@article {6514, title = {Changes in Visual Function in the Elderly Population in the United States: 1995-2010.}, journal = {Ophthalmic Epidemiol}, volume = {23}, year = {2016}, month = {2016 Jun}, pages = {137-44}, chapter = {1}, abstract = {

PURPOSE: To document recent trends in visual function among the United States population aged 70+ years and investigate how the trends can be explained by inter-temporal changes in: (1) population sociodemographic characteristics, and chronic disease prevalence, including eye diseases (compositional changes); and (2) effects of the above factors on visual function (structural changes).

METHODS: Data from the 1995 Asset and Health Dynamics among the Oldest Old (AHEAD) and the 2010 Health and Retirement Study (HRS) were merged with Medicare Part B claims in the interview years and the 2 previous years. Decomposition analysis was performed. Respondents from both studies were aged 70+ years. The outcome measure was respondent self-reported visual function on a 6-point scale (from 6 = blind to 1 = excellent).

RESULTS: Overall, visual function improved from slightly worse than good (3.14) in 1995 to slightly better than good (2.98) in 2010. A decline in adverse effects of aging on vision was found. Among the compositional changes were higher educational attainment leading to improved vision, and higher prevalence of such diseases as diabetes mellitus, which tended to lower visual function. However, compared to compositional changes, structural changes were far more important, including decreased adverse effects of aging, diabetes mellitus (when not controlling for eye diseases), and diagnosed glaucoma.

CONCLUSION: Although the US population has aged and is expected to age further, visual function improved among elderly persons, especially among persons 80+ years, likely reflecting a favorable role of structural changes identified in this study in mitigating the adverse effect of ongoing aging on vision.

}, keywords = {Age Factors, Aged, Aged, 80 and over, Aging, Chronic disease, Cross-Sectional Studies, Female, Humans, Male, Medicare Part B, Prevalence, Self Report, Socioeconomic factors, United States, Visual Acuity, Visually Impaired Persons}, issn = {1744-5086}, doi = {10.3109/09286586.2015.1057603}, url = {http://dx.doi.org/10.3109/09286586.2015.1057603}, author = {Chen, Yiqun and Hahn, Paul and Frank A Sloan} } @article {8268, title = {Adherence to diabetes guidelines for screening, physical activity and medication and onset of complications and death.}, journal = {J Diabetes Complications}, volume = {29}, year = {2015}, month = {2015 Nov-Dec}, pages = {1228-33}, publisher = {29}, abstract = {

AIMS: Analyze relationships between adherence to guidelines for diabetes care - regular screening; physical activity; and medication - and diabetes complications and mortality.

METHODS: Outcomes were onset of congestive heart failure (CHF), stroke, renal failure, moderate complications of lower extremities, lower-limb amputation, proliferative diabetic retinopathy (PDR), and mortality during follow-up. Participants were persons aged 65+ in the Health and Retirement Study (HRS) 2003 Diabetes Study and had Medicare claims in follow-up period (2004-8).

RESULTS: Adherence to screening recommendations decreased risks of developing CHF (odds ratio (OR)=0.83; 95\% confidence interval (CI): 0.72-0.96), stroke (OR=0.80; 95\% CI: 0.68-0.94); renal failure (OR=0. 82; 95\% CI: 0.71-0.95); and death (OR=0.86; 95\% CI: 0.74-0.99). Adherence to physical activity recommendation reduced risks of stroke (OR=0.64; 95\% CI: 0.45-0.90), renal failure (OR=0.71; 95\% CI: 0.52-0.97), moderate lower-extremity complications (OR=0.71; 95\% CI: 0.51-0.99), having a lower limb amputation (OR=0.31, 95\% CI: 0.11-0.85), and death (OR=0.56, 95\% CI: 0.41-0.77). Medication adherence was associated with lower risks of PDR (OR=0.35, 95\% CI: 0.13-0.93).

CONCLUSIONS: Adherence to screening, physical activity and medication guidelines was associated with lower risks of diabetes complications and death. Relative importance of adherence differed among outcome measures.

}, keywords = {Aged, Aged, 80 and over, Combined Modality Therapy, Diabetes Complications, Diabetes Mellitus, Early Diagnosis, Female, Health Promotion, Health Surveys, Humans, Hypoglycemic Agents, Longitudinal Studies, Male, Mass Screening, Medicare Part A, Medicare Part B, Medication Adherence, Motor Activity, Patient Compliance, Practice Guidelines as Topic, Risk, United States}, issn = {1873-460X}, doi = {10.1016/j.jdiacomp.2015.07.005}, author = {Chen, Yiqun and Frank A Sloan and Arseniy P Yashkin} } @article {8228, title = {Explaining Disability Trends in the U.S. Elderly and Near-Elderly Population.}, journal = {Health Serv Res}, volume = {50}, year = {2015}, note = {Times Cited: 1 0 1}, month = {2015 Oct}, pages = {1528-49}, publisher = {50}, abstract = {

OBJECTIVE: To examine disability trends among U.S. near-elderly and elderly persons and explain observed trends.

DATA SOURCE: 1996-2010 waves of the Health and Retirement Study.

STUDY DESIGN: We first examined trends in Activities of Daily Living and Instrumental Activities of Daily Living limitations, and large muscle, mobility, gross motor, and fine motor indexes. Then we used decomposition analysis to estimate contributions of changes in sociodemographic composition, self-reported chronic disease prevalence and health behaviors, and changes in disabling effects of these factors to disability changes between 1996 and 2010.

PRINCIPAL FINDINGS: Disability generally increased or was unchanged. Increased trends were more apparent for near-elderly than elderly persons. Sociodemographic shifts tended to reduce disability, but their favorable effects were largely offset by increased self-reported chronic disease prevalence. Changes in smoking and heavy drinking prevalence had relatively minor effects on disability trends. Increased obesity rates generated sizable effects on lower-body functioning changes. Disabling effects of self-reported chronic diseases often declined, and educational attainment became a stronger influence in preventing disability.

CONCLUSIONS: Such unfavorable trends as increased chronic disease prevalence and higher obesity rates offset or outweighed the favorable effects with the result that disability remained unchanged or increased.

}, keywords = {Activities of Daily Living, Age Distribution, Aged, Aged, 80 and over, Alcohol Drinking, Chronic disease, Disabled Persons, Female, Health Behavior, Health Surveys, Humans, Male, Middle Aged, Mobility Limitation, Obesity, Prevalence, Sex Distribution, Smoking, Socioeconomic factors, United States}, issn = {1475-6773}, doi = {10.1111/1475-6773.12284}, author = {Chen, Yiqun and Frank A Sloan} } @article {8117, title = {Gaps in Receipt of Regular Eye Examinations among Medicare Beneficiaries Diagnosed with Diabetes or Chronic Eye Diseases}, journal = {Ophthalmology}, volume = {121}, year = {2014}, note = {Times Cited: 0 0}, pages = {2452-2460}, publisher = {121}, abstract = {Objective: To examine a wide range of factors associated with regular eye examination receipt among elderly individuals diagnosed with glaucoma, age-related macular degeneration, or diabetes mellitus (DM). Design: Retrospective analysis of Medicare claims linked to survey data from the Health and Retirement Study (HRS). Participants: The sample consisted of 2151 Medicare beneficiaries who responded to the HRS. Methods: Medicare beneficiaries with = 1 of the 3 study diagnoses were identified by diagnosis codes and merged with survey information. The same individuals were followed for 5 years divided into four 15-month periods. Predictors of the number of periods with an eye examination evaluated were beneficiary demographic characteristics, income, health, cognitive and physical function, health behaviors, subjective beliefs about longevity, the length of the individual{\textquoteright}s financial planning horizon, supplemental health insurance coverage, eye disease diagnoses, and low vision/blindness at baseline. We performed logit analysis of the number of 15-month periods in which beneficiaries received an eye examination. Main Outcome Measures: The primary outcome measure was the number of 15-month periods with an eye examination. Results: One third of beneficiaries with the study{\textquoteright}s chronic diseases saw an eye care provider in all 4 followup periods despite having Medicare. One quarter only obtained an eye examination at most during 1 of the four 15-month follow-up periods. Among the 3 groups of patients studied, utilization was particularly low for persons with diagnosed DM and no eye complications. Age, marriage, education, and a higher score on the Charlson index were associated with more periods with an eye examination. Male gender, being limited in instrumental activities of daily living at baseline, distance to the nearest ophthalmologist, and low cognitive function were associated with a reduction in frequency of eye examinations. Conclusions: Rates of eye examinations for elderly persons with DM or frequently occurring eye diseases, especially for DM, remain far below recommended levels in a nationally representative sample of persons with health insurance coverage. Several factors, including limited physical and cognitive function and greater distance to an ophthalmologist, but not health insurance coverage, account for variation in regular use.}, keywords = {Health Conditions and Status, Healthcare, Insurance, Medicare/Medicaid/Health Insurance}, doi = {10.1016/j.ophtha.2014.07.020}, author = {Frank A Sloan and Arseniy P Yashkin and Chen, Yiqun} }