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Sun F, Zimmer Z, Zajacova A. Pain and Disability Transitions Among Older Americans: The Role of Education. THE JOURNAL OF PAIN 2023; 24:1009-1019. [PMID: 36706888 PMCID: PMC10257745 DOI: 10.1016/j.jpain.2023.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 01/06/2023] [Accepted: 01/17/2023] [Indexed: 01/25/2023]
Abstract
Previous literature has rarely examined the role of pain in the process of disablement. We investigate how pain associates with disability transitions among older adults, using educational attainment as a moderator. Data are from the National Health and Aging Trends Study, N = 6,357; 33,201 1 year transitions between 2010 to 2020. We estimate multinomial logistic models predicting incidence or onset of and recovery from functional limitation and disability. Results show pain significantly predicts functional limitation and disability onset 1 year after a baseline observation, and decreases odds of recovery from functional limitation or disability. Contrary to expectations, higher education does not buffer the association of pain in onset of disability, but supporting expectations, it facilitates recovery from functional limitation or disability among those with pain. The analysis implicates pain as having a key role in the disablement process and suggests that education may moderate this with respect to coping with and subsequently recovering from disability. PERSPECTIVE: This article is among the first examining how pain is placed in the disablement process by affecting onset of and recovery from disability. Both paths are affected by pain, but education moderates the association only with respect to the recovery process.
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Affiliation(s)
- Feinuo Sun
- Global Aging and Community Initiative, Mount Saint Vincent University, Halifax, Nova Scotia, Canada.
| | - Zachary Zimmer
- Global Aging and Community Initiative, Mount Saint Vincent University, Halifax, Nova Scotia, Canada; Department of Family Studies and Gerontology, Mount Saint Vincent University, Halifax, Nova Scotia, Canada
| | - Anna Zajacova
- Department of Sociology, University of Western Ontario, London, Ontario, Canada
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Ciol MA, Rasch EK, Hoffman JM, Huynh M, Chan L. Transitions in mobility, ADLs, and IADLs among working-age Medicare beneficiaries. Disabil Health J 2014; 7:206-15. [PMID: 24680050 DOI: 10.1016/j.dhjo.2013.10.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2013] [Accepted: 10/26/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND Disability is a dynamic process where functional status may change over time. Examination of the Medicare population suggests that, for those over age 65, disability status will fluctuate in 30% of beneficiaries each year. Less is known about those under age 65. The dynamic nature of disability is of relevance since it has important implications for social policies related to disability. OBJECTIVES To: (1) describe the characteristics of Medicare beneficiaries eligible due to disability; and (2) estimate the proportion of individuals with transitions in functional status over a one-year period stratified by baseline characteristics and diagnostic subgroups. METHODS We used the Medicare Current Beneficiary Survey from 1995 to 2005 to examine transitions in mobility and daily activities among individuals who were eligible for Medicare coverage due to disability. RESULTS From the standpoint of function in mobility and daily activities, the working-age Medicare population with disability is fairly stable. While 75%-90% of our sample reported no disability or stable disability from one year to the next, depending on the condition and disability metric, as many as 13-14% of individuals showed improvement or decline in their functional status. CONCLUSIONS In the working-age population with disability, a small percentage of individuals will improve or worsen from one year to the next. Since these transitions are associated with a variety of individual characteristics including health conditions, further research applied to larger samples is required to refine policy relevant models that might inform decisions related to ongoing eligibility for disability programs.
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Affiliation(s)
- Marcia A Ciol
- University of Washington, Department of Rehabilitation Medicine, 1959 N.E. Pacific St., UW Box 356490, Seattle, WA 98195-6490, USA.
| | - Elizabeth K Rasch
- National Institutes of Health, Clinical Center, Department of Rehabilitation Medicine, USA
| | - Jeanne M Hoffman
- University of Washington, Department of Rehabilitation Medicine, 1959 N.E. Pacific St., UW Box 356490, Seattle, WA 98195-6490, USA
| | - Minh Huynh
- National Institutes of Health, Clinical Center, Department of Rehabilitation Medicine, USA
| | - Leighton Chan
- National Institutes of Health, Clinical Center, Department of Rehabilitation Medicine, USA
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Rohlfsen LS, Kronenfeld JJ. Gender Differences in Functional Health: Latent Curve Analysis Assessing Differential Exposure. J Gerontol B Psychol Sci Soc Sci 2014; 69:590-602. [DOI: 10.1093/geronb/gbu021] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Tomey K, Diez Roux AV, Clarke P, Seeman T. Associations between neighborhood characteristics and self-rated health: a cross-sectional investigation in the Multi-Ethnic Study of Atherosclerosis (MESA) cohort. Health Place 2013; 24:267-74. [PMID: 24211514 DOI: 10.1016/j.healthplace.2013.10.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Revised: 08/23/2013] [Accepted: 10/06/2013] [Indexed: 10/26/2022]
Abstract
Quantifying the effects of specific neighborhood features on self-reported health is important in understanding the global health impact of neighborhood context. We investigated associations of neighborhood poverty, sociability and walkability with self-rated physical and mental health in the Multi-Ethnic Study of Atherosclerosis (MESA). In separate models, each neighborhood variable was associated with physical health but associations with sociability and walkability were stronger than those for poverty. Only walkability remained significant after adjusting for the other neighborhood variables. There was no evidence that self-rated mental health as assessed by the SF12 was associated with neighborhood poverty, walkability or sociability. This study provides information on how neighborhood context is associated with global health in diverse midlife and older persons.
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Affiliation(s)
- Kristin Tomey
- University of Michigan School of Public Health, Department of Epidemiology, Ann Arbor, MI 48109-2029, USA.
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Rosso AL, Eaton CB, Wallace R, Gold R, Stefanick ML, Ockene JK, Curb JD, Michael YL. Geriatric syndromes and incident disability in older women: results from the women's health initiative observational study. J Am Geriatr Soc 2013; 61:371-9. [PMID: 23452034 PMCID: PMC3602348 DOI: 10.1111/jgs.12147] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To determine how the number of geriatric syndromes is associated with incident disability in community-based populations of older adults. DESIGN Longitudinal analysis from the Women's Health Initiative Observational Study (WHI-OS). SETTING Community. PARTICIPANTS Twenty-nine thousand five hundred forty-four women aged 65 and older enrolled in the WHI-OS and free of disability in activities of daily living (ADLs) at baseline. MEASUREMENTS Geriatric syndromes (high depressive symptoms, dizziness, falls, hearing or visual impairment, osteoporosis, polypharmacy, syncope, sleep disturbance, and urinary incontinence) were self-reported at baseline and 3-year follow-up. Disability was defined as dependence in any ADL and was assessed at baseline and follow-up. Chronic diseases were measured according to a modified Charlson Index. RESULTS Geriatric syndromes were common in this population of women; 76.3% had at least one syndrome at baseline. Greater number of geriatric syndromes at baseline was significantly associated with greater risk of incident ADL disability at follow-up (P ≤ .001). Adjusted risk ratios were 1.21 (95% confidence interval (CI) = 0.78-1.87) for a single syndrome and 6.64 (95% CI = 4.15-10.62) for five or more syndromes compared with no syndromes. These results were only slightly attenuated after adjustment for number of chronic diseases or pain. CONCLUSION Geriatric syndromes are significantly associated with onset of disability in older women; this association is not simply a result of chronic disease or pain. A better understanding of how these conditions contribute to disablement is needed. Geriatric syndrome assessment should be considered along with chronic disease management in the prevention of disability in older women.
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Affiliation(s)
- Andrea L Rosso
- Department of Epidemiology, Center for Aging and Population Health, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Hoffman JM, Ciol MA, Huynh M, Chan L. Estimating transition probabilities in mobility and total costs for medicare beneficiaries. Arch Phys Med Rehabil 2011; 91:1849-55. [PMID: 21112425 DOI: 10.1016/j.apmr.2010.08.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2010] [Revised: 08/06/2010] [Accepted: 08/17/2010] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To examine how persons move back and forth along levels of mobility disability. DESIGN Self-reported mobility limitations were used to create categories of annual transition states. The total cost to Medicare associated with each year was calculated for each participant. In addition, we examined cost relative to transition state, adjusting for demographic and other health status variables. SETTING National survey. PARTICIPANTS Participants in the longitudinal Medicare Current Beneficiary Survey from 1992 to 2005. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Annual self-reported mobility limitations and total Medi costs. RESULTS Most participants remained without mobility limitations or improved over time. Reported average costs were 10 times higher for those who transitioned to severe limitations, unable to walk, or death compared with persons who reported no mobility limitation. Estimated costs were highest for those transitioning to increased states of disability and to death. CONCLUSIONS Mobility limitations in older adults are dynamic, and improvement (as measured by annual transitions) occurred for a large number of Medicare beneficiaries. High total annual costs were observed in groups that transitioned to worsening mobility states, suggesting a link between mobility limitation transitions and cost. Prevention and treatment of mobility limitation may be an important factor to consider in health care reform.
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Affiliation(s)
- Jeanne M Hoffman
- Department of Rehabilitation Medicine, University of Washington, Seattle, 98195-6490, USA.
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Karakus MC, Okunade AA. Obesity, Depression, and Employment Related Outcomes Among Workers Near Retirement. AGEING INTERNATIONAL 2011. [DOI: 10.1007/s12126-010-9107-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Bowen ME. Coronary heart disease from a life-course approach: findings from the health and retirement study, 1998-2004. J Aging Health 2010; 22:219-41. [PMID: 20056814 DOI: 10.1177/0898264309355981] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Guided by a life-course approach to chronic disease, this study examined the ways in which childhood deprivation (low parental education and father's manual occupation) may be associated with coronary heart disease (CHD). METHOD Multilevel modeling techniques and a nationally representative sample of Americans above age 50 from the Health and Retirement Study (HRS; N = 18,465) were used to examine childhood and CHD relationships over the course of 6 years (1998-2004). RESULTS Having a father with </=8 years of education was associated with 11% higher odds of CHD, accounting for demographic characteristics, adult socioeconomic status (SES; education, income, and wealth), CHD risks (diabetes, hypertension, cigarette smoking, and obesity), and other factors (childhood health, exercise, stroke, and marital status). DISCUSSION Policies and programs aimed at improving the conditions of poor children and their families may effectively reduce the prevalence of CHD in later life.
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Affiliation(s)
- Mary Elizabeth Bowen
- HSR&D/RR&D Research Center of Excellence, James A. Haley Veterans Hospital, 8900 Grand Oak Circle, Tampa, FL 33637-1022, USA.
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Feinglass J, Song J, Manheim LM, Semanik P, Chang RW, Dunlop DD. Correlates of improvement in walking ability in older persons in the United States. Am J Public Health 2008; 99:533-9. [PMID: 19106418 DOI: 10.2105/ajph.2008.142927] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We analyzed factors associated with improvement in walking ability among respondents to the nationally representative Health and Retirement Study. METHODS We analyzed data from 6574 respondents aged 53 years or older who reported difficulty walking several blocks, 1 block, or across the room in 2000 or 2002. We examined associations between improvement (versus no change, deterioration, or death) and baseline health status, chronic conditions, baseline walking difficulty, demographic characteristics, socioeconomic status, and behavioral risk factors. RESULTS Among the 25% of the study population with baseline walking limitations, 29% experienced improved walking ability, 40% experienced no change in walking ability, and 31% experienced deteriorated walking ability or died. In a multivariate analysis, we found positive associations between walking improvement and more recent onset and more severe walking difficulty, being overweight, and engaging in vigorous physical activity. A history of diabetes, having any difficulty with activities of daily living, and being a current smoker were all negatively associated with improvement in walking ability. After we controlled for baseline health, improvement in walking ability was equally likely among racial and ethnic minorities and those with lower socioeconomic status. CONCLUSIONS Interventions to reduce smoking and to increase physical activity may help improve walking ability in older Americans.
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Affiliation(s)
- Joe Feinglass
- General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
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Population-based cohorts of the 50s and over: a summary of worldwide previous and ongoing studies for research on health in ageing. Eur J Ageing 2006; 3:41. [PMID: 28794749 DOI: 10.1007/s10433-006-0022-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
As most countries face the ageing of their population, understanding successful and pathologic ageing is a research priority. Longitudinal studies examining the ageing process from middle-age are required to establish causal and valid relationships. This systematic review of the literature aimed at identifying large community-based longitudinal studies either including exclusively elderly people or following people from middle-age (50+ years at enrolment) to death, and resulted in a selection of 72 cohort studies. Design features of selected studies show that most were conducted in North America or Northern Europe, most included both genders, and follow-up period was often less than 10 years. Many cohorts focused on cardiovascular health, cognitive decline or osteoporosis. Usually collected variables comprise of self-reported data on socio-demographics, chronic diseases and functional status, as well as measures of cognition, anthropometrics and physical performances. Biological samples were taken in about 60% of the studies, and a third also undertook genetic analyses. This review summarises information on design and content of large population-based cohorts of older persons, and represents a valuable background from which additional data may be retrieved.
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Hardy SE, Dubin JA, Holford TR, Gill TM. Transitions between states of disability and independence among older persons. Am J Epidemiol 2005; 161:575-84. [PMID: 15746474 DOI: 10.1093/aje/kwi083] [Citation(s) in RCA: 180] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The objectives of this prospective cohort study, conducted in New Haven, Connecticut, from 1998 to 2004, were to describe disability states experienced by older persons, to evaluate the rate of transitions between states and the duration of disability episodes, and to determine whether these findings differ on the basis of physical frailty--a condition of low physical capacity and vulnerability to adverse functional outcomes. Participants included 754 persons aged 70 years or older who were initially independent in four key activities of daily living: bathing, dressing, walking, or transferring. Disability was assessed during monthly telephone interviews for a median of 60 months, and participants were classified each month according to the following four states: no disability, mild disability (one or two activities), severe disability (three or four activities), and death. Transitions between states of disability and independence were common, with a majority of both frail and nonfrail participants experiencing at least one transition. The rate of transitions varied greatly among individuals. Nonfrail participants had lower rates of transition from less to more disability, higher rates of transition from more to less disability, and slightly shorter durations of disability. To fully understand the disabling process, investigators and clinicians must consider the episodic and recurrent nature of disability.
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Affiliation(s)
- Susan E Hardy
- Department of Internal Medicine, Yale University School of Medicine, 20 York Street, Tompkins Basement 15, New Haven, CT 06504, USA.
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