Objectives
To examine the association between function measured according to activities of daily living (ADLs), instrumental activ1ities of daily living (IADLs), and cognition assessed according to ...Mini‐Mental State Examination (MMSE) scores of older African‐American and non‐Hispanic white community‐dwelling men and women.
Design
Cross‐sectional study assessing associations between self‐reported ADL and IADL difficulty and MMSE scores for race‐ and sex‐specific groups.
Setting
Homes of community‐dwelling older adults.
Participants
A random sample of 974 African‐American and non‐Hispanic white Medicare beneficiaries aged 65 and older living in west‐central Alabama and participating in the University of Alabama at Birmingham Study of Aging, excluding those with reported diagnoses of dementia or with missing data.
Measurements
Function, based on self‐reported difficulty in performing ADLs and IADLs, and cognition, using the MMSE. Multivariable linear regression models were used to test the association between function and cognition in race‐ and sex‐specific groups after adjusting for covariates.
Results
Mini‐Mental State Examination scores were modestly correlated with ADL and IADL difficulty in all four race‐ and sex‐specific groups, with Pearson correlation coefficients ranging from −0.189 for non‐Hispanic white women to −0.429 for African‐American men. Correlations between MMSE and ADL or IADL difficulty in any of the race‐ and sex‐specific groups were no longer significant after controlling for sociodemographic factors and comorbidities.
Conclusion
Mini‐Mental State Examination was not significantly associated with functional difficulty in older African‐American and non‐Hispanic white men and women after adjusting for sociodemographic factors and comorbidities, suggesting a mediating role in the relationship between cognition and function.
Purpose: To identify racial/ethnic differences in retention of older adults at 3 levels of participation in a prospective observational study: telephone, in-home assessments, and home visits followed ...by blood draws. Design and Methods: A prospective study of 1,000 community-dwelling Medicare beneficiaries aged 65 years and older included a baseline in-home assessment and telephone follow-up calls at 6-month intervals; at 4 years, participants were asked to complete an additional in-home assessment and have blood drawn. Results: After 4 years, 21.7% died and 0.7% withdrew, leaving 776 participants eligible for follow-up (49% African American; 46% male; 51% rural). Retention for telephone follow-up was 94.5% (N = 733/776); 624/733 (85.1%) had home interviews, and 408/624 (65.4%) had a nurse come to the home for the blood draw. African American race was an independent predictor of participation in in-home assessments, but African American race and rural residence were independent predictors of not participating in a blood draw. Implications: Recruitment efforts designed to demonstrate respect for all research participants, home visits, and telephone follow-up interviews facilitate high retention rates for both African American and White older adults; however, additional efforts are required to enhance participation of African American and rural participants in research requiring blood draws.
OBJECTIVES: To evaluate the feasibility and effectiveness of a falls management program (FMP) for nursing homes (NHs).
DESIGN: A quality improvement project with data collection throughout FMP ...implementation.
SETTING: NHs in Georgia owned and operated by a single nonprofit organization.
PARTICIPANTS: All residents of participating NHs.
INTERVENTION: A convenience sample of 19 NHs implemented the FMP. The FMP is a multifaceted quality improvement and culture change intervention. Key components included organizational leadership buy‐in and support, a designated facility‐based falls coordinator and interdisciplinary team, intensive education and training, and ongoing consultation and oversight by advanced practice nurses with expertise in falls management.
MEASUREMENTS: Process‐of‐care documentation using a detailed 24‐item audit tool and fall and physical restraint use rates derived from quality improvement software currently used in all Georgia NHs (MyInnerView).
RESULTS: Care process documentation related to the assessment and management of fall risk improved significantly during implementation of the FMP. Restraint use decreased substantially during the project period, from 7.9% to 4.4% in the intervention NHs (a relative reduction of 44%), and decreased in the nonintervention NHs from 7.0% to 4.9% (a relative reduction of 30%). Fall rates remained stable in the intervention NHs (17.3 falls/100 residents per month at start and 16.4 falls/100 residents per month at end), whereas fall rates increased 26% in the NHs not implementing the FMP (from 15.0 falls/100 residents/per month to 18.9 falls/100 residents per month).
CONCLUSION: Implementation was associated with significantly improved care process documentation and a stable fall rate during a period of substantial reduction in the use of physical restraints. In contrast, fall rates increased in NHs owned by the same organization that did not implement the FMP. The FMP may be a helpful tool for NHs to manage fall risk while attempting to reduce physical restraint use in response to the Centers for Medicare and Medicaid Services quality initiatives.
Objectives: To determine whether there were racial or ethnic disparities in the use of antidepressants in low‐income elderly patients insured by Medicaid.
Design: Examination of 1998 Medicaid claims ...data.
Setting: Centers for Medicare and Medicaid Services Medicaid claims data for five U.S. states.
Participants: All Medicaid recipients aged 65 to 84 with a diagnosis of depression.
Measurements: Treatment versus no treatment; in those treated, treatment with drugs was classified as old‐ or new‐generation antidepressants.
Results: In 1998, 7,339 unique individuals aged 65 to 84 had at least one outpatient encounter with depression as the primary diagnosis. Nearly one in four (24.2%) received no antidepressant drug therapy, and 22% received neither psychotherapy nor an antidepressant. African‐American individuals were substantially more likely to be untreated (37.1%) than Hispanic (23.6%), white (22.4%), or Asian (13.8%) individuals. In logistic regression models adjusting for sex, state, long‐term care status, and age group, African Americans with a primary diagnosis of depression were almost twice as likely as whites not to receive an antidepressant within the study period (odds ratio=1.91, 95% confidence interval=1.62–2.24). Patients in long‐term care facilities and those aged 65 to 74 were less likely to receive treatment.
Conclusion: Substantial numbers of elderly Medicaid enrollees with a primary diagnosis of depression did not receive antidepressants or behavioral therapy. This gap in care disproportionately affected African‐American patients.
OBJECTIVE: To assess the relationship between ethnicity and decision‐makers expressing healthcare wishes in a group of frail older persons enrolled in the Program of All‐inclusive Care for the ...Elderly (PACE).
DESIGN: A retrospective chart review of 1193 participants in the PACE program.
SETTING: Program of All‐inclusive Care for the Elderly, a comprehensive managed care demonstration program serving frail older participants at 10 sites across the nation.
PARTICIPANTS: A total of 1193 older adults, all of whom met state criteria for nursing home level of care. Three hundred were non‐Hispanic whites, 364 were black, 156 were Hispanic, and 288 were Asian.
MEASUREMENTS: Demographic characteristics of the patients and the presence or absence of an alternative decision‐maker; the characteristics of alternative decision‐makers included the relationship to the participant as recorded in the patient's medical record.
RESULTS: Ninety‐one percent of white patients expressed their own healthcare wishes in contrast to only 85% of Hispanic, 83% of Asian, and 67% of black patients. An alternative decision‐maker was identified for about 15% of Asians and Hispanics and for one‐third of blacks, but only about 8% of whites had an alternative decision‐maker. Black and Hispanic patients were most likely to have a daughter as an alternative decision‐maker, Asians were most likely to have a son, and whites patients were most likely to have a spouse as an alternative decision‐maker. Blacks, particularly black men, were the most likely to have a relative other than a spouse or child as an alternative decision‐maker.
CONCLUSIONS: In this population, we found significant ethnic variation in the person identified to be the decision‐maker in a group of frail older people. Ethnic variation reflected sociodemographic as well as cultural differences. However, there are important limitations to this study, and caution should be used in extrapolating the results to other populations or in attributing the results to ethnicity alone. An awareness of cross‐cultural patterns in identified or de facto decision‐makers can be significant for healthcare workers when they approach patients and their families about issues surrounding end of life decisions.
To assess the relationship between ethnicity and Health Care wishes, including Advance Directives, in a group of frail older persons in PACE (Program For All Inclusive Care Of The Elderly).
...Retrospective chart review of 1193 participants in the PACE program.
Program of All Inclusive Care Of The Elderly (PACE), a comprehensive managed care demonstration program serving frail older participants at 10 sites across the nation.
A total of 1193 older adults, all of whom met state criteria for nursing home level of care. There were 385 non-Hispanic whites, 364 blacks, 156 Hispanics, and 288 Asians.
Presence or absence of advance directives, type of health care wishes selected including living will, durable power of attorney, and health care proxy.
Frail older white, black, Hispanic and Asian Americans differ significantly in their health care wishes and how they choose to express them. Blacks were significantly more likely to select aggressive interventions and less likely than non-Hispanic whites and Hispanics to utilize a written instrument for expressing health care wishes. Whites were significantly more likely to utilize written documents for advance directives, whereas Asians were more likely to select less aggressive interventions but were unlikely to use written advance directives.
In this population, we found significant ethnic variations in choice of health care wishes. Although health care wishes are an individual decision, an awareness of cross cultural patterns can assist practitioners in addressing the concerns of their patients, as well as assisting Health Care Policy Development.
PDF
