1
|
Guittet L, Quipourt V, Aparicio T, Carola E, Seitz JF, Paillaud E, Lievre A, Boulahssass R, Vitellius C, Bengrine L, Canoui-Poitrine F, Manfredi S. Should we screen for colorectal cancer in people aged 75 and over? A systematic review - collaborative work of the French geriatric oncology society (SOFOG) and the French federation of digestive oncology (FFCD). BMC Cancer 2023; 23:17. [PMID: 36604640 PMCID: PMC9817257 DOI: 10.1186/s12885-022-10418-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 12/06/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND We have done a systematic literature review about CRC Screening over 75 years old in order to update knowledge and make recommendations. METHODS PUBMED database was searched in October 2021 for articles published on CRC screening in the elderly, and generated 249 articles. Further searches were made to find articles on the acceptability, efficacy, and harms of screening in this population, together with the state of international guidelines. RESULTS Most benefit-risk data on CRC screening in the over 75 s derived from simulation studies. Most guidelines recommend stopping cancer screening at the age of 75. In private health systems, extension of screening up to 80-85 years is, based on the life expectancy and the history of screening. Screening remains effective in populations without comorbidity given their better life-expectancy. Serious adverse events of colonoscopy increase with age and can outweigh the benefit of screening. The great majority of reviews concluded that screening between 75 and 85 years must be decided case by case. CONCLUSION The current literature does not allow Evidence-Based Medicine propositions for mass screening above 75 years old. As some subjects over 75 years may benefit from CRC screening, we discussed ways to introduce CRC screening in France in the 75-80 age group. IRB: An institutional review board composed of members of the 2 learned societies (SOFOG and FFCD) defined the issues of interest, followed the evolution of the work and reviewed and validated the report.
Collapse
Affiliation(s)
- Lydia Guittet
- grid.412043.00000 0001 2186 4076Public Health Unit, CHU Caen NormandieNormandie University, UNICAEN, INSERM U1086 ANTICIPE, Caen, France
| | - Valérie Quipourt
- grid.31151.37Geriatrics Department and Coordination Unit in Oncogeriatry in Burgundy, University Hospital of Dijon, Dijon, France
| | - Thomas Aparicio
- Department of Gastroenterology and Digestive Oncology, Saint Louis Hospital, APHP, Université de Paris, Paris, France
| | - Elisabeth Carola
- grid.418090.40000 0004 1772 4275Geriatric Oncology Unit, Groupe Hospitalier Public du Sud de L’Oise, Bd Laennec, 60100 Creil, France
| | - Jean-François Seitz
- grid.411266.60000 0001 0404 1115Department of Digestive Oncology & Gastroenterology, CHU Timone, Assistance Publique-Hôpitaux de Marseille (APHM) & Aix-Marseille-Univ, Marseille, France
| | - Elena Paillaud
- grid.414093.b0000 0001 2183 5849Geriatric Oncology Unit, Georges Pompidou European Hospital, Paris Cancer Institute CARPEM, inAP-HP, Paris, France
| | - Astrid Lievre
- grid.414271.5Department of Gastroenterology, INSERM U1242 “Chemistry Oncogenesis Stress Signaling”, University Hospital Pontchaillou, Rennes 1 University, Rennes, FFCD France
| | - Rabia Boulahssass
- grid.410528.a0000 0001 2322 4179Geriatric Coordination Unit for Geriatric Oncology (UCOG), PACA Est CHU de NICE, France; FHU ONCOAGE, Nice, France
| | - Carole Vitellius
- grid.411147.60000 0004 0472 0283Hepato-Gastroenterology Department, Angers University Hospital, Angers, France ,grid.7252.20000 0001 2248 3363HIFIH Laboratory UPRES EA3859, Angers University, SFR 4208, Angers, France
| | - Leila Bengrine
- Department of Medical Oncology, Georges-Francois Leclerc Centre, Dijon, France
| | - Florence Canoui-Poitrine
- grid.412116.10000 0004 1799 3934Public Health Unit, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, 94000 Créteil, France
| | - Sylvain Manfredi
- grid.31151.37Gastroenterology and Digestive Oncology Unit, University Hospital Dijon, INSERM U123-1 University of Bourgogne-Franche-Comté, FFCD (French Federation of Digestive Cancer), Dijon, France
| |
Collapse
|
2
|
Snowdon JL, Scheufele EL, Pritts J, Le PT, Mensah GA, Zhang X, Dankwa-Mullan I. Evaluating Social Determinants of Health Variables in Advanced Analytic and Artificial Intelligence Models for Cardiovascular Disease Risk and Outcomes: A Targeted Review. Ethn Dis 2023; 33:33-43. [PMID: 38846264 PMCID: PMC11152155 DOI: 10.18865/1704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2024] Open
Abstract
Introduction/Purpose Predictive models incorporating relevant clinical and social features can provide meaningful insights into complex interrelated mechanisms of cardiovascular disease (CVD) risk and progression and the influence of environmental exposures on adverse outcomes. The purpose of this targeted review (2018-2019) was to examine the extent to which present-day advanced analytics, artificial intelligence, and machine learning models include relevant variables to address potential biases that inform care, treatment, resource allocation, and management of patients with CVD. Methods PubMed literature was searched using the prespecified inclusion and exclusion criteria to identify and critically evaluate primary studies published in English that reported on predictive models for CVD, associated risks, progression, and outcomes in the general adult population in North America. Studies were then assessed for inclusion of relevant social variables in the model construction. Two independent reviewers screened articles for eligibility. Primary and secondary independent reviewers extracted information from each full-text article for analysis. Disagreements were resolved with a third reviewer and iterative screening rounds to establish consensus. Cohen's kappa was used to determine interrater reliability. Results The review yielded 533 unique records where 35 met the inclusion criteria. Studies used advanced statistical and machine learning methods to predict CVD risk (10, 29%), mortality (19, 54%), survival (7, 20%), complication (10, 29%), disease progression (6, 17%), functional outcomes (4, 11%), and disposition (2, 6%). Most studies incorporated age (34, 97%), sex (34, 97%), comorbid conditions (32, 91%), and behavioral risk factor (28, 80%) variables. Race or ethnicity (23, 66%) and social variables, such as education (3, 9%) were less frequently observed. Conclusions Predictive models should adjust for race and social predictor variables, where relevant, to improve model accuracy and to inform more equitable interventions and decision making.
Collapse
Affiliation(s)
- Jane L. Snowdon
- Center for Artificial Intelligence, Research, and Evaluation, IBM Watson Health, Cambridge, MA 02142
| | - Elisabeth L. Scheufele
- Center for Artificial Intelligence, Research, and Evaluation, IBM Watson Health, Cambridge, MA 02142
| | - Jill Pritts
- Center for Artificial Intelligence, Research, and Evaluation, IBM Watson Health, Cambridge, MA 02142
| | - Phuong-Tu Le
- Division of Integrative Biological and Behavioral Sciences, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD 20892
| | - George A. Mensah
- Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD 20892
| | - Xinzhi Zhang
- Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD 20892
| | - Irene Dankwa-Mullan
- Center for Artificial Intelligence, Research, and Evaluation, IBM Watson Health, Cambridge, MA 02142
| |
Collapse
|
3
|
Stafford M, Knight H, Hughes J, Alarilla A, Mondor L, Pefoyo Kone A, Wodchis WP, Deeny SR. Associations between multiple long-term conditions and mortality in diverse ethnic groups. PLoS One 2022; 17:e0266418. [PMID: 35363804 PMCID: PMC8974956 DOI: 10.1371/journal.pone.0266418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 03/20/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Multiple conditions are more prevalent in some minoritised ethnic groups and are associated with higher mortality rate but studies examining differential mortality once conditions are established is US-based. Our study tested whether the association between multiple conditions and mortality varies across ethnic groups in England. METHODS AND FINDINGS A random sample of primary care patients from Clinical Practice Research Datalink (CPRD) was followed from 1st January 2015 until 31st December 2019. Ethnicity, usually self-ascribed, was obtained from primary care records if present or from hospital records. Long-term conditions were counted from a list of 32 that have previously been associated with greater primary care, hospital admissions, or mortality risk. Cox regression models were used to estimate mortality by count of conditions, ethnicity and their interaction, with adjustment for age and sex for 532,059 patients with complete data. During five years of follow-up, 5.9% of patients died. Each additional condition at baseline was associated with increased mortality. The direction of the interaction of number of conditions with ethnicity showed a statistically higher mortality rate associated with long-term conditions in Pakistani, Black African, Black Caribbean and Other Black ethnic groups. In ethnicity-stratified models, the mortality rate per additional condition at age 50 was 1.33 (95% CI 1.31,1.35) for White ethnicity, 1.43 (95% CI 1.26,1.61) for Black Caribbean ethnicity and 1.78 (95% CI 1.41,2.24) for Other Black ethnicity. CONCLUSIONS The higher mortality rate associated with having multiple conditions is greater in minoritised compared with White ethnic groups. Research is now needed to identify factors that contribute to these inequalities. Within the health care setting, there may be opportunities to target clinical and self-management support for people with multiple conditions from minoritised ethnic groups.
Collapse
Affiliation(s)
| | | | - Jay Hughes
- The Health Foundation, London, United Kingdom
| | | | - Luke Mondor
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Health System Performance Network, Toronto, Ontario, Canada
| | - Anna Pefoyo Kone
- Health System Performance Network, Toronto, Ontario, Canada
- Department of Health Sciences, Lakehead University, Thunder Bay, Ontario, Canada
| | - Walter P Wodchis
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Health System Performance Network, Toronto, Ontario, Canada
- Institute of Health Policy Management & Evaluation, University of Toronto, Toronto, Ontario, Canada
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
| | | |
Collapse
|
4
|
Bennett HQ, Kingston A, Lourida I, Robinson L, Corner L, Brayne C, Matthews FE, Jagger C. A comparison over 2 decades of disability-free life expectancy at age 65 years for those with long-term conditions in England: Analysis of the 2 longitudinal Cognitive Function and Ageing Studies. PLoS Med 2022; 19:e1003936. [PMID: 35290368 PMCID: PMC8923437 DOI: 10.1371/journal.pmed.1003936] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 02/03/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Previous research has examined the improvements in healthy years if different health conditions are eliminated, but often with cross-sectional data, or for a limited number of conditions. We used longitudinal data to estimate disability-free life expectancy (DFLE) trends for older people with a broad number of health conditions, identify the conditions that would result in the greatest improvement in DFLE, and describe the contribution of the underlying transitions. METHODS AND FINDINGS The Cognitive Function and Ageing Studies (CFAS I and II) are both large population-based studies of those aged 65 years or over in England with identical sampling strategies (CFAS I response 81.7%, N = 7,635; CFAS II response 54.7%, N = 7,762). CFAS I baseline interviews were conducted in 1991 to 1993 and CFAS II baseline interviews in 2008 to 2011, both with 2 years of follow-up. Disability was measured using the modified Townsend activities of daily living scale. Long-term conditions (LTCs-arthritis, cognitive impairment, coronary heart disease (CHD), diabetes, hearing difficulties, peripheral vascular disease (PVD), respiratory difficulties, stroke, and vision impairment) were self-reported. Multistate models estimated life expectancy (LE) and DFLE, stratified by sex and study and adjusted for age. DFLE was estimated from the transitions between disability-free and disability states at the baseline and 2-year follow-up interviews, and LE was estimated from mortality transitions up to 4.5 years after baseline. In CFAS I, 60.8% were women and average age was 75.6 years; in CFAS II, 56.1% were women and average age was 76.4 years. Cognitive impairment was the only LTC whose prevalence decreased over time (odds ratio: 0.6, 95% confidence interval (CI): 0.5 to 0.6, p < 0.001), and where the percentage of remaining years at age 65 years spent disability-free decreased for men (difference CFAS II-CFAS I: -3.6%, 95% CI: -8.2 to 1.0, p = 0.12) and women (difference CFAS II-CFAS I: -3.9%, 95% CI: -7.6 to 0.0, p = 0.04) with the LTC. For men and women with any other LTC, DFLE improved or remained similar. For women with CHD, years with disability decreased (-0.8 years, 95% CI: -3.1 to 1.6, p = 0.50) and DFLE increased (2.7 years, 95% CI: 0.7 to 4.7, p = 0.008), stemming from a reduction in the risk of incident disability (relative risk ratio: 0.6, 95% CI: 0.4 to 0.8, p = 0.004). The main limitations of the study were the self-report of health conditions and the response rate. However, inverse probability weights for baseline nonresponse and longitudinal attrition were used to ensure population representativeness. CONCLUSIONS In this study, we observed improvements to DFLE between 1991 and 2011 despite the presence of most health conditions we considered. Attention needs to be paid to support and care for people with cognitive impairment who had different outcomes to those with physical health conditions.
Collapse
Affiliation(s)
- Holly Q. Bennett
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, United Kingdom
| | - Andrew Kingston
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, United Kingdom
| | - Ilianna Lourida
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, United Kingdom
| | - Louise Robinson
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, United Kingdom
| | - Lynne Corner
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, United Kingdom
| | - Carol Brayne
- Cambridge Public Health, University of Cambridge, Cambridge, United Kingdom
| | - Fiona E. Matthews
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, United Kingdom
| | - Carol Jagger
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, United Kingdom
| | | |
Collapse
|
5
|
Lourida I, Bennett HQ, Beyer F, Kingston A, Jagger C. The impact of long-term conditions on disability-free life expectancy: A systematic review. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000745. [PMID: 36962577 PMCID: PMC10021208 DOI: 10.1371/journal.pgph.0000745] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 06/14/2022] [Indexed: 11/18/2022]
Abstract
Although leading causes of death are regularly reported, there is disagreement on which long-term conditions (LTCs) reduce disability-free life expectancy (DFLE) the most. We aimed to estimate increases in DFLE associated with elimination of a range of LTCs. This is a comprehensive systematic review and meta-analysis of studies assessing the effects of LTCs on health expectancy (HE). MEDLINE, Embase, HMIC, Science Citation Index, and Social Science Citation Index were systematically searched for studies published in English from July 2007 to July 2020 with updated searches from inception to April 8, 2021. LTCs considered included: arthritis, diabetes, cardiovascular disease including stroke and peripheral vascular disease, respiratory disease, visual and hearing impairment, dementia, cognitive impairment, depression, cancer, and comorbidity. Studies were included if they estimated HE outcomes (disability-free, active or healthy life expectancy) at age 50 or older for individuals with and without the LTC. Study selection and quality assessment were undertaken by teams of independent reviewers. Meta-analysis was feasible if three or more studies assessed the impact of the same LTC on the same HE at the same age using comparable methods, with narrative syntheses for the remaining studies. Studies reporting Years of Life Lost (YLL), Years of Life with Disability (YLD) and Disability Adjusted Life Years (DALYs = YLL+YLD) were included but reported separately as incomparable with other HE outcomes (PROSPERO registration: CRD42020196049). Searches returned 6072 unique records, yielding 404 eligible for full text retrieval from which 30 DFLE-related and 7 DALY-related were eligible for inclusion. Thirteen studies reported a single condition, and 17 studies reported on more than one condition (two to nine LTCs). Only seven studies examined the impact of comorbidities. Random effects meta-analyses were feasible for a subgroup of studies examining diabetes (four studies) or respiratory diseases (three studies) on DFLE. From pooled results, individuals at age 65 without diabetes gain on average 2.28 years disability-free compared to those with diabetes (95% CI: 0.57-3.99, p<0.01, I2 = 96.7%), whilst individuals without respiratory diseases gain on average 1.47 years compared to those with respiratory diseases (95% CI: 0.77-2.17, p<0.01, I2 = 79.8%). Eliminating diabetes, stroke, hypertension or arthritis would result in compression of disability. Of the seven longitudinal studies assessing the impact of multiple LTCs, three found that stroke had the greatest effect on DFLE for both genders. This study is the first to systematically quantify the impact of LTCs on both HE and LE at a global level, to assess potential compression of disability. Diabetes, stroke, hypertension and arthritis had a greater effect on DFLE than LE and so elimination would result in compression of disability. Guidelines for reporting HE outcomes would assist data synthesis in the future, which would in turn aid public health policy.
Collapse
Affiliation(s)
- Ilianna Lourida
- Faculty of Medical Sciences, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Holly Q Bennett
- Faculty of Medical Sciences, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Fiona Beyer
- Faculty of Medical Sciences, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Andrew Kingston
- Faculty of Medical Sciences, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Carol Jagger
- Faculty of Medical Sciences, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| |
Collapse
|
6
|
Bennett HQ, Kingston A, Lourida I, Robinson L, Corner L, Brayne CEG, Matthews FE, Jagger C. The contribution of multiple long-term conditions to widening inequalities in disability-free life expectancy over two decades: Longitudinal analysis of two cohorts using the Cognitive Function and Ageing Studies. EClinicalMedicine 2021; 39:101041. [PMID: 34386756 PMCID: PMC8342913 DOI: 10.1016/j.eclinm.2021.101041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/07/2021] [Accepted: 07/08/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND : Disability-free life expectancy (DFLE) inequalities by socioeconomic deprivation are widening, alongside rising prevalence of multiple long-term conditions (MLTCs). We use longitudinal data to assess whether MLTCs contribute to the widening DFLE inequalities by socioeconomic deprivation. METHODS : The Cognitive Function and Ageing Studies (CFAS I and II) are large population-based studies of those ≥65 years, conducted in three areas in England. Baseline occurred in 1991 (CFAS I, n=7635) and 2011 (CFAS II, n=7762) with two-year follow-up. We defined disability as difficulty in activities of daily living, MLTCs as the presence of at least two of nine health conditions, and socioeconomic deprivation by area-level deprivation tertiles. DFLE and transitions between disability states and death were estimated from multistate models. FINDINGS : For people with MLTCs, inequalities in DFLE at age 65 between the most and least affluent widened to around 2.5 years (men:2.4 years, 95% confidence interval (95%CI) 0.4-4.4; women:2.6 years, 95%CI 0.7-4.5) by 2011. Incident disability reduced for the most affluent women (Relative Risk Ratio (RRR):0.6, 95%CI 0.4-0.9), and mortality with disability reduced for least affluent men (RRR:0.6, 95%CI 0.5-0.8). MLTCs prevalence increased only for least affluent men (1991: 58.8%, 2011: 66.9%) and women (1991: 60.9%, 2011: 69.1%). However, DFLE inequalities were as large in people without MLTCs (men:2.4 years, 95%CI 0.3-4.5; women:3.1 years, 95% CI 0.8-5.4). INTERPRETATION : Widening DFLE inequalities were not solely due to MLTCs. Reduced disability incidence with MLTCs is possible but was only achieved in the most affluent.
Collapse
Affiliation(s)
- Holly Q Bennett
- Population Health Sciences Institute, Faculty of Medical Sciences, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
| | - Andrew Kingston
- Population Health Sciences Institute, Faculty of Medical Sciences, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
| | - Ilianna Lourida
- Population Health Sciences Institute, Faculty of Medical Sciences, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
| | - Louise Robinson
- Population Health Sciences Institute, Faculty of Medical Sciences, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
| | - Lynne Corner
- Population Health Sciences Institute, Faculty of Medical Sciences, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
| | - Carol EG Brayne
- Cambridge Institute of Public Health, Forvie site, University of Cambridge School of Clinical Medicine, Cambridge Biomedical campus, Cambridge CB2 0SR, UK
| | - Fiona E Matthews
- Population Health Sciences Institute, Faculty of Medical Sciences, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
| | - Carol Jagger
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Edwardson Building, Campus for Ageing and Vitality, Newcastle upon Tyne NE4 5PL, UK
| |
Collapse
|
7
|
Parajuli J, Berish D, Jao YL. Chronic conditions and depressive symptoms in older adults: the mediating role of functional limitations. Aging Ment Health 2021; 25:243-249. [PMID: 31762296 DOI: 10.1080/13607863.2019.1693971] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Depressive symptoms, chronic conditions, and functional limitations are common in older adults. Several studies have examined the relationship between chronic conditions or functional limitations and depressive symptoms separately. However, little is known about how much of the effect of chronic conditions on depressive symptoms is due to the functional limitations resulting from such conditions. METHODS This paper examined the longitudinal association of chronic conditions and functional limitations with depressive symptoms in older adults aged 65 and over in the USA using the data from the 2012 wave and 2014 wave of the Health and Retirement Study (HRS). Mediation analysis was used to examine the mediation effects of 2012 functional limitations on the relationship between 2012 chronic conditions and 2014 depressive symptoms controlling for other measures including gender, age, race, education, marital status, and BMI. RESULTS Results revealed that chronic conditions and functional limitations were significantly associated with depressive symptoms. There was a 13.7% mediation effect when 2012 functional limitations were added as a mediator on the relationship between 2012 chronic conditions and 2014 depressive symptoms. CONCLUSION Functional limitations mediate the relationship between chronic conditions and depressive symptoms. Preventing or managing functional limitations may help reduce depressive symptoms in older adults with chronic conditions.
Collapse
Affiliation(s)
- Jyotsana Parajuli
- College of Nursing, Pennsylvania State University, University Park, PA, USA
| | - Diane Berish
- College of Nursing, Pennsylvania State University, University Park, PA, USA
| | - Ying-Ling Jao
- College of Nursing, Pennsylvania State University, University Park, PA, USA
| |
Collapse
|
8
|
Heid AR, Gerber AR, Kim DS, Gillen S, Schug S, Pruchno R. Timing of onset and self-management of multiple chronic conditions: A qualitative examination taking a lifespan perspective. Chronic Illn 2020; 16:173-189. [PMID: 30180778 DOI: 10.1177/1742395318792066] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Over two-thirds of older individuals live with multiple chronic conditions, yet chronic diseases are often studied in silos. Taking a lifespan approach to understanding the development of multiple chronic conditions in the older population helps to further elucidate opportunities for targeted interventions that address the complexities of multiple chronic conditions. METHODS Semi-structured interviews were conducted with 38 older adults (age 64+) diagnosed with at least two chronic health conditions. Content analysis was used to build understanding of how older adults discuss the timing of diagnoses and subsequent self-management of multiple chronic conditions. RESULTS Findings highlight the complex process by which illnesses unfold in the context of individuals' lives and the subsequent engagement and/or disengagement in self-management behaviors. Two primary themes were evident regarding timing of illnesses: illnesses were experienced within the context of social life events and/or health events, and illnesses were not predominantly seen as connected to one another by patients. Self-management behaviors were described in response to onset of each illness. DISCUSSION Findings provide insight into how older adults understand their experience of multiple chronic conditions and change in self-management behaviors over time. In order for practitioners to ignite behavioral changes, a person's history and life experiences must be considered.
Collapse
Affiliation(s)
- Allison R Heid
- New Jersey Institute for Successful Aging, Rowan University School of Osteopathic Medicine, Stratford, NJ, USA
| | - Andrew R Gerber
- Department of Psychology, Rowan University, Glassboro, NJ, USA
| | - David S Kim
- Rowan University School of Osteopathic Medicine, Stratford, NJ, USA
| | - Stefan Gillen
- Rowan University School of Osteopathic Medicine, Stratford, NJ, USA
| | - Seran Schug
- Department of Sociology & Anthropology, Rowan University, Glassboro, NJ, USA
| | - Rachel Pruchno
- New Jersey Institute for Successful Aging, Rowan University School of Osteopathic Medicine, Stratford, NJ, USA
| |
Collapse
|
9
|
Laditka JN, Laditka SB, Arif AA, Hoyle JN. Work-related asthma in the USA: nationally representative estimates with extended follow-up. Occup Environ Med 2020; 77:617-622. [PMID: 32404531 DOI: 10.1136/oemed-2019-106121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 04/10/2020] [Accepted: 04/25/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVE We studied the associations of working in occupations with high asthma trigger exposures with the prevalence and incidence of asthma, and with ever reporting an asthma diagnosis throughout working life. METHODS We used the nationally representative Panel Study of Income Dynamics (1968-2015; n=13 957; 205 498 person-years), with annual reports of occupation and asthma diagnoses across 48 years. We compared asthma outcomes in occupations likely to have asthma trigger exposures with those in occupations with limited trigger exposures. We estimated the prevalence ratios and the incidence risk ratios using log-binomial regression adjusted for age, sex, race/ethnicity, education, and current and past atopy and smoking, and accounting for the survey design and sampling weights. We calculated the attributable risk fractions and population attributable risks, and used multinomial logistic Markov models and microsimulation to estimate the percentage of people ever diagnosed with asthma during working life. RESULTS The adjusted prevalence ratio comparing high-risk occupations with low-risk was 4.1 (95% CI 3.5 to 4.8); the adjusted risk ratio was 2.6 (CI 1.8 to 3.9). The attributable risk was 16.7% (CI 8.5 to 23.6); the population attributable risk was 11.3% (CI 5.0 to 17.2). In microsimulations, 14.9% (CI 13.4 to 16.3) with low trigger exposure risk reported asthma at least once, ages 18-65, compared with 23.9% (CI 22.3 to 26.0) with high exposure risk. CONCLUSION Adults were more than twice as likely to report a new asthma diagnosis if their occupation involved asthma triggers. Work exposures to asthma triggers may cause or aggravate about 11% of all adult asthma and increase the risk of work-life asthma by 60%.
Collapse
Affiliation(s)
- James N Laditka
- Public Health Sciences, University of North Carolina at Charlotte, Charlotte, North Carolina, USA
| | - Sarah B Laditka
- Public Health Sciences, University of North Carolina at Charlotte, Charlotte, North Carolina, USA
| | - Ahmed A Arif
- Public Health Sciences, University of North Carolina at Charlotte, Charlotte, North Carolina, USA
| | - Jessica N Hoyle
- Public Health Sciences, University of North Carolina at Charlotte, Charlotte, North Carolina, USA
| |
Collapse
|
10
|
Goichot B, Raverot V, Klein M, Vija Racaru L, Abeillon-Du Payrat J, Lairez O, Leroy R, Cailleux A, Wolff P, Groussin L, Kaltenbach G, Caron P. Management of thyroid dysfunctions in the elderly. French Endocrine Society consensus statement 2019. Long version. ANNALES D'ENDOCRINOLOGIE 2020; 81:89-100. [PMID: 32416938 DOI: 10.1016/j.ando.2020.04.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Bernard Goichot
- Service de médecine interne, endocrinologie et nutrition, hôpital de Hautepierre, hôpitaux universitaires, 67098 Strasbourg cedex, France.
| | - Véronique Raverot
- Hospices civils de Lyon, groupement hospitalier Est, LBMMS, laboratoire d'hormonologie, 69677 Bron cedex, France.
| | - Marc Klein
- Service EDN, CHU de Nancy, 54500 Vandœuvre-Lès-Nancy, France.
| | - Lavinia Vija Racaru
- Service de médecine nucléaire, institut universitaire de cancérologie de Toulouse Oncopole, 31059 Toulouse, France.
| | | | - Olivier Lairez
- Fédération des services de cardiologie, centre d'imagerie cardiaque, CHU Rangueil, CHU de Toulouse, Toulouse, France.
| | - Rémy Leroy
- Cabinet d'endocrinologie et diabétologie, 71, rue de La Louvière, 59000 Lille, France.
| | - Anne Cailleux
- Clinique Mathilde, 7, boulevard de l'Europe, 76100 Rouen, France.
| | - Pierre Wolff
- Espace santé, 8, rue de Lattre de Tassigny, 69350 La Mulatière, France.
| | - Lionel Groussin
- Université de Paris, Inserm U1016, CNRS UMR8104, institut Cochin, service d'endocrinologie, AP-HP, hôpital Cochin, 75014 Paris, France.
| | - Georges Kaltenbach
- Pôle de gériatrie, hôpital de la Robertsau, hôpitaux universitaires de Strasbourg, 67000 Strasbourg, France.
| | - Philippe Caron
- Service d'endocrinologie et maladies métaboliques, CHU Larrey, 31059 Toulouse, France.
| |
Collapse
|
11
|
Laditka SB, Laditka JN, Jagger C. Microsimulation of Health Expectancies, Life Course Health, and Health Policy Outcomes. INTERNATIONAL HANDBOOK OF HEALTH EXPECTANCIES 2020. [DOI: 10.1007/978-3-030-37668-0_9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
|
12
|
Laditka SB, Laditka JN. An Enduring Health Risk of Childhood Adversity: Earlier, More Severe, and Longer Lasting Work Disability in Adult Life. J Gerontol B Psychol Sci Soc Sci 2019; 74:136-147. [PMID: 29432605 DOI: 10.1093/geronb/gby018] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 02/06/2018] [Indexed: 11/14/2022] Open
Abstract
Objectives Childhood adversity has been linked with adult health problems. We hypothesized that childhood adversity would also be associated with work limitations due to physical or nervous health problems, known as work disability. Method With data from the Panel Study of Income Dynamics (PSID) (1968-2013; n = 6,045; 82,374 transitions; 129,107 person-years) and the 2014 PSID Childhood Retrospective Circumstances Study, we estimated work disability transition probabilities with multinomial logistic Markov models. Four or more adversities defined a high level. Microsimulations quantified adult work disability patterns for African American and non-Hispanic white women and men, accounting for age, education, race, sex, diabetes, heart disease, obesity, and sedentary behavior. Results Childhood adversity was significantly associated with work disability. Of African American women with high adversity, 10.2% had moderate work disability at age 30 versus 4.1% with no reported adversities; comparable results for severe work disability were 5.6% versus 1.9% (both p < .01). Comparable results for whites were 11.3% versus 4.7%, and 3.5% versus 1.1% (p < .01). The association of childhood adversity with work disability remained significant after adjusting for diabetes, heart disease, obesity, and sedentary behavior (p < .05). Conclusions Childhood adversity may increase work disability throughout adult life.
Collapse
Affiliation(s)
- Sarah B Laditka
- Department of Public Health Sciences, University of North Carolina at Charlotte
| | - James N Laditka
- Department of Public Health Sciences, University of North Carolina at Charlotte
| |
Collapse
|
13
|
Enayati H, Shaw LA. Bounding the return on investment and projecting the costs of expanding PROMISE services and activities: Initial insights from PROMISE for policymakers. JOURNAL OF VOCATIONAL REHABILITATION 2019. [DOI: 10.3233/jvr-191044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
14
|
Supiano KP, McGee N, Dassel KB, Utz R. A Comparison of the Influence of Anticipated Death Trajectory and Personal Values on End-of-Life Care Preferences: A Qualitative Analysis. Clin Gerontol 2019; 42:247-258. [PMID: 28990872 DOI: 10.1080/07317115.2017.1365796] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES We examined anticipated preferences for end-of-life (EOL) care in healthy older adults in the context of various terminal disease scenarios to explore the relationship between personal values and diseases and conditions that would influence EOL care choices. METHODS Qualitative Descriptive Analysis was used to derive themes and the relationship between EOL preference themes and personal value themes in 365 respondents in a national sample of healthy older adults who completed a survey on their anticipated preferences for end-of-life (EOL) care. RESULTS Reluctance to burden close others was the most frequently voiced personal value across all conditions affecting EOL preferences, followed by the personal value of quality of life. Concern about whether one's wishes would be honored was more commonly voiced in the context of hypothetical, prospective terminal cancer than in neurological conditions. Respondents who voiced desire for autonomy in how they would die clearly attributed extreme pain as the primary influence on EOL preferences. CONCLUSIONS Comprehensive assessment of patient personal values should include consideration of particular chronic disease scenarios and death trajectories to fully inform EoL preferences. CLINICAL IMPLICATIONS Because personal values do influence EOL preferences, care should be taken to ascertain patient values when presenting diagnoses, prognoses, and treatment options. In particular, patients and families of patients with progressive neurological diseases will likely face a time when the patient cannot self-represent EOL wishes. Early discussion of values and preferences, particularly in the context of cognitive disease is vital to assure patient-directed care.
Collapse
Affiliation(s)
| | - Nancy McGee
- a College of Nursing , University of Utah , Salt Lake City , Utah , USA.,b University of Utah , Salt Lake City , Utah , USA
| | - Kara B Dassel
- a College of Nursing , University of Utah , Salt Lake City , Utah , USA
| | - Rebecca Utz
- a College of Nursing , University of Utah , Salt Lake City , Utah , USA.,c Department of Sociology , University of Utah , Salt Lake City , Utah , USA
| |
Collapse
|
15
|
Espinoza SE, Quiben M, Hazuda HP. Distinguishing Comorbidity, Disability, and Frailty. CURRENT GERIATRICS REPORTS 2018; 7:201-209. [PMID: 30984516 PMCID: PMC6457658 DOI: 10.1007/s13670-018-0254-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE OF REVIEW Over half of the older adults in U.S. have multimorbidity, defined broadly as the presence of 2 or more chronic diseases in an individual. Multimorbidity has significant overlap with disability and frailty. In this review, we broadly review the concepts of multimorbidity, disability, and frailty, as well as their interrelationships, and ability to predict future adverse health outcomes in older adults. RECENT FINDINGS Depending on the study, the prevalence of individuals with all three of multimorbidity, disability, and frailty ranges from 2-20%. Multimorbidity and patterns of multimorbidity are predictive of functional limitations, disability, health care usage, and mortality. The degree to which multimorbidity predicts these outcomes depends on many factors but partly upon the population examined and the presence of frailty and disability. SUMMARY Multimorbidity is an emerging public health concern that is observed with and predictive of disability and frailty.
Collapse
Affiliation(s)
- Sara E. Espinoza
- The Department of Medicine, Divisions of Geriatrics, Gerontology & Palliative Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
- The Department of Nephrology, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
- The Sam & Ann Barshop Institute for Longevity & Aging Studies, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Myla Quiben
- Geriatrics Research, Education & Clinical Center, South Texas Veterans Health Care System, San Antonio, Texas
| | - Helen P. Hazuda
- The Department of Nephrology, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
- Department of Physical Therapy, University of North Texas Health Science Center
| |
Collapse
|
16
|
Laditka JN, Laditka SB. Lifetime Disadvantages after Childhood Adversity: Health Problems Limiting Work and Shorter Life. THE ANNALS OF THE AMERICAN ACADEMY OF POLITICAL AND SOCIAL SCIENCE 2018; 680:259-277. [PMID: 31031404 PMCID: PMC6481962 DOI: 10.1177/0002716218795436] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
We examine how childhood adversity relates to work disability and life expectancy, using 1999-2015 data from the Panel Study of Income Dynamics. We estimate the probabilities of work disability and death, adjusting for age, sex, race/ethnicity, and education in a nationally representative sample of African American, Hispanic, and white women and men. We find that people in all these groups who experienced high adversity childhoods (individuals with four or more of six adversity indicators) had significantly more work disability and shorter lives than those who experienced no adversity. These findings provide evidence that childhood adversity is associated with substantial disability, and a reduction in life expectancy of at least a decade. Childhood adversity was generally associated with more lost years of life for men than for women, and more disability for women than for men. The results are robust, even when controlling for diabetes, heart disease, depression, obesity, and sedentary behavior.
Collapse
Affiliation(s)
- James N Laditka
- Department of Public Health Sciences, University of North Carolina at Charlotte, 9201 University City Boulevard, Charlotte, NC 28223,
| | - Sarah B Laditka
- Department of Public Health Sciences, University of North Carolina at Charlotte, 9201 University City Boulevard, Charlotte, NC 28223,
| |
Collapse
|
17
|
Laditka JN, Laditka SB. Work disability in the United States, 1968-2015: Prevalence, duration, recovery, and trends. SSM Popul Health 2018; 4:126-134. [PMID: 29349281 PMCID: PMC5769114 DOI: 10.1016/j.ssmph.2017.12.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Revised: 12/03/2017] [Accepted: 12/23/2017] [Indexed: 01/12/2023] Open
Abstract
The United States workforce is aging. At the same time more people have chronic conditions, for longer periods. Given these trends the importance of work disability, physical or nervous problems that limit a person's type or amount of work, is increasing. No research has examined transitions among multiple levels of work disability, recovery from work disability, or trends. Limited research has focused on work disability among African Americans and Hispanics, or separately for women and men. We examined these areas using data from 30,563 adults in the 1968-2015 Panel Study of Income Dynamics. We estimated annual probabilities of work disability, recovery, and death with multinomial logistic Markov models. Microsimulations accounting for age and education estimated outcomes for African American, Hispanic, and non-Hispanic white women and men. Results from these nationally representative data suggested that the majority of Americans experience work disability during working life. Most spells ended with recovery or reduced severity. Among women, African Americans and Hispanics had less moderate and severe work disability than whites. Among men, African Americans became severely work disabled more often than whites, recovered from severe spells more often and had shorter severe spells, yet had more severe work disability at age 65. Hispanic men were more likely to report at least one spell of severe work disability than whites; they also had substantially more recovery from severe work disability, and a lower percentage of working years with work disability. Among African Americans and Hispanics, men were considerably more likely than women to have severe work disability at age 65. Work disability declined significantly across the study period for all groups. Although work disability has declined over several decades, it remains common. Results suggest that the majority of work disability spells end with recovery, underscoring the importance of rehabilitation and workplace accommodation.
Collapse
Affiliation(s)
| | - Sarah B. Laditka
- Department of Public Health Sciences, University of North Carolina at Charlotte, 9201 University City Boulevard, Charlotte, NC 28223, United States
| |
Collapse
|
18
|
Abstract
OBJECTIVE Being oriented toward the future has been associated with better future health. We studied associations of future orientation with life expectancy and the percentage of life with disability. METHOD We used the Panel Study of Income Dynamics (n = 5249). Participants' average age in 1968 was 33.0. Six questions repeatedly measured future orientation, 1968-1976. Seven waves (1999-2011, 33,331 person-years) measured disability in activities of daily living for the same individuals, whose average age in 1999 was 64.0. We estimated monthly probabilities of disability and death with multinomial logistic Markov models adjusted for age, sex, race/ethnicity, childhood health, and education. Using the probabilities, we created large populations with microsimulation, measuring disability in each month for each individual, age 55 through death. RESULTS Life expectancy from age 55 for white men with high future orientation was age 77.6 (95% confidence interval 75.5-79.0), 6.9% (4.9-7.2) of those years with disability; results with low future orientation were 73.6 (72.2-75.4) and 9.6% (7.7-10.7). Comparable results for African American men were 74.8 (72.9-75.3), 8.1 (5.6-9.3), 71.0 (69.6-72.8), and 11.3 (9.1-11.7). For women, there were no significant differences associated with levels of future orientation for life expectancy. For white women with high future orientation 9.1% of remaining life from age 55 was disabled (6.3-9.9), compared to 12.4% (10.2-13.2) with low future orientation. Disability results for African American women were similar but statistically significant only at age 80 and over. CONCLUSION High future orientation during early to middle adult ages may be associated with better health in older age.
Collapse
Affiliation(s)
- Sarah B Laditka
- a Department of Public Health Sciences , University of North Carolina at Charlotte , Charlotte , NC , USA.,b Public Policy , University of North Carolina at Charlotte , Charlotte , NC , USA
| | - James N Laditka
- a Department of Public Health Sciences , University of North Carolina at Charlotte , Charlotte , NC , USA.,b Public Policy , University of North Carolina at Charlotte , Charlotte , NC , USA
| |
Collapse
|
19
|
Wilson-Genderson M, Heid AR, Pruchno R. Onset of Multiple Chronic Conditions and Depressive Symptoms: A Life Events Perspective. Innov Aging 2017; 1:igx022. [PMID: 30480117 PMCID: PMC6177053 DOI: 10.1093/geroni/igx022] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND While the association between depressive symptoms and chronic illness has been the subject of many studies, little is known about whether depressive symptoms differ as a function of the illnesses people have as they transition to living with multiple chronic conditions. METHODS Self-reports of five diagnosed chronic conditions (arthritis, diabetes, heart disease, hypertension, and pulmonary disease) and depressive symptoms were provided by 3,396 people participating in three waves of the ORANJ BOWLSM research panel. Longitudinal multilevel modeling was used to examine the effects that transitioning to having a diagnosis of multiple chronic conditions has on depressive symptoms. RESULTS Between 2006 and 2014, controlling for age, gender, income, race, and a lifetime diagnosis of depression, people who transitioned to having a diagnosis of multiple chronic conditions had significantly higher levels of depressive symptoms than people who did not make this transition. The diagnosis of arthritis, diabetes, heart disease, and pulmonary disease, but not hypertension had independent effects, increasing depressive symptoms. CONCLUSIONS Having a diagnosis of multiple chronic conditions leads to increases in depressive symptoms, but not all illnesses have the same effect. Findings highlight the need for clinicians to be aware of mental health risks in patients diagnosed with multiple chronic conditions, particularly those with a diagnosis of arthritis, diabetes, heart disease, and pulmonary disease. Clinical care providers should take account of these findings, encouraging psychosocial supports for older adults who develop multiple chronic conditions to minimize the negative psychological impact of illness diagnosis.
Collapse
Affiliation(s)
| | - Allison R Heid
- New Jersey Institute for Successful Aging, Rowan University School of Osteopathic Medicine, Stratford
| | - Rachel Pruchno
- New Jersey Institute for Successful Aging, Rowan University School of Osteopathic Medicine, Stratford
| |
Collapse
|
20
|
Abstract
OBJECTIVE We studied the association of childhood adversity with adult functional status. METHOD With data from the Panel Study of Income Dynamics and the 2014 Childhood Retrospective Circumstances Study (1992-2013; N = 6,705; 62,885 person-years), we estimated functional status transition probabilities associated with childhood adversity, with multinomial logistic Markov models adjusted for age, sex, race/ethnicity, and education. Microsimulation then estimated functional status outcomes throughout adulthood for African American, Hispanic, and non-Hispanic White women and men. RESULTS Adversity was significantly associated with functional status. Of White women without adversities, 2.3% had difficulty doing activities of daily living at age 30, compared with 8.2% with high adversity; comparable results were 3.7% and 8.7% for African Americans, 0.9% and 11.5% for Hispanics (all p < .01). Patterns were similar at other ages, for men, and when adjusted for midlife health conditions and health behavior. DISCUSSION Childhood adversity may substantially increase functional impairment throughout adult life.
Collapse
|
21
|
Dassel KB, Utz R, Supiano K, McGee N, Latimer S. The Influence of Hypothetical Death Scenarios on Multidimensional End-of-Life Care Preferences. Am J Hosp Palliat Care 2016; 35:52-59. [DOI: 10.1177/1049909116680990] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Differences in end-of-life (EOL) care preferences (eg, location of death, use of life-sustaining treatments, openness to hastening death, etc) based on hypothetical death scenarios and associated physical and/or cognitive losses have yet to be investigated within the palliative care literature. Aim: The purpose of this study was to explore the multidimensional EOL care preferences in relation to 3 different hypothetical death scenarios: pancreatic cancer (acute death), Alzheimer disease (gradual death), and congestive heart failure (intermittent death). Design: General linear mixed-effects regression models estimated whether multidimensional EOL preferences differed under each of the hypothetical death scenarios; all models controlled for personal experience and familiarity with the disease, presence of an advance directive, religiosity, health-related quality of life, and relevant demographic characteristics. Setting/Participants: A national sample of healthy adults aged 50 years and older (N = 517) completed electronic surveys detailing their multidimensional preferences for EOL care for each hypothetical death scenario. Results: The average age of the participants was 60.1 years (standard deviation = 7.6), 74.7% were female, and 66.1% had a college or postgraduate degree. Results revealed significant differences in multidimensional care preferences between hypothetical death scenarios related to preferences for location of death (ie, home vs medical facility) and preferences for life-prolonging treatment options. Significant covariates of participants’ multidimensional EOL care preferences included age, sex, health-related quality of life, and religiosity. Conclusion: Our hypothesis that multidimensional EOL care preferences would differ based on hypothetical death scenarios was partially supported and suggests the need for disease-specific EOL care discussions.
Collapse
Affiliation(s)
- Kara B. Dassel
- College of Nursing, University of Utah, Salt Lake City, UT, USA
| | - Rebecca Utz
- College of Social and Behavioral Science, University of Utah, Salt Lake City, UT, USA
| | | | - Nancy McGee
- College of Nursing, University of Utah, Salt Lake City, UT, USA
| | - Seth Latimer
- College of Nursing, University of Utah, Salt Lake City, UT, USA
| |
Collapse
|
22
|
Laditka JN, Laditka SB. Associations of Educational Attainment With Disability and Life Expectancy by Race and Gender in the United States. J Aging Health 2016; 28:1403-1425. [PMID: 26690254 DOI: 10.1177/0898264315620590] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE This study provides estimates of associations of education with life expectancy and the percentage of remaining life from age 40 with disability. METHOD We used the Panel Study of Income Dynamics, 1999-2011 ( n = 8,763; 94,246 person-years), measuring five education levels. We estimated probabilities of disability and death with multinomial logistic Markov models, and used microsimulations beginning at age 40, controlling for gender, race/ethnicity, age, and disability. RESULTS With college education, African American and White women, and African American and White men, respectively, lived 46.6%, 44.0%, 55.2%, and 50.4% more years from age 40 than those educated at less than the ninth grade ( p < .001). Corresponding percentages of life with disability were lower with high education, by 37.9%, 38.9%, 41.0%, and 39.9% ( p < .001). There was little evidence of outcome differences between African Americans and Whites within education levels. DISCUSSION Low education is associated with shorter lives with much more disability.
Collapse
Affiliation(s)
- James N Laditka
- 1 University of North Carolina at Charlotte, University City Boulevard, USA
| | - Sarah B Laditka
- 1 University of North Carolina at Charlotte, University City Boulevard, USA
| |
Collapse
|
23
|
Flanagan J, McCord A, Cheney M, Lundquist D. The Feasibility, Safety, and Efficacy of Using a Wireless Pedometer to Improve the Activity Level in a Cohort of Nurses. J Holist Nurs 2016; 35:134-141. [PMID: 26951577 DOI: 10.1177/0898010116632919] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE This study had two aims: (1) to test the feasibility, safety, and efficacy of using a wireless pedometer in a cohort of nurses; and (2) to understand if wireless pedometer use increased number of steps walked, number of flights of stairs climbed, daily activity level, and improved personal perception of health. DESIGN This study used a nonexperimental exploratory design to test the feasibility and efficacy of using a wireless pedometer in a cohort of nurses. Pre- and posttest measures captured the number of steps walked, flights of stairs climbed, activity level, and perception of health. RESULTS Sample characteristics: 27 females, 3 males; 90% non-Hispanic Caucasian, 3% Hispanic; 47% between the ages of 55 and 65 years. Eighty percent of the participants reported that they were caregivers of other people. There was a significant increase from baseline to the end of the study in the following measures: self-perception of steps walked ( p < .001), flights of stairs climbed ( p < .005), self-perception of daily activity ( p < .001), and although there was an improvement in self-perception of health, the change was not significant. CONCLUSIONS The wireless pedometer was a feasible, safe, and efficacious device to use. This study may have implications for interventions aimed at improving caregiver health.
Collapse
Affiliation(s)
- Jane Flanagan
- Boston College William F. Connell School of Nursing.,Massachusetts General Hospital
| | | | | | | |
Collapse
|