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Lohman MC, Wei J, Bawa EM, Fallahi A, Verma M, Merchant AT. Longitudinal Associations of Diet, Food Insecurity, and Supplemental Nutrition Assistance Program Use with Global Cognitive Performance in Middle-Aged and Older Adults. J Nutr 2024; 154:714-721. [PMID: 38158186 DOI: 10.1016/j.tjnut.2023.12.042] [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: 10/13/2023] [Revised: 11/29/2023] [Accepted: 12/26/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND Diet quality, food access, and food assistance policies may be key modifiable factors related to cognitive decline. OBJECTIVE We aimed to evaluate whether diet quality, food insecurity, and Supplemental Nutrition Assistance Program (SNAP) use are associated with longitudinal changes in cognition among older adults in the United States. METHODS Food intake data from the Health Care and Nutrition Study were linked with longitudinal health information from 5 waves of the Health and Retirement Study (2012-2020). The analytic sample (n = 6968) included community-dwelling United States adults aged ≥51 y without cognitive impairment. Global cognition was measured using a telephone-based cognitive status interview (range: 0-27). Diet quality was measured with the Healthy Eating Index, using participants' average intake of 13 dietary components. Questions regarding food access and affordability were used to determine food insecurity and use of SNAP benefits. Linear mixed-effects regression models were used to estimate longitudinal associations between diet-related factors and cognitive score changes. RESULTS Poorer diets [β: -0.24; 95% confidence interval (CI): -0.33, -0.15], food insecurity (β: -1.08; 95% CI: -1.31, -0.85), and SNAP use (β: -0.57; 95% CI: -0.82, -0.32) were associated with lower baseline cognitive scores. Poorer diets (β: -0.17; 95% CI: -0.29, -0.05) and food insecurity (β: -0.23; 95% CI: -0.47, -0.01) were associated with significantly steeper declines in cognitive scores over time, after 8 and 2 y of follow-up, respectively; however, SNAP use was not significantly associated with the rate of cognitive decline over time. Estimates were qualitatively similar when restricting the sample to participants aged ≥65 y. CONCLUSIONS Results suggest that food access and adherence to healthy diet recommendations may be important elements to maintain cognitive health in aging. SNAP benefits may be insufficient to prevent negative cognitive effects of poor diet and limited access to nutritious foods.
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Affiliation(s)
- Matthew C Lohman
- Department of Epidemiology and Biostatistics, University of South Carolina, Arnold School of Public Health, Columbia, SC, United States.
| | - Jingkai Wei
- Department of Epidemiology and Biostatistics, University of South Carolina, Arnold School of Public Health, Columbia, SC, United States
| | - Eric Mishio Bawa
- Department of Epidemiology and Biostatistics, University of South Carolina, Arnold School of Public Health, Columbia, SC, United States
| | - Afsaneh Fallahi
- Department of Epidemiology and Biostatistics, University of South Carolina, Arnold School of Public Health, Columbia, SC, United States
| | - Mansi Verma
- Department of Epidemiology and Biostatistics, University of South Carolina, Arnold School of Public Health, Columbia, SC, United States
| | - Anwar T Merchant
- Department of Epidemiology and Biostatistics, University of South Carolina, Arnold School of Public Health, Columbia, SC, United States
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Alhasan DM, Larson G, Lohman MC, Cai B, LaPorte FB, Miller MC, Jackson WB, MacNell NS, Hirsch JA, Jackson CL. Features of the Physical and Social Neighborhood Environment and Neighborhood-Level Alzheimer's Disease and Related Dementia in South Carolina. Environ Health Perspect 2024; 132:27013. [PMID: 38416540 PMCID: PMC10901285 DOI: 10.1289/ehp13183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 01/16/2024] [Accepted: 01/26/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND Studies are increasingly examining the relationship between the neighborhood environment and cognitive decline; yet, few have investigated associations between multiple neighborhood features and Alzheimer's disease and related dementias (ADRD). OBJECTIVE We investigated the relationship between neighborhood features and ADRD cumulative incidence from 2010 to 2014 in the South Carolina Alzheimer's Disease Registry (SCADR). METHODS Diagnosed ADRD cases ≥ 50 years of age were ascertained from the SCADR by ZIP code and census tract. Neighborhood features from multiple secondary sources included poverty, air pollution [particulate matter with a diameter of 2.5 micrometers or less (PM 2.5 )], and rurality at the census-tract level and access to healthy food, recreation facilities, and diabetes screening at the county level. In addition to using Poisson generalized linear regression to estimate ADRD incident rate ratios (IRR) with 95% confidence intervals (CIs), we applied integrated nested Laplace approximations and stochastic partial differential equations (INLA-SPDE) to address disparate spatial scales. We estimated associations between neighborhood features and ADRD cumulative incidence. RESULTS The average annual ADRD cumulative incidence was 690 per 100,000 people per census tract (95% CI: 660, 710). The analysis was limited to 98% of census tracts with a population ≥ 50 years old (i.e., 1,081 of 1,103). The average percent of families living below the federal poverty line per census tract was 18.8%, and ∼ 20 % of census tracts were considered rural. The average percent of households with limited access to healthy food was 6.4%. In adjusted models, every 5 μ g / m 3 ) increase of PM 2.5 was associated with 65% higher ADRD cumulative incidence (IRR = 1.65 ; 95% CI: 1.30, 2.09), where PM 2.5 at or below 12 μ g / m 3 is considered healthy. Compared to large urban census tracts, rural and small urban tracts had 10% (IRR = 1.10 ; 95% CI: 1.00, 1.23) and 5% (IRR = 1.05 ; 95% CI: 0.96, 1.16) higher ADRD, respectively. For every percent increase of the county population with limited access to healthy food, ADRD was 2% higher (IRR = 1.02 ; 95% CI: 1.01, 1.04). CONCLUSIONS Neighborhood environment features, such as higher air pollution levels, were associated with higher neighborhood ADRD incidence. The INLA-SPDE method could have broad applicability to data collected across disparate spatial scales. https://doi.org/10.1289/EHP13183.
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Affiliation(s)
- Dana M. Alhasan
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, North Carolina, USA
| | - Gary Larson
- Social & Scientific Systems, Inc., a DLH Holdings Company, Durham, North Carolina, USA
| | - Matthew C. Lohman
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Bo Cai
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Frankie B. LaPorte
- Social & Scientific Systems, Inc., a DLH Holdings Company, Durham, North Carolina, USA
| | - Maggi C. Miller
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - W. Braxton Jackson
- Social & Scientific Systems, Inc., a DLH Holdings Company, Durham, North Carolina, USA
| | - Nathaniel S. MacNell
- Social & Scientific Systems, Inc., a DLH Holdings Company, Durham, North Carolina, USA
| | - Jana A. Hirsch
- Urban Health Collaborative, Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| | - Chandra L. Jackson
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, North Carolina, USA
- Intramural Program, National Institute on Minority Health and Health Disparities, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland, USA
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Wende ME, Lohman MC, Friedman DB, McLain AC, LaMonte MJ, Whitsel EA, Shadyab AH, Garcia L, Chrisinger BW, Pan K, Bird CE, Sarto GE, Kaczynski AT. Neighborhood Socioeconomic Status, Green Space, and Walkability and Risk for Falls Among Postmenopausal Women: The Women's Health Initiative. Womens Health Issues 2023; 33:443-458. [PMID: 37149415 PMCID: PMC10330171 DOI: 10.1016/j.whi.2023.03.009] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 03/01/2023] [Accepted: 03/24/2023] [Indexed: 05/08/2023]
Abstract
PURPOSE This study estimated associations between neighborhood socioeconomic status (NSES), walkability, green space, and incident falls among postmenopausal women and evaluated modifiers of these associations, including study arm, race and ethnicity, baseline household income, baseline walking, age at enrollment, baseline low physical functioning, baseline fall history, climate region, and urban-rural residence. METHODS The Women's Health Initiative recruited a national sample of postmenopausal women (50-79 years) across 40 U.S. clinical centers and conducted yearly assessments from 1993 to 2005 (n = 161,808). Women reporting a history of hip fracture or walking limitations were excluded, yielding a final sample of 157,583 participants. Falling was reported annually. NSES (income/wealth, education, occupation), walkability (population density, diversity of land cover, nearby high-traffic roadways), and green space (exposure to vegetation) were calculated annually and categorized into tertiles (low, intermediate, high). Generalized estimating equations assessed longitudinal relationships. RESULTS NSES was associated with falling before adjustment (high vs. low, odds ratio, 1.01; 95% confidence interval, 1.00-1.01). Walkability was significantly associated with falls after adjustment (high vs. low, odds ratio, 0.99; 95% confidence interval, 0.98-0.99). Green space was not associated with falling before or after adjustment. Study arm, race and ethnicity, household income, age, low physical functioning, fall history, and climate region modified the relationship between NSES and falling. Race and ethnicity, age, fall history, and climate region modified relationships between walkability and green space and falling. CONCLUSIONS Our results did not show strong associations of NSES, walkability, or green space with falling. Future research should incorporate granular environmental measures that may directly relate to physical activity and outdoor engagement.
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Affiliation(s)
- Marilyn E Wende
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina.
| | - Matthew C Lohman
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Daniela B Friedman
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Alexander C McLain
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Michael J LaMonte
- Deparment of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York
| | - Eric A Whitsel
- Department of Epidemiology, Gillings School of Global Public Health and Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Aladdin H Shadyab
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, California
| | - Lorena Garcia
- Department of Public Health Sciences, School of Medicine, University of California Davis, Davis, California
| | - Benjamin W Chrisinger
- Department of Social Policy and Intervention, Division of Social Sciences, University of Oxford, Oxford, UK
| | - Kathy Pan
- Department of Medical Oncology and Hematology, Downey Medical Center, Kaiser Permanente, Downey, California
| | - Chloe E Bird
- RAND Corporation, Santa Monica, California; Center for Health Equity Research, Tufts Medical Center, Boston, Massachusetts; Tufts University School of Medicine, Boston, Massachusetts
| | - Gloria E Sarto
- Department of Obstetrics and Gynecology, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin
| | - Andrew T Kaczynski
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina; Prevention Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
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Wei J, Xu H, Liese AD, Merchant AT, Wang L, Yang CH, Lohman MC, Brown MJ, Wang T, Friedman DB. Ten-Year Cardiovascular Disease Risk Score and Cognitive Function Among Older Adults: The National Health and Nutrition Examination Survey 2011 to 2014. J Am Heart Assoc 2023:e028527. [PMID: 37249049 PMCID: PMC10381993 DOI: 10.1161/jaha.122.028527] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Background The Framingham 10-year cardiovascular disease risk score, which is based on age, sex, smoking, total cholesterol, high-density lipoprotein-cholesterol, blood pressure, and diabetes, has been found to be associated with cognitive health, but these findings have not been validated in a representative sample in the United States. We aimed to examine the associations of Framingham risk score with cognitive function among older adults in a nationally representative sample, as well as by race or ethnicity, education, and family income. Methods and Results A total of 2254 older adults ≥60 years (57% female, 79% non-Hispanic White) in the National Health and Nutrition Examination Survey 2011 to 2014 were included in the final sample for analysis. All components of the Framingham risk score were obtained with questionnaire or measured in the laboratory. Cognitive function was examined using the Consortium to Establish a Registry for Alzheimer's Disease Word List Memory Task (immediate and delayed memory), Digit Symbol Substitution Test, and Animal Fluency Test. Multivariable linear regression models were used to assess the associations between Framingham risk score and test-specific and global cognition Z scores. Each incremental 5% in Framingham 10-year cardiovascular disease risk was associated with lower Z scores for Digit Symbol Substitution Test (β=-0.06 [95% CI, -0.09 to -0.03]), delayed memory (β=-0.05 [95% CI, -0.08 to -0.01]), immediate memory (β=-0.07 [95% CI, -0.10 to -0.03]), and global cognition (β=-0.05 [95% CI, -0.09 to -0.02]). Socioeconomic status, particularly race or ethnicity and monthly income levels, were strong effect measure modifiers of the associations. Conclusions Lower cardiovascular risk factors are associated with better cognitive function.
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Affiliation(s)
- Jingkai Wei
- Department of Epidemiology and Biostatics, Arnold School of Public Health University of South Carolina Columbia SC USA
- Office for the Study of Aging, Arnold School of Public Health University of South Carolina Columbia SC USA
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health University of South Carolina Columbia SC USA
| | - Hanzhang Xu
- Department of Family Medicine and Community Health, School of Medicine Duke University Durham SC USA
- School of Nursing Duke University Durham SC USA
| | - Angela D Liese
- Department of Epidemiology and Biostatics, Arnold School of Public Health University of South Carolina Columbia SC USA
- Office for the Study of Aging, Arnold School of Public Health University of South Carolina Columbia SC USA
| | - Anwar T Merchant
- Department of Epidemiology and Biostatics, Arnold School of Public Health University of South Carolina Columbia SC USA
- Office for the Study of Aging, Arnold School of Public Health University of South Carolina Columbia SC USA
| | - Liang Wang
- Department of Public Health, Robbins College of Health and Human Sciences Baylor University Waco TX USA
| | - Chih-Hsiang Yang
- Office for the Study of Aging, Arnold School of Public Health University of South Carolina Columbia SC USA
- Department of Exercise Sciences, Arnold School of Public Health University of South Carolina Columbia SC USA
| | - Matthew C Lohman
- Department of Epidemiology and Biostatics, Arnold School of Public Health University of South Carolina Columbia SC USA
- Office for the Study of Aging, Arnold School of Public Health University of South Carolina Columbia SC USA
| | - Monique J Brown
- Department of Epidemiology and Biostatics, Arnold School of Public Health University of South Carolina Columbia SC USA
- Office for the Study of Aging, Arnold School of Public Health University of South Carolina Columbia SC USA
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health University of South Carolina Columbia SC USA
- Rural and Minority Health Research Center, Arnold School of Public Health University of South Carolina Columbia SC USA
| | - Tiansheng Wang
- Department of Epidemiology, Gillings School of Global Public Health University of North Carolina at Chapel Hill Chapel Hill NC USA
| | - Daniela B Friedman
- Office for the Study of Aging, Arnold School of Public Health University of South Carolina Columbia SC USA
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health University of South Carolina Columbia SC USA
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Gwanzura C, Gavi S, Mangiza M, Moyo FV, Lohman MC, Nhemachena T, Chipato T. Effect of anesthesia administration method on apgar scores of infants born to women undergoing elective cesarean section. BMC Anesthesiol 2023; 23:142. [PMID: 37106343 PMCID: PMC10134612 DOI: 10.1186/s12871-023-02098-w] [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: 09/25/2022] [Accepted: 04/19/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Neonatal health at delivery as measured by apgar scores is an important outcome. This study was done to assess the impact of anesthesia on Apgar 1-minute and 5-minute scores of infants delivered through elective cesarean section in Zimbabwe. METHODS We carried out a secondary analysis of data from the Efficacy of Tranexamic Acid in Preventing Postpartum Hemorrhage (ETAPPH) clinical trial in Zimbabwe. Outcomes measured were infant Apgar scores at 1 and 5 min, exposure was the administration of either a general (intravenous propofol/ketamine/sodium thiopental) or spinal (hyperbaric bupivacaine 0.5%) anesthesia for anesthesia during the elective cesarean section procedure. Marginal Structural Logistic Modelling (MSM) using an unstabilized Inverse Probability Treatment Weight (IPTW) estimator was used to assess the relationship between anesthetic administration method and infant Apgar scores. RESULTS Four hundred and twenty-one (421) women who had an elective caesarean section in the ETAPPH study had their infants assessed for Apgar scores. Comparing general anesthesia to spinal anesthesia, spinal anesthesia was related to good Apgar scores at 1-minute (adjusted odds ratio [aOR] = 4.0, 95% Confidence Interval = 1.5-10.7, sensitivity analysis E-value = 3.41). Spinal anesthetic administration was also related to good Apgar scores at 5 min (adjusted odds ratio [aOR] = 6.2, 95% Confidence Interval = 1.6-23.1, sensitivity analysis E-value = 4.42). CONCLUSIONS When providing anesthesia for patients undergoing elective cesarean section, care should be taken on the method of administration of anesthetic agents. General anesthesia tends to depress Apgar scores at 1 min, although most neonates recover and have better scores at 5 min. Spinal anesthesia should be the first choice whenever possible. TRIAL REGISTRATION The clinical trial from which data of this study was abstracted was registered under clinical trials registration number NCT04733157.
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Affiliation(s)
- Chipo Gwanzura
- Department of Obstetrics and Gynecology, Faculty of Medicine and Health Science, University of Zimbabwe, Harare, Zimbabwe
| | - Samuel Gavi
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA.
| | - Marcia Mangiza
- Department of Pediatrics, Faculty of Medicine and Health Science, University of Zimbabwe, Harare, Zimbabwe
| | - Faith Vhenekai Moyo
- Department of Anesthesia and Critical Care Medicine, Sally Mugabe Central Hospital, PO Box ST14 Southerton, Harare, Zimbabwe
| | - Matthew C Lohman
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA
| | - Taazadza Nhemachena
- Department of Obstetrics and Gynecology, Faculty of Medicine and Health Science, University of Zimbabwe, Harare, Zimbabwe
| | - Tsungai Chipato
- Department of Obstetrics and Gynecology, Faculty of Medicine and Health Science, University of Zimbabwe, Harare, Zimbabwe
- Clinical Trials Research Centre, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
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Kuffel RL, Morin RT, Covinsky KE, Boscardin WJ, Lohman MC, Li Y, Byers AL. Association of Frailty With Risk of Suicide Attempt in a National Cohort of US Veterans Aged 65 Years or Older. JAMA Psychiatry 2023; 80:287-295. [PMID: 36811913 PMCID: PMC9947807 DOI: 10.1001/jamapsychiatry.2022.5144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 12/11/2022] [Indexed: 02/24/2023]
Abstract
Importance Frailty is associated with reduced physiological reserve, lack of independence, and depression and may be salient for identifying older adults at increased risk of suicide attempt. Objectives To examine the association between frailty and risk of suicide attempt and how risk differs based on components of frailty. Design, Setting, and Participants This nationwide cohort study integrated databases from the US Department of Veterans Affairs (VA) inpatient and outpatient health care services, Centers for Medicare & Medicaid Services data, and national suicide data. Participants included all US veterans aged 65 years or older who received care at VA medical centers from October 1, 2011, to September 30, 2013. Data were analyzed from April 20, 2021, to May 31, 2022. Exposures Frailty, defined based on a validated cumulative-deficit frailty index measured using electronic health data and categorized into 5 levels: nonfrailty, prefrailty, mild frailty, moderate frailty, and severe frailty. Main Outcomes and Measures The main outcome was suicide attempts through December 31, 2017, provided by the national Suicide Prevention Applications Network (nonfatal attempts) and Mortality Data Repository (fatal attempts). Frailty level and components of the frailty index (morbidity, function, sensory loss, cognition and mood, and other) were assessed as potential factors associated with suicide attempt. Results The study population of 2 858 876 participants included 8955 (0.3%) who attempted suicide over 6 years. Among all participants, the mean (SD) age was 75.4 (8.1) years; 97.7% were men, 2.3% were women, 0.6% were Hispanic, 9.0% were non-Hispanic Black, 87.8% were non-Hispanic White, and 2.6% had other or unknown race and ethnicity. Compared with patients without frailty, risk of suicide attempt was uniformly higher among patients with prefrailty to severe frailty, with adjusted hazard ratios (aHRs) of 1.34 (95% CI, 1.27-1.42; P < .001) for prefrailty, 1.44 (95% CI, 1.35-1.54; P < .001) for mild frailty, 1.48 (95% CI, 1.36-1.60; P < .001) for moderate frailty, and 1.42 (95% CI, 1.29-1.56; P < .001) for severe frailty. Lower levels of frailty were associated with greater risk of lethal suicide attempt (aHR, 1.20 [95% CI, 1.12-1.28] for prefrail veterans). Bipolar disorder (aHR, 2.69; 95% CI, 2.54-2.86), depression (aHR, 1.78; 95% CI, 1.67-1.87), anxiety (aHR, 1.36; 95% CI, 1.28-1.45), chronic pain (aHR, 1.22; 95% CI, 1.15-1.29), use of durable medical equipment (aHR, 1.14; 95% CI, 1.03-1.25), and lung disease (aHR, 1.11; 95% CI, 1.06-1.17) were independently associated with increased risk of suicide attempt. Conclusions and Relevance This cohort study found that among US veterans aged 65 years or older, frailty was associated with increased risk of suicide attempts and lower levels of frailty were associated with greater risk of suicide death. Screening and involvement of supportive services across the spectrum of frailty appear to be needed to help reduce risk of suicide attempts.
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Affiliation(s)
- Randall L. Kuffel
- San Francisco VA Health Care System, San Francisco, California
- Northern California Institute for Research and Education, San Francisco
| | - Ruth T. Morin
- San Francisco VA Health Care System, San Francisco, California
- Hoag Memorial Hospital Presbyterian, Newport Beach, California
| | - Kenneth E. Covinsky
- Division of Geriatrics, Department of Medicine, University of California, San Francisco
| | - W. John Boscardin
- Division of Geriatrics, Department of Medicine, University of California, San Francisco
| | - Matthew C. Lohman
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia
| | - Yixia Li
- San Francisco VA Health Care System, San Francisco, California
- Northern California Institute for Research and Education, San Francisco
| | - Amy L. Byers
- San Francisco VA Health Care System, San Francisco, California
- Department of Psychiatry and Medicine, University of California, San Francisco
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Lohman MC, Fallahi A, Mishio Bawa E, Wei J, Merchant AT. Social Mediators of the Association Between Depression and Falls Among Older Adults. J Aging Health 2023:8982643231152276. [PMID: 36633960 DOI: 10.1177/08982643231152276] [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] [Indexed: 01/13/2023]
Abstract
OBJECTIVES To investigate the role of social factors in the association between depression and falls among older adults. METHODS The sample included data from 3443 older adults from three waves of the Health and Retirement Study (2010-2014). A Lifestyle Questionnaire was used to measure social engagement, social network contact, and neighborhood social context. Mediating effects of social factors were estimated through causal mediation analysis. Results: Poorer social engagement and network contact were associated with greater likelihood of falls, while poorer neighborhood context was associated with greater likelihood of fall injuries. Social engagement mediated a significant portion of the effect of depression on falls (OR: 1.03, 95% CI: 1.00, 1.06), and neighborhood context mediated a portion of the effect of depression on fall injuries (OR: 1.03, 95% CI: 1.00, 1.07). Discussion: The direct and indirect impacts of social factors suggest that considering them may help improve existing fall prevention approaches.
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Affiliation(s)
- Matthew C Lohman
- Department of Epidemiology and Biostatistics, 2629University of South Carolina, Arnold School of Public Health, Columbia, SC, USA
| | - Afsaneh Fallahi
- Department of Epidemiology and Biostatistics, 2629University of South Carolina, Arnold School of Public Health, Columbia, SC, USA
| | - Eric Mishio Bawa
- Department of Epidemiology and Biostatistics, 2629University of South Carolina, Arnold School of Public Health, Columbia, SC, USA
| | - Jingkai Wei
- Department of Epidemiology and Biostatistics, 2629University of South Carolina, Arnold School of Public Health, Columbia, SC, USA
| | - Anwar T Merchant
- Department of Epidemiology and Biostatistics, 2629University of South Carolina, Arnold School of Public Health, Columbia, SC, USA
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Resciniti NV, Farina MP, Merchant AT, Lohman MC. Depressive Symptoms Partially Mediate the Association of Frailty Phenotype Symptoms and Cognition for Females but Not Males. J Aging Health 2023; 35:42-49. [PMID: 35527693 PMCID: PMC9640765 DOI: 10.1177/08982643221100688] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES We aimed to evaluate whether depressive symptoms mediated the relationship between frailty phenotype and cognitive function by sex. METHODS Data came from the Health and Retirement Study from 2012-2016. The outcome was measured by Fried's frailty criteria, our outcome was continuous global cognition, and mediator was depressive symptoms. We used mediation analysis, stratified by sex, to estimate the direct and indirect effects of frailty symptoms on cognition mediated by depressive symptoms. RESULTS Males had a larger total effect (β= -0.43; 95% CI: -0.66, -0.02) for lower cognitive score for each increase in frailty symptom compared to females (β= -0.28; 95% CI: -0.47, -0.08). A significant indirect effect from frailty phenotype to cognition was found through depressive symptoms for females but not males. CONCLUSION These results highlight the importance of identifying individuals with frailty and depressive symptoms to monitor and provide interventions to preserve cognitive function.
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Affiliation(s)
- Nicholas V. Resciniti
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA
| | - Mateo P. Farina
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA
| | - Anwar T. Merchant
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Matthew C. Lohman
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
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Wei J, Yang CH, Lohman MC, Brown MJ, Friedman DB. Patterns of depressive symptoms over 16 Years with incident dementia: The Health and Retirement Study. J Psychiatr Res 2022; 156:485-490. [PMID: 36347108 DOI: 10.1016/j.jpsychires.2022.10.064] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 10/24/2022] [Accepted: 10/28/2022] [Indexed: 11/06/2022]
Abstract
The associations of patterns of depressive symptoms, including trajectories of depressive symptoms and significant depressive symptoms among older adults over a long period of time with incident dementia are not frequently studied. We aimed to examine the associations of patterns of depressive symptoms among older adults with incident dementia. Participants of the Health and Retirement Study from 1994 to 2018 with information of incident dementia and complete measurements of depressive symptoms were included. Depressive symptoms assessed on 8 waves between 1994 and 2010 using the 8-item Center for Epidemiologic Studies Depression (CES-D) Scale. Significant depressive symptoms were defined as ≥4 points in the CES-D. Trajectories of depressive symptoms and significant depressive symptoms were identified. Cox proportional hazards models were used to examine the associations of patterns of depressive symptoms with incident dementia. A total of 6317 participants were included in the analysis. Over the follow-up period of 8 years, trajectories of "increase from mild" (hazards ratio (HR): 1.84, 95% confidence interval (CI): 1.29, 2.63) and "persistently high" (HR: 1.76, 95% CI: 1.17, 2.65) depressive symptoms were associated with higher risk of incident dementia, after adjustment for covariates. Future studies are needed to examine the interaction of depression in different stages of life on incident dementia. Studies are also expected to estimate the effect of preventing dementia through reducing depressive symptoms.
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Affiliation(s)
- Jingkai Wei
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA; Office for the Study of Aging, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA; South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
| | - Chih-Hsiang Yang
- Office for the Study of Aging, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA; Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Matthew C Lohman
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA; Office for the Study of Aging, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Monique J Brown
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA; Office for the Study of Aging, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA; South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA; Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Daniela B Friedman
- Office for the Study of Aging, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA; Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
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10
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Alhasan DM, Lohman MC, Hirsch JA, Miller MC, Cai B, Jackson CL. Neighborhood characteristics and dementia symptomology among community-dwelling older adults with Alzheimer's disease. Front Aging Neurosci 2022; 14:937915. [PMID: 36204556 PMCID: PMC9530440 DOI: 10.3389/fnagi.2022.937915] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 08/31/2022] [Indexed: 01/05/2023] Open
Abstract
Background Neuropsychiatric symptoms (NPSs) lead to myriad poor health outcomes among individuals with Alzheimer's disease (AD). Prior studies have observed associations between the various aspects of the home environment and NPSs, but macro-level environmental stressors (e.g., neighborhood income) may also disrupt the neuronal microenvironment and exacerbate NPSs. Yet, to our knowledge, no studies have investigated the relationship between the neighborhood environment and NPSs. Methods Using 2010 data among older adults with AD collected from a sample of the South Carolina Alzheimer's Disease Registry, we estimated cross-sectional associations between neighborhood characteristics and NPSs in the overall population and by race/ethnicity. Neighborhood measures (within a 1/2-mile radius of residence) came from the American Community Survey and Rural Urban Commuting Area Code. We categorized median household income into tertiles: < $30,500, $30,500-40,000, and > $40,000, and rurality as: rural, small urban, and large urban. Residential instability was defined as the percent of residents who moved within the past year. NPSs were defined using the Neuropsychiatric Inventory Questionnaire that included the composite measure of all 12 domains. Adjusting for age, sex/gender, race/ethnicity, and caregiver educational attainment, we used negative binomial regression to estimate prevalence ratios (PR) and 95% confidence intervals (CI) for NPSs by neighborhood characteristics. Results Among 212 eligible participants, mean age was 82 ± 8.7 years, 72% were women, and 55% non-Hispanic (NH)-Black. Individuals with AD living in < $30,500 vs. > $40,000 income neighborhoods had a 53% (PR = 1.53; 95% CI = 1.06-2.23) higher prevalence of NPSs while individuals living in rural vs. large urban neighborhoods had a 36% lower prevalence of NPSs (PR = 0.64; 95% CI = 0.45-0.90), after adjustment. We did not observe an association between residential instability and NPSs (PR = 0.92; 95% CI = 0.86-1.00); however, our estimates suggested differences by race/ethnicity where NH-White older adults living in residential instable areas had lower NPSs (PR = 0.89; 95% CI = 0.82-0.96) compared to NH-Black older adults (PR = 0.96; 95% CI = 0.86-1.07). Discussion Across racial/ethnic groups, individuals with AD had more symptomology when living in lower income areas. Pending replication, intervention efforts should consider resource allocation to high-need neighborhoods (e.g., lower income), and studies should investigate underlying mechanisms for this relationship.
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Affiliation(s)
- Dana M Alhasan
- Epidemiology Branch, Department of Health and Human Services, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC, United States
| | - Matthew C Lohman
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Jana A Hirsch
- Urban Health Collaborative, Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, United States
| | - Maggi C Miller
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Bo Cai
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Chandra L Jackson
- Epidemiology Branch, Department of Health and Human Services, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC, United States.,Intramural Program, Department of Health and Human Services, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, United States
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11
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Abstract
OBJECTIVES Although there is a recognized association between depression and greater fall risk among older adults, the mechanisms explaining this association are unclear. This study evaluated the role of frailty, a common geriatric syndrome, in determining greater risk of falls among older adults with depression. METHOD We used longitudinal data from three biennial waves of the Health and Retirement Study (HRS; 2010-2014). The sample included community-dwelling survey respondents age ≥ 65 who participated in objective physiological measures. Major Depression (MD) was measured using Composite International Diagnostic Interview for depression short form. Frailty was measured using criteria outlined in the frailty phenotype model. Causal mediation analysis was used to differentiate the direct effect of depression and indirect effect mediated by frailty on falls, fall injuries, and multiple falls. RESULTS Major depression was associated with significantly greater odds of experiencing a fall (OR: 1.91; 95% CI: 1.31, 2.77), fall injury (OR: 1.86; 95% CI: 1.17, 2.95), and multiple falls (OR: 2.26; 95% CI: 1.52, 3.37) over a two-year period. Frailty was a significant mediator of the effects of depression on falls and multiple falls, accounting for approximately 18.9% and 21.3% of the total effects, respectively. We found no evidence of depression-frailty interaction. Sensitivity analyses showed that results were robust to unmeasured confounding and alternative operationalizations of depression. CONCLUSION Frailty explains a significant proportion of increased likelihood of falls among older adults with depression. Treatment and management of frailty symptoms may be an important components of fall prevention among older adults with depression.
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Affiliation(s)
- Matthew C. Lohman
- Department of Epidemiology and Biostatistics, University of South Carolina, Arnold School of Public Health, Columbia, SC
| | - Briana Mezuk
- Center for Social Epidemiology and Population Health, Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI
| | | | - Nicholas V. Resciniti
- Department of Epidemiology and Biostatistics, University of South Carolina, Arnold School of Public Health, Columbia, SC
| | - Anwar T. Merchant
- Department of Epidemiology and Biostatistics, University of South Carolina, Arnold School of Public Health, Columbia, SC
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12
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Yelton B, Friedman DB, Noblet S, Lohman MC, Arent MA, Macauda MM, Sakhuja M, Leith KH. Social Determinants of Health and Depression among African American Adults: A Scoping Review of Current Research. Int J Environ Res Public Health 2022; 19:ijerph19031498. [PMID: 35162519 PMCID: PMC8834771 DOI: 10.3390/ijerph19031498] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/14/2022] [Accepted: 01/24/2022] [Indexed: 02/04/2023]
Abstract
Depression in the United States (US) is increasing across all races and ethnicities and is attributed to multiple social determinants of health (SDOH). For members of historically marginalized races and ethnicities, depression is often underreported and undertreated, and can present as more severe. Limited research explores multiple SDOH and depression among African American adults in the US. Guided by Healthy People (HP) 2030, and using cross-disciplinary mental health terminology, we conducted a comprehensive search to capture studies specific to African American adults in the US published after 2016. We applied known scoping review methodology and followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. From 12,315 initial results, 60 studies were included in our final sample. Most studies explored the HP 2030 Social and Community Context domain, with a heavy focus on discrimination and social support; no studies examined Health Care Access and Quality. Researchers typically utilized cross-sectional, secondary datasets; no qualitative studies were included. We recommend research that comprehensively examines mental health risk and protective factors over the life course within, not just between, populations to inform tailored health promotion and public policy interventions for improving SDOH and reducing racial and ethnic health disparities.
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Affiliation(s)
- Brooks Yelton
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC 29208, USA; (B.Y.); (S.N.); (M.A.A.); (M.M.M.); (M.S.); (K.H.L.)
| | - Daniela B. Friedman
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC 29208, USA; (B.Y.); (S.N.); (M.A.A.); (M.M.M.); (M.S.); (K.H.L.)
- Office for the Study of Aging, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC 29208, USA;
- Correspondence:
| | - Samuel Noblet
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC 29208, USA; (B.Y.); (S.N.); (M.A.A.); (M.M.M.); (M.S.); (K.H.L.)
- Prevention Research Center, Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC 29208, USA
| | - Matthew C. Lohman
- Office for the Study of Aging, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC 29208, USA;
- Department of Epidemiology & Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC 29208, USA
| | - Michelle A. Arent
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC 29208, USA; (B.Y.); (S.N.); (M.A.A.); (M.M.M.); (M.S.); (K.H.L.)
| | - Mark M. Macauda
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC 29208, USA; (B.Y.); (S.N.); (M.A.A.); (M.M.M.); (M.S.); (K.H.L.)
- Center for Applied Research and Evaluation, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC 29208, USA
| | - Mayank Sakhuja
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC 29208, USA; (B.Y.); (S.N.); (M.A.A.); (M.M.M.); (M.S.); (K.H.L.)
| | - Katherine H. Leith
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC 29208, USA; (B.Y.); (S.N.); (M.A.A.); (M.M.M.); (M.S.); (K.H.L.)
- Office for the Study of Aging, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC 29208, USA;
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13
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Resciniti N, C. Lohman M, McLain A, Merchant A, Friedman AD. Are Drugs that Cause Dysbiosis Longitudinally Associated with Cognitive Scores, Cognitive Impairment, & Dementia? Innov Aging 2021. [PMCID: PMC8681240 DOI: 10.1093/geroni/igab046.2437] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The majority of people living with dementia in the early and middle stages are cared for at home by family caregivers. Participation in meaningful activities is important for good quality of life. Recreation based on horticulture is beneficial for people living with dementia in residential settings, yet evidence within community settings is less clear. The aim of this research was to examine the existing evidence for the impact of using contact with nature, gardens and plants to enhance well-being of people living with dementia in the community. Our secondary aim was to explore the outcome domains and instruments that were employed in the existing research studies, to inform future research efforts and guide clinical practice. A systematic search was conducted covering several databases and gray literature. Original studies that examined group or individual horticulture-based activities or interventions were included. Of 2127 articles identified through searching, 10 were selected for full review. The findings reveal that horticulture-based intervention showed positive impacts on food intake, social interaction, and well-being in older adults with dementia. Some evidence shows that horticulture-based activities may alleviate stressful symptoms associated with living with dementia. Future research may further evaluate the effect of the interventions on cognitive function, physical function, and behavioral symptoms in a more rigorous intervention design.
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Affiliation(s)
- Nicholas Resciniti
- University of Southern California, Los Angeles, California, United States
| | - Matthew C. Lohman
- University of South Carolina, Columbia, South Carolina, United States
| | - Alexander McLain
- University of South Carolina, Columbia, South Carolina, United States
| | - Anwar Merchant
- University of South Carolina, Columbia, South Carolina, United States
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14
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Resciniti N, Kase B, Yelverton V, C. Lohman M. Time-Varying Insomnia Symptoms and Incidence of Cognitive Impairment and Dementia among Older US Adults. Innov Aging 2021. [PMCID: PMC8681250 DOI: 10.1093/geroni/igab046.2470] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
There is conflicting evidence regarding the association between insomnia and the onset of mild cognitive impairment (MCI) or dementia. This study aimed to evaluate if time-varying insomnia is associated with the development of MCI and dementia. Data from the Health and Retirement Study (n = 13,833) from 2002 to 2014 were used (59.4% female). The Brief Insomnia Questionnaire was used to identify insomnia symptoms compiled in an insomnia severity index, ranging from 0 to 4. In the analysis, participants’ symptoms could vary from wave-to-wave. Dementia was defined using results from the Health and Retirement Study (HRS) global cognitive assessment tool. Respondents were classified as either having dementia, MCI or being cognitively healthy. Cox proportional hazards models with time-dependent exposure using the counting process (start-stop time) were used for analysis. For each one-unit increase in the insomnia symptom index, there was a 5-percent greater hazard of MCI (HR = 1.05; 95% CI: 1.04–1.06) and dementia (HR = 1.05; 95% CI: 1.03–1.05), after fully adjusting. Using a nationally representative sample of adults aged 51 and older, this study found that time-varying insomnia symptoms are associated with the risk of MCI and dementia. This highlights the importance of identifying sleep disturbances and their change over time as potentially important risk factors for MCI and dementia.
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Affiliation(s)
- Nicholas Resciniti
- University of Southern California, Los Angeles, California, United States
| | - Bezawit Kase
- University of South Carolina, Columbia, South Carolina, United States
| | - Valerie Yelverton
- University of South Carolina, Columbia, South Carolina, United States
| | - Matthew C. Lohman
- University of South Carolina, Columbia, South Carolina, United States
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15
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Lohman MC, Ko TM, Rapp A, Bennion E, Mezuk B. State Variation in Long-Term Care Availability, Regulation, and Cost and Suicide Mortality Among Older Adults in the United States: 2010-2015. J Am Med Dir Assoc 2021; 22:2337-2343.e3. [PMID: 33722567 PMCID: PMC8483567 DOI: 10.1016/j.jamda.2021.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 02/01/2021] [Accepted: 02/05/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Residential long-term care (LTC) facilities may be key settings for the prevention of suicide among older adults; however, little is known about the relationship between statewide policies determining characteristics of LTC facilities and suicide mortality. The primary goal of this study was to evaluate the association between state policies regarding availability, regulation, and cost of LTC and suicide mortality among adults aged 55 and older in the United States over a 5-year period. DESIGN Longitudinal ecological study. SETTING AND PARTICIPANTS LTC residents from 16 states reporting mortality data to the National Violent Death Reporting System (NVDRS) from 2010 to 2015. METHODS We linked suicide data from the NVDRS and data sources on LTC services and regulations for 16 states. We applied a natural language-processing algorithm to identify suicide deaths related to LTC. We used fixed effect regression models to assess whether state variation in LTC characteristics is related to variation in the rate of suicide (both overall and related to LTC) among older adults. RESULTS There were 25,040 suicides among those aged 55 and older reported to the NVDRS during the study period; 382 suicides were determined to be associated with LTC in some manner. After adjusting for state-level characteristics, greater average nursing home capacity was significantly associated with increase in the cumulative incidence of suicide related to LTC (β = 0.087, SE = 0.026, P < .01), but not overall suicide incidence. Neither cost nor regulation measures were significantly associated with state-level LTC-related suicide incidence. CONCLUSIONS AND IMPLICATIONS State-level variations in LTC facility capacity are related to variation in LTC-related suicide incidence among older adults. Given the challenges of preventing suicide among older adults through facility- or individual-level interventions, policies governing the features and provision of LTC services may therefore serve as a means for public health suicide prevention.
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Affiliation(s)
- Matthew C Lohman
- Department of Epidemiology and Biostatistics, University of South Carolina, Arnold School of Public Health, Columbia, SC, USA.
| | - Tomohiro M Ko
- Center for Social Epidemiology and Population Health, Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA; Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA
| | - Ashley Rapp
- Center for Social Epidemiology and Population Health, Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Erica Bennion
- Center for Social Epidemiology and Population Health, Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Briana Mezuk
- Center for Social Epidemiology and Population Health, Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
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16
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Resciniti NV, Fuller M, Sellner J, Lohman MC. COVID-19 Incidence and Mortality Among Long-Term Care Facility Residents and Staff in South Carolina. J Am Med Dir Assoc 2021; 22:2026-2031.e1. [PMID: 34481792 PMCID: PMC8364806 DOI: 10.1016/j.jamda.2021.08.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 08/06/2021] [Accepted: 08/09/2021] [Indexed: 11/24/2022]
Abstract
Objectives This study explored differences in COVID-19 incidence, mortality, and timing among long-term care facility (LTCF) residents and staff with those living in the community in South Carolina (SC). Design Longitudinal secondary data analysis. Setting and Participants Adults age ≥18 in SC with confirmed COVID-19 diagnosis from 3/15/2020 and 1/2/2021 (n = 307,891). Methods COVID-19 data came from the SC Department of Health and Environmental Control (SCDHEC). We included all COVID-19 cases, hospitalizations, and deaths among adult residents. Residence and employment in LTCF were confirmed by SCDHEC. Descriptive statistics and trends for cases, hospitalizations, and deaths were calculated. We used Cox proportional hazards to compare COVID-19 mortality in LTCF residents and staff to community dwelling older adults and adults not employed in LTCF, respectively, controlling for age, gender, race, and pre-existing chronic health conditions. Results LTC residents experienced greater incidence of cases throughout the study period until the week ending on 1/2/21. LTCF residents with COVID-19 were more likely to be hospitalized compared to older adults in the community and 74% more likely to die (HR: 1.74, 95% CI: 1.59-1.90), after adjusting. LTC staff experienced greater incidence of cases compared to adults not employed in LTCF until the week ending on 12/26/2020, while experiencing similar incidence of death compared to the similar community members. After adjusting, LTC staff had 0.58 (HR = 0.58; CI: 0.39-0.88) times lower hazard of death compared to community members that did not work in a LTCF. Conclusions and Implications Narrowing of the gap between LTCF and community-wide infection and mortality rates over the study period suggests that early detection of COVID-19 in LTCFs could serve as a first indicator of disease spread in the greater community. Results also indicate that policies and regulations addressing staff testing and protection may help to slow or prevent spread within facilities.
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Affiliation(s)
- Nicholas V Resciniti
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
| | - Morgan Fuller
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - Joshua Sellner
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Matthew C Lohman
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
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17
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Lohman MC, Fairchild AJ, Merchant AT. Antidepressant Use Partially Mediates the Association Between Depression and Risk of Falls and Fall Injuries Among Older Adults. J Gerontol A Biol Sci Med Sci 2021; 76:e171-e178. [PMID: 33017840 DOI: 10.1093/gerona/glaa253] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 08/26/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The association between depression and fall risk in older adults is recognized, yet the mechanisms underlying this association are unclear. This study estimated the mediating role of antidepressant use in the association between depression and falls and fall injuries. METHODS Longitudinal data from the Health and Retirement Study (2004-2006) were linked with medication data from the Prescription Drug Study (2005). The sample included community-dwelling adults aged ≥65 with data on depression and medication use (n = 3565). Depression was measured using 2 independent survey tools: Composite International Diagnostic Interview for depression short form and an 8-item version of the Center for Epidemiological Studies-Depression scale. We used causal mediation analysis to estimate and compare the direct and indirect (mediated by antidepressant use) effects of depression on falls and fall injuries. RESULTS Individuals with major depressive disorder were significantly more likely to experience a fall (OR: 1.92; 95% CI: 1.41, 2.62) and a fall injury (OR: 1.67; 95% CI: 1.09, 2.55) over 2 years. Indirect effect estimates showed that antidepressant medication use accounted for approximately 19% and 18% of the association between major depressive disorder and falls and fall injuries, respectively. Results were similar when using an alternative depression measure and when considering only selective serotonin reuptake inhibitor antidepressants. CONCLUSIONS Antidepressant use explains a significant proportion, but not a majority, of the association between depression and greater fall risk. Treatment benefits of antidepressants should be considered with, and may outweigh, concerns about increased risk of falls associated with antidepressant use.
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Affiliation(s)
- Matthew C Lohman
- Department of Epidemiology and Biostatistics, University of South Carolina, Arnold School of Public Health, Columbia
| | | | - Anwar T Merchant
- Department of Epidemiology and Biostatistics, University of South Carolina, Arnold School of Public Health, Columbia
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18
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Crow RS, Haudenschild C, Lohman MC, Roth RM, Roderka M, Masterson T, Brand J, Gooding T, Mackenzie TA, Batsis JA. Modified STEADI Fall Risk Categories Predict Incident Cognitive Impairment. J Am Geriatr Soc 2021; 69:1257-1264. [PMID: 33565618 PMCID: PMC8232824 DOI: 10.1111/jgs.17034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 12/23/2020] [Accepted: 12/30/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND/OBJECTIVES It is unknown whether older adults at high risk of falls but without cognitive impairment have higher rates of subsequent cognitive impairment. DESIGN This was an analysis of cross-sectional and longitudinal data from National Health and Aging Trends Study (NHATS). SETTING NHATS, secondary analysis of data from 2011 to 2019. PARTICIPANTS Community dwelling adults aged 65 and older without cognitive impairment. MEASUREMENTS Participants were classified at baseline in three categories of fall risk (low, moderate, severe) using a modified algorithm from the Center for Disease Control's STEADI (Stop Elderly Accidents, Deaths, and Injuries) and fall risk from data from the longitudinal NHATS. Impaired global cognition was defined as NHATS-derived impairment in either the Alzheimer's Disease-8 score, immediate/delayed recall, orientation, clock-drawing test, or date/person recall. The primary outcome was the first incident of cognitive impairment in an 8 year follow-up period. Cox-proportional hazard models ascertained time to onset of cognitive impairment (referent = low modified STEADI incidence). RESULTS Of the 7,146 participants (57.8% female), the median age category was 75 to 80 years. Prevalence of baseline fall modified STEADI risk categories in participants was low (51.6%), medium (38.5%), and high (9.9%). In our fully adjusted model, the risk of developing cognitive impairment was hazard ratio (HR) 1.18 [95% CI = 1.08, 1.29] in the moderate risk category, and HR 1.74 [95% CI = 1.53, 1.98] in the high-risk category. CONCLUSION Older, cognitively intact adults at high fall risk at baseline had nearly twice the risk of cognitive decline at 8 year follow-up.
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Affiliation(s)
- Rebecca S. Crow
- Veterans Affairs Medical Center, White River Junction, Vermont USA
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Christian Haudenschild
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
- The Dartmouth Institute for Health Policy, Lebanon, New Hampshire, USA
| | - Matthew C. Lohman
- University of South Carolina, Department of Epidemiology and Biostatics
| | - Robert M. Roth
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
- Department of Psychiatry, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Meredith Roderka
- Department of Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Travis Masterson
- Department of Nutritional Sciences at The Pennsylvania State University, State College, PA, USA
| | - John Brand
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Tyler Gooding
- Department of Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Todd A. Mackenzie
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
- Department of Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA
- The Dartmouth Institute for Health Policy, Lebanon, New Hampshire, USA
| | - John A. Batsis
- Division of Geriatric Medicine, School of Medicine, and the Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
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19
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Lohman MC, Sonnega AJ, Resciniti NV, Leggett AN. Frailty Phenotype and Cause-Specific Mortality in the United States. J Gerontol A Biol Sci Med Sci 2021; 75:1935-1942. [PMID: 31956891 DOI: 10.1093/gerona/glaa025] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Frailty is a common condition among older adults increasing risk of adverse outcomes including mortality; however, little is known about the incidence or risk of specific causes of death among frail individuals. METHODS Data came from the Health and Retirement Study (HRS; 2004-2012), linked to underlying cause-of-death information from the National Death Index (NDI). Community-dwelling HRS participants aged 65 and older who completed a general health interview and physical measurements (n = 10,490) were included in analysis. Frailty was measured using phenotypic model criteria-exhaustion, low weight, low energy expenditure, slow gait, and weakness. Underlying causes of death were determined using International Classification of Diseases, Version 10 codes. We used Cox proportional hazards and competing risks regression models to calculate and compare incidence of cause-specific mortality by frailty status. RESULTS During follow-up, prefrail and frail older adults had significantly greater hazard of all-cause mortality compared to individuals without symptoms (adjusted hazard ratio [HR] prefrail: 1.85, 95% CI: 1.51, 2.25; HR frail: 2.75, 95% CI: 2.14, 3.53). Frailty was associated with 2.96 (95% CI: 2.17, 4.03), 2.82 (95% CI: 2.02, 3.94), 3.48 (95% CI: 2.17, 5.59), and 2.87 (95% CI: 1.47, 5.59) times greater hazard of death from heart disease, cancer, respiratory illness, and dementia, respectively. CONCLUSIONS Significantly greater risk of mortality from several different causes should be considered alongside the potential costs of screening and intervention for frailty in subspecialty and general geriatric clinical practice. Findings may help investigators estimate the potential impact of frailty reduction approaches on mortality.
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Affiliation(s)
- Matthew C Lohman
- Department of Epidemiology and Biostatistics, University of South Carolina, Arnold School of Public Health, Columbia
| | - Amanda J Sonnega
- Institute for Social Research, University of Michigan, Ann Arbor
| | - Nicholas V Resciniti
- Department of Epidemiology and Biostatistics, University of South Carolina, Arnold School of Public Health, Columbia
| | - Amanda N Leggett
- Department of Psychiatry, University of Michigan, Ann Arbor.,Institute for Health Policy and Innovation, University of Michigan, Ann Arbor
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20
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Alhasan DM, Hirsch JA, Jackson CL, Miller MC, Cai B, Lohman MC. Neighborhood Characteristics and the Mental Health of Caregivers Cohabiting with Care Recipients Diagnosed with Alzheimer's Disease. Int J Environ Res Public Health 2021; 18:913. [PMID: 33494425 PMCID: PMC7908545 DOI: 10.3390/ijerph18030913] [Citation(s) in RCA: 9] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 01/14/2021] [Accepted: 01/16/2021] [Indexed: 11/28/2022]
Abstract
While studies have documented the influence of caregiver and care recipient factors on caregiver health, it is important to address the potential impact of neighborhood contexts. This study estimated the cross-sectional associations between neighborhood characteristics and mental health among caregivers cohabiting with Alzheimer's disease care recipients that were experiencing severe or non-severe neuropsychiatric symptoms (NPSs) (e.g., aggression/anxiety). We obtained data collected in 2010 on caregivers and care recipients (n = 212) from a subset of South Carolina's Alzheimer's Disease Registry. Neighborhood measures (within 1 mile of the residence) came from the American Community Survey and the Rural-Urban Commuting Area Code. We categorized the neighborhood median household income into tertiles, namely, "low" (<$31,000), "medium" ($31,000-40,758), and "high" (>$40,758), and rurality as "large urban," "small urban," and "rural." We used negative binomial regression to estimate the prevalence ratios (PRs) and 95% confidence intervals (CIs) for caregiver mental health using neighborhood characteristics. The mean age was 58 ± 10.3 years, 85% were women, and 55% were non-Hispanic Black. Among the caregivers cohabiting with a recipient experiencing severe NPS, higher distress was experienced by caregivers living in low- (PR = 1.61 (95% CI = 1.26-2.04)) and medium- (PR = 1.45 (95% CI = 1.17-1.78)) vs. high-income neighborhoods after an adjustment. These results suggest that neighborhood characteristics may amplify other social stressors experienced by caregivers.
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Affiliation(s)
- Dana M. Alhasan
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institute of Health, Department of Health and Human Services, Research Triangle Park, NC 27709, USA;
| | - Jana A. Hirsch
- Urban Health Collaborative, Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA 19104, USA;
| | - Chandra L. Jackson
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institute of Health, Department of Health and Human Services, Research Triangle Park, NC 27709, USA;
- Intramural Program, National Institute on Minority Health and Health Disparities, National Institutes of Health, Department of Health and Human Services, Bethesda, MD 20814, USA
| | - Maggi C. Miller
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA; (M.C.M.); (B.C.); (M.C.L.)
| | - Bo Cai
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA; (M.C.M.); (B.C.); (M.C.L.)
| | - Matthew C. Lohman
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA; (M.C.M.); (B.C.); (M.C.L.)
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21
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Resciniti NV, Yelverton V, Kase BE, Zhang J, Lohman MC. Time-Varying Insomnia Symptoms and Incidence of Cognitive Impairment and Dementia among Older US Adults. Int J Environ Res Public Health 2021; 18:E351. [PMID: 33466468 PMCID: PMC7796486 DOI: 10.3390/ijerph18010351] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 12/29/2020] [Accepted: 12/31/2020] [Indexed: 12/28/2022]
Abstract
There is conflicting evidence regarding the association between insomnia and the onset of mild cognitive impairment (MCI) or dementia. This study aimed to evaluate if time-varying insomnia is associated with the development of MCI and dementia. Data from the Health and Retirement Study (n = 13,833) from 2002 to 2014 were used (59.4% female). The Brief Insomnia Questionnaire was used to identify insomnia symptoms which were compiled in an insomnia severity index, ranging from 0 to 4. In analysis, participants' symptoms could vary from wave-to-wave. Dementia was defined using results from the Health and Retirement Study (HRS) global cognitive assessment tool. Respondents were classified as either having dementia, MCI, or being cognitively healthy. Cox proportional hazards models with time-dependent exposure using the counting process (start-stop time) were used for analysis. For each one-unit increase in the insomnia symptom index, there was a 5-percent greater hazard of MCI (HR = 1.05; 95% CI: 1.04-1.06) and dementia (HR = 1.05; 95% CI: 1.03-1.05), after fully adjusting. Using a nationally representative sample of adults age 51 and older, this study found that time-varying insomnia symptoms are associated with risk of MCI and dementia. This highlights the importance of identifying sleep disturbances and their change over time as potentially important risk factors for MCI and dementia.
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Affiliation(s)
- Nicholas V. Resciniti
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC 29201, USA; (B.E.K.); (J.Z.); (M.C.L.)
| | - Valerie Yelverton
- Department of Health Services Policy & Management, Arnold School of Public Health, University of South Carolina, Columbia, SC 292901, USA;
| | - Bezawit E. Kase
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC 29201, USA; (B.E.K.); (J.Z.); (M.C.L.)
| | - Jiajia Zhang
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC 29201, USA; (B.E.K.); (J.Z.); (M.C.L.)
| | - Matthew C. Lohman
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC 29201, USA; (B.E.K.); (J.Z.); (M.C.L.)
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Abstract
OBJECTIVES This study aimed to review loneliness interventions for older adults living in long-term care (LTC) facilities over the past 10 years, to categorize interventions by type, and to compare effectiveness of loneliness interventions in these settings. METHODS Systematic review followed PRISMA guidelines. Articles matching search criteria were collected from PubMed, PsycINFO, and Web of Science from 2009 to 2019. The inclusion criteria were as follows: 1) English language, 2) intervention studies with a quantitative measure that compares pre-trial to post-trial changes, 3) loneliness as a primary or secondary outcome 4) subjects age >65, and 5) subjects living in a LTC facility, such as a nursing home, assisted-living, or hospice. RESULTS A total of 15 intervention studies qualified for systematic review. Most of these interventions were psychological therapies and leisure/skill development interventions. Approximately, 87% of studies reported significant decreases in loneliness following intervention. Laughter therapy, horticultural therapy, and reminiscence therapy were associated with the greatest decreases in loneliness. DISCUSSION Results suggest that, although less common than interventions in the community, there are several effective interventions to reduce loneliness among older adults living in LTC facilities. Lack of standardized measures and high-quality studies limits comparisons between intervention types and generalizability to different populations.
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Affiliation(s)
- Nicolas G Quan
- Biological Sciences, University of South Carolina, Columbia, SC, USA
| | - Matthew C Lohman
- Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.,Office for the Study of Aging, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Nicholas V Resciniti
- Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.,Office for the Study of Aging, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Daniela B Friedman
- Office for the Study of Aging, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.,Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
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23
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Batsis JA, Haudenschild C, Roth RM, Gooding TL, Roderka MN, Masterson T, Brand J, Lohman MC, Mackenzie TA. Incident Impaired Cognitive Function in Sarcopenic Obesity: Data From the National Health and Aging Trends Survey. J Am Med Dir Assoc 2020; 22:865-872.e5. [PMID: 34248422 DOI: 10.1016/j.jamda.2020.09.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Objectives The prevalence of obesity with sarcopenia is increasing in adults aged ≥65 years. This geriatric syndrome places individuals at risk for synergistic complications that leads to long-term functional decline. We ascertained the relationship between sarcopenic obesity and incident long-term impaired global cognitive function in a representative US population. Design A longitudinal, secondary data set analysis using the National Health and Aging Trends Survey. Setting Community-based older adults in the United States. Participants Participants without baseline impaired cognitive function aged ≥65 years with grip strength and body mass index measures. Methods Sarcopenia was defined using the Foundation for the National Institutes of Health Sarcopenia Project grip strength cut points (men <35.5 kg; women <20 kg), and obesity was defined using standard body mass index (BMI) categories. Impaired global cognition was identified as impairment in the Alzheimer's Disease-8 score or immediate/delayed recall, orientation, clock-draw test, date/person recall. Proportional hazard models ascertained the risk of impaired cognitive function over 8 years (referent = neither obesity or sarcopenia). Results Of the 5822 participants (55.7% women), median age category was 75 to 80, and mean grip strength and BMI were 26.4 kg and 27.5 kg/m2, respectively. Baseline prevalence of sarcopenic obesity was 12.9%, with an observed subset of 21.2% participants having impaired cognitive function at follow-up. Compared with those without sarcopenia or obesity, the risk of impaired cognitive function was no different in obesity alone [hazard ratio (HR) 0.98; 95% confidence interval (CI) 0.82-1.16]), but was significantly higher in sarcopenia (HR 1.60; 95% CI 1.42-1.80) and sarcopenic obesity (HR 1.20; 95% CI 1.03-1.40). There was no significant interaction term between sarcopenia and obesity. Conclusions Both sarcopenia and sarcopenic obesity are associated with an increased long-term risk of impaired cognitive function in older adults.
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Affiliation(s)
- John A Batsis
- Geisel School of Medicine at Dartmouth, Hanover, NH
- Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH
- Division of Geriatric Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Christian Haudenschild
- Geisel School of Medicine at Dartmouth, Hanover, NH
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH
| | - Robert M Roth
- Geisel School of Medicine at Dartmouth, Hanover, NH
- Neuropsychology Program, Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Tyler L Gooding
- Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | | | | | - John Brand
- Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Matthew C Lohman
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC
| | - Todd A Mackenzie
- Geisel School of Medicine at Dartmouth, Hanover, NH
- Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH
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24
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Ureña S, Ingram LA, Leith K, Lohman MC, Resciniti N, Rubin L, Miller MC, Friedman DB. Mentorship and Training to Increase Diversity of Researchers and Practitioners in the Field of Aging and Alzheimer's Disease: A Scoping Review of Program Characteristics. J Aging Health 2020; 33:48-62. [PMID: 32865457 DOI: 10.1177/0898264320953345] [Citation(s) in RCA: 4] [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] [Indexed: 12/21/2022]
Abstract
Objectives: Diversity is needed within the aging and Alzheimer's disease and related dementias (ADRD) research and practice workforce to comprehensively address health inequities faced by underrepresented minority (URM) older adults. We conducted a scoping review of training programs designed to diversify the pool of researchers and practitioners in the field of aging and ADRD. Methods: Online database searches yielded 3976 articles published from 1999 to 2019. Fourteen studies met the inclusion criteria. Results: All programs were from the United States and included URM populations. Nine programs included students, one targeted university faculty, and four targeted clinical staff. Only five programs were guided by theory. Discussion: Our review identified URMs' desire for culturally diverse and representative mentorship, the need for career development support at various training stages, and the importance of incorporating theory to program design. It also identified key characteristics for future program development, creation of systematic evaluation standards, and opportunities for promotion.
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Affiliation(s)
- Stephanie Ureña
- Office for the Study of Aging, Arnold School of Public Health, 2629University of South Carolina, Columbia, SC, USA.,Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, 2629University of South Carolina, Columbia, SC, USA
| | - Lucy A Ingram
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, 2629University of South Carolina, Columbia, SC, USA
| | - Katherine Leith
- Office for the Study of Aging, Arnold School of Public Health, 2629University of South Carolina, Columbia, SC, USA.,Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, 2629University of South Carolina, Columbia, SC, USA
| | - Matthew C Lohman
- Office for the Study of Aging, Arnold School of Public Health, 2629University of South Carolina, Columbia, SC, USA.,Department of Epidemiology and Biostatistics, Arnold School of Public Health, 2629University of South Carolina, Columbia, SC, USA
| | - Nicholas Resciniti
- Office for the Study of Aging, Arnold School of Public Health, 2629University of South Carolina, Columbia, SC, USA.,Department of Epidemiology and Biostatistics, Arnold School of Public Health, 2629University of South Carolina, Columbia, SC, USA
| | - Lindsey Rubin
- Office for the Study of Aging, Arnold School of Public Health, 2629University of South Carolina, Columbia, SC, USA.,Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, 2629University of South Carolina, Columbia, SC, USA
| | - Maggi C Miller
- Office for the Study of Aging, Arnold School of Public Health, 2629University of South Carolina, Columbia, SC, USA.,Department of Epidemiology and Biostatistics, Arnold School of Public Health, 2629University of South Carolina, Columbia, SC, USA
| | - Daniela B Friedman
- Office for the Study of Aging, Arnold School of Public Health, 2629University of South Carolina, Columbia, SC, USA.,Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, 2629University of South Carolina, Columbia, SC, USA
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25
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Abstract
OBJECTIVE We consider whether it is the healthiest dementia caregivers who experience a mortality benefit and whether a protective association is consistent for leading causes of mortality. METHOD Using the Health and Retirement study (2000-2012), Cox survival models predict time to death for dementia caregivers, including an interaction between dementia caregiver status and self-rated health. The nationally representative sample consisted of 10,650 married adults aged 51 or older (917 dementia caregivers). RESULTS A significant interaction between dementia caregiver status and self-rated health suggested that relative to noncaregivers, dementia caregivers had reduced mortality, with this effect particularly strong at lower levels of self-rated health. The protective effect of dementia caregiver status was consistent across death by heart disease, cancer, and cerebrovascular disease. DISCUSSION These findings add to a growing body of literature suggesting that caregiving may provide a mortality benefit and a reason to maintain health.
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26
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Chow PI, Shaffer KM, Lohman MC, LeBaron VT, Fortuna KL, Ritterband LM. Examining the relationship between changes in personality and depression in older adult cancer survivors. Aging Ment Health 2020; 24:1237-1245. [PMID: 30939904 DOI: 10.1080/13607863.2019.1594158] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objectives: Despite widespread agreement that personality traits change across the lifespan into older adulthood, the association between changes in personality and depression among older adult cancer survivors is unknown. It was hypothesized that older adults with (vs. without) a past cancer diagnosis would experience an increase in neuroticism, and decreases in conscientiousness, agreeableness, openness, and extraversion, and that changes in these traits would mediate the relationship between receiving a cancer diagnosis and change in depression. Two hypotheses were tested in a cancer survivor sample. First, that increased chronic stressors and decreased physical health would mediate the link between personality change and increased depression. Second, that personality change would mediate the link between changes in chronic stressors/health and increased depression.Method: Secondary data analysis utilizing three waves of data from the Health and Retirement Study. Data was compiled from 5,217 participants, among whom 707 received a cancer diagnosis.Results: Older adults with (vs. without) a cancer diagnosis decreased in conscientiousness, which was associated with increased depression. Among cancer survivors, worsening chronic stressors/health mediated many pathways between personality change and an increased depression. Increased neuroticism mediated the link between worsening health/chronic stressors and increased depression.Conclusion: With the exception of conscientiousness, changes in personality did not mediate the link between cancer survivor status and depression. Among older adult cancer survivors, changes in personality traits may increase depression through worsening physical health and chronic stressors, potentially informing targeted interventions. Interventions that target increased neuroticism may be particularly useful in older adult cancer survivors.
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Affiliation(s)
- Philip I Chow
- Center for Behavioral Health and Technology, Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, School of Medicine, Charlottesville, VA, USA
| | - Kelly M Shaffer
- Center for Behavioral Health and Technology, Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, School of Medicine, Charlottesville, VA, USA
| | - Matthew C Lohman
- Arnold School of Public Health, University of South Carolina, Charleston, SC, USA
| | - Virginia T LeBaron
- University of Virginia, School of Nursing, Acute and Specialty Care, Charlottesville, VA, USA
| | - Karen L Fortuna
- Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
| | - Lee M Ritterband
- Center for Behavioral Health and Technology, Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, School of Medicine, Charlottesville, VA, USA
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27
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Lohman MC, Sonnega AJ, Nicklett EJ, Estenson L, Leggett AN. Comparing Estimates of Fall-Related Mortality Incidence Among Older Adults in the United States. J Gerontol A Biol Sci Med Sci 2020; 74:1468-1474. [PMID: 30358818 DOI: 10.1093/gerona/gly250] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [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: 07/23/2018] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Falls are the leading cause of injury-related mortality among older adults in the United States, but incidence and risk factors for fall-related mortality remain poorly understood. This study compared fall-related mortality incidence rate estimates from a nationally representative cohort with those from a national vital record database and identified correlates of fall-related mortality. METHODS Cause-of-death data from the National Death Index (NDI; 1999-2011) were linked with eight waves from the Health and Retirement Study (HRS), a representative cohort of U.S. older adults (N = 20,639). Weighted fall-related mortality incidence rates were calculated and compared with estimates from the Centers for Disease Control and Prevention (CDC) vital record data. Fall-related deaths were identified using International Classification of Diseases (Version 10) codes. Person-time at risk was calculated from HRS entry until death or censoring. Cox proportional hazards models were used to identify individual-level factors associated with fall-related deaths. RESULTS The overall incidence rate of fall-related mortality was greater in HRS-NDI data (51.6 deaths per 100,000; 95% confidence interval: 42.04, 63.37) compared with CDC data (42.00 deaths per 100,000; 95% confidence interval: 41.80, 42.19). Estimated differences between the two data sources were greater for men and adults aged 85 years and older. Greater age, male gender, and self-reported fall history were identified as independent risk factors for fall-related mortality. CONCLUSION Incidence rates based on aggregate vital records may substantially underestimate the occurrence of and risk for fall-related mortality differentially in men, minorities, and relatively younger adults. Cohort-based estimates of individual fall-related mortality risk are important supplements to vital record estimates.
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Affiliation(s)
- Matthew C Lohman
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia
| | - Amanda J Sonnega
- Institute for Social Research, University of Michigan, Ann Arbor
| | | | | | - Amanda N Leggett
- Program for Positive Aging, University of Michigan, Ann Arbor.,Department of Psychiatry, University of Michigan, Ann Arbor
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28
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Resciniti NV, Tang W, Tabassum M, Pearson JL, Spencer SM, Lohman MC, Ehlers DK, Al-Hasan D, Miller MC, Teixeira A, Friedman DB. Knowledge evaluation instruments for dementia caregiver education programs: A scoping review. Geriatr Gerontol Int 2020; 20:397-413. [PMID: 32133754 PMCID: PMC7748382 DOI: 10.1111/ggi.13901] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 12/19/2019] [Accepted: 02/12/2020] [Indexed: 01/28/2023]
Abstract
With the increase in our older adult population, there is a need for dementia training for informal and formal dementia caregivers. The objective of this scoping study is to assess dementia knowledge instruments utilized in educational programs and interventions intended for formal and informal dementia caregivers. Scoping review methodology was used to search PubMed, PsycInfo, CINAHL and Web of Science with tailored database search terms. The search yielded 8101 results, with 35 studies meeting inclusion. Studies were conducted in eight countries, had varying study designs (randomized controlled trials [RCTs] = 9, non-RCTs = 6, one-group study design = 20) and utilized previously published (19) and author developed (16) instruments. Furthermore, the studies were internationally diverse, conducted in the United States (n = 18), Australia (n = 7), UK (n = 3), China (n = 2), Canada (n = 2), Taiwan (n = 1), Brazil (n = 1) and multi-country (n = 1). Only two studies focused on minority populations. While author-developed instruments may be more relevant and timesaving, studies should strive to validate instruments or use previously published instruments to help standardize findings across studies and understand better the effects of educational programs on caregiver knowledge. Geriatr Gerontol Int 2020; 20: 397-413.
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Affiliation(s)
- Nicholas V Resciniti
- Office for the Study of Aging, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Weizhou Tang
- Office for the Study of Aging, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
- College of Social Work, University of South Carolina, Columbia, South Carolina
| | - Masroora Tabassum
- Department of Health Services Policy & Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Joseph Lee Pearson
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Sharon Melinda Spencer
- Office for the Study of Aging, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Matthew C Lohman
- Office for the Study of Aging, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Diane K Ehlers
- Office for the Study of Aging, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, Nebraska
| | - Dana Al-Hasan
- Office for the Study of Aging, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Maggi C Miller
- Office for the Study of Aging, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Ana Teixeira
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Daniela B Friedman
- Office for the Study of Aging, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
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29
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Fortuna KL, DiMilia PR, Lohman MC, Cotton BP, Cummings JR, Bartels SJ, Batsis JA, Pratt SI. Systematic Review of the Impact of Behavioral Health Homes on Cardiometabolic Risk Factors for Adults With Serious Mental Illness. Psychiatr Serv 2020; 71:57-74. [PMID: 31500547 PMCID: PMC6939136 DOI: 10.1176/appi.ps.201800563] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This systematic review examined the impact of health homes on cardiometabolic risk among adults with serious mental illness. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses procedures were used to conduct the systematic review. Databases were searched for peer-reviewed articles published between 1946 and August 2018 that compared health homes with a control condition (e.g., usual care and secondary data analyses using matched samples). Participants, interventions, comparisons, outcomes, and study design criteria were used to assess study eligibility. Studies were assessed for methodological quality by using the Quality Assessment of Before and After Studies With No Control Group and the Quality Assessment of Controlled Intervention Studies. RESULTS Eighteen studies (i.e., 11 observational studies, four quasi-experimental studies, and three randomized controlled trials) reported on 17 health homes. Most studies reported increases in receipt of screening for cardiometabolic risk factors and service use. There was a modest reduction in selected cardiometabolic risk factors among people with serious mental illness, but clinical outcomes varied widely among studies. CONCLUSIONS Improvement in cardiometabolic risk factors varied across the studies, and the clinical significance of these reductions was not clear. Peer support and self-management training may represent strategies to improve cardiometabolic risk factors. Colocation of services may not be enough to significantly affect cardiometabolic risk factors. Health homes that include standardized screening, peer support and self-management training, and intervention components that target interdependent risk factors may have a greater impact on clinical outcomes.
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Affiliation(s)
- Karen L. Fortuna
- CDC Health Promotion Research Center at Dartmouth, Lebanon, NH
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH
| | - Peter R. DiMilia
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH
| | - Matthew C. Lohman
- Arnold School of Public Health, University of South Carolina, Columbia, SC
| | | | - Janet R. Cummings
- Department of Health Policy and Management, Emory University, Atlanta, GA
| | - Stephen J. Bartels
- The Mongan Institute at Massachusetts General Hospital, Harvard University, Boston, MA
| | - John A. Batsis
- Section of General Internal Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH
- The Dartmouth Institute at the Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Sarah I. Pratt
- CDC Health Promotion Research Center at Dartmouth, Lebanon, NH
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH
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Lohman MC, Scherer EA, Whiteman KL, Greenberg RL, Bruce ML. Factors Associated With Accelerated Hospitalization and Re-hospitalization Among Medicare Home Health Patients. J Gerontol A Biol Sci Med Sci 2019; 73:1280-1286. [PMID: 28329251 DOI: 10.1093/gerona/glw335] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 12/13/2016] [Indexed: 01/04/2023] Open
Abstract
Background Preventing hospitalizations and re-hospitalizations of older adults receiving Medicare home health (HH) services is a key goal for patients and care providers. This study aimed to identify factors related to greater risk of and earlier hospitalizations from HH, a key step in targeting preventive efforts. Methods Data come from Medicare mandated start-of-care assessments from 87,780 HH patients served by 132 agencies in 32 states, collected from January 2013 to March 2015. Using parametric accelerated failure time (AFT) survival models, we evaluated the association between key patient and environmental characteristics and the hazard of and time until hospitalization and re-hospitalization. Results In total, 15,030 hospitalizations, including 6,539 re-hospitalizations, occurred in the sample within 60 days of start of HH. Factors most strongly associated with substantially greater risk of and earlier hospitalization included male gender, history of hospitalization, polypharmacy, elevated depressive symptoms, greater functional disability, primary diagnoses of heart disease, chronic obstructive pulmonary disease, and urinary tract infection, and government-controlled agency care. In addition to these factors, black race and primary diagnosis of skin wounds were uniquely related to risk of earlier re-hospitalization. Conclusions Results suggest that factors collected during routine HH patient assessments can provide important information to predict risk of earlier hospitalization and re-hospitalization among Medicare HH patients. Identified factors can help identify patients at greatest risk of early hospitalization and may be important targets for agencies and care providers to prevent avoidable hospitalizations.
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Affiliation(s)
- Matthew C Lohman
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.,Department of Community and Family Medicine, Dartmouth Centers for Health and Aging, Lebanon, New Hampshire
| | - Emily A Scherer
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Karen L Whiteman
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.,Department of Community and Family Medicine, Dartmouth Centers for Health and Aging, Lebanon, New Hampshire
| | - Rebecca L Greenberg
- Institute of Geriatric Psychiatry, Weill Cornell Medical College, White Plains, New York
| | - Martha L Bruce
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.,Department of Community and Family Medicine, Dartmouth Centers for Health and Aging, Lebanon, New Hampshire
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Lohman MC, Resciniti NV, Wirth MD, Shivappa N, Hébert JR. Obesity, Dietary inflammation, and Frailty among Older Adults: Evidence from the National Health and Nutrition Examination Survey. J Nutr Gerontol Geriatr 2019; 38:18-32. [PMID: 30849025 DOI: 10.1080/21551197.2018.1552226] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Knowledge related to the relationship between obesity and frailty is limited. This study aimed to investigate associations between obesity, dietary inflammation, and frailty among older adults. Study data came from National Health and Nutrition Examination Survey (2007-2014) examinations of adults age ≥60 years (n = 7182). Dietary inflammatory potential was determined using the Dietary Inflammatory Index (DII®) derived from 24-h dietary recall. We analyzed independent and joint associations of obesity and DII with frailty to evaluate interaction. Multivariable logistic regression revealed that both obesity (Odds Ratio [OR] = 2.24, 95% CI: 1.68, 2.99) and moderately pro-inflammatory DII (OR = 1.68, 95% CI: 1.10, 2.58) were independently associated with greater frailty prevalence. A negative multiplicative interaction between obesity and highest pro-inflammatory diet also was found (adjusted odds in non-obese and obese were 2.07 and 2.37, respectively; p = 0.046). Results indicate the importance of considering obesity and dietary inflammatory potential when screening for frailty or developing treatments.
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Affiliation(s)
- Matthew C Lohman
- a Department of Epidemiology and Biostatistics, Arnold School of Public Health , University of South Carolina , Columbia , SC , USA
| | - Nicholas V Resciniti
- a Department of Epidemiology and Biostatistics, Arnold School of Public Health , University of South Carolina , Columbia , SC , USA
| | - Michael D Wirth
- a Department of Epidemiology and Biostatistics, Arnold School of Public Health , University of South Carolina , Columbia , SC , USA.,b Cancer Prevention and Control Program , University of South Carolina , Columbia , SC , USA.,c College of Nursing , University of South Carolina , Columbia , SC , USA.,d Connecting Health Innovations, LLC , Columbia , SC , USA
| | - Nitin Shivappa
- a Department of Epidemiology and Biostatistics, Arnold School of Public Health , University of South Carolina , Columbia , SC , USA.,b Cancer Prevention and Control Program , University of South Carolina , Columbia , SC , USA.,d Connecting Health Innovations, LLC , Columbia , SC , USA
| | - James R Hébert
- a Department of Epidemiology and Biostatistics, Arnold School of Public Health , University of South Carolina , Columbia , SC , USA.,b Cancer Prevention and Control Program , University of South Carolina , Columbia , SC , USA.,d Connecting Health Innovations, LLC , Columbia , SC , USA
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Fortuna KL, Naslund JA, Aschbrenner KA, Lohman MC, Storm M, Batsis JA, Bartels SJ. Text message exchanges between older adults with serious mental illness and older certified peer specialists in a smartphone-supported self-management intervention. Psychiatr Rehabil J 2019; 42:57-63. [PMID: 30010355 PMCID: PMC6335192 DOI: 10.1037/prj0000305] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To identify the strategies peer specialists use to provide illness self-management support for older adults with serious mental illness (SMI) through text messaging. METHOD Transcripts of text message exchanges between 8 older adult participants with SMI who completed the PeerTECH intervention and 3 older adult certified peer specialists who delivered the 12-week program were analyzed. Text message analyses explored themes relevant to peer support and health behavior change. Quantitative data comprised frequency of text messages by either the peer or consumer. RESULTS Consumers (N = 8) had a mean age of 68.8 years (SD = 4.9) and were mainly women (88%), White (100%), and married (75%). Certified peer specialists (N = 3) were all 55 or older; 100% were female, 66% identified as White, and 33% identified as African American. Overall, peers sent 215 text messages whereas consumers sent 141 text messages. In the peer specialist-consumer text message exchanges, we identified 4 themes on different aspects of illness self-management, including health behavior change, self-management therapeutic techniques, engagement in health technology, and peer support. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE This exploratory qualitative study offers preliminary support that peers are able to use text messages to support the delivery of a peer-delivered home-based medical and psychiatric self-management intervention. Certified peer specialists can potentially provide a range of illness self-management support to older adults with SMI via text messaging. These findings will inform the development of standardized peer text-messaging services to augment evidence-based illness self-management interventions for older adults with SMI. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Crow RS, Lohman MC, Titus AJ, Cook SB, Bruce ML, Mackenzie TA, Bartels SJ, Batsis JA. Association of Obesity and Frailty in Older Adults: NHANES 1999-2004. J Nutr Health Aging 2019; 23:138-144. [PMID: 30697622 PMCID: PMC6371801 DOI: 10.1007/s12603-018-1138-x] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Body composition changes with aging can increase rates of obesity, frailty and impact function. Measuring adiposity using body fat (%BF) or central adiposity using waist circumference (WC) have greater diagnostic accuracy than traditional measures such as body mass index (BMI). DESIGN This is an observational study. SETTING This study focused on older community-dwelling participants. PARTICIPANTS We identified individuals age ≥ 60 years old using the 1999-2004 cross-sectional National Health and Nutrition Survey (NHANES). INTERVENTION The primary analysis evaluated the association between frailty and %BF or WC. Frailty was the primary predictor (robust=referent) and %BF and WC were considered continuous outcomes. Multiple imputation analyses accounted for missing characteristics. MEASUREMENT Dual energy x-ray absorptiometry was used to assess %BF and WC was objectively measured. Frailty was defined using an adapted version of Fried's criteria that was self-reported: (low BMI<18.5kg/m2; slow walking speed [<0.8m/s]; weakness [unable to lift 10lbs]; exhaustion [difficulty walking between rooms on same floor] and low physical activity [compared to others]). Robust, pre-frail and frail persons met zero, 1 or 2, and ≥3 criteria, respectively. RESULTS Of the 4,984 participants, the mean age was 71.1±0.2 (SE) years and 56.5% were females. We classified 2,246 (50.4%), 2,195 (40.3%), and 541 (9.2%) individuals as robust, pre-frail and frail, respectively. Percent BF was 35.9±0.13, 38.3±0.20 and 40.0±0.46 in the robust, pre-frail and frail individuals, respectively. WC was 99.5±0.32 in the robust, 100.1±0.43 in pre-frail, 104.7±1.17 in frail individuals. Compared to robust individuals, only frail individuals had greater %BF on average (β=0.97±0.43,p=0.03); however, pre-frail and frail individuals had 2.18 and 4.80 greater WC, respectively (β=2.18±0.64,p=0.002, and β=4.80±1.1,p<0.001). CONCLUSION Our results demonstrate that in older adults, frailty and pre-frailty are associated with a greater likelihood of high WC (as dichotomized) and a greater average WC (continuous).
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Affiliation(s)
- R S Crow
- Rebecca Crow, DO, Section of General Internal Medicine, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH 03756, Telephone: (603) 653-9500, Facsimile: (603) 650-0915, E-mail:
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Resciniti NV, Lohman MC, Wirth MD, Shivappa N, Hebert JR. Dietary Inflammatory Index, Pre-Frailty and Frailty among Older US Adults: Evidence from the National Health and Nutrition Examination Survey, 2007-2014. J Nutr Health Aging 2019; 23:323-329. [PMID: 30932130 DOI: 10.1007/s12603-019-1164-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [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] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study aimed to investigate the association between dietary inflammation, pre-frailty and frailty among older US adults. Additionally, effect modification of gender on the association between dietary inflammation and frailty was assessed. DESIGN Study data came from the National Health and Nutrition Examination Survey (2007-2014) - a nationally representative, cross-sectional study of adults. PARTICIPANTS The analytic sample included adults ≥60 years (n=7,182). MEASUREMENTS Dietary Inflammatory Index (DII®) scores were calculated from 24-hour dietary recalls; DII was categorized into quintiles from Quintile 1 (Q1) (least inflammatory) to Q5 (most inflammatory). Frailty was assessed by four criteria: exhaustion, weakness, low body mass, and low physical activity. Individuals were then categorized into robust (0 criteria), pre-frail (1-2 criteria), or frail (3-4 criteria). Multinomial logistic regression was used to examine the odds of frailty categories (pre-frail vs. robust; frail vs. robust). RESULTS After adjusting for potential confounders, individuals in DII quintile 5 (vs Q1) were more likely to be pre-frail (OR = 1.71; 95% CI: 1.36-2.15) and frail (OR = 1.70; 95% CI: 1.02-2.85). Individuals in Q4 had greater odds of frailty only (OR = 1.82; 95% CI: 1.13, 2.93). No evidence of effect modification by gender on the association of DII and frailty was found. CONCLUSION This study expands upon previous evidence of a relationship between dietary inflammation and frailty. When designing nutrition-based frailty interventions, inflammatory properties of diets should be considered.
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Affiliation(s)
- N V Resciniti
- Nicholas V. Resciniti, Department of Epidemiology and Biostatistics, University of South Carolina, Arnold School of Public Health,
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Fortuna KL, Aschbrenner KA, Lohman MC, Brooks J, Salzer M, Walker R, St George L, Bartels SJ. Smartphone Ownership, Use, and Willingness to Use Smartphones to Provide Peer-Delivered Services: Results from a National Online Survey. Psychiatr Q 2018; 89:947-956. [PMID: 30056476 PMCID: PMC6413732 DOI: 10.1007/s11126-018-9592-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Assess certified peer specialists' smartphone ownership, use, and willingness to use smartphones to provide peer-delivered services. Certified peer specialist from 38 states completed an online survey. The final sample of 267 certified peer specialists included respondents from 38 states. The majority of certified peer specialists were female (73%; n = 195) and Caucasian (79.8%; n = 213), with an average age of 50.9 (SD = 12) years, range from 21 to 77 years. More than half of the certified peer specialists (82.1%; n = 184) were currently working in peer support positions. Of those who reported their mental health diagnoses, 11% reported their diagnosis as schizophrenia spectrum disorder, 22% of respondents reported bipolar disorder, and 23% reported persistent major depressive disorder. Nearly all respondents owned a smartphone (94.8%; n = 253), and everyone indicated that smartphones and tablets could enhance the services they deliver. Certified peer specialists reported substantial ownership and use of smartphones, comparable to existing national data. They are willing to deliver smartphone interventions for mental health and physical health self-management, suggesting that smartphones may be an increasingly useful tool for offering evidence-based care. Without Medicaid mandate, certified peer specialists are naturally trying to enhance peer delivered services with technology. Peer support could act as a mechanism to promote consumer engagement in a smartphone-based intervention. Certified peer specialist own and utilize smartphones, and the majority are willing to deliver technology-based and technology-enhanced interventions using these devices to address medical and psychiatric self-management.
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Affiliation(s)
- Karen L Fortuna
- Dartmouth Centers for Health and Aging, 46 Centerra Parkway, Suite 200, Lebanon, NH, 03766, USA. .,CDC Health Promotion Research Center at Dartmouth, Lebanon, NH, USA.
| | - Kelly A Aschbrenner
- Dartmouth Centers for Health and Aging, 46 Centerra Parkway, Suite 200, Lebanon, NH, 03766, USA.,CDC Health Promotion Research Center at Dartmouth, Lebanon, NH, USA
| | - Matthew C Lohman
- Arnold School of Public Health, Department of Epidemiology and Biostatistics, University of South Carolina, 921 Assembly St, Columbia, SC, 29208, USA
| | - Jessica Brooks
- Dartmouth Centers for Health and Aging, 46 Centerra Parkway, Suite 200, Lebanon, NH, 03766, USA.,CDC Health Promotion Research Center at Dartmouth, Lebanon, NH, USA
| | - Mark Salzer
- Temple University Department of Rehabilitation Sciences, 1700 N Broad St, Philadelphia, PA, 19121, USA
| | - Robert Walker
- Massachusetts Department of Mental Health, 25 Staniford St, Boston, MA, 02114, USA
| | - Lisa St George
- RI International, 2701 N. 16th Street, Phoenix, AZ, 85006, USA
| | - Stephen J Bartels
- Dartmouth Centers for Health and Aging, 46 Centerra Parkway, Suite 200, Lebanon, NH, 03766, USA.,CDC Health Promotion Research Center at Dartmouth, Lebanon, NH, USA.,The Dartmouth Institute for Health Policy and Clinical Practice, 1 Medical Center Drive, Lebanon, NH, 03766, USA
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Batsis JA, Lohman MC, Fortuna KL, Liu SK, Bartels SJ. Association between obesity and patient-centered measures using the medical expenditure panel survey. Obes Res Clin Pract 2018; 12:485-489. [PMID: 30150161 DOI: 10.1016/j.orcp.2018.07.009] [Citation(s) in RCA: 1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 06/01/2018] [Accepted: 07/17/2018] [Indexed: 10/28/2022]
Abstract
Patient-centeredness is an important factor in patient health and engagement but its association in patients with obesity is not thoroughly understood. Of 28,854 participants aged ≥60 from the Medical Expenditure Panel Survey 2004-2013, we evaluated four patient-centered domains: patient/provider relationship, shared-decision making, access to care, overall medical care provider rating, and prescription care. Weighted logistic (OR [95% CI]) and linear (β±s.e.; p-value) regression models demonstrated that participants as having obesity reported a marginally higher delay in getting the necessary care than healthy BMI (OR 1.25 [1.01, 1.53]). Older adults with obesity report reduced perceived access to care.
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Affiliation(s)
- John A Batsis
- Section of General Internal Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States; Geisel School of Medicine at Dartmouth and The Dartmouth Institute for Health Policy & Clinical, United States; Dartmouth Centers for Health and Aging, Dartmouth College, Hanover, NH, United States; Health Promotion Research Center at Dartmouth, Lebanon, NH, United States; Dartmouth Weight & Wellness Center, Lebanon, NH, United States.
| | - Matthew C Lohman
- School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Karen L Fortuna
- Geisel School of Medicine at Dartmouth and The Dartmouth Institute for Health Policy & Clinical, United States; Dartmouth Centers for Health and Aging, Dartmouth College, Hanover, NH, United States; Health Promotion Research Center at Dartmouth, Lebanon, NH, United States
| | - Stephen K Liu
- Section of General Internal Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States; Geisel School of Medicine at Dartmouth and The Dartmouth Institute for Health Policy & Clinical, United States
| | - Stephen J Bartels
- Geisel School of Medicine at Dartmouth and The Dartmouth Institute for Health Policy & Clinical, United States; Dartmouth Centers for Health and Aging, Dartmouth College, Hanover, NH, United States; Health Promotion Research Center at Dartmouth, Lebanon, NH, United States
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Leggett AN, Sonnega AJ, Lohman MC. The association of insomnia and depressive symptoms with all-cause mortality among middle-aged and old adults. Int J Geriatr Psychiatry 2018; 33:10.1002/gps.4923. [PMID: 29939437 PMCID: PMC6309745 DOI: 10.1002/gps.4923] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 05/01/2018] [Indexed: 01/07/2023]
Abstract
OBJECTIVES Insomnia and depressive symptoms are commonly reported by adults and have independently been found to be associated with mortality, though contrasting findings are reported. Given the high comorbidity and interrelatedness between these symptoms, we tested whether insomnia symptoms explain risk of death independent of depressive symptoms. We examined insomnia symptoms and depressive symptoms, in addition to other health and demographic covariates, as predictors of all-cause mortality. METHODS The sample included 15 418 adults aged 51 and older drawn from a nationally representative, population-based study of adults in the United States, the Health and Retirement Study. Cox survival models were used to analyze time to death between the 2002 and 2014 study waves (5 waves). Controlling for health and demographic covariates, in 3 separate models, depressive symptoms and insomnia symptoms were independently and then together considered as risk factors for all-cause mortality (drawn from the National Death Index). RESULTS After adjustment for covariates, insomnia symptoms (HR = 1.10, CI:1.07-1.13) and depressive symptoms (HR = 1.14, CI:1.12-1.16) each were associated with a greater hazard of death. When considered together, however, depressive symptoms fully accounted for the association between insomnia symptoms and mortality. CONCLUSION Though their effects are small relative to health and demographic characteristics, both insomnia symptoms and depressive symptoms were associated with a greater hazard of death. Yet depressive symptoms accounted for the insomnia association when both were considered in the model. Screening for depression and providing validated treatments may reduce mortality risk in old adults with depressive symptoms.
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Affiliation(s)
- Amanda N Leggett
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | | | - Matthew C Lohman
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Cotton BP, Bryson WC, Lohman MC, Brooks JM, Bruce ML. Characteristics of Medicaid recipients in Methadone Maintenance Treatment: A comparison across the lifespan. J Subst Abuse Treat 2018; 92:40-45. [PMID: 30032943 DOI: 10.1016/j.jsat.2018.06.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 06/02/2018] [Accepted: 06/04/2018] [Indexed: 02/08/2023]
Abstract
Methadone Maintenance Treatment (MMT) is utilized by an increasingly broad age-range of individuals with opioid use disorders. The present study aims to (1) describe health, behavioral, and psychosocial characteristics among adults aged 50 years and older compared with younger adults enrolled in MMT, (2) describe socioeconomic and clinical characteristics by age and time in MMT and (3) investigate whether age influences the associations between duration of MMT and health and psychosocial characteristics. Our sample consisted of 1364 recipients from four MMT programs (age ranged from 18 to 77 years; mean: 38 years: standard deviation: 11.1 years) in Southern New England Using descriptive analysis and logistic regression, we determined that one-third (33%) of adults 50 years of age and older had been admitted or readmitted into MMT within the previous 6 months, 27% had been in treatment for 7-47 months, while 40% had been in treatment for at least 4 years. Psychosocial problems and smoking were both common (>80%) at the time of MMT enrollment but declined with longer duration of MMT for all age groups. The prevalence of metabolic conditions was associated with increased duration of MMT for younger adults for both age (1.03; CI 1.02-1.05; p < 0.001) and time in treatment (1.29; 1.12-1.44; p < 0.001; interaction term 0.0996; CI 0.993-0.998). Tailored strategies to enhance engagement, retention, and prevention among MMT recipients should include considerations of age, health status upon enrollment, duration of treatment, and developmental context.
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Affiliation(s)
- Brandi P Cotton
- University of Rhode Island, College of Nursing, Kingston, RI, United States.
| | - William C Bryson
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Matthew C Lohman
- Department of Epidemiology and Biostatistics, University of South Carolina, Arnold School of Public Health, Columbia, SC, United States
| | - Jessica M Brooks
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States; Department of Rehabilitation & Health Services, University of North Texas, Denton, TX, United States
| | - Martha L Bruce
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
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Fortuna KL, DiMilia PR, Lohman MC, Bruce ML, Zubritsky CD, Halaby MR, Walker RM, Brooks JM, Bartels SJ. Feasibility, Acceptability, and Preliminary Effectiveness of a Peer-Delivered and Technology Supported Self-Management Intervention for Older Adults with Serious Mental Illness. Psychiatr Q 2018; 89:293-305. [PMID: 28948424 PMCID: PMC5874159 DOI: 10.1007/s11126-017-9534-7] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
To assess the feasibility, acceptability, and preliminary effectiveness of a peer-delivered and technology supported integrated medical and psychiatric self-management intervention for older adults with serious mental illness. Ten older adults with serious mental illness (i.e., schizophrenia, schizoaffective disorder, bipolar disorder, or major depressive disorder) and medical comorbidity (i.e., cardiovascular disease, obesity, diabetes, chronic obstructive pulmonary disease, hypertension, and/or high cholesterol) aged 60 years and older received the PeerTECH intervention in their homes. Three certified peer specialists were trained to deliver PeerTECH. Data were collected at baseline, one-month, and three-month. The pilot study demonstrated that a three-month, peer-delivered and technology-supported integrated medical and psychiatric self-management intervention ("PeerTECH") was experienced by peer specialists and participants as feasible and acceptable. PeerTECH was associated with statistically significant improvements in psychiatric self-management. In addition, pre/post, non-statistically significant improvements were observed in self-efficacy for managing chronic health conditions, hope, quality of life, medical self-management skills, and empowerment. This pre/post pilot study demonstrated it is possible to train peers to use technology to deliver an integrated psychiatric and medical self-management intervention in a home-based setting to older adults with serious mental illness with fidelity. These findings provide preliminary evidence that a peer-delivered and technology-supported intervention designed to improve medical and psychiatric self-management is feasible, acceptable, and is potentially associated with improvements in psychiatric self-management, self-efficacy for managing chronic health conditions, hope, quality of life, medical self-management skills, and empowerment with older adults with serious mental illness and chronic health conditions.
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Affiliation(s)
- Karen L Fortuna
- Dartmouth Centers for Health and Aging, 46 Centerra Parkway, Suite 200, Lebanon, NH, 03766, USA.
- CDC Health Promotion Research Center at Dartmouth, Lebanon, NH, USA.
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
| | - Peter R DiMilia
- Dartmouth Centers for Health and Aging, 46 Centerra Parkway, Suite 200, Lebanon, NH, 03766, USA
- The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, NH, USA
| | - Matthew C Lohman
- Dartmouth Centers for Health and Aging, 46 Centerra Parkway, Suite 200, Lebanon, NH, 03766, USA
- CDC Health Promotion Research Center at Dartmouth, Lebanon, NH, USA
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Martha L Bruce
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
- The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, NH, USA
| | - Cynthia D Zubritsky
- Center for Mental Health Policy and Services Research, School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | | | - Jessica M Brooks
- Dartmouth Centers for Health and Aging, 46 Centerra Parkway, Suite 200, Lebanon, NH, 03766, USA
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Stephen J Bartels
- Dartmouth Centers for Health and Aging, 46 Centerra Parkway, Suite 200, Lebanon, NH, 03766, USA
- CDC Health Promotion Research Center at Dartmouth, Lebanon, NH, USA
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
- The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, NH, USA
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Cotton BP, Lohman MC, Brooks JM, LaGasse LL. Perinatal substance use, residential instability, and negative behavioral outcomes among adolescents: Lessons from the maternal lifestyle study. J Child Adolesc Psychiatr Nurs 2018; 30:149-155. [PMID: 29602191 DOI: 10.1111/jcap.12188] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 11/15/2017] [Revised: 02/26/2018] [Accepted: 02/27/2018] [Indexed: 11/27/2022]
Abstract
PROBLEM Both housing instability and prenatal substance use are known risk factors for behavioral problems among adolescents. METHODS The purpose of this study was to investigate the association between residential instability (residential mobility and homelessness) and delinquent behaviors among adolescents enrolled in the maternal lifestyle study (MLS), a 16-year research study that explored short-term and long-term effects of in-utero exposure to cocaine and/or opiates (N = 736). Logistic regression was used to measure the association between housing problems with youth crimes, school delinquency, and substance use at 11, 15, and 16 years of age. FINDINGS Both high-frequency residential mobility and homelessness were associated with deviant behaviors across the entire sample of children born with in-utero cocaine/opiate exposure and those without. CONCLUSIONS Psychiatric nursing care of youth should include a comprehensive assessment of residential instability to identify risk and target potential interventions.
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Affiliation(s)
- Brandi P Cotton
- College of Nursing of the University of Rhode Island, Kingston, RI, USA
| | - Matthew C Lohman
- Epidemiology & Biostatistics of the University of South Carolina, Columbia, SC, USA
| | - Jessica M Brooks
- Department of Psychiatry of the Geisel School of Medicine at Dartmouth, Hanover, NH, USA
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Crow RS, Lohman MC, Pidgeon D, Bruce ML, Bartels SJ, Batsis JA. Frailty Versus Stopping Elderly Accidents, Deaths and Injuries Initiative Fall Risk Score: Ability to Predict Future Falls. J Am Geriatr Soc 2018; 66:577-583. [PMID: 29427525 DOI: 10.1111/jgs.15275] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To compare the ability of frailty status to predict fall risk with that of community fall risk screening tools. DESIGN Analysis of cross-sectional and longitudinal data from NHATS. SETTING National Health and Aging Trend Study (NHATS) 2011-2015. PARTICIPANTS Individuals aged 65 and older (N = 7,392). MEASUREMENTS Fall risk was defined according to the Stopping Elderly Accidents, Deaths and Injuries (STEADI) initiative. Frailty was defined as exhaustion, weight loss, low activity, slow gait speed, and weak grip strength. Robust was defined as meeting 0 criteria, prefrailty as 1 or 2 criteria, and frailty as 3 or more criteria. Falls were self-reported and ascertained using NHATS subsequent rounds (2012-2015). We compared the ability of frailty to predict future falls with that of STEADI score, adjusting for age, race, sex, education, comorbidities, hearing and vision impairment, and disability. RESULTS Of the 7,392 participants (58.5% female), there 3,545 (48.0%) were classified as being at low risk of falling, 2,966 (40.1%) as being at moderate risk, and 881 (11.9%) as being at high risk. The adjusted risk of falling over the 4 subsequent years was 2.5 times as great for the moderate-risk group (hazard ratio (HR) = 2.50, 95% confidence interval (CI) = 2.16-2.89) and almost 4 times as great (HR = 3.79, 95% CI = 2.76-5.21) for the high-risk group as for the low-risk group. Risk of falling was greater for those who were prefrail (HR = 1.34, 95% CI 1.16-1.55) and frail (HR = 1.20, 95% CI = 0.94-1.54) than for those who were robust. CONCLUSION STEADI score is a strong predictor of future falls. Addition of frailty status does not improve the ability of the STEADI measure to predict future falls.
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Affiliation(s)
- Rebecca S Crow
- Section of General Internal Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.,Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire.,Dartmouth Centers for Health and Aging, Dartmouth College, Hanover, New Hampshire
| | - Matthew C Lohman
- Dartmouth Centers for Health and Aging, Dartmouth College, Hanover, New Hampshire.,Health Promotion Research Center, Dartmouth College, Lebanon, New Hampshire
| | - Dawna Pidgeon
- Dartmouth Centers for Health and Aging, Dartmouth College, Hanover, New Hampshire.,Department of Rehabilitation, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Martha L Bruce
- Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire.,Dartmouth Centers for Health and Aging, Dartmouth College, Hanover, New Hampshire.,Health Promotion Research Center, Dartmouth College, Lebanon, New Hampshire
| | - Stephen J Bartels
- Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire.,Dartmouth Centers for Health and Aging, Dartmouth College, Hanover, New Hampshire.,Health Promotion Research Center, Dartmouth College, Lebanon, New Hampshire.,Dartmouth Institute for Health Policy and Clinical Research, Lebanon, New Hampshire
| | - John A Batsis
- Section of General Internal Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.,Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire.,Dartmouth Centers for Health and Aging, Dartmouth College, Hanover, New Hampshire.,Health Promotion Research Center, Dartmouth College, Lebanon, New Hampshire.,Dartmouth Institute for Health Policy and Clinical Research, Lebanon, New Hampshire
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Fortuna KL, Lohman MC, Bruce ML, Bartels SJ. Utility of functioning measures in the prediction of independent living status in older adults with serious mental illness. Int J Geriatr Psychiatry 2018; 33:423-431. [PMID: 28776766 PMCID: PMC5872810 DOI: 10.1002/gps.4764] [Citation(s) in RCA: 1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 06/17/2017] [Accepted: 06/27/2017] [Indexed: 11/10/2022]
Abstract
OBJECTIVE The objective of the study was to compare the predictive utility of three commonly used functioning measures for people with serious mental illness in the prediction of independent living status. METHODS We conducted a secondary data analysis from the Helping Older People Experience Success study with adults aged 50 years and older with a diagnosis of bipolar disorder, schizoaffective disorder, schizophrenia, or major depressive disorder (N = 183). RESULTS Total scores for the Independent Living Skills Survey, Multnomah Community Ability Scale, and UCSD Performance-Based Skills Assessment were modestly inter-correlated. For the overall sample, greater independent living status at baseline and 1-year follow-up was predicted by higher baseline functioning scores on both the self-reported Independent Living Skills Survey and the UCSD Performance-Based Skills Assessment. However, by diagnostic subgroup, independent living status at 1-year follow-up was only predicted by the Independent Living Skills Survey for affective disorders and by the UCSD Performance-Based Skills Assessment for schizophrenia-spectrum disorders. For the total sample, the Independent Living Skills Survey was associated with self-efficacy and employment status. Neither the Independent Living Skills Survey nor UCSD Performance-Based Skills Assessment was associated with medical or psychiatric hospitalizations or with subjective physical or mental health status. CONCLUSIONS These commonly used functioning measures for people with serious mental illness examine different aspects of functioning. The choice of functional measurement should be based on the population under study and intervention goals. Copyright © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
- Karen L. Fortuna
- Dartmouth Centers for Health and Aging, Lebanon, NH, USA,CDC Health Promotion Research Center at Dartmouth, Lebanon, NH, USA,Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
| | - Matthew C. Lohman
- Dartmouth Centers for Health and Aging, Lebanon, NH, USA,CDC Health Promotion Research Center at Dartmouth, Lebanon, NH, USA,Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
| | - Martha L. Bruce
- Dartmouth Centers for Health and Aging, Lebanon, NH, USA,Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA,The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, USA
| | - Stephen J. Bartels
- Dartmouth Centers for Health and Aging, Lebanon, NH, USA,CDC Health Promotion Research Center at Dartmouth, Lebanon, NH, USA,Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA,The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, USA
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Crow RS, Lohman MC, Titus AJ, Bruce ML, Mackenzie TA, Bartels SJ, Batsis JA. Mortality Risk Along the Frailty Spectrum: Data from the National Health and Nutrition Examination Survey 1999 to 2004. J Am Geriatr Soc 2018; 66:496-502. [PMID: 29368330 DOI: 10.1111/jgs.15220] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To determine the relationship between frailty and overall and cardiovascular mortality. DESIGN Longitudinal mortality analysis. SETTING National Health and Nutrition Examination Survey (NHANES) 1999-2004. PARTICIPANTS Community-dwelling older adults aged 60 and older (N = 4,984; mean age 71.1 ± 0.19, 56% female). MEASUREMENTS We used data from 1999-2004 cross-sectional NHANES and mortality data from the National Death Index, updated through December 2011. An adapted version of Fried's frailty criteria was used (low body mass index, slow walking speed, weakness, exhaustion, low physical activity). Frailty was defined as persons meeting 3 or more criteria, prefrailty as meeting 1 or 2 criteria, and robust (reference) as not meeting any criteria. The primary outcome was to evaluate the association between frailty and overall and cardiovascular mortality. Cox proportional hazard models were used to evaluate the association between risk of death and frailty category adjusted for age, sex, race, smoking, education, coronary artery disease, heart failure, nonskin cancer, diabetes, and arthritis. RESULTS Half (50.4%) of participants were classified as robust, 40.3% as prefrail, and 9.2% as frail. Fully adjusted models demonstrated that prefrail (hazard ratio (HR) = 1.64, 95% confidence interval (CI) = 1.45-1.85) and frail (HR = 2.79, 95% CI = 2.35-3.30) participants had a greater risk of death and of cardiovascular death (prefrail: HR = 1.84, 95% CI = 1.45-2.34; frail: HR = 3.39, 95% CI = 2.45-4.70). CONCLUSION Frailty and prefrailty are associated with increased risk of death. Demonstrating the association between prefrail status and mortality is the first step to identifying potential targets of intervention in future studies.
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Affiliation(s)
- Rebecca S Crow
- Section of General Internal Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.,Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire.,Dartmouth Centers for Health and Aging, Dartmouth College, Hanover, New Hampshire
| | - Matthew C Lohman
- Dartmouth Centers for Health and Aging, Dartmouth College, Hanover, New Hampshire.,Health Promotion Research Center at Dartmouth, Dartmouth College, Lebanon, New Hampshire
| | - Alexander J Titus
- Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire.,Department of Epidemiology, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire
| | - Martha L Bruce
- Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire.,Dartmouth Centers for Health and Aging, Dartmouth College, Hanover, New Hampshire.,Health Promotion Research Center at Dartmouth, Dartmouth College, Lebanon, New Hampshire
| | - Todd A Mackenzie
- Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire.,Department of Biomedical Data Science, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire.,Dartmouth Institute for Health Policy and Clinical Research, Lebanon, New Hampshire
| | - Stephen J Bartels
- Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire.,Dartmouth Centers for Health and Aging, Dartmouth College, Hanover, New Hampshire.,Health Promotion Research Center at Dartmouth, Dartmouth College, Lebanon, New Hampshire.,Dartmouth Institute for Health Policy and Clinical Research, Lebanon, New Hampshire
| | - John A Batsis
- Section of General Internal Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.,Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire.,Dartmouth Centers for Health and Aging, Dartmouth College, Hanover, New Hampshire.,Health Promotion Research Center at Dartmouth, Dartmouth College, Lebanon, New Hampshire.,Dartmouth Institute for Health Policy and Clinical Research, Lebanon, New Hampshire.,Dartmouth Weight & Wellness Center, Lebanon, New Hampshire
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Brooks JM, Muller V, Sánchez J, Johnson ET, Chiu CY, Cotton BP, Lohman MC, Catalano D, Bartels S, Chan F. Mindfulness as a protective factor against depressive symptoms in people with fibromyalgia. J Ment Health 2017; 29:161-167. [PMID: 29271273 DOI: 10.1080/09638237.2017.1417555] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background: Depressive symptoms complicate pain management for people with FM, with adverse consequences such as a greater need for pain medications and limited pain coping strategies. Determining risks and protective factors associated with depressive symptoms in persons with FM could inform the development and implementation of mental health interventions.Aims: To formulate and test a behavioral activation model of depression with mindfulness as a protective factor for people with FM.Methods: We conducted an online cross-sectional survey with 117 adults with FM from community and clinic networks. Path analysis was used to assess the relationships of pain intensity, perceived stress, activity interference, pain catastrophizing and mindfulness with depressive symptoms.Results: Mindfulness has a negative direct association with depressive symptoms and a negative indirect association with depressive symptoms through perceived stress, activity interference and pain catastrophizing. Perceived stress, activity interference and pain catastrophizing had direct associations with depressive symptoms. Finally, perceived stress, activity interference and pain catastrophizing had indirect associations with depressive symptoms through pain intensity.Conclusions: Mindfulness seems to play an important role as a protective factor against the negative effects of stress and depression among people with FM and should be included in mental health interventions for chronic pain.
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Affiliation(s)
- Jessica M Brooks
- Department of Psychiatry, Dartmouth College, Lebanon, NH, USA.,Department of Rehabilitation and Health Services, University of North Texas, Denton, TX, USA
| | - Veronica Muller
- Department of Educational Foundation and Counseling Programs, Hunter College, City University of New York, New York, NY, USA
| | - Jennifer Sánchez
- Department of Rehabilitation and Counselor Education, The University of Iowa, Iowa City, IA, USA
| | - Eboneé T Johnson
- Department of Rehabilitation and Counselor Education, The University of Iowa, Iowa City, IA, USA
| | - Chung-Yi Chiu
- Department of Kinesiology and Community Health, The University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | | | | | - Denise Catalano
- Department of Rehabilitation and Health Services, University of North Texas, Denton, TX, USA
| | - Stephen Bartels
- Department of Psychiatry, Dartmouth College, Lebanon, NH, USA
| | - Fong Chan
- Department of Rehabilitation Psychology and Special Education, University of Wisconsin-Madison, Madison, WI, USA
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Lohman MC, Cotton BP, Zagaria AB, Bao Y, Greenberg RL, Fortuna KL, Bruce ML. Hospitalization Risk and Potentially Inappropriate Medications among Medicare Home Health Nursing Patients. J Gen Intern Med 2017; 32:1301-1308. [PMID: 28849426 PMCID: PMC5698223 DOI: 10.1007/s11606-017-4157-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 06/27/2017] [Accepted: 08/03/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Hospitalizations and potentially inappropriate medication (PIM) use are significant and costly issues among older home health patients, yet little is known about the prevalence of PIM use in home health or the relationship between PIM use and hospitalization risk in this population. OBJECTIVE To describe the prevalence of PIM use and association with hospitalization among Medicare home health patients. DESIGN Cross-sectional analysis using data from 132 home health agencies in the US. SUBJECTS Medicare beneficiaries starting home health nursing services between 2013 and 2014 (n = 87,780). MAIN MEASURES Prevalence of individual and aggregate PIM use at start of care, measured using the 2012 Beers criteria. Relative risk (RR) of 30-day hospitalization or re-hospitalization associated with individual and aggregate PIM use, compared to no PIM use. KEY RESULTS In total, 30,168 (34.4%) patients were using at least one PIM, with 5969 (6.8%) taking at least two PIMs according to the Beers list. The most common types of PIMs were those affecting the brain or spinal cord, analgesics, and medications with anticholinergic properties. With the exception of nonsteroidal anti-inflammatory drugs (NSAIDs), PIM use across all classes was associated with elevated risk (10-33%) of hospitalization compared to non-use. Adjusting for demographic and clinical characteristics, patients using at least one PIM (excluding NSAIDs) had a 13% greater risk (RR = 1.13, 95% CI: 1.09, 1.17) of being hospitalized than patients using no PIMs, while patients using at least two PIMs had 21% greater risk (RR = 1.21, 95% CI: 1.12, 1.30). Similar associations were found between PIMs and re-hospitalization risk among patients referred to home health from a hospital. CONCLUSIONS Given the high prevalence of PIM use and the association between PIMs and hospitalization risk, home health episodes represent opportunities to substantially reduce PIM use among older adults and prevent adverse outcomes. Efforts to address medication use during home health episodes, hospitalizations, and care transitions are justified.
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Affiliation(s)
- Matthew C Lohman
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA. .,Dartmouth Centers for Health and Aging, Lebanon, NH, USA.
| | - Brandi P Cotton
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.,Dartmouth Centers for Health and Aging, Lebanon, NH, USA
| | - Alexandra B Zagaria
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Yuhua Bao
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, USA.,Department of Psychiatry, Weill Cornell Medical College, New York, NY, USA
| | - Rebecca L Greenberg
- Institute of Geriatric Psychiatry, Weill Cornell Medical College, White Plains, NY, USA
| | - Karen L Fortuna
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.,Dartmouth Centers for Health and Aging, Lebanon, NH, USA
| | - Martha L Bruce
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.,Dartmouth Centers for Health and Aging, Lebanon, NH, USA
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Lohman MC, Crow RS, DiMilia PR, Nicklett EJ, Bruce ML, Batsis JA. Operationalisation and validation of the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) fall risk algorithm in a nationally representative sample. J Epidemiol Community Health 2017; 71:1191-1197. [PMID: 28947669 DOI: 10.1136/jech-2017-209769] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [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: 07/24/2017] [Revised: 09/12/2017] [Accepted: 09/15/2017] [Indexed: 01/28/2023]
Abstract
BACKGROUND Preventing falls and fall-related injuries among older adults is a public health priority. The Stopping Elderly Accidents, Deaths, and Injuries (STEADI) tool was developed to promote fall risk screening and encourage coordination between clinical and community-based fall prevention resources; however, little is known about the tool's predictive validity or adaptability to survey data. METHODS Data from five annual rounds (2011-2015) of the National Health and Aging Trends Study (NHATS), a representative cohort of adults age 65 years and older in the USA. Analytic sample respondents (n=7392) were categorised at baseline as having low, moderate or high fall risk according to the STEADI algorithm adapted for use with NHATS data. Logistic mixed-effects regression was used to estimate the association between baseline fall risk and subsequent falls and mortality. Analyses incorporated complex sampling and weighting elements to permit inferences at a national level. RESULTS Participants classified as having moderate and high fall risk had 2.62 (95% CI 2.29 to 2.99) and 4.76 (95% CI 3.51 to 6.47) times greater odds of falling during follow-up compared with those with low risk, respectively, controlling for sociodemographic and health-related risk factors for falls. High fall risk was also associated with greater likelihood of falling multiple times annually but not with greater risk of mortality. CONCLUSION The adapted STEADI clinical fall risk screening tool is a valid measure for predicting future fall risk using survey cohort data. Further efforts to standardise screening for fall risk and to coordinate between clinical and community-based fall prevention initiatives are warranted.
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Affiliation(s)
- Matthew C Lohman
- Department of Psychiatry, Dartmouth College Geisel School of Medicine, Hanover, New Hampshire, USA.,Dartmouth Centers for Health and Aging, Lebanon, New Hampshire, USA
| | - Rebecca S Crow
- Dartmouth Centers for Health and Aging, Lebanon, New Hampshire, USA.,Dartmouth-Hitchcock Medical Center, Section of General Internal Medicine, Lebanon, New Hampshire, USA.,The Dartmouth Institute for Health Policy & Clinical Research, Lebanon, New Hampshire, USA
| | - Peter R DiMilia
- Dartmouth Centers for Health and Aging, Lebanon, New Hampshire, USA.,The Dartmouth Institute for Health Policy & Clinical Research, Lebanon, New Hampshire, USA
| | - Emily J Nicklett
- University of Michigan School of Social Work, Ann Arbor, Michigan, USA
| | - Martha L Bruce
- Department of Psychiatry, Dartmouth College Geisel School of Medicine, Hanover, New Hampshire, USA.,Dartmouth Centers for Health and Aging, Lebanon, New Hampshire, USA
| | - John A Batsis
- Department of Psychiatry, Dartmouth College Geisel School of Medicine, Hanover, New Hampshire, USA.,Dartmouth Centers for Health and Aging, Lebanon, New Hampshire, USA.,Dartmouth-Hitchcock Medical Center, Section of General Internal Medicine, Lebanon, New Hampshire, USA.,The Dartmouth Institute for Health Policy & Clinical Research, Lebanon, New Hampshire, USA
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Fortuna KL, Lohman MC, Gill LE, Bruce ML, Bartels SJ. Adapting a Psychosocial Intervention for Smartphone Delivery to Middle-Aged and Older Adults with Serious Mental Illness. Am J Geriatr Psychiatry 2017; 25:819-828. [PMID: 28169129 PMCID: PMC5498268 DOI: 10.1016/j.jagp.2016.12.007] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 11/17/2016] [Accepted: 12/12/2016] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To describe the process of adapting an integrated medical and psychiatric self-management intervention to a smartphone application for middle-aged and older adults with serious mental illness using an adaptive systems engineering framework and user-centered design. METHODS First, we determined the technical abilities and needs of middle-aged and older adults with serious mental illnesses using smartphones. Then, we developed smartphone content through principles of user-centered design and modified an existing smartphone platform. Finally, we conducted a usability test using "think aloud" and verbal probing. RESULTS We adapted a psychosocial self-management intervention to a smartphone application and tested its usability. Ten participants (mean age: 55.3 years, SD: 6.2 years) with serious mental illness and comorbid chronic health conditions reported a high level of usability and satisfaction with the smartphone application. CONCLUSIONS Middle-aged and older adults with serious mental illness and limited technical abilities were able to participate in a process involving user-centered design and adaptation of a self-management intervention to be delivered by a smartphone. High usability ratings suggest that middle-aged and older adults with serious mental illness have the potential to use tailored smartphone interventions. Future research is indicated to establish effectiveness and to determine the type and intensity of clinical support needed to successfully implement smartphone applications as a component of community-based services for older adults with psychiatric and medical conditions.
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Affiliation(s)
- Karen L Fortuna
- Dartmouth Centers for Health and Aging, Lebanon, NH; CDC Health Promotion Research Center at Dartmouth, Lebanon, NH; Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH.
| | - Matthew C Lohman
- Dartmouth Centers for Health and Aging, Lebanon, NH; CDC Health Promotion Research Center at Dartmouth, Lebanon, NH; Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Lydia E Gill
- Dartmouth Centers for Health and Aging, Lebanon, NH; CDC Health Promotion Research Center at Dartmouth, Lebanon, NH
| | - Martha L Bruce
- Dartmouth Centers for Health and Aging, Lebanon, NH; CDC Health Promotion Research Center at Dartmouth, Lebanon, NH; Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Stephen J Bartels
- Dartmouth Centers for Health and Aging, Lebanon, NH; CDC Health Promotion Research Center at Dartmouth, Lebanon, NH; Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH
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Affiliation(s)
- Karen L Whiteman
- The authors are with Dartmouth Centers for Health and Aging and the CDC Health Promotion Research Center at Dartmouth, Department of Psychiatry, Dartmouth College, Lebanon, New Hampshire (e-mail: )
| | - Matthew C Lohman
- The authors are with Dartmouth Centers for Health and Aging and the CDC Health Promotion Research Center at Dartmouth, Department of Psychiatry, Dartmouth College, Lebanon, New Hampshire (e-mail: )
| | - Stephen J Bartels
- The authors are with Dartmouth Centers for Health and Aging and the CDC Health Promotion Research Center at Dartmouth, Department of Psychiatry, Dartmouth College, Lebanon, New Hampshire (e-mail: )
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Abstract
OBJECTIVES This study used latent growth curve modeling (LGCM) to estimate the independent and joint associations between frailty and depression trajectories and likelihood of nursing home admission and falls resulting in injury. METHODS Data come from five waves (2004-2012) of the Health and Retirement Study. Community-dwelling individuals aged 51 and older (N = 13,495) were analyzed using LGCM. Frailty was measured using a frailty index consisting of 30 deficits. Depressive symptoms were measured using the eight-item Centers for Epidemiologic Studies - Depression scale. Adverse health outcomes included nursing home admissions and falls resulting in injury. RESULTS Prevalence of frailty increased over the study period (24.1%-32.1%), while the prevalence of depression was relatively constant over time (approximately 13%). Parallel process LGCM showed that more rapid increases of frailty and depressive symptoms were associated with higher odds of both nursing home admission and serious falls over time (Frailty: ORNursinghome = 1.33, 95% CI: 1.09-1.66; ORFall = 1.52, 95% CI: 1.12-2.08; Depression: ORNursinghome = 3.63, 95% CI: 1.29-9.97; ORFall = 1.16, 95% CI: 1.01-1.34). Associations between frailty and adverse outcomes were attenuated, and in some cases were no longer statistically significant, after accounting for concurrent depression. CONCLUSION Frailty trajectories may be important indicators of risk for nursing home admissions and falls, independent of baseline frailty status; however, concurrent depression trajectories are associated with adverse outcomes to a similar degree as frailty. Focus should be given to distilling elements of the frailty index which confer most risk for poor health outcomes.
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Affiliation(s)
- Matthew C. Lohman
- Department of Psychiatry, Institute of Geriatric Psychiatry, Weill Cornell Medical College, White Plains, New York
| | - Briana Mezuk
- Department of Family Medicine and Population Health, Division of Epidemiology, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Levent Dumenci
- Department of Social and Behavioral Health, Virginia Commonwealth University School of Medicine, Richmond, Virginia
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