@article {8679, title = {Prevalence and Outcomes of Breathlessness in Older Adults: A National Population Study.}, journal = {J Am Geriatr Soc}, volume = {64}, year = {2016}, month = {2016 10}, pages = {2035-2041}, abstract = {

OBJECTIVES: To determine the prevalence and outcomes of breathlessness in older Americans.

SETTING: Community-dwelling older adults.

PARTICIPANTS: Individuals aged 70 and older in the nationally representative Health and Retirement Study (2008, follow-up through 2012) (N = 3,671; mean age 78).

MEASUREMENTS: Breathlessness was assessed by asking the question, "How often do you become short of breath while awake?" Responses of often or sometimes were considered to represent a level of breathlessness sufficient to warrant clinical attention. The prevalence of breathlessness is described overall and in subpopulations, then rates of associated symptoms, well-being, and health services use of participants who were breathless are compared with rates of those who were not. The risk of decline in activities of daily living (ADLs) and death through 2012 was estimated by creating a multivariable Cox proportional hazards model, adjusting for age, sex, race and ethnicity, and education.

RESULTS: Twenty-five percent of participants reported breathlessness. The prevalence of breathlessness was higher in certain subpopulations: chronic lung disease (63\%), multimorbidity (>=2 chronic conditions) (45\%), current smokers (38\%), heart disease (36\%), obesity (body mass index >=30.0 kg/m ) (33\%), and education less than high school (32\%). Breathlessness was associated with higher rates of depression, anxiety, and severe fatigue; lower ratings of well-being; and higher rates of clinic and emergency department visits and hospitalizations (all P < .001). Breathlessness predicted ADL decline over 5 years (adjusted hazard ratio (aHR) = 1.43, 95\% confidence interval (CI) = 1.22-1.68) and death (aHR 1.62, 95\% CI = 1.32-2.02).

CONCLUSION: One in four adults aged 70 and older in the United States experiences breathlessness, which is associated with lack of well-being, greater health services use, and a 40\% greater risk of worsened function and 60\% greater risk of death over the next 5 years.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Anxiety, Chronic disease, Comorbidity, depression, Dyspnea, Female, Geriatric Assessment, Hospitalization, Humans, Male, Prevalence, Proportional Hazards Models, Risk Assessment, Risk Factors, Symptom Assessment, United States}, issn = {1532-5415}, doi = {10.1111/jgs.14313}, author = {David C. Currow and Amy P Abernethy and Miriam J Johnson and Yinghui Miao and W John Boscardin and Christine S Ritchie} } @article {8506, title = {Self-Reported Hearing in the Last 2 Years of Life in Older Adults.}, journal = {J Am Geriatr Soc}, volume = {64}, year = {2016}, month = {2016 07}, pages = {1486-91}, abstract = {

OBJECTIVES: To assess the prevalence and correlates of self-reported hearing loss during the last 2 years of life.

DESIGN: Observational cohort study.

SETTING: The Health and Retirement Study (HRS), a longitudinal nationally representative cohort of adults aged 50 and older (2000-13).

PARTICIPANTS: Older adults (N = 5,895, mean age at death 78, 53\% female, 20\% nonwhite).

MEASUREMENTS: The HRS interview closest to death was used (mean 12.2 months before death). Participants rated their hearing (excellent, very good, good, fair, poor) and indicated whether they used hearing aids. The prevalence and correlates of fair and poor ratings are described, adjusted for age and sex.

RESULTS: Thirty-two percent (95\% confidence interval (CI) = 31-34\%) of all participants and 60\% (95\% CI = 57-64\%) of the 7\% of participants who used hearing aids rated their hearing as fair or poor. The prevalence of fair or poor hearing was highest in participants interviewed closest to death (29\% 19-24 months before death, 36\% 1-6 months before death, P for trend = .01). Correlates of fair or poor hearing during the last 2 years of life included age at death (50-59, 22\%; 60-69, 21\%; 70-79, 26\%; 80-89, 38\%; >=90, 50\%), sex (men 35\%, women 30\%), race and ethnicity (Hispanic 42\%, white 33\%), wealth (lowest quartile 38\%, highest quartile 27\%), history of heart disease (yes 38\%, no 27\%), activity of daily living dependence (yes 42\%, no 26\%), difficulty taking medications (yes 46\%, no 29\%), and probable dementia (yes 44\%, no 24\%).

CONCLUSION: Self-reported hearing loss increases during the last 2 years of life and is associated with physical and social vulnerability.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, California, Demography, Female, Hearing aids, Hearing loss, Humans, Longitudinal Studies, Male, Middle Aged, Prevalence, Quality of Life, Risk Factors, Self Report, Vulnerable Populations}, issn = {1532-5415}, doi = {10.1111/jgs.14145}, url = {http://www.ncbi.nlm.nih.gov/pubmed/27341383}, author = {Christine S Ritchie and Yinghui Miao and W John Boscardin and Margaret Wallhagen} } @article {8224, title = {Discrimination in Healthcare Settings is Associated with Disability in Older Adults: Health and Retirement Study, 2008-2012.}, journal = {J Gen Intern Med}, volume = {30}, year = {2015}, note = {Export Date: 29 May 2015 Article in Press}, month = {2015 Oct}, pages = {1413-20}, publisher = {30}, abstract = {

BACKGROUND: As our society ages, improving medical care for an older population will be crucial. Discrimination in healthcare may contribute to substandard experiences with the healthcare system, increasing the burden of poor health in older adults. Few studies have focused on the presence of healthcare discrimination and its effects on older adults.

OBJECTIVE: We aimed to examine the relationship between healthcare discrimination and new or worsened disability.

DESIGN: This was a longitudinal analysis of data from the nationally representative Health and Retirement Study administered in 2008 with follow-up through 2012.

PARTICIPANTS: Six thousand and seventeen adults over the age of 50 years (mean age 67 years, 56.3 \% female, 83.1 \% white) were included in this study.

MAIN MEASURES: Healthcare discrimination assessed by a 2008 report of receiving poorer service or treatment than other people by doctors or hospitals (never, less than a year=infrequent; more than once a year=frequent). Outcome was self-report of new or worsened disability by 2012 (difficulty or dependence in any of six activities of daily living). We used a Cox proportional hazards model adjusting for age, race/ethnicity, gender, net worth, education, depression, high blood pressure, diabetes, cancer, lung disease, heart disease, stroke, and healthcare utilization in the past 2 years.

KEY RESULTS: In all, 12.6 \% experienced discrimination infrequently and 5.9 \% frequently. Almost one-third of participants (29 \%) reporting frequent healthcare discrimination developed new or worsened disability over 4 years, compared to 16.8 \% of those who infrequently and 14.7 \% of those who never experienced healthcare discrimination (p < 0.001). In multivariate analyses, compared to no discrimination, frequent healthcare discrimination was associated with new or worsened disability over 4 years (aHR = 1.63, 95 \% CI 1.16-2.27).

CONCLUSIONS: One out of five adults over the age of 50 years experiences discrimination in healthcare settings. One in 17 experience frequent healthcare discrimination, and this is associated with new or worsened disability by 4 years. Future research should focus on the mechanisms by which healthcare discrimination influences disability in older adults to promote better health outcomes for an aging population.

}, keywords = {Activities of Daily Living, Aged, Ageism, Aging, Disabled Persons, Female, Follow-Up Studies, Health Status, Humans, Longitudinal Studies, Male, Middle Aged, Retirement, Surveys and Questionnaires}, issn = {1525-1497}, doi = {10.1007/s11606-015-3233-6}, url = {http://www.scopus.com/inward/record.url?eid=2-s2.0-84924662760andpartnerID=40andmd5=4aaf0227e962a58fb0e6670d3d3c6bff}, author = {Stephanie E Rogers and Angela D Thrasher and Yinghui Miao and W John Boscardin} } @article {8746, title = {Subjective, Objective, and Observed Long-term Survival}, journal = {JAMA Internal Medicine}, volume = {175}, year = {2015}, month = {Jan-12-2015}, pages = {1986}, abstract = {Many professional guidelines recommend using life expectancy when considering diagnostic or treatment interventions in which the time to benefit may exceed patients{\textquoteright} survival.1 When subjected to such tests and treatments, these patients are put at risk for up-front harms with little chance of reaping benefits.2 Patients{\textquoteright} perceptions of prognosis are important. Clinicians who follow recommended guidelines may urge patients to change health routines to which they have become accustomed. Patients who underestimate their survival may choose to forego interventions that are likely to help them, while those who overestimate may choose to undergo interventions that are more likely to cause harm. However, little is known about how well older adults estimate their survival, the aim of this analysis. Methods We drew a sample of 64-, 69-, 74-, 79-, 84-, and 89-year-old participants in the 2000 wave of the Health and Retirement Study (HRS), a nationally representative, longitudinal, prospective cohort study of adults in the United States.3 Institutional review board approval for HRS was received from the University of California, San Francisco, Committee on Human Research. Informed consent was obtained by HRS at the time of the interview. Our variable of interest was participants{\textquoteright} subjective estimate of long-term survival, assessed by the question, {\textquotedblleft}What is the percent chance you will live to be x or more?{\textquotedblright} where x was 75, 80, 85, 90, 95, or 100 years old. Our sampling strategy ensured that all participants predicted survival across the same period. We calculated an objective estimate of life expectancy using the Lee life expectancy calculator.4 Observed survival was determined using mortality through 2010 (confirmed using the National Death Index). We compared participants{\textquoteright} subjective estimates to observed survival (using the C statistic) and the objective estimates (using a best-fit analysis). Participants were classified as underestimating or overestimating their survival if their estimate was more than 25 percentage points less or greater than the calculated prediction, respectively. Results A total of 2018 respondents of the specified ages were interviewed directly in the 2000 wave of the HRS, and our final sample included 1722 participants who had complete responses necessary for the calculator (56\% female, 88\% white). We combined the 84- and 89-year-olds because of the small number of respondents in each group. Overall, discrimination was moderate for participants{\textquoteright} subjective estimates of survival compared with observed survival (C statistic = 0.62; P < .001). The 64- and 69-year-olds were moderately able to estimate their survival (C statistic = 0.62 and 0.58, respectively; P < .001 for both), but older participants fared no better than chance (Table). Substantial dissimilarity was seen between participants{\textquoteright} subjective and the objective estimates of survival (Figure). Overall, 54.7\% of participants had estimates similar to the objective calculation; however, 32.7\% underestimated and 11.5\% overestimated. Underestimation was relatively similar across age groups, but overestimation increased significantly with age (Table) (P < .001). Discussion Our findings have important implications for clinicians. First, approximately half the time, participants accurately estimated survival compared with an objective clinical estimate, and when in error, they were more likely to underestimate than overestimate. Consequently, disclosing prognosis is not necessarily bad news. Second, because of the substantial dissimilarity between the subjective and objective estimates, patients may be hesitant to follow guideline recommendations to change long-standing regimens. Third, our findings make a case for using prognostic calculators, which were more accurate than participants{\textquoteright} subjective estimates and have been shown to be superior to clinician estimates.5 Fourth, participants in the HRS were willing to make an estimate of their survival and report it. Previous research suggests that older adults are generally willing to discuss long-term prognosis.6 Clinicians should solicit patients{\textquoteright} individual perception of prognosis and use this information as a starting point for further discussion, particularly among older patients who may be more prone to errors. Then, in conjunction with prognostic tools, they can begin to bridge the gap between subjective and objective estimates of survival.}, keywords = {Health Conditions and Status, Mortality, Older Adults, Self-reported health}, issn = {2168-6106}, doi = {10.1001/jamainternmed.2015.5542}, url = {http://archinte.jamanetwork.com/article.aspx?doi=10.1001/jamainternmed.2015.5542}, author = {Rafael D Romo and Sei J. Lee and Yinghui Miao and W John Boscardin} }