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Bolster-Foucault C, Vedel I, Busa G, Hacker G, Sourial N, Quesnel-Vallée A. Social inequity in ageing in place among older adults in Organisation for Economic Cooperation and Development countries: a mixed studies systematic review. Age Ageing 2024; 53:afae166. [PMID: 39137063 PMCID: PMC11321251 DOI: 10.1093/ageing/afae166] [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: 12/05/2023] [Revised: 03/11/2024] [Indexed: 08/15/2024] Open
Abstract
BACKGROUND Most older adults wish to remain in their homes and communities as they age. Despite this widespread preference, disparities in health outcomes and access to healthcare and social support may create inequities in the ability to age in place. Our objectives were to synthesise evidence of social inequity in ageing in place among older adults using an intersectional lens and to evaluate the methods used to define and measure inequities. METHODS We conducted a mixed studies systematic review. We searched MEDLINE, EMBASE, PsycINFO, CINAHL and AgeLine for quantitative or qualitative literature that examined social inequities in ageing in place among adults aged 65 and older in Organisation for Economic Co-operation and Development (OECD) member countries. Results of included studies were synthesised using qualitative content analysis guided by the PROGRESS-Plus framework. RESULTS Of 4874 identified records, 55 studies were included. Rural residents, racial/ethnic minorities, immigrants and those with higher socioeconomic position and greater social resources are more likely to age in place. Women and those with higher educational attainment appear less likely to age in place. The influence of socioeconomic position, education and social resources differs by gender and race/ethnicity, indicating intersectional effects across social dimensions. CONCLUSIONS Social dimensions influence the ability to age in place in OECD settings, likely due to health inequalities across the lifespan, disparities in access to healthcare and support services, and different preferences regarding ageing in place. Our results can inform the development of policies and programmes to equitably support ageing in place in diverse populations.
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Affiliation(s)
- Clara Bolster-Foucault
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
| | - Isabelle Vedel
- Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Giovanna Busa
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
| | - Georgia Hacker
- Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Nadia Sourial
- Department of Health Management, Evaluation and Policy, School of Public Health, University of Montreal, Montreal, QC, Canada
| | - Amélie Quesnel-Vallée
- Department of Equity, Ethics and Policy, McGill University, Montreal, QC, Canada
- Department of Sociology, McGill University, Montreal, QC, Canada
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Pritchard KT, Mahesri M, Chen Q, Yang CT, Brill G, Kim DH, Lin KJ. Crosswalk Algorithms for Cognitive and Functional Outcomes Among 2013-2018 Medicare Beneficiaries With Dementia. J Am Med Dir Assoc 2024; 25:105168. [PMID: 39067864 DOI: 10.1016/j.jamda.2024.105168] [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: 01/24/2024] [Revised: 06/13/2024] [Accepted: 06/17/2024] [Indexed: 07/30/2024]
Abstract
OBJECTIVE Before 2019, the Minimum Data Set (MDS) and Outcome and Assessment Information Set (OASIS) had incongruent response categories for rating cognitive impairment and activities of daily living (ADLs), hindering direct comparisons between nursing facilities and home health. We devised rule-based algorithms to compare cognitive impairment and ADL limitations between these 2 care settings among people with Alzheimer's disease and Alzheimer's disease-related dementias (ADRD). DESIGN A retrospective cohort study. SETTING AND PARTICIPANTS Included fee-for-service Medicare beneficiaries (2013-2018) transitioning from nursing facilities to home health, with 1-year of continuous enrollment, aged ≥65 years, diagnosed ADRD, and with complete MDS discharge and OASIS admission assessments (N = 398,496). METHODS We identified target phenotypes using the Cognitive Function Scale (CFS) and ADL items from the MDS discharge assessment as reference standards. We compared 6 OASIS-based algorithms for cognitive impairment and 1 for each ADL limitation by estimating sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). RESULTS The average age was 83.5 (SD = 7.5) years and 82.3% transitioned from nursing to home health within 3 days. In the MDS discharge assessment, 42.2% had moderate-to-severe cognitive impairment. ADL limitations ranged from 71.4% for feeding to 97.8% for bathing. Compared with the moderate-to-severe cognitive impairment (CFS ≥3) on the MDS, the OASIS cognitive assessment indicating "considerable assistance to total dependence in routine situations" had 24% sensitivity, 94% specificity, 75% PPV, and 63% NPV. The ADL limitation algorithms exhibited high sensitivities (>96%) and PPVs (>94%) except for feeding (Sensitivity: 82%; PPV: 74%). Despite the short time frame between the 2 assessments, the OASIS admission assessment showed a higher prevalence of ADL limitations than the MDS discharge assessment. CONCLUSIONS AND IMPLICATIONS We highlighted differences in patient function between post-acute care settings. Our algorithms can help researchers, clinicians, and policymakers standardize patient-centered outcomes for comparative effectiveness research or quality initiatives.
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Affiliation(s)
- Kevin T Pritchard
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Mufaddal Mahesri
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Qiaoxi Chen
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Chun-Ting Yang
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Gregory Brill
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Dae Hyun Kim
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, Boston, MA, USA; Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, MA, USA
| | - Kueiyu Joshua Lin
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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Cantu P, Cho TC, Wyman M, Helppie-McFall B, Ajrouch K. Racial and Ethnic Disparities in the Monetary Value of Informal Caregiving for Non-Institutionalized People Living With Dementia. J Aging Health 2024:8982643241262917. [PMID: 38887015 DOI: 10.1177/08982643241262917] [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] [Indexed: 06/20/2024]
Abstract
OBJECTIVE To examine racial and ethnic differences in costs of informal caregiving among older adults with dementia in the United States. METHODS We used data from the 2002 to 2018 Health and Retirement Survey to estimate annual informal care hours for adults with dementia (n = 10,015). We used regression models to examine racial and ethnic differences in hours of informal care for activities of daily living (ADL) and instrumental ADL, controlling for demographic characteristics, education, and level of disability. RESULTS Our sample was 70% non-Hispanic White, 19% non-Hispanic Black, and 11% Hispanic. Hispanics received, on average, 35.8 hours of informal care each week, compared to 30.1 for Blacks and 20.1 for Whites. Racial and ethnic differences persisted when controlling for covariates. DISCUSSION Informal care is a greater cost to racial and ethnic minoritized families. Informal care was valued at a replacement cost of $44,656 for Hispanics, $37,508 for Blacks, and $25,121 for Whites.
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Affiliation(s)
- Phillip Cantu
- Department of Internal Medicine-Geriatrics, University of Texas Medical Branch, Galveston, TX, USA
| | - Tsai-Chin Cho
- Department of Internal Medicine, School of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Mary Wyman
- Department of Psychology, School of Medicine and Public Health, University of Wisconsin, Madison, Madison, WI, USA
| | - Brooke Helppie-McFall
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Kristine Ajrouch
- Department of Sociology, Anthropology, and Criminology, Eastern Michigan University, Ypsilanti, MI, USA
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Mildrum Chana S, Álvarez L, Poe A, Bibriescas N, Wang DH, DiFiglia S, Azuero A, Crowe M, Puga F. The Daily Experiences of Hispanic and Latinx Dementia Caregivers Study: Protocol for a Fully Remote Daily Diary Observational Cohort Study. JMIR Res Protoc 2024; 13:e55216. [PMID: 38869929 PMCID: PMC11211706 DOI: 10.2196/55216] [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: 12/22/2023] [Revised: 03/13/2024] [Accepted: 03/23/2024] [Indexed: 06/14/2024] Open
Abstract
BACKGROUND The Hispanic and Latinx community is disproportionately affected by Alzheimer disease and related dementias (ADRDs). In the United States, approximately 8.5 million caregivers of individuals with ADRDs identify as Hispanic and Latinx people, and caregiving-related stress and burden place caregivers at elevated risk for poor mental health outcomes, as well as loneliness and social isolation. To date, there is limited knowledge about the daily stress experiences of Hispanic and Latinx caregivers. Given this knowledge gap, it is critical to examine how personal, cultural, and contextual factors influence daily stress, mental health, and resilience over time among Hispanic and Latinx ADRD caregivers. OBJECTIVE The goal of this protocol report is to present the rationale, methodology, planned analytical strategy, progress completed to date, and implications of future findings for "Nuestros Días" (Spanish for "our days"), a fully remote daily diary (DD), observational cohort study examining the day-to-day experiences of Hispanic and Latinx ADRD caregivers. METHODS The study will recruit a cohort of up to 500 Hispanic and Latinx caregivers of individuals living with ADRD. Participants will complete measures assessing contextual, individual-level, and cultural factors at 3 intervals (enrollment, 6 months, and 12 months). Each of the timepoints will be followed by 21 days of DD surveys to report on daily stress, stress moderators, and mental health variables. RESULTS Data collection began in March 2023 and is projected to end in December 2026. As of March 2024, we have enrolled 60 caregivers in the Nuestros Días study, 78.9% (n=15) of whom are Spanish speakers. The current completion rate for DD surveys is 79.4%, averaging approximately 18 surveys out of 21 completed. We expect to enroll 10 to 15 participants per month moving forward to achieve our enrollment goal. CONCLUSIONS Results from this study will identify which Hispanic and Latinx ADRD caregivers, and under what circumstances, appear to be at the greatest risk of experiencing poor mental health outcomes over time. This study represents a critical step forward in providing key guidance to develop effective, culturally sensitive interventions to support the health and well-being of Hispanic and Latinx ADRD caregivers, a historically underrepresented and underserved population in aging and caregiving research. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/55216.
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Affiliation(s)
- Sofía Mildrum Chana
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Lorelí Álvarez
- Department of Acute, Chronic and Continuing Care, School of Nursing, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Abigail Poe
- Department of Acute, Chronic and Continuing Care, School of Nursing, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Natashia Bibriescas
- Department of Educational Psychology, University of Texas at Austin, Austin, TX, United States
| | - Danny Hai Wang
- Department of Biobehavioral Health, College of Health and Human Development, The Pennsylvania State University, University Park, PA, United States
| | - Stephanie DiFiglia
- MJHS Institute for Innovation in Palliative Care, New York, NY, United States
| | - Andrés Azuero
- Department of Nursing Family, Community & Health Systems, School of Nursing, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Michael Crowe
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Frank Puga
- Department of Acute, Chronic and Continuing Care, School of Nursing, University of Alabama at Birmingham, Birmingham, AL, United States
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Crimmel S, Hu L, D'Souza RS, Wang EJ. Treatment Disparities in Hispanic Patients with Chronic Pain: An Evidence-Based Narrative Review. Curr Pain Headache Rep 2024; 28:271-278. [PMID: 38358442 DOI: 10.1007/s11916-024-01220-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2024] [Indexed: 02/16/2024]
Abstract
PURPOSE OF REVIEW The purpose of this narrative review is to summarize healthcare disparities experienced by Hispanic and Latino/Latinx patients with chronic pain, evaluate the existing literature exploring the specific therapeutic inequities affecting this patient population, and identify gaps in the literature requiring future study. RECENT FINDINGS Hispanic and Latino/Latinx patients experience disparities in chronic pain management. They are less likely to be prescribed pharmacologic therapies, including non-steroidal anti-inflammatory drugs and opioids. Hispanic and Latino/Latinx patients are also less likely to receive spinal cord stimulators and may be charged higher costs for them. There are no published studies specifically assessing Hispanic and Latino/Latinx patients' utilization and outcomes from other common interventional pain procedures (e.g., epidural steroid injections, radiofrequency ablation). Limited data suggest non-pharmacologic treatments, such as cognitive behavioral therapy and complementary/integrative health modalities, might have more benefit for this population, potentially because of greater utilization. Hispanic and Latino/Latinx patients experience disparities in chronic pain management. There is a paucity of data available pertaining specifically to pain-related outcomes and the utilization of pain treatment modalities, especially in regard to interventional procedures. Additional research is urgently needed in order to understand the full extent of these disparities and develop solutions to provide more equitable care.
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Affiliation(s)
- Stephanie Crimmel
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
| | - Lizbeth Hu
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Ryan S D'Souza
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, United States
| | - Eric J Wang
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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Moyo P, Nishar S, Merrick C, Streltzov N, Asiedu E, Roma C, Vanjani R, Soske J. Perspectives on Admissions and Care for Residents With Opioid Use Disorder in Skilled Nursing Facilities. JAMA Netw Open 2024; 7:e2354746. [PMID: 38315484 PMCID: PMC10844991 DOI: 10.1001/jamanetworkopen.2023.54746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 12/13/2023] [Indexed: 02/07/2024] Open
Abstract
Importance Skilled nursing facilities (SNFs) are being referred more individuals with opioid use disorder (OUD), even when their medical needs are not directly associated with OUD. Objective To characterize factors that influence SNF admission for individuals with OUD and identify strategies for providing medications for OUD (MOUD) in SNFs. Design, Setting, and Participants In this semistructured qualitative study, interviews were conducted with SNF administrators from 27 SNFs in Rhode Island from November 5, 2021, to April 27, 2022. Data analysis occurred from August 22, 2022, to May 31, 2023. Main Outcomes and Measures Themes and subthemes on administrator perspectives on admissions and care for people with OUD in SNFs. Audio interviews were transcribed, coded, and analyzed using codebook thematic analysis and guided by community-engaged and participatory research principles. Results The study included 29 participants representing 27 SNFs in Rhode Island. Participant roles were administrators (17 participants [59%]), directors of nursing (6 participants [21%]), directors of admissions (5 participants [17%]), and unit managers (1 participant [3%]). Participants described active substance use, Medicaid insurance, housing instability, and younger age as potential barriers to SNF admission for individuals with OUD. The lack of formal guidelines for OUD management, staff shortages, facility liability, state regulations, and skills and training deficits among staff were cited among challenges of effectively meeting the needs of residents with OUD. Many participants reported inadequate institutional capacity as a source of negative outcomes for people with OUD yet expressed their concerns by characterizing individuals with OUD as potentially violent, nonadherent, or likely to bring undesirable elements into facilities. Participants also shared strategies they used to better serve residents with OUD, including providing transportation to support group meetings in the community, delivery in advance of resident arrival of predosed methadone, and telemedicine through the state's hotline to prescribe buprenorphine. Conclusions and Relevance In this qualitative study of administrator perspectives about admissions and care for individuals with OUD in SNFs, gaps in institutional capacity overlapped with stigmatizing beliefs about OUD; such beliefs perpetuate discrimination of individuals with OUD. Adequate SNF funding and staffing combined with OUD-specific interventions (eg, antistigma training, community partnerships for MOUD and recovery support) could incentivize SNFs to serve individuals with OUD and facilitate OUD care consistent with practice guidelines.
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Affiliation(s)
- Patience Moyo
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island
| | - Shivani Nishar
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island
| | - Charlotte Merrick
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island
| | - Nicholas Streltzov
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Emmanuella Asiedu
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island
| | - Corinne Roma
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island
| | - Rahul Vanjani
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
- Amos House, Providence, Rhode Island
| | - Jon Soske
- Division of Addiction Medicine, Rhode Island Hospital, Providence, Rhode Island
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Deardorff WJ, Jeon SY, Barnes DE, Boscardin WJ, Langa KM, Covinsky KE, Mitchell SL, Lee SJ, Smith AK. Development and External Validation of Models to Predict Need for Nursing Home Level of Care in Community-Dwelling Older Adults With Dementia. JAMA Intern Med 2024; 184:81-91. [PMID: 38048097 PMCID: PMC10696518 DOI: 10.1001/jamainternmed.2023.6548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 10/09/2023] [Indexed: 12/05/2023]
Abstract
Importance Most older adults living with dementia ultimately need nursing home level of care (NHLOC). Objective To develop models to predict need for NHLOC among older adults with probable dementia using self-report and proxy reports to aid patients and family with planning and care management. Design, Setting, and Participants This prognostic study included data from 1998 to 2016 from the Health and Retirement Study (development cohort) and from 2011 to 2019 from the National Health and Aging Trends Study (validation cohort). Participants were community-dwelling adults 65 years and older with probable dementia. Data analysis was conducted between January 2022 and October 2023. Exposures Candidate predictors included demographics, behavioral/health factors, functional measures, and chronic conditions. Main Outcomes and Measures The primary outcome was need for NHLOC defined as (1) 3 or more activities of daily living (ADL) dependencies, (2) 2 or more ADL dependencies and presence of wandering/need for supervision, or (3) needing help with eating. A Weibull survival model incorporating interval censoring and competing risk of death was used. Imputation-stable variable selection was used to develop 2 models: one using proxy responses and another using self-responses. Model performance was assessed by discrimination (integrated area under the receiver operating characteristic curve [iAUC]) and calibration (calibration plots). Results Of 3327 participants with probable dementia in the Health and Retirement Study, the mean (SD) age was 82.4 (7.4) years and 2301 (survey-weighted 70%) were female. At the end of follow-up, 2107 participants (63.3%) were classified as needing NHLOC. Predictors for both final models included age, baseline ADL and instrumental ADL dependencies, and driving status. The proxy model added body mass index and falls history. The self-respondent model added female sex, incontinence, and date recall. Optimism-corrected iAUC after bootstrap internal validation was 0.72 (95% CI, 0.70-0.75) in the proxy model and 0.64 (95% CI, 0.62-0.66) in the self-respondent model. On external validation in the National Health and Aging Trends Study (n = 1712), iAUC in the proxy and self-respondent models was 0.66 (95% CI, 0.61-0.70) and 0.64 (95% CI, 0.62-0.67), respectively. There was excellent calibration across the range of predicted risk. Conclusions and Relevance This prognostic study showed that relatively simple models using self-report or proxy responses can predict need for NHLOC in community-dwelling older adults with probable dementia with moderate discrimination and excellent calibration. These estimates may help guide discussions with patients and families in future care planning.
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Affiliation(s)
- W. James Deardorff
- Division of Geriatrics, Department of Medicine, University of California, San Francisco
- Geriatrics, Palliative and Extended Care Service Line, San Francisco Veterans Affairs Health Care System, San Francisco, California
| | - Sun Y. Jeon
- Division of Geriatrics, Department of Medicine, University of California, San Francisco
- Geriatrics, Palliative and Extended Care Service Line, San Francisco Veterans Affairs Health Care System, San Francisco, California
| | - Deborah E. Barnes
- Department of Epidemiology and Biostatistics, University of California, San Francisco
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco
| | - W. John Boscardin
- Division of Geriatrics, Department of Medicine, University of California, San Francisco
- Geriatrics, Palliative and Extended Care Service Line, San Francisco Veterans Affairs Health Care System, San Francisco, California
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Kenneth M. Langa
- Department of Internal Medicine, School of Medicine, University of Michigan, Ann Arbor
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Veterans Affairs Ann Arbor Center for Clinical Management Research, Ann Arbor, Michigan
- Institute for Social Research, University of Michigan, Ann Arbor
| | - Kenneth E. Covinsky
- Division of Geriatrics, Department of Medicine, University of California, San Francisco
- Associate Editor, JAMA Internal Medicine
| | - Susan L. Mitchell
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Sei J. Lee
- Division of Geriatrics, Department of Medicine, University of California, San Francisco
- Geriatrics, Palliative and Extended Care Service Line, San Francisco Veterans Affairs Health Care System, San Francisco, California
| | - Alexander K. Smith
- Division of Geriatrics, Department of Medicine, University of California, San Francisco
- Geriatrics, Palliative and Extended Care Service Line, San Francisco Veterans Affairs Health Care System, San Francisco, California
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Cantu P, Chyu J, Mehta N, Markides K. Profiles of COVID-19 Impact on Informal Caregivers of Older Mexican Americans. J Aging Health 2023; 35:819-825. [PMID: 37625170 PMCID: PMC10792534 DOI: 10.1177/08982643231195669] [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] [Indexed: 08/27/2023]
Abstract
Objectives: This manuscript is a descriptive exploratory study of the impact of the COVID-19 pandemic for caregivers of very old Mexican Americans. Methods: Using data from Wave 10 of the Hispanic Established Population for the Epidemiological Study of Elderly (2021), we examined the characteristics of caregivers of very old Mexican Americans by their perceived level of impact from the pandemic. We examined sociodemographic characteristics, COVID-19 testing and vaccination, stress and depression, and health of caregivers and care recipients. Results: Caregivers who reported the most impact were more likely to report financial and emotional stress. They reported more depressive symptoms and high levels of distress related to neuropsychological behavior symptoms of their care recipient. Discussion: High levels of depressive symptoms, financial stress, and neuropsychological behavior symptoms illustrate that the concerns of caregivers before the pandemic were heightened during the pandemic.
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Affiliation(s)
- Phillip Cantu
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Joanna Chyu
- School of Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Neil Mehta
- Department of Epidemiology, University of Texas Medical Branch, Galveston, TX, USA
| | - Kyriakos Markides
- Department of Population Health & Health Disparities, University of Texas Medical Branch, Galveston, TX, USA
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DiPaolo N, Hulsebos IF, Yu J, Gillenwater TJ, Yenikomshian HA. Race and Ethnicity Influences Outcomes of Adult Burn Patients. J Burn Care Res 2023; 44:1223-1230. [PMID: 36881674 PMCID: PMC10480350 DOI: 10.1093/jbcr/irad033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Indexed: 03/09/2023]
Abstract
Outcomes of burn survivors is a growing field of interest; however, there is little data comparing the outcomes of burn survivors by ethnicity. This study seeks to identify any inequities in burn outcomes by racial and ethnic groups. A retrospective chart review of an ABA Certified burn center at a large urban safety net hospital identified adult inpatient admissions from 2015 to 2019. A total of 1142 patients were categorized by primary ethnicity: 142 black or African American, 72 Asian, 479 Hispanic or Latino, 90 white, 215 other, and 144 patients whose race or ethnicity was unrecorded. Multivariable analyses evaluated the relationship between race and ethnicity and outcomes. Covariate confounders were controlled by adjustment of demographic, social, and prehospital clinical factors to isolate differences that might not be explained by other factors. After controlling for covariates, black patients had 29% longer hospital stays (P = .043). Hispanic patients were more likely to be discharged to home or to hospice care (P = .005). Hispanic ethnicity was associated with a 44% decrease in the odds of discharge to acute care, inpatient rehabilitation, or a ward outside the burn unit (P = .022). Black and Hispanic patients had a higher relative chance of having publicly assisted insurance, versus private insurance, than their white counterparts (P = .041, P = .011 respectively). The causes of these inequities are indeterminate. They may stem from socioeconomic status not entirely accounted for, ethnic differences in comorbidity related to stressors, or inequity in health care delivery.
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Affiliation(s)
- Nicola DiPaolo
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Ian F Hulsebos
- Department of Surgery, Hospital Corporation of America Medical City North Texas Hospitals, Plano, Texas, USA
| | - Jeremy Yu
- Clinical and Translational Science Institute, University of Southern California, Los Angeles, California, USA
| | - Timothy Justin Gillenwater
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Haig A Yenikomshian
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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10
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Li J, Ha J, Hoffman G. Unaddressed functional difficulty and care support among White, Black, and Hispanic older adults in the last decade. HEALTH AFFAIRS SCHOLAR 2023; 1:qxad041. [PMID: 38274860 PMCID: PMC10809881 DOI: 10.1093/haschl/qxad041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
Unaddressed functional difficulties contribute to disparities in healthy aging. While the Affordable Care Act (ACA) is believed to have reshaped long-term care, little is known how it has collectively altered the prevalence of older adults with functional difficulties and their use of family and formal care. This study uses nationally representative data from the Health and Retirement Study (2008 - 2018) to describe racial-ethnic differences in prevalence of community-dwelling older adults who had difficulty with, but lacked assistance for self-care, mobility, and household activities before and after the ACA. Individuals with functional difficulties accounted for about a third of Black and Hispanic, compared to one-fifth of White people. Prevalence of Black and Hispanic people with functional difficulties lacking corresponding care support was consistently 1.5 times higher than of White people. Racial-ethnic differences disappeared only for low-income households where unaddressed difficulties were uniformly high. While formal care quantity was similar, Black and Hispanic people with functional difficulties received nearly 50 percent more family care than White people. These gaps between White, Black, and Hispanic older adults were persistent over time. These findings suggest that racial-ethnic gaps in aging needs and supports remain despite major health care reforms in the past decade.
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Affiliation(s)
- Jun Li
- Department of Public Administration and International Affairs, Maxwell School of Citizenship & Public Affairs, Syracuse University
| | - Jinkyung Ha
- Institute of Health Policy and Innovation, University of Michigan
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Roche-Dean M, Baik S, Moon H, Coe NB, Oh A, Zahodne LB. Paid Care Services and Transitioning out of the Community Among Black and White Older Adults With Dementia. J Gerontol B Psychol Sci Soc Sci 2023; 78:S91-S100. [PMID: 36075074 PMCID: PMC10010476 DOI: 10.1093/geronb/gbac117] [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: 02/08/2022] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Paid care provided in the home includes important support services for older adults with dementia such as cleaning and personal care assistance. By reducing unmet needs, these services could delay the transition to residential long-term care, but access may differ across racial groups. This study examined the relationship between paid care and transitioning out of the community among Black and White older adults with dementia. METHODS Using data from 303 participants (29.4% Black) with probable dementia in the 2011 National Health and Aging Trends Study, competing risk hazards models estimated the association between receiving paid care at baseline and the probability of transitioning out of the community over 8 years (through 2019). Covariate selection was guided by the Andersen model of health care utilization. RESULTS Paid care was associated with lower risk of transitioning out of the community (subhazard ratios [SHR] = 0.70, 95% CI [0.50, 0.98]). This effect was similar after controlling for predisposing factors and most prominent after controlling for enabling and need for services factors (SHR = 0.65, 95% CI [0.44, 0.95]). There was no racial difference in the use of paid care despite evidence of greater care needs in Blacks. Furthermore, Black participants were less likely to transition out of the community than Whites. DISCUSSION Paid care services may help delay transitions out of the community. Future research should seek to explain racial differences in access to and/or preferences for home-based, community-based, and residential care.
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Affiliation(s)
- Maria Roche-Dean
- Bronson School of Nursing, Western Michigan University, 1903 West Michigan Avenue, Kalamazoo, MI 49008-5345, USA
| | - Sol Baik
- University of Virginia Weldon Cooper Center for Public Service, University of Virginia, 2400 Old Ivy Rd, Charlottesville, VA 22903, USA
| | - Heehyul Moon
- Kent School of Social Work and Family Science, University of Louisville, 2217 S. 3rd st., Louisville, KY 40292, USA
| | - Norma B Coe
- Department of Medical Ethics and Health Policy, University of Pennsylvania, 423 Guardian Drive, Philadelphia, PA 19104, USA
| | - Anna Oh
- San Francisco VA Health Care System, 4150 Clement Street, San Francisco, CA 94121, USA
- Department of Social and Behavioral Sciences, University of California San Francisco, 490 Illinois St., Floor 12 San Francisco, CA 94143, USA
| | - Laura B Zahodne
- Department of Psychology, University of Michigan, 530 Church Street, Ann Arbor, MI 48109, USA
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12
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Reckrey JM, Leff B, Kumar RG, Yee C, Garrido MM, Ornstein KA. Home, but Not Homebound: A Prospective Analysis of Persons Living With Dementia. J Am Med Dir Assoc 2022; 23:1648-1652.e1. [PMID: 35063398 PMCID: PMC9294063 DOI: 10.1016/j.jamda.2021.12.029] [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: 07/13/2021] [Revised: 11/29/2021] [Accepted: 12/07/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Homebound persons living with dementia may have increased difficulty accessing needed care in the community. This study identifies factors associated with becoming homebound among a national sample of Medicare beneficiaries with newly identified dementia. DESIGN Prospective cohort analysis. SETTING AND PARTICIPANTS We used the National Health and Aging Trends Study (NHATS) 2011-2018 to identify community-dwelling older adults at the time of a new dementia diagnosis (n = 939). Dementia status was determined based on cognitive testing and self and proxy reporting. METHODS We compared characteristics of homebound (ie, those who never or rarely left home) and non-homebound participants at the time of dementia identification. Among non-homebound participants, we used a Fine-Gray subdistribution hazard model to identify factors associated with becoming homebound over follow-up (median follow-up 4 years), accounting for competing risks of death and moving to a nursing home. RESULTS 20% of individuals with newly identified dementia were homebound and this group was more functionally impaired, medically complex, and socioeconomically disadvantaged as compared to the non-homebound. Over time, depression [subhazard ratio (SHR) 2.19, 95% CI 1.36, 3.54], living in an assisted living facility (SHR 2.60, 95% CI 1.35, 4.97), and Hispanic ethnicity (SHR 1.91, 95% CI 1.05, 3.47) were associated with becoming homebound. CONCLUSIONS AND IMPLICATIONS Most adults are not homebound at the time of dementia diagnosis. Identifying and addressing modifiable factors like depression may slow progression to homebound status and enable persons living with dementia to access needed care in the community. In order to accommodate diverse individual and family preferences for long-term care, robust systems of home-based clinical and long-term care are necessary for those who do become homebound.
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Affiliation(s)
| | - Bruce Leff
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Raj G Kumar
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Cynthia Yee
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Melissa M Garrido
- Boston University School of Public Health, Boston, MA, USA; Boston VA Healthcare System, Boston, MA, USA
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13
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Ornstein KA, Liu SH, Husain M, Ankuda CK, Bollens-Lund E, Kelley AS, Garrido MM. Prospective assessment of dementia on transitions in homeboundness using multistate Markov models. J Am Geriatr Soc 2022; 70:1117-1126. [PMID: 34951008 PMCID: PMC8986556 DOI: 10.1111/jgs.17631] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 10/26/2021] [Accepted: 11/25/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND One in 20 older adults in the United States is homebound and rarely/never leaves home. Although being homebound decreases the quality of the lived experience of individuals with serious illnesses, little is known about the frequency or likelihood of transitions in or out of homebound status. The objective of this study was to characterize the probability of transitions to and from homebound status among older adults and examine the relationship between dementia status and homebound transitions. METHODS Using 2011-2018 data from the National Health and Aging Trends Study (NHATS), a nationally representative longitudinal study of aging in the United States, we identified 6375 community-dwelling Medicare beneficiaries. Homebound status (independent, semi-homebound (leaving home but with difficulty or help), homebound (rarely or never leaving home), nursing home resident, dead) was assessed annually via self-report. Transition probabilities across states were assessed using a multistate Markov model. RESULTS Less than half of homebound individuals remain homebound (probability = 41.5% [95% CI: 39.2%, 43.5%]) after 1 year. One out of four dies (24% [22.3%, 26.0%]) and there is a low probability (3.2% [2.5%, 4.1%]) of transition to a nursing home. Dementia status was associated with increased risk of progression from independence to homebound status (HR: 1.83 [1.01, 3.34]). Dementia was consistently associated with increased probabilities of transitions to death including a two-fold increased hazards of progression from homebound to death (HR: 2.18 [1.69, 2.81]). Homebound individuals with dementia have a 34.2% [25.8%, 48.1%] probability of death in 5 years, compared with 17.4% [13.7%, 24.3%] among those without dementia. DISCUSSION Dementia is associated with greater risk of transitioning across homebound states. There is a greater need to support home-based care for patients with dementia, especially as the ongoing COVID pandemic has raised concerns about the need to invest in alternative models to nursing home care.
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Affiliation(s)
- Katherine A. Ornstein
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, NY, NY
| | - Shelley H. Liu
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, NY, NY
| | - Mohammed Husain
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, NY, NY
| | - Claire K. Ankuda
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, NY, NY
| | - Evan Bollens-Lund
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, NY, NY
| | - Amy S. Kelley
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, NY, NY
- James J Peters Veterans Affairs Medical Center, Bronx, NY
| | - Melissa M. Garrido
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA
- Boston VA Healthcare System, Boston, MA
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14
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Cantu PA, Kim J, López-Ortega M, Rote S, Mejia-Arango S, Angel JL. Living Arrangements and Dementia Among the Oldest Old: A Comparison of Mexicans and Mexican Americans. Innov Aging 2022; 6:igac014. [PMID: 35663277 PMCID: PMC9154059 DOI: 10.1093/geroni/igac014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Indexed: 11/14/2022] Open
Abstract
Background and Objectives The growing population of adults surviving past age 85 in the United States and Mexico raises questions about the living arrangements of the oldest old and those living with dementia. This study compares Mexican and Mexican American individuals aged 85 and older to identify associations with cognitive status and living arrangements in Mexico and the United States. Research Design and Methods This study includes 419 Mexican Americans in 5 southwestern states (Hispanic Established Population for the Epidemiologic Studies of the Elderly) and 687 Mexicans from a nationally representative sample (Mexican Health and Aging Study). It examines characteristics associated with living alone using logistic regression and describes the living arrangements of older adults with probable dementia in each country. Results Older adults with dementia were significantly less likely to live alone than with others in the United States while there were no relationships between dementia and living arrangements in Mexico. However, a substantial proportion of older adults with dementia lived alone in both nations: 22% in the United States and 21% in Mexico. Among Mexican Americans with dementia, those living alone were more likely to be women, childless, reside in assisted living facilities, and less likely to own their homes. Similarly, Mexican individuals with dementia who lived alone were also less likely to be homeowners than those living with others. Discussion and Implications Contextual differences in living arrangements and housing between the United States and Mexico pose different challenges for aging populations with a high prevalence of dementia.
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Affiliation(s)
- Phillip A Cantu
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, Texas, USA
| | - Jiwon Kim
- Department of Educational Psychology, The University of Texas at Austin, Austin, Texas, USA
| | - Mariana López-Ortega
- National Institute of Geriatrics, National Institutes of Health, Mexico City, Mexico
| | - Sunshine Rote
- Department of Population Studies, El Colegio de la Frontera Norte, Tijuana, Baja California, Mexico
| | - Silvia Mejia-Arango
- Kent School of Social Work, University of Louisville, Louisville, Kentucky, USA
| | - Jacqueline L Angel
- LBJ School of Public Affairs and Center on Aging and Population Sciences, The University of Texas at Austin, Austin, Texas, USA
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15
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Zheng M, Kane RA, Lightfoot E. Helping Older Residents Remain in Subsidized Housing: Predictive Validity of the Live Well at Home-Rapid Screen (LWAH-RS) in a Real-World Application. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2022; 65:188-200. [PMID: 34193027 DOI: 10.1080/01634372.2021.1947430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 06/18/2021] [Accepted: 06/21/2021] [Indexed: 06/13/2023]
Abstract
Common Bond Communities (CBC) is a nonprofit organization that provides housing for low-income individuals and families. CBC utilized the Live Well at Home-Rapid Screen (LWAH-RS) to identify the risks for nursing home admission or assisted living entry among housing residents aged 60 or above. Drawing data from 842 assessments, we studied how well the LWAH-RS predicted moves to nursing homes or assisted living settings. Cox regression models showed that the LWAH-RS did predict which residents would move to a care setting. Every 1-point higher in the LWAH-RS assessment score was associated with a 38% higher risk of moving to a higher-level care facility due to health issues. Given this demonstrated predictive validity in a real-world setting, we suggest more systematic approaches for housing practitioners to combat low assessment completion rates and unclear protocols for actions based on the scores.
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Affiliation(s)
- Mingyang Zheng
- School of Social Work, University of Minnesota, Saint Paul, Minnesota, USA
| | - Rosalie A Kane
- School of Social Work, University of Minnesota, Saint Paul, Minnesota, USA
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16
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Bowling CB, Sloane R, Pieper C, Luciano A, Davis BR, Simpson LM, Einhorn PT, Oparil S, Muntner P. Sustained SBP control and long-term nursing home admission among Medicare beneficiaries. J Hypertens 2021; 39:2258-2264. [PMID: 34232161 PMCID: PMC9194789 DOI: 10.1097/hjh.0000000000002926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Sustaining SBP control reduces the risk for cardiovascular events that impair function but its association with nursing home admission has not been well studied. METHODS We conducted an analysis of sustained SBP control and long-term nursing home admissions using data from the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) linked to Medicare claims restricted to participants with fee-for-service coverage, at least eight study visits with SBP measurements, who were not living in a nursing home during a 48-month baseline BP assessment period (n = 6557). Sustained SBP control was defined as less than 140 mmHg at less than 50%, 50% to less than 75%, 75% to less than 100%, and 100% of visits. Nursing home admissions were identified using the Medicare Long Term Care Minimum Data Set. RESULTS The mean age of participants was 73.8 years and 44.3% were men. Over a median follow-up of 9.2 years, 844 participants (12.8%) had a nursing home admission. Rates of nursing home admission per 100 person-years were 16.3 for participants with SBP control at less than 50%, 14.1 at 50% to less than 75%, 7.8 at 75% to less than 100%, and 5.3 at 100% of visits. Compared with those with sustained SBP control at less than 50% of visits, hazard ratios (95% confidence intervals) for nursing home admission were 0.79 (0.66-0.93), 0.70 (0.58-0.84), and 0.57 (0.44-0.74) among participants with SBP control at 50% to less than 75%, 75% to less than 100%, and 100% of visits, respectively. CONCLUSION Among Medicare beneficiaries in ALLHAT, sustained SBP control was associated with a lower risk of long-term nursing home admission.
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Affiliation(s)
- C. Barrett Bowling
- Durham Veterans Affairs Geriatric Research Education and Clinical Center, Durham Veterans Affairs Medical Center (VAMC), Durham, NC
- Department of Medicine, Duke University, Durham, NC
| | - Richard Sloane
- Center for Study of Aging and Human Development, Duke University, Durham, NC
| | - Carl Pieper
- Center for Study of Aging and Human Development, Duke University, Durham, NC
| | - Alison Luciano
- Center for Study of Aging and Human Development, Duke University, Durham, NC
| | - Barry R. Davis
- The University of Texas School of Public Health, Houston, TX
| | - Lara M. Simpson
- The University of Texas School of Public Health, Houston, TX
| | - Paula T. Einhorn
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute of the National Institutes of Health, Bethesda, MD
| | - Suzanne Oparil
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Paul Muntner
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL
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17
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Lendon JP, Rome V, Sengupta M. Variations Between Adult Day Services Centers in the United States by the Racial and Ethnic Case-Mix of Center Participants. J Appl Gerontol 2021; 40:1029-1038. [PMID: 32613885 PMCID: PMC7775908 DOI: 10.1177/0733464820934996] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This is the first nationally representative study to identify differences between adult day services centers, a unique home- and community-based service, by racial/ethnic case-mix: Centers were classified as having a majority of participants who were Hispanic, non-Hispanic Black, or non-Hispanic other race/ethnicities and non-Hispanic White. The associations between racial/ethnic case-mix and geographic and operational characteristics of centers and health and functioning needs of participants were assessed using multivariate regression analyses, using the 2014 National Study of Long-term Care Providers' survey of 2,432 centers. Half of all adult day centers predominantly served racial/ethnic minorities, which were more likely to be for-profit, had lower percentages of self-pay revenue, more commonly provided transportation services, and had higher percentages of participants with diabetes, compared with predominantly non-Hispanic White centers. Findings show differences by racial/ethnic case-mix, which are important when considering the long-term care needs of a diverse population of older adults.
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Affiliation(s)
| | - Vincent Rome
- Centers for Disease Control and Prevention, Hyattsville, MD, USA
| | - Manisha Sengupta
- Centers for Disease Control and Prevention, Hyattsville, MD, USA
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18
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Diederich F, König HH, Brettschneider C. Cultural differences in the intended use of long-term care services in the United States: The role of family ties. J Gerontol B Psychol Sci Soc Sci 2021; 77:201-211. [PMID: 33649753 DOI: 10.1093/geronb/gbab035] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES In the light of an increasingly diverse older population in the United States, there is an ongoing discussion how cultural factors contribute to individual long-term care (LTC) needs and service use. This study empirically assesses whether the level of acculturation and cultural differences in the importance of the family shape foreign-born immigrants' intention to use certain LTC services. METHODS We correlated immigrants' intention to use certain LTC services to the cultural strength of family ties that prevails in their region of origin. We used data from the National Health Interview Survey and the World Values Survey/European Values Study for analysis. Multinomial logit models were estimated and predisposing, enabling, and need factors were controlled for. Estimations were weighted to account for the sampling structure and sensitivity analyses were conducted. RESULTS Immigrants from cultures with stronger family ties are significantly more likely to intend the use of LTC options that include the family. Furthermore, immigrants are less likely to intend the use of exclusively family care when having lived in the United States for a longer time. DISCUSSION We conclude that cultural differences in family ties shape immigrants' intention to use certain LTC services. If policy makers aim at increasing the provision of specific LTC services or support to family caregivers, there should be a careful evaluation of demand-side factors in an increasingly culturally diverse society.
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Affiliation(s)
- Freya Diederich
- Department of Health, Long-Term Care and Pensions, SOCIUM Research Center on Inequality and Social Policy, University of Bremen, Germany.,Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Germany
| | - Christian Brettschneider
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Germany
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19
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Gauthier GR, Smith JA, García C, Garcia MA, Thomas PA. Exacerbating Inequalities: Social Networks, Racial/Ethnic Disparities, and the COVID-19 Pandemic in the United States. J Gerontol B Psychol Sci Soc Sci 2021; 76:e88-e92. [PMID: 32756978 PMCID: PMC7454830 DOI: 10.1093/geronb/gbaa117] [Citation(s) in RCA: 72] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES The disruption and contraction of older adults' social networks are among the less discussed consequences of the COVID-19 pandemic. Our objective was to provide an evidence-based commentary on racial/ethnic disparities in social network resources and draw attention to the ways in which disasters differentially affect social networks, with meaningful insight for the ongoing pandemic. METHODS We draw upon prior research on social networks and past natural disasters to identify major areas of network inequality. Attention is given to how pre-pandemic racial/ethnic network disparities are exacerbated during the current crisis, with implications for physical and mental health outcomes. RESULTS Evidence from the literature shows a robust association between strong social networks and physical and mental health outcomes. During times of crisis, access to social networks for older adults is disrupted, particularly for marginalized groups. We document pre-pandemic disparities in social networks resources and offer insight for examining the impact of COVID-19 on disrupting social networks among older adults. DISCUSSION Importantly, racial/ethnic disparities in social networks both prior to and as a result of the pandemic intensify existing inequalities and demonstrate the necessity of better understanding social network inequalities for marginalized older adults, particularly in the context of the COVID-19 health crisis.
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Affiliation(s)
| | - Jeffrey A Smith
- Department of Sociology, University of Nebraska–Lincoln
- Rural Drug Addiction Research Center, University of Nebraska–Lincoln
| | | | - Marc A Garcia
- Department of Sociology, University of Nebraska–Lincoln
- Institute for Ethnic Studies, University of Nebraska–Lincoln
| | - Patricia A Thomas
- Department of Sociology and Center on Aging and the Life Course, Purdue University, West Lafayette, Indiana
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20
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Gorges RJ, Konetzka RT. Factors Associated With Racial Differences in Deaths Among Nursing Home Residents With COVID-19 Infection in the US. JAMA Netw Open 2021; 4:e2037431. [PMID: 33566110 PMCID: PMC7876590 DOI: 10.1001/jamanetworkopen.2020.37431] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
IMPORTANCE It is important to understand differences in coronavirus disease 2019 (COVID-19) deaths by nursing home racial composition and the potential reasons for these differences so that limited resources can be distributed equitably. OBJECTIVE To describe differences in the number of COVID-19 deaths by nursing home racial composition and examine the factors associated with these differences. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study of 13 312 nursing homes in the US used the Nursing Home COVID-19 Public File from the Centers for Medicare and Medicaid Services, which contains COVID-19 cases and deaths among nursing home residents as self-reported by nursing homes beginning between January 1, 2020, and May 24, 2020, and ending on September 13, 2020. Data were analyzed from July 28 to December 18, 2020. EXPOSURES Confirmed or suspected COVID-19 infection. Confirmed cases were defined as COVID-19 infection confirmed by a diagnostic laboratory test. Suspected cases were defined as signs and/or symptoms of COVID-19 infection or patient-specific transmission-based precautions for COVID-19 infection. MAIN OUTCOMES AND MEASURES Deaths associated with COVID-19 among nursing home residents. Death counts were compared by nursing home racial composition, which was measured as the proportion of White residents. RESULTS Among 13 312 nursing homes included in the study, the overall mean (SD) age of residents was 79.5 (6.7) years. A total of 51 606 COVID-19-associated deaths among residents were reported, with a mean (SD) of 3.9 (8.0) deaths per facility. The mean (SD) number of deaths in nursing homes with the lowest proportion of White residents (quintile 1) vs nursing homes with the highest proportions of White residents (quintile 5) were 5.6 (9.2) and 1.7 (4.8), respectively. Facilities in quintile 1 experienced a mean (SE) of 3.9 (0.2) more deaths than those in quintile 5, representing a 3.3-fold higher number of deaths in quintile 1 compared with quintile 5. Adjustment for the number of certified beds reduced the mean (SE) difference between these 2 nursing home groups to 2.2 (0.2) deaths. Controlling for case mix measures and other nursing home characteristics did not modify this association. Adjustment for county-level COVID-19 prevalence further reduced the mean (SE) difference to 1.0 (0.2) death. CONCLUSIONS AND RELEVANCE In this study, nursing homes with the highest proportions of non-White residents experienced COVID-19 death counts that were 3.3-fold higher than those of facilities with the highest proportions of White residents. These differences were associated with factors such as larger nursing home size and higher infection burden in counties in which nursing homes with high proportions of non-White residents were located. Focusing limited available resources on facilities with high proportions of non-White residents is needed to support nursing homes during potential future outbreaks.
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Affiliation(s)
- Rebecca J. Gorges
- Center for Health and the Social Sciences, University of Chicago, Chicago, Illinois
- Department of Public Health Sciences, Biological Sciences Division, University of Chicago, Chicago, Illinois
| | - R. Tamara Konetzka
- Department of Public Health Sciences, Biological Sciences Division, University of Chicago, Chicago, Illinois
- Department of Medicine, Biological Sciences Division, University of Chicago, Chicago, Illinois
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21
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Robison JT, Shugrue NA, Fortinsky RH, Fabius CD, Baker K, Porter M, Grady JJ. A New Stage of the Caregiving Career: Informal Caregiving After Long-Term Institutionalization. THE GERONTOLOGIST 2020; 61:1211-1220. [PMID: 33170252 DOI: 10.1093/geront/gnaa185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The "unexpected career" of caregiving has previously been conceptualized in stages: community care through institutional placement/residence, ending with death of the care recipient. Transition programs such as Money Follows the Person (MFP) created a new stage of the caregiving career, caring for someone post-long-term institutionalization, about which little is known. Using Pearlin's Caregiver Stress Process Model, this study explores effects on caregivers from the return of their loved ones to the community after a long-term institutional stay. RESEARCH DESIGN AND METHODS Cross-sectional surveys of 656 caregivers of persons transitioned through Connecticut's MFP program 2014-18, completed 6 months post-transition. RESULTS Regardless of the age/disability of the care recipient, and despite experiencing high caregiving intensity, caregivers experienced less burden, anxiety, and depression, and higher benefits of caregiving than demonstrated in literature for the general caregiving population. Most felt less stressed than before and during the participant's institutional stay. Factors associated with worse outcomes included worry about safety, strained finances, missing work, and desiring additional services. Black and Hispanic caregivers experienced lower burden and anxiety and higher benefits of caregiving than White caregivers. DISCUSSION AND IMPLICATIONS By providing community supports to participants, transition programs can have broad ancillary benefits for caregivers and improve outcomes in the Pearlin model, lessening potentially deleterious effects of an unexpected return to intensive caregiving duties after institutional placement. Positive results for Black and Hispanic caregivers may reflect cultural expectations in caring for family that buffer the adverse effects of caregiving.
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Affiliation(s)
- Julie T Robison
- Center on Aging, UConn Health, Farmington, Connecticut.,Department of Public Health Sciences, UConn Health, Farmington, Connecticut
| | | | - Richard H Fortinsky
- Center on Aging, UConn Health, Farmington, Connecticut.,Department of Public Health Sciences, UConn Health, Farmington, Connecticut
| | - Chanee D Fabius
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Kristin Baker
- Center on Aging, UConn Health, Farmington, Connecticut
| | - Martha Porter
- Center on Aging, UConn Health, Farmington, Connecticut
| | - James J Grady
- Department of Public Health Sciences, UConn Health, Farmington, Connecticut
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22
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Rivera-Hernandez M, Fabius CD, Fashaw S, Downer B, Kumar A, Panagiotou OA, Epstein-Lubow G. Quality of Post-Acute Care in Skilled Nursing Facilities That Disproportionately Serve Hispanics With Dementia. J Am Med Dir Assoc 2020; 21:1705-1711.e3. [PMID: 32741644 PMCID: PMC7641973 DOI: 10.1016/j.jamda.2020.06.030] [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: 09/10/2019] [Revised: 03/06/2020] [Accepted: 06/12/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVES As the number of Hispanics with dementia continues to increase, greater use of post-acute care in nursing home settings will be required. Little is known about the quality of skilled nursing facilities (SNFs) that disproportionately serve Hispanic patients with dementia and whether the quality of SNF care varies by the concentration of Medicare Advantage (MA) patients with dementia admitted to these SNFs. DESIGN Cross-sectional study using 2016 data from Medicare certified providers. SETTING AND PARTICIPANTS Our cohort included 177,396 beneficiaries with probable dementia from 8884 SNFs. METHODS We examined facility-level quality of care among facilities with high and low proportions of Hispanic beneficiaries with probable dementia enrolled in MA and fee-for-service (FFS) using data from Medicare-certified providers. Three facility-level measures were used to assess quality of care: (1) 30-day rehospitalization rate; (2) successful discharge from the facility to the community; and (3) Medicare 5-star quality ratings. RESULTS About 20% of residents were admitted to 1615 facilities with a resident population that was more than 15% Hispanic. Facilities with a higher share of Hispanic residents had a lower proportion of 4- or 5-star facilities by an average of 14% to 15% compared with facilities with little to no Hispanics. In addition, these facilities had a 1% higher readmission rate. There were also some differences in the quality of facilities with high (>26.5%) and low (<26.5%) proportions of MA beneficiaries. On average, SNFs with a high concentration of MA patients have lower readmission rates and higher successful discharge, but lower star ratings. CONCLUSIONS AND IMPLICATIONS Achieving better quality of care for people with dementia may require efforts to improve the quality of care among facilities with a high concentration of Hispanic residents.
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Affiliation(s)
- Maricruz Rivera-Hernandez
- Department of Health, Services, Policy and Practice at the Brown University School of Public Health, Providence, RI, USA.
| | - Chanee D Fabius
- Bloomberg School of Public Health, Department of Health Policy and Management Johns Hopkins University, Baltimore, MD, USA
| | - Shekinah Fashaw
- Department of Health, Services, Policy and Practice at the Brown University School of Public Health, Providence, RI, USA
| | - Brian Downer
- Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX, USA
| | - Amit Kumar
- College of Health & Human Services, Northern Arizona University, Flagstaff, AZ, USA
| | - Orestis A Panagiotou
- Department of Health, Services, Policy and Practice at the Brown University School of Public Health, Providence, RI, USA
| | - Gary Epstein-Lubow
- Department of Health, Services, Policy and Practice at the Brown University School of Public Health, Providence, RI, USA; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
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Jenkins Morales M, Robert SA. Black-White Disparities in Moves to Assisted Living and Nursing Homes Among Older Medicare Beneficiaries. J Gerontol B Psychol Sci Soc Sci 2020; 75:1972-1982. [PMID: 31665513 PMCID: PMC7566960 DOI: 10.1093/geronb/gbz141] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Investigate black-white disparities in older adults' moves to assisted living and nursing homes and draw from the Andersen Healthcare Utilization Model to test explanations for any disparities. METHODS Data are from a nationally representative sample of older community-dwelling Medicare beneficiaries from the 2015 (N = 5,212) National Health and Aging Trends Study (NHATS). We use stepwise multinomial logistic regression to examine black-white disparities in moves out of community housing to assisted living or a nursing home over 2 years, before and after adjusting for predisposing (age, gender), enabling (income, housing tenure, Medicaid, living arrangement) and need (activities of daily living [ADL] limitation, physical capacity, self-rated health, and dementia) factors. RESULTS Black older adults are less likely to move to assisted living and are more likely to move to a nursing home compared to white older adults. Black-white disparities in moves to nursing homes are explained by black-white differences in enabling and need factors, whereas black-white disparities in moves to assisted living remain even after adjusting for enabling and need factors. DISCUSSION Unmeasured factors related to systemic racism (e.g., residential racial segregation, racial discrimination) and/or black-white differences in care preferences might further explain black-white disparities in moves to assisted living and warrant further investigation.
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Young Y, Papenkov M, Hsu WH, Shahid F, Kuo YH. Permanent transition of homecare recipients with dementia to nursing homes in New York State: Risk factors. Geriatr Nurs 2020; 41:553-558. [DOI: 10.1016/j.gerinurse.2020.02.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 02/23/2020] [Accepted: 02/27/2020] [Indexed: 11/28/2022]
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25
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Lu P, Kong D, Shelley M. Making the Decision to Move to a Nursing Home: Longitudinal Evidence From the Health and Retirement Study. J Appl Gerontol 2020; 40:1197-1205. [PMID: 32795112 DOI: 10.1177/0733464820949042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This study applied the theory of planned behavior to examine predictors of U.S. older adults' (65+ years) intention and behavior of moving to a nursing home. Two waves of Health and Retirement Study data were used (N = 9,969). Moving intention was measured by respondents' self-reported probability to move in the next 5 years in Wave 1. Moving behavior was measured by whether they actually moved in Wave 2. Structural equation modeling was used to examine the relationships of demographic and health predictors with moving intention and behavior. For both genders, advanced age, poorer health, having fewer children, and long-term care insurance were associated with higher levels of moving intention and behavior. Men's intention was a significant predictor of subsequent moving behavior. However, women's intention was not associated with moving behavior, probably due to inadequate resources to support their preference. The findings provide meaningful personhood-centered insights into nursing home entry decisions.
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Affiliation(s)
- Peiyi Lu
- Iowa State University, Ames, USA
| | - Dexia Kong
- Rutgers University, New Brunswick, NJ, USA
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Zhu CW, Ornstein KA, Cosentino S, Gu Y, Andrews H, Stern Y. Medicaid Contributes Substantial Costs to Dementia Care in an Ethnically Diverse Community. J Gerontol B Psychol Sci Soc Sci 2020; 75:1527-1537. [PMID: 31425587 PMCID: PMC7424274 DOI: 10.1093/geronb/gbz108] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The main objective of this study was to estimate effects of dementia on Medicaid expenditures in an ethnically diverse community. METHODS The sample included 1,211 Medicare beneficiaries who did not have any Medicaid coverage and 568 who additionally had full Medicaid coverage enrolled in the Washington Heights-Inwood Columbia Aging Project (WHICAP), a multiethnic, population-based, prospective study of cognitive aging in northern Manhattan (1999-2010). Individuals' dementia status was determined using a rigorous clinical protocol. Relationship between dementia and Medicaid coverage and expenditures were estimated using a two-part model. RESULTS In participants who had full Medicaid coverage, average annual Medicaid expenditures were substantially higher for those with dementia than those without dementia ($50,270 vs. $21,966, p < .001), but Medicare expenditures did not differ by dementia status ($8,458 vs. $9,324, p = .19). In participants who did not have any Medicaid coverage, average annual Medicare expenditures were substantially higher for those with dementia than those without dementia ($12,408 vs. $8,113, p = .02). In adjusted models, dementia was associated with a $6,278 increase in annual Medicaid spending per person after controlling for other characteristics. DISCUSSION Results highlight Medicaid's contribution to covering the cost of dementia care in addition to Medicare. Studies that do not include Medicaid are unlikely to accurately reflect the true cost of dementia.
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Affiliation(s)
- Carolyn W Zhu
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
- James J Peters VA Medical Center, Bronx, New York
| | - Katherine A Ornstein
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Stephanie Cosentino
- Cognitive Neuroscience Division of the Department of Neurology, Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University Medical Center, New York, New York
| | - Yian Gu
- Cognitive Neuroscience Division of the Department of Neurology, Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University Medical Center, New York, New York
| | - Howard Andrews
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York
| | - Yaakov Stern
- Cognitive Neuroscience Division of the Department of Neurology, Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Columbia University Medical Center, New York, New York
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Health Outcomes of Immigrants in Nursing Homes: A Population-Based Retrospective Cohort Study in Ontario, Canada. J Am Med Dir Assoc 2020; 21:740-746.e5. [PMID: 32536433 DOI: 10.1016/j.jamda.2020.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 02/03/2020] [Accepted: 03/02/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Older adults account for a significant portion of Canadian immigrants, yet characteristics and health outcomes of older immigrants in nursing homes have not been studied. We aimed to describe the prevalence of immigrants living in nursing homes, their characteristics, and their hospitalization and mortality rates compared to long-term residents in the first year of entry to nursing homes. DESIGN Population-based, retrospective cohort study using linked health administrative databases. SETTING AND PARTICIPANTS We assessed all incident admissions into publicly funded nursing homes in Ontario between April 2013 and March 2016. Immigrants were defined as those who arrived in Canada after 1985; long-term residents are those who arrived before 1985 or are Canadian-born. METHODS The primary outcome was all-cause hospitalization and mortality rates within 1 year of nursing home entry. Nested Cox proportional hazards models were estimated to explore the associations of facility, demographic, and clinical characteristics to the primary outcomes. RESULTS Immigrants comprised 4.4% of residents in Ontario's nursing homes, compared to 13.9% in the general population. The majority were from East and Southeast Asia (52.2%), and more than half (53.9%) had no competency in either official language on arrival in Canada. At the time of nursing home entry, immigrants were younger than long-term residents but had greater functional and cognitive impairments. Immigrants had a lower rate of mortality [hazard ratio 0.58, 95% confidence interval (CI) 0.51, 0.68; P < .001] but were more likely to be hospitalized (hazard ratio 1.14, 95% CI 1.06, 1.23; P < .001). Adjusting for language ability, the effect of immigrant status on hospitalization was not statistically significant. CONCLUSIONS AND IMPLICATIONS Despite greater functional and cognitive impairments, immigrants in nursing homes had lower mortality than long-term residents, potentially reflecting the "healthy immigrant effect." Inability to speak English was associated with increased risk of hospitalization, highlighting the need for strategies to overcome communication barriers.
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Cross SH, Kaufman BG, Taylor DH, Kamal AH, Warraich HJ. Trends and Factors Associated with Place of Death for Individuals with Dementia in the United States. J Am Geriatr Soc 2019; 68:250-255. [PMID: 31609481 DOI: 10.1111/jgs.16200] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 08/28/2019] [Accepted: 08/28/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To assess trends and factors associated with place of death among individuals with Alzheimer's disease-related dementias (ADRD). DESIGN Cross-sectional analysis. SETTING Centers for Disease Control and Prevention Wide-ranging OnLine Data for Epidemiologic Research, 2003-2017. PARTICIPANTS Natural deaths occurring between 2003 and 2017 for which ADRD was determined to be the underlying cause. MEASUREMENTS Place of death was categorized as hospital, home, nursing facility, hospice facility, and other. Aggregate data included age, race, Hispanic ethnicity, sex, urbanization, and census division. Individual-level predictors included age, race, Hispanic ethnicity, sex, marital status, and education. RESULTS From 2003 to 2017, nursing facility and hospital deaths declined from 65.7% and 12.7% to 55.0% and 8.0% while home and hospice facility deaths increased from 13.6% and .2% to 21.9% and 6.2%, respectively. Odds of hospital and hospice facility deaths declined with age while odds of nursing facility deaths increased with age. Male sex was associated with higher odds of hospital or hospice facility death and lower odds of home or nursing facility death. Nonwhite race, Hispanic ethnicity, and being married were associated with increased odds of hospital or home death and reduced odds of nursing facility death. More education was associated with higher odds of home or in a hospice facility death and reduced odds of death in a nursing facility or hospital. Significant disparities in place of death by urban-rural status were also noted. CONCLUSION As ADRD deaths at home increase, the need for caregiver support and home-based palliative care may become more critical. Further research should examine the care preferences and experiences of ADRD patients and caregivers, the financial impact of home death on families and insurers, and explore factors that may contribute to differences in actual and preferred place of death. J Am Geriatr Soc 68:250-255, 2020.
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Affiliation(s)
- Sarah H Cross
- Sanford School of Public Policy, Duke University, Durham, North Carolina
| | - Brystana G Kaufman
- Margolis Center for Health Policy, Duke University, Durham, North Carolina
| | - Donald H Taylor
- Social Science Research Institute, Duke University, Durham, North Carolina
| | - Arif H Kamal
- Duke Cancer Institute, Durham, North Carolina.,Duke University School of Medicine, Durham, North Carolina
| | - Haider J Warraich
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Cardiology Section, Department of Medicine, Boston VA Healthcare System, Boston, Massachusetts
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29
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Epps F, Rose KM, Lopez RP. Who's Your Family?: African American Caregivers of Older Adults With Dementia. Res Gerontol Nurs 2019; 12:20-26. [PMID: 30653648 DOI: 10.3928/19404921-20181212-04] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 10/04/2018] [Indexed: 11/20/2022]
Abstract
The nature and outcome of family caregiving is different for various racial and ethnic groups. The purpose of the current study was to use qualitative methods to examine and characterize family networks of African American family caregivers (N = 26) who provided care to family members with dementia (N = 18). Researchers used data generated from a parent study that addressed family involvement in health promotion activities for African American older adults with dementia. Data were analyzed using sociograms and thematic analysis. Three themes that characterized African American family caregiving networks were identified: (a) Complexity, (b) Familism, and (c) Religiosity. Findings suggest that narrowly defining family caregivers as a dyad of a caregiver and care recipient does not reflect how these family networks function. A better understanding of the complex functioning of these networks may help explain physical and psychological well-being outcomes for individuals with dementia and their family members. [Res Gerontol Nurs. 2019; 12(1):20-26.].
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30
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Akarsu NE, Prince MJ, Lawrence VC, Das-Munshi J. Depression in carers of people with dementia from a minority ethnic background: Systematic review and meta-analysis of randomised controlled trials of psychosocial interventions. Int J Geriatr Psychiatry 2019; 34:790-806. [PMID: 30714226 DOI: 10.1002/gps.5070] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 01/26/2019] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Systematic review and meta-analysis to determine the effectiveness of interventions in reducing depressive symptoms in ethnic minority carers of people with dementia. METHODS We systematically searched EMBASE, CINAHL, MEDLINE, PsycINFO, PsycARTICLES, Applied Social Sciences Index and Abstracts (ASSIA), The Cochrane Central Register of Controlled Trials (CENTRAL), and Sociological Abstracts and Social Policy and Practices databases from 1990 to 2015, supplemented by a grey literature search, hand searches of bibliographies, and contacting authors. Study quality was assessed independently by two researchers using The Effective Public Health Practice Project Quality Assessment Tool, with an inter-rater reliability of Cohen's kappa of 0.72 (95% CI, 0.42-1.01). Narrative synthesis and meta-analysis were used to assess intervention effectiveness. Meta-regression was used to assess whether factors such as intervention type, peer support, and ethnicity accounted for hetereogeneity. RESULTS Thirteen studies were eligible for inclusion, with 1076 participants in control groups and 980 participants in intervention groups; 12 studies provided estimates for meta-analysis. All studies were from the United States. Interventions were associated with an overall mean reduction in depression in caregivers (SMD -0.17 (95% CI, -0.29 to -0.05; P = 0.005). Meta-regression did not indicate any potential sources of heterogeneity, although narrative synthesis suggested that interventions developed with the target ethnic minority group's preferred mode of engagement in mind alongside cultural adaptations may have enhanced effectiveness. CONCLUSIONS Psychosocial interventions for depression in ethnic minority carers of people with dementia are effective and could be enhanced through cultural adaptations. High-quality studies targeting minority ethnic groups outside of the United States are needed.
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Affiliation(s)
- Nazire E Akarsu
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Martin J Prince
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Vanessa C Lawrence
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Jayati Das-Munshi
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London & Maudsley Trust, London, UK
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Mudrazija S. Work-Related Opportunity Costs Of Providing Unpaid Family Care In 2013 And 2050. Health Aff (Millwood) 2019; 38:1003-1010. [DOI: 10.1377/hlthaff.2019.00008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Stipica Mudrazija
- Stipica Mudrazija is a senior research associate at the Income and Benefits Policy Center, Urban Institute, in Washington, D.C
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32
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Valluru G, Yudin J, Patterson CL, Kubisiak J, Boling P, Taler G, De Jonge KE, Touzell S, Danish A, Ornstein K, Kinosian B. Integrated Home- and Community-Based Services Improve Community Survival Among Independence at Home Medicare Beneficiaries Without Increasing Medicaid Costs. J Am Geriatr Soc 2019; 67:1495-1501. [PMID: 31074846 DOI: 10.1111/jgs.15968] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 02/25/2019] [Accepted: 02/28/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To determine the effect of home-based primary care (HBPC) for frail older adults, operating under Independence at Home (IAH) incentive alignment on long-term institutionalization (LTI). DESIGN Case-cohort study using HBPC site, Medicare administrative data, and National Health and Aging Trends Study (NHATS) benchmarks. SETTING Three IAH-participating HBPC sites in Philadelphia, PA, Richmond, VA, and Washington, DC. PARTICIPANTS HBPC integrated with long-term services and supports (LTSS) cases (n = 721) and concurrent comparison groups (HBPC not integrated with LTSS: n = 82; no HBPC: n = 573). Cases were eligible if enrolled at one of the three HBPC sites from 2012 to 2015. Independence at Home-qualified (IAH-Q) concurrent comparison groups were selected from Philadelphia, PA; Richmond, VA; and Washington, DC. INTERVENTION HBPC integrated with LTSS under IAH demonstration incentives. MEASUREMENTS Measurements include LTI rate and mortality rates, community survival, and LTSS costs. RESULTS The LTI rate in the three HBPC programs (8%) was less than that of both concurrent comparison groups (IAH-Q beneficiaries not receiving HBPC, 16%; patients receiving HBPC but not in the IAH demonstration practices, 18%). LTI for patients at each HBPC site declined over the three study years (9.9%, 9.4%, and 4.9%, respectively). Costs of home- and community-based services (HCBS) were nonsignificantly lower among integrated care patients ($2151/mo; observed-to-expected ratio = .88 [.68-1.09]). LTI-free survival in the IAH HBPC group was 85% at 36 months, extending average community residence by 12.8 months compared with IAH-q participants in NHATS. CONCLUSION HBPC integrated with long-term support services delays LTI in frail, medically complex Medicare beneficiaries without increasing HCBS costs.
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Affiliation(s)
- Girish Valluru
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jean Yudin
- Division of Geriatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,Independence at Home Learning Collaborative, American Academy of Home Care Medicine, Chicago, Illinois
| | | | | | - Peter Boling
- Division of Geriatrics, Virginia Commonwealth University, Richmond, Virginia.,Independence at Home Learning Collaborative, American Academy of Home Care Medicine, Chicago, Illinois
| | - George Taler
- Independence at Home Learning Collaborative, American Academy of Home Care Medicine, Chicago, Illinois.,MedStar House Call Program, MedStar Health, Washington, DC.,School of Medicine, Georgetown University, Washington, DC
| | - Karl Eric De Jonge
- Independence at Home Learning Collaborative, American Academy of Home Care Medicine, Chicago, Illinois.,MedStar House Call Program, MedStar Health, Washington, DC.,School of Medicine, Georgetown University, Washington, DC
| | - Steve Touzell
- Philadelphia Corporation for Aging, Philadelphia, Pennsylvania
| | - Ann Danish
- Philadelphia Corporation for Aging, Philadelphia, Pennsylvania
| | - Katherine Ornstein
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Bruce Kinosian
- Division of Geriatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,Independence at Home Learning Collaborative, American Academy of Home Care Medicine, Chicago, Illinois.,Geriatrics and Extended Care Data Analysis Center, Cpl Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania.,Center for Health Equity Research and Policy, Cpl Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania.,Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
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33
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Miller VJ, Hamler T. A value-critical policy analysis of the nursing home reform act: a focus on care of African American and Latino residents. SOCIAL WORK IN HEALTH CARE 2019; 58:471-493. [PMID: 30920360 DOI: 10.1080/00981389.2019.1587660] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 01/25/2019] [Accepted: 02/22/2019] [Indexed: 06/09/2023]
Abstract
Improving nursing home care has been a central legislative focus since the 1980s; The major response effort to address these reports of poor-quality care was first met with a federal rule in 1987, the Nursing Home Reform Act (NHRA). Since enactment of the NHRA in 1987, and despite an increasing utilization of nursing home care by aging minorities, the standardization of care practice, or quality indicators (e.g., structural, process, and outcome measures), within long-term nursing home care have remained relatively unchanged. This paper reports a value-critical policy analysis of the most recent final action rule, effective on November 28 of 2016 by the Centers for Medicare and Medicaid Services (CMS) with a particular focus on its impact on African-American and Latino older adults. This paper presents results of two policy analyses. Taken together, this merged analysis focuses on an overview of the problem, the groups most affected by the problem, current program goals and objectives, forms of benefits and services, and a current state of the social problem. Following the analysis, we present changes and improvements to be made, as well as proposals for reform and recommendations for policy changes.
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Affiliation(s)
- Vivian J Miller
- a School of Social Work , The University of Texas at Arlington , Arlington , Texas , USA
| | - Tyrone Hamler
- b Mandel School of Applied Social Sciences , Case Western Reserve University , Cleveland , Ohio , USA
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Untapped Potential: Using the HRS-Medicare-Linked Files to Study the Changing Nursing Home Population. Med Care 2018; 56:216-219. [PMID: 29298176 DOI: 10.1097/mlr.0000000000000866] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Nursing home (NH) care in the United States now includes many short-term admissions to skilled nursing facilities (SNFs) for postacute care. OBJECTIVE To demonstrate the potential of the Health and Retirement Study (HRS) linked to administrative data to study this group. RESEARCH DESIGN Descriptive retrospective panel study. SUBJECTS HRS respondents between 2002 and 2010 linked to administrative data from the Centers for Medicare and Medicaid Services (CMS). MEASURES NH use was defined in 3 ways: by survey responses, Medicare SNF claims, and mandatory NH assessments. RESULTS In total, 8.5% of observation periods (ie, time between 2 consecutive survey dates or 2 years before initial survey) reported by the survey and 26.0% reported by administrative data indicated some NH use. There was 98% agreement between survey responses and administrative data when there was no indication of a NH observation in the administrative data. However, there was only 33% agreement between survey responses and administrative data when a NH stay was indicated in the administrative data. NH stays associated with SNF care were responsible for the discrepancy-they were not consistently captured by the HRS survey. Rates of agreement were highest when a proxy respondent was used, and lowest among respondents who rated themselves in excellent overall health. Rates of agreement were higher later in the decade than earlier. CONCLUSIONS The HRS-Medicare-linked files enhance the ability of the HRS to examine the growing use of NH for postacute care as well as offer a more comprehensive view of who uses NHs.
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Downer B, Garcia MA, Saenz J, Markides KS, Wong R. The Role of Education in the Relationship Between Age of Migration to the United States and Risk of Cognitive Impairment Among Older Mexican Americans. Res Aging 2018; 40:411-431. [PMID: 28367726 PMCID: PMC5503795 DOI: 10.1177/0164027517701447] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Prior research indicates age of migration is associated with cognitive health outcomes among older Mexican Americans; however, factors that explain this relationship are unclear. This study used eight waves from the Hispanic Established Populations for the Epidemiologic Study of the Elderly to examine the role of education in the risk for cognitive impairment (CI) by nativity, age of migration, and gender. Foreign-born women had a higher risk for CI than U.S.-born women, regardless of age of migration. After adjusting for education, this risk remained significant only for late-life migrant women (risk ratio [RR] = 1.28). Foreign-born men who migrated at >50 had significantly higher risk for CI compared to U.S.-born men (RR = 1.33) but not significant after adjusting for education. Findings from a decomposition analysis showed education significantly mediated the association between age of migration and CI. This study highlights the importance of education in explaining the association between age of migration and CI.
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Affiliation(s)
- Brian Downer
- University of Texas Medical Branch, Galveston, TX, USA
| | | | - Joseph Saenz
- University of Texas Medical Branch, Galveston, TX, USA
| | | | - Rebeca Wong
- University of Texas Medical Branch, Galveston, TX, USA
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36
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Collins DM, Downer B, Kumar A, Krishnan S, Li CY, Markides KS, Karmarkar AM. Impact of Multiple Chronic Conditions on Activity Limitations Among Older Mexican-American Care Recipients. Prev Chronic Dis 2018; 15:E51. [PMID: 29729133 PMCID: PMC5951156 DOI: 10.5888/pcd15.170358] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Older Mexican Americans are living longer with multiple chronic conditions (MCCs). This has placed greater demands on caregivers to assist with basic activities of daily living (ADL) or instrumental activities of daily living (IADL). To understand the needs of older Mexican-American care recipients, we examined the impact of MCC on ADL and IADL limitations. METHODS We analyzed data from 485 Mexican American care-receiving/caregiving dyads. Selected MCCs in the analysis were diabetes, hypertension, stroke, heart disease, arthritis, emphysema/chronic obstructive pulmonary disease, cognitive impairment, depression, and cancer. Care recipients were dichotomized as having 3 or more conditions or as having 2 or fewer conditions. Three comorbidity clusters were established on the basis of the most prevalent health conditions among participants with comorbid arthritis and hypertension. These clusters included arthritis and hypertension plus: diabetes (cluster 1), cognitive impairment (cluster 2), and heart disease (cluster 3). RESULTS Care recipients with 3 or more chronic conditions (n = 314) had higher odds of having mobility limitations (OR = 1.98; 95% CI, 1.34-2.94), self-care limitations (OR = 2.53; 95% CI, 1.70-3.81), >3 ADL limitations (OR = 2.00; 95% CI, 1.28-3.17), and >3 IADL limitations (OR = 1.88; 95% CI, 1.26-2.81). All clusters had increased odds of ADL and severe ADL limitations. Of care recipients in cluster 2, those with arthritis, hypertension, and cognitive impairment had significantly higher odds of mobility limitations (OR = 2.33; 95% CI, 1.05-5.24) than those with just arthritis and hypertension. CONCLUSION MCCs were associated with more ADL and IADL limitations among care recipients, especially for those with hypertension and arthritis plus diabetes, cognitive impairment, or heart disease. These findings can assist in developing programs to meet the needs of older Mexican-American care recipients.
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Affiliation(s)
- Diane M Collins
- University of Texas Medical Branch, Department of Occupational Therapy, 301 University Blvd, 3.916 School of Health Professions, Galveston, TX 77555-1142.
- Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, Texas
| | - Brian Downer
- Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, Texas
| | - Amit Kumar
- Department of Health Services, Policy, and Practice, Brown University, Providence, Rhode Island
| | - Shilpa Krishnan
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University, Atlanta, Georgia
| | - Chih-Ying Li
- Department of Occupational Therapy, University of Texas Medical Branch, Galveston, Texas
| | - Kyriakos S Markides
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, Texas
| | - Amol M Karmarkar
- Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, Texas
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Low LF, LoGiudice D. Residents from non-English-speaking countries of birth in Australian aged care facilities. Australas J Ageing 2018; 37:E85-E90. [DOI: 10.1111/ajag.12527] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Lee-Fay Low
- Faculty of Health Sciences; University of Sydney; Sydney New South Wales Australia
| | - Dina LoGiudice
- Department of Aged Care; Royal Melbourne Hospital; Melbourne Victoria Australia
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Angel JL, Berlinger N. The Trump Administration's assault on health and social programs: potential consequences for older Hispanics. J Aging Soc Policy 2018; 30:300-315. [PMID: 29634422 PMCID: PMC10371221 DOI: 10.1080/08959420.2018.1462678] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Health and social welfare policy proposals put forth by the Trump administration and Republican-controlled Congress could have huge impacts on low-income groups. This paper focuses on older Hispanics, with an emphasis on the Mexican-origin population who form the largest Hispanic subgroup. A demographic portrait is presented that indicates that Mexican-origin individuals have less wealth and lower incomes than do non-Hispanic Whites. Given rising health care costs, lower use of nursing homes, and greater propensity to live with grown children, prevailing economic disadvantage has serious consequences for this population. More restrictive immigration policies aimed at limiting family reunification could have intergenerational caregiving consequences. In addition, because of labor-force disadvantages, low-income Mexican-origin adults are less likely to have private insurance compared to non-Hispanic Whites as they approach retirement. Consequently, Mexican-origin older adults tend to rely on Medicaid when eligible; in contrast, late-life migrants-who do not qualify for federally funded benefits for at least five years-and unauthorized migrants-who are excluded from federally funded benefits-have extremely limited access to safety net provisions. The potential effects of proposed cutbacks in health care financing on older Hispanics are discussed.
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Affiliation(s)
- Jacqueline L Angel
- a Department of Sociology and LBJ School of Public Affairs, The University of Texas , Austin , Texas , USA
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Garcia MA, Reyes AM. Prevalence and Trends in Morbidity and Disability Among Older Mexican Americans in the Southwestern United States, 1993-2013. Res Aging 2018; 40:311-339. [PMID: 29298598 PMCID: PMC5758427 DOI: 10.1177/0164027517697800] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study examines the prevalence of morbidity and disability among older Mexican Americans using 5-year age groups. Twenty-year panel data from the Hispanic Established Populations for the Epidemiological Study of the Elderly are used to make detailed comparisons by nativity and gender. Results show that prevalence rates for most chronic conditions for both males and females do not vary by nativity. For disabilities, nativity is a significant predictor of increased instrumental activity of daily living disability for foreign-born females and reduced activity of daily living disability for U.S.-born males. Additionally, results show significant interactions between nativity and age cohorts, with the gap increasing with age for males and decreasing with age for females. These results have important implications for health services and health policy. Given the rapid aging of the Mexican American population, the prevention and treatment of medical conditions, particularly among the foreign-born, should be a major public health priority to reduce dependence from disabilities.
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Affiliation(s)
- Marc A. Garcia
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX, USA
| | - Adriana M. Reyes
- Population Studies Center, University of Michigan, Ann Arbor, MI, USA
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Zhu CW, Cosentino S, Ornstein KA, Gu Y, Andrews H, Stern Y. Interactive Effects of Dementia Severity and Comorbidities on Medicare Expenditures. J Alzheimers Dis 2018; 57:305-315. [PMID: 28222520 DOI: 10.3233/jad-161077] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Few studies have examined how dementia and comorbidities may interact to affect healthcare expenditures. OBJECTIVE To examine whether effects of dementia severity on Medicare expenditures differed for individuals with different levels of comorbidities. METHODS Data are drawn from the Washington Heights-Inwood Columbia Aging Project (WHICAP). Comprehensive clinical assessments of dementia severity were systematically carried out at ∼18 month intervals. Dementia severity was measured by Clinical Dementia Rating (CDR). Comorbidities were measured by a modified Elixhauser comorbidities index. Generalized linear models examined effects of dementia severity, comorbidities, and their interactions on Medicare expenditures (1999-2010). RESULTS At baseline, 1,280 subjects were dementia free (CDR = 0, 66.4%), 490 had very mild dementia (CDR = 0.5, 25.4%), 108 had mild dementia (CDR = 1, 5.6%), and 49 had moderate/severe dementia (CDR = 2/3, 2.5%). Average annual Medicare expenditures for individuals with moderate/severe dementia were more than twice as high as those who were dementia free (CDR = 0: $9,108, CDR = 0.5/1: $11,664, CDR≥2: $19,604, p < 0.01). Expenditures were approximately 10 times higher among those with≥3 comorbidities than among those with no comorbidities ($2,612 for those with no comorbidities, to $6,109 for those with 1, $10,656 for those with 2, and $30,244 for those with≥3 comorbidities, p < 0.001). Dementia severity was associated with higher expenditures, but comorbidities were the most important predictor of expenditures. We did not find strong interaction effects between number of comorbidities and dementia severity. CONCLUSIONS Increasing dementia severity and higher comorbidities are associated with higher Medicare expenditures. Care of individuals with dementia should focus on management of comorbidities.
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Affiliation(s)
- Carolyn W Zhu
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,James J Peters VA Medical Center, Bronx, NY, USA
| | - Stephanie Cosentino
- Cognitive Neuroscience Division of the Department of Neurology, Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Medical Center, New York, NY, USA
| | - Katherine A Ornstein
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Yian Gu
- Cognitive Neuroscience Division of the Department of Neurology, Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Medical Center, New York, NY, USA
| | - Howard Andrews
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Yaakov Stern
- Cognitive Neuroscience Division of the Department of Neurology, Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Medical Center, New York, NY, USA
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Middleton A, Li S, Kuo YF, Ottenbacher KJ, Goodwin JS. New Institutionalization in Long-Term Care After Hospital Discharge to Skilled Nursing Facility. J Am Geriatr Soc 2018; 66:56-63. [PMID: 29112226 PMCID: PMC5777887 DOI: 10.1111/jgs.15131] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND/OBJECTIVES Approximately half of individuals newly admitted to long-term care (LTC) nursing homes (NHs) experienced a prior hospitalization followed by discharge to a skilled nursing facility (SNF). The objective was to examine characteristics associated with new institutionalizations of older adults on this care trajectory. DESIGN Retrospective cohort study. SETTING SNFs and LTC NHs. PATIENTS Medicare fee-for-service beneficiaries admitted to 7,442 SNFs in 2013 (N = 597,986). MEASUREMENTS We used demographic and clinical characteristics from Medicare data and the Minimum Data Set. We defined "new institutionalization" as LTC NH residence for longer than 90 non-SNF days, starting within 6 months of hospital discharge. RESULTS For individuals who survived 6 months after hospital discharge, the overall rate of new LTC institutionalizations was 10.0% (N = 59,736). Older age, white race, being unmarried, Medicaid eligibility, higher income, more comorbidities, cognitive impairment, depression, functional limitations, hallucinations and delusions, aggressive behavior, incontinence, and pressure ulcers were associated with higher adjusted odds of new LTC institutionalization. In analyses stratified according to race and ethnicity, higher income was associated with lower odds of LTC institutionalization for whites (odds ratio (OR) = 0.92, 95% confidence interval (CI) = 0.89-0.96) and greater odds for blacks (OR = 1.40, 95% CI = 1.27-1.55) and Hispanics (OR = 1.44, 95% CI = 1.25-1.66). Moderate or severe depression, functional limitations, hallucinations and delusions, aggressive behavior, and being unmarried were stronger risk factors for LTC for cognitively intact individuals than for those with moderate to severe cognitive impairment. Being unmarried and having more comorbidities were stronger predictors in those aged 66 to 70 than in those aged 81 to 85 and 91 and older. CONCLUSION Associations between risk factors and new LTC institutionalizations varied according to race and ethnicity, age, and level of cognitive function. Programs that target older adults at greater risk may be an effective strategy for reducing new institutionalizations and fostering aging in place.
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Affiliation(s)
- Addie Middleton
- Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, Texas
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, Texas
- Division of Physical Therapy, Medical University of South Carolina, Charleston, SC
| | - Shuang Li
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, Texas
| | - Yong-Fang Kuo
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, Texas
- Department of Preventative Medicine and Community Health, University of Texas Medical Branch, Galveston, Texas
| | - Kenneth J. Ottenbacher
- Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, Texas
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, Texas
| | - James S. Goodwin
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, Texas
- Department of Internal Medicine, Division of Geriatric Medicine, University of Texas Medical Branch, Galveston, Texas
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Levitan EB, Van Dyke MK, Chen L, Durant RW, Brown TM, Rhodes JD, Olubowale O, Adegbala OM, Kilgore ML, Blackburn J, Albright KC, Safford MM. Medical therapy following hospitalization for heart failure with reduced ejection fraction and association with discharge to long-term care: a cross-sectional analysis of the REasons for Geographic And Racial Differences in Stroke (REGARDS) population. BMC Cardiovasc Disord 2017; 17:249. [PMID: 28915854 PMCID: PMC5602915 DOI: 10.1186/s12872-017-0682-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 09/11/2017] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Less intensive treatment for heart failure with reduced ejection fraction (HFrEF) may be appropriate for patients in long-term care settings because of limited life expectancy, frailty, comorbidities, and emphasis on quality of life. METHODS We compared treatment patterns between REasons for Geographic And Racial Differences in Stroke (REGARDS) study participants discharged to long-term care versus home following HFrEF hospitalizations. We examined medical records and Medicare pharmacy claims for 147 HFrEF hospitalizations among 80 participants to obtain information about discharge disposition and medication prescriptions and fills. RESULTS Discharge to long-term care followed 22 of 147 HFrEF hospitalizations (15%). Participants discharged to long-term care were more likely to be prescribed beta-blockers and less likely to be prescribed aldosterone receptor antagonists and hydralazine/isosorbide dinitrate (96%, 14%, and 5%, respectively) compared to participants discharged home (81%, 22%, and 23%, respectively). The percentages of participants discharged to long-term care and home who had claims for filled prescriptions were similar for beta-blockers (68% versus 66%) and angiotensin converting enzyme inhibitors or angiotensin receptor blockers (ACEI/ARBs) (45% versus 47%) after 1 year. Smaller percentages of participants discharged to long-term care had claims for filled prescriptions of other medications compared to participants discharged home (diuretics: long-term care-50%, home-72%; hydralazine/isosorbide dinitrate: long-term care-5%, home-23%; aldosterone receptor antagonists: long-term care-5%, home-23%). CONCLUSIONS Differences in medication prescriptions and fills among individuals with HFrEF discharged to long-term care versus home may reflect prioritization of some medical therapies over others for patients in long-term care.
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Affiliation(s)
- Emily B Levitan
- University of Alabama at Birmingham, Birmingham, AL, USA.
- Department of Epidemiology, University of Alabama at Birmingham, 1720 2nd Ave S, RPHB 220, Birmingham, AL, 35294-0022, USA.
| | | | - Ligong Chen
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Todd M Brown
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - J David Rhodes
- University of Alabama at Birmingham, Birmingham, AL, USA
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Cantu PA, Angel JL. Demography of Living Arrangements Among Oldest-Old Mexican Americans: Evidence From the Hispanic Epidemiologic Study of the Elderly. J Aging Health 2017; 29:1015-1038. [PMID: 30231830 PMCID: PMC6380186 DOI: 10.1177/0898264317727790] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE In this article, we examine the demographics of living arrangements and household headship status among Mexican-origin individuals aged 85+ years. METHOD Data come from the Hispanic Established Populations for the Epidemiologic Study of the Elderly (H-EPESE) caregiver and respondent surveys. RESULTS Finances of the elderly individual and their caregiver inform living arrangement decisions. Physical and cognitive disability differentiate among living arrangements: The most mentally and physically impaired are most likely to live with others and less likely to be the head of the household. DISCUSSION Motivations for living with others are clearly more complex than simple filial piety considerations might hold. Extended living arrangements provide concrete financial and instrumental benefits for both elderly parents and their adult child caregiver. Future research should address the question of the capacity of the Mexican American family to provide care for elderly parents in the face of major demographic and social changes.
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Affiliation(s)
- Phillip A. Cantu
- Population Research Center and Department of Sociology and 2 LBJ School of Public Affairs and Department of Sociology, The University of Texas at Austin
| | - Jacqueline L. Angel
- LBJ School of Public Affairs and Department of Sociology, University of Texas at Austin
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Middleton A, Zhou J, Ottenbacher KJ, Goodwin JS. Hospital Variation in Rates of New Institutionalizations Within 6 Months of Discharge. J Am Geriatr Soc 2017; 65:1206-1213. [PMID: 28263369 PMCID: PMC5478433 DOI: 10.1111/jgs.14760] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Hospitalization in community-dwelling elderly is often accompanied by functional loss, increasing the risk for continued functional decline and future institutionalization. The primary objective of our study was to examine the hospital-level variation in rates of new institutionalizations among Medicare beneficiaries. DESIGN Retrospective cohort study. SETTING Hospitals and nursing homes. PARTICIPANTS Medicare fee-for-service beneficiaries discharged from 4,469 hospitals in 2013 (N = 4,824,040). MEASUREMENTS New institutionalization, defined as new long term care nursing home residence (not skilled nursing facility) of at least 90 days duration within 6 months of hospital discharge. RESULTS The overall observed rate of new institutionalizations was 3.6% (N = 173,998). Older age, white race, Medicaid eligibility, longer hospitalization, and having a skilled nursing facility stay over the 6 months before hospitalization were associated with higher adjusted odds. Observed rates ranged from 0.9% to 5.9% across states. The variation in rates attributable to the hospital after adjusting for case-mix and state was 5.1%. Odds were higher for patients treated in smaller (OR = 1.36, 95% CI: 1.27-1.45, ≤50 vs >500 beds), government owned (OR = 1.15, 95% CI: 1.09-1.21 compared to for-profit), limited medical school affiliation (OR = 1.13, 95% CI: 1.07-1.19 compared to major) hospitals and lower for patients treated in urban hospitals (OR = 0.79, 95% CI: 0.76-0.82 compared to rural). Higher Summary Star ratings (OR = 0.75, 95% CI: 0.67-0.93, five vs one stars) and Overall Hospital Rating (OR = 0.62, 95% CI: 0.57-0.67, ratings of 9-10 vs 0) were associated with lower odds of institutionalization. CONCLUSION Hospitalization may be a critical period for preventing future institutionalization among elderly patients. The variation in rates across hospitals and its association with hospital quality ratings suggest some of these institutionalizations are avoidable and may represent targets for care improvement.
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Affiliation(s)
- Addie Middleton
- Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, Texas
| | - Jie Zhou
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, Texas
| | - Kenneth J. Ottenbacher
- Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, Texas
| | - James S. Goodwin
- Department of Internal Medicine, Division of Geriatric Medicine, University of Texas Medical Branch, Galveston, Texas
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Abstract
This study examines the transition from independent living to a coresidential living arrangement across the late life course among older unmarried (i.e., widowed, divorced/separated, and single) Mexican Americans. Using 18 years' worth of panel data from the Hispanic Established Populations for the Epidemiologic Study of the Elderly, event history analyses revealed that age at migration, physical disability, and cognitive impairment were strong predictors of the transition to a coresidential living arrangement. Importantly, a decline in physical and cognitive abilities heightened the risk of transition to a coresidential living arrangement, net of time-variant measures of disability and impairment. These findings provide evidence for incorporating a dynamic approach to examining living arrangements across the late life course for Mexican-origin Hispanics living in the United States, with implications for policy and service providers.
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Affiliation(s)
- Kate C. Prickett
- The Population Research Center, University of Texas at Austin, Austin, TX, USA
| | - Jacqueline L. Angel
- LBJ School of Public Affairs and Department of Sociology, University of Texas at Austin, Austin, TX, USA
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Brenner AB, Clarke PJ. Understanding Socioenvironmental Contributors to Racial and Ethnic Disparities in Disability Among Older Americans. Res Aging 2016; 40:103-130. [PMID: 27909061 DOI: 10.1177/0164027516681165] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Our understanding of the mechanisms through which racial/ethnic disparities in disability in older adults develop and are maintained is limited. We examined the role of physical impairment, socioeconomic factors and health for racial/ethnic disparities in activities of daily living (ADL), and the modifying role of the indoor home environment. Data come from the National Health and Aging Trends Study ( N = 5,640), and negative binomial regression models were specified separately for men and women. Blacks and Hispanics reported more ADL difficulty than Whites. Living in homes with clutter was associated with higher rates of ADL difficulty, but it was not related to racial/ethnic disparities. Racial/ethnic differences were explained by physical impairment for men, but not for women. Socioeconomic factors and health accounted for remaining disparities for Black, but not for Hispanic women. Attention to individual and environmental factors is necessary to fully understand and address race/ethnic disparities in disability in older Americans.
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Affiliation(s)
- Allison B Brenner
- 1 Survey Research Center at the Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Philippa J Clarke
- 1 Survey Research Center at the Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
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Savage B, Foli KJ, Edwards NE, Abrahamson K. Familism and Health Care Provision to Hispanic Older Adults. J Gerontol Nurs 2016; 42:21-9; quiz 30-1. [DOI: 10.3928/00989134-20151124-03] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 10/27/2015] [Indexed: 11/20/2022]
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Thomeer MB, Mudrazija S, Angel JL. Relationship Status and Long-Term Care Facility Use in Later Life. J Gerontol B Psychol Sci Soc Sci 2015; 71:711-23. [PMID: 26577030 DOI: 10.1093/geronb/gbv106] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Accepted: 10/21/2015] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Most older adults prefer to "age in place" and avoid formal long-term care. Yet demographic shifts, including population aging and an increasing prevalence of remarried and unmarried older adults, could undermine these goals, making it important to consider carefully how and why relationship status relates to long-term care risk. METHOD We fit hazard models to a sample of adults aged 65 and older from eight waves (1998-2012) of the Health and Retirement Study (N = 21,564). We consider risk of any long-term care facility admission, as well as risk of long-duration stays. RESULTS Widowed, divorced, and never married adults have the highest risks of long-term care admission. Remarried and partnered adults have similar risks of long-term care admission as continuously married adults. Relationship status is more important for men than for women, especially when considering long-duration stays. Relationship status is also more significant for non-Hispanic White and Hispanic adults compared with non-Hispanic Black adults. Economic resources and, to some extent, social ties partially explain the association between relationship status and long-term care use. DISCUSSION By addressing the prohibitive costs of long-term care services which enable aging in place (e.g., home health care), relationship status disparities in long-term care may be reduced. Future studies should consider the link between long-term care facility use and relationship status in future cohorts as well as examine how relationship status structures access to a range of long-term care options.
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Affiliation(s)
| | - Stipica Mudrazija
- Income and Benefits Policy Center, Urban Institute, Washington, District of Columbia
| | - Jacqueline L Angel
- Lyndon B. Johnson School of Public Affairs, and Population Research Center, The University of Texas at Austin
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Bell CL, LaCroix AZ, Desai M, Hedlin H, Rapp SR, Cene C, Savla J, Shippee T, Wassertheil-Smoller S, Stefanick ML, Masaki K. Factors Associated with Nursing Home Admission after Stroke in Older Women. J Stroke Cerebrovasc Dis 2015; 24:2329-37. [PMID: 26169547 PMCID: PMC4592792 DOI: 10.1016/j.jstrokecerebrovasdis.2015.06.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Accepted: 06/14/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND We examined the social and economic factors associated with nursing home (NH) admission in older women, overall and poststroke. METHODS The Women's Health Initiative (WHI) included women aged 50-79 years at enrollment (1993-1998). In the WHI Extension Study (2005-2010), participants annually reported any NH admission in the preceding year. Separate multivariate logistic regression models analyzed social and economic factors associated with long-term NH admission, defined as an admission on 2 or more questionnaires, overall and poststroke. RESULTS Of 103,237 participants, 8904 (8.6%) reported NH admission (2005-2010); 534 of 2225 (24.0%) women with incident stroke reported poststroke NH admission. Decreased likelihoods of NH admission overall were demonstrated for Asian, Black, and Hispanic women (versus whites, adjusted odds ratio [aOR] = .35-.44, P < .001) and women with higher income (aOR = .75, 95% confidence interval [CI] = .63-.90), whereas increased likelihoods of NH admission overall were seen for women with lower social support (aOR = 1.34, 95% CI = 1.16-1.54) and with incident stroke (aOR = 2.59, 95% CI = 2.15-3.12). Increased odds of NH admission after stroke were demonstrated for women with moderate disability after stroke (aOR = 2.76, 95% CI = 1.73-4.42). Further adjustment for stroke severity eliminated the association found for race/ethnicity, income, and social support. CONCLUSIONS The level of care needed after a disabling stroke may overwhelm social and economic structures in place that might otherwise enable avoidance of NH admission. We need to identify ways to provide care consistent with patients' preferences, even after a disabling stroke.
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Affiliation(s)
- Christina L Bell
- Department of Geriatric Medicine, University of Hawaii John A. Burns School of Medicine, Honolulu, Hawaii.
| | - Andrea Z LaCroix
- Women's Health Center of Excellence, Department of Family and Preventive Medicine, University of California, San Diego, California
| | - Manisha Desai
- Quantitative Sciences Unit, Department of Medicine, Stanford University, Stanford, California
| | - Haley Hedlin
- Quantitative Sciences Unit, Department of Medicine, Stanford University, Stanford, California
| | - Stephen R Rapp
- Department of Psychiatry and Behavioral Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Crystal Cene
- Division of General Internal Medicine and Clinical Epidemiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Jyoti Savla
- Center for Gerontology and Department of Human Development, Virginia Tech, Blacksburg, Virginia
| | - Tetyana Shippee
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | | | - Marcia L Stefanick
- Department of Medicine, Stanford Prevention Research Center, Stanford University School of Medicine, Palo Alto, California
| | - Kamal Masaki
- Department of Geriatric Medicine, University of Hawaii John A. Burns School of Medicine, Honolulu, Hawaii.
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Gogol M. Stress und optimales Altern. Z Gerontol Geriatr 2015. [DOI: 10.1007/s00391-015-0934-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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