Antecedents of Disability for Older Adults with Multiple Chronic Health Conditions

Data from community-dwelling older adults (65+) with two or more chronic health conditions who participated in a 30-month longitudinal panel survey ( N = 898) are used to examine the factors that are associated with the presence and development of functional disabilities. Both logistic regression and discrete time hazard models are used to address the risk factors associated with the presence and development of activities of daily living and instrumental activities of daily living disabilities. Results indicate that education, income, and age are consistent predictors of disability, and that arthritis and obesity have consistently stronger effects on disability than do other chronic conditions. A need for stronger conceptual models focusing on disability is discussed.

Racial Differences in Satisfaction with Physicians

This analysis examines the association between race and satisfaction with physicians among a sample of community-dwelling older adults. It is hypothesized that minority elderly will hold more negative attitudes toward physicians than will their White peers due to the difficulty in establishing rapport in the physician-patient relationship. Using data from the Established Populations for Epidemiologic Studies of the Elderly (Duke), we find that African Americans believe that physicians do not display much compassion for, and respect toward, the elderly. However, African Americans report more positive attitudes about the prudence of physicians. These findings are discussed in the context of improving the physician-patient relationship.

Familismo and its impact on the family caregiving of Latinos with Alzheimer's disease: a complex narrative

Despite the long-held view that Latinos' value and reliance on family leads to greater involvement of extended family in caring for sick members and reduced perception of burden, some research reports low levels of social support and high levels of distress among Latino caregivers. We explore this seeming discrepancy in a qualitative study of 41 Latino caregivers of family members with Alzheimer's disease, interviewing them regarding the role of familism in their caregiving experience. For some it facilitates caregiving in the traditional, expected manner. Other caregivers disavow its current relevance. Yet others feel a contrast between familism, which they may value in a general, abstract way and more personal, immediate negative feelings they are experiencing from caregiving. We discuss these complex, multidimensional findings, the variation among caregivers, and present implications for practice, policy, and research.

Learning from recruitment challenges: barriers to diagnosis, treatment, and research participation for Latinos with symptoms of Alzheimer's disease

This article discusses barriers to diagnosis and treatment of Alzheimer's disease (AD) and concomitantly to participation in AD research as elicited from 29 potential Latino participants who ultimately did not enroll in a study evaluating a caregiver intervention. Nearly half of all individuals contacting the researcher about the intervention study failed to meet criteria stipulating an existing AD diagnosis. Barriers to obtaining a diagnosis include lack of knowledge about AD, perceptions of memory loss as normal aging, and structural barriers to accessing care. A quarter of caregivers contacting the researcher felt too overwhelmed to participate. Many of these barriers have been previously identified as challenges to treatment, suggesting this is not just a methodological research problem, but inextricably tied to larger issues of AD knowledge and service accessibility. Engaging Latino communities equitably in the assessment of needs and the process of addressing them, thus ensuring the validity and applicability of the research and findings, is important both for increasing this group's participation in relevant studies and for addressing existing health disparities.

Life course determinants of racial and ethnic disparities in functional health trajectories

Previous research has documented racial/ethnic disparities in functional health trajectories in old age, though little work has investigated the relative contribution of early and later life insults in their genesis. This paper uses two-part latent curve models to investigate the life course determinants of racial/ethnic disparities in functional health trajectories in the USA. We find that blacks and Hispanics have both a greater probability of having any limitation at baseline and more limitations on average among those who have any. Over time, there is convergence in trajectories between Hispanics and non-Hispanic whites, though the black-white gap remains constant. In addition, we find that disparities result from differential exposure to poor childhood health, early life socioeconomic deprivation, as well as adult health and socioeconomic attainment. However, the impact of childhood insults is largely mediated by more contemporaneous factors. We also find little evidence that the impact of life course factors varies across groups.

Parkinson's disease and functional decline in older Mexican Americans

The purpose of this study was to establish prevalence and five-year incidence, and explore functional decline among older Mexican Americans with Parkinson's disease (PD). Using data from the Hispanic EPESE, baseline characteristics were compared across PD response profiles. Weighted generalized estimating equations (GEE) modeled the association between PD and outcomes. Prevalence was 1.30%; incidence at wave 4 was 1.18%. Those with prevalent PD had worse function than those without PD at each wave. Progressive functional decline across time was observed among those with PD. Older Mexican Americans with PD often live in the community, and those who provide care for them may be overburdened.

Cumulative Disadvantage and Black-White Disparities in Life-Course Health Trajectories

In this study, the authors use longitudinal data from the Panel Study of Income Dynamics and growth curve models to examine the utility of the concept of cumulative disadvantage as an explanation for race differences in life-course health (self-rated) in the United States. The authors ask whether socioeconomic resources equally benefit the health of Blacks and Whites, or if Whites receive higher rates of return to resources across the life course. The authors find that the relationship differs depending on the indicator of socioeconomic status that is examined. Education does not offer the same advantages for the health of Blacks as it does for Whites, particularly at higher levels of education, and this is compounded with age. In contrast, returns to income and wealth are similar for Blacks and Whites, and these resources remain equally important to protecting the health of Blacks and Whites across the life course. Over time, Blacks are at an increasing health disadvantage relative to Whites, a result that is not attenuated by educational attainment.

Waist circumference and weight change are associated with disability among elderly Hispanics

BACKGROUND

Studies have suggested that both high and low body mass index (BMI) and weight change are related to functional disability in elderly populations. Elderly Hispanics have a high prevalence of both obesity and disability, yet few studies have examined their interrelationship in this population. Therefore, we examined these relationships in a mostly Puerto Rican group of Hispanic elders.

METHODS

We investigated associations between a three-level disability score created from responses to a questionnaire on activities of daily living and BMI, waist circumference (WC), and weight change since age 50, using the proportional odds model in a cross-sectional study of 763 elderly Hispanics, aged 60 to 92 years, residing in Massachusetts.

RESULTS

After adjusting for potential confounders, men with a WC > or =109.3 cm (vs <90 cm), or with a reported weight loss of -0.32 to -0.01 kg/year, or a weight gain > or =0.55 kg/year since age 50 (vs relatively stable weight, -0.01 to +0.21 kg/year [y]) were each significantly associated with an approximately threefold higher risk for greater disability. Women with a BMI > or =35 kg/m(2) were almost four times as likely to have higher disability as those with a BMI of 20 to 25 kg/m(2). Compared with women with a WC < or =85.2 cm, those with a WC of 91.5 to 106.6 cm were two times more likely, and those with a WC > or =106.6 cm were five times more likely, to have higher disability scores. Compared with relatively stable weight (-0.05 to +0.23 kg/y), weight gain > or =0.23 kg/year was associated with a twofold higher risk of greater disability among women. When BMI and WC were included in the same model, WC, but not BMI, remained significantly associated with disability.

CONCLUSIONS

Abdominal obesity (WC > or =109.3 cm for men, or WC > or =91.5 cm for women) and weight gain > or =0.55 kg/year after age 50 in men or > or =0.23 kg/year in women may increase the risk of disability among elderly Hispanics.

Race and ethnic variation in the disablement process

OBJECTIVES

This analysis examines ethnoracial group differences in the transition from health to disability.

METHODS

Using data from the AHEAD study, the authors examine the relative influence of each stage in the disablement process in the evolution of ethnoracial group differences in basic and instrumental disability.

RESULTS

Predisposing factors account for disability differences between Whites and other Latinos, whereas excess disability among African Americans stems from their higher level of cognitive limitation. The excess disability of Mexican Americans arises from their higher level of physical limitations. The data also reveal a larger impact of medical conditions and physical limitations on acquisition of disability among African Americans and Mexican Americans. This article demonstrates the importance of cognitive status in the disablement process, especially in ethnoracial group differences.

DISCUSSION

The authors discuss the practical implications for health care delivery to non-White elders and the theoretical implications for understanding the complexities of disablement.

Prevalence and correlates of depressive symptoms among Hispanic elders in Massachusetts

BACKGROUND

Few studies have addressed depression among Puerto Rican and Dominican elders. This study examined the prevalence of depressive symptomatology and associated situational factors, among a representative sample of Hispanic elders in the state of Massachusetts and a neighborhood comparison group of non-Hispanic whites (NHWs).

METHODS

Participants included 715 Hispanic elders (429 Puerto Rican, 128 Dominican, and 149 other Hispanic) in Massachusetts and 238 NHW elders living in the same neighborhoods. Depressive symptomatology was measured with the Center for Epidemiologic Studies Depression Scale (CES-D). The associations between socioeconomic status, household arrangements, acculturation, health problems, and depression score were examined with multiple linear and logistic regression.

RESULTS

Puerto Rican and Dominican elders had significantly greater prevalences of high depression scores when compared with neighborhood NHWs. After controlling for various social, demographic, and health characteristics, the scores of Puerto Ricans remained significantly greater than those of the NHWs, but not "Other Hispanic" groups. Higher CES-D scores were significantly associated with being female, living alone, and having a higher number of health problems, but not with income. Effects of acculturation were only found among Dominican elders.

CONCLUSIONS

Puerto Rican elders experience high rates of depressive symptomatology that are associated with, but not fully explained by, high numbers of chronic health conditions. Further investigation is needed to both understand and treat this prevalent problem.

Cross-cultural ranking of IADL skills

Although causal theories of aging differ considerably across disciplines, the common denominator in published papers on the health and function of the aged is to be found in the methods section. The instrumental activities of daily living (IADL), used to determine the independence of the aged living in the community, are utilized both at a clinical and population level. While there has been a cross-disciplinary need for a scale to measure sub-populations, many scholars have been reticent to use the existing IADL items across geographical backgrounds. The results of this study, which surveys 236 physicians from 11 different cultures on the importance of individual IADL items, suggests the IADL may be useful as a universal measure of function.