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Katz J, Tielsch J. Visual Function and Visual Acuity in An Urban Adult Population. JOURNAL OF VISUAL IMPAIRMENT & BLINDNESS 2020. [DOI: 10.1177/0145482x9609000503] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In this survey, 6,850 Baltimore residents aged 40 and older were interviewed about activities they had difficulty doing or could no longer do because of poor vision. One-fourth of the sample reported limitations in activities, most frequently reading and other near-vision tasks, because of poor vision. In addition to poor vision, general health status, educational level, and time since the last eye care visit were associated with the loss of visual function.
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Affiliation(s)
- J. Katz
- International Health, Ophthalmology, and Biostatistics Department, Johns Hopkins School of Hygiene and Public Health, 615 North Wolfe Street, Room 5515, Baltimore, MD 21205-2103
| | - J.M. Tielsch
- International Health, Ophthalmology, and Epidemiology Department, Johns Hopkins School of Hygiene and Public Health, 615 North Wolfe Street, Room 5515, Baltimore, MD 21205-2103
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Vásquez E, Germain CM, Tang F, Lohman MC, Fortuna KL, Batsis JA. The Role of Ethnic and Racial Disparities in Mobility and Physical Function in Older Adults. J Appl Gerontol 2018; 39:502-508. [PMID: 29909728 DOI: 10.1177/0733464818780631] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Objective: To compare estimates of the prevalence of mobility and physical function limitations by race and ethnicity using data from the Medical Expenditure Panel Survey (MEPS). Method: The sample comprised of 28,854 adults aged ≥60 from the MEPS (2004-2013). Physical function (limitations in basic and instrumental activities of daily living [ADL/IADL]) and mobility limitations were assessed by self-report. Results: Non-Hispanic Whites (NHWs) represented the majority of the sample followed by non-Hispanic Blacks (NHBs), Hispanic and non-Hispanic Other (Other). For mobility limitation, NHBs had the highest prevalence followed by NHWs and Hispanics (33.3%, 28.6%, and 26.2%, respectively). Multivariable logistic regression analyses were performed for the primary outcome of mobility limitation. In the adjusted model, Hispanics had lower odds of mobility limitations (prevalence odds ratio [POR]: 0.78; 95% confidence interval [CI] = [0.67,0.91]) compared with NHWs. For ADL limitations, NHBs had higher odds of having ADLs (POR: 1.87; 95% CI = [1.44, 2.44]) when compared with NHWs. Conclusion: This article evaluated the influence of race and ethnicity, on the prevalence of mobility and functional limitations that are not always consistent with expected racial and ethnic differences.
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Affiliation(s)
| | | | - Fei Tang
- University at Albany, Rensselaer, NY, USA
| | - Matthew C Lohman
- Geisel School of 004Dedicine at Dartmouth, Hanover, NH, USA.,Dartmouth Centers for Health and Aging, Dartmouth College, Hanover, New Hampshire
| | - Karen L Fortuna
- Geisel School of 004Dedicine at Dartmouth, Hanover, NH, USA.,Dartmouth Centers for Health and Aging, Dartmouth College, Hanover, New Hampshire
| | - John A Batsis
- Geisel School of 004Dedicine at Dartmouth, Hanover, NH, USA.,Dartmouth Centers for Health and Aging, Dartmouth College, Hanover, New Hampshire.,The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, NH, USA
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Dhamoon MS, Longstreth WT, Bartz TM, Kaplan RC, Elkind MSV. Disability Trajectories Before and After Stroke and Myocardial Infarction: The Cardiovascular Health Study. JAMA Neurol 2017; 74:1439-1445. [PMID: 29059266 DOI: 10.1001/jamaneurol.2017.2802] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Importance Ischemic strokes may accelerate long-term functional decline apart from their acute effects on neurologic function. Objective To test whether the increase in long-term disability is steeper after than before the event for ischemic stroke but not myocardial infarction (MI). Design, Settings, and Participants In the population-based, prospective cohort Cardiovascular Health Study (1989-2013), longitudinal follow-up was conducted for a mean (SD) of 13 (6.2) years. Follow-up data were used until September 1, 2013; data analysis was performed from August 1, 2013, to June 1, 2016. Models based on generalized estimating equations adjusted for baseline covariates and included a test for different slopes of disability before and after the event. Participants included 5888 Medicare-eligible individuals 65 years or older who were not institutionalized, expected to reside in the area for 3 or more years, and able to provide informed consent. Exclusions were needing a wheelchair, receiving hospice care, and undergoing radiotherapy or chemotherapy. Exposures Ischemic stroke and MI. Main Outcomes and Measures Annual assessments with a disability scale (measuring activities of daily living [ADLs] and instrumental ADLs). The number of ADLs and instrumental ADLs (range, 0-12) that the participant could not perform was analyzed continuously. Results The mean (SD) age of the entire cohort (n = 5888) was 72.8 (5.6) years; 2495 (42.4%) were male. During follow-up, 382 (6.5%) participants had ischemic stroke and 395 (6.7%) had MI with 1 or more disability assessment after the event. There was a mean of 3.7 (2.4) visits before stroke and 3.7 (2.3) visits after stroke; there was a mean of 3.8 (2.5) visits before MI and 3.8 (2.4) visits after MI. The increase in disability near the time of the event was greater for stroke (0.88 points on the disability scale; 95% CI, 0.57 to 1.20; P < .001) than MI (0.20 points on the disability scale; 95% CI, 0.06 to 0.35; P = .006). The annual increase in disability before stroke (0.06 points per year; 95% CI, 0.002 to 0.12; P = .04) more than tripled after stroke (0.15 additional points per year; 95% CI, 0.004 to 0.30; P = .04). The annual increase in disability before MI (0.04 points per year; 95% CI, 0.004 to 0.08; P = .03) did not change significantly after MI (0.02 additional points per year; 95% CI, -0.07 to 0.11; P = .69). Conclusions and Relevance In this large, population-based study, a trajectory of increasing disability became significantly steeper after stroke but not after MI. Thus, in addition to the acute brain injury and consequent impairment, ischemic stroke may also be associated with potentially treatable long-term adverse effects on the brain that lead to accelerated functional decline.
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Affiliation(s)
- Mandip S Dhamoon
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - W T Longstreth
- Departments of Neurology and Epidemiology, University of Washington, Seattle
| | - Traci M Bartz
- Department of Biostatistics, University of Washington, Seattle
| | - Robert C Kaplan
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Mitchell S V Elkind
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York.,Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, New York
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Jette AM, Crawford SL, Tennstedt SL. Toward Understanding Ethnic Differences in Late-Life Disability. Res Aging 2016. [DOI: 10.1177/0164027596183002] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The authors hypothesized that ethnic differences in late-life disability would be observed and that ethnic differentials would be attributed to differences in physical capacity versus measurement error or cultural response to disabling disease. This study employed performance-based and self-report disability measures in a probability sample of 156 older African American, White, and Puerto Rican adults living in Springfield, Massachusetts. Analyses revealed that Puerto Rican and African American older adults reported significantly more disability than did Whites and that observed ethnic differences in disability were attributed to functional limitations. The current cohort of Puerto Rican and African American older adults clearly is at higher risk of needing long-term health and social services related to their increased levels of disability.
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Ylitalo KR, Karvonen-Gutierrez C, McClure C, El Khoudary SR, Jackson EA, Sternfeld B, Harlow SD. Is self-reported physical functioning associated with incident cardiometabolic abnormalities or the metabolic syndrome? Diabetes Metab Res Rev 2016; 32:413-20. [PMID: 26518120 PMCID: PMC4838533 DOI: 10.1002/dmrr.2765] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Revised: 05/13/2015] [Accepted: 10/11/2015] [Indexed: 01/22/2023]
Abstract
BACKGROUND Physical functioning may be an important pre-clinical marker of chronic disease, used as a tool to identify patients at risk for future cardiometabolic abnormalities. This study evaluated if self-reported physical functioning was associated with the development of cardiometabolic abnormalities or their clustering (metabolic syndrome) over time. METHODS Participants (n = 2,254) from the Study of Women's Health Across the Nation who reported physical functioning on the Short Form health survey and had a metabolic syndrome assessment (elevated fasting glucose, blood pressure, triglycerides and waist circumference; reduced HDL cholesterol) in 2000 were included. Discrete survival analysis was used to assess the 10-year risk of developing metabolic syndrome or a syndrome component through 2010. RESULTS At baseline, the prevalence of metabolic syndrome was 22.0%. Women with substantial limitations (OR = 1.60; 95% CI: 1.12, 2.29) in physical functioning were significantly more likely to develop the metabolic syndrome compared with women reporting no limitations. Self-reported physical functioning was significantly associated with incident hypertension and increased waist circumference. CONCLUSIONS Simple screening tools for cardiometabolic risk in clinical settings are needed. Self-reported physical functioning assessments are simple tools that may allow healthcare providers to more accurately predict the course of chronic conditions.
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Affiliation(s)
- Kelly R. Ylitalo
- School of Public Health, University of Michigan
- School of Medicine, University of Michigan
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Liu PL, Cohen HJ, Fillenbaum GG, Burchett BM, Whitson HE. Association of Co-Existing Impairments in Cognition and Self-Rated Vision and Hearing With Health Outcomes in Older Adults. Gerontol Geriatr Med 2016; 2. [PMID: 27054148 PMCID: PMC4820285 DOI: 10.1177/2333721415623495] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective: The objective of this study was to assess the relationship of disability (activities of daily living [ADL] and instrumental ADL [IADL]), self-rated health (SRH), and 6-year mortality with co-existing impairments in vision (self-rated), hearing (self-rated), and/or cognition (Short Portable Mental Status Questionnaire) in older adults. Method: The study sample comprised of 3,871 participants from the North Carolina Established Populations for Epidemiologic Studies of the Elderly study (NC EPESE). Results: Persons with all three impairments had increased odds of ADL/IADL disability and low SRH. Participants with combined visual and cognitive impairments had increased odds of mortality. Whereas sensory impairments were associated with poor SRH, cognitive impairment was not unless both sensory impairments were present. Conclusion: Co-existent sensory and cognitive impairments were associated with higher risk of impaired functional status. Self-rated auditory impairment alone was not associated with higher odds of death, but mortality was linked to visual and, particularly, cognitive impairment, alone or combined.
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Affiliation(s)
- Phillip L Liu
- Center for the Study of Aging and Human Development, Duke University Durham, NC; Department of Medicine, Duke University, Durham, NC
| | - Harvey Jay Cohen
- Center for the Study of Aging and Human Development, Duke University Durham, NC; Department of Medicine, Duke University, Durham, NC; Durham VA Medical Center, Geriatrics Research Education and Clinical Center, Durham, NC
| | - Gerda G Fillenbaum
- Center for the Study of Aging and Human Development, Duke University Durham, NC
| | - Bruce M Burchett
- Center for the Study of Aging and Human Development, Duke University Durham, NC
| | - Heather E Whitson
- Center for the Study of Aging and Human Development, Duke University Durham, NC; Department of Medicine, Duke University, Durham, NC; Department of Ophthalmology, Duke University, Durham, NC; Durham VA Medical Center, Geriatrics Research Education and Clinical Center, Durham, NC
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Brown RT, Pierluissi E, Guzman D, Kessell ER, Goldman LE, Sarkar U, Schneidermann M, Critchfield JM, Kushel MB. Functional disability in late-middle-aged and older adults admitted to a safety-net hospital. J Am Geriatr Soc 2014; 62:2056-63. [PMID: 25367281 DOI: 10.1111/jgs.13103] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To determine the prevalence of preadmission functional disability in late-middle-aged and older safety-net inpatients and to identify characteristics associated with functional disability by age. DESIGN Cross-sectional analysis. SETTING Safety-net hospital in San Francisco, California. PARTICIPANTS English-, Spanish-, and Chinese-speaking community-dwelling individuals aged 55 and older admitted to a safety-net hospital with anticipated return to the community (N = 699). MEASUREMENTS At hospital admission, participants reported their need for help performing five activities of daily living (ADLs) and seven instrumental activities of daily living (IADLs) 2 weeks before admission. ADL disability was defined as needing help performing one or more ADLs and IADL disability as needing help performing two or more IADLs. Participant characteristics were assessed, including sociodemographic characteristics, health status, health-related behaviors, and health-seeking behaviors. RESULTS Overall, 28.3% of participants reported that they had an ADL disability 2 weeks before admission, and 40.4% reported an IADL disability. The prevalence of preadmission ADL disability was 28.9% of those aged 55 to 59, 20.7% of those aged 60 to 69, and 41.2% of those aged 70 and older (P < .001). The prevalence of IADL disability had a similar distribution. The characteristics associated with functional disability differed according to age; in participants aged 55 to 59, African Americans had a higher odds of ADL and IADL disability, whereas in participants aged 60 to 69 and aged 70 and older, inadequate health literacy was associated with functional disability. CONCLUSION Preadmission functional disability is common in individuals aged 55 and older admitted to a safety-net hospital. Late-middle-aged individuals admitted to safety-net hospitals may benefit from models of acute care currently used for older adults that prevent adverse outcomes associated with functional disability.
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Affiliation(s)
- Rebecca T Brown
- Division of Geriatrics, University of California at San Francisco, San Francisco, California; San Francisco Veterans Affairs Medical Center, San Francisco, California
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Ylitalo KR, McEwen LN, Karter AJ, Lee P, Herman WH. Self-reported physical functioning and mortality among individuals with type 2 diabetes: insights from TRIAD. J Diabetes Complications 2013; 27:565-9. [PMID: 23891274 PMCID: PMC4278639 DOI: 10.1016/j.jdiacomp.2013.06.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Revised: 06/13/2013] [Accepted: 06/14/2013] [Indexed: 01/22/2023]
Abstract
AIMS To examine the association between physical functioning and mortality in people with type 2 diabetes, and determine if this association differs by race/ethnicity in managed care. METHODS We studied 7894 type 2 diabetic patients in Translating Research Into Action for Diabetes (TRIAD), a prospective observational study of diabetes care in managed care. Physical functioning was assessed with the Short Form Health Survey. The National Death Index was searched for deaths over 10years of follow-up (2000-2009). RESULTS At baseline, mean age was 61.7years, 50% were non-Hispanic White, 22% were Black, and 16% of participants reported good physical functioning. Over 10years, 28% of participants died; 39% due to cardiovascular disease. Relative to those reporting good functioning, those reporting poor physical functioning had a 39% higher all-cause death rate after adjusting for age, sex, race/ethnicity, education, income, body mass index, smoking, and comorbidities (Hazard Ratio=1.39; 95% Confidence Interval: 1.16, 1.67). Although Blacks were less likely than Whites to report good functioning (p<0.01), the association between functioning and mortality did not differ by race/ethnicity. CONCLUSIONS In this managed care population, self-reported physical functioning was a robust independent predictor of mortality and may be a useful benchmark for tailoring clinical care.
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Affiliation(s)
- Kelly R Ylitalo
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA; Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
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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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Ayotte BJ, Allaire JC, Whitfield KE. Understanding within-group variability of everyday cognition in aging Black/African American adults: a mimic (multiple indicators, multiple causes) model approach. Exp Aging Res 2013; 38:488-510. [PMID: 23092220 DOI: 10.1080/0361073x.2012.726022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
UNLABELLED BACKGROUND/STUDY CONTEXT: Everyday cognition represents the ability to solve problems within domains that are representative of issues faced by adults on a daily basis. The current study examined individual differences in everyday cognitive ability among aging Black/African American adults. METHODS Demographic data on age, gender, education, physical functioning, chronic illnesses, self-reported health, and depression were collected from 248 African American adults (mean age = 67.8 years, standard deviation = 8.47 years). A multiple indicators, multiple causes (MIMIC) modeling approach was used to examine the associations of individual characteristics with latent everyday cognitive ability and composite score indicators. RESULTS Age, depressive symptoms, and number of chronic illnesses were negatively related to latent everyday cognition. The individual characteristics of age, depressive symptoms, self-rated health, and education were directly associated with composite indicators of latent everyday cognition. This suggests that within this sample of older Black/African American adults that certain composite scores (i.e., telephone use, food preparation, and finances) may be particularly sensitive to these individual characteristics. CONCLUSION These results identify specific sources of variability in everyday cognitive ability among aging Blacks/African Americans. These individual differences should be accounted for when studying everyday cognition among Blacks/African Americans and when comparing the everyday cognitive ability of Blacks/African Americans with other groups.
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Affiliation(s)
- Brian J Ayotte
- Department of Psychology, University of Massachusetts Dartmouth, North Dartmouth, MA 02747, 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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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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Louie GH, Ward MM. Socioeconomic and ethnic differences in disease burden and disparities in physical function in older adults. Am J Public Health 2011; 101:1322-9. [PMID: 21164082 PMCID: PMC3110229 DOI: 10.2105/ajph.2010.199455] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2010] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We investigated whether a greater burden of disease among poorer individuals and ethnic minorities accounted for socioeconomic and racial disparities in self-reported physical functioning among older adults. METHODS We used data from adults aged 60 years or older (n = 5556) in the Third National Health and Nutrition Examination Survey, 1988-1994 to test associations between education level, poverty index, and race/ethnicity and limitations in 11 functions. We adjusted for demographic features and measures of disease burden (comorbid conditions, smoking, hemoglobin level, serum albumin level, knee pain, body mass index, and skeletal muscle index). RESULTS Associations between education and functional limitations were attenuated after adjustment, but those with 0-8 years of education were more likely than those with 13 or more years of education to have limitations in 3 functions. Poverty was associated with a higher likelihood of limitations despite adjustment. The likelihood of limitations among non-Hispanic Blacks and Mexican Americans was similar to that of non-Hispanic Whites after adjustment. CONCLUSIONS Socioeconomic disparities in functional limitations among older Americans exist independent of disease burden, whereas socioeconomic differences and disease burden account for racial disparities.
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Affiliation(s)
- Grant H Louie
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, US Department of Health and Human Services,Bethesda, MD, USA.
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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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Whitson HE, Landerman LR, Newman AB, Fried LP, Pieper CF, Cohen HJ. Chronic medical conditions and the sex-based disparity in disability: the Cardiovascular Health Study. J Gerontol A Biol Sci Med Sci 2010; 65:1325-31. [PMID: 20675619 DOI: 10.1093/gerona/glq139] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Older women experience disability more commonly than their male peers. This disparity may be due, in part, to sex-based differences in the prevalence or the disabling effects of common medical conditions. The objectives of this analysis were to (a) quantify the extent to which excess disability in women is explained by higher prevalence of selected medical conditions and (b) evaluate whether the same conditions have differing effects on disability in men and women. METHODS We analyzed cross-sectional data from 5,888 community-dwelling older men and women. Disability was defined as difficulty with greater than or equal to one activity of daily living. Thirteen medical conditions were assessed by self-report, testing, or record review. RESULTS Controlling for age, race, education, and marital status, women were more likely to experience disability (odds ratio = 1.70, 95% confidence interval = 1.36-2.11). Higher prevalence of arthritis and obesity in women explained 30.2% and 12.9%, respectively, of the sex-based difference in disability rates, whereas male prevalent diseases like vascular conditions and emphysema narrowed the disability gap. Women with arthritis, hearing problems, coronary artery disease, congestive heart failure, stroke, and claudication were more likely to exhibit disability compared with men with the same conditions (p < .001). CONCLUSIONS Efforts to lessen sex-based inequality in disability should focus on reducing the prevalence of arthritis and obesity. Future generations may see greater functional disparity if rates of vascular disease and emphysema rise among women. Several conditions were more often associated with disability in women, suggesting additional sex-based differences in the disablement process.
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Affiliation(s)
- Heather E Whitson
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC 27710, USA.
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Nikolova R, Demers L, Béland F, Giroux F. Transitions in the functional status of disabled community-living older adults over a 3-year follow-up period. Arch Gerontol Geriatr 2009; 52:12-7. [PMID: 19945757 DOI: 10.1016/j.archger.2009.11.003] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2009] [Revised: 10/22/2009] [Accepted: 11/03/2009] [Indexed: 10/20/2022]
Abstract
The purpose of this study was to investigate transitions over time in the functional status of disabled community-living elderly. The study explored clinical and socio-demographic predictors of functional status decline. Data from the SIPA 3-year longitudinal study were analyzed (n=1164). Three categories of functional status were defined: no important disability, significant IADL disability and significant ADL disability. At baseline, results show that the prevalence rates were 26.9%, 58.6% and 14.5% for the three categories of functional status. After 12 months, about 50-60% of participants had remained in the same status, while some 10-15% of those with baseline significant disability had improved. The patterns of transitions between 12 and 36 months of follow-up were slightly different. The results indicated more deterioration (13-38%) and less improvement (6-9%). After controlling for baseline functional status, the best predictors for functional decline at 36 months were prior disability, functional limitations, cognitive impairment and comorbidity burden. We found that older adults' functional status may decline or improve even if the participants are disabled. Disabled conditions play a crucial role in the development of future disability and preventive actions need to be implemented.
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Affiliation(s)
- Rossitza Nikolova
- Research Center, Montreal Geriatric University Institute, 4565 Queen Mary, Montreal, (Quebec), H3W 1W5 Canada.
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Mwachofi AK, Broyles R, Khaliq A. Factors Affecting Vocational Rehabilitation Intervention Outcomes. JOURNAL OF DISABILITY POLICY STUDIES 2009. [DOI: 10.1177/1044207309338670] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Vocational rehabilitation (VR) services are designed to help individuals with disabilities achieve gainful employment. This study examines VR’s effectiveness in assisting minorities achieve gainful employment. The study uses case management data from 617,149 cases closed by VR in 2006 in all states. It examines differences in access, employment, and earnings for White and ethnic minority clients. Multivariate techniques are used to assess factors that influence competitive employment outcomes, hourly earnings, and hours worked. Findings show significant differences in employment and earnings outcomes for minority and majority clients, with minorities faring worse. VR intervention length and per capita expenditures for services significantly influence employment and earnings outcomes. VR is more effective with White than with minority clients. There is a need to implement policies or practices that ensure equity in access to services that might translate into more equitable employment and earnings outcomes.
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Affiliation(s)
| | | | - Amir Khaliq
- University of Oklahoma Health Sciences Center
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Boyington JEA, Howard DL, Holmes DN. Self-rated health, activities of daily living, and mobility limitations among black and white stroke survivors. J Aging Health 2009; 20:920-39. [PMID: 18836032 DOI: 10.1177/0898264308324643] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective. To explore racial differences in self-rated health (SRH) and its relationship to activities of daily living (ADLs) and mobility limitations among stroke survivors. Method. Data from 580 Black and White participants of the North Carolina Established Populations for Epidemiologic Studies of the Elderly (EPESE) were used to assess relationships between SRH, ADLs, and mobility variables. Fisher's exact tests, t tests, and logistic regression with backward selection (p < .20) were used. Results. No racial difference in SRH was found. SRH was significant in predicting ADL status among Whites only (OR = 0.23; CI = 0.08-0.69; p < .01). Participants older than 75 years had a greater likelihood of being in the lowest functioning ADL categories (OR = 2.31; CI = 1.48-3.60; p < .01). Discussion. Though no racial differences in SRH were found, the relationship between SRH, ADLs, and mobility status was moderated by race. SRH was predictive of limitations in Whites only. Observed differences suggest SRH construct may differ by race.
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Parahyba MI, Veras R. [Socio-demographic differentials in the functional decline among the elderly in Brazil]. CIENCIA & SAUDE COLETIVA 2009; 13:1257-64. [PMID: 18813625 DOI: 10.1590/s1413-81232008000400022] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2008] [Accepted: 04/14/2008] [Indexed: 11/21/2022] Open
Abstract
There is a positive reversion in the expectations regarding the health condition of the elderly population, possibly due to the progresses in medical technology; behavioural changes; development of special programmes for the elderly; improvements in the socio-economic status; decrease of infectious diseases. This study aims analyzing differentials in the prevalence rates of mobility disability among elderly people in Brazil. The data used were from 'The 1998 and 2003 National Household Survey (PNAD)', conducted by the Brazilian Institute of Geographic and Statistics (IBGE). The two samples were nationally representative, including approximately 30 thousand individuals aged 60 years or more respectively. "Difficulty to walk more than 100 meters" was the variable selected as the indicator of disability. Socio-demographic status measures were sex, age group, region of residence and family income per capita. Comparison of the PNAD results of 1998 and 2003 showed that over that period in Brazil the elderly disability rates decreased among all socio-demographic groups considered. Public policies directed to the elderly must focus on reducing mobility disability.
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Mwachofi AK, Broyles R. Is Minority Status a More Consistent Predictor of Disability Than Socioeconomic Status? JOURNAL OF DISABILITY POLICY STUDIES 2008. [DOI: 10.1177/1044207308315275] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Applying the social and capabilities models of disability and using individuals as the unit of analysis, the authors examined the consistency of socioeconomic status and membership in a minority group as covariates of four dimensions of disability. Using the responses of 260,062 individuals to the 2003 Behavioral Risk Factor Surveillance System, the authors examined three binary variables identifying individuals who required assistive devices or experienced at least 1 day of limited activity because of physical, emotional, or mental problems or because of only physical problems. Among 55,026 respondents who experienced at least 1 day of limited activity, the authors examined variation in the number of disability days. After health needs, lifestyle risks, demographic attributes, and access to care were controlled, the results indicated that socioeconomic status is a more consistent predictor of disability than membership in a minority group.
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Mwachofi A. Rural access to vocational rehabilitation services: minority farmers' perspective. Disabil Rehabil 2007; 29:891-902. [PMID: 17577724 DOI: 10.1080/09638280701240409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE The paper documents the need for, and obstacles to effective access to rehabilitation services by minority farmers. It draws from the findings of a study conducted in the Mississippi delta. METHOD Applying community-based participatory research approach (CBPR) the study trained farmers to conduct interviews and focus group discussions. They interviewed 1308 farmers and had 18 focus group discussions with 254 farmers. The study also interviewed 290 service providers and conducted 8 focus group discussions with 72 State Vocational Rehabilitation services (VR) counselors. RESULTS The study found an unmet need for VR services in this population. Farmers were not aware of VR services or how to access them and VR was not aware of farmers' needs. Farmers felt marginalized and afraid that access to VR services would diminish their ability to earn a living on the farm. CONCLUSIONS Collaboration between VR and rural organizations, agencies and with rural people would help close the information and gaping service gap. One-stop service centers in rural areas could improve access to services. CBPR is an invaluable research tool especially among marginalized people.
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Affiliation(s)
- Ari Mwachofi
- Health Administration and Policy, College of Public Health, The University of Oklahoma Health Sciences Center, Oklahoma City 73104, USA.
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22
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Whitson HE, Cousins SW, Burchett BM, Hybels CF, Pieper CF, Cohen HJ. The Combined Effect of Visual Impairment and Cognitive Impairment on Disability in Older People. J Am Geriatr Soc 2007; 55:885-91. [PMID: 17537089 DOI: 10.1111/j.1532-5415.2007.01093.x] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To determine the risk of disability in individuals with coexisting visual and cognitive impairment and to compare the magnitude of risk associated with visual impairment, cognitive impairment, or the multimorbidity. DESIGN Prospective cohort. SETTING North Carolina. PARTICIPANTS Three thousand eight hundred seventy-eight participants in the North Carolina Established Populations for the Epidemiologic Studies of the Elderly with nonmissing visual status, cognitive status, and disability status data at baseline MEASUREMENTS Short Portable Mental Status Questionnaire (cognitive impairment defined as > or =4 errors), self reported visual acuity (visual impairment defined as inability to see well enough to recognize a friend across the street or to read newspaper print), demographic and health-related variables, disability status (activities of daily living (ADLs), instrumental activities of daily living (IADLs), mobility), death, and time to nursing home placement. RESULTS Participants with coexisting visual and cognitive impairment were at greater risk of IADL disability (odds ratio (OR)=6.50, 95% confidence interval (CI)=4.34-9.75), mobility disability (OR=4.04, 95% CI=2.49-6.54), ADL disability (OR=2.84, 95% CI=1.87-4.32), and incident ADL disability (OR=3.66, 95%, CI=2.36-5.65). In each case, the estimated OR associated with the multimorbidity was greater than the estimated OR associated with visual or cognitive impairment alone, a pattern that was not observed for other adverse outcomes assessed. No significant interactions were observed between cognitive impairment and visual impairment as predictors of disability status. CONCLUSION Individuals with coexisting visual impairment and cognitive impairment are at high risk of disability, with each condition contributing additively to disability risk. Further study is needed to improve functional trajectories in patients with this prevalent multimorbidity. When visual or cognitive impairment is present, efforts to maximize the other function may be beneficial.
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Affiliation(s)
- Heather E Whitson
- Department of Medicine, Division of Geriatrics, Duke University Medical Center, Durham, NC 27710, USA.
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Reijneveld SA, Spijker J, Dijkshoorn H. Katz' ADL index assessed functional performance of Turkish, Moroccan, and Dutch elderly. J Clin Epidemiol 2007; 60:382-8. [PMID: 17346613 DOI: 10.1016/j.jclinepi.2006.02.022] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2005] [Revised: 12/08/2005] [Accepted: 02/23/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND AND OBJECTIVE We examined the reliability and validity of self-reported limitations encountered in the activities of daily living (ADL) as measure of functional performance, for Turkish, Moroccan, and indigenous Dutch elderly in the Netherlands. METHODS We obtained data on self-reported ADL measured by Katz' ADL index and on five related health outcomes among a general population sample of 304 Dutch, 330 Turkish, and 299 Moroccan respondents aged 55-74 years, in Amsterdam, the Netherlands (response: 60%). RESULTS Katz' ADL index demonstrated good internal consistencies for each ethnic group (Cronbach's alphas: 0.84-0.94). Regarding validity, the ADL index showed relatively strong associations with related outcomes, that is, long-term limitations in mobility and SF-36 physical functioning (rank correlations: 0.64 and -0.60, respectively). Associations with more general health outcomes, number of chronic disorders, Center for Epidemiologic Studies-Depression scale symptoms, and SF-36 role performance were weaker, as expected. Associations were stronger for Moroccans than for indigenous Dutch elderly regarding both SF-36 outcomes and depressive symptoms. CONCLUSION Katz' ADL index is valid to assess functional performance of Turkish, Moroccan, and Dutch elderly, but comparisons with Moroccan elderly should be handled with caution. The explanation of these findings and their generalizability to other ethnic groups deserve further study.
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Affiliation(s)
- Sijmen A Reijneveld
- University Medical Center Groningen, University of Groningen, Department of Health Sciences, Northern Center for Healthcare Research, Groningen, P.O. Box 196, 9700 AD Groningen, the Netherlands.
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Baker TA, Whitfield KE. Physical functioning in older blacks: an exploratory study identifying psychosocial and clinical predictors. J Natl Med Assoc 2006; 98:1114-20. [PMID: 16895281 PMCID: PMC2569446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
OBJECTIVES The primary objective of this investigation was to examine the relationship between physical functioning and various clinical (pain intensity, pain locations, medications, comorbidities) and psychosocial (depression, locus of control) variables in a sample of older blacks. METHODS Data were collected from community-dwelling black adults (N=247), with a mean age of 69.4 +/- 9.4 years. Participants were recruited from several senior high-rise facilities located in an urban community in Baltimore, MD. A multivariate regression model was tested to determine the relationship between selected clinical, psychosocial and demographic characteristics, and physical functioning; and to assess the amount of unique variance in functional status accounted for by specific psychosocial, clinical and demographic indicators (independently and collectively). RESULTS It was established that reporting more depressive symptoms (beta=0.18, p<0.05), multiple pain locations (beta=0.25, p<0.01) and pain intensity (beta=0.30, p<0.01) was a significant indicator of physical impairment and accounted for 36% of its variation. CONCLUSION Identifying indicators of physical impairment is critical in providing baseline information on the functional well-being in older blacks. This emphasizes the need for further studies to rigorously examine the relationship between physical functioning, and clinical and psychosocial indicators within defined race and ethnic groups in order to develop data that provide meaningful comparisons between different race and ethnic groups.
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Affiliation(s)
- Tamara A Baker
- School of Aging Studies, University of South Florida, Tampa, FL, 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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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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Abstract
OBJETIVO: Estimar as taxas de incapacidade funcional e identificar os fatores sociodemográficos associados com a prevalência de incapacidade funcional entre as mulheres idosas. MÉTODOS: As estimativas das taxas de incapacidade funcional foram produzidas com informações da Pesquisa Nacional por Amostra de Domicílios, de 1998, realizada pelo Instituto Brasileiro de Geografia e Estatística. O estudo analisou a população de mulheres idosas, num total de 16.186. Foram elaborados modelos de regressão logística, utilizando como variável dependente a dificuldade para caminhar 100 metros. RESULTADOS: A prevalência de incapacidade funcional leve, moderada e severa foi maior entre as mulheres, e aumentou com a idade. Na análise de regressão logística, os indicadores mais fortemente associados com o aumento da prevalência de incapacidade funcional foram baixo nível de educação e baixo rendimento familiar. Residência rural foi também associada com redução de prevalência. CONCLUSÕES: Os resultados sugerem possíveis fatores de risco para o desenvolvimento de declínio funcional em idosas, tendo em vista que as associações encontradas foram consistentes com aquelas reportadas por outros estudos.
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Affiliation(s)
- Maria Isabel Parahyba
- Universidade Aberta da Terceira Idade, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil.
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Melzer D, Lan TY, Tom BDM, Deeg DJH, Guralnik JM. Variation in Thresholds for Reporting Mobility Disability Between National Population Subgroups and Studies. J Gerontol A Biol Sci Med Sci 2004; 59:1295-303. [PMID: 15699529 DOI: 10.1093/gerona/59.12.1295] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Disability questions require older people to report difficulties with everyday activities, using broad categorical responses. Relatively little is known about population group differences in the thresholds for reporting difficulty or inability with medium-distance mobility against tested mobility-related performance. We aimed to estimate the thresholds on tested performance at which self-reports change from one category to another, across a range of sociodemographic subgroups. We also aimed to compare reported and tested performance across two national population studies. METHODS The samples were from the third U.S. National Health and Nutrition Examination Study (NHANES III) and the Longitudinal Aging Study Amsterdam (LASA). Measures of gait speed, chair stands, and peak expiratory flow rate in both studies yielded the validated index of mobility-related physical limitations (MOBLI). Latent probit models were used to estimate cutpoints (thresholds) on the index for reporting difficulty or inability to walk a medium distance. RESULTS Thresholds for reporting difficulty or inability were studied by age, sex, race, educational level, and income in NHANES III. In models adjusting for the other factors, performance thresholds for reporting disability categories varied by age and income. The younger elderly persons in NHANES III on average reported difficulties or inabilities only when they reached a more severe level of tested limitation compared with older old persons. A similar pattern exists for those on higher incomes. For race, differences in threshold were present only for reporting inability, but not difficulty. Significant differences in thresholds were not present between groups defined by sex or for years of education. Comparisons between the NHANES and LASA studies show that lower reported mobility difficulty or inability prevalence in the Dutch sample is attributable both to reporting at higher levels of limitation and to better functioning. CONCLUSIONS There is evidence of differences in thresholds for reporting mobility disability, especially across age and income groups in older Americans. Further work is needed to understand the perceptual, attitudinal, or environmental factors that cause these reporting differences.
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Affiliation(s)
- David Melzer
- Department of Public Health and Primary Care, University of Cambridge, Cambridge CB2 2SR, UK.
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Allman RM, Baker PS, Maisiak RM, Sims RV, Roseman JM. Racial similarities and differences in predictors of mobility change over eighteen months. J Gen Intern Med 2004; 19:1118-26. [PMID: 15566441 PMCID: PMC1494786 DOI: 10.1111/j.1525-1497.2004.30239.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To define racial similarities and differences in mobility among community-dwelling older adults and to identify predictors of mobility change. DESIGN Prospective, observational, cohort study. PARTICIPANTS Nine hundred and five community-dwelling older adults. MEASURES Baseline in-home assessments were conducted to assess life-space mobility, sociodemographic variables, disease status, geriatric syndromes, neuropsychological factors, and health behaviors. Disease reports were verified by review of medications, physician questionnaires, or hospital discharge summaries. Telephone interviews defined follow-up life-space mobility at 18 months of follow-up. RESULTS African Americans had lower baseline life-space (LS-C) than whites (mean 57.0 +/- standard deviation [SD] 24.5 vs. 72.7 +/- SD 22.6; P < .001). This disparity in mobility was accompanied by significant racial differences in socioeconomic and health status. After 18 months of follow-up, African Americans were less likely to show declines in LS-C than whites. Multivariate analyses showed racial differences in the relative importance and strength of the associations between predictors and LS-C change. Age and diabetes were significant predictors of LS-C decline for both African Americans and whites. Transportation difficulty, kidney disease, dementia, and Parkinson's disease were significant for African Americans, while low education, arthritis/gout, stroke, neuropathy, depression, and poor appetite were significant for whites. CONCLUSIONS There are significant disparities in baseline mobility between older African Americans and whites, but declines were more likely in whites. Improving transportation access and diabetes care may be important targets for enhancing mobility and reducing racial disparities in mobility.
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Affiliation(s)
- Richard M Allman
- Birmingham/Atlanta VA Geriatric Research, Education, and Clinical Center, University of Alabama, Birmingham, AL 35294, USA.
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Dietz TL, Wright JD. Racial and ethnic identity of older adults residing in assisted living facilities in central Florida. CARE MANAGEMENT JOURNALS : JOURNAL OF CASE MANAGEMENT ; THE JOURNAL OF LONG TERM HOME HEALTH CARE 2003; 3:185-91. [PMID: 12847935 DOI: 10.1891/cmaj.3.4.185.57455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In response to the growing concern over the provision of long-term care to an ever-expanding older population, new methods of delivering services to older adults are constantly being developed. The development and expansion of long-term care via assisted living facilities (ALFs) is one approach that has proven surprisingly popular all across the nation. Despite the popularity of ALFs, relatively little appears to be known about the residents of these facilities. This article examines the racial and ethnic identities and certain other characteristics of residents in a stratified probability sample of assisted living facilities in central Florida, a region that contains one of the nation's densest populations of older adults. Fifty-nine facilities serving 1,805 residents were surveyed. Predictably, racial and ethnic minorities were significantly underrepresented among the residents of these facilities. Facilities serving relatively large minority populations were characterized by lower room rates and a larger proportion of beds set aside for Office of Social Services (OSS) residents (i.e., beds funded through state funds or by Medicaid). The general run of these findings suggests that as they have been implemented in central Florida, ALFs may well perpetuate preexisting socioeconomic inequalities among the aged population.
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Affiliation(s)
- Tracy L Dietz
- Department of Sociology and Anthropology, University of Central Florida, Orlando, FL 32816-1360, USA.
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Tan EJ, Lui LY, Eng C, Jha AK, Covinsky KE. Differences in mortality of black and white patients enrolled in the program of all-inclusive care for the elderly. J Am Geriatr Soc 2003; 51:246-51. [PMID: 12558723 DOI: 10.1046/j.1532-5415.2003.51065.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To examine the relationship between race and mortality in frail community-dwelling older people with access to a program providing comprehensive access and coordination of services. DESIGN A longitudinal cohort study. SETTING Twelve nationwide demonstration sites of the Program of All-Inclusive Care for the Elderly (PACE) from 1990 to 1996. PACE provides comprehensive medical and long-term care services for nursing home-eligible older people who live in the community. PARTICIPANTS Two thousand two white patients and 859 black patients. MEASUREMENTS Patients were followed after enrollment until death or the end of the follow-up period. Time from enrollment to death was measured with adjustment of the Cox proportional hazards model for comorbid conditions, functional status, site, and other demographic characteristics. RESULTS Black patients were younger than white patients (mean age 77 vs 80, P <.001) but had worse functional status (mean activity of daily living (ADL) score 6.5 vs 7.2, P <.001) on enrollment. Survival for black and white patients was 88% and 86% at 1 year, 67% and 61% at 3 years, and 51% and 42% at 5 years, respectively (unadjusted hazard ratio (HR) for black patients = 0.77; 95% confidence interval (CI) = 0.67-0.89). After adjustment for baseline comorbid conditions, functional status, site, and demographic characteristics, black patients still had a lower mortality rate (HR = 0.77; 95% CI =.65-0.93). The survival advantage for black patients did not emerge until about 1 year after PACE enrollment (HR for first year after enrollment = 0.97; 95% CI = 0.72-1.31; HR after first year = 0.67; 95% CI = 0.54-0.85, P-value for time interaction <.001). During the first year of enrollment, black patients were more likely to improve and less likely to decline in ADL function than white patients (P <.001). CONCLUSION In PACE, a system providing access to and coordination of comprehensive medical and long-term care services for frail older people, black patients have a lower mortality rate than white patients. This survival advantage, which emerges approximately 1 year after PACE enrollment, may be related to the comprehensive access and coordination of services provided by the PACE program.
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Affiliation(s)
- Erwin J Tan
- Division of Geriatrics, University of California at San Francisco, San Francisco, California, USA.
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Mills TL, Lichtenberg PA, Wakeman MA, Scott-Okafor H. Correlates of rehabilitation hospital length of stay among older African-American patients. J Natl Med Assoc 2002; 94:846-55. [PMID: 12392049 PMCID: PMC2594158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
This study addresses a gap in the current literature on the correlates of rehabilitation hospital length of stay for older African Americans. Using data from 616 consecutively admitted rehabilitation patients who ranged in age from 50 to 103 years old, we tested the effect of patient's primary medical impairment; structural factors such as admit and discharge setting; level of depression (Geriatric Depression Scale); functional ability upon hospital admission (FIM score); and other control variables. Hierarchical linear regression models show that medical impairment alone was not a robust predictor of LOS. However, when controlling for structural and psychosocial factors, and medical condition, then circulation/amputation impairment was directly associated with longer LOS. Being unmarried or at risk for depression were also directly related to longer LOS. Consequently, rehabilitation administrators and hospital staff should note these findings to determine whether and how these factors affect discharge outcomes in their particular rehabilitative environments.
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Dunlop DD, Manheim LM, Sohn MW, Liu X, Chang RW. Incidence of functional limitation in older adults: the impact of gender, race, and chronic conditions. Arch Phys Med Rehabil 2002; 83:964-71. [PMID: 12098157 DOI: 10.1053/apmr.2002.32817] [Citation(s) in RCA: 136] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To evaluate the relation of chronic conditions, gender, and race to the incidence of activities of daily living (ADLs) limitation in older adults. DESIGN The 2-year cumulative incidence of functional limitation was estimated from survival analysis methods by using elders without baseline functional limitations. SETTING Longitudinal Study of Aging (LSOA). Initial interviews: 1984; reinterviews: 1986, 1988, and 1990. PARTICIPANTS A total of 4205 elderly subjects from the LSOA. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES DEPENDENT VARIABLES self-reported moderate (1-2 ADLs) and severe (> or =3 ADLs) functional limitation. INDEPENDENT VARIABLES sociodemographics, self-reported chronic conditions, and prior levels of functional limitation. RESULTS Gender and race predicted moderate functional limitation onset, after controlling for age and education. Arthritis, diabetes, prior cerebrovascular disease (CVD), incontinence, and impaired vision were significant predictors of moderate functional limitation onset after controlling for demographics. Differences in the prevalence of chronic conditions appear to explain why moderate functional limitation incidence rates are higher in older women and blacks. Gender, but not race, predicted onset of severe functional limitation, after controlling for age and education. Prior moderate functional limitation, CVD, and vision impairment predicted onset of severe functional limitation after controlling for demographics. CONCLUSION Prevention of functional decline should target chronic conditions and moderate functional limitation in older adults.
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Affiliation(s)
- Dorothy D Dunlop
- Institute for Health Services Research and Policy Studies, Northwestern University, Evanston IL 60208, USA.
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Vaccarino V, Gahbauer E, Kasl SV, Charpentier PA, Acampora D, Krumholz HM. Differences between African Americans and whites in the outcome of heart failure: Evidence for a greater functional decline in African Americans. Am Heart J 2002; 143:1058-67. [PMID: 12075264 DOI: 10.1067/mhj.2002.122123] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND National statistics indicate that African Americans are disproportionately affected by mortality and hospitalizations resulting from heart failure when compared with other racial/ethnic groups. This might, in part, reflect a poorer course of heart failure among African Americans. METHODS We conducted a prospective cohort study of 316 white and 82 African American consecutive patients aged > or =50 years with decompensated heart failure on hospital admission. The outcome of the study was death or decline in activities of daily living function at 6 months relative to baseline. RESULTS African American patients were on average 8 years younger and had less favorable socioeconomic and access-to-care indicators. African Americans more often had a history of hypertension, renal insufficiency, and diabetes, but there were no differences in functional status, self-reported health status, signs of decompensation, or left ventricular ejection fraction. Quality-of-care indicators did not differ by race. Mortality rates at 6 months were similar in African Americans and whites (19.5% vs 17.2%, age adjusted), but African Americans had a greater functional decline (37.6% vs 24.7%). After adjusting for baseline characteristics, African Americans had an almost 50% higher risk of either death or decline in activities of daily living functioning (relative risk 1.45, 95% CI, 1.06-1.81). Adjustment for socioeconomic, access-to-care and quality-of-care indicators did not substantially change this estimate. CONCLUSIONS African Americans have similar mortality but greater functional decline than whites after hospitalization for heart failure. This outcome is not explained by clinical, socioeconomic, access-to-care or quality-of-care differences.
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Affiliation(s)
- Viola Vaccarino
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Ga 30306, USA.
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Abstract
This study investigated regional differences in functional status among aged Medicare beneficiaries in the United States, and the degree to which population risk factors and certain geographic/environmental attributes of communities accounted for the regional differences. Four years of the Medicare Current Beneficiary Survey (1992-1995) were pooled together yielding 37,150 person-year observations of functional status for a sample of aged Medicare beneficiaries residing in the community or nursing homes. Multinomial logit models, estimated on a four-category functional status scale, produced strong empirical evidence of substantial regional differences in the prevalence of functional independence, functional limitations, IADL limitations, and ADL limitations, that could not be attributed to regional population composition, socio-demographic factors, lifestyle characteristics, and chronic medical conditions. Although such population risk factors accounted for much of the regional variations in functional status among older men, the notably higher prevalence of IADL and ADL limitations among older women residing in the Deep South could not be similarly attributed to such risk factors. Rather, the empirical results suggest that a significant portion of the harmful effects associated with residence in the Deep South among older women may be attributed to a higher prevalence of residence in counties characterized by lower population density and/or higher poverty concentration.
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Affiliation(s)
- Frank W Porell
- Gerontology Institute, University of Massachusetts Boston, 02125-3393, USA.
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Rios DA, Abdulah DR, Wei JY, Hausdorff JM. Disparate effects of socioeconomic status on physical function and emotional well-being in older adults. AGING (MILAN, ITALY) 2001; 13:30-7. [PMID: 11292150 DOI: 10.1007/bf03351491] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We tested the hypothesis that among community living older adults with relatively low and high socioeconomic status (SES), low SES is associated with both poorer emotional well-being and physical function. Ambulatory, community living older men and women (70-89 years of age) were recruited from outpatient geriatric assessment clinics in relatively high socioeconomic areas of greater Boston (High SES, N=47), and from an urban senior center in the inner city (Low SES, N=66). We assessed health status, mental health, upper and lower extremity strength and physical function. We found that health status was not significantly different in the two groups. Quadriceps strength (Low SES: 199+/-57 N; High SES: 190+/-56 N; p=0.531) and Up and Go times (Low SES: 14.3+/-3.1 sec; High SES: 16.7+/-9.5 sec; p=0.068) were not significantly different in the two groups, while grip strength was slightly higher in the Low SES group (Low SES: 22.8+/-6.45 kg; High SES: 20.07+/-7.55 kg; p=0.049). In contrast, subjects with Low SES tended to have an increased tendency towards depression. Scores on the Geriatric Depression Scale were 3.8+/-3.0 in Low SES, and 1.8+/-2.8 in High SES (p<0.001). We conclude that while health status and physical function were not worse in subjects with low SES, emotional well-being was markedly less compared to seniors with high SES. SES may have disparate effects on physical function and mental health, perhaps due to different compensatory mechanisms.
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Affiliation(s)
- D A Rios
- Division on Aging, Harvard Medical School, Boston, Massachusetts, USA
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Abstract
The link between nonaudiological variables and outcomes measurement is explored. Hearing impairment can affect an individual's everyday communication in numerous ways. Both audiological and nonaudiological variables interact with each other to produce a unique predicament for each individual with hearing impairment. The nonaudiological variables that are addressed in this article include race/ethnicity, gender, age, personality, self-efficacy, and social support, as well as a number of other factors. Some of these variables, such as personality, have been found to exert more influence than audiological factors on audiological rehabilitation outcomes. The potential influence of each variable is discussed and directions for future research are provided.
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Affiliation(s)
- P B Kricos
- Department of Communication Sciences and Disorders, University of Florida, Gainesville 32611-7420, USA
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Whitfield KE, Fillenbaum GG, Pieper C, Albert MS, Berkman LF, Blazer DG, Rowe JW, Seeman T. The effect of race and health-related factors on naming and memory. The MacArthur Studies of Successful Aging. J Aging Health 2000; 12:69-89. [PMID: 10848126 DOI: 10.1177/089826430001200104] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The purpose of the analyses was to examine the impact of health-related variables on race differences in neuropsychological functioning (Boston Naming Task). METHODS Using cross-sectional data from the MacArthur Successful Aging Study, the authors examined the relationship of demographic characteristics, health status, health habits, physical functioning, and speed of performance to naming and incidental recall of items from the Boston Naming Task. Participants were 1,175 healthy African American and European American older persons 70 to 79 years old. RESULTS Regression analyses indicated that although race differences persisted for confrontational naming after controlling for demographic and health factors, there was no effect due to race for incidental recall scores or for savings scores for recall. DISCUSSION The racial differences found in test performance may reflect differences in cultural appropriateness of the material rather than differences in ability.
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Stuck AE, Walthert JM, Nikolaus T, Büla CJ, Hohmann C, Beck JC. Risk factors for functional status decline in community-living elderly people: a systematic literature review. Soc Sci Med 1999; 48:445-69. [PMID: 10075171 DOI: 10.1016/s0277-9536(98)00370-0] [Citation(s) in RCA: 1164] [Impact Index Per Article: 46.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
To lay the groundwork for devising, improving and implementing strategies to prevent or delay the onset of disability in the elderly, we conducted a systematic literature review of longitudinal studies published between 1985 and 1997 that reported statistical associations between individual base-line risk factors and subsequent functional status in community-living older persons. Functional status decline was defined as disability or physical function limitation. We used MEDLINE, PSYCINFO, SOCA, EMBASE, bibliographies and expert consultation to select the articles, 78 of which met the selection criteria. Risk factors were categorized into 14 domains and coded by two independent abstractors. Based on the methodological quality of the statistical analyses between risk factors and functional outcomes (e.g. control for base-line functional status, control for confounding, attrition rate), the strength of evidence was derived for each risk factor. The association of functional decline with medical findings was also analyzed. The highest strength of evidence for an increased risk in functional status decline was found for (alphabetical order) cognitive impairment, depression, disease burden (comorbidity), increased and decreased body mass index, lower extremity functional limitation, low frequency of social contacts, low level of physical activity, no alcohol use compared to moderate use, poor self-perceived health, smoking and vision impairment. The review revealed that some risk factors (e.g. nutrition, physical environment) have been neglected in past research. This review will help investigators set priorities for future research of the Disablement Process, plan health and social services for elderly persons and develop more cost-effective programs for preventing disability among them.
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Affiliation(s)
- A E Stuck
- Department of Geriatrics and Rehabilitation, Zieglerspital, Bern, Switzerland.
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Kington R, Carlisle D, McCaffrey D, Myers H, Allen W. Racial differences in functional status among elderly U.S. migrants from the South. Soc Sci Med 1998; 47:831-40. [PMID: 9690828 DOI: 10.1016/s0277-9536(98)00145-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
This study describes patterns of functional status among older blacks and whites by their history of birth in and migration out of the South. We used multivariate regression to analyze data on functional status of US-born non-Hispanic blacks (N = 1868) and whites (N = 13469) age 60 years or above. In general, the functional status of blacks who were born in the South and migrated was similar to that of blacks born outside the South and better than those born in the South who did not migrate. Whites who migrated from the South had functional status similar to those who did not migrate and worse than those born outside of the South. Socioeconomic status did not explain differences by race and migration history. These results differ sharply from mortality studies, which have found a consistent pattern of high mortality among black migrants from the South. Differences among race groups by migration history vary across health measures. Selective migration and selective survival may account for the complex patterns of racial differences in geographic distributions of function and health.
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Berkman CS, Gurland BJ. The relationship between ethnoracial group and functional level in older persons. ETHNICITY & HEALTH 1998; 3:175-188. [PMID: 9798116 DOI: 10.1080/13557858.1998.9961860] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
The objective of this study was to determine: (1) the differences between blacks, Latinos, and whites in relation to functional level, (2) whether these differences could be entirely explained by differences in socioeconomic status (SES) for both blacks and Latinos, and (3) which SES indicators might account for differences in function. Data from the 1570 respondents in the Growing Older in New York City Study, a representative sample of black, Latino, and non-Latino white persons, age 65 years and over, were used. Latinos were significantly more functionally impaired than the other two ethnoracial groups, but this was accounted for by income, education, and the residential environment. Blacks were the least functionally impaired when income, education and the residential environment were controlled. Possible explanations for these results and implications for service delivery are discussed.
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Affiliation(s)
- C S Berkman
- Fordham University, Graduate School of Social Service, New York, NY 10023, USA
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Unger JB, Johnson CA, Marks G. Functional decline in the elderly: evidence for direct and stress-buffering protective effects of social interactions and physical activity. Ann Behav Med 1998; 19:152-60. [PMID: 9603690 DOI: 10.1007/bf02883332] [Citation(s) in RCA: 107] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Advances in medical technology and improvements in health behavior have greatly increased the proportion of Americans who survive into old age. Consequently, identifying environmental and behavioral factors that enhance or protect the health and functional capacity of older adults is an important goal. This study investigated the extent to which social interactions and physical activity can protect older adults from the declines in functional ability that typically occur with age and the extent to which they buffer the negative effects of widowhood on physical functioning. Data were from the Longitudinal Study of Aging, a six-year follow-up of over 7,000 respondents in the 1984 National Health Interview Survey. Using individual growth curve models which examine the effects of predictor variables on change over time, this study investigated how physical activity, social interactions, and widowhood are related to the rate of change in functional health over a six-year period. Results suggested that physical activity and social interactions each exerted independent effects on functional decline. In addition, physical activity and social interactions buffered the effects of widowhood on functional decline, especially in men who died before the end of the study. Results suggest a need for health promotion programs to encourage both physical and social activities in the elderly.
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Affiliation(s)
- J B Unger
- University of Southern California School of Medicine, USA
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Wallhagen MI, Strawbridge WJ, Cohen RD, Kaplan GA. An increasing prevalence of hearing impairment and associated risk factors over three decades of the Alameda County Study. Am J Public Health 1997; 87:440-2. [PMID: 9096550 PMCID: PMC1381021 DOI: 10.2105/ajph.87.3.440] [Citation(s) in RCA: 76] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES This study assessed changes in the prevalence of hearing impairment in persons aged 50 years and older over the past 30 years and identified risk factors. METHODS Age-adjusted hearing impairment prevalence rates at four time intervals were calculated from the Alameda County Study (n = 5108). Logistic regression models analyzed risk factors from 1974 for 1994 incident hearing impairment. RESULTS The prevalence of hearing impairment nearly doubled between 1965 and 1994. The increase was significantly greater for men. The higher incidence was associated with potentially high-noise-exposure occupations for men and with symptoms and conditions associated with ototoxic drug use for both men and women. Exercise was protective. CONCLUSIONS Given the serious health and social consequences of hearing impairment, its increasing prevalence is cause for concern.
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Affiliation(s)
- M I Wallhagen
- Department of Physiological Nursing, School of Nursing University of California, San Francisco 94143-0610, USA
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Clark DO. US trends in disability and institutionalization among older Blacks and Whites. Am J Public Health 1997; 87:438-40. [PMID: 9096549 PMCID: PMC1381020 DOI: 10.2105/ajph.87.3.438] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES This study estimated and compared the prevalence of disability and institutionalization in 1982, 1984, and 1989 among the older Black and White populations of the United States. METHODS Data on over 1100 Blacks and 14,000 Whites in each of a series of three National Long Term Care Surveys were used. RESULTS Diverging trends for Blacks and Whites led to statistically significant increases in the age- and sex-adjusted odds of disability (19%) and institutionalization (31%) for Blacks relative to Whites. CONCLUSIONS Black and White disparities in disability appear to have widened, while disparities in institutionalization appear to have narrowed during the decade of the 1980s.
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Affiliation(s)
- D O Clark
- Department of Medicine, Indiana University School of Medicine, Regenstrief Institute 46202-2859, USA
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Tomita MR, Mann WC, Fraas LF, Burns LL. Racial differences of frail elders in assistive technology. Assist Technol 1996; 9:140-51. [PMID: 10177451 DOI: 10.1080/10400435.1997.10132305] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
This study compared differences in coping strategies, such as the use and ownership of assistive devices and home modifications, for 64 black and 441 white frail elders from the University at Buffalo Consumer Assessment Study. Controlling age, income, and education, there was no difference between black and white elders on health and functional status. Black elders on average own and use fewer assistive devices than white elders. There is no difference between the two groups in the number of home modifications, although black elders experience more home environmental problems than white elders. The majority of black elders rent their residence and thus lack the authority and ability to make the necessary adjustments to their home environmental problems. Predictor variables for assistive device use and environmental problems varied for black and white elders.
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Affiliation(s)
- M R Tomita
- Rehabilitation Engineering Research Center on Aging, University at Buffalo, NY 14214, USA
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