Optimal mobility, defined as relative ease and freedom of movement in all of its forms, is central to healthy aging. Mobility is a significant consideration for research, practice, and policy in ...aging and public health. We examined the public health burdens of mobility disability, with a particular focus on leading public health interventions to enhance walking and driving, and the challenges and opportunities for public health action. We propose an integrated mobility agenda, which draws on the lived experience of older adults. New strategies for research, practice, and policy are needed to move beyond categorical promotion programs in walking and driving to establish a comprehensive program to enhance safe mobility in all its forms.
Both social networks and social support are important in addressing bio-psycho-social events in older adults. Their associations with health-related quality of life (HRQOL), however, are not well ...understood. This study aims to examine the associations of diversity of social networks and perceived quality of social support with HRQOL in older adults. We used data from 2012 to 2013 National Epidemiological Survey on Alcohol and Related Conditions Wave III (NESARC-III), and included respondents aged 65 or older (n = 5799 unweighted). We used the Social Network Index (SNI) to measure diversity of social connections and the Interpersonal Support Evaluation List (ISEL-12) to measure perceived quality of social support. We also constructed HRQOL (mental component summary (MCS) and physical component summary (PCS)) and quality-adjusted life years (QALYs). We characterized socio-demographic, behavioral, and clinical factors, and HRQOL and QALYs by type of social support. We also used multivariable-adjusted regression analyses to assess the associations of diversity of social networks and perceived quality of social support with HRQOL and QALYs, respectively. Older adults with greater diversity of social networks, regardless of perceived quality of social support, had higher mean scores in HRQOL domains, although effect sizes were small. In multivariable-adjusted analyses, diversity of social networks was positively associated with HRQOL-MCS (coefficient = 0.59; 95% confidence intervals CI, 0.08–1.09), HRQOL-PCS (coefficient = 1.00; 95% CI, 0.38–1.61), and QALYs (coefficient = 0.01; 95% CI, 0.00–0.02). Perceived quality of social support was not associated with HRQOL. The diversity of social networks, more than perceived quality of social support, may be protective for HRQOL in older adults.
•Social support is an important component of quality of life (QOL) in older adults.•Diversity of social networks and perceived quality of social support play key roles in social support.•Social networks are more important than quality of social support in older adults' QOL.
OBJECTIVES
To estimate the rate of and risk factors associated with cost‐related medication nonadherence among older adults.
DESIGN
Cross‐sectional analysis of the 2017 National Health Interview ...Survey (NHIS).
SETTING
Nationally representative health interview survey in the United States.
PARTICIPANTS
Survey respondents, aged 65 years or older (n = 5701 unweighted) in the 2017 wave of the NHIS.
MEASUREMENTS
Self‐reported, cost‐related medication nonadherence (due to cost: skip dose, reduce dose, or delay or not fill a prescription) and actions taken due to cost‐related medication nonadherence (ask for lower‐cost prescription, use alternative therapy, or buy medications from another country) were quantified. We used a series of multivariable logistic regression analyses to identify factors associated with cost‐related medication nonadherence. We also reported analyses by chronic disease subgroups.
RESULTS
In 2017, 408 (6.8%) of 5901 older adults, representative of 2.7 million older adults nationally, reported cost‐related medication nonadherence. Among those with cost‐related medication nonadherence, 44.2% asked a physician for lower‐cost medications, 11.5% used alternative therapies, and 5.3% bought prescription drugs outside the United States to save money. Correlates independently associated with a higher likelihood of cost‐related medication nonadherence included: younger age, female sex, lower socioeconomic levels (eg, low income and uninsured), mental distress, functional limitations, multimorbidities, and obesity (P < .05 for all). Similar patterns were found in subgroup analyses.
CONCLUSION
Cost‐related medication nonadherence among older adults is increasingly common, with several potentially modifiable risk factors identified. Interventions, such as medication therapy management, may be needed to reduce cost‐related medication nonadherence in older adults. J Am Geriatr Soc 67:2463–2473, 2019
See related editorial by Claire Easthall
Older minority individuals are less likely to receive adequate health care than their white counterparts. This study investigates whether perceived racism is associated with delayed/forgone care ...among minority older adults, and whether poor doctor communication mediates this relationship.
Study cohort consisted of minority participants, aged ≥65 years, in the 2015 California Health Interview Survey (N=1,756). Authors obtained data in November 2017, and statistical analyses were performed from February to April 2018. Multivariable logistic regression analyses were conducted with relevant covariates, including insurance coverage, years living in the U.S., and language. A mediation analysis was also performed.
Among minority older individuals, perceived racism was significantly associated with delayed/forgone care (AOR=3.92, 95% CI=1.38, 11.15, p=0.010). Poor doctor communication significantly and partially mediated the relationship (AOR=3.64, 95% CI=1.30, 10.21, p=0.014), accounting for 9.9% of the total effect.
Perceived racism may contribute to health disparities for older minority individuals in part through doctors communicating messages that discourage adequate utilization of health care. Future research should explore culturally sensitive communication skills that reduce this barrier to receiving adequate health care.
To examine patterns and perceived benefits of seven major complementary health approaches (CHA) among older adults in the United States.
Data from the 2012 National Health Interview Survey (NHIS), ...which represents non-institutionalized adults aged 65 or older (n = 7,116 unweighted), were used. We elicited seven most common CHA used in older adults, which are acupuncture, herbal therapies, chiropractic, massage, meditation, Tai Chi, and yoga. Survey participants were asked to self-report perceived benefits (eg, maintaining health and stress reduction) in their CHA used. We estimated prevalence and perceived benefits of CHA use. We also investigated socio-demographic and clinical factors associated with the use of any of these seven CHA.
Overall, 29.2% of older adults used any of seven CHA in the past year. Most commonly used CHA included herbal therapies (18.1%), chiropractic (8.4%), and massage (5.7%). More than 60% of older CHA users reported that CHA were important for maintaining health and well-being. Other perceived benefits included improving overall health and feeling better (52.3%), giving a better sense of control over health (27.4%), and making it easier to cope with health problems (24.7%). Older adults with higher education and income levels, ≥2 chronic conditions, and functional limitations had greater odds of using CHA (p < .01, respectively).
A substantial number of older CHA users reported CHA-related benefits. CHA may play a crucial role in improving health status among older adults. At the population level, further research on the effects of CHA use on bio-psycho-social outcomes is needed to promote healthy aging in older adults.
OBJECTIVES
To characterize the cumulative risk factors of social and behavioral determinants of health (SDoH) and examine their association with self‐rated general health, functional limitations, and ...use of health services among US older adults.
DESIGN
Cross‐sectional analysis of the 2013‐2014 National Health and Nutrition Examination Survey.
SETTING
Nationally representative health interview survey in the United States.
PARTICIPANTS
Survey respondents aged 65 or older (n = 1,306 unweighted).
MEASUREMENTS
A cumulative risk score of SDoH, developed by the National Academy of Medicine expert panel, was assessed using validated measures. Outcome variables included self‐rated general health, functional limitations (eg, activities of daily living), and use of health services (eg, usual source of care and overnight hospitalization). We quantified the cumulative risk score of SDoH in older adults and used multivariable‐adjusted logistic and Poisson regression analyses to assess the association of SDoH with self‐rated health, functional limitations, and use of health services, adjusting for other covariates.
RESULTS
About 25.7% of older adults, representative of 11.0 million people nationwide, reported having three or more cumulative SDoH risk factors. These older adults were more likely to have functional limitations (eg, activities of daily living) and less likely to report their general health as “very good” or “excellent” than those with two or fewer cumulative SDoH risk factors (P < .001 for each). Each additional cumulative SDoH risk factor was associated with increased odds of not having a usual source of care (adjusted odds ratio = 1.57; 95% confidence interval = 1.09‐2.27).
CONCLUSION
The SDoH index score may be a useful tool to predict access to care and quality of care in older adults. J Am Geriatr Soc 68:1731‐1738, 2020.
Abstract Objectives: To examine any association between social, productive, and physical activity and 13 year survival in older people. Design: Prospective cohort study with annual mortality follow ...up. Activity and other measures were assessed by structured interviews at baseline in the participants' homes Proportional hazards models were used to model survival from time of initial interview. Setting: City of New Haven, Connecticut, United States. Participants: 2761 men and women from a random population sample of 2812 people aged 65 and older. Main outcome measure: Mortality from all causes during 13 years of follow up. Results: All three types of activity were independently associated with survival after age, sex, race/ethnicity, marital status, income, body mass index, smoking, functional disability, and history of cancer, diabetes, stroke, and myocardial infarction were controlled for. Conclusions: Social and productive activities that involve little or no enhancement of fitness lower the risk of all cause mortality as much as fitness activities do. This suggests that in addition to increased cardiopulmonary fitness, activity may confer survival benefits through psychosocial pathways. Social and productive activities that require less physical exertion may complement exercise programmes and may constitute alternative interventions for frail elderly people. Key messages Little is known about predictors of survival among elderly people Physical activity is clearly good for health, but the potential benefits of social activities have not been studied Social and productive activities are as effective as fitness activities in lowering the risk of death Enhanced social activities may help to increase the quality and length of life
Effective education and support for adults with dementia and their caregivers around pandemic issues is critical for protecting them. Animation-based learning has shown promise in patient education. ...We collaborated with educators and support staff at Alzheimer's Association Connecticut (AACT) to conduct a mixed-methods study and develop an animated e-curriculum addressing pandemic related challenges.
We conducted focus groups and surveys with dementia and caregiver educators and support staff at AACT for the initial needs assessment and the later e-curriculum evaluation. An interdisciplinary team of educators followed a step-wise process to transform the needs assessment results into an animation based e-curriculum.
Participants identified the following pandemic challenges: 1) social isolation, 2) caregiver fatigue, 3) safety, and 4) difficulty navigating the healthcare system. The overall quality and usefulness of the e-curriculum was “very good” or “excellent”.
An animated e-curriculum addressing pandemic related issues relevant to adults with dementia and caregivers had positive reviews and was associated with improvement in self-reported ability to perform curriculum objectives among community dementia educators.
The pandemic challenges identified may facilitate the development of further resources. Additionally, this project may serve as a guide for clinicians interested in incorporating animation into education efforts.
•A local assessment revealed safety concerns and difficulty navigating the changing healthcare system as major pandemic challenges for adults with dementia and caregivers.•An animated e-curriculum addressing these challenges was associated with improvement in self-reported ability to perform curriculum objectives among community dementia educators.•Motivated educators with minimal background in animation or film can follow a stepwise process to use animation for curriculum development.
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