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Muhammad T, Srivastava S, Muneera K, Kumar M, Kelekar U. Treatment for Insomnia Symptoms is Associated with Reduced Depression Among Older Adults: A Propensity Score Matching Approach. Clin Gerontol 2024; 47:436-451. [PMID: 37153958 DOI: 10.1080/07317115.2023.2208582] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
OBJECTIVES The study aimed to investigate the effect of utilization of treatment for insomnia symptoms on the prevalence of major depressive disorder among older adults in India. METHODS We used the data from the Longitudinal Ageing Study in India (LASI), 2017-18. The sample included 10,911 older individuals who reported insomnia symptoms. The propensity score matching (PSM) approach was used to compare the depressive disorder among those who received vs. not received treatment. RESULTS Only 5.7% of older adults reporting insomnia symptoms received treatment. On average, prevalence of depressive disorder among men and women who received treatment for insomnia symptoms was lesser by 0.79 and 0.33 points, respectively, than those who did not receive treatment. In the matched sample, treatment for insomnia symptoms was significantly associated with lesser prevalence of depression for both older men (β= -0.68, p < .001) and older women (β= -0.62, p < .001). CONCLUSIONS The current findings suggest that treatment for insomnia symptoms can reduce the risk of depressive disorder among older adults and the effects are higher among older men than women.
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Affiliation(s)
- T Muhammad
- Department of Family & Generations, International Institute for Population Sciences, Mumbai, India
| | - Shobhit Srivastava
- Department of Survey Research & Data Analytics, International Institute for Population Sciences, Mumbai, India
| | - K Muneera
- School of Management Studies, National Institute of Technology, Calicut, Kerala, India
| | - Manish Kumar
- Population Research Centre, Dharwad, Karnataka, India
| | - Uma Kelekar
- School of Business, College of Business, Innovation, Leadership and Technology
- Marymount Center for Optimal Aging, Marymount University, Arlington-VA, USA
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Das Gupta D, Kelekar U, Turner SC. Older Adult Falls in the Community: Does Unsafe Home Environment Have a Risk Role Through the Mediating Effect of Functional Limitations? Gerontologist 2024; 64:gnad139. [PMID: 37870156 DOI: 10.1093/geront/gnad139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Indexed: 10/24/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Fall incidents from unsafe home environments are frequent in older-adult homes but the literature is ambiguous whether it is the presence/absence, or the interplay of such conditions and physical functioning that is of salience. We therefore estimated whether unsafe home environment is adversely associated with subsequent falls among older adults and what proportion of this association was mediated through limitations in daily and instrumental activities of daily living (ADL/IADL). RESEARCH DESIGN AND METHODS Using a nationally representative sample of community-dwelling Medicare beneficiaries (≥65 years) in the 2018-2019 National Health and Aging Trends Study (n = 2,599), we conducted bivariate and multivariable analyses. We examined baseline conditions of home disorders, unsafe bathroom settings, unsafe house/building features, and house disrepairs in 2018 and their relation with subsequent falls in 2019, after controlling for covariates. To assess whether ADL/IADL limitations mediated this relationship, we employed the Karlson-Holm-Breen methodology. RESULTS In 2019, the self-reported prevalence of falls among older adults was estimated at 34.68%. Although baseline home disorders had both a direct (adjusted odds ratio [aOR]: 1.14, 95% confidence interval [CI]:1.03,1.26) and an indirect effect through limitations in ADL and IADL (aOR: 1.01; 95% CI: 1.00,1.03), the relation between unsafe bathroom settings and subsequent falls was unclear. Unsafe house/building features and house disrepairs were not statistically significantly related either directly or indirectly with subsequent falls. DISCUSSION AND IMPLICATIONS Addressing home disorders through policy and housing assessments to highlight home environmental safety would be essential to address falls among older adults.
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Affiliation(s)
- Debasree Das Gupta
- Department of Kinesiology and Health Science, Emma Eccles Jones College of Education and Human Services, Utah State University, Logan, Utah, USA
| | - Uma Kelekar
- School of Business, College of Business, Innovation, Leadership and Technology, Marymount University, Marymount Center for Optimal Aging, Arlington, Virginia, USA
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Das Gupta D, Kelekar U, Abram-Moyle M. Association between ideal cardiovascular health and multiple disabilities among US adults, BRFSS 2017-2019. Public Health 2023; 218:60-67. [PMID: 36965465 DOI: 10.1016/j.puhe.2023.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 01/18/2023] [Accepted: 02/14/2023] [Indexed: 03/27/2023]
Abstract
OBJECTIVES Cardiovascular health is the leading cause of death and disability in the United States. Our objective was to estimate the association between ideal cardiovascular health (ICVH) and multiple disabilities among US adults stratified into the three age groups of young (18-44 years), midlife (45-64 years), and older adults (≥65 years). STUDY DESIGN We conducted a cross-sectional analysis using data pooled from the 2017 and 2019 Behavioral Risk Factor Surveillance System (BRFSS). METHODS Using American Heart Association's seven-component (four ideal behaviors and three ideal health factors) scoring tool, we identified ICVH as a composite score ≥5 and also computed the ideal behavioral (score ≥3) and ideal health factors (score = 3) submetrics. The outcome, single vs multiple disabilities indicator, was defined using US Census's disability domains and analyzed using multinomial regression. RESULTS For all three groups, the prevalence of multiple disabilities was significantly lower among those meeting ICVH, ideal behavioral, and ideal health factors compared with those that did not. After controlling for covariates, ICVH score ≥5 was associated with lower relative risk of multiple disabilities in all groups. Although both ideal health and ideal behavioral factors were associated with lower relative risk of multiple disabilities among all groups, the reduction in risk was the highest for multiple disabilities and ideal behavioral factors among midlife (relative risk ratio: 0.30, 95% confidence interval: 0.25, 0.36) and older adults (relative risk ratio: 0.40, 95% confidence interval: 0.33, 0.48). CONCLUSION Adults with less-than-ideal cardiovascular health had a higher relative risk of multiple disabilities. Addressing the risk of multiple disabilities of US adults will require effective promotion of ICVH.
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Affiliation(s)
- D Das Gupta
- Department of Kinesiology and Health Science, Emma Eccles Jones College of Education and Human Services, Utah State University, 7000 Old Main Hill, Logan, UT, 84322, USA.
| | - U Kelekar
- School of Business, Innovation, Leadership and Technology and Marymount Center for Optimal Aging, Marymount University, USA
| | - M Abram-Moyle
- Department of Kinesiology and Health Science, Emma Eccles Jones College of Education and Human Services, Utah State University, USA
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Kelekar U, Elrod C, Heyn P, Wong R. FEASIBILITY OF FALLS PREVENTION PROGRAMS IMPLEMENTATION BASED ON ACADEMIC-COMMUNITY PARTNERSHIPS. Innov Aging 2022. [DOI: 10.1093/geroni/igac059.3097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Abstract
The Northern Virginia (NoVa) region is diverse in age, race, ethnicity, economic status, health status, culture, and language. Based on state data, it is estimated that 28.7% of the 75,000 older adults in NoVa will experience at least one fall annually. Since 2014, the Administration for Community Living (ACL) has sponsored implementation of evidence-based fall prevention programs (EBFPPs). The aims of this study are to 1) describe the EBFPP participants and delivery sites and 2) report initial effectiveness. Marymount University (MU) received two cooperative agreement grants (2016, 2018) from the ACL to implement in NoVa three EBFPPs: 1) Stay Active and Independent for Life (SAIL), 2) A Matter of Balance (MOB), and 3) Otago Exercise Program (OEP). The Northern Virginia Falls Prevention Alliance was formed and a Regional Training Office was built. The data source is the ACL national falls database. From 2016–2022, over 5,000 older adults were reached, over 400 EBFPP leaders were trained, and programs were delivered at 60 sites. Data analysis indicates that falls decreased from 20% to 15%. Those participating in MOB showed the greatest decline in falls (from 34% to 14%). Fall injuries declined from 11% to 7% and ED visits decreased from 3% to 1%. Preliminary analysis indicates beneficial impact: this academic-community partnership has reached people at low risk of falling (SAIL), and had an impactful decline in falls for individuals at moderate to high risk (MOB). Future research will investigate program outcome differences based on other demographics and delivery models.
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Affiliation(s)
- Uma Kelekar
- Marymount University , Arlington, Virginia , United States
| | - Cathy Elrod
- Marymount University , Arlington, Virginia , United States
| | - Patricia Heyn
- Center for Optimal Aging, Marymount University , Fairfax Station, Virginia , United States
| | - Rita Wong
- Marymount University , Arlington, Virginia , United States
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Pushpalata Zanwar P, Perianayagam A, Zazdravnykh E, Omar Z, Vinod Joseph KJ, Santos FH, Negm AM, Reistetter TA, Heyn PC, Kelekar U. Examining the Impacts of Coronavirus Disease 2019 Mitigation Policies on Health Outcomes of Older Adults: Lessons Learned From Six High-Income or Middle-Income Countries. Public Policy Aging Rep 2022; 32:121-130. [PMID: 36349280 PMCID: PMC9619694 DOI: 10.1093/ppar/prac023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Indexed: 11/16/2022]
Affiliation(s)
- Preeti Pushpalata Zanwar
- Address correspondence to: Preeti Zanwar, PhD, MPH, MS, Jefferson College of Population Health, Thomas Jefferson University, 901 Walnut Street, 10th Floor, Philadelphia, Pennsylvania, 19107, USA.
| | - Arokiasamy Perianayagam
- International Institute for Population Sciences, Mumbai, India,National Council of Applied Economic Research (NCAER), Delhi, India
| | - Evguenii Zazdravnykh
- Department of Management, International Centre of Health Economics, Policy, and Management, HSE University, St. Petersburg, Russia
| | - Zaliha Omar
- Department of Rehabilitation Medicine, Fujita Health University, Toyoake, Aichi, Japan,Department of Rehabilitation Medicine, University Malaya, Kuala Lumpur, Malaysia
| | - K J Vinod Joseph
- Department of Public Health and Mortality Studies, International Institute for Population Sciences, Mumbai, India
| | - Flavia H Santos
- Centre for Disability Studies, University College Dublin, Ireland
| | - Ahmed M Negm
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada,School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Timothy A Reistetter
- Department of Occupational Therapy, School of Health Professions, University of Texas Health Science Center, San Antonio, Texas, USA
| | - Patricia C Heyn
- Marymount Center for Optimal Aging, Marymount University, Arlington, Virginia, USA
| | - Uma Kelekar
- Marymount Center for Optimal Aging, Marymount University, Arlington, Virginia, USA,School of Business, Innovation, Leadership and Technology, Marymount University, Arlington, Virginia, USA
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Das Gupta D, Kelekar U, Turner SC, Sule AA, Jerman TG. Interpreting COVID-19 deaths among nursing home residents in the US: The changing role of facility quality over time. PLoS One 2021; 16:e0256767. [PMID: 34469483 PMCID: PMC8409689 DOI: 10.1371/journal.pone.0256767] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 08/13/2021] [Indexed: 11/18/2022] Open
Abstract
A report published last year by the Centers for Medicare & Medicaid Services (CMS) highlighted that COVID-19 case counts are more likely to be high in lower quality nursing homes than in higher quality ones. Since then, multiple studies have examined this association with a handful also exploring the role of facility quality in explaining resident deaths from the virus. Despite this wide interest, no previous study has investigated how the relation between quality and COVID-19 mortality among nursing home residents may have changed, if at all, over the progression of the pandemic. This understanding is indeed lacking given that prior studies are either cross-sectional or are analyses limited to one specific state or region of the country. To address this gap, we analyzed changes in nursing home resident deaths across the US between June 1, 2020 and January 31, 2021 (n = 12,415 nursing homes X 8 months) using both descriptive and multivariable statistics. We merged publicly available data from multiple federal agencies with mortality rate (per 100,000 residents) as the outcome and CMS 5-star quality rating as the primary explanatory variable of interest. Covariates, based on the prior literature, consisted of both facility- and community-level characteristics. Findings from our secondary analysis provide robust evidence of the association between nursing home quality and resident deaths due to the virus diminishing over time. In connection, we discuss plausible reasons, especially duration of staff shortages, that over time might have played a critical role in driving the quality-mortality convergence across nursing homes in the US.
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Affiliation(s)
- Debasree Das Gupta
- Department of Kinesiology and Health Science, Emma Eccles Jones College of Education and Human Services, Utah State University, Logan, Utah, United States of America
| | - Uma Kelekar
- School of Business, College of Business, Innovation, Leadership and Technology, Marymount University, Arlington, Virginia, United States of America
| | | | - Anupam A. Sule
- St. Joseph Mercy Oakland, Pontiac, Michigan, United States of America
| | - Taya G. Jerman
- Department of Kinesiology and Health Science, Emma Eccles Jones College of Education and Human Services, Utah State University, Logan, Utah, United States of America
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Kelekar U, Das Gupta D, Shepherd J, Sule A. Risk Factors of Fall-Related Emergency Department Visits by Fall Location of Older Adults in the US. West J Emerg Med 2021; 22:988-999. [PMID: 35354005 PMCID: PMC8328180 DOI: 10.5811/westjem.2021.2.49307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 02/24/2021] [Indexed: 11/11/2022] Open
Abstract
Introduction: Prior evidence indicates that predictors of older adult falls vary by indoor-outdoor location of the falls. While a subset of United States’ studies reports this finding using primary data from a single geographic area, other secondary analyses of falls across the country do not distinguish between the two fall locations. Consequently, evidence at the national level on risk factors specific to indoor vs outdoor falls is lacking.
Methods: Using the 2017 Nationwide Emergency Department Sample (NEDS) data, we conducted a multivariable analysis of fall-related emergency department (ED) visits disaggregated by indoor vs outdoor fall locations of adults 65 years and older (N = 6,720,937) in the US.
Results: Results are compatible with findings from previous primary studies. While women (relative risk [RR] = 1.43, 95% confidence interval [CI], 1.42-1.44) were more likely to report indoor falls, men were more likely to present with an outdoor fall. Visits for indoor falls were highest among those 85 years and older (RR = 2.35, 95% CI, 2.33-2.37) with outdoor fall visits highest among those 84 years and younger. Additionally, the probabilities associated with an indoor fall in the presence of chronic conditions were consistently much higher when compared to an outdoor fall. We also found that residence in metropolitan areas increased the likelihood of an indoor elderly fall compared to higher outdoor fall visits from seniors in non-core rural areas, but both indoor and outdoor fall visits were higher among older adults in higher income ZIP codes.
Conclusion: Our findings highlight the contrasting risk profile for elderly ED patients who report indoor vs outdoor falls when compared to the elderly reporting no falls. In conjunction, we highlight implications from three perspectives: a population health standpoint for EDs working with their primary care and community care colleagues; an ED administrative vantage point; and from an individual emergency clinician’s point of view.
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Affiliation(s)
- Uma Kelekar
- Marymount University, College of Business, Innovation, Leadership and Technology, Division of Health Care Management, Arlington, Virginia
| | - Debasree Das Gupta
- Utah State University, Department of Kinesiology and Health Science, Logan, Utah
| | - Jewel Shepherd
- University of South Dakota, Beacom School of Business, Vermillion, South Dakota
| | - Anupam Sule
- St. Joseph Mercy Oakland, Department of Informatics and Outcomes, Pontiac, Michigan
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Naavaal S, Kelekar U, Shah S. Opioid and Nonopioid Analgesic Prescriptions for Dental Visits in the Emergency Department, 2015-2017 National Hospital Ambulatory Medical Care Survey. Prev Chronic Dis 2021; 18:E58. [PMID: 34114544 PMCID: PMC8220966 DOI: 10.5888/pcd18.200571] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Prescription and nonprescription opioid misuse and the rising number of dental visits in emergency departments (EDs) are growing public health concerns in the US. Our study objective was to examine the relationship between prescription analgesics (opioids and nonopioids) and the type of ED visits (dental and nondental) at the national level. METHODS We used data from the 2015-2017 National Hospital Ambulatory Medical Care Survey to examine the association between opioid, nonopioid, and combination of opioid and nonopioid analgesic prescriptions and dental and nondental visits in the ED. Covariates included socioeconomic variables, time of visit, provider type, triage level, hospital location (urban vs rural), and pain level. We conducted descriptive, bivariate, and multivariable analyses using weighted estimates. RESULTS The final study sample included 57,098 ED visits from approximately 6 million dental and 414 million nondental visits to EDs during 2015-2017 nationally. Among dental visits, 20.8% received nonopioid analgesics (vs 23.4% among nondental visits), 36.6% received opioid analgesics (vs 14.0% among nondental visits), and 17.7% received both opioids and nonopioid analgesics (vs 8.7% among nondental visits). Adjusted multinomial logistic regression model indicated that, compared with nondental visits, dental visits had 4.8, 1.9, and 3.4 times higher likelihood of receipt of an opioid, nonopioid, or both opioid and nonopioid analgesic prescription, respectively, in the ED than no analgesic prescriptions. CONCLUSION Dental visits resulted in receipt of a significantly higher proportion of opioid prescriptions compared with nondental visits during 2015-2017. The study findings highlight the need for developing interventions to reduce opioid prescriptions in the ED, especially for dental visits.
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Affiliation(s)
- Shillpa Naavaal
- Department of Dental Public Health and Policy, School of Dentistry, Virginia Commonwealth University, Richmond, Virginia.,Oral Health Equity Core, Institute for Inclusion, Inquiry and Innovation, Virginia Commonwealth University, Richmond, Virginia.,1101 E Leigh St, Richmond, Virginia 23298.
| | - Uma Kelekar
- School of Business, College of Business, Innovation, Leadership and Technology, Marymount University, Arlington, Virginia
| | - Shital Shah
- Department of Health Systems Management, Rush University, Chicago, Illinois.,Department of Emergency Medicine, Rush University Medical Center, Chicago, Illinois
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Claiborne DM, Kelekar U, Shepherd JG, Naavaal S. Emergency department use for nontraumatic dental conditions among children and adolescents: NEDS 2014-2015. Community Dent Oral Epidemiol 2021; 49:594-601. [PMID: 33755217 DOI: 10.1111/cdoe.12631] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 01/13/2021] [Accepted: 02/03/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Despite great efforts to improve paediatric dental care access in the last two decades, the use of emergency departments (ED) for dental conditions among children that are more appropriately addressed in dental offices remains a public health concern in the United States. We examined factors associated with ED visits for nontraumatic dental conditions or NTDCs and ED visits for any other reason among children and adolescents. METHODS A retrospective secondary data analysis of ED visits was conducted using the 2014-2015 Nationwide Emergency Department Sample (NEDS) data. NTDCs were further categorized as diseases of hard tissue (eg dental caries), pulp/periapical (eg root canal infections), gingival/periodontal (eg conditions that affect the supporting tissues) and other. We included patient/socioeconomic characteristics, disposition, time of visit, and the Grouped Charlson Comorbidity Index (GRPCI) in our analysis. Bivariate associations were tested using chi-squared test (α = 0.05). RESULTS There were 70 616 194 ED visits in 2014-15, with 465 353 (0.7%) visits for NTDCs. Statistically significant differences were observed for all patient characteristics tested, except for gender when comparing children visiting the ED for NTDCs and children visiting for any other reason. Medicaid was the expected payer for nearly 60% of all ED visits, and the uninsured shared a larger proportion of NTDC visits (19.4%) than other visits (8.8%). Late adolescents (aged 18-21) accounted for over 50% of NTDC visits but only one-fifth of all other types of ED visits. Late adolescents (18-21 years old) who were uninsured had a significantly higher proportion of NTDC visits. Of all NTDC visits, 19.1% were related to hard tissue disease, 25.3% pulp/periapical, 7.9% periodontal disease, and the remaining were grouped as other dental diseases. CONCLUSIONS The ED use for NTDCs is more common among late adolescents, Medicaid and uninsured groups. Examining and implementing new approaches that improve access to routine dental care for these groups may help in reducing inefficient ED use related to NTDCs.
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Affiliation(s)
- Denise M Claiborne
- Gene W. Hirschfeld School of Dental Hygiene, Old Dominion University, Norfolk, VA, USA
| | - Uma Kelekar
- School of Business, Innovation, Leadership and Technology, Marymount University, Arlington, VA, USA
| | | | - Shillpa Naavaal
- Dental Public Health and Policy, School of Dentistry, Virginia Commonwealth University, Richmond, VA, USA.,Oral Health in Childhood and Adolescence Core, Institute for Inclusion, Inquiry and Innovation, Virginia Commonwealth University, Richmond, VA, USA
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Das Gupta D, Kelekar U, Rice D. Associations between living alone, depression, and falls among community-dwelling older adults in the US. Prev Med Rep 2020; 20:101273. [PMID: 33354494 PMCID: PMC7744925 DOI: 10.1016/j.pmedr.2020.101273] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 11/24/2020] [Indexed: 12/26/2022] Open
Abstract
Social isolation is closely linked to depression and falls in late life and are common among seniors. Although the literature has highlighted age-related variations in these three geriatric conditions, evidence on heterogeneities across older adult age categories is lacking. To address this gap, we present cross-sectional analyses using indicators of social isolation, depression, and falls of older adults constructed from the most recent Behavioral Risk Factor Surveillance System (BRFSS) data. An age-based understanding is critical to improve health interventions since health changes occur at a faster rate among seniors than in any other population subgroup. We included all adults 60 years and older (n = 113,233) in the 2018 BRFSS landline dataset and used the status of living alone, depressive disorder diagnosis, and fall incidences reported by these seniors to respectively create the social isolation, depression, and fall indicators. We conducted multivariable logistic regressions to compare findings on these indicators across the three age categories of 60-69, 70-79, and 80 and above after adjusting for a common set of covariates. Results indicate that the likelihood of seniors living alone and reporting depression is the highest among those 80 years and above. Conversely, the odds of depressed seniors reporting falls is the greatest among the 60-69 year olds. Accordingly, we highlight key implications for targeted health promotion and care delivery to seniors.
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Affiliation(s)
- Debasree Das Gupta
- Department of Kinesiology and Health Science, Emma Eccles Jones College of Education and Human Services, Utah State University, 7000 Old Main Hill, Logan, UT
| | - Uma Kelekar
- Department Chair/Program Director of Healthcare Management, School of Business, Ideation, Leadership and Technology, Marymount University, Arlington, VA
| | - Dominique Rice
- Department of Kinesiology and Health Science, Emma Eccles Jones College of Education and Human Services, Utah State University
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Kelekar U, Naavaal S. Dental visits and associated emergency department-charges in the United States: Nationwide Emergency Department Sample, 2014. J Am Dent Assoc 2019; 150:305-312.e1. [PMID: 30922460 DOI: 10.1016/j.adaj.2018.11.021] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 11/26/2018] [Accepted: 11/26/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Use of hospital emergency department (ED) for dental care is on the rise. This study estimates the total ED dental visits and determines mean charges by the type of disease and other patient characteristics. METHODS Using the first-listed diagnosis from the 2014 National Emergency Department Sample, the number and types of dental visits in the ED were identified and descriptive statistics were summarized. Using bivariate analyses, we determined the mean ED charges for adults and children by the type of dental disease and other sociodemographic correlates, comorbidity index, income, disposition, and payer. RESULTS There were 2.43 million dental-related ED visits in 2014 with average charge of $992: $994 for adults and $971 for children under age 18. Bivariate analyses suggested that ED visits were higher among adults aged 19 through 45, those from urban areas, low-income neighborhoods, with higher comorbidity index, or those uninsured/Medicaid. A P-value of ≤ .05 was considered significant. CONCLUSIONS High number of ED visits result due to dental problems. Our results provide most current estimates of volume and charges of dental-related ED visits. PRACTICAL IMPLICATIONS Dental treatment in emergency room is costly. Collaborative care approaches need to be identified and tested to provide effective care for dental patients in the ED.
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Abstract
INTRODUCTION Poor oral health is associated with lost hours at work or school, which may affect a person's productivity. The objective of our study was to estimate work or school hours lost to dental visits among adults aged 18 and older by the types of visits (emergency or unplanned; routine, planned, or orthodontic; or cosmetic) and to determine the factors associated with hours lost. METHODS We used the most recent Oral Health Supplement data, from the 2008 National Health Interview Survey (NHIS), to estimate the total hours lost at work or school for dental visits among adults in the United States. The associations of the hours lost in unplanned and planned dental visits with socioeconomic characteristics, oral health status, and affordability were calculated. We used χ2 tests and logistic regression to determine associations at P < .05. RESULTS An average of 320.8 million work or school hours were lost annually for dental care in the United States, of which 92.4 million hours were for emergency (unplanned) care (0.99 h/adult), 159.8 million for routine (planned) care or orthodontic care (1.71 h/adult), and 68.6 million for cosmetic care (0.73 h/adult). Adults with poor oral health were more likely to lose one or more hours in unplanned dental visits (OR = 5.60; 95% confidence interval [CI], 3.25-9.63) than those who reported very good oral health. Not being able to afford dental care was positively associated with more work hours lost in unplanned care (odds ratio [OR] = 2.56; 95% CI, 1.76-3.73). Compared with Hispanic adults, non-Hispanic white adults (OR = 2.09; 95% CI, 1.40-3.11) and non-Hispanic Asian adults and adults of other races/ethnicities (OR =1.91; 95% CI, 1.06-3.47) were more likely to lose any hours for planned care. Consistently, those with more than a high school education were more likely to lose any hours in planned care (OR = 1.39; 95% CI, 1.06-1.83) than those with a high school education or less. CONCLUSIONS Dental problems result in hours lost from work and may adversely affect a person's productivity. There is disparity in lost hours at work by race/ethnicity and dental care affordability.
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Affiliation(s)
- Uma Kelekar
- Department of Health Care Management and Legal Studies, Marymount University, Arlington, VA 22207.
| | - Shillpa Naavaal
- Department of Oral Health Promotion and Community Outreach, Philips Institute for Oral Health Research, Virginia Commonwealth University, Richmond, Virginia
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Kelekar U. Oral Health Matters in Bending the Cost Curve. World Medical & Health Policy 2017. [DOI: 10.1002/wmh3.240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Kelekar U, Llanto G. Evidence of horizontal and vertical interactions in health care spending in the Philippines. Health Policy Plan 2014; 30:853-62. [PMID: 25148843 DOI: 10.1093/heapol/czu086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2014] [Indexed: 11/13/2022] Open
Abstract
This article examines whether within a decentralized system of health care spending, local government units in developing countries have any incentive to compete with one another. The existence of spatial competition, whether horizontal or vertical, is tested in the case of Philippines using local government health expenditures data. Results indicate that health spending is characterized by a strong positive interaction between municipalities, consistent with the existence of a horizontal fiscal interaction. However, the results provide less support for the existence of vertical externalities, with the interaction of municipalities with provinces being positive and marginally significant.
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Affiliation(s)
- Uma Kelekar
- School of Business Administration, Marymount University, 1000, North Glebe Road Arlington, Virginia 22201, USA and
| | - Gilberto Llanto
- Philippine Institute for Development Studies, NEDA sa Makati Building, 106 Amorsolo Street, Legaspi Village 1229, Makati City, Philippines
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Kelekar U. Fiscal competition in health spending among local governments in the Philippines. WHO South East Asia J Public Health 2013; 2:198-200. [PMID: 28615598 DOI: 10.4103/2224-3151.206769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The Philippines is one of several Asian countries that has decentralized the provision of health care to its local governments in recent decades. In the context of decentralization, a few studies have previously examined the issue of fiscal competition among local governments in the developing world. This report presents a summary of a published study that examined the existence of inter-jurisdictional competition in health-care spending in the Philippines. The results indicate the presence of positive fiscal "spillovers" in health spending, consistent with municipalities/cities competing to outspend their neighbours. Several potential explanations forthis finding are discussed.
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Affiliation(s)
- Uma Kelekar
- School of Business Marymount University, Arlington, VA, United States of America
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Kelekar U, Liu X. Why should 'geography' matter to public health managers? IJBPM 2013. [DOI: 10.1504/ijbpm.2013.056870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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17
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Kelekar U. Do Local Government Units (LGUS) Interact Fiscally While Providing Public Health Services In The Philippines? World Med & Health Policy 2012. [DOI: 10.1515/1948-4682.1233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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