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Haque R, Alam K, Gow J, Neville C, Keramat SA. Age and Gender Differences in the Relationship Between Chronic Pain and Dementia Among Older Australians. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2024:S1098-3015(24)02805-5. [PMID: 39127253 DOI: 10.1016/j.jval.2024.07.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Revised: 06/11/2024] [Accepted: 07/21/2024] [Indexed: 08/12/2024]
Abstract
OBJECTIVES Chronic pain is a highly debilitating condition that affects older adults and has the potential to increase their odds of experiencing cognitive impairment. The primary objective of this study was to examine the correlation between chronic pain and dementia. Additionally, this research endeavors to ascertain whether the association between chronic pain and dementia differs by age and gender. METHODS Cross-sectional data were derived from the Survey of Disability, Ageing, and Carers. A total of 20 671 and 20 081 participants aged 65 years and older in 2015 and 2018, respectively, were included in this study. The pooled association between chronic pain and dementia was assessed using a multivariable logistic regression model. Furthermore, the study also examined the multiplicative interaction effects between chronic pain and age, as well as chronic pain and gender, with dementia. RESULTS The pooled analysis demonstrated that chronic pain was associated with a heightened odds of dementia (adjusted odds ratio 1.95; 95% CI 1.85-2.05) among older Australians compared with their counterparts without chronic pain. The interaction effect indicated that individuals with chronic pain across all age groups exhibited increased odds of living with dementia. Additionally, women with chronic pain had higher odds of dementia compared with their counterparts without chronic pain and being male. CONCLUSIONS A continuous, coordinated, and tailored healthcare strategy is necessary to determine the pain management goals and explore early treatment options for chronic pain in older adults, particularly in groups with the greatest need.
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Affiliation(s)
- Rezwanul Haque
- School of Business, University of Southern Queensland, Toowoomba, Queensland, Australia.
| | - Khorshed Alam
- School of Business, University of Southern Queensland, Toowoomba, Queensland, Australia; Centre for Health Research, University of Southern Queensland, Toowoomba, Queensland, Australia
| | - Jeff Gow
- School of Business, University of Southern Queensland, Toowoomba, Queensland, Australia; Centre for Health Research, University of Southern Queensland, Toowoomba, Queensland, Australia; School of Accounting, Economics and Finance, University of KwaZulu-Natal, Durban, South Africa
| | - Christine Neville
- School of Nursing and Midwifery, University of Southern Queensland, Toowoomba, Queensland, Australia
| | - Syed Afroz Keramat
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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Hamedani AG, Ellis CA, Ehrlich JR, Willis AW. Interaction between visual impairment and genetic risk of dementia and psychosis in older adults. Age Ageing 2024; 53:afae163. [PMID: 39058917 DOI: 10.1093/ageing/afae163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND Visual impairment (VI) is associated with dementia and other neuropsychiatric outcomes, but previous studies have not considered genetic sources of confounding or effect modification. METHODS We analysed data from the Health and Retirement Study, an ongoing nationally representative survey of older US adults, a subset of whom underwent genetic testing from 2006 to 2012 (n = 13 465). Using discrete time proportional hazards models and generalised estimating equations, we measured the association between VI and dementia, depression and hallucinations adjusting for demographics and comorbidities, ancestry-specific principal components and polygenic risk scores (PRS) for Alzheimer's disease, major depressive disorder or schizophrenia. Effect modification was assessed using VI-PRS interaction terms and stratified analyses. RESULTS VI was associated with dementia, depression and hallucinations after adjusting polygenic risk and other confounders. There was no VI-PRS interaction for dementia or depression. However, the association between VI and hallucinations varied by genetic risk of schizophrenia. Within the bottom four quintiles of schizophrenia PRS, VI was not associated with hallucinations among White (OR 1.16, 95% CI: 0.87-1.55) or Black participants (OR 0.96, 95% CI: 0.49-1.89). In contrast, VI was strongly associated with hallucinations among White (OR 2.08, 95% CI: 1.17-3.71) and Black (OR 10.63, 95% CI: 1.74-65.03) participants in the top quintile of schizophrenia PRS. CONCLUSIONS The association between VI and neuropsychiatric outcomes is not explained by shared genetic risk factors, and there is a significant interaction between VI and polygenic risk of hallucinations in older adults.
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Affiliation(s)
- Ali G Hamedani
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Colin A Ellis
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Joshua R Ehrlich
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Allison W Willis
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Xu S, Wang H, Song Q, Burr JA. Sensory impairment and depressive symptoms among older adults before and during the COVID-19 pandemic. Aging Ment Health 2024; 28:112-120. [PMID: 37551091 PMCID: PMC10841205 DOI: 10.1080/13607863.2023.2242290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 07/21/2023] [Indexed: 08/09/2023]
Abstract
OBJECTIVES This study examined the associations between sensory impairment (SI), lack of social contact during the COVID-19 pandemic, and depressive symptoms among Americans aged 50 and above. METHODS We employed data from the 2018 and 2020 Health and Retirement Study (N = 13,460) to examine four SI groups: no SI, visual impairment (VI) only, hearing impairment (HI) only, and dual sensory impairment (DSI). First, multilevel models were employed to estimate the associations between SI and depressive symptoms before and during the pandemic using the full dataset (N = 13,460). Second, linear regression models were employed to estimate the moderation effect of lack of social contact during the pandemic using the 2020 wave data only (N = 4,133). RESULTS Among older adults, 15.60% had VI only, 10.16% had HI only, and 9.66% had DSI. All SI groups reported significantly more depressive symptoms than the no SI group. The differences between older adults with VI and DSI and those without SI regarding depressive symptoms narrowed during the pandemic. There was no statistically significant moderation effect of lack of social contact for SI and depressive symptoms. CONCLUSION Older adults with SI faced mental health challenges and demonstrated psychological resilience during the pandemic. Future research should examine other risk factors that may modify the relationship between SI and mental health during public health crises.
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Affiliation(s)
- Shu Xu
- Department of Gerontology, John W. McCormack Graduate School of Policy and Global Studies, University of Massachusetts Boston, Boston, MA, USA
| | - Haowei Wang
- Department of Sociology, Maxwell School of Citizenship and Public Affairs, Syracuse University, Syracuse, NY, USA
| | - Qian Song
- Department of Gerontology, John W. McCormack Graduate School of Policy and Global Studies, University of Massachusetts Boston, Boston, MA, USA
| | - Jeffrey A Burr
- Department of Gerontology, John W. McCormack Graduate School of Policy and Global Studies, University of Massachusetts Boston, Boston, MA, USA
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Park CM, Sison SDM, McCarthy EP, Shi S, Gouskova N, Lin KJ, Kim DH. Claims-Based Frailty Index as a Measure of Dementia Severity in Medicare Claims Data. J Gerontol A Biol Sci Med Sci 2023; 78:2145-2151. [PMID: 37428879 PMCID: PMC10613007 DOI: 10.1093/gerona/glad166] [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: 02/13/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND Dementia severity is unavailable in administrative claims data. We examined whether a claims-based frailty index (CFI) can measure dementia severity in Medicare claims. METHODS This cross-sectional study included the National Health and Aging Trends Study Round 5 participants with possible or probable dementia whose Medicare claims were available. We estimated the Functional Assessment Staging Test (FAST) scale (range: 3 [mild cognitive impairment] to 7 [severe dementia]) using information from the survey. We calculated CFI (range: 0-1, higher scores indicating greater frailty) using Medicare claims 12 months prior to the participants' interview date. We examined C-statistics to evaluate the ability of the CFI in identifying moderate-to-severe dementia (FAST stage 5-7) and determined the optimal CFI cut-point that maximized both sensitivity and specificity. RESULTS Of the 814 participants with possible or probable dementia and measurable CFI, 686 (72.2%) patients were ≥75 years old, 448 (50.8%) were female, and 244 (25.9%) had FAST stage 5-7. The C-statistic of CFI to identify FAST stage 5-7 was 0.78 (95% confidence interval: 0.72-0.83), with a CFI cut-point of 0.280, achieving the maximum sensitivity of 76.9% and specificity of 62.8%. Participants with CFI ≥0.280 had a higher prevalence of disability (19.4% vs 58.3%) and dementia medication use (6.0% vs 22.8%) and higher risk of mortality (10.7% vs 26.3%) and nursing home admission (4.5% vs 10.6%) over 2 years than those with CFI <0.280. CONCLUSIONS Our study suggests that CFI can be useful in identifying moderate-to-severe dementia from administrative claims among older adults with dementia.
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Affiliation(s)
- Chan Mi Park
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, USA
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Stephanie Denise M Sison
- Division of General Internal Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Ellen P McCarthy
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, USA
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Sandra Shi
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, USA
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Natalia Gouskova
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, USA
| | - Kueiyu Joshua Lin
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Dae Hyun Kim
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, USA
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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Sison SDM, Shi SM, Kim KM, Steinberg N, Jeong S, McCarthy EP, Kim DH. A crosswalk of commonly used frailty scales. J Am Geriatr Soc 2023; 71:3189-3198. [PMID: 37289180 PMCID: PMC10592534 DOI: 10.1111/jgs.18453] [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: 12/26/2022] [Revised: 04/07/2023] [Accepted: 05/22/2023] [Indexed: 06/09/2023]
Abstract
BACKGROUND Several validated scales have been developed to measure frailty, yet the direct relationship between these measures and their scores remains unknown. To bridge this gap, we created a crosswalk of the most commonly used frailty scales. METHODS We used data from 7070 community-dwelling older adults who participated in National Health and Aging Trends Study (NHATS) Round 5 to construct a crosswalk among frailty scales. We operationalized the Study of Osteoporotic Fracture Index (SOF), FRAIL Scale, Frailty Phenotype, Clinical Frailty Scale (CFS), Vulnerable Elder Survey-13 (VES-13), Tilburg Frailty Indictor (TFI), Groningen Frailty Indicator (GFI), Edmonton Frailty Scale (EFS), and 40-item Frailty Index (FI). A crosswalk between FI and the frailty scales was created using the equipercentile linking method, a statistical procedure that produces equivalent scoring between scales according to percentile distributions. To demonstrate its validity, we determined the 4-year mortality risk across all scales for low-risk (equivalent to FI <0.20), moderate-risk (FI 0.20 to <0.40), and high-risk (FI ≥0.40) categories. RESULTS Using NHATS, the feasibility of calculating frailty scores was at least 90% for all nine scales, with the FI having the highest number of calculable scores. Participants considered frail on FI (cutpoint of 0.25) corresponded to the following scores on each frailty measure: SOF 1.3, FRAIL 1.7, Phenotype 1.7, CFS 5.3, VES-13 5.5, TFI 4.4, GFI 4.8, and EFS 5.8. Conversely, individuals considered frail according to the cutpoint of each frailty measure corresponded to the following FI scores: 0.37 for SOF, 0.40 for FRAIL, 0.42 for Phenotype, 0.21 for CFS, 0.16 for VES-13, 0.28 for TFI, 0.21 for GFI, and 0.37 for EFS. Across frailty scales, the 4-year mortality risks between the same categories were similar in magnitude. CONCLUSION Our results provide clinicians and researchers with a useful tool to directly compare and interpret frailty scores across scales.
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Affiliation(s)
- Stephanie Denise M. Sison
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA
| | - Sandra M. Shi
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA
| | - Kyung Moo Kim
- John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI
| | - Nessa Steinberg
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA
| | - Sohyun Jeong
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA
| | - Ellen P. McCarthy
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Dae Hyun Kim
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
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Janower A, St John P. Dual Sensory Impairment and Functional Status in a Prospective Cohort Study. Can Geriatr J 2023; 26:364-371. [PMID: 37662059 PMCID: PMC10444523 DOI: 10.5770/cgj.26.669] [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: 09/05/2023] Open
Abstract
Objective To examine the impact of visual impairment, hearing impairment, and dual sensory impairment (DSI) on functional status in older adults. Methods Secondary analysis of the Manitoba Health and Aging Study, a population-based cohort study of 1751 adults age 65+. Data were collected from 1991 to 1992 (Time 1), with follow-up five years later (Time 2). Vision and hearing were self-reported. Functional status was measured using the Older Americans Resource and Services (OARS). Logistic regression models were constructed to assess functional status at both Time 1 and Time 2. Results Dual sensory impairment (DSI) at Time 1 predicted poor functional status at both Time 1 and Time 2. The adjusted odds ratios (OR; 95% confidence interval [CI]) for poor functional status at Time 1 for those with only hearing impairment was 1.74 (1.25, 2.44) for visual impairment was 2.95 (2.19, 3.98), and for DSI was 3.58 (2.58, 4.95). At Time 2, the adjusted ORs for poor functional status for those with only hearing impairment was 1.32 (0.86, 2.03), for visual impairment was 1.63 (1.05, 2.52), and for DSI was 2.61 (1.54, 4.40). Conclusions DSI is associated with lower functional status, but the effect of visual impairment is more pronounced than hearing impairment.
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Affiliation(s)
- Amber Janower
- Section of General Internal Medicine, Max Rady College of Medicine, University of Manitoba
| | - Philip St John
- Section of Geriatric Medicine, Max Rady College of Medicine, University of Manitoba
- Centre on Aging, University of Manitoba, Winnipeg, MB, Canada
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Guo R, Li X, Sun M, Wang Y, Wang X, Li J, Xie Z, Yao N, Yang Y, Li B, Jin L. Vision impairment, hearing impairment and functional Limitations of subjective cognitive decline: a population-based study. BMC Geriatr 2023; 23:230. [PMID: 37060058 PMCID: PMC10103414 DOI: 10.1186/s12877-023-03950-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 04/03/2023] [Indexed: 04/16/2023] Open
Abstract
BACKGROUND The association between sensory impairment including vision impairment (VI), hearing impairment (HI), dual impairment (DI) and the functional limitations of SCD (SCD-related FL) are still unclear in middle-aged and older people. METHODS 162,083 participants from BRFSS in 2019 to 2020 was used in this cross-sectional study. After adjusting the weights, multiple logistic regression was used to study the relationship between sensory impairment and SCD or SCD-related FL. In addition, we performed subgroup analysis on the basis of interaction between sensory impairment and covariates. RESULTS Participants who reported sensory impairment were more likely to report SCD or SCD-related FL compared to those without sensory impairment (p < 0.001). The association between dual impairment and SCD-related FL was the strongest, the adjusted odds ratios (aORs) and 95% confidence interval (95% CI) were [HI, 2.88 (2.41, 3.43); VI, 3.15(2.61, 3.81); DI, 6.78(5.43, 8.47)] respectively. In addition, subgroup analysis showed that men with sensory impairment were more likely to report SCD-related FL than women, the aORs and 95% CI were [HI, 3.15(2.48, 3.99) vs2.69(2.09, 3.46); VI,3.67(2.79, 4.83) vs. 2.86(2.22, 3.70); DI, 9.07(6.67, 12.35) vs. 5.03(3.72, 6.81)] respectively. The subject of married with dual impairment had a stronger association with SCD-related FL than unmarried subjects the aOR and 95% CI was [9.58(6.69, 13.71) vs. 5.33(4.14, 6.87)]. CONCLUSIONS Sensory impairment was strongly associated with SCD and SCD-related FL. Individuals with dual impairment had the greatest possibility to reported SCD-related FL, and the association was stronger for men or married subjects than other subjects.
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Affiliation(s)
- Ruirui Guo
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, 1163 Xinmin Avenue, Changchun, 130021, P. R. China
| | - Xiaotong Li
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, 1163 Xinmin Avenue, Changchun, 130021, P. R. China
| | - Mengzi Sun
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, 1163 Xinmin Avenue, Changchun, 130021, P. R. China
| | - Yuxiang Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, 1163 Xinmin Avenue, Changchun, 130021, P. R. China
| | - Xuhan Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, 1163 Xinmin Avenue, Changchun, 130021, P. R. China
| | - Jing Li
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, 1163 Xinmin Avenue, Changchun, 130021, P. R. China
| | - Zechun Xie
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, 1163 Xinmin Avenue, Changchun, 130021, P. R. China
| | - Nan Yao
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, 1163 Xinmin Avenue, Changchun, 130021, P. R. China
| | - Yixue Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, 1163 Xinmin Avenue, Changchun, 130021, P. R. China
| | - Bo Li
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, 1163 Xinmin Avenue, Changchun, 130021, P. R. China.
| | - Lina Jin
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, 1163 Xinmin Avenue, Changchun, 130021, P. R. China.
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Ding Y, Yan Y, Tian Y, Du W, Fan L. Health-related quality of life associated with sensory impairment in Chinese middle-aged and older adults: a cohort study. J Epidemiol Community Health 2023; 77:258-264. [PMID: 36725347 DOI: 10.1136/jech-2022-219728] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 01/24/2023] [Indexed: 02/03/2023]
Abstract
BACKGROUND The impact of sensory impairment (SI) on individual multidimensional health has not been adequately explored in developing countries. This study examined the association of hearing or/and visual impairment with health-related quality of life (HRQoL) in the Chinese middle-aged and older population, and further explored potential discrepancies in associations by gender and rural-urban residence. METHODS This cohort study used four-wave data during 2011-2018 from the China Health and Retirement Longitudinal Study, and enrolled 13 342 community-dwelling adults aged 45 years or older. We employed linear mixed effects models to estimate the longitudinal associations between SI and HRQoL, and conducted interaction tests to assess gender or rural-urban differences in above associations. RESULTS Hearing impairment (HI) and visual impairment (VI) were separately and jointly associated with deteriorated overall HRQoL and decreased physical/mental component of HRQoL (all β<0, all p<0.05), and in particular, dual sensory impairment (DSI) exhibited greater impacts on HRQoL than either HI or VI alone. The impacts of SI on HRQoL were more evident among women or rural population than their counterparts (all p for interaction<0.05). CONCLUSION This study observed decreased HRQoL in association with SI. The greater impact of DSI underlines the need for integrated care for comorbid sensory conditions. Our findings also indicate the necessity to reduce the burden of SI among more vulnerable populations such as females and rural adults.
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Affiliation(s)
- Yue Ding
- Department of Public Health, Southeast University, Nanjing, Jiangsu, China
| | - Yuhan Yan
- Department of Geriatrics, General Hospital of Eastern Theater Command, Nanjing, Jiangsu, China
| | - Yong Tian
- Department of Public Health, Southeast University, Nanjing, Jiangsu, China
| | - Wei Du
- Department of Public Health, Southeast University, Nanjing, Jiangsu, China
| | - Lijun Fan
- Department of Public Health, Southeast University, Nanjing, Jiangsu, China
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Zhang S, Wang Q, Zhao D, Fu P, Qi K, Wang X, Zhou Y, Li P, Sun J, Zhou C. Association of Sensory Impairment With Institutional Care Willingness Among Older Adults in Urban and Rural China: An Observational Study. Innov Aging 2023; 7:igad013. [PMID: 37033409 PMCID: PMC10079818 DOI: 10.1093/geroni/igad013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Indexed: 02/23/2023] Open
Abstract
Background and Objectives An aging population has contributed to increasing rates of sensory impairment (SI) among older adults and a boom in institutional elder care. However, little is known regarding the association between SI and institutional care willingness. This study identified the association between SI and institutional care willingness among older adults living both in urban and rural China. Research Design and Methods This was an observational study using the sixth National Health Service Survey of Shandong Province, China, in 2018. A total of 8 583 individuals aged ≥60 years were included. The primary outcome was institutional care willingness. Self-reported SI was categorized as vision impairment (VI), hearing impairment (HI), and dual sensory impairment (DSI). We used multivariable logistic regression models to estimate the association between SI and institutional care willingness, stratified by the place of residence. Results The overall proportion of older adults with institutional care willingness was 7.8%. In fully adjusted models, older adults with HI only (odds ratio [OR] = 1.57, 95% confidence interval [CI]: 1.12-2.20) or DSI (OR = 1.68, 95% CI: 1.14-2.49) were more likely to show institutional care willingness than those without SI in urban areas, but no significant associations between VI only (OR = 0.95, 95% CI: 0.68-1.31), HI only (OR = 0.99, 95% CI: 0.73-1.34), or DSI (OR = 0.95, 95% CI: 0.68-1.31) and institutional care willingness were observed among rural older adults. Discussion and Implications Our results underscore that the relationship between SI and institutional care willingness varied by place of residence, and provide a reference for making targeted and appropriate endowment policies. Improving the quality of institutional elder care is vital for urban older adults with SI, whereas community-based care might be more appropriate for rural older adults with SI.
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Affiliation(s)
- Shimin Zhang
- Centre for Health Management and Policy, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China
| | - Qiong Wang
- Centre for Health Management and Policy, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China
| | - Dan Zhao
- Centre for Health Management and Policy, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China
| | - Peipei Fu
- Centre for Health Management and Policy, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China
| | - Kaili Qi
- Centre for Health Management and Policy, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China
| | - Xiyuan Wang
- Centre for Health Management and Policy, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China
| | - Yanxin Zhou
- Centre for Health Management and Policy, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China
| | - Peilong Li
- Shandong Health Commission Medical Management Service Center, Jinan, China
| | - Jingjie Sun
- Shandong Health Commission Medical Management Service Center, Jinan, China
| | - Chengchao Zhou
- Centre for Health Management and Policy, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China
- Institute of Health and Elderly Care, Shandong University, Jinan, China
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Liu K, Peng W, Ge S, Li C, Zheng Y, Huang X, Liu M. Longitudinal associations of concurrent falls and fear of falling with functional limitations differ by living alone or not. Front Public Health 2023; 11:1007563. [PMID: 37124793 PMCID: PMC10131081 DOI: 10.3389/fpubh.2023.1007563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 02/22/2023] [Indexed: 05/02/2023] Open
Abstract
Background Falls and fear of falling (FOF) are independent risk factors for functional limitations in older adults. However, the combined effect of falls and FOF on functional limitations and the moderating role of living alone or not is unclear. We aimed to examine (1) the independent and combined effect of falls and FOF on functional limitations in older adults and (2) whether living alone moderates these associations. Methods We used data from the National Health and Aging Trends Study (NHATS) and included 5,950 U.S. community-dwelling older adults aged 65 and older from Round 1 (Year 2011) and Round 2 (Year 2012). Falls and FOF were ascertained by asking participants whether they had any falls in the last year and whether they had worried about falling in the previous month at R1. Assessed functional limitations included any difficulties with mobility, self-care, or household activities at R2. Poisson regression models were used to examine the longitudinal associations of falls and FOF with functional limitations and the moderation effects of baseline living alone. Results Of the 5,950 participants, 16.3% had falls only; 14.3% had FOF only; 14.3% had both, and 55.1% had neither at baseline. In the adjusted model, those who experienced concurrent falls and FOF in R1 had a higher risk of functional limitations at R2 than those with neither (Mobility: Incidence risk ratio [IRR] = 1.34, 95% CI: 1.24-1.45; Self-care: IRR = 1.18, 95% CI: 1.11-1.26; Household: IRR = 1.20, 95% CI: 1.11-1.30). Moreover, living alone significantly moderated the longitudinal associations of concurrent falls and FOF with mobility activity limitations. Conclusion The findings suggest that strategies to improve falls and FOF together could potentially help prevent functional limitations. Older adults who live with others and have falls or FOF should receive interventions to promote their mobility activities.
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Affiliation(s)
- Kehan Liu
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Wenting Peng
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Song Ge
- Department of Natural Sciences, University of Houston-Downtown, Houston, TX, United States
| | - Chunxiao Li
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Yu Zheng
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Xiaoting Huang
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Minhui Liu
- Xiangya School of Nursing, Central South University, Changsha, China
- *Correspondence: Minhui Liu ; @MinhuiLiu2
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Tomida K, Lee S, Bae S, Makino K, Chiba I, Harada K, Katayama O, Morikawa M, Shimada H. Association of dual sensory impairment with changes in life space: A longitudinal study with two-year follow-up. Maturitas 2022; 165:78-84. [PMID: 35940025 DOI: 10.1016/j.maturitas.2022.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 06/19/2022] [Accepted: 07/28/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Dual sensory impairment (DSI) of hearing and vision in older adults may limit lifestyle activities of daily living and contribute to a reduced life space. This study aimed to investigate how DSI is associated with specific lifestyle activities and predicts changes in mobility in life space. STUDY DESIGN Participants comprised 4214 older adults (52.3 % female, mean age 75.8 years) who met the study's inclusion criteria. The participants were divided into three groups according to the number of sensory impairments: (1) no sensory impairment (NSI), (2) single sensory impairment (SSI), and (3) DSI. MAIN OUTCOME MEASURE We investigated the association between DSI and specific lifestyle activities at baseline. The Active Mobility Index (AMI) was used to assess life-space. Two years later, the association between DSI and life-space mobility was verified using multinomial logistic regression analysis. RESULTS DSI was more likely to have limited people's instrumental activities of daily living and cognitive, social, and productive activities at baseline (P < 0.05). In the adjusted model with potential covariates, people with DSI had a lower life-space score at 2 years than people with NSI (odds ratio [OR] = 1.40, 95 % confidence interval [CI]: 1.01-1.95), but the difference was not significant for SSI (OR = 0.98, 95 % CI: 0.78-1.24). CONCLUSIONS This study suggested that DSI was a factor that limited various activities and narrowed the life-space mobility of older adults. Prevention of DSI may be important for community-dwelling older adults to maintain a more active lifestyle.
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Affiliation(s)
- Kouki Tomida
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan.
| | - Sangyoon Lee
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan
| | - Seongryu Bae
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan
| | - Keitaro Makino
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan; Japan Society for the Promotion of Science, Chiyoda-ku, Tokyo, Japan
| | - Ippei Chiba
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan
| | - Kenji Harada
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan
| | - Osamu Katayama
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan; Japan Society for the Promotion of Science, Chiyoda-ku, Tokyo, Japan
| | - Masanori Morikawa
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan
| | - Hiroyuki Shimada
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan
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Baylor C, Brown C, Mroz TM, Burns M. Understanding How Older Adults with Communication Difficulties Access Health Services: What We Can Learn from the National Health and Aging Trends Study (NHATS). Semin Speech Lang 2022; 43:176-197. [PMID: 35858604 DOI: 10.1055/s-0042-1749618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
People with communication disorders face barriers to accessing safe and respectful healthcare. These barriers result in increased healthcare complications and inefficiencies, both of which contribute to increased healthcare costs. One obstacle to advocating for accommodations that could improve healthcare for this population is the absence of cost effectiveness studies of such accommodations specifically, as well as a paucity of data defining the needs of this population in general. The purpose of this study was to explore how people with communication and swallowing difficulties are characterized in the National Health and Aging Trends Study (NHATS), a nationally representative survey of Medicare beneficiaries aged 65 and older, and how they manage their healthcare. Cross-sectional data from the NHATS rounds 5 to 9 (2015-2019) resulted in 8,038 unique respondents, 3,243 of who reported speech, memory, hearing, and/or swallowing difficulties. More than 90% of respondents with communication difficulties reported having a regular doctor. Less than 60% of respondents with communication difficulties had a family member or caregiver go to medical appointments with them, and around 70% of that subset of participants received help from that caregiver with communication during appointments. Fewer than 15% of respondents with communication difficulties used the internet for healthcare communication or information. Less than 5% of respondents across all communication difficulty categories had received rehabilitation services for communication in the year prior to their survey responses. While the information gleaned from NHATS points to likely gaps between the needs people with communication disorders may have for safe and accessible healthcare, and the support available, future research is needed to improve and clarify how communication disorders are defined and characterized in large-scale surveys to generate more interpretable data. These stronger empirical foundations are needed to support cost-effectiveness analyses to advocate for better communication accessibility of healthcare settings.
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Affiliation(s)
- Carolyn Baylor
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
| | - Cait Brown
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
| | - Tracy M Mroz
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
| | - Michael Burns
- Department of Speech and Hearing Sciences, University of Washington, Seattle, Washington
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Shu R, Liu C, Liang H, Liang Y. Potential mediators of the relationship between vision impairment and self-rated health in older adults: A comparison between long-term care insurance claimants in residential care institutions versus those living in the community. Geriatr Nurs 2022; 44:259-265. [DOI: 10.1016/j.gerinurse.2022.02.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 02/16/2022] [Accepted: 02/18/2022] [Indexed: 01/24/2023]
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