@article {12735, title = {The Role of Incarceration as a Risk Factor for Cognitive Impairment.}, journal = {The Journals of Gerontology, Series B }, volume = {77}, year = {2022}, pages = {e247-e262}, abstract = {

OBJECTIVES: The objective of this study was to understand disparities in cognitive impairment between middle aged formerly incarcerated (FI) and nonincarcerated (NI) individuals.

METHODS: The 1979 National Longitudinal Survey of Youth is a nationally representative longitudinal dataset containing information on incarceration, cognitive functioning, and other health conditions. Using a modified version of the Telephone Interview for Cognitive Status (TICS-m), adapted from the Health and Retirement Study, we analyzed the association between incarceration and cognitive impairment, cognitive impairment-not dementia, and dementia. Multivariable regression models were estimated including prior incarceration status and covariates associated with incarceration and cognitive functioning.

RESULTS: FI individuals had lower unadjusted scores on TICS-m (-2.5, p<.001), and had significantly greater unadjusted odds ratios (OR) for scoring in the cognitive impairment (OR=2.4, p<.001) and dementia (OR=2.7, p<.001) range. Differences were largely explained by a combination of risk factors associated with incarceration and cognition. Education and premorbid cognition (measured by Armed Forces Qualifying Test) separately and completely explained differences in the odds of dementia. Regardless of incarceration status, Blacks and Hispanics had significantly greater odds of cognitive impairment and dementia relative to Whites, holding other factors constant.

DISCUSSION: The association between prior incarceration and cognitive impairment in middle age was largely explained by differences in educational attainment and premorbid cognitive functioning, supporting the cognitive reserve hypothesis. Greater prevalence of cognitive impairment and dementia among the FI could create challenges and should be considered in reentry planning. Structural and institutional factors should be considered when addressing health disparities in ADRD.

}, keywords = {cognitive impairment, Cognitive Reserve, formerly incarcerated, Health Disparities, reentry}, issn = {1758-5368}, doi = {10.1093/geronb/gbac138}, author = {Cox, Robynn J A and Robert B Wallace} } @article {8936, title = {Clinical Trials Targeting Aging and Age-Related Multimorbidity}, journal = {The Journals of Gerontology Series A: Biological Sciences and Medical Sciences}, volume = {72}, year = {2017}, pages = {355-361}, abstract = {Background: There is growing interest in identifying interventions that may increase health span by targeting biological processes underlying aging. The design of efficient and rigorous clinical trials to assess these interventions requires careful consideration of eligibility criteria, outcomes, sample size, and monitoring plans. Methods: Experienced geriatrics researchers and clinical trialists collaborated to provide advice on clinical trial design. Results: Outcomes based on the accumulation and incidence of age-related chronic diseases are attractive for clinical trials targeting aging. Accumulation and incidence rates of multimorbidity outcomes were developed by selecting at-risk subsets of individuals from three large cohort studies of older individuals. These provide representative benchmark data for decisions on eligibility, duration, and assessment protocols. Monitoring rules should be sensitive to targeting aging-related, rather than disease-specific, outcomes. Conclusions: Clinical trials targeting aging are feasible, but require careful design consideration and monitoring rules.}, keywords = {Chronic disease, Clinical trials, Older Adults}, issn = {1079-5006}, doi = {10.1093/gerona/glw220}, url = {https://academic.oup.com/biomedgerontology/article-lookup/doi/10.1093/gerona/glw220https://academic.oup.com/biomedgerontology/article/2328606/Clinical-Trials-Targeting-Aging-and-AgeRelated}, author = {Mark A. Espeland and Eileen M. Crimmins and Brandon R. Grossardt and Jill P. Crandall and Jonathan A. L. Gelfond and Tamara B Harris and Stephen B Kritchevsky and JoAnn E Manson and Jennifer G Robinson and Walter A Rocca and Temprosa, Marinella and Thomas, Fridtjof and Robert B Wallace and Barzilai, Nir} } @article {5954, title = {Documentation of Biomarkers in the 2006 and 2008 Health and Retirement Study}, year = {2013}, institution = {Institute for Social Research, University of Michigan}, address = {Ann Arbor, Michigan}, abstract = {Biomarkers refer to the general range of physiological, metabolic, biochemical, endocrine and genetic measures that can be obtained in living organisms. The term is most commonly used to refer to one-time biochemical or hematological measures made on blood or other available bodily fluids, but perhaps the term should be used for a broader range of measures. In 2006 and 2008, HRS included the following biomarkers measurements, administered in this order: Saliva collection for DNA extraction; Blood spot collection for cholesterol, hemoglobin A1C, CRP and cystatin C analysis (results for C-reactive protein and cystatin C are forthcoming). This report describes the following for each of the measures listed above: Rationale and key citations; Sample description; Measure description; Equipment; Protocol description; Special instructions.}, keywords = {Health Conditions and Status, Healthcare, Methodology}, author = {Eileen M. Crimmins and Jessica Faul and Jung K Kim and Heidi M Guyer and Kenneth M. Langa and Mary Beth Ofstedal and Amanda Sonnega and Robert B Wallace and David R Weir} } @article {7676, title = {Restless legs syndrome and functional limitations among American elders in the Health and Retirement Study.}, journal = {BMC Geriatr}, volume = {12}, year = {2012}, month = {2012 Jul 26}, pages = {39}, publisher = {12}, abstract = {

BACKGROUND: Restless legs syndrome (RLS) is a common condition associated with decreased quality of life in older adults. This study estimates the prevalence, risk factors, and functional correlates of among U.S. elders.

METHODS: Subjects (n = 1,008) were sub-sampled from the 2002 cross-sectional interview survey of the Health and Retirement Study (HRS), a nationally representative study of U.S. elders. Symptoms and sleep disturbances consistent with RLS were identified. Activities of daily living (ADL), instrumental activities of daily living (IADL), and limitations for mobility, large muscle groups, gross and fine motor function were measured using standardized questions. Incident functional limitations were detected over six years of observation.

RESULTS: The prevalence of RLS among U.S. elders born before 1947 was 10.6\%. Factors associated with increased prevalence RLS at baseline included: overweight body mass index (multivariate adjusted prevalence ratio = 1.77; 95\% confidence interval (CI) 1.05-2.99); mild-to-moderate pain (2.67, 1.47-4.84) or pain inferring with activity (3.44, 2.00-5.93); three or more chronic medications (2.54, 1.26-5.12), highest quartile of out-of-pocket medical expenses (2.12, 1.17-3.86), frequent falls (2.63, 1.49-4.66), health limiting ability to work (2.91, 1.75-4.85), or problems with early waking or frequent wakening (1.69, 1.09-2.62 and 1.55, 1.00-2.41, respectively). Current alcohol consumption (0.59, 0.37-0.92) and frequent healthcare provider visits (0.49, 0.27-0.90) were associated with decreased RLS prevalence. RLS did not predict incident disability for aggregate measures but was associated with increased risk for specific limitations, including: difficulty climbing several stair flights (multivariate-adjusted hazard ratio = 2.38, 95\% CI 1.39-4.06), prolonged sitting (2.17, 1.25-3.75), rising from a chair (2.54, 1.62-3.99), stooping (2.66, 1.71-4.15), moving heavy objects (1.79, 1.08-2.99), carrying ten pounds (1.61, 1.05-2.97), raising arms (1.76, 1.05-2.97), or picking up a dime (1.97, 1.12-3.46).

CONCLUSIONS: RLS sufferers are more likely to have functional disability, even after adjusting for health status and pain syndrome correlates.

}, keywords = {Activities of Daily Living, Age Factors, Aged, Aged, 80 and over, Body Mass Index, Cross-Sectional Studies, Disabled Persons, Female, Humans, Male, Middle Aged, Prevalence, Restless Legs Syndrome, Risk Factors, United States}, issn = {1471-2318}, doi = {10.1186/1471-2318-12-39}, author = {Dominic J Cirillo and Robert B Wallace} } @article {7443, title = {Continuity of care with a primary care physician and mortality in older adults.}, journal = {J Gerontol A Biol Sci Med Sci}, volume = {65}, year = {2010}, month = {2010 Apr}, pages = {421-8}, publisher = {65A}, abstract = {

BACKGROUND: We examined whether older adults who had continuity of care with a primary care physician (PCP) had lower mortality.

METHODS: Secondary analyses were conducted using baseline interview data (1993-1994) from the nationally representative Survey on Assets and Health Dynamics among the Oldest Old (AHEAD). The analytic sample included 5,457 self-respondents 70 years old or more who were not enrolled in managed care plans. AHEAD data were linked to Medicare claims for 1991-2005, providing up to 12 years of follow-up. Two time-dependent measures of continuity addressed whether there was more than an 8-month interval between any two visits to the same PCP during the prior 2-year period. The "present exposure" measure calculated this criterion on a daily basis and could switch "on" or "off" daily, whereas the "cumulative exposure" measure reflected the percentage of follow-up days, also on a daily basis allowing it to switch on or off daily, for which the criterion was met.

RESULTS: Two thousand nine hundred and fifty-four (54\%) participants died during the follow-up period. Using the cumulative exposure measure, 27\% never had continuity of care, whereas 31\%, 20\%, 14\%, and 8\%, respectively, had continuity for 1\%-33\%, 34\%-67\%, 68\%-99\%, and 100\% of their follow-up days. Adjusted for demographics, socioeconomic status, social support, health lifestyle, and morbidity, both measures of continuity were associated (p < .001) with lower mortality (adjusted hazard ratios of 0.84 for the present exposure measure and 0.31, 0.39, 0.46, and 0.62, respectively, for the 1\%-33\%, 34\%-67\%, 68\%-99\%, and 100\% categories of the cumulative exposure measure).

CONCLUSION: Continuity of care with a PCP, as assessed by two distinct measures, was associated with substantial reductions in long-term mortality.

}, keywords = {Aged, Continuity of Patient Care, Female, Health Services for the Aged, Humans, Male, Mortality, Physicians, Family}, issn = {1758-535X}, doi = {10.1093/gerona/glp188}, author = {Frederic D Wolinsky and Suzanne E Bentler and Li Liu and John F Geweke and Elizabeth A Cook and Maksym Obrizan and Elizabeth A Chrischilles and Kara B Wright and Michael P Jones and Gary E Rosenthal and Robert L. Ohsfeldt and Robert B Wallace} } @article {7526, title = {Defining emergency department episodes by severity and intensity: A 15-year study of Medicare beneficiaries.}, journal = {BMC Health Serv Res}, volume = {10}, year = {2010}, month = {2010 Jun 21}, pages = {173}, publisher = {8}, abstract = {

BACKGROUND: Episodes of Emergency Department (ED) service use among older adults previously have not been constructed, or evaluated as multi-dimensional phenomena. In this study, we constructed episodes of ED service use among a cohort of older adults over a 15-year observation period, measured the episodes by severity and intensity, and compared these measures in predicting subsequent hospitalization.

METHODS: We conducted a secondary analysis of the prospective cohort study entitled the Survey on Assets and Health Dynamics among the Oldest Old (AHEAD). Baseline (1993) data on 5,511 self-respondents >or=70 years old were linked to their Medicare claims for 1991-2005. Claims then were organized into episodes of ED care according to Medicare guidelines. The severity of ED episodes was measured with a modified-NYU algorithm using ICD9-CM diagnoses, and the intensity of the episodes was measured using CPT codes. Measures were evaluated against subsequent hospitalization to estimate comparative predictive validity.

RESULTS: Over 15 years, three-fourths (4,171) of the 5,511 AHEAD participants had at least 1 ED episode, with a mean of 4.5 episodes. Cross-classification indicated the modified-NYU severity measure and the CPT-based intensity measure captured different aspects of ED episodes (kappa = 0.18). While both measures were significant independent predictors of hospital admission from ED episodes, the CPT measure had substantially higher predictive validity than the modified-NYU measure (AORs 5.70 vs. 3.31; p < .001).

CONCLUSIONS: We demonstrated an innovative approach for how claims data can be used to construct episodes of ED care among a sample of older adults. We also determined that the modified-NYU measure of severity and the CPT measure of intensity tap different aspects of ED episodes, and that both measures were predictive of subsequent hospitalization.

}, keywords = {Aged, Aged, 80 and over, Cohort Studies, Emergency Service, Hospital, Humans, Insurance Claim Review, Medicare, Prospective Studies, Severity of Illness Index, United States}, issn = {1472-6963}, doi = {10.1186/1472-6963-10-173}, author = {Kaskie, Brian and Maksym Obrizan and Elizabeth A Cook and Michael P Jones and Li Liu and Suzanne E Bentler and Robert B Wallace and John F Geweke and Kara B Wright and Elizabeth A Chrischilles and Claire E Pavlik and Robert L. Ohsfeldt and Gary E Rosenthal and Frederic D Wolinsky} } @article {7484, title = {Prior hospitalization and the risk of heart attack in older adults: a 12-year prospective study of Medicare beneficiaries.}, journal = {J Gerontol A Biol Sci Med Sci}, volume = {65}, year = {2010}, month = {2010 Jul}, pages = {769-77}, publisher = {65}, abstract = {

BACKGROUND: We investigated whether prior hospitalization was a risk factor for heart attacks among older adults in the survey on Assets and Health Dynamics among the Oldest Old.

METHODS: Baseline (1993-1994) interview data were linked to 1993-2005 Medicare claims for 5,511 self-respondents aged 70 years and older and not enrolled in managed Medicare. Primary hospital International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) 410.xx discharge codes identified postbaseline hospitalizations for acute myocardial infarctions (AMIs). Participants were censored at death or postbaseline managed Medicare enrollment. Traditional risk factors and other covariates were included. Recent postbaseline non-AMI hospitalizations (ie, prior hospitalizations) were indicated by a time-dependent marker, and sensitivity analyses identified their peak effect.

RESULTS: The total number of person-years of surveillance was 44,740 with a mean of 8.1 (median = 9.1) per person. Overall, 483 participants (8.8\%) suffered postbaseline heart attacks, with 423 participants (7.7\%) having their first-ever AMI. As expected, significant traditional risk factors were sex (men); race (whites); marital status (never being married); education (noncollege); geography (living in the South); and reporting a baseline history of angina, arthritis, diabetes, and heart disease. Risk factors were similar for both any postbaseline and first-ever postbaseline AMI analyses. The time-dependent recent non-AMI hospitalization marker did not alter the effects of the traditional risk factors but increased AMI risk by 366\% (adjusted hazards ratio = 4.66, p < .0001). Discussion. Our results suggest that some small percentage (<3\%) of heart attacks among older adults might be prevented if effective short-term postdischarge planning and monitoring interventions were developed and implemented.

}, keywords = {Aged, Educational Status, Female, Hospitalization, Humans, Male, Marital Status, Medicare, Myocardial Infarction, Patient Discharge, Proportional Hazards Models, Prospective Studies, Risk Factors, Sex Factors, United States}, issn = {1758-535X}, doi = {10.1093/gerona/glq003}, author = {Frederic D Wolinsky and Suzanne E Bentler and Li Liu and Michael P Jones and Kaskie, Brian and Jason Hockenberry and Elizabeth A Chrischilles and Kara B Wright and John F Geweke and Maksym Obrizan and Robert L. Ohsfeldt and Gary E Rosenthal and Robert B Wallace} } @article {7326, title = {A 12-year prospective study of stroke risk in older Medicare beneficiaries.}, journal = {BMC Geriatr}, volume = {9}, year = {2009}, month = {2009 May 09}, pages = {17}, publisher = {9}, abstract = {

BACKGROUND: 5.8 M living Americans have experienced a stroke at some time in their lives, 780K had either their first or a recurrent stroke this year, and 150K died from strokes this year. Stroke costs about $66B annually in the US, and also results in serious, long-term disability. Therefore, it is prudent to identify all possible risk factors and their effects so that appropriate intervention points may be targeted.

METHODS: Baseline (1993-1994) interview data from the nationally representative Survey on Assets and Health Dynamics among the Oldest Old (AHEAD) were linked to 1993-2005 Medicare claims. Participants were 5,511 self-respondents >or= 70 years old. Two ICD9-CM case-identification approaches were used. Two approaches to stroke case-identification based on ICD9-CM codes were used, one emphasized sensitivity and the other emphasized specificity. Participants were censored at death or enrollment into managed Medicare. Baseline risk factors included sociodemographic, socioeconomic, place of residence, health behavior, disease history, and functional and cognitive status measures. A time-dependent marker reflecting post-baseline non-stroke hospitalizations was included to reflect health shocks, and sensitivity analyses were conducted to identify its peak effect. Competing risk, proportional hazards regression was used.

RESULTS: Post-baseline strokes occurred for 545 (9.9\%; high sensitivity approach) and 374 (6.8\%; high specificity approach) participants. The greatest static risks involved increased age, being widowed or never married, living in multi-story buildings, reporting a baseline history of diabetes, hypertension, or stroke, and reporting difficulty picking up a dime, refusing to answer the delayed word recall test, or having poor cognition. Risks were similar for both case-identification approaches and for recurrent and first-ever vs. only first-ever strokes. The time-dependent health shock (recent hospitalization) marker did not alter the static model effect estimates, but increased stroke risk by 200\% or more.

CONCLUSION: The effect of our health shock marker (a time-dependent recent hospitalization indicator) was large and did not mediate the effects of the traditional risk factors. This suggests an especially vulnerable post-hospital transition period from adverse effects associated with both their underlying health shock (the reasons for the recent hospital admission) and the consequences of their treatments.

}, keywords = {Aged, Aged, 80 and over, Female, Humans, Insurance Benefits, Male, Medicare, Prospective Studies, Risk Factors, Socioeconomic factors, Stroke, United States}, issn = {1471-2318}, doi = {10.1186/1471-2318-9-17}, author = {Frederic D Wolinsky and Suzanne E Bentler and Elizabeth A Cook and Elizabeth A Chrischilles and Li Liu and Kara B Wright and John F Geweke and Maksym Obrizan and Claire E Pavlik and Robert L. Ohsfeldt and Michael P Jones and Robert B Wallace and Gary E Rosenthal} } @article {7379, title = {The aftermath of hip fracture: discharge placement, functional status change, and mortality.}, journal = {Am J Epidemiol}, volume = {170}, year = {2009}, month = {2009 Nov 15}, pages = {1290-9}, publisher = {170}, abstract = {

The authors prospectively explored the consequences of hip fracture with regard to discharge placement, functional status, and mortality using the Survey on Assets and Health Dynamics Among the Oldest Old (AHEAD). Data from baseline (1993) AHEAD interviews and biennial follow-up interviews were linked to Medicare claims data from 1993-2005. There were 495 postbaseline hip fractures among 5,511 respondents aged >or=69 years. Mean age at hip fracture was 85 years; 73\% of fracture patients were white women, 45\% had pertrochanteric fractures, and 55\% underwent surgical pinning. Most patients (58\%) were discharged to a nursing facility, with 14\% being discharged to their homes. In-hospital, 6-month, and 1-year mortality were 2.7\%, 19\%, and 26\%, respectively. Declines in functional-status-scale scores ranged from 29\% on the fine motor skills scale to 56\% on the mobility index. Mean scale score declines were 1.9 for activities of daily living, 1.7 for instrumental activities of daily living, and 2.2 for depressive symptoms; scores on mobility, large muscle, gross motor, and cognitive status scales worsened by 2.3, 1.6, 2.2, and 2.5 points, respectively. Hip fracture characteristics, socioeconomic status, and year of fracture were significantly associated with discharge placement. Sex, age, dementia, and frailty were significantly associated with mortality. This is one of the few studies to prospectively capture these declines in functional status after hip fracture.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, depression, Female, Health Status, Health Status Indicators, Hip Fractures, Humans, Interviews as Topic, Iowa, Length of Stay, Logistic Models, Medicare, Patient Discharge, Prospective Studies, Psychometrics, Socioeconomic factors, Time Factors, Treatment Outcome, United States}, issn = {1476-6256}, doi = {10.1093/aje/kwp266}, author = {Suzanne E Bentler and Li Liu and Maksym Obrizan and Elizabeth A Cook and Kara B Wright and John F Geweke and Elizabeth A Chrischilles and Claire E Pavlik and Robert B Wallace and Robert L. Ohsfeldt and Michael P Jones and Gary E Rosenthal and Frederic D Wolinsky} } @article {7405, title = {Recent hospitalization and the risk of hip fracture among older Americans.}, journal = {J Gerontol A Biol Sci Med Sci}, volume = {64}, year = {2009}, month = {2009 Feb}, pages = {249-55}, publisher = {64}, abstract = {

BACKGROUND: We identified hip fracture risks in a prospective national study.

METHODS: Baseline (1993-1994) interview data were linked to Medicare claims for 1993-2005. Participants were 5,511 self-respondents aged 70 years and older and not in managed Medicare. ICD9-CM 820.xx (International Classification of Diseases, 9th Edition, Clinical Modification) codes identified hip fracture. Participants were censored at death or enrollment into managed Medicare. Static risk factors included sociodemographic, socioeconomic, place of residence, health behavior, disease history, and functional and cognitive status measures. A time-dependent marker reflecting postbaseline hospitalizations was included.

RESULTS: A total of 495 (8.9\%) participants suffered a postbaseline hip fracture. In the static proportional hazards model, the greatest risks involved age (adjusted hazard ratios [AHRs] of 2.01, 2.82, and 4.91 for 75-79, 80-84, and > or =85 year age groups vs those aged 70-74 years; p values <.001), sex (AHR = 0.45 for men vs women; p < .001), race (AHRs of 0.37 and 0.46 for African Americans and Hispanics vs whites; p values <.001 and <.01), body mass (AHRs of 0.40, 0.77, and 1.73 for obese, overweight, and underweight vs normal weight; p values <.001, <.05, and <.01), smoking status (AHRs = 1.49 and 1.52 for current and former smokers vs nonsmokers; p values <.05 and <.001), and diabetes (AHR = 1.99; p < .001). The time-dependent recent hospitalization marker did not alter the static model effect estimates, but it did substantially increase the risk of hip fracture (AHR = 2.51; p < .001).

CONCLUSIONS: Enhanced discharge planning and home care for non-hip fracture hospitalizations could reduce subsequent hip fracture rates.

}, keywords = {Accidental Falls, Age Distribution, Aged, Aged, 80 and over, Aging, Cohort Studies, Female, Follow-Up Studies, Geriatric Assessment, Hip Fractures, Hospitalization, Humans, Logistic Models, Male, Multivariate Analysis, Probability, Proportional Hazards Models, Prospective Studies, Risk Factors, Sex Distribution, Survival Analysis, United States}, issn = {1758-535X}, doi = {10.1093/gerona/gln027}, author = {Frederic D Wolinsky and Suzanne E Bentler and Li Liu and Maksym Obrizan and Elizabeth A Cook and Kara B Wright and John F Geweke and Elizabeth A Chrischilles and Claire E Pavlik and Robert L. Ohsfeldt and Michael P Jones and Kelly K Richardson and Gary E Rosenthal and Robert B Wallace} } @article {5734, title = {Documentation of Physical Measures, Anthropometrics and Blood Pressure in the Health and Retirement Study}, year = {2008}, institution = {Institute for Social Research, University of Michigan}, address = {Ann Arbor, Michigan}, abstract = {The assessment of physical performance is an important component of the evaluation of functioning of older persons. The HRS has employed a set of standardized assessments of lung function, grip strength, balance, and walking speed. In addition, HRS collected measures of blood pressure, height, weight, and waist circumference. In 2006, HRS included the following measurements, administered in this order: Blood pressure; Lung function; Hand grip strength; Balance tests; Timed walk; Height; Weight; Waist circumference. This report describes the following for each of the measures listed above: Rationale and key citations; Sample description; Measure description; Equipment; Protocol description; Special instructions}, keywords = {Health Conditions and Status, Healthcare, Methodology}, author = {Eileen M. Crimmins and Heidi M Guyer and Kenneth M. Langa and Mary Beth Ofstedal and Robert B Wallace and David R Weir} } @article {7231, title = {Emergency department utilization patterns among older adults.}, journal = {J Gerontol A Biol Sci Med Sci}, volume = {63}, year = {2008}, month = {2008 Feb}, pages = {204-9}, publisher = {63A}, abstract = {

BACKGROUND: We identified 4-year (2 years before and 2 years after the index [baseline] interview) ED use patterns in older adults and the factors associated with them.

METHODS: A secondary analysis of baseline interview data from the nationally representative Survey on Assets and Health Dynamics Among the Oldest Old linked to Medicare claims data. Participants were 4310 self-respondents 70 years old or older. Current Procedural Terminology (CPT) codes 99281 and 99282 identified low-intensity use, and CPT codes 99283-99285 identified high-intensity use. Exploratory factor analysis and multivariable multinomial logistic regression were used.

RESULTS: The majority (56.6\%) of participants had no ED visits during the 4-year period. Just 5.7\% had only low-intensity ED use patterns, whereas 28.9\% used the ED only for high-intensity visits, and 8.7\% had a mixture of low-intensity and high-intensity use. Participants with lower immediate word recall scores and those who did not live in major metropolitan areas were more likely to be low-intensity-only ED users. Older individuals, those who did not live in rural counties, had greater morbidity and functional status burdens, and lower immediate word recall scores were more likely to be high-intensity-only ED users. Participants who were older, did not live in major cities, had lower education levels, had greater morbidity and functional status burdens, and lower immediate word recall scores were more likely to have mixed ED use patterns.

CONCLUSIONS: Nearly half of these older adults used the ED at least once over a 4-year period, with a mean annual ED use percentage of 18.4. Few, however, used the ED only for visits that may have been avoidable. This finding suggests that triaging Medicare patients would not decrease ED overcrowding, although continued surveillance is necessary to detect potential changes in ED use patterns among older adults.

}, keywords = {Aged, Emergency Service, Hospital, Factor Analysis, Statistical, Female, Humans, Logistic Models, Male, Medicare, Risk Factors, United States}, issn = {1079-5006}, doi = {10.1093/gerona/63.2.204}, author = {Frederic D Wolinsky and Li Liu and Thomas R Miller and An, Hyonggin and John F Geweke and Kaskie, Brian and Kara B Wright and Elizabeth A Chrischilles and Claire E Pavlik and Elizabeth A Cook and Robert L. Ohsfeldt and Kelly K Richardson and Gary E Rosenthal and Robert B Wallace} } @article {7243, title = {Racial disparities in receipt of hip and knee joint replacements are not explained by need: the Health and Retirement Study 1998-2004.}, journal = {J Gerontol A Biol Sci Med Sci}, volume = {63}, year = {2008}, month = {2008 Jun}, pages = {629-34}, publisher = {63A}, abstract = {

BACKGROUND: Hip and knee joint replacement rates vary by demographic group. This article describes the epidemiology of need for joint replacement, and of subsequent receipt of a joint replacement by those in need.

METHODS: Data from the Health and Retirement Study were used to assess need for hip or knee joint replacement in a total of 14,807 adults aged 60 years or older in 1998, 2000, and 2002 and receipt of needed surgery 2 years later. "Need" classification was based on difficulty walking, joint pain, stiffness, or swelling and receipt of treatment for arthritis, without contraindications to surgery.

RESULTS: Need in 2002 was greater in participants who were older than 74 years (vs 60-64: adjusted odds ratio 2.06; 95\% confidence interval, 1.68-2.53), women (vs men: 1.81; 1.53-2.14), less educated (vs college educated: 1.27; 1.06-1.52), in the poorest third (vs richest: 2.20; 1.78-2.72), or obese (vs nonobese: 2.39; 2.02-2.81). One hundred sixty-eight participants in need received a joint replacement, with lower receipt in black or African American participants (vs white: 0.47; 0.26-0.83) or less educated (vs college educated: 0.65; 0.44-0.96). These differences were not explained by current employment, access to medical care, family responsibilities, disability, living alone, comorbidity, or exclusion of those younger than Medicare eligibility age.

CONCLUSIONS: After taking variations in need into consideration, being black or African American or lacking a college education appears to be a barrier to receiving surgery, whereas age, sex, relative poverty, and obesity do not. These disparities maintain disproportionately high levels of pain and disability in disadvantaged groups.

}, keywords = {Aged, Arthroplasty, Replacement, Hip, Arthroplasty, Replacement, Knee, Black or African American, Educational Status, Female, Health Services Needs and Demand, Humans, Male, Middle Aged, United States}, issn = {1079-5006}, doi = {10.1093/gerona/63.6.629}, author = {Steel, Nicholas and Clark, Allan and Iain A Lang and Robert B Wallace and David Melzer} } @article {7187, title = {Hospital episodes and physician visits: the concordance between self-reports and medicare claims.}, journal = {Med Care}, volume = {45}, year = {2007}, month = {2007 Apr}, pages = {300-7}, publisher = {45}, abstract = {

BACKGROUND: Health services use typically is examined using either self-reports or administrative data, but the concordance between the 2 is not well established.

OBJECTIVE: We evaluated the concordance of hospital and physician utilization data from self-reports and claims data, and identified factors associated with disagreement.

METHODS: We performed a secondary analysis on linked observational and administrative data. A national sample of 4310 respondents who were 70 years old or older at their baseline interviews was used. Self-reported and Medicare claims-based hospital episodes and physician visits for 12 months before baseline were examined. Kappa statistics were used to evaluate concordance, and multivariable multinomial logistic regression was used to identify factors associated with overreporting (self-reports > claims), underreporting (self-reports < claims), and concordant-reporting (self-reports approximately claims).

RESULTS: The concordance of hospital episodes was high (kappa = 0.767 for the 2 x 2 comparison of none vs. some and kappa = 0.671 for the 6 x 6 comparison of none, 1, ..., 4, or 5 or more), but concordance for physician visits was low (kappa = 0.255 for the 2 x 2 comparison of none versus some and kappa = 0.351 for the 14 x 14 comparison of none, 1, ..., 12, and 13 or more). Multivariable multinomial logistic regression indicated that over-, under-, and concordant-reporting of hospital episodes was significantly associated with gender, alcohol consumption, arthritis, cancer, heart disease, psychologic problems, lower body functional limitations, self-rated health, and depressive symptoms. Over-, under-, and concordant-reporting of physician visits were significantly associated with age, gender, race, living alone, veteran status, private health insurance, arthritis, cancer, diabetes, hypertension, heart disease, lower body functional limitations, and poor memory.

CONCLUSIONS: Concordance between self-reported and claims-based hospital episodes was high, but concordance for physician visits was low. Factors significantly associated with bidirectional (over- and underreporting) and unidirectional (over- or underreporting) error patterns were detected. Therefore, caution is advised when drawing conclusions based on just one physician visit data source.

}, keywords = {Aged, Centers for Medicare and Medicaid Services, U.S., Episode of Care, Female, Hospitalization, Humans, Insurance Claim Review, Interviews as Topic, Male, Physicians, Quality Assurance, Health Care, Self Disclosure, United States}, issn = {0025-7079}, doi = {10.1097/01.mlr.0000254576.26353.09}, author = {Frederic D Wolinsky and Thomas R Miller and An, Hyonggin and John F Geweke and Robert B Wallace and Kara B Wright and Elizabeth A Chrischilles and Li Liu and Claire E Pavlik and Elizabeth A Cook and Robert L. Ohsfeldt and Kelly K Richardson and Gary E Rosenthal} } @article {7161, title = {An interpersonal continuity of care measure for Medicare Part B claims analyses.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {62}, year = {2007}, month = {2007 May}, pages = {S160-8}, publisher = {62B}, abstract = {

OBJECTIVES: This article presents an interpersonal continuity of care measure.

METHODS: We operationalized continuity of care as no more than an 8-month interval between any two visits during a 2-year period to either (a) the same primary care physician or (b) the same physician regardless of specialty. Sensitivity analyses evaluated two interval censoring algorithms and two alternative intervals. We linked Medicare Part A and B claims to baseline survey data for 4,596 respondents to the Survey on Asset and Health Dynamics Among the Oldest Old. We addressed the potential for selection bias by using propensity score methods, and we explored construct validity.

RESULTS: Interpersonal continuity with a primary care physician was 17.3\%, and interpersonal continuity of care with any physician was 26.1\%. Older participants; men; individuals who lived alone; people who had difficulty walking; and respondents with medical histories of arthritis, cancer, diabetes, heart conditions, hypertension, and stroke were most likely to have continuity. Individuals who had never married, were widowed, were working, or had low subjective life expectancy were least likely to have continuity.

DISCUSSION: Researchers can measure interpersonal continuity of care using Medicare Part B claims. Replication of these findings and further construct validation, however, are needed prior to widespread adoption of this method.

}, keywords = {Aged, Aged, 80 and over, Continuity of Patient Care, Disability Evaluation, Female, Health Services Accessibility, Health Surveys, Humans, Insurance Claim Review, Male, Medicare Part B, Mobility Limitation, Physician-Patient Relations, Primary Health Care, United States}, issn = {1079-5014}, doi = {10.1093/geronb/62.3.s160}, author = {Frederic D Wolinsky and Thomas R Miller and John F Geweke and Elizabeth A Chrischilles and An, Hyonggin and Robert B Wallace and Claire E Pavlik and Kara B Wright and Robert L. Ohsfeldt and Gary E Rosenthal} } @article {7179, title = {The use of chiropractors by older adults in the United States.}, journal = {Chiropr Osteopat}, volume = {15}, year = {2007}, month = {2007 Sep 06}, pages = {12}, publisher = {15}, abstract = {

BACKGROUND: In a nationally representative sample of United States Medicare beneficiaries, we examined the extent of chiropractic use, factors associated with seeing a chiropractor, and predictors of the volume of chiropractic use among those having seen one.

METHODS: We performed secondary analyses of baseline interview data on 4,310 self-respondents who were 70 years old or older when they first participated in the Survey on Assets and Health Dynamics Among the Oldest Old (AHEAD). The interview data were then linked to their Medicare claims. Multiple logistic and negative binomial regressions were used.

RESULTS: The average annual rate of chiropractic use was 4.6\%. During the four-year period (two years before and two years after each respondent{\textquoteright}s baseline interview), 10.3\% had one or more visits to a chiropractor. African Americans and Hispanics, as well as those with multiple depressive symptoms and those who lived in counties with lower than average supplies of chiropractors were much less likely to use them. The use of chiropractors was much more likely among those who drank alcohol, had arthritis, reported pain, and were able to drive. Chiropractic services did not substitute for physician visits. Among those who had seen a chiropractor, the volume of chiropractic visits was lower for those who lived alone, had lower incomes, and poorer cognitive abilities, while it was greater for the overweight and those with lower body limitations.

CONCLUSION: Chiropractic use among older adults is less prevalent than has been consistently reported for the United States as a whole, and is most common among Whites, those reporting pain, and those with geographic, financial, and transportation access.

}, issn = {1746-1340}, doi = {10.1186/1746-1340-15-12}, author = {Frederic D Wolinsky and Li Liu and Thomas R Miller and John F Geweke and Elizabeth A Cook and Barry R. Greene and Kara B Wright and Elizabeth A Chrischilles and Claire E Pavlik and An, Hyonggin and Robert L. Ohsfeldt and Kelly K Richardson and Gary E Rosenthal and Robert B Wallace} } @article {7027, title = {Use of complementary medicine in older Americans: results from the Health and Retirement Study.}, journal = {Gerontologist}, volume = {45}, year = {2005}, month = {2005 Aug}, pages = {516-24}, publisher = {45}, abstract = {

PURPOSE: The correlates of complementary and alternative medicine (CAM) utilization among elders have not been fully investigated. This study was designed to identify such correlates in a large sample of older adults, thus generating new data relevant to consumer education, medical training, and health practice and policy.

DESIGN AND METHODS: A subsample from the 2000 Wave of the Health and Retirement Study (n = 1,099) aged 52 or older were surveyed regarding use of CAM (chiropractic, alternative practitioners, dietary and herbal supplements, and personal practices).

RESULTS: Of respondents over 65 years of age, 88\% used CAM, with dietary supplements and chiropractic most commonly reported (65\% and 46\%, respectively). Users of alternate practitioners and dietary supplements reported having more out-of-pocket expenses on health than nonusers of these modalities. Age correlated positively with use of dietary supplements and personal practices and inversely with alternative practitioner use. Men reported less CAM use than women, except for chiropractic and personal practices. Blacks and Hispanics used fewer dietary supplements and less chiropractic, but they reported more personal practices than Whites. Advanced education correlated with fewer chiropractic visits and more dietary and herbal supplement and personal practices use. Higher income, functional impairment, alcohol use, and frequent physician visits correlated with more alternative practitioner use. There was no association between CAM and number of chronic diseases.

IMPLICATIONS: The magnitude and patterns of CAM use among elders lend considerable importance to this field in public health policy making and suggest a need for further epidemiological research and ongoing awareness efforts for both patients and providers.

}, keywords = {Activities of Daily Living, Aged, Chi-Square Distribution, Complementary Therapies, Female, Humans, Male, Middle Aged, Regression Analysis, Surveys and Questionnaires, United States}, issn = {0016-9013}, doi = {10.1093/geront/45.4.516}, author = {Ness, Jose and Dominic J Cirillo and David R Weir and Nisly, Nicole L. and Robert B Wallace} } @article {6903, title = {Urinary incontinence and depression in middle-aged United States women.}, journal = {Obstet Gynecol}, volume = {101}, year = {2003}, month = {2003 Jan}, pages = {149-56}, publisher = {101}, abstract = {

OBJECTIVE: To determine the correlates of incontinence in middle-aged women and to test for an association between incontinence and depression.

METHODS: This was a population-based cross-sectional study of 5701 women who were residents of the United States, aged 50-69 years, and participated in the third interview of the Health and Retirement Study. The primary outcome measure was self-reported urinary incontinence. Depression was ascertained based on criteria set by the Diagnostic and Statistical Manual of Mental Disorders, using a short form of the Composite International Diagnostic Interview. In addition, depressive symptoms were assessed using the revised Center for Epidemiologic Studies Depression Scale. Multivariable logistic regression models were constructed to determine the independent association between incontinence and depression, after adjusting for confounders.

RESULTS: Approximately 16\% reported either mild-moderate or severe incontinence. Depression, race, age, body mass index, medical comorbidities, and limited activities of daily living were associated with incontinence. After adjusting for medical morbidity, functional status, and demographic variables, women with severe and mild-moderate incontinence were 80\% (odds ratio [OR] 1.82; 95\% confidence interval [CI] 1.26, 2.63) and 40\% (OR 1.41; 95\% CI 1.06, 1.87) more likely, respectively, to have depression than continent women. The association did not hold for depressive symptoms measured by the revised Center for Epidemiologic Studies Depression Scale after adjusting for covariates.

CONCLUSION: Depression and incontinence are associated in middle-aged women. The strength of the association depends on the instrument used to classify depression. This reinforces the need to screen patients presenting for treatment of urinary incontinence for depression.

}, keywords = {Activities of Daily Living, Aged, Comorbidity, Cross-Sectional Studies, depression, Female, Humans, Logistic Models, Middle Aged, United States, Urinary incontinence}, issn = {0029-7844}, doi = {10.1016/s0029-7844(02)02519-x}, author = {Ingrid E Nygaard and Carolyn L. Turvey and Burns, Trudy L. and Elizabeth A Chrischilles and Robert B Wallace} } @article {6825, title = {Linking clinical variables to health-related quality of life in Parkinson{\textquoteright}s disease.}, journal = {Parkinsonism Relat Disord}, volume = {8}, year = {2002}, month = {2002 Jan}, pages = {199-209}, publisher = {8}, abstract = {

OBJECTIVE: Identify the point-in-time relationship between Parkinson{\textquoteright}s disease (PD) signs and symptoms and measures of health-related quality of life (HRQL).

BACKGROUND: Clinical measures used in PD assessments traditionally emphasize physical signs and symptoms. We hypothesized that these measures would be strongly associated with the physical function dimensions of HRQL that reflect mental symptoms.

DESIGN/METHODS: A cross-sectional study of 193 neurology clinic PD patients employed self-administered in-clinic and take-home questionnaires and in-person clinical examinations and interviews.

RESULTS: The variance explained by PD physical signs and symptoms was substantial for physical function, but only modest for all other HRQL dimensions. Mental symptoms explained a larger proportion of variance than physical symptoms for 12 of the 14 HRQL measures.

CONCLUSION: PD patients{\textquoteright} well-being, general health perceptions, health satisfaction and overall HRQL are strongly influenced by mental health symptoms and more weakly influenced by physical symptoms. Clinical evaluation of PD patients should include mental health and self-reported HRQL assessment.

}, keywords = {Aged, Cross-Sectional Studies, Female, Health Status, Humans, Male, Mental Health, Middle Aged, Parkinson Disease, Quality of Life}, issn = {1353-8020}, doi = {10.1016/s1353-8020(01)00044-x}, author = {Elizabeth A Chrischilles and Linda M. Rubenstein and Voelker, Margaret D. and Robert B Wallace and Rodnitzky, Robert L.} } @article {6738, title = {National estimates of the quantity and cost of informal caregiving for the elderly with dementia.}, journal = {J Gen Intern Med}, volume = {16}, year = {2001}, month = {2001 Nov}, pages = {770-8}, publisher = {16}, abstract = {

OBJECTIVE: Caring for the elderly with dementia imposes a substantial burden on family members and likely accounts for more than half of the total cost of dementia for those living in the community. However, most past estimates of this cost were derived from small, nonrepresentative samples. We sought to obtain nationally representative estimates of the time and associated cost of informal caregiving for the elderly with mild, moderate, and severe dementia.

DESIGN: Multivariable regression models using data from the 1993 Asset and Health Dynamics Study, a nationally representative survey of people age 70 years or older (N = 7,443).

SETTING: National population-based sample of the community-dwelling elderly.

MAIN OUTCOME MEASURES: Incremental weekly hours of informal caregiving and incremental cost of caregiver time for those with mild dementia, moderate dementia, and severe dementia, as compared to elderly individuals with normal cognition. Dementia severity was defined using the Telephone Interview for Cognitive Status.

RESULTS: After adjusting for sociodemographics, comorbidities, and potential caregiving network, those with normal cognition received an average of 4.6 hours per week of informal care. Those with mild dementia received an additional 8.5 hours per week of informal care compared to those with normal cognition (P < .001), while those with moderate and severe dementia received an additional 17.4 and 41.5 hours (P < .001), respectively. The associated additional yearly cost of informal care per case was 3,630 dollars for mild dementia, 7,420 dollars for moderate dementia, and 17,700 dollars for severe dementia. This represents a national annual cost of more than 18 billion dollars.

CONCLUSION: The quantity and associated economic cost of informal caregiving for the elderly with dementia are substantial and increase sharply as cognitive impairment worsens. Physicians caring for elderly individuals with dementia should be mindful of the importance of informal care for the well-being of their patients, as well as the potential for significant burden on those (often elderly) individuals providing the care.

}, keywords = {Aged, Aged, 80 and over, Caregivers, Cost of Illness, Dementia, Female, Health Care Costs, Humans, Male, Multivariate Analysis, Regression Analysis, Severity of Illness Index, Time Factors, United States}, issn = {0884-8734}, doi = {10.1111/j.1525-1497.2001.10123.x}, author = {Kenneth M. Langa and M.E. Chernew and Mohammed U Kabeto and A. Regula Herzog and Mary Beth Ofstedal and Robert J. Willis and Robert B Wallace and Mucha, L.M. and Walter L. Straus and A. Mark Fendrick} } @article {6646, title = {Conjugal loss and syndromal depression in a sample of elders aged 70 years or older.}, journal = {Am J Psychiatry}, volume = {156}, year = {1999}, month = {1999 Oct}, pages = {1596-601}, publisher = {156}, abstract = {

OBJECTIVE: The goal of this study was to describe the association between conjugal loss and both syndromal depression and depressive symptoms in a prospective cohort study of people aged 70 years or older.

METHOD: A measure of syndromal depression, the shortform Composite International Diagnostic Interview (CIDI), and a revised version of the Center for Epidemiologic Studies--Depression Scale (CES-D Scale) were administered to a group of 5,449 elders in a longitudinal cohort study. The authors compared the rates of syndromal depression (CIDI diagnosis) and depressive symptoms (six CES-D Scale symptoms) in married participants and those who lost spouses between the first and second waves of assessment.

RESULTS: The rate of syndromal depression in the newly bereaved was nearly nine times as high as the rate for married individuals, and the rate of depressive symptoms was nearly four times as high. The percentage of the bereaved respondents who had scores above threshold on the revised CES-D Scale was higher for those interviewed up to 2 years after loss of a spouse than for married respondents. Age, sex, prior psychiatric history, and the expectedness of the death did not differ between depressed and nondepressed newly bereaved subjects.

CONCLUSIONS: Recent bereavement is a significant risk factor for syndromal depression in the elderly. Some widows and widowers experienced high levels of depressive symptoms up to 2 years after the loss of their spouses. Neither demographic variables nor variables concerning the nature of the spouse{\textquoteright}s death predicted bereavement-related depression.

}, keywords = {Age Factors, Aged, Aged, 80 and over, Bereavement, Cohort Studies, depression, Depressive Disorder, Female, Humans, Logistic Models, Longitudinal Studies, Male, Marital Status, Odds Ratio, Psychiatric Status Rating Scales, Risk Factors, Sex Factors, Widowhood}, issn = {0002-953X}, doi = {10.1176/ajp.156.10.1596}, author = {Carolyn L. Turvey and Carney, C. and Arndt, Stephan and Robert B Wallace and A. Regula Herzog} }