Black-white disparity in disability: the role of medical conditions

Association Between Vision Difficulty and Sociodemographic Factors in Children: A Population-Based Analysis

PURPOSE

To determine sociodemographic predictors of poor vision in children and adolescents less than 18 years of age in a large, nationally representative sample of the US population.

DESIGN

Retrospective, population-based cross-sectional study.

METHODS

Using data from the 2021 National Health Interview Survey (NHIS), participants less than 18 years of age for whom data were available on vision difficulty were included in our analysis. Our primary outcome was vision difficulty. Sociodemographic variables were investigated as predictors of vision difficulty. Logistic regression models were performed using Stata version 17.0. An odds ratio (OR) and 95% CI were reported for analyses.

RESULTS

The 2021 NHIS reported on 8261 children and adolescents, of whom 7373 had data pertaining to vision difficulty and were included in our sample. Vision difficulty was associated with being unable to afford medical care (OR = 2.60, 95% CI = 1.17, 5.80, P = 0.02) and having public health insurance (OR = 1.52, 95% CI = 1.09, 2.12, P = .01). Compared to children less than 5 years of age, children ranging from 5 to 8 years (OR = 4.29, 95% CI = 2.26, 8.15, P < .01) and adolescents ranging from 16 to 17 years (OR = 6.06, 95% CI = 3.17, 11.58, P < .01) had a higher odds of vision difficulty. Compared to participants for whom the highest level of education of adults in their family was grade 1 to 11, the odds of vision difficulty were lower in those whose parents had a professional school or doctoral degree (OR = 0.30, 95% CI = 0.11, 0.84, P = .02).

CONCLUSIONS

Multiple sociodemographic factors are associated with vision difficulty in young persons. In working toward achieving equity in vision health, it is imperative that disparities mediated by sociodemographic factors be addressed through public health policies.

Racial, Ethnic, Nativity, and Educational Disparities in Cognitive Impairment and Activity Limitations in the United States, 1998-2016

Despite extensive research on cognitive impairment and limitations in basic activities of daily living, no study has investigated the burden of their co-occurrence (co-impairment). Using the Health and Retirement Study data and incidence-based multistate models, we study the population burden of co-impairment using three key indicators: mean age at onset, lifetime risk, and health expectancy. We examine patterns by gender, race, ethnicity, nativity, education, and their interactions for U.S. residents aged 50-100. Furthermore, we analyze what fractions of racial, ethnic, and nativity disparities in co-impairment are attributable to inequalities in educational attainment. Results reveal that an estimated 56% of women and 41% of men aged 50 will experience co-impairment in their remaining life expectancy. Men experience an earlier onset of co-impairment than women (74 vs. 77 years), and women live longer in co-impairment than men (3.4 vs. 1.9 years). Individuals who are Black, Latinx, and lower educated, especially those experiencing intersecting disadvantages, have substantially higher lifetime risk of co-impairment, earlier co-impairment onset, and longer life in co-impairment than their counterparts. Up to 75% of racial, ethnic, and nativity disparity is attributable to inequality in educational attainment. This study provides novel insights into the burden of co-impairment and offers evidence of dramatic disparities in the older U.S. population.

The epidemiology of preexisting geriatric and palliative conditions in older adults with poor prognosis cancers

BACKGROUND

Older patients with poor prognosis cancers have complex needs that can benefit from geriatrics and palliative care principles. Because they are not routinely assessed, the prevalence of preexisting geriatric and palliative conditions in this population is unknown.

METHODS

We used the nationally representative Health and Retirement Study (HRS) linked with Medicare claims (1998-2016) to identify adults aged ≥65 years diagnosed with poor prognosis cancers (cancers with a median survival ≤1 year). Using the HRS interview before the first Medicare cancer claim, we used survey-weighted descriptive statistics and modified Poisson regression analysis to examine the prevalence of the following clinically significant conditions: functional impairment, difficulty with mobility, falls and injurious falls, social support, cognition, advance care planning, use of pain or sleep medications, and presence of pain or breathlessness.

RESULTS

Of 2105 participants (mean age 76, 53% women, 34% lung cancer, 21% gastrointestinal cancer), the median survival was 9.6 months. Approximately 65% had difficulty climbing stairs (95% CI 63%-67%), 49% had no advance directive (95% CI 45%-54%), 35% lived alone (95% CI 33%-37%), 36% fell in the last 2 years (95% CI 34%-38%), and 32% rated their memory as poor (95% CI 29%-34%). After adjusting for gender, cancer type, and HRS survey time before the first Medicare claim for a poor prognosis cancer, functional impairment and falls were highest among adults aged 85+. Adults aged 65-74 years were less likely to have an advance directive. After adjusting for age, cancer type, and HRS survey time, women had a higher rate of pain and physical impairment. In exploratory analyses, race and socioeconomic status predicted difficulty with mobility and instrumental activities of daily living, living alone, and advance directive completion.

CONCLUSIONS

Due to a high prevalence across multiple domains, all older adults with poor prognosis cancers should be assessed for geriatric and palliative care conditions.

Preserving independence among under-resourced older adults in the Southeastern United States: existing barriers and potential strategies for research

Disability prevention and preservation of independence is crucial for successful aging of older adults. To date, relatively little is known regarding disparities in independent aging in a disadvantaged older adult population despite widely recognized health disparities reported in other populations and disciplines. In the U.S., the Southeastern region also known as “the Deep South”, is an economically and culturally unique region ravaged by pervasive health disparities – thus it is critical to evaluate barriers to independent aging in this region along with strategies to overcome these barriers. The objective of this narrative review is to highlight unique barriers to independent aging in the Deep South and to acknowledge gaps and potential strategies and opportunities to fill these gaps. We have synthesized findings of literature retrieved from searches of computerized databases and authoritative texts. Ultimately, this review aims to facilitate discussion and future research that will help to address the unique challenges to the preservation of independence among older adults in the Deep South region.

Prevalence of Instrumental Activities of Daily Living Difficulties and Associated Cognitive Predictors Across Racial/Ethnic Groups: Findings From the KHANDLE Study

OBJECTIVE

Cognitive functioning is associated with instrumental activity of daily living (IADL) performance among older adults. The present study examines potential differences in the prevalence of IADL difficulty and association with cognition across diverse groups.

METHOD

Participants included 455 non-Hispanic Whites, 395 Blacks, 370 Asians, and 296 Latinos aged 65 years and older without a current dementia diagnosis from the Kaiser Healthy Aging and Diverse Life Experience cohort. Participants' self-reported IADL functioning and cognition was measured across episodic memory and executive functioning.

RESULTS

Older age, male gender, and being Black were associated with more IADL difficulties. Executive functioning showed a stronger association with IADLs than memory, and it was independent of health status, whereas memory was not. In joint models including both cognitive domains, executive functioning remained a significant predictor of IADL difficulty, but memory did not. Results for both cognitive domains were attenuated with self-rated health added to the joint model. These relationships did not significantly differ across racial/ethnic groups.

CONCLUSIONS

Our study supports previous work suggesting that Black older adults are at increased risk for IADL disability. This is the first study we are aware of that examined the association between specific cognitive domains and IADL performance across multiple racial/ethnic groups. Findings indicate that cognitive functioning has similar associations with self-reported IADL disability across diverse groups, and that executive functioning plays a particularly important role in IADL disability among older adults without dementia; however, health status largely attenuates the relationship between IADL difficulty and cognition.

Persistent Racial Disparities in Deep Brain Stimulation for Parkinson's Disease

We sought to determine whether racial and socioeconomic disparities in the utilization of deep brain stimulation (DBS) for Parkinson's disease (PD) have improved over time. We examined DBS utilization and analyzed factors associated with placement of DBS. The odds of DBS placement increased across the study period, whereas White patients with PD were 5 times more likely than Black patients to undergo DBS. Individuals, regardless of racial background, with 2 or more comorbidities were 14 times less likely to undergo DBS. Privately insured patients were 1.6 times more likely to undergo DBS. Despite increasing DBS utilization, significant disparities persist in access to DBS. ANN NEUROL 2022;92:246–254

Correlates of Strength and Balance Training Exercises in Older African American Adults

BACKGROUND AND OBJECTIVES

This study investigated the behavioral and psychological correlates of strength and balance training (SBT) participation among older African Americans.

RESEARCH DESIGN AND METHODS

A cross-sectional survey of 90 older African Americans (M = 66.7 ± 8.7 years; 70% female) was conducted to assess correlates of intention to undertake SBT exercises and the number of days that they currently engage in SBT. The Theory of Planned Behavior (TPB) and the threat appraisal of the Protection Motivation Theory (PMT) were used as frameworks for the analyses.

RESULTS

The intention to do SBT exercises was positively associated with favorable attitudes and subjective norm, knowledge about the benefits of SBT, and hours worked per week. The frequency of SBT participation was significantly correlated with behavioral intention, high fear of falling, and a low score on the kinesiophobia scale.

DISCUSSION AND IMPLICATIONS

This study demonstrated the utility of the TPB and PMT's threat appraisal construct in modeling intention and number of days of SBT participation among African American older adults. The study affirmed the link between intention and behavior and between knowledge of the benefits of SBT and intention. Fear of falling's positive association with days of SBT suggests that respondents' saw SBT's efficacy in reducing falls. The unique contributions of this study are the inclusions of kinesiophobia as a correlate and multiple threat appraisals in the PMT. Health promotion interventions should consider the interrelationship among these constructs.

Recovery From Mobility Limitation in Middle-Aged African Americans: The Jackson Heart Study

BACKGROUND

Despite evidence that African Americans shoulder a high burden of mobility limitation, little is known about factors associated with recovery.

METHOD

Participants from the Jackson Heart Study underwent 3 in-person exams from 2000 to 2013. Mobility limitations were assessed over this period by self-reported limitations in walking half a mile or climbing stairs during annual phone calls. The outcome of interest, recovery from mobility limitation, was defined as no mobility limitation the year following an incident event. Candidate predictor variables were assessed in logistic regression models, including sociodemographic, psychosocial, and health measures. Inverse probability weights were used to address missing data in the outcome.

RESULTS

Among 4526 participants (mean [SD] age = 54.5 (12.8) years) without a mobility limitation at baseline, 1445 (32%) had an incident mobility limitation over 12 years of follow-up, and 709 (49%) reported recovery from mobility limitation by 1 year later. Low income and daily discrimination were associated with a lower likelihood of recovery even after adjustment for covariates. In adjusted models, greater comorbidity was associated with a lower likelihood of recovering (p-value for trend = .05). History of heart failure and cancer were associated with a lower likelihood of recovering from mobility limitation (OR: 0.52, 95% CI: 0.29, 0.94 and OR: 0.74, 95% CI: 0.55, 1.00). Adiposity, smoking status, and physical activity were not associated with recovery from mobility limitation.

CONCLUSION

Half of incident mobility limitations in this population of middle-aged African Americans were transient. Adverse sociodemographic factors and comorbidities were associated with lower likelihood of recovery.

Adapting to chronic pain: A focused ethnography of black older adults

This study aimed to understand the coping strategies used by a group of Black older adults to manage chronic pain. To this end, a focused ethnography was completed within a senior housing facility. Following participant observation, 106 residents completed informal interviews and surveys comprised of a demographic tool, the Brief Pain Inventory, the PROMIS Global Health scale, and the Psychological Stress Measure – 9. Further, a subset of 20 participants that reported daily pain completed formal semi-structured interviews, which were recorded and transcribed. Descriptive statistics were completed on survey data while interviews were analyzed contextually and thematically. The adaptive coping strategies used by participants to manage pain included: remaining positive, remaining active, being engaged in the community, prayer/meditation, and maintaining positive support systems. Effective coping strategies lead to compensated levels of adaptation for participants. A middle range schema of pain is presented that may guide future nursing pain management practice.

Ethnic Differences in Functional Limitations by Age Across the Adult Life Course

Background

Despite compelling evidence from the United States of ethnic inequalities in physical functioning and ethnic differences in risk factors for poor physical functioning, very little is known about ethnic differences in the United Kingdom. Furthermore, the life stage at which these ethnic differentials are first observed has not been examined.

Methods

Using cross-sectional data from Wave 1 of the UK Household Longitudinal Study (UKHLS), we compared self-reported physical functioning among 35,816 White British, 4,450 South Asian and 2,512 African Caribbean men and women across different stages of adulthood (young adulthood, early middle age, late middle age, older age). Regression analyses examined ethnic differences in functional limitations, with adjustment for socioeconomic and clinical covariates. Ethnicity by sex and ethnicity by age-group interactions were examined, and subgroup heterogeneity was explored.

Results

Compared with White British adults over the age of 60, older South Asian men and women reported higher odds of functional limitations (odds ratio [OR] 2.77 [95% confidence interval {CI}: 2.00–3.89] and OR 3.99 [2.61–6.10], respectively); these ethnic differentials were observed as early as young adulthood. Young African Caribbean men had lower odds of functional limitations than White British men (OR 0.56 [0.34–0.94]), yet African Caribbean women reported higher odds of functional limitations in older age (OR 1.84 [1.21–2.79]).

Conclusions

There is an elevated risk of functional limitations relating to ethnicity, even in young adulthood where the impact on future health and socioeconomic position is considerable. When planning and delivering health care services to reduce ethnic inequalities in functional health, the intersectionality with age and sex should be considered.

Racial Differences in Change in Physical Functioning in Older Male Veterans with HIV

Little is known about longitudinal change in physical functioning of older African American/Black and White HIV-infected persons. We examined up to 10 years of data on African American (N = 1,157) and White (N = 400) men with HIV infection and comparable HIV-negative men (n = 1,137 and 530, respectively), age 50-91 years from the Veterans Aging Cohort Study Survey sample. Physical functioning was assessed using the SF-12 (12-Item Short Form Health Survey) physical component summary (PCS) score. Mixed-effects models examined association of demographics, health conditions, health behaviors, and selected interactions with PCS score; HIV biomarkers were evaluated for HIV-infected persons. PCS scores were approximately one standard deviation below that of the general U.S. population of similar age. Across the four HIV/race groups, over time and through ages 65-75 years, PCS scores were maintained; differences were not clinically significant. PCS score was not associated with race or with interactions among age, race, and HIV status. CD4 and viral load counts of African American and White HIV-infected men were similar. Older age, low socioeconomic status, chronic health conditions and depression, lower body mass index, and smoking were associated with poorer PCS score in both groups. Exercising and, counterintuitively, being HIV infected were associated with better PCS score. Among these older African American and White male veterans, neither race nor HIV status was associated with PCS score, which remained relatively stable over time. Chronic disease, depression, and lack of exercise were associated with lower PCS score. To maintain independence in this population, attention should be paid to controlling chronic conditions, and emphasizing good health behaviors.

Age, Race, and Gender Factors in Incident Disability

Background

Incident disability rates enable the comparison of risk across populations. Understanding these by age, sex, and race is important for planning for the care of older adults and targeting prevention.

Methods

We calculated incident disability rates among older adults in the Cardiovascular Health Study, a study of 5,888 older adults aged ≥ 65 years over 6 years of follow-up. Disability was defined in the following two ways: (i) self-report of disability (severe difficulty or inability) in any of six Activities of Daily Living (ADL), and (ii) mobility difficulty (any difficulty walking half a mile or climbing 10 steps). Incident disability rates were calculated as events per 100 person years for age, gender, and race groups.

Results

The incidence of ADL disability, and mobility difficulty were 2.7 (2.5-2.8), and 9.8 (9.4-10.3) events per 100 person years. Women, older participants, and blacks had higher rates in both domains.

Conclusion

Incidence rates are considerably different based on the domain examined as well as age, race, and gender composition of the population. Prevention efforts should focus on high risk populations and attempt to ameliorate factors that increase risk in these groups.

Relationship Between Chronic Conditions and Disability in African American Men and Women

BACKGROUND

Race differences in chronic conditions and disability are well established; however, little is known about the association between specific chronic conditions and disability in African Americans. This is important because African Americans have higher rates and earlier onset of both chronic conditions and disability than white Americans.

METHODS

We examined the relationship between chronic conditions and disability in 602 African Americans aged 50 years and older in the Baltimore Study of Black Aging. Disability was measured using self-report of difficulty in activities of daily living (ADL). Medical conditions included diagnosed self-reports of asthma, depressive symptoms, arthritis, cancer, diabetes, cardiovascular disease (CVD), stroke, and hypertension.

RESULTS

After adjusting for age, high school graduation, income, and marital status, African Americans who reported arthritis (women: odds ratio (OR)=4.87; 95% confidence interval(CI): 2.92-8.12; men: OR=2.93; 95% CI: 1.36-6.30) had higher odds of disability compared to those who did not report having arthritis. Women who reported major depressive symptoms (OR=2.59; 95% CI: 1.43-4.69) or diabetes (OR=1.83; 95% CI: 1.14-2.95) had higher odds of disability than women who did not report having these conditions. Men who reported having CVD (OR=2.77; 95% CI: 1.03-7.41) had higher odds of disability than men who did not report having CVD.

CONCLUSIONS

These findings demonstrate the importance of chronic conditions in understanding disability in African Americans and how it varies by gender. Also, these findings underscore the importance of developing health promoting strategies focused on chronic disease prevention and management to delay or postpone disability in African Americans.

PUBLICATION INDICES

Pubmed, Pubmed Central, Web of Science database.

Racial or Ethnic Health Disparities among Older Adults in Four Population Groups in South Africa

BACKGROUND

Racial or ethnic health disparities have been evidently apparent during the apartheid era in South Africa. This study aims to assess ethnic health disparities in four elderly population groups.

METHODS

Data for this study emanated from the 2008 study of "Global AGEing and adult health (SAGE) wave 1" (N = 3284) aged 50 years or older in South Africa. Associations between exposure variables and outcome variables (health status variables and chronic conditions) were examined through bivariate analyses and multivariable logistic regression.

RESULTS

Indians or Asians reported the highest prevalence of poor self-rated health (23.7%) and functional disability (11.6% and 29.1%). Coloureds had the lowest grip strength (55.3%) and Whites the highest cognitive functioning (80.1%). Coloureds had the highest prevalence of hypertension (85.0%), stroke and/or angina (15.0%), edentulism (26.8%) and low vision (50.6%); and Indians or Asians had the highest prevalence of arthritis (43.5%) and diabetes (24.4%). In adjusted analysis, Whites (Odds Ratio [OR]: 0.24, Confidence Interval [CI]: 0.11, 0.57) and Coloureds (OR: 0.50, CI: 0.29, 0.87) had lower odds of self-reported health status compared to Black Africans. Coloureds (OR: 0.36, CI: 0.22, 0.61) had lower odds of grip strength than Black Africans. Indians or Asians had higher odds of functional disability (OR: 1.87, CI: 1.03, 3.02) and diabetes (OR: 2.65, CI: 1.45, 4.83) than Black Africans. Whites (OR: 3.92, CI: 1.63, 9.41) and Coloureds (OR: 2.14, CI: 1.21, 3.78) had higher odds of cognitive functioning than Black Africans. Whites had lower odds (OR: 0.54, CI: 0.31, 0.93) and Indians or Asians had higher odds (OR: 1.91, CI: 1.91, 1.01, 3.59) of arthritis than Black Africans. Coloureds had a higher prevalence of hypertension (OR: 1.71, CI: 1.14, 2.58), stroke and/or angina (OR: 1.74, CI = 1.36, 2.22), edentulism (OR: 6.51, CI: 4.07, 10.41) and low vision (OR: 1.68, CI: 1.29, 2.19) than Black Africans.

CONCLUSION

There are still ethnic health disparities in South Africa in the post-apartheid era (i.e., Black Africans [lower cognitive functioning], Whites [poor self-reported health status and edentulism], Coloureds [poor self-reported health status, lower grip strength, arthritis, hypertension, stroke and/or angina, edentulism and low vision], Indians or Asians [poor functional disability, arthritis and diabetes]). Understanding these ethnic health disparities may help in developing better strategies to improve health across population groups.

Characterizing Mobility Limitations Among Older African American Men

This study represents an effort to contribute to the limited body of research on biopsychosocial contextual factors that influence or contribute to mobility limitations for older African American men. Specifically, we were interested in examining associations between socio-demographic, physical and emotional health experiences with mobility limitations. A secondary analysis of 1666 older African American men was performed to investigate socio-demographic, mental and physical health correlates to a specific measures of mobility limitation. In the final model, difficulty with self-care, severe pain interference, and problems with usual activities were most strongly associated with mobility limitations. Men who were married were significantly less likely to experience mobility limitations. Findings highlighted the relationship between mobility limitations and difficulty performing activities of daily living. Additional research should examine the impact of poor emotional health and the buffering effects of marriage on mobility for older African American men, a population at high risk of experiencing disparate health outcomes.

The Best Predictors of Survival: Do They Vary by Age, Sex, and Race?

We consider a broad set of variables used by social scientists and clinicians to identify the leading predictors of five‐year survival among American adults. We address a question not considered in earlier research: Do the strongest predictors of survival vary by age, sex or race/ethnicity? The analysis uses hazard models with 30 well‐established predictors to examine five‐year survival in the National Health and Nutrition Examination Survey. We find that the simple measure of self‐assessed health and self‐reported measures of functional ability and disability are the strongest predictors in all demographic groups, and are generally ranked considerably higher than biomarkers. Among the biomarkers, serum albumin is highly ranked in most demographic groups, whereas clinical measures of cardiovascular and metabolic function are consistently among the weakest predictors. Despite these similarities, there is substantial variation in the leading predictors across demographic groups, most notably by race and ethnicity

Racial/Ethnic Disparities in Disability Prevalence

PURPOSE

Worldwide, the number of disabled individuals is used as a marker for population health status because of high morbidity and mortality burden associated with disability. The primary objective of the current study is to use the 2012 NHIS disability supplement and examine racial/ethnic disparities in disability after controlling for a comprehensive list of factors, using the World Health Organization's International Classification of Functioning, Disability, and Health (WHO-ICF).

METHODS

A retrospective cross-sectional study design with data from 7993 individuals aged above 21 years from the 2012 National Health Interview Survey (NHIS) was adopted. Disability was defined based on a standard set of questions related to mobility, self-care, and cognition from the "Functioning and Disability" supplement of 2012 NHIS. Chi-squared tests and multinomial logistic regressions were conducted to examine the association between race/ethnicity and disability.

RESULTS

There were statistically significant racial/ethnic differences in disability status; 10.2 % non-Hispanic whites, 14.8 % non-Hispanic African Americans, 8.1 % Latino, and 6.7 % other racial minorities had severe disability. Non-Hispanic African Americans were more likely to have severe disability than were non-Hispanic whites (OR = 1.56, 95 % CI = 1.24, 1.95), and Latinos were less likely to have severe disability (OR = 0.70, 95 % CI = 0.55, 0.90) in the unadjusted model. There was no difference in disability status among non-Hispanic African Americans and non-Hispanic whites after adjusting for socio-economic status.

CONCLUSION

The study findings highlighted the role of socio-economic characteristics in reducing disparities in disability between non-Hispanic African Americans and non-Hispanic whites. As SES can affect health through a complex interaction of biological, psychological, lifestyle, environmental, social, and neighborhood factors, a multipronged approach that focuses on primary, secondary, and territory prevention of disability is needed.

Association between race, obesity and diabetes in elderly community dwellers: data from the FIBRA study

This study sought to investigate the effect of race on measures of body fat (body mass index - BMI, waist circumference - WC and waist-hip ratio - WHR), as well as its relationship with diabetes, among elderly individuals living in urban areas in seven places in Brazil, according to gender. This is a cross-sectional study carried out with a probabilistic sample comprising 2,566 individuals with 65 years of age or more who participated in the FIBRA Study (Frailty in Elderly Brazilians). We used several self-reported sociodemographic variables (gender, age, race, schooling and family income), anthropometric measures of general (BMI) and abdominal obesity (WC and WHR) and self-reported diabetes. Adjusting for schooling and income, white race was associated with higher WC values (p = 0.001) and WHR (p > 0.001) for male gender, regardless of diabetes status. However, when we considered only diabetic individuals, black race became associated with general (BMI) (p = 0.007) and central obesity (CC) (p > 0.001), only among women.

Relationship between Physical Function and Sleep Quality in African Americans

STUDY OBJECTIVES

There is a growing body of research examining the relationship between sleep and functional outcomes. However, little is known about sleep and physical functioning in older African Americans.

METHODS

Data for this project included 450 community-dwelling older African Americans (71.4 ± 9.2 years of age) who participated in the Baltimore Study of Black Aging. Overall sleep pattern and quality was measured by the Pittsburgh Sleep Quality Index (PSQI). Physical functioning was measured by the number of activities of daily living that each participant reported difficulty (ADL; e.g. eating, dressing, and bathing). Negative binomial regression models were conducted to estimate the association between sleep quality and physical functioning.

RESULTS

Seventy-two percent of the participants reported poor sleep quality. African Americans who reported poor sleep quality had a greater likelihood of an increase in the number of difficulties in ADLs that they reported even after accounting for demographic characteristics and health conditions. The relationship between sleep quality and physical functioning did not vary by gender.

CONCLUSIONS

Sleep may be an important factor to consider when seeking to improve physical functioning among community-dwelling older African Americans.

The Relationship between Pain, Disability, and Sex in African Americans

Older African Americans consistently report diminished capacities to perform activities of daily living (ADL) compared with other racial groups. The extent to which bodily pain is related to declining abilities to perform ADL/ADL disability in African Americans remains unclear, as does whether this relationship exists to the same degree in African American men and women. For nurses to provide optimal care for older African Americans, a better understanding of the relationship between bodily pain and ADL disability and how it may differ by sex is needed. The aim of this study was to examine whether pain, age, education, income, marital status and/or comorbid conditions were associated with ADL disabilities in older African American women and men. This was a cross-sectional descriptive study. The sample included 598 participants (446 women, 152 men) from the first wave of the Baltimore Study on Black Aging. African American women (odds ratio [OR] = 4.06; 95% confidence interval [CI] 2.63-6.26) and African American men (OR = 6.44; 95% CI = 2.84-14.57) who reported bodily pain had greater ADL disability than those who did not report bodily pain. Having two or more comorbid conditions also was significantly associated with ADL disability in African American women (OR = 3.95; 95% CI: 2.09-7.47). Further work is needed to understand pain differences between older African American women and men to develop interventions that can be tailored to meet the individual pain needs of both groups.

Racial Disparities in Cognitive Performance in Mid- and Late Adulthood: Analyses of Two Cohort Studies

OBJECTIVES

To examine whether the attenuation of racial disparities observed in physical health outcomes at older ages can be extended to cognitive outcomes in mid- and late-life samples.

DESIGN

Cross-sectional associations between race and cognitive functioning were examined as a function of age.

SETTING

The National Survey of Midlife Development in the United States (MIDUS) and the Washington Heights-Inwood Columbia Aging Project (WHICAP).

PARTICIPANTS

Non-Hispanic African American or white individuals aged 40 and older (MIDUS; n = 3875, 10.5% African American) and non-Hispanic African American or white individuals aged 65 and older without a diagnosis of dementia (WHICAP; n = 2,729, 53.8% African American).

MEASUREMENTS

Composite scores of executive functioning and episodic memory.

RESULTS

Independent of main effects of age, birth cohort, sex, education, and chronic health conditions, significant interactions between age and race indicated that racial disparities in episodic memory and executive functioning were larger at younger than older age in both samples.

CONCLUSION

Attenuation of racial inequalities in older age can be extended to cognitive outcomes, which probably reflects selective survival. Research on cognitive disparities or on race-specific causes of cognitive outcomes in old age must incorporate corrections for selective survival if the goal is to identify causal predictors of cognitive outcomes rather than merely statistical predictors.

Motor Function Is Associated With Incident Disability in Older African Americans

BACKGROUND

Disability in older African American adults is common, but its basis is unclear. We tested the hypothesis that the level of motor function is associated with incident disability in older African Americans after adjusting for cognition.

METHODS

A prospective observational cohort study of 605 older community-dwelling African American adults without dementia was carried out. Baseline global motor score summarized 11 motor performances, cognition was based on 19 cognitive tests, and self-reported disability was obtained annually. We examined the association of motor function with incident disability (instrumental activities of daily living [IADL], activities of daily living [ADL], and mobility disability) with a series of Cox proportional hazards models which controlled for age, sex, and education.

RESULTS

Average follow-up was about 5 years. In proportional hazards models, a 1-SD increase in baseline level of global motor score was associated with about a 50% decrease in the risk of subsequent IADL, ADL, and mobility disability (all p values < .001). These associations were unchanged in analyses controlling for cognition and other covariates. Further, the association of global motor score and incident ADL disability varied with the level of cognition (estimate -5.541, SE 1.634, p < .001), such that higher motor function was more protective at higher levels of cognition. Mobility and dexterity components of global motor score were more strongly associated with incident disability than strength (all p values < .001).

CONCLUSIONS

Better motor function in older African Americans is associated with a decreased risk of developing disability. Moreover, the association of motor function and disability is stronger in individuals with better cognitive function.

Change in motor function and adverse health outcomes in older African-Americans

OBJECTIVE

We tested whether declining motor function accelerates with age in older African-Americans.

METHODS

Eleven motor performances were assessed annually in 513 older African-Americans.

RESULTS

During follow-up of 5 years, linear mixed-effect models showed that motor function declined by about 0.03 units/year (Estimate, -0.026, p<0.001); about 4% more rapidly for each additional year of age at baseline. A proportional hazard model showed that both baseline motor function level and its rate of change were independent predictors of death and incident disability (all p's<0.001). These models showed that the additional annual amount of motor decline in 85 year old persons at baseline versus 65 year old persons was associated with a 1.5-fold higher rate of death and a 3-fold higher rate of developing Katz disability.

CONCLUSIONS

The rate of declining motor function accelerates with increasing age and its rate of decline predicts adverse health outcomes in older African-Americans.

Diabetes, race, and functional limitations in older U.S. men and women

AIMS

The presence of diabetes is associated with increased odds of difficulties in functional tasks but it remains unclear if the burden is similar by race.

METHODS

Our study included 122,004 non-Hispanic Black (NHB) and non-Hispanic White (NHW) adults ≥50 years from the U.S. National Health Interview Survey (2001-2012). Diabetes was defined as self-reported diagnosis or medication use. Functional limitations were defined as any self-reported difficulty in performing mobility tasks, general physical activities (GPA), or leisure and social activities (LSA). Logistic regression models were created to investigate the relationship of race with functional limitations accounting for key covariates, among men and women, by diabetes status.

RESULTS

Among older U.S. adults, NHB versus NHW women without diabetes had a higher odds of limitations in mobility (OR=1.39, 1.30-1.49) and LSA (OR=1.13, 1.05-1.23) without diabetes but a similar odds of these limitations with diabetes by race, after adjusting for age, income, education, obesity, arthritis, heart disease, stroke, COPD, and cancer. Interestingly, NHB versus NHW women had significantly lower odds of GPA, irrespective of diabetes status. However, NHB versus NHW men with diabetes had a persistently higher odds for mobility and LSA limitations with diabetes as follows: mobility (OR=1.30, 1.12-1.51) and LSA limitations (OR=1.07, 1.06-1.34). The interaction of race and diabetes was significant among women for mobility limitations (p<0.01), but not men.

CONCLUSIONS

The burden of functional limitations differs by race among both men and women with diabetes. Future studies should examine mechanisms underlying these differences to prevent progression to disability in older adults with diabetes.

"Living well with diabetes": evaluation of a pilot program to promote diabetes prevention and self-management in a medically underserved community

A substantial disparity exists in the prevalence and effective self-management of diabetes among African Americans in the United States. Community-level programs have the potential to affect self-efficacy and may be helpful in overcoming common barriers to self-management. The Neighborhood Health Talker Program used community members trained as cultural health brokers to engage their communities in conversations about "living diabetes well." Program evaluators used mixed methods to analyze post-conversation surveys and Health Talker field notes. These indicated an increase in diabetes-related knowledge and increased confidence among conversation participants. Conversations included discussion of barriers and facilitators to lifestyle changes and effective self-management that are frequently overlooked in a clinical setting.

Employing a Participatory Research Approach to Explore Physical Activity among Older African American Women

Introduction. Older African American women are particularly vulnerable to unhealthy lifestyle behaviors such as physical inactivity and the resultant chronic diseases and conditions. This study explored older African American women's perception of physical activity as well as facilitators of and barriers to being physically active in their local environment. Methods. Using a participatory research approach, a total of 7 women aged 65 years and over had their PA level assessed objectively through accelerometry. In addition, physical activity was discussed through the photo-elicitation procedure, which was supplemented by semistructured interviews. Qualitative thematic analysis was used to identify patterns and themes emerging from participants' interview. Results. Participants exhibited low levels of physical activity and viewed “physical activity” to be a broadly defined, nonspecific construct. Interviews revealed that many participants lack important knowledge about physical activity. A variety of personal, social, and environmental facilitators and barriers were reported by the participants. Conclusion. Efforts should be made towards clarifying information on physical activity in this population in order to help them incorporate physical activity into their routines, overcome barriers, and make use of opportunities to be active.

Disparities in access to health care among adults with physical disabilities: analysis of a representative national sample for a ten-year period

BACKGROUND

People with physical disabilities are the largest underserved subpopulation in the U.S. However, disparities in access to health care and how these have changed over time have not been fully explored.

OBJECTIVE

To examine national trends in disparities in access to health care and to identify the impact of physical disability and the personal factors that are associated with unmet health care needs, defined as self-reported ability to get medical care, dental care or prescription medications, among working age adults within the United States.

METHODS

Logistic regression analysis of a nationally representative sample of adults ages 25-64 (n = 163,220) with and without physical disabilities, using pooled data from the 2002-2011 Medical Expenditure Panel Survey.

RESULTS

Individuals with physical disabilities have 75% (p < 0.0001), 57% (p < 0.0001), and 85% (p < 0.000) higher odds of having unmet medical, dental, and prescription medication needs, respectively. Sociodemographic and health factors were related to unmet needs in all three measures of access to care. In particular, being female, living at or near the poverty level, and lacking health insurance increased the odds of unmet health care needs. Predicted probabilities of unmet health care needs from 2002 to 2011 show persistent gaps between individuals with and without physical disabilities, with a growing gap in unmet dental care (p = 0.004).

CONCLUSION

Having physical disabilities increase the odds of unmet health care needs. This study has important policy and community program implications. The Affordable Care Act could significantly reduce unmet health care needs, especially among individuals with physical disabilities.

Effects of health insurance on racial disparity in osteoporosis medication adherence

OBJECTIVE

To explore whether racial disparity in osteoporosis drug therapy maintenance varies by health insurance coverage status.

DESIGN

Longitudinal observation study.

SETTING

Cleveland Clinic Health System (Cleveland, OH) from January 2006 to December 2009.

PATIENTS

3,901 black and white female Medicare beneficiaries starting osteoporosis drug therapy.

INTERVENTION

Analysis of the health system's integrated electronic medical records.

MAIN OUTCOME MEASURES

Drug therapy adherence (medication possession ratio ≥80%) for more than 12 of 15 surveillance units and occurrence of extended nonadherence gaps for at least two surveillance units in a row.

RESULTS

Among patients with supplementary health insurance (n = 2,278), no difference was observed for drug therapy adherence ( P = 0.17) and extended nonadherence gaps ( P = 0.53) between black and white participants. When patients did not have supplementary health insurance (n = 1,623), blacks (36% [95% CI 28-47]) were less likely to adhere to drug therapy than whites (47% [38-57]; odds ratio [OR] 0.34 [95% CI 0.09-0.92], P = 0.004). Blacks (25% [19-32]) also were more likely to have an extended nonadherence gap episode than whites (18% [11-26]; OR 2.42 [1.13-3.50], P = 0.03).

CONCLUSION

Similar to previous research on racial disparity in health services, racial disparity in osteoporosis drug therapy maintenance between black and white female older patients existed when supplementary health insurance was not affordable.

Racial and ethnic differences in obesity and overweight as predictors of the onset of functional impairment

OBJECTIVES

To examine racial and ethnic differences in the effects of body mass index (BMI) on the onset of functional impairment over 10 years of follow-up.

DESIGN

Longitudinal analyses of a cohort from a nationally representative survey of community-dwelling American adults.

SETTING

Six waves (1996-2006) of the Health and Retirement Study (HRS).

PARTICIPANTS

Two groups of HRS participants aged 50 and older without functional impairment at baseline (1996): 5,884 with no mobility difficulty and 8,484 with no activity of daily living (ADL) difficulty.

MEASUREMENTS

Mobility difficulty was a composite measure of difficulty walking several blocks, walking one block, climbing several flights of stairs, and climbing one flight of stairs. ADL difficulty was measured as difficulty in dressing, bathing or showering, eating, and getting in and out of bed without help. The association between baseline BMI and risk of developing functional impairment was estimated using generalized estimating equation models.

RESULTS

Overweight and obesity were significant predictors of functional impairment. Overweight and obese Hispanics were 41% and 91% more likely, respectively, to develop ADL disability than whites in the same BMI categories. Overweight and severely obese blacks were also more likely than their white counterparts to develop ADL disability. Risk of developing ADL difficulty was higher for Hispanics than for blacks in the obese category. No significant differences in onset of mobility difficulty were found between racial or ethnic groups within any BMI category.

CONCLUSION

Blacks and Hispanics were at higher risk than whites of ADL but not mobility impairment. In addition to weight control, prevention efforts should promote exercise to reduce functional impairment, especially for blacks and Hispanics, who are at higher risk.

Disparity implications of the Medicare medication therapy management eligibility criteria: a literature review

The emphasis on eliminating racial and ethnic disparities in healthcare has received national attention, with various policy initiatives addressing this problem and proposing solutions. However, in the current economic era requiring tight monetary constraints, emphasis is increasingly being placed on economic efficiency, which often conflicts with the equality doctrine upon which many policies have been framed. The authors' review aims to highlight the disparity implications of one such policy provision - the predominantly utilization-based eligibility criteria for medication therapy management services under Medicare Part D - by identifying studies that have documented racial and ethnic disparities in health status and the use of and spending on prescription medications. Future design and evaluation of various regulations and legislations employing utilization-based eligibility criteria must use caution in order to strike an equity-efficiency balance.

Impact of a Culturally Sensitive Health Self-Empowerment Workshop Series on Health Behaviors/Lifestyles, BMI, and Blood Pressure of Culturally Diverse Overweight/Obese Adults

OBJECTIVE

Examine the impact of the Health Self-Empowerment Theory-based, culturally sensitive Health Self-Empowerment (HSE) Workshop Series to Modify and Prevent Obesity on levels of health promoting (health-smart) behaviors, motivators of and barriers to these behaviors, health promoting lifestyle variables, and health status indicators (Body Mass Index [BMI] and blood pressure) among a culturally diverse sample of overweight/obese adults from mostly low income households.

DESIGN

153 overweight/obese adults participated in an Immediate Treatment (IT) Group (n = 100) or a Waitlist Control (WC) Group (n = 53).

RESULTS

Post-intervention, the IT Group compared to the WC Group reported (a) significantly higher engagement in physical activity and healthy eating, (b) significantly less intake of calories, total fat, transfat, saturated fat, sugar, and added sugar, (c) significantly higher motivators for engaging in two of four specific health-smart behaviors, (d) significantly lower barriers to engaging in three of four specific health-smart behaviors, and (e) significantly lower BMI and systolic blood pressure.

CONCLUSION

The HSE Workshop Series may be an effective intervention for treating and preventing obesity among diverse low-income adults - individuals who often perceive/experience limited power over their health. Health care providers, particularly physicians, have important health empowerment roles in this intervention.

Racial disparities in functional disability among older women with newly diagnosed nonmetastatic breast cancer

BACKGROUND

This study sought to assess racial differences in functional disability among older women with nonmetastatic breast cancer.

METHODS

In this cross-sectional study, between April 2008 and December 2012, women aged ≥ 65 years with newly diagnosed stage I through III breast cancer were recruited from ambulatory oncology clinics at an academic center. Prior to receiving any adjuvant treatment, participants completed a comprehensive geriatric assessment. The primary outcome was functional disability, defined as dependency in any basic or instrumental activity of daily living, categorized as "yes" or "no." Logistic regression analyses were undertaken.

RESULTS

The study enrolled 190 women whose mean age was 75.0 years at diagnosis (standard deviation = 7.0, range = 65-93 years). Thirty-two percent were African American (AA), and 39% had functional disability. Controlling for age, participants with functional disability were more likely to be AA (versus non-Hispanic white), odds ratio = 4.19, 95% confidence interval = 2.12-8.27. Fifty-nine percent of the racial difference in functional disability was explained by a higher prevalence of lower income and education among AAs. In addition, the higher prevalence of chronic medical conditions and obesity among AAs, after accounting for socioeconomic factors, further explained 40% of the black-white difference in functional disability.

CONCLUSIONS

Among older women with newly diagnosed nonmetastatic breast cancer, functional disability is highly prevalent, and AAs are disproportionately affected. Interventions to optimize the functional status of at-risk individuals, particularly AAs, during and after cancer treatment may improve treatment tolerance and overall survival outcomes.

The effect modification of supplemental insurance on the relationship between race and bone mineral density screening in female Medicare beneficiaries

To determine the effect modification of supplemental insurance on the relationship between race and bone mineral density (BMD) in female Medicare beneficiaries. Retrospectively analyzing hospital administrative claim and clinical data of female Medicare beneficiaries (n = 1,398), we performed multivariate logistic regressions of BMD testing including data from all study participants and the subsets of health insurance. Significantly fewer Black than White female Medicare beneficiaries received the BMD testing in the overall sample (odds ratio, OR = 0.63; p = 0.02) and those without supplementary health insurance (n = 709; OR = 0.38; p = 0.004). By contrast, the magnitude of this racial disparity in the BMD testing was diminished among those with supplementary private health insurance (n = 689). We found a significant racial disparity in BMD testing for Black and White female Medicare beneficiaries. This disparity became more pronounced among those without supplementary private health insurance.

The Junior Faculty Laboratory: an innovative model of peer mentoring

Mentoring in academic medicine has been shown to contribute to the success of junior faculty, resulting in increased productivity, career satisfaction, and opportunities for networking. Although traditional dyadic mentoring, involving one senior faculty member and one junior protégé, is the dominant model for mentoring in the academic environment, there is increasing recognition that the sharing of knowledge, skills, and experiences among peers may also contribute to the career development of junior faculty. The authors describe the structure, activities, and outcomes of the Junior Faculty Laboratory (JFL), a self-organized, flexible, and dynamic peer-mentoring model within the Duke University Center for the Study of Aging and Human Development. As an innovative mentoring model, JFL is entirely peer driven, and its activities are determined by the real-time needs of members. In contrast to some other peer-mentoring models, JFL lacks senior faculty input or a structured curriculum, members are multidisciplinary, meeting times are project driven rather than preset, and participation in collaborative projects is optional based on the interests and needs of group members. Additionally, JFL was not formed as a substitute for, but as a complement to, the dyadic mentoring relationships enjoyed by its members. The model, now in its fifth year, has demonstrated success and sustainability. The authors present the JFL as an innovative, mentoring model that can be reproduced by other junior faculty seeking to foster collegial relationships with peers while simultaneously enhancing their career development.