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Fullwood D, Booker S, Fallon E, Means S, Asto-Flores E, Stickley ZL, Ellie-Turenne MC, Wilkie DJ. A descriptive study of physical function and performance in older black men with low back pain. Geriatr Nurs 2023; 53:78-84. [PMID: 37454422 PMCID: PMC10530352 DOI: 10.1016/j.gerinurse.2023.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 06/27/2023] [Accepted: 06/28/2023] [Indexed: 07/18/2023]
Abstract
The purpose of this paper is to describe physical function and performance scores and examine the relationships between measures of physical performance in older Black men with low back pain. The Mobility, Aging, Pain, and Disparities study used a cross-sectional, observational design to objectively measure physical performance on the Short Physical Performance Battery (SPPB), the Back Performance Scale (BPS), and the 400-meter Walk Test along with subjective ratings of pain intensity in the past 24 hours. Sixty community-based Black men aged 61-87 (x̄= 70 ± 6) years had an average BPS score of 7.0 ± 4 and total score on the SPPB 8.5 ± 2.1. Average 400-meter Walk time was 6.3 ± 3.1 minutes. Men's average pain intensity in the past 24 hours was 5.7 ± 2, indicating moderate pain. In conclusion, older Black men with low back pain demonstrated low physical function scores and a higher level of disability.
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Affiliation(s)
- Dottington Fullwood
- Mayo Clinic Florida, Cancer Health Equity Research Program, Jacksonville, Florida, USA.
| | - Staja Booker
- Department of Biobehavioral Nursing Science, University of Florida, Gainesville Florida, USA
| | - Elizabeth Fallon
- Mayo Clinic Florida, Cancer Health Equity Research Program, Jacksonville, Florida, USA
| | - Sydney Means
- Mayo Clinic Florida, Cancer Health Equity Research Program, Jacksonville, Florida, USA
| | - Emelina Asto-Flores
- Mayo Clinic Florida, Cancer Health Equity Research Program, Jacksonville, Florida, USA
| | - Zachary L Stickley
- Department of Educational Psychology, Leadership, & Counseling, Texas Tech University, Lubbock, Texas, USA
| | - Marie-Carmelle Ellie-Turenne
- Department of Emergency Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Diana J Wilkie
- Department of Biobehavioral Nursing Science, University of Florida, Gainesville Florida, USA
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2
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Lange-Maia BS, Buchman AS, Leurgans SE, Lamar M, Lynch EB, Erlandson KM, Barnes LL. Racial Differences in the Effect of HIV Status on Motor and Pulmonary Function and Mobility Disability in Older Adults. J Racial Ethn Health Disparities 2022; 9:1888-1896. [PMID: 34403124 PMCID: PMC8850535 DOI: 10.1007/s40615-021-01126-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 07/29/2021] [Accepted: 08/02/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Older Black adults face a disproportionate burden of HIV prevalence, but less is known about racial disparities in age-related outcomes in HIV. We assessed the effect of HIV status and race on motor and pulmonary function, as well as how they contribute to mobility disability. SETTING Community-based study; Chicago, IL METHODS: Participants were 363 community-dwelling adults age ≥ 50 years, 48% living with HIV, and 68% Black. Participants with HIV were recruited from a specialty HIV clinic, and participants without HIV (comparable on key demographic, lifestyle, and behavioral characteristics) were recruited from the community. Measures included motor function summarized by 10 motor performance measures, pulmonary function summarized by 3 measures assessed using handheld spirometry, and self-reported mobility disability. RESULTS In fully adjusted linear models, HIV was associated with better motor (β = 9.35, p < 0.001) and pulmonary function (β = 16.34, p < 0.001). For pulmonary function, the effect of HIV status was moderated by race (interaction between Black race and HIV status: β = - 11.66, p = 0.02), indicating that better pulmonary function among participants with HIV was less evident among Black participants. In fully adjusted models, odds of mobility disability did not differ by race, HIV status, or pulmonary function; better motor function was associated with lower odds of mobility disability (OR = 0.91 per 1-point higher, 95% CI 0.88-0.93). CONCLUSION Better motor and pulmonary function exhibited by participants with HIV could reflect access to medical care. Racial differences in lung function among participants with HIV indicate potential disparities in prevention or treatment of pulmonary disease or underlying risk factors.
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Affiliation(s)
- Brittney S Lange-Maia
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA.
- Department of Preventive Medicine, Rush University Medical Center, Chicago, IL, USA.
| | - Aron S Buchman
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
- Department of Neurological Sciences Rush, University Medical Center, Chicago, IL, USA
| | - Sue E Leurgans
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
- Department of Neurological Sciences Rush, University Medical Center, Chicago, IL, USA
| | - Melissa Lamar
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
- Department of Psychiatry & Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Elizabeth B Lynch
- Department of Preventive Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Kristine M Erlandson
- Department of Medicine and Epidemiology, University of Colorado Anschutz Medical Center, Aurora, CO, USA
| | - Lisa L Barnes
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
- Department of Neurological Sciences Rush, University Medical Center, Chicago, IL, USA
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Odden MC, Sims KD, Thorpe RJ, Sims M, Dhamoon M, Min YI, Correa A. Recovery From Mobility Limitation in Middle-Aged African Americans: The Jackson Heart Study. J Gerontol A Biol Sci Med Sci 2021; 76:937-943. [PMID: 33075819 DOI: 10.1093/gerona/glaa272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Despite evidence that African Americans shoulder a high burden of mobility limitation, little is known about factors associated with recovery. METHOD Participants from the Jackson Heart Study underwent 3 in-person exams from 2000 to 2013. Mobility limitations were assessed over this period by self-reported limitations in walking half a mile or climbing stairs during annual phone calls. The outcome of interest, recovery from mobility limitation, was defined as no mobility limitation the year following an incident event. Candidate predictor variables were assessed in logistic regression models, including sociodemographic, psychosocial, and health measures. Inverse probability weights were used to address missing data in the outcome. RESULTS Among 4526 participants (mean [SD] age = 54.5 (12.8) years) without a mobility limitation at baseline, 1445 (32%) had an incident mobility limitation over 12 years of follow-up, and 709 (49%) reported recovery from mobility limitation by 1 year later. Low income and daily discrimination were associated with a lower likelihood of recovery even after adjustment for covariates. In adjusted models, greater comorbidity was associated with a lower likelihood of recovering (p-value for trend = .05). History of heart failure and cancer were associated with a lower likelihood of recovering from mobility limitation (OR: 0.52, 95% CI: 0.29, 0.94 and OR: 0.74, 95% CI: 0.55, 1.00). Adiposity, smoking status, and physical activity were not associated with recovery from mobility limitation. CONCLUSION Half of incident mobility limitations in this population of middle-aged African Americans were transient. Adverse sociodemographic factors and comorbidities were associated with lower likelihood of recovery.
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Affiliation(s)
- Michelle C Odden
- Department of Epidemiology and Population Health, Stanford University School of Medicine, California
| | - Kendra D Sims
- School of Biological and Population Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis
| | - Roland J Thorpe
- Hopkins Center for Health Disparities Solutions, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Mario Sims
- Department of Medicine, University of Mississippi Medical Center, Jackson
| | - Mandip Dhamoon
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Yuan-I Min
- Department of Medicine, University of Mississippi Medical Center, Jackson
| | - Adolfo Correa
- Department of Medicine, University of Mississippi Medical Center, Jackson
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Cappelli M, Bordonali A, Giannotti C, Montecucco F, Nencioni A, Odetti P, Monacelli F. Social vulnerability underlying disability amongst older adults: A systematic review. Eur J Clin Invest 2020; 50:e13239. [PMID: 32301509 DOI: 10.1111/eci.13239] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 02/24/2020] [Accepted: 03/19/2020] [Indexed: 01/02/2023]
Abstract
BACKGROUND Older adults face radical changes in their social life during ageing, dealing with several age-related social adaptations. The aim of this review is to systematically explore the literature on social vulnerability (SV) and its association with functional decline activity of daily living (ADL)/instrumental activities of daily living (IADL) as an endpoint in older adults. METHODS We searched for relevant studies in three different databases: PubMed, Ovid Medline and PsychInfo. Inclusion criteria included: prospective cohort studies assessing SV correlation; studies in English, Italian, French and Spanish to the end of March 2018; a general population aged >65 years living in a community setting and/or studies including younger participants if the mean age was >65 years; and basic ADL and/or IADL by Katz and Lawton, respectively, as functional decline and clinical outcomes. RESULTS We identified 65 manuscripts that assessed the role of SV in functional decline. Our systematic analysis showed that 26, 36 and 19 studies observed a correlation between Basic Social Needs, Social Resources and Social Behaviour and Activity, respectively, and the onset of ADL/IADL functional decline. Twenty-six studies explored the correlation between General Social Resources and the onset of ADL/IADL functional decline. CONCLUSIONS When examining a wide set of social variables, the "quality," rather than just structure, and "type" of social relationship represents the core feature of SV that predicts functional decline in older adults. By defining individual SV, its measurement and evaluation, we can plan effective social interventions aimed at preventing or delaying functional decline or death.
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Affiliation(s)
- Miriam Cappelli
- Department of Internal Medicine and Medical Specialties, DIMI, Section of Geriatrics, University of Genoa, Genoa, Italy
| | - Alessandro Bordonali
- Department of Internal Medicine and Medical Specialties, DIMI, Section of Geriatrics, University of Genoa, Genoa, Italy
| | - Chiara Giannotti
- Department of Internal Medicine and Medical Specialties, DIMI, Section of Geriatrics, University of Genoa, Genoa, Italy
| | - Fabrizio Montecucco
- IRCCS Ospedale Policlinico San Martino Genoa - Italian Cardiovascular Network, Genoa, Italy.,First Clinic of Internal Medicine, Department of Internal Medicine and Centre of Excellence for Biomedical Research (CEBR), University of Genoa, Genoa, Italy
| | - Alessio Nencioni
- Department of Internal Medicine and Medical Specialties, DIMI, Section of Geriatrics, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino Genoa, largo Benzi, Genoa, Italy
| | - Patrizio Odetti
- Department of Internal Medicine and Medical Specialties, DIMI, Section of Geriatrics, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino Genoa, largo Benzi, Genoa, Italy
| | - Fiammetta Monacelli
- Department of Internal Medicine and Medical Specialties, DIMI, Section of Geriatrics, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino Genoa, largo Benzi, Genoa, Italy
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5
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McKellar MS, Kuchibhatla MN, Oursler KAK, Crystal S, Akgün KM, Crothers K, Gibert CL, Nieves-Lugo K, Womack J, Tate JP, Fillenbaum GG. Racial Differences in Change in Physical Functioning in Older Male Veterans with HIV. AIDS Res Hum Retroviruses 2019; 35:1034-1043. [PMID: 30963773 DOI: 10.1089/aid.2018.0296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Little is known about longitudinal change in physical functioning of older African American/Black and White HIV-infected persons. We examined up to 10 years of data on African American (N = 1,157) and White (N = 400) men with HIV infection and comparable HIV-negative men (n = 1,137 and 530, respectively), age 50-91 years from the Veterans Aging Cohort Study Survey sample. Physical functioning was assessed using the SF-12 (12-Item Short Form Health Survey) physical component summary (PCS) score. Mixed-effects models examined association of demographics, health conditions, health behaviors, and selected interactions with PCS score; HIV biomarkers were evaluated for HIV-infected persons. PCS scores were approximately one standard deviation below that of the general U.S. population of similar age. Across the four HIV/race groups, over time and through ages 65-75 years, PCS scores were maintained; differences were not clinically significant. PCS score was not associated with race or with interactions among age, race, and HIV status. CD4 and viral load counts of African American and White HIV-infected men were similar. Older age, low socioeconomic status, chronic health conditions and depression, lower body mass index, and smoking were associated with poorer PCS score in both groups. Exercising and, counterintuitively, being HIV infected were associated with better PCS score. Among these older African American and White male veterans, neither race nor HIV status was associated with PCS score, which remained relatively stable over time. Chronic disease, depression, and lack of exercise were associated with lower PCS score. To maintain independence in this population, attention should be paid to controlling chronic conditions, and emphasizing good health behaviors.
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Affiliation(s)
- Mehri S. McKellar
- Division of Infectious Diseases, Department of Medicine, Duke University, Durham, North Carolina
| | | | - Kris Ann K. Oursler
- Department of Internal Medicine, Salem Veterans Affairs Medical Center, Salem, Virginia
- Department of Medicine, Virginia Tech Carilion School of Medicine, Roanoke, Virginia
| | - Stephen Crystal
- Institute for Health, Health Care Policy, and Aging Research, Rutgers University, New Brunswick, New Jersey
| | - Kathleen M. Akgün
- Department of Internal Medicine, Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Kristina Crothers
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Cynthia L. Gibert
- Washington DC Veterans Affairs Medical Center, Washington, District of Columbia
- George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Karen Nieves-Lugo
- Department of Psychology, George Washington University, Washington, District of Columbia
| | - Julie Womack
- Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut
- Yale School of Nursing, New Haven, Connecticut
| | - Janet P. Tate
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
- Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut
| | - Gerda G. Fillenbaum
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, North Carolina
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Lange-Maia BS, Karvonen-Gutierrez CA, Strotmeyer ES, Avery EF, Appelhans BM, Fitzpatrick SL, Janssen I, Dugan SA, Kravitz HM. Factors Influencing Longitudinal Stair Climb Performance from Midlife to Early Late Life: The Study of Women's Health Across the Nation Chicago and Michigan Sites. J Nutr Health Aging 2019; 23:821-828. [PMID: 31641731 PMCID: PMC6818752 DOI: 10.1007/s12603-019-1254-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To quantify the longitudinal change in stair climb performance (a measure indicative of both physical function and muscle power), determine whether physical activity is related to slower decline in performance, and to identify factors that modify the longitudinal change in performance among women from midlife to late life. DESIGN Longitudinal cohort study with up to 15 study visits. SETTING Two sites of the Study of Women's Health Across the Nation. PARTICIPANTS Black (n=411) and white (N=419) women followed from median age 47.0 (44.6-49.6) to 62.0 (55.8-65.3) years. INTERVENTIONS N/A. MEASUREMENTS Performance on a stair climb test (ascend/descend 4 steps, 3 cycles) was timed. Physical activity (PA) was assessed using the Kaiser Physical Activity Survey (KPAS; possible range 0-15 points). Sociodemographic and health factors were assessed via self-report. BMI was calculated with measured height and weight. Mixed-effects regression modeled longitudinal change in stair climb performance. RESULTS Average baseline stair climb time was 18.12 seconds (95% CI: 17.83-18.41), with 0.98% (95% CI: 0.84%-1.11%) annual slowing. In fully adjusted models, higher levels of PA were associated with faster stair climb times (2.09% faster per point higher, 95% CI: -2.87%- -1.30%), and black women had 5.22% (95% CI: 2.43%-8.01%) slower performance compared to white women. Smoking, financial strain, diabetes, osteoarthritis, fair/poor health, and stroke were associated with 3.36% (95% CI: 0.07%-6.65%), 7.56% (95% CI: 4.75%-10.37%), 8.40% (95% CI: 2.89%-13.92%), 8.46% (95% CI: 5.12%-11.79%), 9.16% (95% CI: 4.72%-13.60%), and 16.94% (95% CI: 5.37%-28.51%) slower performance, respectively. In separate models, higher BMI (per 1-unit), osteoarthritis, fair/poor health, and diabetes, were each associated with 0.06% (95% CI:0.04%-0.08%), 0.48% (95% CI:0.12%-0.84%), 0.81% (95% CI:0.35%-1.28%), and 0.84% (95% CI:0.22%-1.46%), additional slowing per year over time. CONCLUSION Significant declines in function were evident as women transitioned from midlife to early late life. Declines were amplified by indicators of poor health, emphasizing the importance of health in midlife for promoting healthy aging.
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Affiliation(s)
- B S Lange-Maia
- Brittney Lange-Maia, PhD, MPH, 1700 W. Van Buren St., Suite 470, Chicago, IL 60612, Phone: 312-942-9697; Fax: 312-942-8119;
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7
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Jamerson BD, Fillenbaum GG, Sloane R, Morey MC. A New Method of Identifying Characteristics of Needing Help to Take Medications in an Older Representative Community-Dwelling Population: The Older Adults Medication Assist Scale. J Am Geriatr Soc 2017; 64:1195-202. [PMID: 27321598 DOI: 10.1111/jgs.14166] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To determine the sociodemographic characteristics, health conditions, and cognitive and functional status associated with baseline prevalence and new need for help taking medication 3 years later and to construct a brief scale indicative of need for help taking medications. DESIGN Retrospective cross-sectional and 3-year longitudinal study. SETTING Five-county area in north-central Piedmont, North Carolina. PARTICIPANTS Representative community-dwelling sample of black and white individuals aged 65 and older (N = 4,136). MEASUREMENTS Information was obtained in person in participants' homes using structured questionnaires. Health conditions included sensory impairment and self-report of physician-diagnosed conditions. Cognitive status was assessed using the 10-item Short Portable Mental Status Questionnaire. Functional status was assessed using the three-item Rosow-Breslau scale, the five-item Katz activity of daily living scale, and a modified six-item Older Americans Resources and Services instrumental activities of daily living scale. RESULTS Characteristics associated with need for help taking medications were aged 80 and older, being male, living with others, having four or more chronic conditions, and impaired cognitive or functional status (c-statistic 0.94, 77.1% sensitivity, 87.9% specificity). Predictors of new need for help with medications 3 years later included aged 75 and older at baseline, being male, and impaired cognitive and functional status (c-statistic 0.75). CONCLUSION This brief scale can help identify persons needing help with medications and could be useful in assisting clinicians with medication management.
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Affiliation(s)
- Brenda D Jamerson
- Claude D. Pepper Older Americans Independence Center, Duke University, Durham, North Carolina.,Center on Biobehavioral Health Disparities Research, Duke University, Durham, North Carolina.,Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina.,Geriatric Research Education and Clinical Center, Veterans Administration Medical Center, Durham, North Carolina
| | - Gerda G Fillenbaum
- Claude D. Pepper Older Americans Independence Center, Duke University, Durham, North Carolina.,Center on Biobehavioral Health Disparities Research, Duke University, Durham, North Carolina
| | - Richard Sloane
- Claude D. Pepper Older Americans Independence Center, Duke University, Durham, North Carolina.,Center for the Study of Aging and Human Development, Duke University, Durham, North Carolina.,Geriatric Research Education and Clinical Center, Veterans Administration Medical Center, Durham, North Carolina
| | - Miriam C Morey
- Claude D. Pepper Older Americans Independence Center, Duke University, Durham, North Carolina.,Center for the Study of Aging and Human Development, Duke University, Durham, North Carolina.,Geriatric Research Education and Clinical Center, Veterans Administration Medical Center, Durham, North Carolina
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8
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Brenner AB, Clarke PJ. Understanding Socioenvironmental Contributors to Racial and Ethnic Disparities in Disability Among Older Americans. Res Aging 2016; 40:103-130. [PMID: 27909061 DOI: 10.1177/0164027516681165] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Our understanding of the mechanisms through which racial/ethnic disparities in disability in older adults develop and are maintained is limited. We examined the role of physical impairment, socioeconomic factors and health for racial/ethnic disparities in activities of daily living (ADL), and the modifying role of the indoor home environment. Data come from the National Health and Aging Trends Study ( N = 5,640), and negative binomial regression models were specified separately for men and women. Blacks and Hispanics reported more ADL difficulty than Whites. Living in homes with clutter was associated with higher rates of ADL difficulty, but it was not related to racial/ethnic disparities. Racial/ethnic differences were explained by physical impairment for men, but not for women. Socioeconomic factors and health accounted for remaining disparities for Black, but not for Hispanic women. Attention to individual and environmental factors is necessary to fully understand and address race/ethnic disparities in disability in older Americans.
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Affiliation(s)
- Allison B Brenner
- 1 Survey Research Center at the Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Philippa J Clarke
- 1 Survey Research Center at the Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
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Cary MP, Thorpe RJ, Walker JL, Gamaldo AA, Allaire JC, Whitfield KE. The Effects of Social Support on Physical Functioning in Older African Americans: Longitudinal Results from the Baltimore Study of Black Aging. J Natl Med Assoc 2016; 108:195-200. [PMID: 27979004 PMCID: PMC6625651 DOI: 10.1016/j.jnma.2016.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 07/22/2016] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Compared with other racial/ethnic groups, African Americans have higher rates of chronic conditions and suffer a disproportionate burden of disability. We aimed to examine the effects of social support on physical functioning among older African Americans. METHODS We analyzed a sample of 448 urban, community-dwelling, older African Americans (aged 48-98 years) from the Baltimore Study of Black Aging. Baseline physical functioning was collected between 2006 and 2008 (wave 1), and change in physical functioning was collected between 2009 and 2011 (wave 2), physical functioning was assessed by self-reported limitations in 7 activities of daily living-eating, dressing, grooming, walking, bathing, using the toilet, and transferring in and out of bed-using a binary variable to indicate whether the individual had difficulty performing each specific activity. Social support was measured by how frequently participants provided/received goods and services, financial assistance, transportation, companionship, advice, or encouragement (never [0], rarely [1], sometimes [2], frequently [3]). Negative binomial regression models were used to test the effects of social support given, received, and a ratio (support received/support given) on physical functioning for those who improved and those who declined in physical functioning. RESULTS Participants reported physical functioning at wave 1 (1.24, standard deviation [SD] = 1.98) and at wave 2 (0.34, SD = 0.83). Average social support given was 7.49 (SD = 3.26), and average social support received was 7.81 (SD = 3.17). Those who improved in physical function gave less social support and had lower social support ratios; social support received had no effect. Those who remained stable or declined in physical function gave more social support; neither social support received nor social ratio had an effect. CONCLUSION Social support given and social support received as well as the ratio should be considered when seeking to understand how physical functioning changes over time among older African Americans.
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Affiliation(s)
- Michael P Cary
- School of Nursing, Duke University, Durham, NC, USA; Center for Biobehavioral Center Health Disparities Research, Duke University, Durham, NC, USA.
| | - Roland J Thorpe
- Center for Biobehavioral Center Health Disparities Research, Duke University, Durham, NC, USA; Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Hopkins Center for Health Disparities Solutions, Johns Hopkins University, Baltimore, MD, USA
| | | | - Alyssa A Gamaldo
- School of Aging Studies, University of South Florida, Tampa, FL, USA
| | - Jason C Allaire
- Department of Psychology, North Carolina State University, Raleigh, NC, USA
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Abstract
In this study, the author examined the effects of psychosocial and health factors on the ADL disability trajectory of low-income frail elders living in the community. She analyzed three-year longitudinal data with a maximum of 15 repeated observations from a cohort of elderly participants in Michigan’s Medicaid Waiver Program ( N=3,161), using the hierarchical linear modeling approach. Baseline data of this cohort were taken in 1999; a reassessment was conducted about every three months. The analysis shows that major risk factors for a poor activity of daily living (ADL) disability trajectory include being Black, older, living with nonspouse others, and no confidence in functional improvement. Presence of arthritis, cancer, and cognitive limitation had significant and modest effects on ADL disability trajectories. The findings have implications to community-based intervention programs for frail elderly persons in the community.
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11
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Thorpe RJ, McCleary R, Smolen JR, Whitfield KE, Simonsick EM, LaVeist T. Racial disparities in disability among older adults: finding from the exploring health disparities in integrated communities study. J Aging Health 2015; 26:1261-79. [PMID: 25502241 DOI: 10.1177/0898264314534892] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Persistent and consistently observed racial disparities in physical functioning likely stem from racial differences in social resources and environmental conditions. METHOD We examined the association between race and reported difficulty performing instrumental activities of daily living (IADL) in 347 African American (45.5%) and Whites aged 50 or above in the Exploring Health Disparities in Integrated Communities-Southwest Baltimore, Maryland Study (EHDIC-SWB). RESULTS Contrary to previous studies, African Americans had lower rates of disability (women: 25.6% vs. 44.6%, p = .006; men: 15.7% vs. 32.9%; p = .017) than Whites. After adjusting for sociodemographics, health behaviors, and comorbidities, African American women (odds ratio [OR] = 0.32, 95% confidence interval [CI] = [0.14, 0.70]) and African American men (OR = 0.34, 95% CI = [0.13, 0.90]) retained their functional advantage compared with White women and men, respectively. CONCLUSION These findings within an integrated, low-income urban sample support efforts to ameliorate health disparities by focusing on the social context in which people live.
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Affiliation(s)
- Roland J Thorpe
- Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA Center on Biobehavorial Health Disparities Research, Duke University, Durham, NC, USA
| | - Rachael McCleary
- Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jenny R Smolen
- Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Keith E Whitfield
- Center on Biobehavorial Health Disparities Research, Duke University, Durham, NC, USA
| | - Eleanor M Simonsick
- Johns Hopkins School of Medicine, Baltimore, MD, USA National Institute on Aging, Baltimore, MD, USA
| | - Thomas LaVeist
- Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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12
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Gill TM. Disentangling the disabling process: insights from the precipitating events project. THE GERONTOLOGIST 2014; 54:533-49. [PMID: 25035454 PMCID: PMC4155452 DOI: 10.1093/geront/gnu067] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 04/28/2014] [Indexed: 12/31/2022] Open
Abstract
Among older persons, disability in activities of daily living is common and highly morbid. The Precipitating Events Project (PEP Study), an ongoing longitudinal study of 754 initially nondisabled, community-living persons, aged 70 or older, was designed to further elucidate the epidemiology of disability, with the goal of informing the development of effective interventions to maintain and restore independent function. Over the past 16 years, participants have completed comprehensive, home-based assessments at 18-month intervals and have been interviewed monthly to reassess their functional status and ascertain intervening events, other health care utilization, and deaths. Findings from the PEP Study have demonstrated that the disabling process for many older persons is characterized by multiple and possibly interrelated disability episodes, even over relatively short periods of time, and that disability often results when an intervening event is superimposed upon a vulnerable host. Given the frequency of assessments, long duration of follow-up, and recent linkage to Medicare data, the PEP Study will continue to be an outstanding platform for disability research in older persons. In addition, as the number of decedents accrues, the PEP Study will increasingly become a valuable resource for investigating symptoms, function, and health care utilization at the end of life.
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Affiliation(s)
- Thomas M Gill
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.
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Lin SF, Beck AN, Finch BK. Black-white disparity in disability among U.S. older adults: age, period, and cohort trends. J Gerontol B Psychol Sci Soc Sci 2014; 69:784-97. [PMID: 24986183 DOI: 10.1093/geronb/gbu010] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES This study delineates activities of daily living (ADL) and instrumental activities of daily living (IADL) black-white disparity trends by age, period, and cohort (APC) and explores sociodemographic contributors of cohort-based disparity trends. METHOD We utilized multiple cross-sectional waves of National Health Interview Survey data (1982-2009) to describe APC trends of ADL and IADL disparities using a cross-classified random effect model. Further, we decomposed the cohort-based disparity trends using Fairlie's decomposition method for nonlinear outcomes. RESULTS The crossover ADL and IADL disparities (whites > blacks) occurring at age 75 increased with age and reached a plateau at age of 80, whereas period-based ADL and IADL disparities remained constant for the past 3 decades. The cohort disparity trends for both disabilities showed a decline with each successive cohort except for ADL disparity among women. DISCUSSION We examined the role of aging on racial disparity in disability and found support for the racial crossover effect. Further, the racial disparity in disability will disappear should the observed pattern of declining cohort-based ADL and IADL disparities persist. Although education, income, and marital status are important sociodemographic contributors to cohort disparity trends, future studies should investigate individual behavioral health determinants and cohort-specific characteristics that explain the cohort-based racial difference in ADL and IADL disabilities.
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Affiliation(s)
- Shih-Fan Lin
- Institute for Behavioral and Community Health (IBACH) and Center for Health Equity Research and Policy, San Diego State University, California.
| | - Audrey N Beck
- Institute for Behavioral and Community Health (IBACH) and Center for Health Equity Research and Policy, San Diego State University, California
| | - Brian K Finch
- Department of Sociology, USC Population Research Center, Center for Economic and Social Research, University of Southern California, Los Angeles. Graduate School of Public Health, Center for Health Equity Research and Policy, San Diego State University, California
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Ylitalo KR, Karvonen-Gutierrez CA, Fitzgerald N, Zheng H, Sternfeld B, El Khoudary SR, Harlow SD. Relationship of race-ethnicity, body mass index, and economic strain with longitudinal self-report of physical functioning: the Study of Women's Health Across the Nation. Ann Epidemiol 2013; 23:401-8. [PMID: 23694761 PMCID: PMC3898343 DOI: 10.1016/j.annepidem.2013.04.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Revised: 03/19/2013] [Accepted: 04/07/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE This study examined progression and improvement of physical functioning limitations during the mid-life and whether race-ethnicity, economic strain, or body mass index were associated with these changes. METHODS Women from the Study of Women's Health Across the Nation with one or more measure of self-reported physical functioning, categorized as no, some, or substantial limitations, between study visits 4 and 12 were included (n = 2497). RESULTS When women were aged 56-66 years, almost 50% reported limitations in functioning. African American women were more likely to report substantial (odds ratio, 1.63; 95% confidence interval, 1.06-2.52) and Chinese women were more likely to report some limitations (odds ratio, 2.03; 95% CI, 1.22-3.36) compared with Caucasian women. Economic strain and obesity predicted limitations. The probability of worsening ranged from 6% to 22% and of improving ranged from 11% to 30%. Caucasian and Japanese women had the highest probability of remaining fully functional (80% and 84%, respectively) compared with 71% of African American women. CONCLUSIONS Race-ethnicity, obesity, and economic strain were associated with prevalence and onset of physical functioning limitations. Functional improvement is common, even among vulnerable subgroups of women. Future studies should characterize predictors of decline and improvement so that interventions can sustain functioning even in the context of many known immutable risk factors.
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Affiliation(s)
- Kelly R Ylitalo
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI 48109-2029, USA.
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Latham K. Progressive and accelerated disability onset by race/ethnicity and education among late midlife and older adults. J Aging Health 2012; 24:1320-45. [PMID: 22982972 DOI: 10.1177/0898264312459345] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This study explores the pace of severe disability onset with an emphasis on the role of race/ethnicity and education. More specifically, this research examines whether race/ethnicity and educational attainment are independent predictors of progressive and accelerated disability onset. METHOD Using the Health and Retirement Study (HRS) Waves 2 to 10 (1994-2010), a series of discrete-time Cox proportional hazards models with multiple competing events were created to ascertain whether respondents developed progressive or accelerated disability in subsequent waves. RESULTS Black and Hispanic respondents were at an increased risk of developing progressive disability. Respondents without a high school degree were more likely to experience progressive or accelerated disability. DISCUSSION Low educational attainment was a particularly strong predictor of accelerated disability onset and may represent an acute lack of resources over the life course. Race and ethnicity were important predictors of progressive disability onset, which may reflect racial/ethnic variations in the disabling process.
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Affiliation(s)
- Kenzie Latham
- University of Michigan, Ann Arbor, MI 48106-1248, USA.
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Blanco I, Verghese J, Lipton RB, Putterman C, Derby CA. Racial differences in gait velocity in an urban elderly cohort. J Am Geriatr Soc 2012; 60:922-6. [PMID: 22587854 DOI: 10.1111/j.1532-5415.2012.03927.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To investigate whether there are racial differences in gait velocity in elderly adults. DESIGN Cross-sectional analysis. SETTING Bronx, New York. PARTICIPANTS Two hundred thirteen participants of the Einstein Aging Study (157 Caucasian, 56 African American), a longitudinal study of community-residing elderly adults recruited using Medicare and voter registration records. MEASUREMENTS Demographic characteristics, medical history, Geriatric Depression Scale, Blessed Information-Memory-Concentration Test, Total Pain Index, gait velocity. RESULTS Caucasians were older (median 79.9 vs 75.5, P = .002) and more educated (median 14 vs 12 years, P = .007) and had lower body mass index (mean 26.9 ± 4.3 vs 28.9 ± 6.4, P = .03). African Americans were more likely to be female (80.4% vs 59.9%, P = .006) and to have diabetes mellitus (28.6% vs 13.4%, P = .01). Pain levels were not significantly different between Caucasians and African Americans. African Americans had a significantly slower gait velocity (mean 90.2 ± 17.9 vs 99.1 ± 20.1 cm/s, P = .004). This difference persisted after adjusting for multiple covariates. Differences in common factors known to influence gait did not explain a 7.79-cm/s slower gait speed in African Americans than Caucasians. CONCLUSION Differences in gait velocity persist between African Americans and Caucasians despite adjusting for many confounders. Increases of just 10 cm/s are associated with lower mortality. Further studies are needed to evaluate whether there are modifiable risk factors that may explain this difference and whether an intervention could reduce the discrepancy between the groups.
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Affiliation(s)
- Irene Blanco
- Division of Rheumatology, Albert Einstein College of Medicine, Bronx, New York 10461, USA.
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Hybels CF, Blazer DG, George LK, Koenig HG. The complex association between religious activities and functional limitations in older adults. THE GERONTOLOGIST 2012; 52:676-85. [PMID: 22403163 DOI: 10.1093/geront/gnr156] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
PURPOSE OF THE STUDY To examine the longitudinal associations between 3 dimensions of religious involvement-religious attendance, use of religious media, and private religious activities-and 3 domains of functional status-limitations in basic activities of daily living (ADL), instrumental activities of daily living (IADL), and mobility in older adults. DESIGN AND METHODS Using the data from a survey of 2,924 adults aged 65+, with self-reported religious involvement and functional status collected at baseline, 3, 6, and 10 years postbaseline, we used repeated measures mixed models to predict functional change by religious status at the prior interview. RESULTS Increased religious attendance was associated with fewer ADL, IADL, and mobility limitations 3-4 years later, controlling for demographic, health, and social variables as well as prior functional status. Neither use of religious media nor private religious activities was associated with functional change in controlled analyses. Use of religious media, however, was associated with developing more IADL and mobility limitations in uncontrolled analysis, suggesting a potential indirect association. IMPLICATIONS Religious attendance may protect against decline in functional limitations in older adults. Clinicians may wish to consider the importance of attendance at services in preventing disability for those patients for whom religious involvement is important. Gerontologists may wish to include religious participation in their conceptual framework outlining risk factors for functional decline.
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Affiliation(s)
- Celia F Hybels
- Department of Psychiatry and Behavioral Sciences, Center for the Study of Aging and Human Development, Duke University Medical Center, Box 3003, Durham, NC 27710, USA.
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Nuru-Jeter AM, Thorpe RJ, Fuller-Thomson E. Black-white differences in self-reported disability outcomes in the U.S.: early childhood to older adulthood. Public Health Rep 2012; 126:834-43. [PMID: 22043099 DOI: 10.1177/003335491112600609] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE We examined black-white differences in activities of daily living (ADLs), functional limitations (FLs), vision/hearing/sensory impairment, and memory/learning problems in a large, nationally representative sample of community-dwelling and institutionalized people across the lifespan. METHODS Data are from the 2006 American Community Survey (n=2,288,800). We included data on non-Hispanic black respondents (125,985 males and 145,780 females) and non-Hispanic white respondents (977,792 males and 1,039,243 females) ≥5 years of age. We used logistic regression to examine the black-white odds for each disability outcome. The overall response rate was 97.5%. RESULTS For FLs, ADL limitations, and memory/learning problems, black people experienced higher odds of disability across the adult lifespan compared with white people. Black-white differences narrowed in older age. For vision/hearing problems, a black-white crossover was found in older age (≥85 years), where odds of vision/hearing problems were lower among black people than among white people. For all disability outcomes, black-white differences peaked in midlife (50-69 years of age), with black people having approximately 1.5 to two times the odds of disabilities as their white peers. CONCLUSIONS The study findings suggest the need to address black-white disparities across a range of disability outcomes throughout the lifespan. Future work identifying the factors accounting for this pattern of disparities will help inform the development of appropriate prevention strategies.
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Thorpe RJ, Koster A, Kritchevsky SB, Newman AB, Harris T, Ayonayon HN, Perry S, Rooks RN, Simonsick EM. Race, socioeconomic resources, and late-life mobility and decline: findings from the Health, Aging, and Body Composition study. J Gerontol A Biol Sci Med Sci 2011; 66:1114-23. [PMID: 21743093 DOI: 10.1093/gerona/glr102] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND This study examines the relationship between race and mobility over 5 years in initially well-functioning older adults and evaluates how a broad set of socioeconomic status indicators affect this relationship. METHODS Data were from 2,969 black and white participants aged 70-79 from the Health, Aging, and Body Composition study. Mobility parameters included self-reported capacity to walk a quarter mile and climb 10 steps and usual gait speed. Incident mobility limitation was defined as reported difficulty walking a quarter mile or climbing 10 steps at two consecutive semiannual assessments. Gait speed decline was defined as a 4% reduction in speed per year. RESULTS At baseline, even though all participants were free of mobility limitation, blacks had slower walking speed than their white counterparts, which was not explained by poverty, education, reading level, or income adequacy. After 5 years, accounting for age, site, and baseline mobility, blacks were more likely to develop mobility limitation than whites. Adjusting for prevalent conditions at baseline eliminated this difference in women; controlling for education eliminated this difference in men. No differences in gait speed decline were identified. CONCLUSIONS Higher rates of mobility loss observed in older blacks relative to older whites appear to be a function of both poorer initial mobility status and existing health conditions particularly for women. Education may also play a role especially for men.
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Affiliation(s)
- Roland J Thorpe
- Hopkins Center for Health Disparities Solutions, Department of Health Policy and Management, The Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway Ste. 441, Baltimore, MD 21205, USA.
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Taş Ü, Verhagen AP, Bierma-Zeinstra SMA, Hofman A, Pols HAP, Koes BW. Course and prognostic factors of disability in community-dwelling older people with mild disability: The Rotterdam Study. Australas J Ageing 2011; 31:28-33. [DOI: 10.1111/j.1741-6612.2011.00524.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Whitson HE, Hastings SN, Landerman LR, Fillenbaum GG, Cohen HJ, Johnson KS. Black-white disparity in disability: the role of medical conditions. J Am Geriatr Soc 2011; 59:844-50. [PMID: 21568956 PMCID: PMC3107524 DOI: 10.1111/j.1532-5415.2011.03401.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To describe the independent contributions of selected medical conditions to the disparity between black and white people in disability rates, controlling for demographic and socioeconomic factors. DESIGN Cross-sectional analysis of a community-based cohort. SETTING Urban and rural counties of central North Carolina. PARTICIPANTS Two thousand nine hundred sixty-six adults aged 68 and older participating in the Duke Established Populations for Epidemiologic Studies of the Elderly (EPESE). MEASUREMENTS Self-reported data on sociodemographic characteristics and medical conditions, Short Portable Mental Status Questionnaire, activities of daily living (ADLs). RESULTS Fifty-five percent of the cohort was black. Blacks were more likely than whites to report disability (odds ratio=1.39, 95% confidence interval= 1.15-1.68). Controlling for age, sex, marital status, and socioeconomic status, blacks were more likely to be obese and have diabetes mellitus, and less likely to report vision problems, fractures, and heart attacks. The higher prevalence of obesity and diabetes mellitus in blacks, after adjustment for sociodemographic factors, accounted for more than 30% of the black-white difference in disability. Conversely, the black-white disability gap would be approximately 45% wider if whites had a lower prevalence of fractures and vision impairment, similar to their black peers. CONCLUSION Higher rates of obesity and diabetes mellitus in older black Americans account for a large amount of the racial disparity in disability, even after controlling for socioeconomic differences. Culturally appropriate interventions that lower the prevalence or the functional consequences of obesity and diabetes mellitus in blacks could substantially decrease this racial health disparity.
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Affiliation(s)
- Heather E Whitson
- Duke Aging Center, Duke University Medical Center, Durham, North Carolina, USA.
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Araujo AB, Chiu GR, Kupelian V, Hall SA, Williams RE, Clark RV, McKinlay JB. Lean mass, muscle strength, and physical function in a diverse population of men: a population-based cross-sectional study. BMC Public Health 2010; 10:508. [PMID: 20727198 PMCID: PMC2933725 DOI: 10.1186/1471-2458-10-508] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2009] [Accepted: 08/21/2010] [Indexed: 01/13/2023] Open
Abstract
Background Age-related declines in lean body mass appear to be more rapid in men than in women but our understanding of muscle mass and function among different subgroups of men and their changes with age is quite limited. The objective of this analysis is to examine racial/ethnic differences and racial/ethnic group-specific cross-sectional age differences in measures of muscle mass, muscle strength, and physical function among men. Methods Data were obtained from the Boston Area Community Health/Bone (BACH/Bone) Survey, a population-based, cross-sectional, observational survey. Subjects included 1,157 black, Hispanic, and white randomly-selected Boston men ages 30-79 y. Lean mass was assessed by dual-energy x-ray absorptiometry. Upper extremity (grip) strength was assessed with a hand dynamometer and lower extremity physical function was derived from walk and chair stand tests. Upper extremity strength and lower extremity physical function were also indexed by lean mass and lean mass was indexed by the square of height. Results Mean age of the sample was 47.5 y. Substantial cross-sectional age differences in grip strength and physical function were consistent across race/ethnicity. Racial/ethnic differences, with and without adjustment for covariates, were evident in all outcomes except grip strength. Racial differences in lean mass did not translate into parallel differences in physical function. For instance, multivariate modeling (with adjustments for age, height, fat mass, self-rated health and physical activity) indicated that whereas total body lean mass was 2.43 kg (approximately 5%) higher in black compared with white men, black men had a physical function score that was approximately 20% lower than white men. Conclusions In spite of lower levels of lean mass, the higher levels of physical function observed among white compared with non-white men in this study appear to be broadly consistent with known racial/ethnic differences in outcomes.
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Affiliation(s)
- Andre B Araujo
- New England Research Institutes, Inc,, Watertown, MA, USA.
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Muangpaisan W, Assantachai P, Intalapaporn S, Richardson K, Brayne C. Health expectancies in the older Thai population. Arch Gerontol Geriatr 2010; 53:3-7. [PMID: 20570376 DOI: 10.1016/j.archger.2010.05.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2009] [Revised: 03/30/2010] [Accepted: 04/01/2010] [Indexed: 11/30/2022]
Abstract
This study aims to investigate health expectancies in five domains: cognitive health, psychological health, physical health, functional ability and self-perceived global health (SPGH) in the older Thai population. There are few studies reporting health expectancies in multidimensional health domains, most of which reported only one health dimension. The dataset used was from the Bangkok Longitudinal Study by Siriraj Hospital for the Older Men and Women (BLOSSOM), which is a community cohort study in Bangkok, Thailand. This analysis is based on the cross-sectional data in the year 2005-2006 and includes 5936 participants aged 50 years and over from community settings within six suburban areas in Bangkok. The study found that women had a longer total life expectancy (LE), but had shorter cognitive impairment-free (CIFLE), physical illness-free (PHILE) and disability-free (DIFLE) LEs, than men. However, there was no difference between the life expectancies for living with good SPGH in men and in women. Differences in health expectations might explain this finding. Health promotion and disease prevention should be initiated at a younger age and should target all health domains.
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Affiliation(s)
- Weerasak Muangpaisan
- Department of Preventive and Social Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.
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Dunlop DD, Semanik P, Song J, Sharma L, Nevitt M, Jackson R, Mysiw J, Chang RW. Moving to maintain function in knee osteoarthritis: evidence from the osteoarthritis initiative. Arch Phys Med Rehabil 2010; 91:714-21. [PMID: 20434608 DOI: 10.1016/j.apmr.2010.01.015] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2009] [Revised: 01/18/2010] [Accepted: 01/19/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To investigate the association between baseline physical activity and 1-year functional performance in adults with knee osteoarthritis (OA). DESIGN Prospective cohort study of knee OA development and progression with 1-year follow-up. SETTING Community. PARTICIPANTS Osteoarthritis Initiative public data on adults with knee OA (n=2274; age, 45-79y) who participated in functional performance assessments (timed 20-m walk and chair stand test) at baseline and 1-year follow-up. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE A good 1-year performance outcome (separately defined for walk time and chair stand measures) was improvement from baseline quintile or maintenance in the best quintile. RESULTS Almost 2 in 5 persons with radiographic knee OA improved or maintained high performance at 1 year. Physical activity measured by the Physical Activity Scale for the Elderly (PASE) was significantly associated with good walk rate and chair stand outcomes (odds ratio per 40 units PASE [95% confidence interval]=1.13 [1.13, 1.17] and 1.10 [1.05, 1.15], respectively), as were participation in sports/recreational activities (1.45 [1.23, 1.71] and 1.29 [1.09, 1.51], respectively) and lifestyle activities (1.11 [1.06, 1.16] and 1.09 [1.04, 1.14], respectively). An independent protective relationship for these physical activity measures approached significance after adjusting for sociodemographic and health factors. Older adults reported the least baseline physical activity and least frequent good 1-year outcomes. CONCLUSIONS These findings support public health recommendations to be physically active in order to preserve function for persons with knee OA. Physical activity messages should specifically target older adults whose low activity levels may jeopardize their ability to maintain functional performance.
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Affiliation(s)
- Dorothy D Dunlop
- Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.
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Liang J, Xu X, Bennett JM, Ye W, Quiñones AR. Ethnicity and changing functional health in middle and late life: a person-centered approach. J Gerontol B Psychol Sci Soc Sci 2009; 65:470-81. [PMID: 20008483 DOI: 10.1093/geronb/gbp114] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Following a person-centered approach, this research aims to depict distinct courses of disability and to ascertain how the probabilities of experiencing these trajectories vary across Black, Hispanic, and White middle-aged and older Americans. METHODS Data came from the 1995-2006 Health and Retirement Study, which involved a national sample of 18,486 Americans older than 50 years of age. Group-based semiparametric mixture models (Proc Traj) were used for data analysis. RESULTS Five trajectories were identified: (a) excellent functional health (61%), (b) good functional health with small increasing disability (25%), (c) accelerated increase in disability (7%), (d) high but stable disability (4%), and (e) persistent severe impairment (3%). However, when time-varying covariates (e.g., martial status and health conditions) were controlled, only 3 trajectories emerged: (a) healthy functioning (53%), moderate functional decrement (40%), and (c) large functional decrement (8%). Black and Hispanic Americans had significantly higher probabilities than White Americans in experiencing poor functional health trajectories, with Blacks at greater risks than Hispanics. CONCLUSIONS Parallel to the concepts of successful aging, usual aging, and pathological aging, there exist distinct courses of changing functional health over time. The mechanisms underlying changes in disability may vary between Black and Hispanic Americans.
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Affiliation(s)
- Jersey Liang
- Department of Health Management and Policy, University of Michigan School of Public Health., Ann Arbor, MI 48109-2029, USA.
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Hybels CF, Pieper CF, Blazer DG. The complex relationship between depressive symptoms and functional limitations in community-dwelling older adults: the impact of subthreshold depression. Psychol Med 2009; 39:1677-88. [PMID: 19356260 PMCID: PMC2741540 DOI: 10.1017/s0033291709005650] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Depressive symptoms above screening thresholds have been shown to predict functional decline in older adults. Less is known about the impact of subthreshold depression, and whether more symptoms confer significantly greater risk compared to fewer symptoms. METHOD Using data from the Duke Established Populations for Epidemiologic Studies of the Elderly (EPESE) collected over 10 years, we used repeated-measures mixed models to predict functional change by depression status at the prior (index) in-person interview. Depressive symptoms were measured using a modified version of the Center for Epidemiologic Studies Depression Scale (CES-D). Subthreshold depression was operationalized as 6-8 symptoms and CES-D-defined depression as 9-20 symptoms in the previous week. Three domains of functional status were assessed at the subsequent in-person interview: limitations in basic activities of daily living (ADL), instrumental ADL (IADL) and mobility. RESULTS Controlling for race, sex, age, education, marital status, cognitive status, health status, self-perceived health, perceived social support and functional status at the index interview, having 6 depressive symptoms predicted an increase of 0.12 IADL limitations 3-4 years later (p=0.03). The incremental effect of CES-D-defined depression (9 symptoms compared to 6-8 symptoms) was not significant, suggesting that the effect of more symptomatic depression did not add to that of subthreshold depression. CES-D score modeled as a continuous variable predicted functional change for all domains, but the relationship was not linear, supporting a possible threshold effect. CONCLUSIONS The relationship between depressive symptoms and functional change is complex, not necessarily linear, and may vary by tasks assessed.
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Affiliation(s)
- C F Hybels
- Department of Psychiatry and Behavioral Sciences, Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC 27710, USA.
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Fuller-Thomson E, Nuru-Jeter A, Minkler M, Guralnik JM. Black-White disparities in disability among older Americans: further untangling the role of race and socioeconomic status. J Aging Health 2009; 21:677-98. [PMID: 19584411 PMCID: PMC2907066 DOI: 10.1177/0898264309338296] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To explore the impact of adjusting for income and education on disparities in functional limitations and limitations in activities of daily living (ADLs) between Black and White older Americans. METHOD Data from the 2003 American Community Survey were used to examine the associations of education and income, stratified by race and gender, with functional limitations and ADLs, in a sample of 16,870 non-Hispanic Blacks and 186,086 non-Hispanic Whites aged 55 to 74. Sequential logistic regressions were used to examine the relative contribution of income and education to racial disparities. RESULTS Ninety percent of the Black-White difference in disability rates for men and 75% of the difference for women aged 55 to 64 were explained by income and education. DISCUSSION The greatly elevated risk of disability among Blacks aged 55 to 74 is largely explained by differences in socioeconomic status. Reductions in Black-White health disparities require a better understanding of the mechanisms whereby lower income and education are associated with functional outcomes in older persons.
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Affiliation(s)
- Esme Fuller-Thomson
- Faculty of Social Work & Department of Family and Community Medicine, University of Toronto, 246 Bloor Street W., Toronto, Ontario, Canada M5S 1A1.
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Liu SY, Lapane KL. Residential modifications and decline in physical function among community-dwelling older adults. THE GERONTOLOGIST 2009; 49:344-54. [PMID: 19377046 DOI: 10.1093/geront/gnp033] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE The purpose of this study is to quantify the effect of residential modification on decreasing risk of physical function decline in 2 years. DESIGN Cohort study using propensity scores method to control for baseline differences between individuals with residential modifications and those without residential modifications. PARTICIPANTS Participants (N = 9,447) were from the Second Longitudinal Study on Aging, a nationally representative sample of the civilian noninstitutionalized population, aged 70 years and older in the United States at the time of baseline interview in 1994-1995. METHODS Participants self-reported residential modifications at baseline (e.g., railings, bathroom modifications). Decline in physical functioning was measured by comparing self-reported activities of daily living at baseline and at 2-year follow-up. RESULTS Compared with individuals without baseline modifications, a higher proportion of those with baseline modifications were aged 85 years and older (16% vs. 10%), used special aides (36% vs. 14%), and lived alone (40% vs. 31%). Using a weighted propensity score method, we found a modest decrease in risk of decline at Wave 2 for those with baseline modifications (risk difference = 3.1%). Respondents with a baseline residential modification were less likely to experience subsequent decline in functional ability (adjusted odds ratio = 0.88, 95% confidence interval = 0.79-0.97) after adjusting for quintile of propensity score in a survey-weighted regression model. IMPLICATIONS Baseline modifications may be associated with reduced risk of decline among a nationally representative sample of older community-dwelling adults. Widespread adoption of residential modifications may reduce the overall population estimates of decline.
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Affiliation(s)
- Sze Y Liu
- Department of Community Health, Brown Medical School, Providence, RI 02903, USA.
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A systematic literature review of studies analyzing the effect of sex, age, education, marital status, obesity, and smoking on health transitions. DEMOGRAPHIC RESEARCH 2009. [DOI: 10.4054/demres.2009.20.5] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Popa MA, Reynolds SL, Small BJ. Is the effect of reported physical activity on disability mediated by cognitive performance in white and african american older adults? J Gerontol B Psychol Sci Soc Sci 2009; 64:4-13. [PMID: 19196688 DOI: 10.1093/geronb/gbn030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
This study examined if reported physical activity has beneficial outcomes on disability through cognitive performance-mediated effects and if these mediation effects are comparable for White and African American elders. Longitudinal data from the Assets and Health Dynamics among the Oldest Old study (N = 4,472) are used to test mediation in multilevel models. During the 7-year follow-up, cognitive performance mediated the effects of reported physical activity on disability in the entire sample and in Whites but not in African Americans. Our results indicate that reported physical activity may delay the disability development through improvement in cognitive performance. Unmeasured education and comorbidity influences may have obscured the mediation effects in African Americans. Reported physical activity plays a key role in the independence of older adults and should be particularly promoted in African Americans and during the entire life course.
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Affiliation(s)
- Mihaela A Popa
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612-9497, USA.
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Marengoni A, von Strauss E, Rizzuto D, Winblad B, Fratiglioni L. The impact of chronic multimorbidity and disability on functional decline and survival in elderly persons. A community-based, longitudinal study. J Intern Med 2009; 265:288-95. [PMID: 19192038 DOI: 10.1111/j.1365-2796.2008.02017.x] [Citation(s) in RCA: 231] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE We aimed to disentangle the effect of chronic multimorbidity and disability on 3-year functional decline and survival in the elderly. DESIGN Prospective cohort study with a mean of follow-up of 2.8 years. SETTING Swedish elderly persons from the Kungsholmen Project (1987-2000). SUBJECTS A total of 1099 subjects, 77-100 years old, living in the community and institutions. MAIN OUTCOME MEASUREMENTS Medical diagnoses (based on clinical examination, drug use, medical records and blood tests), and functional assessment (according to Katz Index) at baseline were investigated in relation to functional decline and death occurring during follow-up. RESULTS At baseline, 12.1% of participants had disability, and 52.3% were affected by multimorbidity. During follow-up, 363 persons died and 85 worsened in functioning. The number of chronic conditions incrementally increased the risk of functional decline [hazard ratio (HR) increased from 1.5 in subjects with one disease to 6.2 in persons with 4+ diseases]. However, this was not the case for mortality, as the HR of death was the same for people with one disease as well as 4+ diseases (HR=2.3). Baseline disability had the highest impact on survival, independently of number of diseases [HR=8.1; 95% confidence interval (CI)=4.8-13.7 in subjects with one disease and HR=7.7; 95% CI=4.7-12.6 in those with 2+ diseases]. CONCLUSIONS In the elderly subjects, chronic disability rather than multimorbidity emerged as the strongest negative prognostic factor for functionality and survival.
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Affiliation(s)
- A Marengoni
- NVS Department, Aging Research Center, Karolinska Institutet, Stockholm, Sweden.
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Ebrahim S, Adamson J, Ayis S, Beswick A, Gooberman-Hill R. Locomotor disability: meaning, causes and effects of interventions. J Health Serv Res Policy 2009; 13 Suppl 3:38-46. [PMID: 18806191 DOI: 10.1258/jhsrp.2008.008013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This paper provides a synopsis of a long-term programme of MRC-funded work on locomotor disability in older people. Specifically it describes the meaning and experience of disability, examines the risk factors for disability and systematically reviews the evidence from randomized trials of complex interventions for disability. We undertook a national prospective study of a representative sample of 999 people aged 65 years or more plus in-depth interviews with a small subsample and a selected sample obtained from hospital sources. Secondary analysis of several large prospective studies was carried out and a systematic review and meta-analysis of published randomized controlled trials of the effects of complex interventions for disability. Very few participants subscribed to the constructs of longstanding illness, disability or infirmity that surveys often use. A wide range of social and psychological factors, independently of chronic diseases, were strongly associated with disability. People with greater functional reserve capacity and those with greater self-efficacy were generally less likely to suffer from catastrophic decline in ability and had better quality of life in the face of disability. In reviewing 89 trials (over 97,000 participants) of complex interventions for disability, evidence of benefits was found although no relationship with intensity of intervention was apparent. Our findings on the meaning and experience of disability suggest the need for modifications to routinely used survey questions and for different ways of understanding the need for and receipt of care among older people with disabilities. The diverse risk factors for disability suggest that novel approaches across social, psychological as well as more traditional rehabilitation and behavioural risk factor modification would be worth exploring. Complex interventions appeared to help older people to live independently and limit functional decline irrespective of age and health status.
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Affiliation(s)
- Shah Ebrahim
- Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
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Geropharmacology: a primer for advanced practice acute care and critical care nurses, part I. AACN Adv Crit Care 2008; 19:23-35; quiz 36-7. [PMID: 18418102 DOI: 10.1097/01.aacn.0000310748.00911.93] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Advanced practice nurses' challenge in managing older adults' medication regimens from an evidence base is difficult because older adults are vulnerable to medication errors and adverse drug reactions related to a number of factors. Predicting patients' responses to drugs is compounded during critical illness, adding to the heterogeneity and unpredictability of drug effects that are prevalent premorbidly. In the first part of this 2-part continuing education series, sources of medication errors and older adults' vulnerability are discussed, including normal changes of aging affecting pharmacokinetics and pharmacodynamics, polypharmacy, self-medicating, patient-family noncompliance, and inappropriately prescribed medications. In the second part, drug classes and drugs posing particular problems for older adults and cautions for acute care and critical care nurses who manage the medications of older adults are highlighted.
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Resnick B, Petzer-Aboff I, Galik E, Russ K, Cayo J, Simpson M, Zimmerman S. Barriers and benefits to implementing a restorative care intervention in nursing homes. J Am Med Dir Assoc 2008; 9:102-8. [PMID: 18261702 DOI: 10.1016/j.jamda.2007.08.011] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2007] [Revised: 08/16/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVES This study considered the factors that facilitated or prevented nursing assistants (NAs) from engaging in restorative care activities. DESIGN This was a qualitative study using a focus group methodology. SETTING Study participants were recruited from 6 nursing homes. PARTICIPANTS Participants were nursing assistants (NAs) from a study testing the implementation of a restorative care intervention (Res-Care) study. Of the 244 NAs recruited from the 6 treatment sites, 179 were available at 12 months and 93 (52%) participated in the study. MEASUREMENT An interview guide was used during each of the focus groups. Data analysis was done using basic content analysis. RESULTS Sixty-one codes were identified and reduced to 4 themes: facilitators of restorative care; barriers to restorative care; benefits of restorative care; and sustaining restorative care. CONCLUSION The findings provide an important NA perspective with regard to implementation of a restorative philosophy of care and provide recommendations for future work in this area.
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Affiliation(s)
- Barbara Resnick
- University of Maryland School of Nursing, Baltimore MD 21201, USA.
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Abstract
Examining the Black/White disability gap among older adults, this study focuses on the role of timing in racial inequality over time. Using the Duke Established Populations for Epidemiologic Studies of the Elderly (EPESE), the author reexamines Black and White disability trajectories with attention to timing of onset. In addition, known mediators are examined for their relative impact on onset and accumulation of disability. The author finds that diverging trajectories of Black and White disability, evidence of a cumulative disadvantage argument, are fueled solely by differences in onset. A more nuanced picture of racial disparities arises when controls are included, lending support to a weathering hypothesis. Access to health care is primary in explaining the Black/White disparity. The author concludes that timing is integral to the study of health trajectories and that research using cumulative disadvantage benefits from supplemental theories with specific assertions as to timing, including weathering.
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Guerra RO, Alvarado BE, Zunzunegui MV. Life course, gender and ethnic inequalities in functional disability in a Brazilian urban elderly population. Aging Clin Exp Res 2008; 20:53-61. [PMID: 18283229 DOI: 10.1007/bf03324748] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND AIMS To examine life course social, gender and ethnic inequalities in ADL disability in a Brazilian urban elderly population. METHODS We used the São Paulo-SABE study (health, well-being and aging in Latin America and the Caribbean) to assess the associations between ADL disability and gender, ethnicity and life course social conditions (childhood socio-economic and health status, education, lifetime occupation, current perception of income), controlling for current physical and mental health (cognitive impairment and comorbidity). ADL disability was defined as the presence of one or more difficulties with six tasks: bathing, toileting, dressing, walking across the room, eating, and getting out of bed. RESULTS Results suggest that social inequalities during the life course (hunger and poverty in early life; illiteracy, a low skilled occupation, having been a housewife; insufficient income) tend to result in disability in later life. The prevalence of ADL disability was higher among women (22.4%) than among men (14.8%). Mestizo/ Native elders reported higher prevalence of disability compared with Whites and Blacks/Mulattos. Ethnic inequalities concerning ADL disability were explained by social and health conditions, but the gender gap persisted (OR women vs men= 2.16; 95% CI 1.32-3.55). Despite their higher rate of ADL disability in old age, women appear to be more resilient than men toward poor socio-economic conditions throughout the life course. Chronic conditions were more likely to result in ADL disability among men than women (OR= 1.83; 95% CI 1.41-2.38 in women; OR= 3.42; 95% CI 2.41-4.86 in men). CONCLUSIONS Decreasing social inequalities during childhood and adulthood will reduce socio-economic inequalities in disability in old age, especially among men.
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Affiliation(s)
- Ricardo O Guerra
- Department of Physical Therapy, Federal University of Rio Grande do Norte, Natal, Brazil.
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Hardy SE, Allore HG, Guo Z, Gill TM. Explaining the effect of gender on functional transitions in older persons. Gerontology 2008; 54:79-86. [PMID: 18230952 PMCID: PMC2517150 DOI: 10.1159/000115004] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2007] [Accepted: 11/07/2007] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Women live longer but experience greater disability than men. The reasons for this gender difference in disability are not well understood. OBJECTIVE Our objectives were to determine if the higher prevalence of disability in women is due to greater incidence of disability, longer duration of disability, or both, and to identify factors that potentially explain these gender differences. METHODS 754 community-living persons aged 70 and older who were non-disabled (required no personal assistance) in four essential activities of daily living (ADLs) were assessed monthly for disability for up to 6 years. A multi-state extension of the proportional hazards model was used to determine the effects of gender on transitions between states of no disability, mild disability, severe disability, and death, and to evaluate potential mediators of these effects. RESULTS Women were more likely to make the transition from no disability to mild disability and less likely to make the transitions from mild to no disability and from both mild and severe disability to death. The gender difference in the transitions between no disability and mild disability was largely explained by differences in gait speed and physical activity, but gender difference in transitions to death persisted despite adjustment for multiple potential mediators. CONCLUSION The higher prevalence of disability in women versus men is due to a combination of higher incidence and longer duration, resulting from lower rates of recovery and mortality among disabled women.
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Affiliation(s)
- Susan E Hardy
- Department of Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA.
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Ciol MA, Shumway-Cook A, Hoffman JM, Yorkston KM, Dudgeon BJ, Chan L. Minority disparities in disability between Medicare beneficiaries. J Am Geriatr Soc 2008; 56:444-53. [PMID: 18179505 DOI: 10.1111/j.1532-5415.2007.01570.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To examine racial and ethnic disparities in mobility limitation, activities of daily living (ADLs), and instrumental activities of daily living (IADLs) in older adults enrolled in Medicare. DESIGN Longitudinal national survey. PARTICIPANTS Community-dwelling respondents in the Medicare Current Beneficiaries Survey from 1992 to 2004 (10,180-16,788 respondents per year). MEASUREMENTS Disability-related outcomes included mobility limitation, difficulty in six ADLs and six IADLs. Explanatory variables included age, sex, racial or ethnic group, living situation, and income level. RESULTS From 1992 to 2004, proportions of Medicare beneficiaries with mobility limitations were stable across racial and ethnic groups, improving slightly for ADLs and IADLs. Blacks reported more limitations in all three disability-related measures. In a longitudinal analysis, the probability of developing mobility limitation was consistently higher for blacks, followed by white Hispanics, white non-Hispanics, and Asians, after adjusting for age, sex, socioeconomic status, and living situation. For ADL and IADL difficulties, the number of reported difficulties increased with age for all ethnic and racial groups. At approximately age 75, Asians and white Hispanics reported difficulties with much higher numbers of ADLs and IADLs than the other groups. CONCLUSION Across all ethnic and racial groups, self-reported disability has declined in the past decade, but even after adjusting for age, sex, socioeconomic status, and living situation, racial and ethnic disparities in disability outcomes persist. Race and ethnicity may influence the reporting of disability, potentially affecting measures of prevalence. Further research is needed to understand whether these differences are a result of perceptions related to disablement or true differences in disability between racial and ethnic groups.
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Affiliation(s)
- Marcia A Ciol
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, Washington 98195, USA.
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Thorpe RJ, Kasper JD, Szanton SL, Frick KD, Fried LP, Simonsick EM. Relationship of race and poverty to lower extremity function and decline: findings from the Women's Health and Aging Study. Soc Sci Med 2007; 66:811-21. [PMID: 18164113 DOI: 10.1016/j.socscimed.2007.11.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2007] [Indexed: 12/26/2022]
Abstract
Race- and poverty-related disparities in physical function are well documented, though little is known about effects of race and poverty on functional decline and the progression of disability. We examined cross-sectional and longitudinal relationships between race, poverty and lower extremity function using data from moderately to severely disabled women in the U.S. Women's Health and Aging Study. Severity of lower extremity functional limitation was determined from scaled responses of reported difficulty walking (1/4) mile, walking across a room, climbing stairs, and stooping, crouching or kneeling. Usual walking speed assessed over 4m was our objective measure of function. Of the 996 women who described themselves as black or white, 284 (29%) were black and 367 (37%) were living at or below 100% of the federal poverty level. Independent of demographic and health-related factors, among white women, the poor exhibited consistently worse lower extremity function than the non-poor; this association, however, was not observed in black women. Among the non-poor, black women had slower walking speeds, and reported more limitation in lower extremity function than their non-poor white counterparts, even after adjusting for demographic variables and health-related characteristics. After 3 years, accounting for baseline function, demographic and health-related factors, race and poverty status were unrelated to functional decline. Thus, while race and poverty status were associated with functional deficits in old age, they do not appear to impact the rate of functional decline or progression of disability over 3 years.
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Dunlop DD, Song J, Manheim LM, Daviglus ML, Chang RW. Racial/ethnic differences in the development of disability among older adults. Am J Public Health 2007; 97:2209-15. [PMID: 17971548 PMCID: PMC2089103 DOI: 10.2105/ajph.2006.106047] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2007] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We investigated differences in the development of disability in activities of daily living among non-Hispanic Whites, African Americans, Hispanics interviewed in Spanish, and Hispanics interviewed in English. METHODS We estimated 6-year risk for disability development among 8161 participants 65 years or older and free of baseline disability. We evaluated mediating factors amenable to clinical and public health intervention on racial/ethnic difference. RESULTS The risk for developing disability among Hispanics interviewed in English was similar to that among Whites (hazard ratio [HR]=0.99; 95% confidence interval [CI] = 0.6, 1.4) but was substantially higher among African Americans (HR=1.6; 95% CI=1.3, 1.9) and Hispanics interviewed in Spanish (HR=1.8; 95% CI=1.4, 2.1). Adjustment for demographics, health, and socioeconomic status reduced a large portion of those disparities (African American adjusted HR=1.1, Spanish-interviewed Hispanic adjusted HR=1.2). CONCLUSIONS Higher risks for developing disability among older African Americans, and Hispanics interviewed in Spanish compared with Whites were largely attenuated by health and socioeconomic differences. Language- and culture-specific programs to increase physical activity and promote weight maintenance may reduce rates of disability in activities of daily living and reduce racial/ethnic disparities in disability.
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Affiliation(s)
- Dorothy D Dunlop
- Institute for Healthcare Studies, the Multidisciplinary Clinical Research Center in Rheumatology, and the Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Ill 60611, USA.
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Holstein BE, Avlund K, Due P, Martinussen T, Keiding N. The measurement of change in functional ability: Dealing with attrition and the floor/ceiling effect. Arch Gerontol Geriatr 2006; 43:337-50. [PMID: 16469399 DOI: 10.1016/j.archger.2005.12.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2005] [Revised: 12/08/2005] [Accepted: 12/10/2005] [Indexed: 10/25/2022]
Abstract
The purpose was to describe four-year change in functional ability among older persons and the relationship to sex, age, and other background factors. The baseline study, performed in 1986, is based on a random sample of older persons (n=1261). Follow-up data were collected four-years later (n=912). The analyses of change in functional ability were based on the assumption that the categories reflected an underlying latent continuous dimension. The change in functional ability, DeltaFA, was calculated by a logistic model for paired observations and applied in parallel analyses with and without inclusion of the dead to deal with the attrition problem. Fifty percent had no change in functional ability, 37% had declined and 13% improved. Models including the dead showed more functional decline with increasing age but this was not the case when the dead were excluded. Functional change was not related to sex, functional ability at baseline, relative wealth, social network, self-rated health, and life-satisfaction. Inclusion of the dead in statistical models for the study of change in functional ability reduced the attrition problem. A logistic model for paired observations of functional ability at two points in time reduced the problem related to the floor/ceiling problem.
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Affiliation(s)
- Bjørn E Holstein
- University of Copenhagen, Institute of Public Health, Department of Social Medicine, Blegdamsvej 3, 2200 Copenhagen N, Denmark
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Sulander T, Martelin T, Sainio P, Rahkonen O, Nissinen A, Uutela A. Trends and educational disparities in functional capacity among people aged 65-84 years. Int J Epidemiol 2006; 35:1255-61. [PMID: 16931522 DOI: 10.1093/ije/dyl183] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND This study examined 10 year trends in functional capacity by gender, age, and education among elderly Finns aged 65-84 years, focusing on difficulties in basic activities of daily living (BADL). Educational disparities and their trends in the prevalence of these difficulties were also assessed. METHODS Data were derived from nationally representative monitoring surveys conducted biennially from 1993 to 2003 by the National Public Health Institute (KTL). A total of 5740 men and 5746 women were included in the study (response rate 80%). Activities of daily living (ADL) measures were used to assess levels of functional capacity. Education was divided into two groups: low (0-8 years) and high (9+ years). Age-adjusted trends and logistic regression analyses were computed. RESULTS A clear downward trend in BADL difficulties was observed in all age groups in both genders. 80-84 year olds had clearly poorer functional ability than 65-69 year olds, even when adjusted for chronic diseases. Despite the overall improvement in functional capacity in both educational groups, low educational status persistently predicted poorer functional capacity. When chronic diseases and survey period were controlled for, the educational disparities attenuated slightly but remained significant. CONCLUSIONS The number of Finnish elderly with BADL difficulties has declined markedly over the past 10 years. However, persistent educational disparities continue to present a challenge to public health initiatives for reducing inequalities in health.
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Affiliation(s)
- Tommi Sulander
- Department of Epidemiology and Health Promotion, National Public Health Institute, Helsinki, Finland.
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Mendes de Leon CF, Hansberry MR, Bienias JL, Morris MC, Evans DA. Relative weight and mobility: a longitudinal study in a biracial population of older adults. Ann Epidemiol 2006; 16:770-6. [PMID: 16882461 DOI: 10.1016/j.annepidem.2006.05.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2005] [Revised: 04/26/2006] [Accepted: 05/02/2006] [Indexed: 10/24/2022]
Abstract
PURPOSE We examined the association of relative weight with mobility and changes in mobility over time and whether these associations differed by race. METHODS Data come from a prospective, population-based, observational study of adults aged 65 years or older. Mobility outcomes were assessed at baseline and two follow-up interviews at 3-year intervals. The study included 4195 participants with a mean age of 73.8 +/- 6.3 (SD) years; 61.4% were women, and 60.9% were black. Assessment of mobility included a brief self-report instrument and a performance-based walk test. Body mass index (BMI, kilograms per square meter) was used as a measure of relative weight. We used generalized estimating equation models to examine change in mobility outcomes over time as a function of BMI. RESULTS Average BMI was 26.6 +/- 5.7 kg/m(2), with 34.0% overweight and 23.4% obese. BMI showed a significant curvilinear association with mobility outcomes at baseline (p < 0.001), but was not associated with change in mobility during follow-up. Maximum mobility levels occurred at a significantly higher level of BMI among blacks than whites. CONCLUSIONS Higher levels of BMI may lead to mobility impairments earlier in life, but there is little evidence that they increase the rate of decline in mobility in older age itself.
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Lee Y, Park KH. Health practices that predict recovery from functional limitations in older adults. Am J Prev Med 2006; 31:25-31. [PMID: 16777539 DOI: 10.1016/j.amepre.2006.03.018] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2005] [Revised: 01/11/2006] [Accepted: 03/03/2006] [Indexed: 11/24/2022]
Abstract
BACKGROUND Although previous studies show the benefits of certain health behaviors in reducing physical disability in older people, their effects on functional limitation, an antecedent of disability, are not well established. This study aims to identify health behavioral practices that affect recovery from functional limitations in older adults. METHODS A total of 312 community-dwelling adults aged 65 and older with functional limitations were examined in 2002 for functional recovery in 2003. Functional limitations were measured by self-reports of difficulty performing upper- and lower-body movements. Positive health practices included regular physical activity, normal body mass index (BMI), periodic medical checkups, and moderate alcohol consumption. Logistic regression models were fitted to identify individual as well as combined health practices that predict functional recovery, adjusting for sociodemographic and health-related covariates. RESULTS Although each of the positive health practices was significantly associated with functional recovery in the bivariate analyses, only physical activity continued to be a strong independent predictor in the multivariate analysis. The likelihood of functional recovery tended to increase with the number of health practices adopted by the elderly. Physical activity, in combination with normal BMI, proved to be one of the most influential health practice profiles, resulting in a high percentage of functional recovery. CONCLUSIONS Health behaviors, especially physical activity, contribute to an older person's functional independence. The benefit of an increased number of health practices on recovery from functional limitations suggests that targeting multiple behavioral risks may help delay the onset of disability in later life.
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Affiliation(s)
- Yunhwan Lee
- Department of Preventive Medicine & Public Health, Ajou University School of Medicine, Suwon, South Korea.
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Kelley-Moore JA. Assessing racial health inequality in older adulthood: comparisons from mixed-mode panel interviews. J Gerontol B Psychol Sci Soc Sci 2006; 61:S212-20. [PMID: 16855042 DOI: 10.1093/geronb/61.4.s212] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Estimates of the extent of health disparities among Black and White older adults are not consistent across studies. The purpose of this study was to systematically compare responses from Black and White older adults in telephone and face-to-face interviews in order to determine whether estimates of racial health inequality vary by survey interview mode. METHODS By using data from a mixed-mode panel study, I compared estimates of changing health inequality for Black and White older adults collected from face-to-face and telephone interviews. I calculated trajectories of physical disability by using latent growth models across seven waves of data. RESULTS Face-to-face interviews yielded consistently higher reports of disability relative to telephone interviews of the same persons. Black adults had significantly greater and increasing disability than did White adults for both interview modes. After adjusting for covariates, I found that Black and White older adults had parallel disability trajectories in face-to-face interviews but a widening gap in disability over time in telephone interviews. DISCUSSION Researchers should judiciously consider whether estimates of racial health inequality-and change in disability more broadly-may be misleading because of interview-mode effects.
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Affiliation(s)
- Jessica A Kelley-Moore
- Sociology and Anthropology, University of Maryland Baltimore County, 1000 Hilltop Circle, Baltimore, MD 21250, USA.
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Hardy SE, Allore HG, Guo Z, Dubin JA, Gill TM. The effect of prior disability history on subsequent functional transitions. J Gerontol A Biol Sci Med Sci 2006; 61:272-7. [PMID: 16567377 DOI: 10.1093/gerona/61.3.272] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Many older persons experience multiple transitions between states of disability and independence, but little is known about the effect of prior disability history on subsequent functional transitions. Our objective was to determine the effect of prior disability on subsequent transitions between no disability, mild disability, severe disability, and death. METHODS For 60 months, 754 persons aged 70 or older underwent monthly assessments of disability in basic activities of daily living. We used a multistate extension of the proportional hazards model to determine the effects of amount, defined as cumulative duration, and distribution, defined as number of episodes, of prior disability on subsequent functional transitions, adjusted for age, gender, cognitive status, timed gait, and habitual physical activity. RESULTS For each additional month of prior disability, participants were more likely to make transitions representing new or worsening disability and were less likely to make transitions from disability to independence or from severe disability to death. Adjusting for the cumulative duration of prior disability, more episodes of prior disability were associated with a higher likelihood of most transitions, representing both increasing and decreasing disability, but had no effect on transitions to death. CONCLUSIONS Both the amount and distribution of prior disability are important determinants of the likelihood of subsequent functional transitions. Analytic methods that account for prior disability history should be used in studies of functional transitions, and new measures of disability burden are needed that incorporate distribution as well as amount of disability.
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Affiliation(s)
- Susan E Hardy
- Department of Internal Medicine, University of Pittsburgh School of Medicine, PA 15213, USA.
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Kelley-Moore JA, Ferraro KF. A 3-D model of health decline: disease, disability, and depression among Black and White older adults. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2005; 46:376-91. [PMID: 16433282 DOI: 10.1177/002214650504600405] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Much of the research on health decline in older adulthood has specified a single causal direction between two health domains, often measured at the same time point, making it difficult to disentangle the mechanisms of health decline over time. Using three waves of data over seven years from older residents of North Carolina, a 3-D model is used to examine the temporal ordering of general health decline and the pathways of influence across three health domains (disease, disability, and depression). In addition, we test whether the 3-D model of health decline is similar for Black and White older adults. Results indicate that both prevalent and incident disease lead to increases in depression and that prevalent disease leads to greater disability three years later. Depression, in turn, leads to disease, identifying a cycle of health decline that is, for the most part, similar for Black and White older adults. The effect of widowhood is more deleterious to the health of Black older adults than for their White counterparts.
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Mendes de Leon CF, Barnes LL, Bienias JL, Skarupski KA, Evans DA. Racial disparities in disability: recent evidence from self-reported and performance-based disability measures in a population-based study of older adults. J Gerontol B Psychol Sci Soc Sci 2005; 60:S263-71. [PMID: 16131627 DOI: 10.1093/geronb/60.5.s263] [Citation(s) in RCA: 110] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Although disability levels have been declining in older adults, there is little current information on racial differences in disability. METHODS Our data came from a longitudinal, population-based study of 6,158 Black and White adults aged 65 and older from the south side of Chicago. Data were collected during three face-to-face interviews between 1993 and 2002. We ascertained disability using three self-report measures and a performance-based measure of physical function. Using longitudinal data analysis, we examined overall racial differences in disability and the degree to which they varied by age and gender. RESULTS After an average of 6 years of follow-up, Blacks reported significantly higher disability levels than Whites after adjustment for age and sex. There was a significant increase in disability during follow-up on all four measures. Racial differences in disability did not vary consistently by age at baseline or over time but were greater among women. Findings were largely similar for self-reported and performance-based measures of disability. Adjustment for socioeconomic status substantially reduced racial differences in disability, although some of the differences remained significant, especially among women. CONCLUSION Racial disparities in disability have not been eliminated, are greater among women, and have their origins earlier in adulthood.
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Affiliation(s)
- Carlos F Mendes de Leon
- Rush Institute for Healthy Aging, Rush University Medical Center, 1645 W. Jackson Blvd., Suite 675, Chicago, IL 60612, USA.
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Grzywacz JG, Lang W, Suerken C, Quandt SA, Bell RA, Arcury TA. Age, race, and ethnicity in the use of complementary and alternative medicine for health self-management: evidence from the 2002 National Health Interview Survey. J Aging Health 2005; 17:547-72. [PMID: 16177450 DOI: 10.1177/0898264305279821] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Determine if complementary and alternative medicine (CAM) use for treating existing conditions and for health maintenance differs by age and ethnicity. METHODS Data from the 2002 National Health Interview Survey were used to operationalize distinct types of CAM in terms of (a) no use, (b) use for treatment only, (c) use for prevention only, and (d) use for both treatment and prevention. Differences in CAM use by age and ethnicity were examined using SUDAAN to adjust for design effects. RESULTS Associations of age with CAM use are curvilinear but differed by ethnicity. Some types of CAM are used primarily for treatment; others are used for health maintenance. DISCUSSION CAM use is one component of adults' overall approach to health self-management. Patterns of CAM use by age and ethnicity likely reflect differences in CAM availability and prevailing public health policies when adults began making their own health-related decisions.
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Affiliation(s)
- Joseph G Grzywacz
- Department of Family and Community Medicine, Wake Forest University School of Medicine, Medical Center Blvd., Winston-Salem, NC 27157-1084, USA.
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Moody-Ayers SY, Mehta KM, Lindquist K, Sands L, Covinsky KE. Black-white disparities in functional decline in older persons: the role of cognitive function. J Gerontol A Biol Sci Med Sci 2005; 60:933-9. [PMID: 16079221 DOI: 10.1093/gerona/60.7.933] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Black elders have a greater frequency of functional decline than do white elders. The impact of cognitive function on explaining black-white disparities in functional decline has not been extensively explored. METHODS To compare the extent to which different risk domains (comorbidity, smoking, socioeconomic status (SES), self-rated health, and cognitive function) explain more frequent functional decline in black elders, we studied 779 black and 4892 white community-dwelling adults aged 70 and older from the Assets and Health Dynamics Among the Oldest Old (AHEAD), a population-based cohort study begun in 1993. Our primary outcome was worse functional status at 2 years than at baseline. We used logistic regression to compare the unadjusted with the adjusted black-white odds ratios (ORs) after adjusting for each risk domain. RESULTS At baseline black participants aged 70-79 had higher rates of smoking, diabetes, and hypertension; lower SES; and worse cognitive function than did white participants (p <.05 for all). The mean cognitive score was 15.7 in black and 21.8 in white participants (p <.01). Black participants had a higher frequency of 2-year functional decline than did white participants (10.9% vs 4.7%; OR = 2.61, 95% confidence interval [CI], 1.69-4.03 adjusted for age and sex). Adjustment for comorbidity and smoking did not significantly change the black-white OR, whereas self-rated health and SES accounted for about half the risk. Adjustment for cognitive function accounted for nearly all the associated decline (OR = 1.10, 95% CI, 0.67-1.79). Among participants aged 80 and over, those who were black had significantly lower risk for functional decline after adjustment for cognitive function (OR = 0.61, 95% CI, 0.38-0.96 vs OR = 1.08, 95% CI, 0.70-1.66 adjusted for age and sex only). CONCLUSIONS Cognitive function mediated the higher frequency of functional decline among black elders. Efforts to understand cognitive function may enhance our understanding of black-white disparities in health outcomes.
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Affiliation(s)
- Sandra Y Moody-Ayers
- San Francisco VA Medical Center (181G), 4150 Clement Street, San Francisco, CA 94121, USA.
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