@article {13243, title = {Associations of Social, Cultural, and Community Engagement With Health Care Utilization in the US Health and Retirement Study.}, journal = {JAMA Netw Open}, volume = {6}, year = {2023}, pages = {e236636}, abstract = {

IMPORTANCE: There is growing evidence for the health benefits associated with social, cultural, and community engagement (SCCE), including for supporting healthy behaviors. However, health care utilization is an important health behavior that has not been investigated in association with SCCE.

OBJECTIVE: To examine the associations between SCCE and health care utilization.

DESIGN, SETTING, AND PARTICIPANTS: This population-based cohort study used data from the 2008 to 2016 waves of the Health and Retirement Study (HRS), a longitudinal panel study using a nationally representative sample of the US population aged 50 years and older. Participants were eligible if they reported SCCE and health care utilization in the relevant HRS waves. Data were analyzed from July to September 2022.

EXPOSURES: SCCE was measured with a 15-item Social Engagement scale (including community, cognitive, creative, or physical activities) at baseline (frequency) and longitudinally over 4 years (no, consistent, increased, or decreased engagement).

MAIN OUTCOMES AND MEASURES: Health care utilization was assessed in association with SCCE within 4 overarching categories: inpatient care (ie, hospital stays, hospital readmissions, length of hospital stays), outpatient care (ie, outpatient surgery, physician visits, number of physician visits), dental care (including dentures), and community health care (ie, home health care, nursing home stays, nights in a nursing home).

RESULTS: A total of 12 412 older adults (mean [SE] age, 65.0 [0.1] years; 6740 [54.3\%] women) were included in short-term analyses with 2 years of follow-up. Independent of confounders, more SCCE was associated with shorter hospital stays (incidence rate ratio [IRR], 0.75; 95\% CI, 0.58-0.98), greater odds of outpatient surgery (odds ratio [OR], 1.34; 95\% CI, 1.12-1.60) and dental care (OR, 1.73; 95\% CI, 1.46-2.05), and lower odds of home health care (OR, 0.75; 95\% CI, 0.57-0.99) and nursing home stays (OR, 0.46; 95\% CI, 0.29-0.71). Longitudinal analysis included 8635 older adults (mean [SE] age, 63.7 [0.1] years; 4784 [55.4\%] women) with data on health care utilization 6 years after baseline. Compared with consistent SCCE, reduced SCCE or consistent nonparticipation in SCCE was associated with more inpatient care utilization, such as hospital stays (decreased SCCE: IRR, 1.29; 95\% CI, 1.00-1.67; consistent nonparticipation: IRR, 1.32; 95\% CI, 1.04-1.68) but lower levels of subsequent outpatient care, such as physician visits (decreased SCCE: OR, 0.68; 95\% CI, 0.50-0.93; consistent nonparticipation: OR, 0.62; 95\% CI, 0.46-0.82) and dental care utilization (decreased SCCE: OR, 0.68; 95\% CI, 0.57-0.81; consistent nonparticipation: OR, 0.51; 95\% CI, 0.44-0.60).

CONCLUSIONS AND RELEVANCE: These findings suggest that more SCCE was associated with more dental and outpatient care utilization and reduced inpatient and community health care utilization. SCCE might be associated with shaping beneficial early and preventive health-seeking behaviors, facilitating health care decentralization and alleviating financial burden by optimizing health care utilization.

}, keywords = {Aged, Cohort Studies, Delivery of Health Care, Female, Hospitalization, Humans, Male, Middle Aged, Patient Acceptance of Health Care, Retirement}, issn = {2574-3805}, doi = {10.1001/jamanetworkopen.2023.6636}, author = {Gao, Qian and Bone, Jessica K and Bu, Feifei and Paul, Elise and Sonke, Jill K and Fancourt, Daisy} } @article {13686, title = {Dementia Attributable Healthcare Utilizations in the Caribbean versus United States.}, journal = {Journal of Alzheimers Disease: JAD}, volume = {96}, year = {2023}, pages = {801-811}, abstract = {

BACKGROUND: Despite the high burden of Alzheimer{\textquoteright}s disease and other dementias among the Hispanic population worldwide, little is known about how dementia affects healthcare utilizations among this population outside of the US, in particular among those in the Caribbean region.

OBJECTIVE: This study examines healthcare utilization associated with Alzheimer{\textquoteright}s disease and other dementias among older adults in the Caribbean as compared to the US.

METHODS: We conducted harmonized analyses of two population-based surveys, the 10/66 Dementia Group Research data collected in Dominican Republic, Cuba, and Puerto Rico, and the US-based Health and Retirement Study. We examined changes in hospital nights and physician visits in response to incident and ongoing dementias.

RESULTS: Incident dementia significantly increased the risk of hospitalization and number of hospital nights in both populations. Ongoing dementia increased the risk of hospitalization and hospital nights in the US, with imprecise estimates for the Caribbean. The number of physician visits was elevated in the US but not in the Caribbean.

CONCLUSIONS: The concentration of increased healthcare utilization on hospital care and among patients with incident dementia suggests an opportunity for improved outpatient management of new and existing dementia patients in the Caribbean.

}, keywords = {Aged, Alzheimer disease, Delivery of Health Care, ethnicity, Humans, Patient Acceptance of Health Care, Puerto Rico, United States}, issn = {1875-8908}, doi = {10.3233/JAD-230505}, author = {Li, Jing and Weiss, Jordan and Rajadhyaksha, Ashish and Acosta, Daisy} } @article {13684, title = {Dementia Attributable Healthcare Utilizations in the Caribbean versus United States.}, journal = {Journal of Alzheimers Disease: JAD}, volume = {96}, year = {2023}, pages = {801-811}, abstract = {

BACKGROUND: Despite the high burden of Alzheimer{\textquoteright}s disease and other dementias among the Hispanic population worldwide, little is known about how dementia affects healthcare utilizations among this population outside of the US, in particular among those in the Caribbean region.

OBJECTIVE: This study examines healthcare utilization associated with Alzheimer{\textquoteright}s disease and other dementias among older adults in the Caribbean as compared to the US.

METHODS: We conducted harmonized analyses of two population-based surveys, the 10/66 Dementia Group Research data collected in Dominican Republic, Cuba, and Puerto Rico, and the US-based Health and Retirement Study. We examined changes in hospital nights and physician visits in response to incident and ongoing dementias.

RESULTS: Incident dementia significantly increased the risk of hospitalization and number of hospital nights in both populations. Ongoing dementia increased the risk of hospitalization and hospital nights in the US, with imprecise estimates for the Caribbean. The number of physician visits was elevated in the US but not in the Caribbean.

CONCLUSIONS: The concentration of increased healthcare utilization on hospital care and among patients with incident dementia suggests an opportunity for improved outpatient management of new and existing dementia patients in the Caribbean.

}, keywords = {Aged, Alzheimer disease, Delivery of Health Care, ethnicity, Humans, Patient Acceptance of Health Care, Puerto Rico, United States}, issn = {1875-8908}, doi = {10.3233/JAD-230505}, author = {Li, Jing and Weiss, Jordan and Rajadhyaksha, Ashish and Acosta, Daisy and Harrati, Amal and Jim{\'e}nez Vel{\'a}zquez, Ivonne Z and Liu, Mao-Mei and Guerra, Jorge J Llibre and Rodriguez, Juan de Jes{\'u}s Llibre and Dow, William H} } @article {13122, title = {The effect of housing wealth on older adults{\textquoteright} health care utilization: Evidence from fluctuations in the U.S. housing market.}, journal = {J Health Econ}, volume = {88}, year = {2023}, month = {2023 Mar}, pages = {102737}, abstract = {

Do wealthier individuals use more health care services than those less affluent? Our paper addresses this question by examining the relationship between housing wealth and health care utilization. Exploiting fluctuations in the U.S. housing market, we estimate the effect of unanticipated wealth shocks on older adults{\textquoteright} health care utilization, using county-year variation in house prices to construct an instrumental variable. Using data from the 1996-2016 Health and Retirement Study, we find that an increase in wealth significantly increases numbers of doctor visits, prescription drugs, outpatient surgery, and dental services. Notably, an economic downturn like that in the Great Recession, when housing wealth declined by 16 percent on average, could reduce the utilization of prescription drugs by 0.4 percent, outpatient services by 0.5 percent, dental care by 0.6 percent, and numbers of doctor visits by 0.5 visits annually.

}, keywords = {Aged, Housing, Humans, Patient Acceptance of Health Care, prescription drugs, Retirement}, issn = {1879-1646}, doi = {10.1016/j.jhealeco.2023.102737}, author = {Tran, My and Gannon, Brenda and Rose, Christiern} } @article {8563, title = {Mental health and breast cancer screening utilization among older Hispanic women.}, journal = {J Women Aging}, volume = {29}, year = {2017}, month = {2017 Mar-Apr}, pages = {163-172}, abstract = {

Considerable racial and ethnic differences exist in the way the burden of cancer is experienced in the United States for older Hispanic women. This study utilized data from the 2008 wave of the Health and Retirement Study to investigate the mental health factors associated with older Hispanic women{\textquoteright}s participation in breast cancer screening services. Logistic regression models were used. Findings indicated that anxiety and positive affect were associated with a greater likelihood of participating in breast cancer screening. Despite ongoing national conversations, evidence indicates there is agreement that underserved women need to be screened, particularly the older Hispanic population.

}, keywords = {Affect, Aged, Anxiety, Breast Neoplasms, Early Detection of Cancer, Female, Hispanic Americans, Humans, Logistic Models, Middle Aged, Motivation, Patient Acceptance of Health Care, United States, Vulnerable Populations}, issn = {1540-7322}, doi = {10.1080/08952841.2015.1113726}, url = {https://www.ncbi.nlm.nih.gov/pubmed/27485158}, author = {Tamara J. Cadet and Berrett-Abebe, Julie and Stewart, Kathleen} } @article {8806, title = {Desire for predictive testing for Alzheimer{\textquoteright}s disease and impact on advance care planning: a cross-sectional study.}, journal = {Alzheimers Res Ther}, volume = {8}, year = {2016}, month = {2016 12 13}, pages = {55}, abstract = {

BACKGROUND: It is unknown whether older adults in the United States would be willing to take a test predictive of future Alzheimer{\textquoteright}s disease, or whether testing would change behavior. Using a nationally representative sample, we explored who would take a free and definitive test predictive of Alzheimer{\textquoteright}s disease, and examined how using such a test may impact advance care planning.

METHODS: A cross-sectional study within the 2012 Health and Retirement Study of adults aged 65~years or older asked questions about a test predictive of Alzheimer{\textquoteright}s disease (N = 874). Subjects were asked whether they would want to take a hypothetical free and definitive test predictive of future Alzheimer{\textquoteright}s disease. Then, imagining they knew they would develop Alzheimer{\textquoteright}s disease, subjects rated the chance of completing advance care planning activities from 0 to 100. We classified a score > 50 as being likely to complete that activity. We evaluated characteristics associated with willingness to take a test for Alzheimer{\textquoteright}s disease, and how such a test would impact completing an advance directive and discussing health plans with loved ones.

RESULTS: Overall, 75\% (N = 648) of the sample would take a free and definitive test predictive of Alzheimer{\textquoteright}s disease. Older adults willing to take the test had similar race and educational levels to those who would not, but were more likely to be <=75~years old (odds ratio 0.71 (95\% CI 0.53-0.94)). Imagining they knew they would develop Alzheimer{\textquoteright}s, 81\% would be likely to complete an advance directive, although only 15\% had done so already.

CONCLUSIONS: In this nationally representative sample, 75\% of older adults would take a free and definitive test predictive of Alzheimer{\textquoteright}s disease. Many participants expressed intent to increase activities of advance care planning with this knowledge. This confirms high public interest in predictive testing for Alzheimer{\textquoteright}s disease and suggests this may be an opportunity to engage patients in advance care planning discussions.

}, keywords = {Advance care planning, Aged, Aged, 80 and over, Alzheimer disease, Cross-Sectional Studies, Female, Health Knowledge, Attitudes, Practice, Humans, Male, Patient Acceptance of Health Care}, issn = {1758-9193}, doi = {10.1186/s13195-016-0223-9}, url = {http://alzres.biomedcentral.com/articles/10.1186/s13195-016-0223-9http://link.springer.com/content/pdf/10.1186/s13195-016-0223-9.pdf}, author = {Sheffrin, Meera and Stijacic-Cenzer, Irena and Michael A Steinman} } @article {8377, title = {Disparity in dental attendance among older adult populations: a comparative analysis across selected European countries and the USA.}, journal = {Int Dent J}, volume = {66}, year = {2016}, month = {2016 Feb}, pages = {36-48}, publisher = {66}, abstract = {

BACKGROUND: The current study addresses the extent to which diversity in dental attendance across population subgroups exists within and between the USA and selected European countries.

METHOD: The analyses relied on 2006/2007 data from the Survey of Health, Ageing and Retirement in Europe (SHARE) and 2004-2006 data from the Health and Retirement Study (HRS) in the USA for respondents>=51 years of age. Logistic regression models were estimated to identify impacts of dental-care coverage, and of oral and general health status, on dental-care use.

RESULTS: We were unable to discern significant differences in dental attendance across population subgroups in countries with and without social health insurance, between the USA and European countries, and between European countries classified according to social welfare regime. Patterns of diverse dental use were found, but they did not appear predominately in countries classified according to welfare state regime or according to the presence or absence of social health insurance.

CONCLUSIONS: The findings of this study suggest that income and education have a stronger, and more persistent, correlation with dental use than the correlation between dental insurance and dental use across European countries. We conclude that: (i) higher overall rates of coverage in most European countries, compared with relatively lower rates in the USA, contribute to this finding; and that (ii) policies targeted to improving the income of older persons and their awareness of the importance of oral health care in both Europe and the USA can contribute to improving the use of dental services.

}, keywords = {Aged, Aged, 80 and over, Demography, Dental Care, Europe, Female, Humans, Insurance Coverage, Interviews as Topic, Male, Middle Aged, Oral Health, Patient Acceptance of Health Care, United States}, issn = {0020-6539}, doi = {10.1111/idj.12190}, url = {http://onlinelibrary.wiley.com/doi/10.1111/idj.12190/epdf}, author = {Richard J. Manski and John F Moeller and Haiyan Chen and Widstrom, Eeva and Listl, Stefan} } @article {8551, title = {Does the Relationship of the Proxy to the Target Person Affect the Concordance between Survey Reports and Medicare Claims Measures of Health Services Use?}, journal = {Health Serv Res}, volume = {51}, year = {2016}, month = {2016 Feb}, pages = {314-27}, abstract = {

OBJECTIVES: To compare concordance of survey reports of health service use versus claims data between self respondents and spousal and nonspousal relative proxies.

DATA SOURCES: 1995-2010 data from the Survey on Assets and Health Dynamics among the Oldest Old and 1993-2010 Medicare claims for 3,229 individuals (13,488 person-years).

STUDY DESIGN: Regression models with individual fixed effects were estimated for discordance of any hospitalizations and outpatient surgery and for the numbers of under- and over-reported physician visits.

PRINCIPAL FINDINGS: Spousal proxies were similar to self respondents on discordance. Nonspousal proxies, particularly daughters/daughters-in-law and sons/sons-in-law, had less discordance, mainly due to reduced under-reporting.

CONCLUSIONS: Survey reports of health services use from nonspousal relatives are more consistent with Medicare claims than spousal proxies and self respondents.

}, keywords = {Ambulatory Surgical Procedures, Female, Hospitalization, Humans, Insurance Claim Review, Male, Medicare, Patient Acceptance of Health Care, Proxy, Self Report, Socioeconomic factors, Spouses, United States}, issn = {1475-6773}, doi = {10.1111/1475-6773.12321}, url = {https://www.ncbi.nlm.nih.gov/pubmed/26059195}, author = {George L Wehby and Michael P Jones and Fred A Ullrich and Yiyue Lou and Frederic D Wolinsky} } @article {8583, title = {High Levels of Geriatric Palliative Care Needs in Hip Fracture Patients Before the Hip Fracture.}, journal = {J Pain Symptom Manage}, volume = {52}, year = {2016}, month = {2016 10}, pages = {533-538}, abstract = {

CONTEXT: Most hip fracture care models are grounded in curative models where the goal is to return the patient to independent function. In many instances, however, hip fractures contribute to continued functional decline and mortality. Although the negative impact of hip fractures is appreciated once they have occurred, what is less understood is what proportion of older adults have high illness burden before experiencing hip fracture and might benefit from geriatric palliative care.

OBJECTIVES: Using data from the Health and Retirement Study linked to Medicare claims (January 1992 through December 2010), we sought to understand the extent of premorbid illness burden before hip fracture.

METHODS: Characteristics were based on the interview before hip fracture. Features used to indicate need for geriatric palliative care included evidence of functional and medical vulnerability, pain, and depression.

RESULTS: Eight hundred fifty-six older adults who experienced a hip fracture were compared to 851 age-, gender-, and race-matched controls. Older adults with hip fractures had significantly more premorbid functional vulnerability (activities of daily living dependent 25.7\% vs. 16.1\% [P~<~0.001]; dementia 16.2\% vs. 7.3\% (P~<~0.001); use of helpers 41.2\% vs. 28.7\% [P~<~0.001]). They also experienced more medical vulnerability (multimorbidity 43\% vs. 29.8\% [P~<~0.001]; high health care utilization 30.0\% vs. 20.9\% [P~<~0.001]; and poor prognosis 36.1\% vs. 25.4\% [P~<~0.001] in controls). There was no difference in premorbid pain and depression between subsequent hip fracture patients and controls.

CONCLUSIONS: A significant proportion of older adults have evidence of functional and medical vulnerability before hip fracture. For these individuals, integration of geriatric palliative care may be particularly important for optimizing quality of life and addressing the high morbidity experienced by this population.

}, keywords = {Activities of Daily Living, Aged, 80 and over, Dementia, depression, Female, Hip Fractures, Humans, Interviews as Topic, Male, multimorbidity, pain, Palliative care, Patient Acceptance of Health Care, Prodromal Symptoms, Vulnerable Populations}, issn = {1873-6513}, doi = {10.1016/j.jpainsymman.2016.07.003}, url = {http://www.sciencedirect.com/science/article/pii/S0885392416302214}, author = {Christine S Ritchie and Amy Kelley and Irena Cenzer and Margaret Wallhagen and Kenneth E Covinsky} } @article {8677, title = {A pilot study among older adults of the concordance between their self-reports to a health survey and spousal proxy reports on their behalf.}, journal = {BMC Health Serv Res}, volume = {16}, year = {2016}, month = {2016 09 09}, pages = {485}, abstract = {

BACKGROUND: Proxy respondents are frequently used in health surveys, and the proxy is most often the spouse. Longstanding concerns linger, however, about the validity of using spousal proxies, especially for older adults. The purpose of this pilot study was to evaluate the concordance between self-reports and spousal proxy reports to a standard health survey in a small convenience sample of older married couples.

METHODS: We used the Seniors Together in Aging Research (STAR) volunteer registry at the University of Iowa to identify and consent a cross-sectional, convenience sample of 28 married husband and wife couples. Private, personal interviews with each member of the married couple using a detailed health survey based on the 2012 Health and Retirement Study (HRS) instrument were conducted using computer assisted personal interviewing software. Within couples, each wife completed the health survey first for herself and then for her husband, and each husband completed the health survey first for himself and then for his wife. The health survey topics included health ratings, health conditions, mobility, instrumental activities of daily living (IADLs), health services use, and preventative services. Percent of agreement and prevalence and bias adjusted kappa statistics (PABAKs) were used to evaluate concordance.

RESULTS: PABAK coefficients indicated moderate to excellent concordance (PABAKs >0.60) for most of the IADL, health condition, hospitalization, surgery, preventative service, and mobility questions, but only slight to fair concordance (PABAKs = -0.21 to 0.60) for health ratings, and physician and dental visits.

CONCLUSIONS: These results do not allay longstanding concerns about the validity of routinely using spousal proxies in health surveys to obtain health ratings or the number of physician and dental visits among older adults. Further research is needed in a nationally representative sample of older couples in which each wife completes the health survey first for herself and then for her husband, each husband completes the health survey first for himself and then for his wife, and both spouses{\textquoteright} Medicare claims are linked to their health survey responses to determine not just the concordance between spousal reports, but the concordance of those survey responses to the medical record.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Epidemiologic Methods, Female, Health Status, Hospitalization, Humans, Iowa, Male, Medicare, Middle Aged, Patient Acceptance of Health Care, Physicians, Proxy, Spouses, United States}, issn = {1472-6963}, doi = {10.1186/s12913-016-1734-6}, author = {Frederic D Wolinsky and Ayres, Lioness and Michael P Jones and Yiyue Lou and George L Wehby and Fred A Ullrich} } @article {8488, title = {Self-reported herpes zoster, pain, and health care seeking in the Health and Retirement Study: implications for interpretation of health care-based studies.}, journal = {Ann Epidemiol}, volume = {26}, year = {2016}, month = {2016 06}, pages = {441-446.e3}, abstract = {

PURPOSE: To describe self-reported herpes zoster (HZ) and explore factors that could impact interpretation of results from health care-based HZ studies.

METHODS: We performed logistic regression using data from the 2008 Health and Retirement Study (HRS) to evaluate risk factors for having a history of HZ and experiencing severe HZ pain, and predictors for seeking health care for HZ.

RESULTS: Among 14,564 respondents aged >=55~years, women were more likely than men to report a history of HZ (15.7\% vs. 11.6\%, P~<~.01). Blacks (6.4\% vs. 14.7\% in whites, P~<~.01) and respondents with less than a high school diploma (12.2\% vs.14.2\% in respondents with at least a high school diploma, P~= .01) were less likely to report a history of HZ. Women, blacks, Hispanics, and those with less than a high school diploma were more likely to report severe HZ pain. Most (91.1\%) respondents sought health care for HZ; Hispanics (64.2\% vs. 92.1\% in whites, P~<~.001) and those with recurrent HZ were less likely to seek health care for HZ, whereas those with severe pain were more likely (95.4\% vs. 87.9\% in those without severe pain, P~<~.01).

CONCLUSIONS: HRS provides a new platform for studies of HZ, one which allowed us to uncover issues that warrant particular attention when interpreting results of health care-based studies.

}, keywords = {Age Factors, Aged, Aged, 80 and over, Cross-Sectional Studies, Female, Health Surveys, Herpes Zoster, Humans, Independent Living, Logistic Models, Male, Middle Aged, Outcome Assessment, Health Care, pain, Pain Measurement, Patient Acceptance of Health Care, Reproducibility of Results, Retirement, Risk Assessment, Self Report, Severity of Illness Index, Sex Factors, Treatment Outcome, United States}, issn = {1873-2585}, doi = {10.1016/j.annepidem.2016.04.006}, url = {http://www.ncbi.nlm.nih.gov/pubmed/27180114}, author = {Hales, Craig M and Harpaz, Rafael and Bialek, Stephanie R} } @article {8128, title = {Purpose in life and use of preventive health care services.}, journal = {Proc Natl Acad Sci U S A}, volume = {111}, year = {2014}, note = {Times Cited: 0 0}, month = {2014 Nov 18}, pages = {16331-6}, publisher = {111}, abstract = {

Purpose in life has been linked with better health (mental and physical) and health behaviors, but its link with patterns of health care use are understudied. We hypothesized that people with higher purpose would be more proactive in taking care of their health, as indicated by a higher likelihood of using preventive health care services. We also hypothesized that people with higher purpose would spend fewer nights in the hospital. Participants (n = 7,168) were drawn from the Health and Retirement Study, a nationally representative panel study of American adults over the age of 50, and tracked for 6 y. After adjusting for sociodemographic factors, each unit increase in purpose (on a six-point scale) was associated with a higher likelihood that people would obtain a cholesterol test [odds ratio (OR) = 1.18, 95\% confidence interval (CI) = 1.08-1.29] or colonoscopy (OR = 1.06, 95\% CI = 0.99-1.14). Furthermore, females were more likely to receive a mammogram/X-ray (OR = 1.27, 95\% CI = 1.16-1.39) or pap smear (OR = 1.16, 95\% CI = 1.06-1.28), and males were more likely to receive a prostate examination (OR = 1.31, 95\% CI = 1.18-1.45). Each unit increase in purpose was also associated with 17\% fewer nights spent in the hospital (rate ratio = 0.83, 95\% CI = 0.77-0.89). An increasing number of randomized controlled trials show that purpose in life can be raised. Therefore, with additional research, findings from this study may inform the development of new strategies that increase the use of preventive health care services, offset the burden of rising health care costs, and enhance the quality of life among people moving into the ranks of our aging society.

}, keywords = {Aged, Aged, 80 and over, Early Detection of Cancer, Educational Status, ethnicity, Female, Habits, Hematologic Tests, Hospitalization, Humans, Influenza Vaccines, Insurance Coverage, Male, Marital Status, Middle Aged, Models, Psychological, Motivation, Patient Acceptance of Health Care, Preventive Health Services, Surveys and Questionnaires, Vaccination}, issn = {1091-6490}, doi = {10.1073/pnas.1414826111}, author = {Eric S Kim and Victor J Strecher and Carol D Ryff} } @article {8016, title = {Satisfaction with aging and use of preventive health services.}, journal = {Prev Med}, volume = {69}, year = {2014}, note = {Times Cited: 0 0}, month = {2014 Dec}, pages = {176-80}, publisher = {69}, abstract = {

OBJECTIVE: Preventive health service use is relatively low among older age groups. We hypothesized that aging satisfaction would be associated with increased use of preventive health services four years later.

METHOD: We conducted multiple logistic regression analyses on a sample of 6177 people from the Health and Retirement Study, a nationally representative study of U.S. adults over the age of 50 (M age=70.6; women n=3648; men n=2529).

RESULTS: Aging satisfaction was not associated with obtaining flu shots. However, in fully-adjusted models, each standard deviation increase in aging satisfaction was associated with higher odds of reporting service use for cholesterol tests (OR=1.10, 95\% CI=1.00-1.20). Further, women with higher aging satisfaction were more likely to obtain a mammogram/x-ray (OR=1.17, 95\% CI=1.06-1.29) or Pap smear (OR=1.10, 95\% CI=1.00-1.21). Among men, the odds of obtaining a prostate exam increased with higher aging satisfaction (OR=1.20 95\% CI=1.09-1.34).

CONCLUSION: These results suggest that aging satisfaction potentially influences preventive health service use after age 50.

}, keywords = {Aged, Aged, 80 and over, Aging, Chronic disease, Female, Health Behavior, Health Knowledge, Attitudes, Practice, Humans, Influenza Vaccines, Logistic Models, Male, Mammography, Middle Aged, Patient Acceptance of Health Care, Patient Satisfaction, Personal Satisfaction, Preventive Health Services, Prostatic Neoplasms, Surveys and Questionnaires, United States, Vaginal Smears}, issn = {1096-0260}, doi = {10.1016/j.ypmed.2014.09.008}, author = {Eric S Kim and Kyle D Moored and Hannah L. Giasson and Jacqui Smith} } @article {7825, title = {Patterns of older Americans{\textquoteright} health care utilization over time.}, journal = {Am J Public Health}, volume = {103}, year = {2013}, month = {2013 Jul}, pages = {1314-24}, publisher = {103}, abstract = {

OBJECTIVES: We analyzed correlates of older Americans{\textquoteright} continuous and transitional health care utilization over 4 years.

METHODS: We analyzed data for civilian, noninstitutionalized US individuals older than 50 years from the 2006 and 2008 waves of the Health and Retirement Study. We estimated multinomial logistic models of persistent and intermittent use of physician, inpatient hospital, home health, and outpatient surgery over the 2004-2008 survey periods.

RESULTS: Individuals with worse or worsening health were more likely to persistently use medical care and transition into care and not transition out of care over time. Financial variables were less often significant and, when significant, were often in an unexpected direction.

CONCLUSIONS: Older individuals{\textquoteright} health and changes in health are more strongly correlated with persistence of and changes in care-seeking behavior over time than are financial status and changes in financial status. The more pronounced sensitivity to health status and changes in health are important considerations in insurance and retirement policy reforms.

}, keywords = {Aged, Aged, 80 and over, Ambulatory Surgical Procedures, Delivery of Health Care, Female, Health Services, Health Status, Health Surveys, Home Care Services, Hospitalization, Humans, Income, Insurance Coverage, Logistic Models, Longitudinal Studies, Male, Middle Aged, Office Visits, Patient Acceptance of Health Care, Time Factors, United States}, issn = {1541-0048}, doi = {10.2105/AJPH.2012.301124}, author = {Richard J. Manski and John F Moeller and Haiyan Chen and Jody Schimmel and Patricia A St Clair and John V Pepper} } @article {7497, title = {Impact of cognitive impairment on screening mammography use in older US women.}, journal = {Am J Public Health}, volume = {100}, year = {2010}, month = {2010 Oct}, pages = {1917-23}, publisher = {100}, abstract = {

OBJECTIVES: We evaluated mammography rates for cognitively impaired women in the context of their life expectancies, given that guidelines do not recommend screening mammography in women with limited life expectancies because harms outweigh benefits.

METHODS: We evaluated Medicare claims for women aged 70 years or older from the 2002 wave of the Health and Retirement Study to determine which women had screening mammography. We calculated population-based estimates of 2-year screening mammography prevalence and 4-year survival by cognitive status and age.

RESULTS: Women with severe cognitive impairment had lower rates of mammography (18\%) compared with women with normal cognition (45\%). Nationally, an estimated 120,000 screening mammograms were performed among women with severe cognitive impairment despite this group{\textquoteright}s median survival of 3.3 years (95\% confidence interval = 2.8, 3.7). Cognitively impaired women who had high net worth and were married had screening rates approaching 50\%.

CONCLUSIONS: Although severe cognitive impairment is associated with lower screening mammography rates, certain subgroups with cognitive impairment are often screened despite lack of probable benefit. Given the limited life expectancy of women with severe cognitive impairment, guidelines should explicitly recommend against screening these women.

}, keywords = {Aged, Aged, 80 and over, Cognition Disorders, Female, Humans, Incidence, Longitudinal Studies, Mammography, Medicare, Patient Acceptance of Health Care, Social Class, United States}, issn = {1541-0048}, doi = {10.2105/AJPH.2008.158485}, author = {Kala M. Mehta and Kathy Z Fung and Christine E Kistler and Chang, Anna and Louise C Walter} } @article {7466, title = {Untreated poor vision: a contributing factor to late-life dementia.}, journal = {Am J Epidemiol}, volume = {171}, year = {2010}, month = {2010 Mar 15}, pages = {728-35}, publisher = {171}, abstract = {

Ophthalmologic abnormalities have been described in patients with dementia, but the extent to which poor vision and treatment for visual disorders affect cognitive decline is not well defined. Linked data from the Health and Retirement Study and Medicare files (1992-2005) were used to follow the experiences of 625 elderly US study participants with normal cognition at baseline. The outcome was a diagnosis of dementia, cognitively impaired but no dementia, or normal cognition. Poor vision was associated with development of dementia (P = 0.0048); individuals with very good or excellent vision at baseline had a 63\% reduced risk of dementia (95\% confidence interval (CI): 20, 82) over a mean follow-up period of 8.5 years. Participants with poorer vision who did not visit an ophthalmologist had a 9.5-fold increased risk of Alzheimer disease (95\% CI: 2.3, 39.5) and a 5-fold increased risk of cognitively impaired but no dementia (95\% CI: 1.6, 15.9). Poorer vision without a previous eye procedure increased the risk of Alzheimer disease 5-fold (95\% CI: 1.5, 18.8). For Americans aged 90 years or older, 77.9\% who maintained normal cognition had received at least one previous eye procedure compared with 51.7\% of those with Alzheimer disease. Untreated poor vision is associated with cognitive decline, particularly Alzheimer disease.

}, keywords = {Aged, 80 and over, Cognition Disorders, Dementia, Female, Humans, Logistic Models, Male, Medicare, Ophthalmology, Patient Acceptance of Health Care, Risk Factors, United States, Vision Disorders}, issn = {1476-6256}, doi = {10.1093/aje/kwp453}, author = {Mary A M Rogers and Kenneth M. Langa} } @article {7365, title = {Patterns of food insecurity and participation in food assistance programmes over time in the elderly.}, journal = {Public Health Nutr}, volume = {12}, year = {2009}, month = {2009 Nov}, pages = {2113-9}, publisher = {12}, abstract = {

OBJECTIVE: The present study aimed to understand the relationship between need and help-seeking behaviour in older adults by examining the patterns of food insecurity and participation in food assistance programmes (FAP), i.e. the Food Stamp Program and home-delivered meals.

DESIGN: Data from two longitudinal studies were used. The studies were designed to obtain nationally representative information on health, insurance coverage, financial status, family support systems, labour market status and retirement planning, every two years: the Health and Retirement Study (HRS, 1996-2002) and Asset and Health Dynamics Among the Oldest Old (AHEAD, 1995-2002).

SETTING: USA.

SUBJECTS: There were 7623 participants for HRS and 3378 for AHEAD.

RESULTS: The older adults appeared to have persistent patterns between food insecurity and participation in FAP, especially in the Food Stamp Program. More persistently food-insecure older adults had higher participation in FAP (P < 0.001). Food-insecure older adults at one time were more likely to shift from non-participation to participation in FAP the next time than food-secure older adults (P < 0.001). Regardless of previous food insecurity status, previous participants in FAP were more likely to participate subsequently.

CONCLUSIONS: The relationship between need and help-seeking behaviour in older adults was found to follow a persistent positive pattern, determined by looking at the patterns of food insecurity and participation in FAP. Although food insecurity as a need is a good predictor of participation in FAP, it is not enough to fully predict participation in FAP. Help-seeking behaviour (i.e. previous programme participation) is also important in predicting participation in FAP.

}, keywords = {Aged, diet, Food Supply, Humans, Longitudinal Studies, Malnutrition, National Health Programs, Patient Acceptance of Health Care, Prevalence, Public Assistance, United States}, issn = {1475-2727}, doi = {10.1017/S1368980009005357}, author = {Kim, Kirang and Edward A Frongillo} } @article {7129, title = {Use of preventive care by the working poor in the United States.}, journal = {Prev Med}, volume = {44}, year = {2007}, month = {2007 Mar}, pages = {254-9}, publisher = {44}, abstract = {

OBJECTIVE: Examine the association between poverty and preventive care use among older working adults.

METHOD: Cross-sectional analysis of the pooled 1996, 1998 and 2000 waves of the Health and Retirement Study, a nationally representative sample of older community-dwelling adults, studying self-reported use of cervical, breast, and prostate cancer screening, as well as serum cholesterol screening and influenza vaccination. Adults with incomes within 200\% of the federal poverty level were defined as poor.

RESULTS: Among 10,088 older working adults, overall preventive care use ranged from 38\% (influenza vaccination) to 76\% (breast cancer screening). In unadjusted analyses, the working poor were significantly less likely to receive preventive care. After adjustment for insurance coverage, education, and other socio-demographic characteristics, the working poor remained significantly less likely to receive breast cancer (RR 0.92, 95\% CI, 0.86-0.96), prostate cancer (RR 0.89, 95\% CI, 0.81-0.97), and cholesterol screening (RR 0.91, 95\% CI, 0.86-0.96) than the working non-poor, but were not significantly less likely to receive cervical cancer screening (RR 0.96, 95\% CI, 0.90-1.01) or influenza vaccination (RR 0.92, 95\% CI, 0.84-1.01).

CONCLUSION: The older working poor are at modestly increased risk for not receiving preventive care.

}, keywords = {Cost of Illness, Cross-Sectional Studies, Employment, Female, Health Promotion, Health Services Accessibility, Health Services Needs and Demand, Humans, Male, Mass Screening, Middle Aged, Patient Acceptance of Health Care, Poverty, Preventive Health Services, Risk Assessment, Socioeconomic factors, United States, Vulnerable Populations}, issn = {0091-7435}, doi = {10.1016/j.ypmed.2006.11.006}, author = {Joseph S. Ross and Bernheim, Susannah M. and Elizabeth H Bradley and Teng, Hsun-Mei and William T Gallo} } @article {7089, title = {Insurance coverage and health care use among near-elderly women.}, journal = {Womens Health Issues}, volume = {16}, year = {2006}, note = {Official publication of the Jacobs Institute of Women{\textquoteright}s Health}, month = {2006 May-Jun}, pages = {139-48}, publisher = {16}, abstract = {

OBJECTIVES: Data on near-elderly (ages 55-64) women{\textquoteright}s access to and use of health care have been limited. In this study, we sought to examine the status of near-elderly women{\textquoteright}s health insurance coverage in the United States and how it may influence their use of health care services.

METHODS: A nationwide random sample of women aged 55-64 was drawn from the 2002 wave of the Health and Retirement Study. Descriptive statistics were calculated and multivariable regression analyses were performed to quantify the impact of insurance coverage on near-elderly women{\textquoteright}s use of outpatient services, inpatient services, and prescription medication over a 2-year period.

RESULTS: In 2002, 9.4\% of near-elderly women in the United States were uninsured and 15.4\% had public coverage. Those who had coverage for a particular service were significantly more likely to use that service compared to women without coverage, with odds ratios ranging from 2.0-6.7 for services such as a physician visit, hospital stay, dental visit, and use of prescription medication. Among those who had at least one physician visit, near-elderly women who had some of the cost covered by insurance reported significantly more visits than women without coverage. Likewise, for near-elderly women regularly taking prescription medications, having more extensive coverage significantly increased their likelihood of medication adherence. The frequency of hospitalization was also higher for women who had complete coverage for the cost.

CONCLUSIONS: The nature of a near-elderly woman{\textquoteright}s insurance coverage significantly affects her use of health care services. More attention is needed to improve the health care of near-elderly women with inadequate insurance coverage.

}, keywords = {Attitude to Health, Female, Health Services Accessibility, Health Services Needs and Demand, Health Status, Humans, Insurance Coverage, Insurance, Health, Medically Uninsured, Middle Aged, Patient Acceptance of Health Care, Socioeconomic factors, United States, Women{\textquoteright}s Health, Women{\textquoteright}s Health Services}, issn = {1049-3867}, doi = {10.1016/j.whi.2006.02.005}, author = {Xiao Xu and Patel, Divya A. and Vahratian, Anjel and Ransom, Scott B.} } @article {6922, title = {Quality of preventive clinical services among caregivers in the health and retirement study.}, journal = {J Gen Intern Med}, volume = {19}, year = {2004}, month = {2004 Aug}, pages = {875-8}, publisher = {19}, abstract = {

We examined the association between caregiving for a spouse and preventive clinical services (self-reported influenza vaccination, cholesterol screening, mammography, Pap smear, and prostate cancer screening over 2 years and monthly self-breast exam) for the caregiver in a cross-sectional analysis of the Health and Retirement Study, a nationally representative sample of U.S. adults aged > or = 50 years (N = 11,394). Spouses engaged in 0, 1-14, or > or = 14 hours per week of caregiving. Each service was examined in logistic regression models adjusting for caregiver characteristics. After adjustment for covariates, there were no significant associations between spousal caregiving and likelihood of caregiver receipt of preventive services.

}, keywords = {Aged, Caregivers, Cohort Studies, Cross-Sectional Studies, Female, Health Care Surveys, Humans, Male, Middle Aged, Patient Acceptance of Health Care, Preventive Health Services, Quality of Health Care, Time Factors, United States}, issn = {0884-8734}, doi = {10.1111/j.1525-1497.2004.30411.x}, author = {Kim, Catherine and Mohammed U Kabeto and Robert B Wallace and Kenneth M. Langa} } @article {6945, title = {Religion and preventative health care utilization among the elderly.}, journal = {Soc Sci Med}, volume = {58}, year = {2004}, month = {2004 Jan}, pages = {109-18}, publisher = {58}, abstract = {

Evidence supporting a relationship between religion and physical health has increased substantially in the recent past. One possible explanation for this relationship that has not received much attention in the literature is that health care utilization may differ by religious involvement or religious denomination. A nationally representative sample of older adults was used to estimate the effects of religious salience and denomination on six different types of preventative health care (i.e. flu shots, cholesterol screening, breast self-exams, mammograms, pap smears, and prostate screening). Findings show that both men and women who report high levels of religiosity are more likely to use preventative services. Denominational differences show that affiliated individuals, especially those who are Jewish, are significantly more likely to use each type of preventative care than non-affiliated individuals. The results of this study open the door to further exploration of this potentially important, but relatively neglected, link between religion and health.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Catholicism, Diagnostic Tests, Routine, Female, Health Services for the Aged, Health Status, Humans, Interviews as Topic, Jews, Logistic Models, Longitudinal Studies, Male, Patient Acceptance of Health Care, Preventive Health Services, Primary Health Care, Protestantism, Religion and Psychology, Socioeconomic factors, United States}, issn = {0277-9536}, doi = {10.1016/s0277-9536(03)00152-7}, author = {Benjamins, Maureen Reindl and Brown, Carolyn} } @article {6849, title = {Intermittent lack of health insurance coverage and use of preventive services.}, journal = {Am J Public Health}, volume = {93}, year = {2003}, month = {2003 Jan}, pages = {130-7}, publisher = {93}, abstract = {

OBJECTIVES: This study examined the association between intermittent lack of health insurance coverage and use of preventive health services.

METHODS: Analyses focused on longitudinal data on insurance status and preventive service use among a national sample of US adults who participated in the Health and Retirement Study.

RESULTS: Findings showed that, among individuals who obtain insurance coverage after histories of intermittent coverage, relatively long periods may be necessary to reestablish clinically appropriate care patterns. Increasing periods of noncoverage led to successively lower rates of use of most preventive services.

CONCLUSIONS: Intermittent lack of insurance coverage-even across a relatively long period-results in less use of preventive services. Studies that examine only current insurance status may underestimate the population at risk from being uninsured.

}, keywords = {Episode of Care, Female, Health Behavior, Health Status, Humans, Insurance Coverage, Logistic Models, Longitudinal Studies, Male, Medically Uninsured, Middle Aged, Outcome Assessment, Health Care, Patient Acceptance of Health Care, Preventive Health Services, Socioeconomic factors, United States}, issn = {0090-0036}, doi = {10.2105/ajph.93.1.130}, author = {Joseph J Sudano and David W. Baker} } @article {6876, title = {Screening mammography and Pap tests among older American women 1996-2000: results from the Health and Retirement Study (HRS) and Asset and Health Dynamics Among the Oldest Old (AHEAD).}, journal = {Ann Fam Med}, volume = {1}, year = {2003}, month = {2003 Nov-Dec}, pages = {209-17}, publisher = {1}, abstract = {

BACKGROUND: We wanted to determine the frequency of self-reported receipt of screening mammography and Papanicolaou (Pap) tests in older women and investigate important predictors of utilization, based on 2 national longitudinal surveys.

METHODS: This cohort study includes participants from 4 waves (1994-2000) of the Health and Retirement Study (HRS)--5,942 women aged 50 to 61 years, and 4 waves (1993-2000) of the Asset and Health Dynamics Among the Oldest Old (AHEAD) survey--4,543 women aged 70 years and older. The self-reported receipt of screening mammograms and Pap smears in the most recent 2 years were reported in 1996 and 2000 for HRS, with predictors of receipt measured in 1994 and 1998. In AHEAD, the self-reported receipt of screening mammograms and Pap smears in the most recent 2 years were reported in 1995 and 2000, with predictors of receipt measured in 1993 and 1998.

RESULTS: Receipt of mammography is stable at 70\% to 80\% among women aged 50 to 64 years, then declines to around 40\% among those aged 85 to 90 years. For Pap tests there is a decline from 75\% among women aged 50 to 54 years to 25\% in those aged 85 to 90 years. For both mammography and Pap tests, the rates increased in all groups from 1995/1996 to 2000. Higher education, being married, higher income, not smoking, and vigorous exercise were consistently associated with higher rates of receipt.

CONCLUSIONS: Although the use of mammography and Pap tests for screening declines into old age, use has been increasing recently. The large and increasing number of tests performed might not be justified given the lack of evidence of effect in older age-groups.

}, keywords = {Age Factors, Aged, Aged, 80 and over, Breast Neoplasms, Cost-Benefit Analysis, Female, Health Services for the Aged, Humans, Longitudinal Studies, Mammography, Middle Aged, Multivariate Analysis, Papanicolaou Test, Patient Acceptance of Health Care, Risk, United States, Uterine Cervical Neoplasms, Vaginal Smears}, issn = {1544-1709}, doi = {10.1370/afm.54}, author = {Truls Ostbye and Gary N. Greenberg and Donald H. Taylor Jr. and Lee, Ann Marie M.} } @article {6855, title = {Sickness and preventive medical behavior.}, journal = {J Health Econ}, volume = {22}, year = {2003}, month = {2003 Jul}, pages = {675-89}, publisher = {22}, abstract = {

Using data from two sources, the Health and Retirement Study (HRS) and the Medical Expenditure Panel Survey (MEPS), I analyze the relationship between health status and the likelihood of engaging in medical screening and other preventive behavior. The results show that individuals who are in poorer health are more likely to get flu shots and cholesterol checks, but less likely to have mammograms, pap smears, breast examinations and prostate checks. There is some evidence that suggests that psychological factors such as fear and anxiety may be important reasons why sicker people are less likely to get cancer screens.

}, keywords = {Aged, Anxiety, Breast Self-Examination, Cholesterol, Female, Health Behavior, Health Expenditures, Health Status, Humans, Influenza Vaccines, Male, Mammography, Mass Screening, Middle Aged, Papanicolaou Test, Patient Acceptance of Health Care, Preventive Health Services, Primary Prevention, Prostatic Neoplasms, Retirement, Risk Factors, Vaginal Smears}, issn = {0167-6296}, doi = {10.1016/S0167-6296(03)00042-0}, author = {Stephen Wu} } @article {6588, title = {Medical insurance and the use of health care services by the elderly.}, journal = {J Health Econ}, volume = {16}, year = {1997}, month = {1997 Apr}, pages = {129-54}, publisher = {16}, abstract = {

The objective of this paper is to find how health insurance influences the use of health care services by the elderly. On the basis of the first wave of the Asset and Health Dynamics Survey, we find that those who are the most heavily insured use the most health care services. Because our data show little relationship between observable health measures and either the propensity to hold or to purchase private insurance, we interpret this as an effect of the incentives embodied in the insurance, rather than as the result of adverse selection in the purchase of insurance.

}, keywords = {Activities of Daily Living, Aged, Health Care Surveys, Health Services for the Aged, Health Status Indicators, Hospitalization, Humans, Insurance, Health, Medicare, Office Visits, Patient Acceptance of Health Care, Private Sector, Probability, United States}, issn = {0167-6296}, doi = {10.1016/s0167-6296(96)00515-2}, url = {https://www.ncbi.nlm.nih.gov/pubmed/10169091}, author = {Michael D Hurd and Kathleen McGarry} }