Wachi M, Shichiri N, Ochi J, Fujikawa T. Relationship between walking speed, respiratory muscle strength, and dynamic balance in community-dwelling older people who required long-term care or support and used a daycare center. PeerJ 2023; 11:e16630. [PMID: 38144200 PMCID: PMC10749086 DOI: 10.7717/peerj.16630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 11/16/2023] [Indexed: 12/26/2023] Open
Abstract
Background Focusing on the relationship between frail older people and gait speed is vital to minimize the need for long-term care or increased support. The relationship between gait speed, respiratory muscle strength, and dynamic balance, is not well understood in older people requiring long-term care or support. Therefore, this study aimed to provide new insights into the relationship between gait speed, respiratory muscle strength, and dynamic balance in community-dwelling older people who required long-term care or support and used a daycare center. Methods This was a cross-sectional study of 49 community-dwelling older people (21 men, 28 women) aged ≥65 years who were certified as requiring long-term care or support under the Japanese system. The participants' maximal inspiratory pressure (PImax), maximal expiratory pressure (PEmax), walking speed (maximal and normal walking speed), and maximal double-step length test (MDST) results were recorded. The measurement data were evaluated using Pearson's correlation coefficient and multiple regression analysis. Results Pearson's correlation coefficient revealed correlations between PImax and the following: maximal walking speed (r = 0.606, p < 0.001), normal walking speed (r = 0.487, p < 0.001), and MDST (r = 0.435, p = 0.002). Correlations were also observed between PEmax and the following: maximal walking speed (r = 0.522, p < 0.001), normal walking speed (r = 0.467, p < 0.001), and MDST (r = 0.314, p = 0.028). Moreover, a correlation was found between MDST and both maximal walking speed and (r = 0.684, p < 0.001) and normal walking speed (r = 0.649, p < 0.001). The effect size was 0.379. Multiple regression analysis using a forced entry method with maximal walking speed as the dependent variable showed that maximal walking speed was significantly associated with MDST (p < 0.001) and PEmax (p = 0.036), with an effect size of 0.272. The model's adjusted coefficient of determination was 0.593 (p < 0.001). Multiple regression analysis using a forced entry method with normal walking speed as the dependent variable showed that normal walking speed was significantly associated with MDST (p < 0.001) and PEmax (p = 0.021), with an effect size of 0.272. The model's adjusted coefficient of determination was 0.497 (p < 0.001). Multiple regression analysis using a forced entry method with MDST as the dependent variable showed that MDST was significantly associated with PImax (p < 0.025), with an effect size of 0.243. The model's adjusted coefficient of determination was 0.148 (p = 0.017). Conclusions Respiratory muscle strength and dynamic balance were related to walking speed in older people requiring long-term care or support.
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Affiliation(s)
- Takumi Jiroumaru
- Department of Physical Therapy, School of Health Sciences, Bukkyo University, Kyoto Nakagyo-ku, Kyoto, Japan
| | - Yutaro Hyodo
- Department of Rehabilitation, Kanazawa Orthopaedic and Sports Medicine Clinic, Ritto, Shiga, Japan
| | - Michio Wachi
- Department of Physical Therapy, School of Health Sciences, Bukkyo University, Kyoto Nakagyo-ku, Kyoto, Japan
| | - Nobuko Shichiri
- Department of Occupational Therapy, School of Health Sciences, Bukkyo University, Kyoto Nakagyo-ku, Kyoto, Japan
| | - Junko Ochi
- Department of Physical Therapy, School of Health Sciences, Bukkyo University, Kyoto Nakagyo-ku, Kyoto, Japan
| | - Takamitsu Fujikawa
- Department of Physical Therapy, School of Health Sciences, Bukkyo University, Kyoto Nakagyo-ku, Kyoto, Japan
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Abay RJY, Gold LS, Cawthon PM, Andrews JS. Lean mass, grip strength, and hospital-associated disability among older adults in Health ABC. Alzheimers Dement 2022; 18:1898-1906. [PMID: 34978129 PMCID: PMC9250537 DOI: 10.1002/alz.12527] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 10/11/2021] [Accepted: 10/13/2021] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Older adults with cognitive impairment, including those with Alzheimer's disease and related dementias, are particularly at risk for hospitalization and hospital-associated disability. Understanding of key risk factors for hospital-associated disability is limited. Sarcopenia, age-related declines in muscle mass and strength, is common in older adults with cognitive impairment and may be an important risk factor for hospital-associated disability. METHODS Using data from the Health ABC Study, we examined associations of pre-hospitalization appendicular lean mass (ALM) and grip strength with the development of a new activity of daily living (ADL) disability at the next annual assessment after hospitalization. RESULTS Grip strength, but not ALM, was negatively associated with increased risk of hospital-associated ADL disability, and this association was greater among those with cognitive impairment compared to those without. DISCUSSION Lower grip strength may be an important risk factor for hospital-associated ADL disability in older adults, particularly those with cognitive impairment.
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Affiliation(s)
- Rebecca J Y Abay
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Laura S Gold
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Peggy M Cawthon
- California Pacific Medical Center Research Institute, University of California San Francisco, San Francisco, California, USA
| | - James S Andrews
- Department of Medicine, University of Washington, Seattle, Washington, USA
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How does it all end? Trends and disparities in health at the end of life. PLoS One 2022; 17:e0267551. [PMID: 35895597 PMCID: PMC9328500 DOI: 10.1371/journal.pone.0267551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 04/11/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To consider trends and disparities in end-of-life health in the US. METHODS I use data from the National Health Interview Survey, linked to death records through 2015, for respondents who died at ages 65+ to compare the prevalence of three health outcomes in the last six years of life across time, sex, age, race, and educational attainment. Self-rated health (SRH) is available for respondents interviewed in years 1987-2014, while information on activities of daily living (ADL) and instrumental activities of daily living (IADL) is available for the period 1997-2014. RESULTS By the end of the study period, individuals reported two fewer months of fair/poor health at the end of life than those dying in earlier years. In contrast, time lived with at least one activity limitation at the end of life generally remained comparable. Compared to men, women on average reported an additional year of living with an IADL limitation before death, and an additional eight months with an ADL limitation. Despite sex differences in disability, both sexes reported similar periods of fair/poor SRH before death. Similarly, while individuals who lived to older ages experienced a longer disabled period before death than individuals who died at younger ages, all age groups were equally likely to report fair/poor SRH. Black adults and adults with less formal schooling also spent more time with an end-of-life disability. For men, these racial and socioeconomic disparities lessened as death approached. For women, inequalities persisted until death. DISCUSSION These findings suggest that despite increasing life expectancy, the period of poor health and disability prior to death has not recently been extended. Black women and women with less than a high school degree, require extended support at the end of life.
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Andrews JS, Gold LS, Reed MJ, Garcia JM, McClelland RL, Fitzpatrick AL, Hough CL, Cawthon PM, Covinsky KE. Appendicular Lean Mass, Grip Strength, and the Development of Hospital-Associated Activities of Daily Living Disability among Older Adults in the Health ABC Study. J Gerontol A Biol Sci Med Sci 2021; 77:1398-1404. [PMID: 34734252 PMCID: PMC9255680 DOI: 10.1093/gerona/glab332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Half of all physical disability, including activity of daily living (ADL) disability, among older adults occurs in the setting of hospitalization. This study examines whether appendicular lean mass (ALM) and grip strength, which are commonly included in various definitions of sarcopenia, are associated with development of hospital-associated ADL disability in older adults in the Health ABC Study. METHODS Individuals hospitalized during the first 5 years of follow-up (n=1,724) were analyzed. ALM to body mass index (BMI) ratio (ALMBMI), by dual energy x-ray absorptiometry (DXA), and grip strength, by hand-held dynamometery, were assessed annually. Development of new ADL disability was assessed at the time of the next annual assessment after hospitalization. Separate regression analyses modeled the association of pre-hospitalization ALMBMI or grip strength with death before the next scheduled annual assessment. Next, among those who survived to the next annual assessment, separate regression analyses modeled the association of ALMBMI or grip strength with development of ADL disability. RESULTS Each standard deviation decrement in pre-hospitalization grip strength was associated with an adjusted 1.80 odds of new ADL disability at follow-up (95% CI: 1.18, 2.74). Low, compared to not low, grip strength (per FNIH definition) was associated with an adjusted 2.36 odds of ADL disability at follow-up (95% CI: 1.12, 4.97). ALM measures were not associated with development of hospital-associated ADL disability. ALM and grip strength measures were not associated with death. CONCLUSIONS Pre-hospitalization lower grip strength may be an important risk factor for ADL disability among older adult survivors of hospitalization.
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Affiliation(s)
| | - Laura S Gold
- Department of Radiology, University of Washington
| | - May J Reed
- Department of Medicine, University of Washington
| | - Jose M Garcia
- Department of Medicine, University of Washington.,GRECC, VA Puget Sound Health Care System
| | | | - Annette L Fitzpatrick
- Department Family Medicine, Epidemiology, and Global Health, University of Washington
| | | | - Peggy M Cawthon
- California Pacific Medical Center Research Institute, University of California San Francisco
| | - Ken E Covinsky
- Department of Medicine, University of California San Francisco
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Landré B, Fayosse A, Ben Hassen C, Machado-Fragua MD, Dumurgier J, Kivimaki M, Sabia S, Singh-Manoux A. Terminal decline in objective and self-reported measures of motor function before death: 10 year follow-up of Whitehall II cohort study. BMJ 2021; 374:n1743. [PMID: 34348957 PMCID: PMC8336001 DOI: 10.1136/bmj.n1743] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To examine multiple objective and self-reported measures of motor function for their associations with mortality. DESIGN Prospective cohort study. SETTING UK based Whitehall II cohort study, which recruited participants aged 35-55 years in 1985-88; motor function component was added at the 2007-09 wave. PARTICIPANTS 6194 participants with motor function measures in 2007-09 (mean age 65.6, SD 5.9), 2012-13, and 2015-16. MAIN OUTCOME MEASURES All cause mortality between 2007 and 2019 in relation to objective measures (walking speed, grip strength, and timed chair rises) and self-reported measures (physical component summary score of the SF-36 and limitations in basic and instrumental activities of daily living (ADL)) of motor function. RESULTS One sex specific standard deviation poorer motor function in 2007-09 (cases/total, 610/5645) was associated with an increased mortality risk of 22% (95% confidence interval 12% to 33%) for walking speed, 15% (6% to 25%) for grip strength, 14% (7% to 23%) for timed chair rises, and 17% (8% to 26%) for physical component summary score over a mean 10.6 year follow-up. Having basic/instrumental ADL limitations was associated with a 30% (7% to 58%) increased mortality risk. These associations were progressively stronger when measures were drawn from 2012-13 (mean follow-up 6.8 years) and 2015-16 (mean follow-up 3.7 years). Analysis of trajectories showed poorer motor function in decedents (n=484) than survivors (n=6194) up to 10 years before death for timed chair rises (standardised difference 0.35, 95% confidence interval 0.12 to 0.59; equivalent to a 1.2 (men) and 1.3 (women) second difference), nine years for walking speed (0.21, 0.05 to 0.36; 5.5 (men) and 5.3 (women) cm/s difference), six years for grip strength (0.10, 0.01 to 0.20; 0.9 (men) and 0.6 (women) kg difference), seven years for physical component summary score (0.15, 0.05 to 0.25; 1.2 (men) and 1.6 (women) score difference), and four years for basic/instrumental ADL limitations (prevalence difference 2%, 0% to 4%). These differences increased in the period leading to death for timed chair rises, physical component summary score, and ADL limitations. CONCLUSION Motor function in early old age has a robust association with mortality, with evidence of terminal decline emerging early in measures of overall motor function (timed chair rises and physical component summary score) and late in basic/instrumental ADL limitations.
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Affiliation(s)
- Benjamin Landré
- Université de Paris, Inserm U1153, CRESS, Epidemiology of Ageing and Neurodegenerative diseases, Paris, France
| | - Aurore Fayosse
- Université de Paris, Inserm U1153, CRESS, Epidemiology of Ageing and Neurodegenerative diseases, Paris, France
| | - Céline Ben Hassen
- Université de Paris, Inserm U1153, CRESS, Epidemiology of Ageing and Neurodegenerative diseases, Paris, France
| | - Marcos D Machado-Fragua
- Université de Paris, Inserm U1153, CRESS, Epidemiology of Ageing and Neurodegenerative diseases, Paris, France
| | - Julien Dumurgier
- Université de Paris, Inserm U1153, CRESS, Epidemiology of Ageing and Neurodegenerative diseases, Paris, France
- Cognitive Neurology Center, Lariboisière - Fernand Widal Hospital, AP-HP, Université de Paris, Paris, France
| | - Mika Kivimaki
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Séverine Sabia
- Université de Paris, Inserm U1153, CRESS, Epidemiology of Ageing and Neurodegenerative diseases, Paris, France
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Archana Singh-Manoux
- Université de Paris, Inserm U1153, CRESS, Epidemiology of Ageing and Neurodegenerative diseases, Paris, France
- Department of Epidemiology and Public Health, University College London, London, UK
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Teraoka E, Kunisawa S, Imanaka Y. Trajectories of end-of-life medical and long-term care expenditures for older adults in Japan: retrospective longitudinal study using a large-scale linked database of medical and long-term care claims. BMC Geriatr 2021; 21:403. [PMID: 34193081 PMCID: PMC8243899 DOI: 10.1186/s12877-021-02215-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 04/12/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND An accurate understanding of the current state of end-of-life care is important for healthcare planning. The objectives of this study were to examine the trajectories of end-of-life medical and long-term care expenditures and associated factors. METHODS This was a retrospective longitudinal study using a large-scale linked database of medical and long-term care claims-National Health Insurance, Advanced Elderly Medical Insurance, and long-term care insurance-covering Prefecture A in Japan. Patients aged ≥70 years who died between April 1, 2016, and March 31, 2017, were included (N = 16,084 patients; mean age = 85.1 ± 7.5 years; 7804 men (48.5%) and 8280 women (51.5%)). The outcome measures were medical expenditures (inpatient, outpatient, and prescription), long-term care expenditures, and total healthcare expenditures (the sum of medical and long-term care expenditures) during the 60 months before the date of death. We calculated each patient's monthly medical and long-term care expenditures for 60 months before the date of death and applied group-based trajectory modeling to identify distinct trajectories. Factors associated with spending trajectories were examined via multinomial logistic regression analyses. Explanatory variables included age, sex, diseases, and the medical services used. RESULTS We identified six distinct spending trajectories for the total healthcare expenditures: high persistent (45.6%), medium-to-high persistent (26.1%), early rise then high persistent (9.8%), late rise (6.4%), low persistent then very late rise (i.e., when spending starts increasing later than "late rise"; 6.4%), and progressive increase (5.7%). Factors associated with the high-persistent trajectory were chronic illnesses, various organ failures, neurodegenerative diseases, fractures, and tube feeding. The trajectory pattern of medical expenditures was similar to that of total healthcare expenditures; however, a different pattern was seen for long-term care expenditures. CONCLUSIONS Regarding combined medical and long-term care spending of the last 5 years, most patients belonged to a pattern in which the healthcare expenditures remained high, and a combination of multiple factors contributed to these patterns. This finding can offer healthcare providers a longer-term perspective on end-of-life care.
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Affiliation(s)
- Emi Teraoka
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto City, 606-8501, Japan
| | - Susumu Kunisawa
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto City, 606-8501, Japan
| | - Yuichi Imanaka
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto City, 606-8501, Japan.
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Maxwell CA, Rothman R, Wolever R, Simmons S, Dietrich MS, Miller R, Patel M, Karlekar MB, Ridner S. Development and testing of a frailty-focused communication (FCOM) aid for older adults. Geriatr Nurs 2020; 41:936-941. [PMID: 32709372 PMCID: PMC7738367 DOI: 10.1016/j.gerinurse.2020.07.003] [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] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 07/03/2020] [Accepted: 07/07/2020] [Indexed: 01/16/2023]
Abstract
The concept of frailty as it pertains to aging, health and well-being is poorly understood by older adults and the public-at-large. We developed an aging and frailty education tool designed to improve layperson understanding of frailty and promote behavior change to prevent and/or delay frailty. We subsequently tested the education tool among adults who attended education sessions at 16 community sites. Specific aims were to: 1) determine acceptability (likeability, understandability) of content, and 2) assess the likelihood of behavior change after exposure to education tool content. Results: Over 90% of participants "liked" or "loved" the content and found it understandable. Eighty-five percent of participants indicated that the content triggered a desire to "probably" or "definitely" change behavior. The desire to change was particularly motivated by information about aging, frailty and energy production. Eight focus areas for proactive planning were rated as important or extremely important by over 90% of participants.
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Affiliation(s)
- Cathy A Maxwell
- Vanderbilt University School of Nursing (VUSN), 461 21st Ave. South, Godchaux Hall 420, Nashville 37240, TN, United States.
| | - Russell Rothman
- Vanderbilt University Medical Center (VUMC), Nashville, TN, United States.
| | - Ruth Wolever
- Vanderbilt University Medical Center (VUMC), Nashville, TN, United States.
| | - Sandra Simmons
- Vanderbilt University Medical Center (VUMC), Nashville, TN, United States.
| | - Mary S Dietrich
- Vanderbilt University School of Nursing (VUSN), 461 21st Ave. South, Godchaux Hall 420, Nashville 37240, TN, United States.
| | - Richard Miller
- Vanderbilt University Medical Center (VUMC), Nashville, TN, United States.
| | - Mayur Patel
- Vanderbilt University Medical Center (VUMC), Nashville, TN, United States.
| | - Mohana B Karlekar
- Vanderbilt University Medical Center (VUMC), Nashville, TN, United States.
| | - Sheila Ridner
- Vanderbilt University School of Nursing (VUSN), 461 21st Ave. South, Godchaux Hall 420, Nashville 37240, TN, United States.
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Crist JD, Liu J, Shea KD, Peterson RL, Martin-Plank L, Lacasse CL, May JT, Wyles CL, Williams DK, Slebodnik M, Heasley BJ, Phillips LR. "Tipping point" concept analysis in the family caregiving context. Nurs Forum 2019; 54:582-592. [PMID: 31373002 DOI: 10.1111/nuf.12373] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
AIM Analyze the concept "tipping point" in the older adult family caregiving context to further knowledge about caregiving families, enhancing transdisciplinary theory, research, and practice. BACKGROUND While used commonly in some disciplines, how "tipping point" has been used in health care, generally, and in relation to caregiving families, specifically, is less clear. This project was conducted to offer conceptual clarity to tipping point. DESIGN Walker and Avant's framework. DATA SOURCE Searches of scholarly literature in PsycINFO, CINAHL, and PubMed using the search term "tipping point" in either title or abstract. REVIEW METHODS Definitions used were extracted; instances when the concept was implied but the actual term "tipping point" was not used and contexts where the term was used or implied were identified. RESULTS The composite definition of a caregiving tipping point is a seemingly abrupt, severe, and absolute change event involving either the older adult or caregiver(s), or both that indicates a breakdown in the status quo of the caregiving system. CONCLUSIONS Transdisciplinary research, care, and policy should treat caregiving families as complex systems, use longitudinal assessments, and include colloquial communication. Early detection of impending tipping points will provide family-centered decisional support and enhance families' quality of life and safety.
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Affiliation(s)
- Janice D Crist
- Community and Systems Health Science Division, College of Nursing, The University of Arizona, Tucson, Arizona
| | - Jian Liu
- Department of Systems and Industrial Engineering, The University of Arizona, Tucson, Arizona
| | - Kim D Shea
- Community and Systems Health Science Division, College of Nursing, The University of Arizona, Tucson, Arizona
| | - Rachel L Peterson
- College of Medicine, University of Arizona Center on Aging, The University of Arizona, Tucson, Arizona
| | - Lori Martin-Plank
- Community and Systems Health Science Division, College of Nursing, The University of Arizona, Tucson, Arizona
| | - Cheryl L Lacasse
- Community and Systems Health Science Division, College of Nursing, The University of Arizona, Tucson, Arizona
| | - Jennifer T May
- Community and Systems Health Science Division, College of Nursing, The University of Arizona, Tucson, Arizona
| | - Christina L Wyles
- Community and Systems Health Science Division, College of Nursing, The University of Arizona, Tucson, Arizona
| | - Deborah K Williams
- Community and Systems Health Science Division, College of Nursing, The University of Arizona, Tucson, Arizona
| | - Maribeth Slebodnik
- Arizona Health Sciences Library, College of Nursing, The University of Arizona, Tucson, Arizona
| | - Beverly J Heasley
- Community and Systems Health Science Division, College of Nursing, The University of Arizona, Tucson, Arizona
| | - Linda R Phillips
- College of Medicine, University of Arizona Center on Aging, The University of Arizona, Tucson, Arizona
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Capsule Commentary on Lunney et al., Three Year Functional Trajectories Among Old Age Survivors and Decedents: Dying Eliminates a Racial Disparity. J Gen Intern Med 2018; 33:190. [PMID: 29234977 PMCID: PMC5789117 DOI: 10.1007/s11606-017-4254-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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