Background
The number of older adults in the criminal justice system is rapidly increasing. While this population is thought to experience an early onset of aging-related health conditions ...(“accelerated aging”), studies have not directly compared rates of geriatric conditions in this population to those found in the general population. The aims of this study were to compare the burden of geriatric conditions among older adults in jail to rates found in an age-matched nationally representative sample of community dwelling older adults.
Methods
This cross sectional study compared 238 older jail inmates age 55 or older to 6871 older adults in the national Health and Retirement Study (HRS). We used an age-adjusted analysis, accounting for the difference in age distributions between the two groups, to compare sociodemographics, chronic conditions, and geriatric conditions (functional, sensory, and mobility impairment). A second age-adjusted analysis compared those in jail to HRS participants in the lowest quintile of wealth.
Results
All geriatric conditions were significantly more common in jail-based participants than in HRS participants overall and HRS participants in the lowest quintile of net worth. Jail-based participants (average age of 59) experienced four out of six geriatric conditions at rates similar to those found in HRS participants age 75 or older.
Conclusions
Geriatric conditions are prevalent in older adults in jail at significantly younger ages than non-incarcerated older adults suggesting that geriatric assessment and geriatric-focused care are needed for older adults cycling through jail in their 50s and that correctional clinicians require knowledge about geriatric assessment and care.
Outcomes. 1. Compare impact of hospice versus nonhospice on the last-month-of-life care quality for people with dementia (PWDs) 2. Compare impact of hospice on the last-month-of-life care quality ...comparing PWDs vs those with no dementia Importance. The Medicare Hospice Benefit was originally designed around a cancer disease paradigm but increasingly serves people with dementia (PWDs). There is ongoing debate about whether the benefit structure of hospice is suited for PWDs. Objective(s). We sought to evaluate the impact of hospice on perceived quality of end-of-life care for PWDs and whether the impact of hospice differed between PWDs and those without dementia. Method(s). Retrospective study of 2,059 decedents age 70+ using data from the National Health Aging and Trends Study linked to Medicare claims (2011-2017). Last-month-of-life care quality was assessed by a proxy in a post-death survey and included overall ratings of care, management of pain, dyspnea, sadness or anxiety, personal needs, and spiritual support; provision of goal-consistent, respectful, family-involved, coordinated care; and late transitions in the last 3 days of life. Analyses included multivariable logistic regressions, covariate balancing propensity score methodology, and post-estimation commands for adjusted predicted probabilities. Results. Among 2,059 decedents, participants had a mean age at death of 84.6 years (SD 7.1); 46% (n = 951) were PWDs. A higher proportion of PWDs used hospice (59% vs 43%, p < 0.001). In adjusted analyses, hospice-enrolled PWDs were more likely to rate last-month-of-life care as excellent compared with PWDs who did not use hospice (52.0%, CI 47.7, 56.2 vs. 41.4%, CI 34.9, 47.9). Hospice recipients had a higher predicted probability (66.9%, CI 58.9, 75.0) of managed sadness or anxiety compared to PWDs without hospice (45.7%, CI 35.1, 56.2). Hospice recipients had fewer late transitions: 9.8% (CI 6.6, 13.0) compared to 24.6% (CI 17.9, 31.2) of PWDs without hospice. Interaction terms revealed no differences in the impact of hospice on PWDs versus those without dementia. Conclusion(s). Hospice improves outcomes for PWDs enrolled in hospice, and care ratings are similar for PWDs and those without dementia receiving hospice care. Impact. Given the benefits of hospice to PWDs, policies to facilitate hospice enrollment and prevent live discharge for PWDs seeking hospice care are warranted.
It is unknown whether older adults in the United States would be willing to take a test predictive of future Alzheimer's disease, or whether testing would change behavior. Using a nationally ...representative sample, we explored who would take a free and definitive test predictive of Alzheimer's disease, and examined how using such a test may impact advance care planning.
A cross-sectional study within the 2012 Health and Retirement Study of adults aged 65 years or older asked questions about a test predictive of Alzheimer's disease (N = 874). Subjects were asked whether they would want to take a hypothetical free and definitive test predictive of future Alzheimer's disease. Then, imagining they knew they would develop Alzheimer's disease, subjects rated the chance of completing advance care planning activities from 0 to 100. We classified a score > 50 as being likely to complete that activity. We evaluated characteristics associated with willingness to take a test for Alzheimer's disease, and how such a test would impact completing an advance directive and discussing health plans with loved ones.
Overall, 75% (N = 648) of the sample would take a free and definitive test predictive of Alzheimer's disease. Older adults willing to take the test had similar race and educational levels to those who would not, but were more likely to be ≤75 years old (odds ratio 0.71 (95% CI 0.53-0.94)). Imagining they knew they would develop Alzheimer's, 81% would be likely to complete an advance directive, although only 15% had done so already.
In this nationally representative sample, 75% of older adults would take a free and definitive test predictive of Alzheimer's disease. Many participants expressed intent to increase activities of advance care planning with this knowledge. This confirms high public interest in predictive testing for Alzheimer's disease and suggests this may be an opportunity to engage patients in advance care planning discussions.
Background
Persons with cognitive impairment without dementia are at high risk of adverse health outcomes. Tailored intervention targeting moderate–vigorous physical activity (MVPA) may reduce these ...risks.
Aims
To identify the prevalence and predictors of physical inactivity among older adults with cognitive impairment, no dementia (CIND); and estimate the proportion of inactive people with CIND who are capable of greater MVPA.
Methods
We studied 1875 community dwelling participants (over age 65) with CIND in the Health and Retirement Study. Physical inactivity was defined as MVPA ≤ 1
x
/week. Associations of physical inactivity with sociodemographic, health, and physical function were examined using chi-square and modified Poisson regression. We considered physically inactive participants capable of greater MVPA if they reported MVPA at least 1–3
x
/month, no difficulty walking several blocks, or no difficulty climbing several flights of stairs.
Results
Fifty-six percent of participants with CIND were physically inactive. Variables with the highest age, sex, and race/ethnicity adjusted risk ratio (ARR) for physical inactivity were self-rated health (poor 76.9%vs. excellent 34.2%; ARR 95% CI 2.27 1.56–3.30), difficulty walking (across the room 86.5% vs. none 40.5%; ARR 95% CI 2.09 1.87–2.35), total assets (lowest quartile 62.6% vs. highest quartile 43.1%; ARR 95% CI 1.54 1.29–1.83), and lower education attainment (less than high school 59.6% vs college graduate 42.8%; ARR 95% CI 1.46 1.17–1.83). Among physically inactive older adults with CIND, 61% were estimated to be capable of greater MVPA.
Conclusions
Although physical inactivity is prevalent among older adults with CIND, many are capable of greater MVPA. Developing tailored physical activity interventions for this vulnerable population may improve cognitive, health, and quality of life outcomes.
The health and retirement study is a longitudinal, nationally representative study of older adults that has been collecting data since 1992.1 Participants are selected using a multistage probability ...sampling design and surveyed every two years in topics ranging from health, to finances, to cognition and physical function. The HRS data with a linkage to Medicare claims are particularly valuable, facilitating many high-impact health services studies.2In any HRS wave, approximately 80%–90% of HRS participants consent to have their HRS survey linked to their Medicare claims. Given this high consent rate, adjustments for non-consent to Medicare linkage are not typical among claims-based analyses because there is an assumption of similarity with those who consent. However, systematic differences between participants who consent and those who do not could introduce bias. Understanding these differences could provide insights for possible adjustments of statistical analyses. Therefore, we aimed to examine the differences between HRS participants with and without a Medicare data linkage.
Pain as a Risk Factor for Disability or Death Andrews, James S.; Cenzer, Irena Stijacic; Yelin, Edward ...
Journal of the American Geriatrics Society,
April 2013, Letnik:
61, Številka:
4
Journal Article
Recenzirano
Odprti dostop
Objectives
To determine whether pain predicts future activity of daily living (ADL) disability or death in individuals aged 60 and older.
Design
Prospective cohort study.
Setting
The 1998 to 2008 ...Health and Retirement Study (HRS), a nationally representative study of older community‐living individuals.
Participants
Twelve thousand six hundred thirty‐one participants in the 1998 HRS aged 60 and older who did not need help in any ADL.
Measurements
Participants reporting that they had moderate or severe pain most of the time were defined as having significant pain. The primary outcome was time to development of ADL disability or death over 10 yrs, assessed at five successive 2‐year intervals. ADL disability was defined as needing help performing any ADL: bathing, dressing, transferring, toileting, eating, or walking across a room. A discrete hazards survival model was used to examine the relationship between pain and incident disability over each 2‐year interval using only participants who started the interval with no ADL disability. Several potential confounders were adjusted for at the start of each interval: demographic factors, seven chronic health conditions, and functional limitations (ADL difficulty and difficulty with five measures of mobility).
Results
At baseline, 2,283 (18%) participants had significant pain. Participants with pain were more likely (all P < .001) to be female (65% vs 54%), have ADL difficulty (e.g., transferring 12% vs 2%, toileting 11% vs 2%), have difficulty walking several blocks (60% vs 21%), and have difficulty climbing one flight of stairs (40% vs 12%). Over 10 years, participants with pain were more likely to develop ADL disability or death (58% vs 43%, unadjusted hazard ratio (HR) = 1.67, 95% confidence interval (CI) = 1.57–1.79), although after adjustment for confounders, participants with pain were not at greater risk for ADL disability or death (HR = 0.98, 95% CI = 0.91–1.07). Adjustment for functional status almost entirely explained the difference between the unadjusted and adjusted results.
Conclusion
Although there are strong cross‐sectional relationships between pain and functional limitations, individuals with pain are not at higher risk of subsequent disability or death after accounting for functional limitations. Like many geriatric syndromes, pain and disability may represent interrelated phenomena that occur simultaneously and require unified treatment paradigms.
Geriatric Syndromes in Older HIV-Infected Adults Greene, Meredith; Covinsky, Kenneth E; Valcour, Victor ...
Journal of acquired immune deficiency syndromes,
2015-Jun-01, 2015-06-1, 20150601, Letnik:
69, Številka:
2
Journal Article
Recenzirano
Odprti dostop
Geriatric syndromes such as falls, frailty, and functional impairment are multifactorial conditions used to identify vulnerable older adults. Limited data exist on these conditions in older ...HIV-infected adults, and no studies have comprehensively examined these conditions.
Geriatric syndromes including falls, urinary incontinence, functional impairment, frailty, sensory impairment, depression, and cognitive impairment were measured in a cross-sectional study of HIV-infected adults aged 50 years and older who had an undetectable viral load on antiretroviral therapy. We examined both HIV and non-HIV-related predictors of geriatric syndromes including sociodemographics, number of comorbidities and nonantiretroviral medications, and HIV-specific variables in multivariate analyses.
We studied 155 participants with a median age of 57 (interquartile range: 54-62) and 94% were men. Prefrailty (56%), difficulty with instrumental activities of daily living (46%), and cognitive impairment (47%) were the most frequent geriatric syndromes. Lower CD4 nadir incidence rate ratio IRR: 1.16, 95% (confidence interval) CI: 1.06 to 1.26, non-white race (IRR: 1.38, 95% CI: 1.10 to 1.74), and increasing number of comorbidities (IRR: 1.09, 95% CI: 1.03 to 1.15) were associated with increased risk of having more geriatric syndromes.
Geriatric syndromes are common in older HIV-infected adults. Treatment of comorbidities and early initiation of antiretroviral therapy may help to prevent development of these age-related complications. Clinical care of older HIV-infected adults should consider incorporation of geriatric principles.
Abstract
Objectives
Unmet health-related social needs can influence health outcomes and increase healthcare utilization. There is growing interest in integrating social needs care into healthcare ...delivery. We conducted an assessment of health-related social needs in an academic adult primary care practice in San Francisco, California.
Methods
We recruited a random convenience sample of adult English-, Chinese- or Spanish-speaking patients from clinic waiting rooms at the study sites to complete a self-administered, anonymous survey. We used the Accountable Health Communities Health-Related Social Needs Screening Tool for these domains: housing instability, food insecurity, transportation problems, utility help needs, interpersonal safety, financial strain, and family/community support. We conducted univariate and multivariate analyses adjusting for age, sex and survey language.
Results
679 patients completed the survey. Respondents were 57% female and mean age of 58 ± 18 years old. 54% of patients had at least one unmet health-related social need. The most prevalent health-related social needs were financial strain (35%), at least one issue with housing conditions (27%), and food insecurity (23%). Respondents completing the survey in Spanish had significantly higher odds of reporting food insecurity (AOR 3.97, 95%CI 1.86, 8.46), transportation problems (AOR 3.13, 95%CI 1.32, 7.43), and need for support with activities of daily living (AOR 4.58, 95%CI 2.04, 10.25) than respondents completing the survey in English.
Conclusions
The burden of unmet health-related social needs was considerable in this adult primary care practice. These findings can support a case for integrating health-related social need screening and social care in the delivery of primary care in the United States to advance health equity.
Background
Difficulty managing medicines and finances becomes increasingly common with advanced age, and compromises the ability to live safely and independently. Remarkably little is known how often ...this occurs.
Objectives
To provide population‐based estimates of the risk of developing incident difficulty managing medications and finances in older adults.
Design
A prospective cohort study.
Setting
The Health and Retirement Study (HRS), a nationally representative study of older adults.
Participants
9,434 participants aged 65 and older who did not need help in managing medications or managing finances in 2002. Follow‐up assessments occurred every 2 years until 2012.
Measurements
The primary outcomes were time to difficulty managing medications and time to difficulty managing finances. Risk factors such as demographics, comorbidities, functional status, and cognitive status were assessed at baseline. Hazard models that considered the competing risk of death were used to estimate both the cumulative incidence of developing difficulty managing medications and finances and to identify potential risk factors. Analyses were adjusted for age, gender, race, marital status, wealth and education.
Results
The 10 years incidence of difficulty increased markedly with age, ranging from 10.3% (95% CI 9.3–11.6) for managing medications and 23.1% (95% CI 21.6–24.7) for managing finances in those aged 65–69, to 38.2% (95% CI 33.4–43.5) for medicines and 69% (95% CI 63.7–74.3) for finances in those over age 85. Women had a higher probability of developing difficulty managing medications and managing finances than men.
Conclusion
This study highlights the importance of preparing older adults for the likelihood they will need assistance with managing their medicines and finances as the risk for having difficulty with these activities over time is substantial.
1. Participants will be able to understand the associations between wealth and end-of-life symptom prevalence.
2. Participants will be able to evaluate how hospice or Medicaid enrollment modifies the ...impact of wealth on end-of-life symptoms.
This study found wealth-related disparities in the end-of-life experiences of older adults, with lower wealth linked to a higher likelihood of experiencing 6+ end-of-life symptoms. Medicaid enrollment seems to mitigate this disparity, suggesting certain programs can reduce these differences.
Prior research examined health disparities in end-of-life (EOL) based on race, ethnicity and college education. This study examines wealth-related disparities in EOL experience among older adults.
Our study aims to: (1) Assess EOL symptom prevalence and associations with wealth; (2) Determine if wealth's effect on EOL symptoms is modified by hospice or Medicaid enrollment.
The study included 9,509 Health and Retirement Study (HRS) participants who died between 2000 and 2020 at age 65+. Wealth was measured by RAND household net worth variable at the last core interview before death4,5, categorized into bottom quartile, two middle quartiles, and top quartile. End-of-life symptoms, reported by proxies at the exit interview, included 10 symptoms. Our primary outcome was a binary variable, indicating presence of 6+ EOL symptoms.
The mean age at death was 81 (SD 9); 55% women, 83% White, and 15% college graduates. Overall, 28% of descendants experienced 6+ EOL symptoms. Those with low wealth had higher likelihood of 6+ EOL symptoms compared to middle or high wealth groups (36% vs. 28% vs. 23%, p< 0.001). These differences persisted after adjusting for age, gender, marital status, race or ethnicity, and college education (low-middle wealth: aOR=0.69 (CI: 0.60-0.78); low-high wealth: aOR=0.56 (CI: 0.47-0.65)). There was no significant difference in the effect of wealth among those enrolled in hospice. Medicaid enrollment seemed to diminish the difference between low and middle wealth groups (not in Medicaid: aOR=0.74 (CI: 0.59-0.95); in Medicaid: aOR=0.90 (CI: 0.71-1.12), p for interaction=0.133).
Lower wealth at the end of life is associated with worse EOL experience. However, enrollment in Medicaid decreases the difference between low and middle wealth groups.
Our findings suggest that Medicaid may alleviate wealth-related end-of-life differences. Further studies are needed to determine if the wealth directly impacts EOL outcomes, or if its effects are mediated by functional decline.
Under served, under resourced populations/Models of palliative/hospice care delivery
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