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Schmucker AM, Reyes-Farias D, Nicosia FM, Xu E, B Potter M, Karliner LS, Brown RT. Caring for Patients with Functional Impairment in Middle Age: Perspectives from Primary Care Providers and Geriatricians. J Gen Intern Med 2024; 39:2292-2299. [PMID: 38489004 PMCID: PMC11347537 DOI: 10.1007/s11606-024-08701-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 02/23/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND The prevalence of functional impairment is increasing among middle-aged adults and is associated with adverse health outcomes. Primary care providers (PCPs) and geriatricians may have important insights about optimal approaches to caring for these patients, but little is known about their perspectives. OBJECTIVE To examine PCPs' and geriatricians' perspectives on clinical needs and optimal approaches to care for middle-aged patients with functional impairment. DESIGN Qualitative study using semi-structured interviews. PARTICIPANTS PCPs and geriatricians from outpatient practices in the San Francisco Bay area. APPROACH Interviews focused on characteristics and care needs of middle-aged patients with functional impairment and models of care to address these needs. We analyzed interviews using hybrid deductive-inductive qualitative thematic analysis. KEY RESULTS Clinicians (14 PCPs, 15 geriatricians) described distinct characteristics of functional impairment in middle-aged versus older adults, such as different rates of onset, but similar clinical needs. Despite these similar needs, clinicians identified age-specific barriers to delivering optimal care to middle-aged patients. These included system-level challenges such as limited access to insurance and social services; practice- and clinician-level barriers including inadequate clinician training; and patient-level factors including less access to family caregivers and perceptions of stigma. To overcome these challenges, clinicians suggested clinical approaches including addressing health-related social needs within healthcare systems; implementing practice-based models that are multi-disciplinary, team-based, and coordinated; training clinicians to effectively manage functional impairment; and expanding community-based services and supports to help patients navigate the medical system. Identified needs, challenges, and solutions were generally similar across geriatricians and PCPs. CONCLUSIONS Clinicians face challenges in delivering optimal care to middle-aged patients who have functional impairments similar to their older counterparts but lack access to services and supports available to older people. These findings suggest the importance of increasing access to care models that address functional impairment regardless of age.
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Affiliation(s)
- Abigail M Schmucker
- Department of Internal Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
| | - David Reyes-Farias
- Division of Geriatric Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
| | - Francesca M Nicosia
- Geriatrics, Palliative, and Extended Care, San Francisco VA Health Care System, San Francisco, CA, USA
- Division of Geriatrics, University of California, San Francisco, San Francisco, CA, USA
| | - Edison Xu
- Division of General Internal Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Michael B Potter
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Leah S Karliner
- Division of General Internal Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Rebecca T Brown
- Division of Geriatric Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
- Geriatrics and Extended Care Program, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
- Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
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Joundi RA, Hu B, Rangarajan S, Leong DP, Islam S, Smith EE, Mirrakhimov E, Seron P, Alhabib KF, Assembekov B, Chifamba J, Yusuf R, Khatib R, Felix C, Yusufali A, Mohammadifard N, Rosengren A, Oguz A, Iqbal R, Yeates K, Avezum A, Kruger I, Anjana R, Pvm L, Gupta R, Zatońska K, Barbarash O, Pelliza E, Rammohan K, Li M, Li X, Ismail R, Lopez-Jaramillo P, Evans M, O'Donnell M, Yusuf S. Activity limitations, use of assistive devices, and mortality and clinical events in 25 high-income, middle-income, and low-income countries: an analysis of the PURE study. Lancet 2024; 404:554-569. [PMID: 39068950 DOI: 10.1016/s0140-6736(24)01050-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 04/04/2024] [Accepted: 05/16/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND The focus of most epidemiological studies has been mortality or clinical events, with less information on activity limitations related to basic daily functions and their consequences. Standardised data from multiple countries at different economic levels in different regions of the world on activity limitations and their associations with clinical outcomes are sparse. We aimed to quantify the prevalence of activity limitations and use of assistive devices and the association of limitations with adverse outcomes in 25 countries grouped by different economic levels. METHODS In this analysis, we obtained data from individuals in 25 high-income, middle-income, and low-income countries from the Prospective Urban Rural Epidemiological (PURE) study (175 660 participants). In the PURE study, individuals aged 35-70 years who intended to continue living in their current home for a further 4 years were invited to complete a questionnaire on activity limitations. Participant follow-up was planned once every 3 years either by telephone or in person. The activity limitation screen consisted of questions on self-reported difficulty with walking, grasping, bending, seeing close, seeing far, speaking, hearing, and use of assistive devices (gait, vision, and hearing aids). We estimated crude prevalence of self-reported activity limitations and use of assistive devices, and prevalence standardised by age and sex. We used logistic regression to additionally adjust prevalence for education and socioeconomic factors and to estimate the probability of activity limitations and assistive devices by age, sex, and country income. We used Cox frailty models to evaluate the association between each activity limitation with mortality and clinical events (cardiovascular disease, heart failure, pneumonia, falls, and cancer). The PURE study is registered with ClinicalTrials.gov, NCT03225586. FINDINGS Between Jan 12, 2001, and May 6, 2019, 175 584 individuals completed at least one question on the activity limitation questionnaire (mean age 50·6 years [SD 9·8]; 103 625 [59%] women). Of the individuals who completed all questions, mean follow-up was 10·7 years (SD 4·4). The most common self-reported activity limitations were difficulty with bending (23 921 [13·6%] of 175 515 participants), seeing close (22 532 [13·4%] of 167 801 participants), and walking (22 805 [13·0%] of 175 554 participants); prevalence of limitations was higher with older age and among women. The prevalence of all limitations standardised by age and sex, with the exception of hearing, was highest in low-income countries and middle-income countries, and this remained consistent after adjustment for socioeconomic factors. The use of gait, visual, and hearing aids was lowest in low-income countries and middle-income countries, particularly among women. The prevalence of seeing close limitation was four times higher (6257 [16·5%] of 37 926 participants vs 717 [4·0%] of 18 039 participants) and the prevalence of seeing far limitation was five times higher (4003 [10·6%] of 37 923 participants vs 391 [2·2%] of 18 038 participants) in low-income countries than in high-income countries, but the prevalence of glasses use in low-income countries was half that in high-income countries. Walking limitation was most strongly associated with mortality (adjusted hazard ratio 1·32 [95% CI 1·25-1·39]) and most consistently associated with other clinical events, with other notable associations observed between seeing far limitation and mortality, grasping limitation and cardiovascular disease, bending limitation and falls, and between speaking limitation and stroke. INTERPRETATION The global prevalence of activity limitations is substantially higher in women than men and in low-income countries and middle-income countries compared with high-income countries, coupled with a much lower use of gait, visual, and hearing aids. Strategies are needed to prevent and mitigate activity limitations globally, with particular emphasis on low-income countries and women. FUNDING Funding sources are listed at the end of the Article.
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Affiliation(s)
- Raed A Joundi
- Population Health Research Institute, McMaster University, Hamilton Health Sciences, ON, Canada.
| | - Bo Hu
- Medical Research and Biometrics Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Beijing, China; National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Sumathy Rangarajan
- Population Health Research Institute, McMaster University, Hamilton Health Sciences, ON, Canada
| | - Darryl P Leong
- Population Health Research Institute, McMaster University, Hamilton Health Sciences, ON, Canada
| | | | | | | | | | | | | | | | - Rita Yusuf
- Independent University, Dhaka, Bangladesh
| | - Rasha Khatib
- Advocate Aurora Research Institute, Milwaukee, WI, USA
| | | | | | - Noushin Mohammadifard
- Isfahan Cardiovascular Research Centre, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Annika Rosengren
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Aytekin Oguz
- Istanbul Medeniyet University, Istanbul, Türkiye
| | | | | | - Alvaro Avezum
- International Research Center, Hospital Alemão Oswaldo Cruz and UNISA, São Paulo University, São Paulo, Brazil
| | | | | | - Lakshmi Pvm
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rajeev Gupta
- Eternal Heart Care Centre and Research Institute, Rajasthan, India
| | | | | | | | | | - Mengya Li
- Medical Research and Biometrics Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Beijing, China; National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaocong Li
- Medical Research and Biometrics Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Beijing, China; National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Rosnah Ismail
- Universiti Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | | | - Marc Evans
- Philippine General Hospital, Manila, Philippines
| | | | - Salim Yusuf
- Population Health Research Institute, McMaster University, Hamilton Health Sciences, ON, Canada
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Beller J, Sperlich S, Epping J, Tetzlaff J. Trends in severe functional limitations among working and non-working adults in Germany: Towards an (un)-healthy working life? Eur J Ageing 2024; 21:13. [PMID: 38652375 DOI: 10.1007/s10433-024-00809-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2024] [Indexed: 04/25/2024] Open
Abstract
We examined trends in severe functional limitations among working and non-working adults in Germany (ages 40-65). Four population-based samples of 11,615 participants were used, spanning the time periods 2002-2021. The overall prevalence of severe limitations was found to be 12.8% in the sample, but also varied from 10 to 20% according to occupational group. Over time, severe limitations were found to have increased, from 10.6% in 2002 to 13.2% in 2021. Logistic regression analysis showed that severe limitations increased significantly in certain subgroups, including working women with a low skilled white collar occupational group, working men with a low skilled blue collar occupational group and, particularly, among the whole non-working population, whereas limitations remained largely the same in the other groups, including most of the working population. In terms of expectancies, overall working life expectancy increased. Along with this increase, healthy (non-severely limited) working life expectancy increased, but this trend was accompanied by a clear increase in unhealthy working life expectancy (severely limited). Thus, although severe limitations have increased in some groups in the working-age adults, people today can expect to work more years free from severe limitations than before. In the future, potentials to increase working life expectancy may come to an end, as severe limitations increased strongly in the non-working population, which could limit the prospects for a further increase in the proportion of the population in employment. Further studies are needed to investigate the potential impact of the increasing prevalence of severe limitations on the population's ability to work.
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Affiliation(s)
- Johannes Beller
- Medical Sociology Unit, Center for Public Health and Health Care, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Stefanie Sperlich
- Medical Sociology Unit, Center for Public Health and Health Care, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Jelena Epping
- Medical Sociology Unit, Center for Public Health and Health Care, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Juliane Tetzlaff
- Medical Sociology Unit, Center for Public Health and Health Care, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
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Donnelly R, Lin Z, Umberson D. Parental Death Across the Life Course, Social Isolation, and Health in Later Life: Racial/Ethnic Disadvantage in the U.S. SOCIAL FORCES; A SCIENTIFIC MEDIUM OF SOCIAL STUDY AND INTERPRETATION 2023; 102:586-608. [PMID: 37840946 PMCID: PMC10569383 DOI: 10.1093/sf/soad027] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 01/13/2023] [Indexed: 10/17/2023]
Abstract
Bereavement is a risk factor for poor health, yet prior research has not considered how exposure to parental death across the life course may contribute to lasting social isolation and, in turn, poor health among older adults. Moreover, prior research often fails to consider the racial context of bereavement in the United States wherein Black and Hispanic Americans are much more likely than White Americans to experience parental death earlier in life. The present study uses longitudinal data from the Health and Retirement Study (HRS; 1998-2016) to consider linkages of parental death, social isolation, and health (self-rated health, functional limitations) for Black, Hispanic, and White older adults. Findings suggest that exposure to parental death is associated with higher levels of isolation, greater odds of fair/poor self-rated health, and greater odds of functional limitations in later life. Moreover, social isolation partially explains associations between parental bereavement and later-life health. These patterns persist net of psychological distress-an additional psychosocial response to bereavement. Racial inequities in bereavement are central to disadvantage: Black and Hispanic adults are more likely to experience a parent's death earlier in the life course, and this differential exposure to parental death in childhood or young adulthood has implications for racial and ethnic inequities in social isolation and health throughout life.
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Affiliation(s)
- Rachel Donnelly
- Vanderbilt University, Department of Sociology, 2101 W End Ave, Nashville, TN 37249, USA
| | - Zhiyong Lin
- University of Texas at San Antonio, Department of Sociology, One UTSA Circle, San Antonio, TX 78249, USA
| | - Debra Umberson
- University of Texas at Austin, Department of Sociology and Population Research Center, 110 Inner Campus Drive, Austin, TX 78705, USA
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5
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Abrams LR, Berkman LF. Quantifying the Contribution of Work Characteristics to Educational Disparities in Health-Induced Work Limitations. J Gerontol B Psychol Sci Soc Sci 2023; 78:1957-1964. [PMID: 37587022 PMCID: PMC10645315 DOI: 10.1093/geronb/gbad112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Indexed: 08/18/2023] Open
Abstract
OBJECTIVES To quantify how poor health and inhospitable working conditions each contribute to educational disparities in work disability in midlife and old age. METHODS We used the Health and Retirement Study (2006-2016) to examine educational disparities in reporting "any impairment or health problem that limits the kind or amount of paid work" in ages 51-80. RESULTS We found disparities to be profound and persistent over time. Blinder-Oaxaca threefold decomposition revealed that distributions of income and employer insurance made the largest contribution to explaining different rates of work limitations among respondents with versus without high school degrees, followed by work characteristics (physical job demands, insufficient hours) and health conditions (diabetes, lung disease). Comparing respondents with high school versus college degrees, distributions of health conditions mattered most (high blood pressure, lung disease, heart disease, stroke), followed by health behaviors (smoking, drinking). Health-induced work limitations are often used as a measure of health, but we found that work characteristics explained 57% of the disadvantage of those without a high school degree and 44% of the disadvantage of high school compared to college graduates. DISCUSSION Work environments appear to play an important role in educational disparities in mid- to late-life disability.
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Affiliation(s)
- Leah R Abrams
- Department of Community Health, Tufts University, Medford, Massachusetts, USA
| | - Lisa F Berkman
- Harvard Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, Cambridge, Massachusetts, USA
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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Heimbuch H, Rhee Y, Douglas M, Juhl K, Knoll K, Stastny S, McGrath R. Prevalence and Trends of Basic Activities of Daily Living Limitations in Middle-Aged and Older Adults in the United States. EPIDEMIOLOGIA 2023; 4:483-491. [PMID: 37987312 PMCID: PMC10660458 DOI: 10.3390/epidemiologia4040040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 10/12/2023] [Accepted: 11/06/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND Population-level surveillance of the prevalence and trends of basic self-care limitations will help to identify the magnitude of physical disablement in the rapidly growing older American demographic. We sought to evaluate the prevalence and trends of activities of daily living (ADL) limitations in the United States. METHODS The analytic sample included 30,418 Americans aged ≥50 years from the 2006-2018 waves of the Health and Retirement Study. ADLs were self-reported. Weighted prevalence estimates were presented, and trends analyses were performed. RESULTS Although overall ADL disability prevalence was 16.5% (95% confidence interval: 15.8-17.2) in 2018, there were no changes in limitations during the study period (p = 0.52). Older adults had a greater ADL disability prevalence than middle-aged adults (p < 0.001). While older persons experienced a declining trend of ADL limitations (p < 0.001), middle-aged persons had an increasing trend (p < 0.001). Males had a lower ADL limitation prevalence than females (p < 0.001). Hispanic and non-Hispanic Black had a higher ADL disability prevalence than non-Hispanic White (p < 0.001). CONCLUSIONS This investigation revealed that while the estimated prevalence of ADL limitations in the United States was substantial, changes in such limitations were not observed. Our findings can help guide ADL screening, target sub-populations with an elevated ADL limitation prevalence, and inform interventions.
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Affiliation(s)
- Halli Heimbuch
- Healthy Aging North Dakota (HAND), North Dakota State University, Fargo, ND 58102, USA
- Department of Health, Nutrition, and Exercise Sciences, Fargo, ND 58108, USA
| | - Yeong Rhee
- Department of Health, Nutrition, and Exercise Sciences, Fargo, ND 58108, USA
| | - Marty Douglas
- Department of Health, Nutrition, and Exercise Sciences, Fargo, ND 58108, USA
| | - Kirsten Juhl
- Sanford Health, Fargo, ND 58102, USA
- Department of Internal Medicine, University of North Dakota, Grand Forks, ND 58202, USA
| | - Kelly Knoll
- Healthy Aging North Dakota (HAND), North Dakota State University, Fargo, ND 58102, USA
- Department of Health, Nutrition, and Exercise Sciences, Fargo, ND 58108, USA
| | - Sherri Stastny
- Department of Health, Nutrition, and Exercise Sciences, Fargo, ND 58108, USA
| | - Ryan McGrath
- Healthy Aging North Dakota (HAND), North Dakota State University, Fargo, ND 58102, USA
- Department of Health, Nutrition, and Exercise Sciences, Fargo, ND 58108, USA
- Fargo VA Healthcare System, Fargo, ND 58102, USA
- Department of Geriatrics, University of North Dakota, Grand Forks, ND 58202, USA
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, Adelaide 5000, Australia
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Beller J, Epping J, Sperlich S, Tetzlaff J. Changes in disability over time among older working-age adults: Which global and specific limitations are increasing in Germany using the SHARE-data from 2004 to 2015? SAGE Open Med 2023; 11:20503121231184012. [PMID: 37435099 PMCID: PMC10331346 DOI: 10.1177/20503121231184012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 06/07/2023] [Indexed: 07/13/2023] Open
Abstract
Objectives Previous studies have observed increasing limitations among the middle-aged, including those aged 40-64, raising the question how healthy work participation has changed. Helping answer this question, we ask: How have general and specific limitations changed in working and non-working adults in Germany? Methods We used population-based data of older working-age adults, aged 50-64 years old, from Germany provided by the Survey of Health Aging and Retirement (SHARE) study from 2004 to 2014 (N = 3522). Multiple logistic regression analyses were used to study changes in limitations over time. Results We found that employment rates generally increased over time, whereas limitation rates mostly increased among participants aged 50-54 and mostly decreased among participants aged 60-64 in both the working and non-working population. Regarding type of disability, increases were more pronounced with movement-related and general activity-related limitations. Conclusion Therefore, if the comparatively younger more-limited cohorts age and replace the older less-limited cohorts, a larger part of the working and non-working life might be expected to be spent with limitations in the future, and it seems questionable whether further substantial increases in healthy work participation can be achieved. Further prevention efforts and assistance should be directed at current middle-aged cohorts to improve and maintain their health, including adapting current working conditions to a work force with more limitations.
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Sun F, Zimmer Z, Zajacova A. Pain and Disability Transitions Among Older Americans: The Role of Education. THE JOURNAL OF PAIN 2023; 24:1009-1019. [PMID: 36706888 PMCID: PMC10257745 DOI: 10.1016/j.jpain.2023.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 01/06/2023] [Accepted: 01/17/2023] [Indexed: 01/25/2023]
Abstract
Previous literature has rarely examined the role of pain in the process of disablement. We investigate how pain associates with disability transitions among older adults, using educational attainment as a moderator. Data are from the National Health and Aging Trends Study, N = 6,357; 33,201 1 year transitions between 2010 to 2020. We estimate multinomial logistic models predicting incidence or onset of and recovery from functional limitation and disability. Results show pain significantly predicts functional limitation and disability onset 1 year after a baseline observation, and decreases odds of recovery from functional limitation or disability. Contrary to expectations, higher education does not buffer the association of pain in onset of disability, but supporting expectations, it facilitates recovery from functional limitation or disability among those with pain. The analysis implicates pain as having a key role in the disablement process and suggests that education may moderate this with respect to coping with and subsequently recovering from disability. PERSPECTIVE: This article is among the first examining how pain is placed in the disablement process by affecting onset of and recovery from disability. Both paths are affected by pain, but education moderates the association only with respect to the recovery process.
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Affiliation(s)
- Feinuo Sun
- Global Aging and Community Initiative, Mount Saint Vincent University, Halifax, Nova Scotia, Canada.
| | - Zachary Zimmer
- Global Aging and Community Initiative, Mount Saint Vincent University, Halifax, Nova Scotia, Canada; Department of Family Studies and Gerontology, Mount Saint Vincent University, Halifax, Nova Scotia, Canada
| | - Anna Zajacova
- Department of Sociology, University of Western Ontario, London, Ontario, Canada
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Pan C, Cao N, Kelifa MO, Luo S. Age and cohort trends in disability among Chinese older adults. Front Public Health 2023; 11:998948. [PMID: 36969644 PMCID: PMC10031081 DOI: 10.3389/fpubh.2023.998948] [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: 07/20/2022] [Accepted: 02/03/2023] [Indexed: 03/29/2023] Open
Abstract
Objective This study aimed to examine age and cohort trends in disability among Chinese older adults and explore the disablement process factors that may explain the cohort trends in disability. Methods This study used data from five waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS). A hierarchical logistic growth model was used to analyze the A-P-C effects and the contributors of cohort trends. Results ADL, IADL, and FL among Chinese older adults showed increasing age and cohort trends. FL was more likely to result in IADL disability than ADL disability. Among the disablement process factors, gender, residence, education, health behavior, disease, and family income contributed to most of the cohort trends in disability. Conclusions As older adults face increasing disability trends, it is necessary to distinguish age and cohort trends and develop more effective interventions according to relative contributors to prevent disability among them.
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Affiliation(s)
- Chaoping Pan
- School of Public Health, Wuhan University, Wuhan, Hubei, China
| | - Na Cao
- School of Public Health, Wuhan University, Wuhan, Hubei, China
- Na Cao
| | | | - Shuren Luo
- The Second Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
- *Correspondence: Shuren Luo
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Xu E, Nicosia FM, Zamora K, Barrientos M, Spar MJ, Reyes-Farias D, Karliner LS, Potter MB, Brown RT. When Functional Impairment Develops Early: Perspectives from Middle-Aged Adults. J Gen Intern Med 2023; 38:90-97. [PMID: 35391621 PMCID: PMC9849615 DOI: 10.1007/s11606-022-07541-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 03/29/2022] [Indexed: 01/22/2023]
Abstract
BACKGROUND Difficulty performing basic daily activities such as bathing and dressing ("functional impairment") affects more than 15% of middle-aged people, and this proportion is increasing. Little is known about the experiences and needs of individuals who develop functional impairment in middle age. OBJECTIVE To examine the experiences and needs of adults who developed functional impairment in middle age. DESIGN Qualitative study using semi-structured interviews. PARTICIPANTS Forty patients aged 50-64 years who developed functional impairment in middle age, recruited from four primary care clinics in San Francisco. APPROACH Interviews included open-ended questions about participants' daily life, ability to perform activities of daily living (ADLs), and needs related to functional impairment. We analyzed interviews using qualitative thematic analysis. KEY RESULTS Interviews revealed several themes related to the psychosocial and physical impacts of developing functional impairment in middle age. Participants noted that losses associated with functional impairment, such as loss of independence, control, and social roles, caused conflict in their sense of identity. To cope with these losses, participants used strategies including acceptance, social comparison, adjusting standards, and engaging in valued life activities. Participants reflected on the intersection of their functional impairment with the aging process, noting that their impairments seemed premature compared to the more "natural" aging process in older adults. In terms of physical impacts, participants described how a lack of accommodations in the built environment exacerbated their impairments. While participants used behavioral strategies to overcome these challenges, unmet needs remained, resulting in downstream physical and psychological impacts including safety risks, falls, frustration, and fear. CONCLUSIONS Unmet psychosocial and physical needs were common among middle-aged adults with functional impairment and led to negative downstream effects. Eliciting and addressing unmet needs may help mitigate downstream health consequences for this growing population, optimizing function and quality of life.
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Affiliation(s)
- Edison Xu
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
- Geriatrics, Palliative, and Extended Care, San Francisco VA Health Care System, San Francisco, CA, USA.
- Division of Geriatrics, University of California, San Francisco, San Francisco, CA, USA.
| | - Francesca M Nicosia
- Geriatrics, Palliative, and Extended Care, San Francisco VA Health Care System, San Francisco, CA, USA
- Division of Geriatrics, University of California, San Francisco, San Francisco, CA, USA
| | - Kara Zamora
- Geriatrics, Palliative, and Extended Care, San Francisco VA Health Care System, San Francisco, CA, USA
- Division of Geriatrics, University of California, San Francisco, San Francisco, CA, USA
| | - Maureen Barrientos
- Geriatrics, Palliative, and Extended Care, San Francisco VA Health Care System, San Francisco, CA, USA
- Division of Geriatrics, University of California, San Francisco, San Francisco, CA, USA
| | - Malena J Spar
- Geriatrics, Palliative, and Extended Care, San Francisco VA Health Care System, San Francisco, CA, USA
- Division of Geriatrics, University of California, San Francisco, San Francisco, CA, USA
| | - David Reyes-Farias
- Division of Geriatric Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
| | - Leah S Karliner
- Division of General Internal Medicine, Multiethnic Health Equity Research Center, University of California, San Francisco, San Francisco, CA, USA
| | - Michael B Potter
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Rebecca T Brown
- Division of Geriatric Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
- Geriatrics and Extended Care Program, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
- Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
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11
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Beller J, Luy M, Giarelli G, Regidor E, Lostao L, Tetzlaff J, Geyer S. Trends in Activity Limitations From an International Perspective: Differential Changes Between Age Groups Across 30 Countries. J Aging Health 2022:8982643221141123. [DOI: 10.1177/08982643221141123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Objectives: Examine trends in limitations among young (15–39), middle-aged (40–64) and older age-groups (>=65) and their socioeconomic differences. Methods: Population-based European Social Survey data ( N = 396,853) were used, covering 30 mostly European countries and spanning the time-period 2002–2018. Limitations were measured using a global activity limitations indicator. Results: Age-differential trends in limitations were found. Activity limitations generally decreased in older adults, whereas trends varied among younger and middle-aged participants, with decreasing limitations in some countries but increasing limitations in others. These age-differential trends were replicated across limitation severity and socioeconomic groups; however, stronger limitation increases occurred regarding less-severe limitations. Discussion: Functional health has improved in older adults. Contrarily, the increasing limitations in younger and middle-aged individuals seem concerning, which were mostly observed in Western and Northern European countries. Given its public health importance, future studies should investigate the reasons for this declining functional health in the young and middle-aged.
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Affiliation(s)
| | - Marc Luy
- Vienna Institute of Demography, Austrian Academy of Sciences, Austria
| | - Guido Giarelli
- Department of Health Sciences, University “MAGNA GRAECIA” Catanzaro, Italy
| | - Enrique Regidor
- Department of Public Health & Maternal and Child Health, Complutense University of Madrid, Spain
| | - Lourdes Lostao
- Department of Sociology, Public University of Navarre, Germany
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12
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Choi H, Schoeni RF, Steptoe A, Cho TC, Langa KM. Differential Trends in Disability Among Rich and Poor Adults in the United States and England From 2002 to 2016. J Gerontol B Psychol Sci Soc Sci 2022; 77:S189-S198. [PMID: 35191479 PMCID: PMC9154230 DOI: 10.1093/geronb/gbac029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Disability in the United States has not improved in recent decades. Comparing temporal trends in disability prevalence across different income groups, both within and between the United States and England, would inform public policy aimed at reducing disparities in disability. METHODS Using the Health and Retirement Study and the English Longitudinal Study of Ageing, we estimated annual percent change from 2002 to 2016 in disability among community-dwelling adults (197,021 person-years of observations). Disability was defined based on self-report of limitations with 5 instrumental activities of daily living and 6 activities of daily living. We examined the trends by age and income quintile and adjusted for individual-level sociodemographic status and survey design. RESULTS The adjusted annual percent change (AAPC) in disability prevalence declined significantly in both countries for ages 75 and older during 2002-2016. For ages 55-64 and 65-74, disability prevalence was unchanged in the United States but declined in England. Both countries experienced a widening gap in disability between low- and high-income adults among the younger age groups. For example, for those ages 55-64 in each country, there was no significant improvement in disability for the low-income group but a significant improvement for the high-income group (AAPC = -3.60; 95% confidence interval [CI; -6.57, -0.63] for the United States; AAPC = -6.06; 95% CI [-8.77, -3.35] for England). DISCUSSION Improvements in disability were more widespread in England than in the United States between 2002 and 2016. In both countries, the disparity in disability between low- and high-income adults widened for middle-aged adults. Policies targeted at preventing disability among low-income adults should be a priority in both countries.
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Affiliation(s)
- HwaJung Choi
- Department of Internal Medicine, School of Medicine, University of Michigan, Ann Arbor, Michigan, USA.,Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Robert F Schoeni
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA.,Gerald R. Ford School of Public Policy, University of Michigan, Ann Arbor, Michigan, USA
| | - Andrew Steptoe
- Department of Behavioural Science and Health, University College London, London, UK
| | - Tsai-Chin Cho
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Kenneth M Langa
- Department of Internal Medicine, School of Medicine, University of Michigan, Ann Arbor, Michigan, USA.,Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
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13
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Wahl HW, Drewelies J, Duezel S, Lachman ME, Smith J, Eibich P, Steinhagen-Thiessen E, Demuth I, Lindenberger U, Wagner GG, Ram N, Gerstorf D. Subjective age and attitudes toward own aging across two decades of historical time. Psychol Aging 2022; 37:413-429. [PMID: 34694838 PMCID: PMC9487183 DOI: 10.1037/pag0000649] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
A large body of empirical evidence has accumulated showing that the experience of old age is "younger," more "agentic," and "happier" than ever before. However, it is not yet known whether historical improvements in well-being, control beliefs, cognitive functioning, and other outcomes generalize to individuals' views on their own aging process. To examine historical changes in such views on aging, we compared matched cohorts of older adults within two independent studies that assessed differences across a two-decade interval, the Berlin Aging Studies (BASE; 1990/1993 vs. 2017/2018, each n = 256, Mage = 77) and the Midlife in the United States Study (MIDUS; 1995/1996 vs. 2013/14, each n = 848, Mage = 67). Consistent across four different dimensions of individuals' subjective views on aging (age felt, age appeared, desired age, and attitudes toward own aging) in the BASE and corroborated with subjective age felt and subjective age desired in the MIDUS, there was no evidence whatsoever that older adults of today have more favorable views on how they age than older adults did two decades ago. Further, heterogeneity in views on aging increased across two decades in the MIDUS but decreased in BASE. Also consistent across studies, associations of views on aging with sociodemographic, health, cognitive, and psychosocial correlates did not change across historical times. We discuss possible reasons for our findings, including the possibility that individual age views may have become increasingly decoupled from societal age views. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- Hans-Werner Wahl
- Network Aging Research & Institute of Psychology, Heidelberg University, Heidelberg, Germany
| | - Johanna Drewelies
- Department of Psychology, Humboldt University Berlin, Berlin, Germany
| | - Sandra Duezel
- Center for Lifespan Psychology, Max Planck Institute for Human Development, Berlin, Germany
| | | | - Jacqui Smith
- Institute for Social Research, University of Michigan
| | - Peter Eibich
- Research Group: Labor Demography, Max Planck Institute for Demographic Research, Rostock, Germany
| | - Elisabeth Steinhagen-Thiessen
- Divison of Lipid Metabolism of the Department of Endocrinology and Metabolic Medicine, Charité – Universitätsmedizin, Berlin, Germany
| | - Ilja Demuth
- Divison of Lipid Metabolism of the Department of Endocrinology and Metabolic Medicine, Charité – Universitätsmedizin, Berlin, Germany
| | - Ulman Lindenberger
- Center for Lifespan Psychology, Max Planck Institute for Human Development, Berlin, Germany
- Max Planck UCL Centre for Computational Psychiatry and Ageing Research, Max Planck Institute for Human Development, Berlin, Germany
| | - Gert G. Wagner
- Center for Lifespan Psychology, Max Planck Institute for Human Development, Berlin, Germany
- German Socio-Economic Panel study, German Institute for Economic Research (DIW Berlin), Berlin, Germany
| | - Nilam Ram
- German Socio-Economic Panel study, German Institute for Economic Research (DIW Berlin), Berlin, Germany
- Departments of Communication and Psychology, Stanford University
| | - Denis Gerstorf
- Department of Psychology, Humboldt University Berlin, Berlin, Germany
- German Socio-Economic Panel study, German Institute for Economic Research (DIW Berlin), Berlin, Germany
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14
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Donnelly R. Precarious Work in Midlife: Long-Term Implications for the Health and Mortality of Women and Men. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2022; 63:142-158. [PMID: 34794348 DOI: 10.1177/00221465211055090] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Although prior research documents adverse health consequences of precarious work, we know less about how chronic exposure to precarious work in midlife shapes health trajectories among aging adults. The present study uses longitudinal data from the Health and Retirement Study to consider how histories of precarious work in later midlife (ages 50-65) shape trajectories of health and mortality risk after age 65. Results show that greater exposure to unemployment, job insecurity, and insufficient work hours in midlife predicts more chronic conditions and functional limitations after age 65. Characteristics of precarious work also predict increased mortality risk in later life. Findings indicate few gender differences in linkages between precarious work and health; however, women are more likely than men to experience job insecurity throughout midlife. Because precarious work is unlikely to abate, results suggest the need to reduce the health consequences of working in precarious jobs.
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15
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Kersey J, Kringle E, Rodakowski J. An Expansive View of the Relationship Between Meaningful Activities and Health: A Call to Action. J Am Med Dir Assoc 2022; 23:1266-1267. [PMID: 35216955 DOI: 10.1016/j.jamda.2022.01.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 01/25/2022] [Indexed: 11/15/2022]
Affiliation(s)
- Jessica Kersey
- College of Applied Health Sciences, Department of Occupational Therapy, University of Illinois at Chicago Chicago, IL, USA
| | - Emily Kringle
- College of Medicine, Department of Medicine University of Illinois at Chicago Chicago, IL, USA
| | - Juleen Rodakowski
- School of Health and Rehabilitation Sciences, Department of Occupational Therapy University of Pittsburgh Pittsburgh, PA, USA
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16
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Kemp B, Grumbach JM, Montez JK. U.S. State Policy Contexts and Physical Health among Midlife Adults. SOCIUS : SOCIOLOGICAL RESEARCH FOR A DYNAMIC WORLD 2022; 8:10.1177/23780231221091324. [PMID: 36268202 PMCID: PMC9581408 DOI: 10.1177/23780231221091324] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
This study examines how state policy contexts may have contributed to unfavorable adult health in recent decades. It merges individual-level data from the 1993-2016 Behavioral Risk Factor Surveillance System (n=2,166,835) with 15 state-level policy domains measured annually on a conservative to liberal continuum. We examined associations between policy domains and health among adults ages 45-64 years and assess how much of the associations is accounted by adults' socioeconomic, behavioral/lifestyle, and family factors. A more liberal version of the civil rights domain was associated with better health. It was disproportionately important for less-educated adults and women, and its association with adult health was partly accounted by educational attainment, employment, and income. Environment, gun safety, and marijuana policy domains were, to a lesser degree, predictors of health in some model specifications. In sum, health improvements require a greater focus on macro-level factors that shape the conditions in which people live.
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17
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Donnelly R. Precarious work and heath: Do occupation- and state-specific unemployment rates matter for women and for men? SSM Popul Health 2021; 16:100967. [PMID: 34849389 PMCID: PMC8608613 DOI: 10.1016/j.ssmph.2021.100967] [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: 06/29/2021] [Revised: 08/11/2021] [Accepted: 11/12/2021] [Indexed: 11/25/2022] Open
Abstract
Precarious work has the potential to undermine workers' health and well-being, and linkages between precarious work and health may depend on contextual measures of unemployment. The present study uses data from the Current Population Survey (CPS; 2001-2019) to examine whether several characteristics of precarious work are associated with self-rated health, with attention to differences in these associations by occupation- and state-specific unemployment rates. Findings indicate that experiences of unemployment, part-time work, and poor work quality (limited social benefits and low wages) are associated with worse self-rated health for working women and men. Moreover, associations between some measures of precarious work and health are weaker at higher levels of occupation- and state-specific unemployment for men, but not for women. The present study points to precarious work as a chronic stressor for many workers that must be considered within broader economic contexts.
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18
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Trends and Disparities in Functional Impairment among US Adults Age 55-64, 2002 to 2016. J Gen Intern Med 2021; 36:3903-3906. [PMID: 32918202 PMCID: PMC8642514 DOI: 10.1007/s11606-020-06209-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 08/31/2020] [Indexed: 10/23/2022]
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19
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Andrasfay T, Raymo N, Goldman N, Pebley AR. Physical work conditions and disparities in later life functioning: Potential pathways. SSM Popul Health 2021; 16:100990. [PMID: 34917747 PMCID: PMC8666356 DOI: 10.1016/j.ssmph.2021.100990] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 10/19/2021] [Accepted: 11/30/2021] [Indexed: 11/24/2022] Open
Abstract
Research in the US on the social determinants of reduced physical functioning at older ages has typically not considered physical work conditions as contributors to disparities. We briefly describe a model of occupational stratification and segregation, review and synthesize the occupational health literature, and outline the physiological pathways through which physical work exposures may be tied to long-term declines in physical functioning. The literature suggests that posture, force, vibration, and repetition are the primary occupational risk factors implicated in the development of musculoskeletal disorders, through either acute injuries or longer-term wear and tear. Personal risk factors and environmental and structural work characteristics can modify this association. In the long-term, these musculoskeletal disorders can become chronic and ultimately lead to functional limitations and disabilities that interfere with one's quality of life and ability to remain independent. We then use data on occupational characteristics from the Occupational Information Network (O*NET) linked to the 2019 American Community Survey (ACS) to examine disparities among sociodemographic groups in exposure to these risk factors. Occupations with high levels of these physical demands are not limited to those traditionally thought of as manual or blue-collar jobs and include many positions in the service sector. We document a steep education gradient with less educated workers experiencing far greater physical demands at work than more educated workers. There are pronounced racial and ethnic differences in these exposures with Hispanic, Black, and Native American workers experiencing higher risks than White and Asian workers. Occupations with high exposures to these physical risk factors provide lower compensation and are less likely to provide employer-sponsored health insurance, making it more difficult for workers to address injuries or conditions that arise from their jobs. In sum, we argue that physical work exposures are likely an important pathway through which disparities in physical functioning arise.
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Affiliation(s)
- Theresa Andrasfay
- Leonard Davis School of Gerontology, University of Southern California, USA
| | - Nina Raymo
- University of North Carolina Geriatrics Clinic, MedServe, AmeriCorps, USA
| | - Noreen Goldman
- Office of Population Research, Princeton School of Public and International Affairs, Princeton University, USA
| | - Anne R. Pebley
- California Center for Population Research, Fielding School of Public Health, University of California Los Angeles, USA
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20
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Jackson H, Young NAE, Taylor D. Beyond question wording: How survey design and administration shape estimates of disability. Disabil Health J 2021; 14:101115. [PMID: 34154971 PMCID: PMC10237032 DOI: 10.1016/j.dhjo.2021.101115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 05/05/2021] [Accepted: 05/06/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Between 2008 and 2014, annual estimates of disability prevalence among U.S. adults varied somewhat across federal surveys that use a standardized measure of disability, but trends over-time were relatively stable and consistent. In 2014, however, estimates of disability from the Survey of Income and Program Participation (SIPP) increased markedly relative to previous years and were much higher than disability estimates from other federal surveys. OBJECTIVE To examine why disability prevalence among adults aged 40 and older substantially increased in the first wave of the 2014 SIPP Panel. METHODS We consider three factors that may have contributed to the rise in disability: data processing, context effects linked to question order, and sampling. To do so, we compare estimates with and without survey weights and imputed data, analyze supplemental disability-related data collected among SIPP participants, and employ decomposition analysis to assess what proportion of the increase in disability can be attributed to changes in sample composition. RESULTS We find evidence that differences in sample composition contributed to the observed rise in disability prevalence in SIPP between 2011 and 2014. There is less evidence that weighting and imputation or context effects played a role. CONCLUSIONS Previous studies emphasize differences in operationalization and conceptualization of disability as the major factor driving discrepancies in disability estimates. This study suggests that other factors related to survey design and administration may influence disability measurement. Such aspects of surveys, like question order and sampling, may be difficult to standardize, leading to meaningful cross-survey differences in disability estimates.
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Affiliation(s)
- Heide Jackson
- Social, Economic, And Housing Statistics Division, U.S. Census Bureau, 4600 Silver Hill Rd., Suitland, MD 20746, USA
| | - Natalie A E Young
- Social, Economic, And Housing Statistics Division, U.S. Census Bureau, 4600 Silver Hill Rd., Suitland, MD 20746, USA.
| | - Danielle Taylor
- Social, Economic, And Housing Statistics Division, U.S. Census Bureau, 4600 Silver Hill Rd., Suitland, MD 20746, USA
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21
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Donnelly R, Schoenbachler A. Part-time work and health in the United States: The role of state policies. SSM Popul Health 2021; 15:100891. [PMID: 34409150 PMCID: PMC8361317 DOI: 10.1016/j.ssmph.2021.100891] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 07/16/2021] [Accepted: 08/03/2021] [Indexed: 11/17/2022] Open
Abstract
Part-time work is a common work arrangement in the United States that can be precarious, insecure, and lacking opportunities for advancement. In turn, part-time work, especially involuntary part-time work, tends to be associated with worse health outcomes. Although prior research documents heterogeneity in the health consequences of precarious work across countries, we do not know whether state-level institutional contexts shape the association between part-time work and self-rated health in the United States. Using data from the Current Population Survey (2009-2019; n = 813,077), the present study examined whether linkages between part-time work and self-rated health are moderated by state-level social policies and contexts. At the population level, we document differences in the prevalence of fair/poor health among part-time workers across states. For instance, 21% of involuntary part-time workers reported fair/poor health in West Virginia compared to 7% of involuntary part-time workers in Massachusetts. Findings also provide evidence that voluntary (β =.51) and involuntary (β=.57) part-time work is associated with greater odds of fair/poor health among individuals. Moreover, the association between voluntary part-time work and self-rated health is weaker for individuals living in states with higher amounts for maximum unemployment insurance, higher minimum wage, and lower income inequality. State-level policies did not moderate the association between involuntary part-time work and health. The present study points to the need to mitigate the health consequences of part-time work with social policies that enhance the health of workers.
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22
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Schneider ALC, Wang D, Gottesman RF, Selvin E. Prevalence of Disability Associated With Head Injury With Loss of Consciousness in Adults in the United States: A Population-Based Study. Neurology 2021; 97:e124-e135. [PMID: 34039721 PMCID: PMC8279570 DOI: 10.1212/wnl.0000000000012148] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 03/29/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To provide nationally representative prevalence estimates of disability associated with prior head injury with loss of consciousness in the United States and to examine associations between prior head injury and disability. METHODS This was a cross-sectional analysis of 7,390 participants ≥40 years of age in the 2011-2014 National Health and Nutrition Examination Surveys (NHANES). Head injury with loss of consciousness was assessed by self-report. Domains of disability were assessed with a standardized structured questionnaire and measured grip strength. Logistic and linear regression models adjusted for demographic, socioeconomic/behavioral, and medical comorbidity variables were used. Multiple imputation was used to account for missing covariate data. RESULTS Mean age of participants was 58 years; 53% were female; 71% were non-Hispanic White; and 16% had a history of head injury with loss of consciousness. Overall, participants with a history of head injury had higher prevalence of disability in at least 1 domain of functioning compared to individuals without head injury (47.4% vs 38.6%, p < 0.001), with the highest prevalence of disability in the domains of mobility and work productivity. In fully adjusted models, head injury was significantly positively associated with disability in all domains assessed on the standardized questionnaire (all p < 0.05). Participants with head injury had greater grip strength (all p < 0.05). CONCLUSIONS We found that 47.4% of individuals ≥40 years of age in the United States with a history of head injury are living with disability in at least 1 domain of functioning, corresponding to 11.4 million affected individuals. This significant burden of disability suggests that efforts are needed to improve functioning among individuals with head injury.
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Affiliation(s)
- Andrea L C Schneider
- From the Department of Neurology (A.L.C.S.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Epidemiology (D.W., R.F.G., E.S.), Johns Hopkins University Bloomberg School of Public Health; and Department of Neurology (R.F.G.), Johns Hopkins University School of Medicine, Baltimore, MD.
| | - Dan Wang
- From the Department of Neurology (A.L.C.S.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Epidemiology (D.W., R.F.G., E.S.), Johns Hopkins University Bloomberg School of Public Health; and Department of Neurology (R.F.G.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Rebecca F Gottesman
- From the Department of Neurology (A.L.C.S.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Epidemiology (D.W., R.F.G., E.S.), Johns Hopkins University Bloomberg School of Public Health; and Department of Neurology (R.F.G.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Elizabeth Selvin
- From the Department of Neurology (A.L.C.S.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Epidemiology (D.W., R.F.G., E.S.), Johns Hopkins University Bloomberg School of Public Health; and Department of Neurology (R.F.G.), Johns Hopkins University School of Medicine, Baltimore, MD
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23
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Zajacova A, Grol-Prokopczyk H, Zimmer Z. Pain Trends Among American Adults, 2002-2018: Patterns, Disparities, and Correlates. Demography 2021; 58:711-738. [PMID: 33834222 PMCID: PMC8035485 DOI: 10.1215/00703370-8977691] [Citation(s) in RCA: 88] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Determining long-term trends in chronic pain prevalence is critical for evaluating and shaping U.S. health policies, but little research has examined such trends. This study (1) provides estimates of pain trends among U.S. adults across major population groups; (2) tests whether sociodemographic disparities in pain have widened or narrowed over time; and (3) examines socioeconomic, behavioral, psychological, and medical correlates of pain trends. Regression and decomposition analyses of joint, low back, neck, facial/jaw pain, and headache/migraine using the 2002-2018 National Health Interview Survey for adults aged 25-84 (N = 441,707) assess the trends and their correlates. We find extensive escalation of pain prevalence in all population subgroups: overall, reports of pain in at least one site increased by 10%, representing an additional 10.5 million adults experiencing pain. Socioeconomic disparities in pain are widening over time, and psychological distress and health behaviors are among the salient correlates of the trends. This study thus comprehensively documents rising pain prevalence among Americans across the adult life span and highlights socioeconomic, behavioral, and psychological factors as important correlates of the trends. Chronic pain is an important dimension of population health, and demographic research should include it when studying health and health disparities.
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Affiliation(s)
- Anna Zajacova
- Department of Sociology, The University of Western Ontario, London, Ontario, Canada
| | - Hanna Grol-Prokopczyk
- Department of Sociology, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Zachary Zimmer
- Department of Family Studies and Gerontology and Global Aging and Community Initiative, Mount Saint Vincent University, Halifax, Nova Scotia, Canada
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24
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Brown RT, Covinsky KE. Moving prevention of functional impairment upstream: is middle age an ideal time for intervention? Womens Midlife Health 2020; 6:4. [PMID: 32695430 PMCID: PMC7366897 DOI: 10.1186/s40695-020-00054-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 07/13/2020] [Indexed: 12/20/2022] Open
Abstract
To live independently, individuals must be able to perform basic activities of daily living (ADLs), including bathing, dressing, and transferring out of a bed or chair. When older adults develop difficulty or the need for help performing ADLs, they experience decreased quality of life and an increased risk of acute care utilization, nursing home admission, and death. For these reasons, slowing or preventing the progression to functional problems is a key focus of the care of older adults. While preventive efforts currently focus mainly on older people, difficulty performing basic ADLs (“functional impairment”) affects nearly 15% of middle-aged adults, and this prevalence is increasing. People who develop functional impairment in middle age are at increased risk for adverse outcomes similar to those experienced by older adults. Developing ADL impairment in middle age also impacts work force participation and health expenditures, not just in middle age but also older age. Middle-aged adults have a high capacity for recovery from functional impairment, and many risk factors for developing functional impairment in middle and older age have their roots in mid-life. Taken together, these findings suggest that middle age may be an ideal period to intervene to prevent or delay functional impairment. To address the rising prevalence of functional impairment in middle age, we will need to work on several fronts. These include developing improved prognostic tools to identify middle-aged people at highest risk for functional impairment and developing interventions to prevent or delay impairment among middle-aged people. More broadly, we need to recognize functional impairment in middle age as a problem that is as prevalent and central to health outcomes as many chronic medical conditions.
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Affiliation(s)
- Rebecca T Brown
- Division of Geriatric Medicine, Perelman School of Medicine at the University of Pennsylvania, 3615 Chestnut Street, Philadelphia, PA 19104 USA.,Geriatrics and Extended Care, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA USA.,Center for Health Equity and Research Promotion, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA USA
| | - Kenneth E Covinsky
- Division of Geriatrics, University of California, San Francisco, CA USA.,San Francisco Veterans Affairs Medical Center, San Francisco, CA USA
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25
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Djibo DA, Goldstein J, Ford JG. Prevalence of disability among adults with chronic obstructive pulmonary disease, Behavioral Risk Factor Surveillance System 2016-2017. PLoS One 2020; 15:e0229404. [PMID: 32106254 PMCID: PMC7046217 DOI: 10.1371/journal.pone.0229404] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 02/05/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The prevalence of disabilities is rising steadily, reflecting an aging population and an increasing burden of chronic conditions affecting quality of life. There are scant national data on the prevalence of disability among individuals with chronic obstructive pulmonary disease (COPD). The main objective was to estimate the prevalence of common disabilities among US-based individuals diagnosed with COPD. METHODS Data from the BRFSS, a national telephone survey examining health-related behaviors in 2016-2017 were analyzed. The study population consisted of individuals with self-reported COPD (N = 38352 in 2016 and N = 35423 in 2017). The prevalence of disabilities in hearing, vision, cognition, mobility, and independent living were obtained and adjusted with sampling weights. Healthcare access measures were described by type of disability. RESULTS Mobility disability had the highest prevalence of 45.9 (44.8-47.0) % in 2016 and 48.4 (47.3-49.5) % in 2017 among respondents with COPD. The prevalence of disabilities was highest among those 45-64 years old, except for hearing and cognition. Hearing disabilities were most prevalent among males with COPD while cognitive and mobility disabilities were most prevalent among females with COPD. While differences in the prevalence of disabilities were observed, access to health care was similar by disability type and age group among respondents. CONCLUSION Contrary to expectation, the highest prevalence of disabilities was found not to be among those 65 years old and above. Further research is needed to explain this age-specific shift in the burden of disability, as long-term care planning and prevention support systems should be informed by the demographical patterns of disabilities among individuals with COPD.
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Affiliation(s)
- Djeneba Audrey Djibo
- Division of Research, Department of Medicine, Einstein Healthcare Network, Philadelphia, PA, United States of America
- * E-mail:
| | - Jessica Goldstein
- Division of Research, Department of Medicine, Einstein Healthcare Network, Philadelphia, PA, United States of America
| | - Jean G. Ford
- Department of Medicine, Einstein Healthcare Network, Philadelphia, PA, United States of America
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Prevalence and domains of disability within and outside Appalachian North Carolina: 2013-2016 Behavioral Risk Factor Surveillance System. Disabil Health J 2020; 13:100879. [PMID: 31899201 DOI: 10.1016/j.dhjo.2019.100879] [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: 06/05/2019] [Revised: 10/25/2019] [Accepted: 12/07/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND The health and social conditions of the Appalachian region generally are poorer than in the US overall, and this gap is widening, suggesting disability may be higher in Appalachia. OBJECTIVE To describe the prevalence of disability overall and by domain in Appalachian and non-Appalachian regions in North Carolina (NC) and describe the characteristics of people with and without disability in each region. METHODS We conducted a cross-sectional study using data from the NC Behavioral Risk Factor Surveillance System from 2013 to 2016 which assessed disability in five domains: vision, cognitive, mobility, self-care, and independent living. We calculated weighted proportions and age- and sex-adjusted prevalence using direct standardization to the 2010 Census. RESULTS The prevalence of disability in Appalachian NC was significantly higher than in non-Appalachian NC after standardizing by age and sex (26.6% in Appalachia, 24.1% outside Appalachia, p < 0.001). In both regions, mobility disability was most common and self-care disability was least common. People within Appalachia more frequently reported disability in all domains compared to people outside Appalachia. CONCLUSIONS More than one in four adults in Appalachian North Carolina experience disability in at least one domain and one in eight experiences disability in multiple domains. The high prevalence of disability should be considered when planning programs and services across the spectrum of public health. Understanding common disability domains present in populations can inform public health agencies and service providers and help them develop programs and messaging that meet the needs of residents in Appalachia and are accessible to people with disabilities.
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Kemp B, Karas Montez J. Why does the importance of education for health differ across the United States? SOCIUS : SOCIOLOGICAL RESEARCH FOR A DYNAMIC WORLD 2020; 6. [PMID: 32206726 DOI: 10.1177/2378023119899545] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The positive association between educational attainment and adult health ("the gradient") is stronger in some areas of the United States than in others. Explanations for the geographic pattern have not been rigorously investigated. Grounded in a contextual and life course perspective, this study assesses childhood circumstances (e.g., childhood health, compulsory schooling laws) and adult circumstances (e.g., wealth, lifestyles, economic policies) as potential explanations. Using data on US-born adults aged 50-59 at baseline (N=13,095) and followed for up to 16 years across the 1998-2014 waves of the Health and Retirement Study, this study examined how and why educational gradients in morbidity, functioning, and mortality vary across nine U.S. regions. The findings indicate that the gradient is stronger in some areas than others partly because of geographic differences in childhood socioeconomic conditions and health, but mostly because of geographic differences in adult circumstances such as wealth, lifestyles, and economic and tobacco policies.
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Jehn A, Zajacova A. Disability trends in Canada: 2001-2014 population estimates and correlates. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2019; 110:354-363. [PMID: 30547289 PMCID: PMC6964543 DOI: 10.17269/s41997-018-0158-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 11/15/2018] [Indexed: 01/23/2023]
Abstract
OBJECTIVES Disability is a major concern for the health of midlife and older Canadians. Understanding disability trends is critical for detecting socio-economic and health precursors that could be amenable to policy interventions. The purpose of this study is to assess trends in rates of disability among Canadian adults age 40-64 and 65+. We also examine the impact of changing socio-demographic and health factors over time on the trends. METHODS Data from the 2001-2014 Canadian Community Health Survey (CCHS), a repeated cross-sectional nationally representative study, are used to estimate age- and gender-stratified logistic regression models of disability as a function of the year of interview to assess trends. Disability is defined as experiencing difficulties with a variety of individual functions, such as seeing, walking, climbing stairs, and bending. RESULTS Among men and women 65 and older, disability has declined since 2001 in most subgroups and regardless of changing socio-economic and health characteristics. Adults 40-64 years of age, in contrast, have experienced stagnating disability over the observation period. If it were not for changes in the distribution of education and household income, the disability rate would be increasing significantly. CONCLUSION Older Canadian adults are experiencing mild but systemic improvements in disability. More worrisome is the stagnating trend among midlife cohorts, which could portend greater disability burden in the future as Canada's population ages. Preventive efforts need to be targeted at vulnerable groups at earlier ages in order to prevent future increases in disability-related financial, caregiving, and medical burden.
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Affiliation(s)
- Anthony Jehn
- Social Science Centre, University of Western Ontario, 1151 Richmond Street, London, ON N6G 2V4 Canada
| | - Anna Zajacova
- Social Science Centre, University of Western Ontario, 1151 Richmond Street, London, ON N6G 2V4 Canada
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