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Hosseini-Shokouh SM, Ghanei M, Mousavi B, Bagheri H, Bahadori M, Meskarpour-Amiri M, Mehdizadeh P. Social disparities and inequalities in healthcare access and expenditures among Iranians exposed to sulfur mustard: a national study using spatio-temporal analysis. BMC Health Serv Res 2023; 23:1406. [PMID: 38093322 PMCID: PMC10720241 DOI: 10.1186/s12913-023-10352-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Accepted: 11/20/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Sulfur Mustard (SM) is a chemical warfare agent that has serious short-term and long-term effects on health. Thousands of Iranians were exposed to SM during the eight-year Iran-Iraq conflict and permanently injured while the socioeconomic imbalance in their healthcare utilization (HCU) and health expenditures remains. This study aims to describe the HCU of SM-exposed survivors in Iran from 2018 to 2021; identify high-risk areas; and apply an inequality analysis of utilization regarding the socioeconomic groups to reduce the gap by controlling crucial determinants. METHODS From Oct 2018 to June 2021, the Veterans and Martyrs Affairs Foundation (VMAF) recorded 58,888 living war survivors with eye, lung, and skin ailments. After cleaning the dataset and removing junk codes, we defined 11 HCU-related variables and predicted the HCU for the upcoming years using Bayesian spatio-temporal models. We explored the association of individual-level HCU and determinants using a Zero-inflated Poisson (ZIP) model and also investigated the provincial hotspots using Local Moran's I. RESULTS With ≥ 90% confidence, we discovered eleven HCU clusters in Iran. We discovered that the expected number of HCU 1) rises with increasing age, severity of complications in survivors' eyes and lungs, wealth index (WI), life expectancy (LE), and hospital beds ratio; and 2) decreases with growing skin complications, years of schooling (YOS), urbanization, number of hospital beds, length of stay (LOS) in bed, and bed occupancy rate (BOR). The concentration index (CInd) of HCU and associated costs in age and wealth groups were all positive, however, the signs of CInd values for HCU and total cost in YOS, urbanization, LOS, and Hospital beds ratio groups were not identical. CONCLUSIONS We observed a tendency of pro-rich inequity and also higher HCU and expenditures for the elderly population. Finally, health policies should tackle potential socioeconomic inequities to reduce HCU gaps in the SM-exposed population. Also, policymakers should allocate the resources according to the hotspots of HCU.
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Affiliation(s)
- Seyed-Morteza Hosseini-Shokouh
- Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
- Health Management and Economics Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran
- Department of Health Services Management, Faculty of Health, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Mostafa Ghanei
- Chemical Injuries Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Batool Mousavi
- Prevention Department, Janbazan Medical and Engineering Research Center (JMERC), Tehran, Iran
| | - Hassan Bagheri
- Chemical Injuries Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Mohammadkarim Bahadori
- Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | | | - Parisa Mehdizadeh
- Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran.
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Mateo-Abad M, Vrotsou K, Padilla Ruiz M, Montiel-Luque A, Saucedo Figueredo MDC, Machón M, Rivas Ruiz F, Vergara I. Use of health care services according to functional performance in community-dwelling older adults in Spain. An approach using GAMLSS models. PLoS One 2022; 17:e0277681. [PMID: 36395339 PMCID: PMC9671440 DOI: 10.1371/journal.pone.0277681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 11/01/2022] [Indexed: 11/18/2022] Open
Abstract
Functional performance in older adults is a predictor of survival and other health outcomes and its measurement is highly recommended in primary care settings. Functional performance and frailty are closely related concepts, and frailty status is associated with the use of health care services. However, there is insufficient evidence on the utilization of services profile according to the functional performance of older adults. The aim of this study was to assess the relationship between functional performance and the use of a wide range of health services in community-dwelling older adults. Generalized additive models for location, scale and shape were used to study these complex data of services utilization, from primary to hospital care. A total of 749 participants from two Spanish regions were followed up for 2 years. Of those, 276 (37%) presented low functional performance and 473 (63%) normal performance according to the Timed Up and Go test. The results showed that even after adjusting for burden of comorbidity and polypharmacy, participants with low functional performance used primary and secondary care health services more intensively, visited emergency rooms more often, and were hospitalized more frequently and for longer periods of time. A negative binomial distribution and a variant thereof were found to be the best models to describe health service utilization data. In conclusion, functionality should be considered as an important health indicator for tailoring the provision of health services for older adults.
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Affiliation(s)
- Maider Mateo-Abad
- Instituto de Investigación Sanitaria Biodonostia, Grupo de Atención Primaria, Donostia-San Sebastián, Gipuzkoa, España
- Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Salamanca, España
- Red de Investigación en Servicios Sanitarios en Enfermedades Crónicas (REDISSEC), Marbella, España
- * E-mail:
| | - Kalliopi Vrotsou
- Instituto de Investigación Sanitaria Biodonostia, Grupo de Atención Primaria, Donostia-San Sebastián, Gipuzkoa, España
- Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Salamanca, España
- Red de Investigación en Servicios Sanitarios en Enfermedades Crónicas (REDISSEC), Marbella, España
| | - María Padilla Ruiz
- Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Salamanca, España
- Red de Investigación en Servicios Sanitarios en Enfermedades Crónicas (REDISSEC), Marbella, España
- Unidad de Investigación, Agencia Sanitaria Costa del Sol, Marbella, Málaga, España
| | - Alonso Montiel-Luque
- Red de Investigación en Servicios Sanitarios en Enfermedades Crónicas (REDISSEC), Marbella, España
- Centro de Salud San Miguel, Distrito Sanitario Costa del Sol, Torremolinos, Málaga, España
| | - María del Carmen Saucedo Figueredo
- Red de Investigación en Servicios Sanitarios en Enfermedades Crónicas (REDISSEC), Marbella, España
- Centro de Salud Los Boliches, Distrito Sanitario Costa del Sol, Fuengirola, Málaga, España
| | - Mónica Machón
- Instituto de Investigación Sanitaria Biodonostia, Grupo de Atención Primaria, Donostia-San Sebastián, Gipuzkoa, España
- Red de Investigación en Servicios Sanitarios en Enfermedades Crónicas (REDISSEC), Marbella, España
| | - Francisco Rivas Ruiz
- Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Salamanca, España
- Red de Investigación en Servicios Sanitarios en Enfermedades Crónicas (REDISSEC), Marbella, España
- Unidad de Investigación, Agencia Sanitaria Costa del Sol, Marbella, Málaga, España
| | - Itziar Vergara
- Instituto de Investigación Sanitaria Biodonostia, Grupo de Atención Primaria, Donostia-San Sebastián, Gipuzkoa, España
- Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Salamanca, España
- Red de Investigación en Servicios Sanitarios en Enfermedades Crónicas (REDISSEC), Marbella, España
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Mahar AL, Cyr KS, Enns JE, Aiken AB, Whitehead M, Cramm H, Kurdyak P. Canadian Veteran chronic disease prevalence and health services use in the five years following release: a matched retrospective cohort study using routinely collected data. BMC Public Health 2022; 22:1678. [PMID: 36064372 PMCID: PMC9442935 DOI: 10.1186/s12889-022-14053-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 07/07/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Occupational exposures may result in Canadian military Veterans having poorer health and higher use of health services after transitioning to civilian life compared to the general population. However, few studies have documented the physical health and health services use of Veterans in Canada, and thus there is limited evidence to inform public health policy and resource allocation. METHODS In a retrospective, matched cohort of Veterans and the Ontario general population between 1990-2019, we used routinely collected provincial administrative health data to examine chronic disease prevalence and health service use. Veterans were defined as former members of the Canadian Armed Forces or RCMP. Crude and adjusted effect estimates, and 95% confidence limits were calculated using logistic regression (asthma, COPD, diabetes, myocardial infarction, rheumatoid arthritis, family physician, specialist, emergency department, and home care visits, as well as hospitalizations). Modified Poisson was used to estimate relative differences in the prevalence of hypertension. Poisson regression compares rates of health services use between the two groups. RESULTS The study included 30,576 Veterans and 122,293 matched civilians. In the first five years after transition to civilian life, Veterans were less likely than the general population to experience asthma (RR 0.50, 95% CI 0.48-0.53), COPD (RR 0.32, 95% CI 0.29-0.36), hypertension (RR 0.74, 95% CI 0.71-0.76), diabetes (RR 0.71, 95% CI 0.67-0.76), myocardial infarction (RR 0.76, 95% CI 0.63-0.92), and rheumatoid arthritis (RR 0.74, 95% CI 0.60-0.92). Compared to the general population, Veterans had greater odds of visiting a primary care physician (OR 1.76, 95% CI 1.70-1.83) or specialist physician (OR 1.39, 95% CI 1.35-1.42) at least once in the five-year period and lower odds of visiting the emergency department (OR 0.95, 95% CI 0.92-0.97). Risks of hospitalization and of receiving home care services were similar in both groups. CONCLUSIONS Despite a lower burden of comorbidities, Veterans had slightly higher physician visit rates. While these visits may reflect an underlying need for services, our findings suggest that Canadian Veterans have good access to primary and specialty health care. But in light of contradictory findings in other jurisdictions, the underlying reasons for our findings warrant further study.
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Affiliation(s)
- Alyson L Mahar
- ICES, Toronto, Canada. .,Manitoba Centre for Health Policy, Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada.
| | - Kate St Cyr
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Jennifer E Enns
- Manitoba Centre for Health Policy, Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Alice B Aiken
- Faculty of Health, Dalhousie University, Halifax, Canada
| | | | - Heidi Cramm
- School of Rehabilitation Therapy, Queen's University, Kingston, Canada
| | - Paul Kurdyak
- ICES, Toronto, Canada.,Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
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Preoperative Point-of-Care Ultrasound to Identify Frailty and Predict Postoperative Outcomes: A Diagnostic Accuracy Study. Anesthesiology 2022; 136:268-278. [PMID: 34851395 PMCID: PMC9843825 DOI: 10.1097/aln.0000000000004064] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Frailty is increasingly being recognized as a public health issue, straining healthcare resources and increasing costs to care for these patients. Frailty is the decline in physical and cognitive reserves leading to increased vulnerability to stressors such as surgery or disease states. The goal of this pilot diagnostic accuracy study was to identify whether point-of-care ultrasound measurements of the quadriceps and rectus femoris muscles can be used to discriminate between frail and not-frail patients and predict postoperative outcomes. This study hypothesized that ultrasound could discriminate between frail and not-frail patients before surgery. METHODS Preoperative ultrasound measurements of the quadriceps and rectus femoris were obtained in patients with previous computed tomography scans. Using the computed tomography scans, psoas muscle area was measured in all patients for comparative purposes. Frailty was identified using the Fried phenotype assessment. Postoperative outcomes included unplanned intensive care unit admission, delirium, intensive care unit length of stay, hospital length of stay, unplanned skilled nursing facility admission, rehospitalization, falls within 30 days, and all-cause 30-day and 1-yr mortality. RESULTS A total of 32 patients and 20 healthy volunteers were included. Frailty was identified in 18 of the 32 patients. Receiver operating characteristic curve analysis showed that quadriceps depth and psoas muscle area are able to identify frailty (area under the curve-receiver operating characteristic, 0.80 [95% CI, 0.64 to 0.97] and 0.88 [95% CI, 0.76 to 1.00], respectively), whereas the cross-sectional area of the rectus femoris is less promising (area under the curve-receiver operating characteristic, 0.70 [95% CI, 0.49 to 0.91]). Quadriceps depth was also associated with unplanned postoperative skilled nursing facility discharge disposition (area under the curve 0.81 [95% CI, 0.61 to 1.00]) and delirium (area under the curve 0.89 [95% CI, 0.77 to 1.00]). CONCLUSIONS Similar to computed tomography measurements of psoas muscle area, preoperative ultrasound measurements of quadriceps depth shows promise in discriminating between frail and not-frail patients before surgery. It was also associated with skilled nursing facility admission and postoperative delirium. EDITOR’S PERSPECTIVE
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Andrade LEL, New York BSDAC, Gonçalves RSDSA, Fernandes SGG, Maciel ÁCC. Mapping instruments for assessing and stratifying frailty among community-dwelling older people: a scoping review. BMJ Open 2021; 11:e052301. [PMID: 34937719 PMCID: PMC8704957 DOI: 10.1136/bmjopen-2021-052301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 11/13/2021] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To map in the current literature instruments for the assessment and stratification of frailty in community-dwelling older people, as well as to analyse them from the perspective of the Brazilian context. DESIGN Scoping review. STUDY SELECTION The selection of studies took place between March and April 2020. Includes electronic databases: Medline, Latin American and Caribbean Literature in Health Sciences, Scopus, Web of Science and Cumulative Index of Nursing and Literature Health Alliance, in addition to searching grey literature. DATA EXTRACTION A data extraction spreadsheet was created to collect the main information from the studies involved, from the title to the type of assessment and stratification of frailty. RESULTS In summary, 17 frailty assessment and stratification instruments applicable to community-dwelling older people were identified. Among these, the frailty phenotype of Fried et al was the instrument most present in the studies (45.5%). The physical domain was present in all the instruments analysed, while the social, psychological and environmental domains were present in only 10 instruments. CONCLUSIONS This review serves as a guideline for primary healthcare professionals, showing 17 instruments applicable to the context of the community-dwelling older people, pointing out advantages and disadvantages that influence the decision of the instrument to be used. Furthermore, this scoping review was a guide for further studies carried out by the same authors, which aim to compare instruments.
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Ysea-Hill O, Sani TN, Nasr LA, Gomez CJ, Ganta N, Sikandar S, Theou O, Ruiz JG. Concurrent Validity of Pictorial Fit-Frail Scale (PFFS) in Older Adult Male Veterans with Different Levels of Health Literacy. Gerontol Geriatr Med 2021; 7:23337214211003804. [PMID: 35047654 PMCID: PMC8762487 DOI: 10.1177/23337214211003804] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 02/24/2021] [Accepted: 02/26/2021] [Indexed: 12/31/2022] Open
Abstract
Introduction: Frailty is a state of vulnerability characterized by multisystemic physiological decline. The Pictorial Fit Frail Scale (PFFS) is a practical, image-based assessment that may facilitate the assessment of frailty in individuals with inadequate health literacy (HL). Objective: Determine the concurrent validity and feasibility of the PFFS in older Veterans with different levels of HL and cognition. Methods: Cross-sectional study in a geriatric clinic at a Veteran Health Administration (VHA) medical center. Veterans ≥65 years old completed a HL evaluation, PFFS, FRAIL scale and cognitive screening. We assessed the associations between PFFS, FRAIL scale, and VA-Frailty Index (VA-FI), and compared PFFS and FRAIL scale accuracy with a Receiver Operating Characteristic curve, Area Under the Curve (AUC) analysis, using the VA-FI as reference. Results: Eighty-three Veterans, mean age 76.20 (SD = 6.02) years, 65.1% Caucasian, 69.9% had inadequate HL, 57.8% were frail and 20.5% had cognitive impairment. All participants completed the 43 PFFS items. There were positive correlations between PFFS and VA-FI, r = .55 (95% CI: 0.365–0.735, p < .001), and FRAIL scale, r = .673 (95% CI: 0.509–0.836, p < .001). Compared to the VA-FI, the PFFS (AUC = 0.737; 95% CI: 0.629–0.844) and FRAIL scale (AUC = 0.724;95% CI: 0.615–0.824; p < .001) showed satisfactory diagnostic accuracy. Conclusions: The PFFS is valid and feasible in evaluating frailty in older Veterans with different levels of HL and cognition.
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Affiliation(s)
| | | | | | | | | | | | - Olga Theou
- Dalhousie University, Halifax, NS, Canada
| | - Jorge G Ruiz
- Miami VA Healthcare System, FL, USA.,University of Miami Miller, FL, USA
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Ganta N, Sikandar S, Ruiz SJ, Nasr LA, Mohammed YN, Aparicio-Ugarriza R, Cevallos V, Tang F, Ruiz JG. Incidence of Frailty in Community-Dwelling United States Older Veterans. J Am Med Dir Assoc 2020; 22:564-569. [PMID: 33234447 DOI: 10.1016/j.jamda.2020.10.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 09/14/2020] [Accepted: 10/10/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Determine the incidence rates of frailty among community-dwelling older veterans. DESIGN Population-based retrospective cohort study. SETTING AND PARTICIPANTS Veterans Health Administration Medical Center study included community-dwelling veterans 60 years and older with determinations of frailty from 2013 to 2014 and followed until September 2019. METHODS A 31-item frailty index was generated at baseline and during each subsequent primary care encounters as a proportion of potential variables from electronic health record data. Period prevalence was calculated by dividing total number of cases of frailty during the baseline period. After adjusting for covariates, the association of frailty with mortality was determined using a multivariate Cox regression model. Using baseline and follow-up data, incidence rates of frailty per 1000 person/years based on event rates and mean duration of follow-up were calculated, including survivor and entire cohorts. RESULTS Patients in this cohort were 16,761 veterans, mean age 72.18 (9.32) years, 74.00% Caucasian, 90.75% non-Hispanic, and 97.78% male. The period prevalence of frailty in this cohort was 20.84%. Over a median follow-up of 3.96 (interquartile range = 3.73) years, 25.86% of the baseline population died during follow up. Veterans with frailty had a higher all-cause mortality during follow up, adjusted hazard ratio = 3.12 (95% confidence interval 2.87-3.38), P value of < .0005. Among 10,513 veterans who survived a median follow-up of 4.81 (interquartile range = 3.12) years, 29.84% became frail. The incidence rate of frailty was 75.05 cases per 1000 person-years. Among the entire cohort of 13,268 nonfrail veterans, 29.93% became frail. The incidence rate of frailty was 84.03 cases per 1000 person-years. CONCLUSIONS AND IMPLICATIONS This study shows high incidence of frailty in community dwelling older US veterans. Future studies should be done for identification, implementation of adequate interventions aimed at preventing frailty or reducing frailty-related complications in community dwelling older individuals.
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Affiliation(s)
- Nagapratap Ganta
- Miami VA Healthcare System Geriatric Research, Education and Clinical Center (GRECC), Miami, FL, USA
| | - Sehrish Sikandar
- Miami VA Healthcare System Geriatric Research, Education and Clinical Center (GRECC), Miami, FL, USA
| | - Sergio J Ruiz
- Miami VA Healthcare System Geriatric Research, Education and Clinical Center (GRECC), Miami, FL, USA
| | - Lubna A Nasr
- Department of Public Health, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Yaqub Nadeem Mohammed
- Miami VA Healthcare System Geriatric Research, Education and Clinical Center (GRECC), Miami, FL, USA; Department of Public Health, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Raquel Aparicio-Ugarriza
- Miami VA Healthcare System Geriatric Research, Education and Clinical Center (GRECC), Miami, FL, USA; Department of Public Health, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Victor Cevallos
- Miami VA Healthcare System Geriatric Research, Education and Clinical Center (GRECC), Miami, FL, USA
| | - Fei Tang
- Miami VA Healthcare System Geriatric Research, Education and Clinical Center (GRECC), Miami, FL, USA
| | - Jorge G Ruiz
- Miami VA Healthcare System Geriatric Research, Education and Clinical Center (GRECC), Miami, FL, USA; Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA.
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Poor Self-Rated Health Is Associated with Hospitalization and Emergency Department Visits in African American Older Adults with Diabetes. J Racial Ethn Health Disparities 2020; 7:880-887. [DOI: 10.1007/s40615-020-00711-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 01/17/2020] [Accepted: 01/26/2020] [Indexed: 12/22/2022]
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Bazargan M, Smith JL, Cobb S, Barkley L, Wisseh C, Ngula E, Thomas RJ, Assari S. Emergency Department Utilization among Underserved African American Older Adults in South Los Angeles. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16071175. [PMID: 30986915 PMCID: PMC6479964 DOI: 10.3390/ijerph16071175] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 03/21/2019] [Accepted: 04/01/2019] [Indexed: 12/14/2022]
Abstract
Objectives: Using the Andersen’s Behavioral Model of Health Services Use, we explored social, behavioral, and health factors that are associated with emergency department (ED) utilization among underserved African American (AA) older adults in one of the most economically disadvantaged urban areas in South Los Angeles, California. Methods: This cross-sectional study recruited a convenience sample of 609 non-institutionalized AA older adults (age ≥ 65 years) from South Los Angeles, California. Participants were interviewed for demographic factors, self-rated health, chronic medication conditions (CMCs), pain, depressive symptoms, access to care, and continuity of care. Outcomes included 1 or 2+ ED visits in the last 12 months. Polynomial regression was used for data analysis. Results: Almost 41% of participants were treated at an ED during the last 12 months. In all, 27% of participants attended an ED once and 14% two or more times. Half of those with 6+ chronic conditions reported being treated at an ED once; one quarter at least twice. Factors that predicted no ED visit were male gender (OR = 0.50, 95% CI = 0.29–0.85), higher continuity of medical care (OR = 1.55, 95% CI = 1.04–2.31), individuals with two CMCs or less (OR = 2.61 (1.03–6.59), second tertile of pain severity (OR = 2.80, 95% CI = 1.36–5.73). Factors that predicted only one ED visit were male gender (OR = 0.45, 95% CI = 0.25–0.82), higher continuity of medical care (OR = 1.39, 95% CI = 1.01–2.15) and second tertile of pain severity (OR = 2.42, 95% CI = 1.13–5.19). Conclusions: This study documented that a lack of continuity of care for individuals with multiple chronic conditions leads to a higher rate of ED presentations. The results are significant given that ED visits may contribute to health disparities among AA older adults. Future research should examine whether case management decreases ED utilization among underserved AA older adults with multiple chronic conditions and/or severe pain. To explore the generalizability of these findings, the study should be repeated in other settings.
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Affiliation(s)
- Mohsen Bazargan
- Department of Family Medicine, Charles R. Drew University of Medicine and Science (CDU), Los Angeles, CA 90059, USA.
- Department of Family Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA 90095, USA.
| | - James L Smith
- Department of Family Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA 90095, USA.
| | - Sharon Cobb
- Department of Family Medicine, Charles R. Drew University of Medicine and Science (CDU), Los Angeles, CA 90059, USA.
- School of Nursing, Charles R. Drew University of Medicine and Science, Los Angeles, CA 90095, USA.
| | - Lisa Barkley
- Department of Family Medicine, Charles R. Drew University of Medicine and Science (CDU), Los Angeles, CA 90059, USA.
| | - Cheryl Wisseh
- Department of Pharmacy Practice, West Coast University, Los Angeles, CA 90004, USA.
| | - Emma Ngula
- Department of public health, Charles R. Drew University of Medicine and Science, Los Angeles, CA 90095, USA.
| | - Ricky J Thomas
- Department of Emergency Medicine, UC Davis Medical Center, University of California, Davis, Sacramento, CA 95817, USA.
| | - Shervin Assari
- Department of Family Medicine, Charles R. Drew University of Medicine and Science (CDU), Los Angeles, CA 90059, USA.
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Kojima G. Frailty as a Predictor of Emergency Department Utilization among Community-Dwelling Older People: A Systematic Review and Meta-Analysis. J Am Med Dir Assoc 2018; 20:103-105. [PMID: 30470576 DOI: 10.1016/j.jamda.2018.10.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 10/05/2018] [Indexed: 11/24/2022]
Affiliation(s)
- Gotaro Kojima
- Department of Primary Care and Population Health, University College London, London, United Kingdom
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RETRACTED ARTICLE: Rapid Screening for Frailty and Sarcopenia in Daily Clinical Practice. J Nutr Health Aging 2018. [DOI: 10.1007/s12603-018-1057-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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