@article {12934, title = {Telehealth uptake among middle-aged and older Americans during COVID-19: chronic conditions, social media communication, and race/ethnicity.}, journal = {Aging \& Mental Health}, year = {Forthcoming}, abstract = {

OBJECTIVES: This study investigated whether and to what extent constructs of the protection motivation theory of health (PMT)-threat appraisal (perceived vulnerability/severity) and coping appraisal (response efficacy and self-efficacy)-are related to telehealth engagement during the COVID-19 pandemic, and how these associations differ by race/ethnicity among middle-aged and older Americans.

METHODS: Data were from the 2020 Health and Retirement Study. Multivariable ordinary least-squares regression analyses were computed adjusting for health and sociodemographic factors.

RESULTS: Some PMT constructs are useful in understanding telehealth uptake. Perceived vulnerability/severity, particularly comorbidity ( = 0.13, 95\% confidence interval (CI) [0.11, 0.15], < 0.001), and response efficacy, particularly participation in communication via social media ( = 0.24, 95\% CI [0.21, 0.27], < 0.001), were significantly and positively associated with higher telehealth uptake during the COVID-19 pandemic among middle-aged and older Americans. Non-Hispanic Black adults were more likely to engage in telehealth during the pandemic than their non-Hispanic White counterparts ( = 0.20, 95\% CI [0.12, 0.28], < 0.001). Multiple moderation analyses revealed the significant association between comorbidity and telehealth uptake was similar across racial/ethnic groups, whereas the significant association between social media communication and telehealth uptake varied by race/ethnicity. Specifically, the association was significantly less pronounced for Hispanic adults ( = -0.11, 95\% CI [-0.19, -0.04], < 0.01) and non-Hispanic Asian/other races adults ( = -0.13, 95\% CI [-0.26, -0.01], < 0.05) than it was for their non-Hispanic White counterparts.

CONCLUSION: Results suggest the potential of using social media and telehealth to narrow health disparities, particularly serving as a bridge for members of underserved communities to telehealth uptake.

}, keywords = {Comorbidity, COVID-19, midlife, Race/ethnicity, social media communication, telehealth}, issn = {1364-6915}, doi = {10.1080/13607863.2022.2149696}, author = {Choi, Shinae L and Hites, Lisle and Bolland, Anneliese C and Lee, Jiyoung and Payne-Foster, Pamela and Bissell, Kimberly} } @article {13623, title = {The Construction of a Multidomain Risk Model of Alzheimer{\textquoteright}s Disease and Related Dementias.}, journal = {Journal of Alzheimer{\textquoteright}s Disease : JAD}, volume = {96}, year = {2023}, pages = {535-550}, abstract = {

BACKGROUND: Alzheimer{\textquoteright}s disease (AD) and related dementia (ADRD) risk is affected by multiple dependent risk factors; however, there is no consensus about their relative impact in the development of these disorders.

OBJECTIVE: To rank the effects of potentially dependent risk factors and identify an optimal parsimonious set of measures for predicting AD/ADRD risk from a larger pool of potentially correlated predictors.

METHODS: We used diagnosis record, survey, and genetic data from the Health and Retirement Study to assess the relative predictive strength of AD/ADRD risk factors spanning several domains: comorbidities, demographics/socioeconomics, health-related behavior, genetics, and environmental exposure. A modified stepwise-AIC-best-subset blanket algorithm was then used to select an optimal set of predictors.

RESULTS: The final predictive model was reduced to 10 features for AD and 19 for ADRD; concordance statistics were about 0.85 for one-year and 0.70 for ten-year follow-up. Depression, arterial hypertension, traumatic brain injury, cerebrovascular diseases, and the APOE4 proxy SNP rs769449 had the strongest individual associations with AD/ADRD risk. AD/ADRD risk-related co-morbidities provide predictive power on par with key genetic vulnerabilities.

CONCLUSION: Results confirm the consensus that circulatory diseases are the main comorbidities associated with AD/ADRD risk and show that clinical diagnosis records outperform comparable self-reported measures in predicting AD/ADRD risk. Model construction algorithms combined with modern data allows researchers to conserve power (especially in the study of disparities where disadvantaged groups are often grossly underrepresented) while accounting for a high proportion of AD/ADRD-risk-related population heterogeneity stemming from multiple domains.

}, keywords = {Alzheimer disease, Comorbidity, Dementia, Humans, Hypertension, Medicare, United States}, issn = {1875-8908}, doi = {10.3233/JAD-221292}, author = {Akushevich, Igor and Yashkin, Arseniy and Ukraintseva, Svetlana and Yashin, Anatoliy I and Kravchenko, Julia} } @article {11791, title = {Associations of mental health and chronic physical illness during childhood with major depression in later life.}, journal = {Aging \& Mental Health}, volume = {26}, year = {2022}, pages = {1813-1820}, abstract = {

OBJECTIVES: This study examined whether childhood chronic physical illness burden was associated with major depression in later life (>50 years) and whether this relationship was mediated by childhood mental health status.

METHOD: Data came from the 2016 United States Health and Retirement Study ( = 18,483). Logistic regression tested associations of childhood chronic physical illness burden with childhood mental health status and major depression in later life. Path analysis quantified mediation of the association between chronic physical illness burden and major depression by childhood mental health status.

RESULTS: One standard deviation increase in childhood chronic physical illness burden was associated with 1.34 (95\% = 1.25, 1.43) times higher odds of major depression in later life. Childhood mental health status explained 53.4\% (95\% : 37.3\%, 69.6\%) of this association. In follow-up analyses of categorical diagnoses, having difficulty seeing, ear problems or infections, a respiratory disorder, asthma, an allergic condition, epilepsy or seizures, migraines or severe headaches, heart trouble, stomach problems, or a disability lasting >=6 months was associated with major depression in later life with mediation by childhood mental health status.

CONCLUSION: Findings of this study indicate that children with a higher chronic physical illness burden are more likely to have major depression in later life and poor mental health during childhood mediates this relationship. Further research is needed to determine whether increased screening and treatment of psychiatric symptoms in pediatrics can decrease the burden of major depression across the life course.

}, keywords = {Chronic disease, Comorbidity, life history, major depressive disorder}, issn = {1364-6915}, doi = {10.1080/13607863.2021.1958143}, author = {Rachel S. Bergmans and Jacqui Smith} } @article {11941, title = {Impact of Comorbid Dementia on Patterns of Hospice Use.}, journal = {Journal of Palliative Medicine}, volume = {25}, year = {2022}, pages = {396-404}, abstract = {

The evidence base for understanding hospice use among persons with dementia is almost exclusively based on individuals with a primary terminal diagnosis of dementia. Little is known about whether comorbid dementia influences hospice use patterns. To estimate the prevalence of comorbid dementia among hospice enrollees and its association with hospice use patterns. Pooled cross-sectional analysis of the nationally representative Health and Retirement Study (HRS) linked to Medicare claims. Fee-for-service Medicare beneficiaries in the United States who enrolled with hospice and died between 2004 and 2016. Dementia was assessed using a validated survey-based algorithm. Hospice use patterns were enrollment less than or equal to three days, enrollment greater than six months, hospice disenrollment, and hospice disenrollment after six months. Of 3123 decedents, 465 (14.9\%) had a primary hospice diagnosis of dementia and 943 (30.2\%) had comorbid dementia and died of another illness. In fully adjusted models, comorbid dementia was associated with increased odds of hospice enrollment greater than six months (adjusted odds ratio [AOR] = 1.52, 95\% confidence interval [CI]: 1.11-2.09) and hospice disenrollment following six months of hospice (AOR = 2.55, 95\% CI: 1.43-4.553). Having a primary diagnosis of dementia was associated with increased odds of hospice enrollment greater than six months (AOR = 2.62, 95\% CI: 1.86-3.68), hospice disenrollment (AOR = 1.82, 95\% CI: 1.32-2.51), and hospice disenrollment following six months of hospice (AOR = 4.31, 95\% CI: 2.37-7.82). Approximately 45\% of the hospice population has primary or comorbid dementia and are at increased risk for long hospice enrollment periods and hospice disenrollment. Consideration of the high prevalence of comorbid dementia should be inherent in hospice staff training, quality metrics, and Medicare Hospice Benefit policies.

}, keywords = {Comorbidity, Dementia, end of life, Health Services Research, Hospice}, issn = {1557-7740}, doi = {10.1089/jpm.2021.0055}, author = {Aldridge, Melissa D and Hunt, Lauren and Husain, Mohammed and Li, Lihua and Amy Kelley} } @article {11887, title = {Long-Term Evolution of Functional Limitations in Stroke Survivors Compared With Stroke-Free Controls: Findings From 15 Years of Follow-Up Across 3 International Surveys of Aging.}, journal = {Stroke}, volume = {53}, year = {2022}, pages = {228-237}, abstract = {

BACKGROUND AND PURPOSE: In the chronic phase 2 to 5 years poststroke, limitations in activities of daily living (ADL) and instrumental ADL (IADL) initially plateau before steady increasing. However, the impact of age and differences in initial levels of disability on the evolution of these limitations remains unclear. As such, this study aims to evaluate differences in long-term evolution of ADL/IADL limitations between stroke survivors and stroke-free population, and how limitations differ by initial level of disability for stroke survivors.

METHODS: Thirty-three thousand six hundred sixty participants (5610 first-ever stroke cases with no recurrence during follow-up and 28 050 stroke-free controls) aged >=50 from the Health and Retirement Study, Survey of Health, Ageing and Retirement in Europe, and English Longitudinal Study of Ageing were assessed for number of ADL/IADL limitations during the poststroke chronic phase (for cases) and over follow-up years 1996 to 2018 (for controls). Three thousand seven hundred eighteen stroke cases were additionally categorized by disability level using the modified Rankin Scale score of 1 to 2 years poststroke. Evolution of ADL/IADL limitations was assessed in stroke cases and controls and by modified Rankin Scale score (0-1, 2-3, 4-5) using linear mixed models. Models were stratified by age group (50-74 and >=75 years) and adjusted for baseline characteristics, health behaviors, BMI, and comorbidities.

RESULTS: Findings showed relative stability of ADL/IADL limitations during 3 to 6 years poststroke followed by an increase for both populations, which was faster for younger stroke cases, suggesting a differential age-effect (<0.001). Disability level at 1 to 2 years poststroke influenced the evolution of limitations over time, especially for severe disability (modified Rankin Scale score, 4-5) associated with a reduction in limitations at 5 to 6 years poststroke.

CONCLUSIONS: Our findings showed that during the poststroke chronic phase functional limitations first plateau and then increase and the evolution differs by disability severity. These results highlight the importance of adaptive long-term health and social care measures for stroke survivors.

}, keywords = {Body Mass Index, Comorbidity, Health Behavior, Prognosis, Survivors}, issn = {1524-4628}, doi = {10.1161/STROKEAHA.121.034534}, author = {Gil-Salcedo, Andres and Aline Dugravot and Fayosse, Aurore and Jacob, Louis and Mikaela Bloomberg and S{\'e}verine Sabia and Schnitzler, Alexis} } @article {12458, title = {Sleep Disorders as a Potential Risk Factor for Dementia in Elderly Adults}, journal = {Sleep}, volume = {45}, year = {2022}, pages = {A123}, abstract = {Introduction Sleep disorders such as insomnia are seen in the early onset of Alzheimer{\textquoteright}s disease, the most common form of dementia. Simultaneously, sleep disorders may indicate increased risk for the development of dementia. Due to the rate of comorbidity of these two conditions seen in the elderly population, the relationship between dementia and sleep disorders is a topic of interest for researchers. A bidirectional correlation between the two could have important implications in the clinical field exploring factors that lead to dementia Methods Data was assessed from 17,146 older adults from the 2018 Health and Retirement Survey. Participants were surveyed using questionnaires regarding both incident dementia or serious memory impairment in the past 2 years and the presence of a sleep disorder, as diagnosed by a doctor or health professional. Those who reported no dementia in the previous wave (N=16,547) were asked if they had been diagnosed since they were last asked. N=185 individuals reported incident dementia in the 2-years between assessments. Responses were coded to either {\textquotedblleft}Yes{\textquotedblright} or {\textquotedblleft}No{\textquotedblright}. A Poisson regression analysis was conducted to explore the relationship between incident dementia and sleep disorders. Results In a sample of older adults, unadjusted results indicate that having a sleep disorder was associated with a 0.6\% increased risk of new onset dementia (PRR=1.006; 95\%CI[1.001,1.012]; p=0.026). These results were sustained when adjusted for sex, age, race, ethnicity, and depression (PRR=1.006; 95\%CI[1.001,1.012]; p=0.013). Conclusion Chronic sleep disturbances may be a factor used to indicate increased risk for dementia and help with early detection of the disease. These results demonstrate the value of sleep disorders screening among those at risk for dementia. Further research is needed to clarify these findings (e.g., explore specific sleep disorders) and expand the follow-up window (i.e., beyond 2 years).}, keywords = {Alzheimer disease, Comorbidity, Dementia, depressive disorders, Early Diagnosis, ethnic group, Health Personnel, insomnia, memory impairment, sleep disorders}, doi = {10.1093/sleep/zsac079.271}, author = {Kuhler, Cassandra and Wills, Chloe and Tubbs, Andrew and Seixas, Azizi and Turner, Arlener and Jean-Louis, Girardin and Killgore, William and Grandner, Michael} } @article {12938, title = {State-level metabolic comorbidity prevalence and control among adults age 50-plus with diabetes: estimates from electronic health records and survey data in five states.}, journal = {Population Health Metrics}, volume = {20}, year = {2022}, pages = {22}, abstract = {

BACKGROUND: Although treatment and control of diabetes can prevent complications and reduce morbidity, few data sources exist at the state level for surveillance of diabetes comorbidities and control. Surveys and electronic health records (EHRs) offer different strengths and weaknesses for surveillance of diabetes and major metabolic comorbidities. Data from self-report surveys suffer from cognitive and recall biases, and generally cannot be used for surveillance of undiagnosed cases. EHR data are becoming more readily available, but pose particular challenges for population estimation since patients are not randomly selected, not everyone has the relevant biomarker measurements, and those included tend to cluster geographically.

METHODS: We analyzed data from the National Health and Nutritional Examination Survey, the Health and Retirement Study, and EHR data from the DARTNet Institute to create state-level adjusted estimates of the prevalence and control of diabetes, and the prevalence and control of hypertension and high cholesterol in the diabetes population, age 50 and over for five states: Alabama, California, Florida, Louisiana, and Massachusetts.

RESULTS: The estimates from the two surveys generally aligned well. The EHR data were consistent with the surveys for many measures, but yielded consistently lower estimates of undiagnosed diabetes prevalence, and identified somewhat fewer comorbidities in most states.

CONCLUSIONS: Despite these limitations, EHRs may be a promising source for diabetes surveillance and assessment of control as the datasets are large and created during the routine delivery of health care.

TRIAL REGISTRATION: Not applicable.

}, keywords = {Comorbidity, Diabetes Mellitus, Electronic Health Records, Prevalence, Self Report}, issn = {1478-7954}, doi = {10.1186/s12963-022-00298-z}, author = {Mardon, Russell and Campione, Joanne and Nooney, Jennifer and Merrill, Lori and Johnson, Maurice and Marker, David and Jenkins, Frank and Saydah, Sharon and Rolka, Deborah and Zhang, Xuanping and Shrestha, Sundar and Gregg, Edward} } @article {12246, title = {Trends in the Use of Residential Settings Among Older Adults.}, journal = {The Journals of Gerontology: Series B}, volume = {77}, year = {2022}, pages = {424-428}, abstract = {

OBJECTIVES: As the U.S. population ages, the prevalence of disability and functional limitations, and demand for long-term services and supports (LTSS), will increase. This study identified the distribution of older adults across different residential settings, and how their health characteristics have changed over time.

METHODS: A cross-sectional analysis of older adults residing in traditional housing, community-based residential facilities (CBRFs), and nursing facilities using 3 data sources: the Medicare Current Beneficiary Survey (MCBS), 2008 and 2013; the Health and Retirement Study (HRS), 2008 and 2014; and the National Health and Aging Trends Study, 2011 and 2015. We calculated the age-standardized prevalence of older adults by setting, functional limitations, and comorbidities and tested for health characteristics changes relative to the baseline year (2002).

RESULTS: The proportion of older adults in traditional housing increased over time, relative to baseline (p < .05), while the proportion of older adults in CBRFs was unchanged. The proportion of nursing facility residents declined from 2002 to 2013 in the MCBS (p < .05). The prevalence of dementia and functional limitations among traditional housing residents increased, relative to the baseline year in the HRS and MCBS (p < .05).

DISCUSSION: The proportion of older adults residing in traditional housing is increasing, while the nursing facility population is decreasing. This change may not be due to better health; rather, older adults may be relying on noninstitutional LTSS.

}, keywords = {Activities of Daily Living, Aged, Comorbidity, Cross-Sectional Studies, Dementia, Female, Health Status Disparities, Health Transition, Homes for the Aged, Humans, Independent Living, Male, Medicare, Nursing homes, United States}, issn = {1758-5368}, doi = {10.1093/geronb/gbab092}, author = {Toth, Matt and Palmer, Lauren and Lawren E. Bercaw and Voltmer, Helena and Sarita Karon} } @article {9914, title = {The association between the number of chronic health conditions and advance care planning varies by race/ethnicity.}, journal = {Aging \& Mental Health}, volume = {24}, year = {2020}, pages = {453-463}, type = {Journal}, abstract = {

OBJECTIVES: Although a national consensus exists on the need to increase the rates of advance care planning (ACP) for all adults, racial/ethnic differences in ACP have been consistently observed. This study investigated the intersection of racial/ethnic differences and the number of chronic health conditions on ACP among middle-aged and older adults in the United States.

METHOD: Responses from 8,926 adults from the 2014 wave of the Health and Retirement Study were entered into multilevel hierarchical logistic regression analyses with generalized linear mixed models to predict ACP focused on assigning a durable power of attorney for healthcare (DPOAHC) and having a written living will after adjusting for covariates.

RESULTS: We found a significant positive relationship between the number of chronic health conditions and ACP. Non-Hispanic Blacks/African Americans and Hispanics were less likely to engage in ACP than non-Hispanic Whites/Caucasians. Racial/ethnic disparities were even starker for completing a living will. The number of chronic health conditions had a greater effect for Hispanics than non-Hispanic Whites/Caucasians on ACP through assigning a DPOAHC and having a living will. The initial disparity in ACP among Hispanics with no chronic health conditions decreased as the number of chronic health conditions increased.

CONCLUSION: Our findings suggest that more chronic health conditions increase the likelihood that Hispanics will complete ACP documents. These ACP differences should be highlighted to researchers, policymakers, and healthcare professionals to reduce stark racial/ethnic disparities in ACP. A comprehensive and culturally caring decision-making approach should be considered when individuals and families engage in ACP.

}, keywords = {Advance care planning, Comorbidity, Racial/ethnic differences}, issn = {1364-6915}, doi = {10.1080/13607863.2018.1533521}, url = {https://www.tandfonline.com/doi/abs/10.1080/13607863.2018.1533521?journalCode=camh20}, author = {Shinae L Choi and Ian M McDonough and Kim, Minjung and Kim, Giyeon} } @article {10155, title = {Multimorbidity and cognitive decline over 14 years in older Americans.}, journal = {Journals of Gerontology. Series A, Biological Sciences \& Medical Sciences}, year = {2020}, abstract = {

BACKGROUND: Multimorbidity is associated with greater disability and accelerated declines in physical functioning over time in older adults. However, less is known about its effect on cognitive decline.

METHODS: Participants without dementia from the Health and Retirement Study were interviewed about physician-diagnosed conditions, from which their multimorbidity-weighted index (MWI) that weights diseases to physical functioning was computed. We used linear mixed-effects models to examine the predictor MWI with the modified Telephone Interview for Cognitive Status (TICSm, global cognition), 10-word immediate recall and delayed recall, and serial 7s outcomes biennially after adjusting for baseline cognition and covariates.

RESULTS: 14,265 participants, 60\% female, contributed 73,700 observations. Participants had a meanSD age 679.3 years and MWI 4.43.9 at baseline. Each point increase in MWI was associated with declines in global cognition (0.04, 95\%CI: 0.03-0.04 TICSm), immediate recall (0.01, 95\%CI: 0.01-0.02 words), delayed recall (0.01, 95\%CI: 0.01-0.02 words), and working memory (0.01, 95\%CI: 0.01-0.02 serial 7s) (all P<0.001). Multimorbidity was associated with faster declines in global cognition (0.003 points/year faster, 95\%CI: 0.002-0.004), immediate recall (0.001 words/year faster, 95\%CI: 0.001-0.002), and working memory (0.006 incorrect serial 7s/year faster, 95\%CI: 0.004-0.009) (all P<0.001), but not delayed recall compared with premorbid slopes.

CONCLUSIONS: Multimorbidity using a validated index weighted to physical functioning was associated with acute decline in cognition and accelerated and persistent cognitive decline over 14 years. This study supports an ongoing geriatric syndrome of coexisting physical and cognitive impairment in adults with multimorbidity. Clinicians should monitor and address both domains in older multimorbid adults.

}, keywords = {Cognitive Ability, Comorbidity, Longitudinal data}, issn = {1758-535X}, doi = {10.1093/gerona/glz147}, author = {Melissa Y Wei and Deborah A Levine and Laura B Zahodne and Mohammed U Kabeto and Kenneth M. Langa} } @article {doi:10.1111/jgs.16310, title = {Multimorbidity in Medicare Beneficiaries: Performance of an ICD-Coded Multimorbidity-Weighted Index}, journal = {Journal of the American Geriatrics Society}, volume = {n/a}, year = {2020}, abstract = {OBJECTIVES Most older adults have multimorbidity that impairs physical functioning, but it is difficult to quantify using claims data. We previously developed and validated a multimorbidity-weighted index (MWI) that embeds physical functioning through disease weightings. We mapped these conditions to International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes and compared them with existing indices. DESIGN Population-based prospective cohort. SETTING Respondents to the 2006-2016 waves of the Health and Retirement Study (HRS) with linked Medicare claims data and continuous enrollment in 2006. PARTICIPANTS Community-dwelling Medicare-eligible HRS participants (N = 9923; mean age = 75.5 {\textpm} 8.5 y). MEASUREMENTS Individuals were followed for future physical functioning (2006-2014) and mortality (2007-2016). MWI conditions were mapped to ICD-9-CM codes to produce an ICD-coded MWI (MWI-ICD). We compared MWI-ICD, simple disease count, Charlson, Elixhauser, and the health-related quality of life comorbidity index (HRQOL-CI) through distributions, hazard ratios for mortality, and relationships with future physical functioning. RESULTS MWI-ICD exhibited the broadest distribution and most unique values (5891). Left censoring was most pronounced for Charlson (34.3\% score = 0) and Elixhauser (13.1\% score = 0) vs MWI (5.0\% score = 0). Hazard ratios and concordance (C)-statistics for mortality across extreme quartiles were similar for MWI-ICD, Elixhauser, and Charlson but lower for disease count and the HRQOL-CI. For physical functioning, MWI-ICD yielded the greatest contrast across extreme quartiles and overall coefficient of determination (R2). CONCLUSION MWI-ICD was significantly associated with mortality and future physical functioning and comparable with established metrics for mortality prediction although not weighted to mortality. MWI-ICD successfully captures diseases accumulation and functioning in claims data.}, keywords = {administrative claims data, Comorbidity, Medicare, multimorbidity, physical functioning}, doi = {10.1111/jgs.16310}, url = {https://onlinelibrary.wiley.com/doi/abs/10.1111/jgs.16310}, author = {Melissa Y Wei and Ratz, David and Kenneth J Mukamal} } @article {10052, title = {The burden of health conditions for middle-aged and older adults in the United States: Disability-adjusted life years.}, journal = {BMC Geriatrics}, volume = {19}, year = {2019}, pages = {100}, abstract = {

BACKGROUND: Many adults are living longer with health conditions in the United States. Understanding the disability-adjusted life years (DALYs) for such health conditions may help to inform healthcare providers and their patients, guide health interventions, reduce healthcare costs, improve quality of life, and increase longevity for aging Americans. The purpose of this study was to determine the burden of 10 health conditions for a nationally-representative sample of adults aged 50 years and older in the United States.

METHODS: Data from the 1998-2014 waves of the Health and Retirement Study were analyzed. At each wave, participants indicated if they were diagnosed with the following 10 conditions: cancer, chronic obstructive pulmonary disease~(COPD), congestive heart failure, diabetes, back pain, hypertension, a fractured hip, myocardial infarction, rheumatism or arthritis, and a stroke. Years lived with a disability and years of life lost to premature mortality were summed for calculating DALYs. Sample weights were utilized in the analyses to make the DALY estimates nationally-representative. Results for the DALYs were presented in thousands.

RESULTS: There were 30,101 participants included. Sex stratified DALY estimates ranged from 4092 (fractured hip)-to-178,055 (hypertension) for men and 13,621 (fractured hip)-to-200,794 (hypertension) for women. The weighted overall DALYs were: 17,660 for hip fractures, 62,630 for congestive heart failure, 64,710 for myocardial infarction, 90,337 for COPD, 93,996 for stroke, 142,012 for cancer, 117,534 for diabetes, 186,586 for back pain, 333,420 for arthritis, and 378,849 for hypertension. In total, there were an estimated 1,487,734 years of healthy life lost from the 10 health conditions examined~over the study period.

CONCLUSIONS: The burden of these health conditions accounted for over a million years of healthy life lost for middle-aged and older Americans over the 16 year study period. Our results should be used to inform healthcare providers and guide health interventions aiming to improve the health of middle-aged and older adults. Moreover, shifting health policy and resources to match DALY trends may help to improve quality of life during aging and longevity.

}, keywords = {Comorbidity, Disabilities, Longevity}, issn = {1471-2318}, doi = {10.1186/s12877-019-1110-6}, author = {Ryan P McGrath and Soham Al Snih and Kyriakos S Markides and Orman T Hall and Mark D Peterson} } @article {10092, title = {Complex multimorbidity and breast cancer screening among midlife and older women: The role of perceived need}, journal = {The Gerontologist}, volume = {59}, year = {2019}, pages = {S77 - S87}, abstract = {Background and Objectives There is minimal survival benefit to cancer screening for those with poor clinical presentation (complex multimorbidity) or at advanced ages. The current screening mammography guidelines consider these objective indicators. There has been less attention, however, to women{\textquoteright}s subjective assessment of screening need. This study examines the interplay between complex multimorbidity, age, and subjective assessments of health and longevity for screening mammography receipt. Research Design and Method This cross-sectional study uses self-reported data from 8,938 women over the age of 52 in the 2012 Health and Retirement Study. Logistic regression models estimated the association between women{\textquoteright}s complex multimorbidity (co-occurrence of chronic conditions, functional limitations, and/or geriatric syndromes), subjective health and longevity assessments, age, and screening mammography in the 2 years before the interview. These associations were evaluated adjusting for sociodemographic and behavioral factors. Results Both age and complex multimorbidity were negatively associated with screening mammography. However, women{\textquoteright}s perceived need for screening moderated these effects. Most significantly, women optimistic about their chances of living another 10{\textendash}15 years were more likely to have had screening mammography regardless of their health conditions or advanced age. Discussion and Implications Women with more favorable self-assessed health and perceived life expectancy were more likely to receive screening mammography even if they have poor clinical presentation or advanced age. This is contrary to current cancer screening guidelines and suggests an opportunity to engage women{\textquoteright}s subjective health and longevity assessments for cancer screening decision making in both for screening policy and in individual clinician recommendations.}, keywords = {Cancer screenings, Comorbidity, Decision making, Women and Minorities}, issn = {0016-9013}, doi = {10.1093/geront/gny180}, url = {https://academic.oup.com/gerontologist/article/59/Supplement_1/S77/5491135http://academic.oup.com/gerontologist/article-pdf/59/Supplement_1/S77/28667857/gny180.pdf}, author = {David F Warner and Siran M Koroukian and Nicholas K Schiltz and Kathleen A Smyth and Cooper, Gregory S and Owusu, Cynthia and Kurt C Stange and Nathan A. Berger} } @article {10070, title = {Diabetes-multimorbidity combinations and disability among middle-aged and older adults.}, journal = {Journal of General Internal Medicine}, year = {2019}, month = {2019 Feb 27}, abstract = {

BACKGROUND: Older adults with diabetes rarely have only one chronic disease. As a result, there is a need to re-conceptualize research and clinical practice to address the growing number of older Americans with diabetes and concurrent chronic diseases (diabetes-multimorbidity).

OBJECTIVE: To identify prevalent multimorbidity combinations and examine their association with poor functional status among a nationally representative sample of middle-aged and older adults with diabetes.

DESIGN: A prospective cohort study of the 2012-2014 Health and Retirement Study (HRS) data. We identified the most prevalent diabetes-multimorbidity combinations and estimated negative binomial models of diabetes-multimorbidity on prospective disability.

PARTICIPANTS: Analytic sample included 3841 HRS participants with diabetes, aged 51~years and older.

MAIN MEASURES: The main outcome measure was the combined activities of daily living (ADL)-instrumental activities of daily living (IADL) index (range 0-11; higher index denotes higher disability). The main independent variables were diabetes-multimorbidity combination groups, defined as the co-occurrence of diabetes and at least one of six somatic chronic diseases (hypertension, cardiovascular disease, lung disease, cancer, arthritis, and stroke) and/or two mental chronic conditions (cognitive impairment and high depressive symptoms (CESD score >= 4).

KEY RESULTS: The three most prevalent multimorbidity combinations were, in rank-order diabetes-arthritis-hypertension (n = 694, 18.1\%); diabetes-hypertension (n = 481, 12.5\%); and diabetes-arthritis-hypertension-heart disease (n = 383, 10\%). Diabetes-multimorbidity combinations that included high depressive symptoms or stroke had significantly higher counts of ADL-IADL limitations compared with diabetes-only. In head-to-head comparisons of diabetes-multimorbidity combinations, high depressive symptoms or stroke added to somatic multimorbidity combinations was associated with a higher count of ADL-IADL limitations (diabetes-arthritis-hypertension-high depressive symptoms vs. diabetes-arthritis-hypertension: IRR = 1.95 [1.13, 3.38]; diabetes-arthritis-hypertension-stroke vs. diabetes-arthritis-hypertension: IRR = 2.09 [1.15, 3.82]) even after adjusting for age, gender, education, race/ethnicity, BMI, baseline ADL-IADL, and diabetes duration. Coefficients were robust to further adjustment for diabetes treatment.

CONCLUSIONS: Depressive symptoms or stroke added onto other multimorbidity combinations may pose a substantial functional burden for middle-aged and older adults with diabetes.

}, keywords = {Chronic disease, Comorbidity, Diabetes, Disabilities}, issn = {1525-1497}, doi = {10.1007/s11606-019-04896-w}, author = {Ana R Qui{\~n}ones and Markwardt, Sheila and Anda Botoseneanu} } @article {9518, title = {The Influence of Multimorbidity on Leading Causes of Death in Older Adults With Cognitive Impairment.}, journal = {Journal of Aging \& Health}, volume = {31}, year = {2019}, abstract = {

OBJECTIVE: The aim of this study is to evaluate the relationship of leading causes of death with gradients of cognitive impairment and multimorbidity.

METHOD: This is a population-based study using data from the linked 1992-2010 Health and Retirement Study and National Death Index ( n = 9,691). Multimorbidity is defined as a combination of chronic conditions, functional limitations, and geriatric syndromes. Regression trees and Random Forest identified which combinations of multimorbidity associated with causes of death.

RESULTS: Multimorbidity is common in the study population. Heart disease is the leading cause in all groups, but with a larger percentage of deaths in the mild and moderate/severe cognitively impaired groups than among the noncognitively impaired. The different "paths" down the regression trees show that the distribution of causes of death changes with different combinations of multimorbidity.

DISCUSSION: Understanding the considerable heterogeneity in chronic conditions, functional limitations, geriatric syndromes, and causes of death among people with cognitive impairment can target care management and resource allocation.

}, keywords = {Cognitive Ability, Comorbidity, Mortality, NDI}, issn = {1552-6887}, doi = {10.1177/0898264317751946}, author = {Nicholas K Schiltz and David F Warner and Kathleen A Smyth and Gravenstein, Stefan and Kurt C Stange and Siran M Koroukian} } @article {9804, title = {Light-Intensity Physical Activity and Cardiometabolic Risk Among Older Adults With Multiple Chronic Conditions.}, journal = {American Journal of Health Promotion}, volume = {33}, year = {2019}, pages = {507-515}, abstract = {

PURPOSE: To assess the relationship between light-intensity physical activity (LIPA) and cardiometabolic risk factors among middle-aged and older adults with multiple chronic conditions.

DESIGN: Cross-sectional design utilizing data from the Health and Retirement Study (2010, 2012).

SETTING: Laboratory- and survey-based testing of a nationally representative sample of community-dwelling middle aged and older adults.

PARTICIPANTS: Adults aged 50 years and older (N = 14 996).

MEASURES: Weighted metabolic equivalent of tasks was calculated using self-reported frequency of light, moderate, and vigorous physical activity. Cardiometabolic risk factors (systolic and diastolic blood pressure, glycosylated hemoglobin [HbA], high-density lipoprotein cholesterol [HDL-C], total cholesterol, and non-HDL-C) were objectively measured. A multiple chronic condition index was based on 8 self-reported chronic conditions.

ANALYSIS: Weighted multivariate linear regression models.

RESULTS: Light-intensity physical activity was independently associated with favorable HDL-C (β = 1.25; 95\% confidence interval [CI]: 0.46-2.05) and total cholesterol (β = 2.72; 95\% CI: 0.53-4.90) after adjusting for relevant confounders. The HDL-C health benefit was apparent when stratified by number of chronic conditions, for individuals with 2 to 3 conditions (β = 1.73; 95\% CI: 0.58-2.89). No significant associations were observed between LIPA and blood pressure, HbA, or non-HDL-C.

CONCLUSIONS: Engaging in LIPA may be an important health promotion activity to manage HDL-C and total cholesterol. Additional longitudinal research is needed to determine the causal association between LIPA and cardiometabolic risk which can potentially inform physical activity guidelines targeting older adults with multiple chronic conditions.

}, keywords = {Community-dwelling, Comorbidity, Physical activity}, issn = {2168-6602}, doi = {10.1177/0890117118796459}, author = {Yueyao Li and White, Kellee and Katherine R O{\textquoteright}Shields and Alexander C McLain and Anwar T Merchant} } @article {9548, title = {Physical Functioning Decline and Mortality in Older Adults with Multimorbidity: Joint Modeling of Longitudinal and Survival Data.}, journal = {Journals of Gerontology Series A: Biological Sciences \& Medical Sciences}, volume = {74}, year = {2019}, pages = {226-232}, abstract = {

Background: Multimorbidity is common among older adults and strongly associated with physical functioning decline and increased mortality. However, the full spectrum of direct and indirect effects of multimorbidity on physical functioning and survival has not been quantified. We aimed to determine the longitudinal relationship of multimorbidity on physical functioning and quantify the impact of multimorbidity and multimorbidity-attributed changes in physical functioning on mortality risk.

Methods: The Health and Retirement Study is a nationally-representative population-based prospective cohort of adults aged 51 or older. In 2000, participants were interviewed about physician-diagnosed chronic conditions, from which their multimorbidity-weighted index (MWI) was computed. Between 2000-2011, participants reported their current physical functioning using a modified Short Form-36. With MWI as a time-varying exposure, we jointly modeled its associations with physical functioning and survival.

Results: The final sample included 74,037 observations from 18,174 participants. At baseline, participants had a weighted mean MWI of 4.64.2 (range 0-36.8). During follow-up, physical functioning declined -1.72~(95\% CI:~-1.77, -1.67, p<0.001) HRS physical functioning units per point MWI in adjusted models. Over follow-up, 6,362 (34\%) participants died. Mortality risk increased 8\% (HR 1.08, 95\% CI 1.07-1.08, p<0.001) per point MWI in adjusted models. Across all population subgroups, MWI was associated with greater physical functioning decline and mortality risk.

Conclusions: Multimorbidity and its associated decline in physical functioning were significantly associated with increased mortality. These associations can be predicted with an easily interpreted and applied multimorbidity index that can better identify and target adults at increased risk for disability and death.

}, keywords = {Comorbidity, Mortality, Physical Ability}, issn = {1758-535X}, doi = {10.1093/gerona/gly038}, author = {Melissa Y Wei and Mohammed U Kabeto and Andrzej T Galecki and Kenneth M. Langa} } @article {10147, title = {Racial/ethnic differences in multimorbidity development and chronic disease accumulation for middle-aged adults.}, journal = {PLoS One}, volume = {14}, year = {2019}, pages = {e0218462}, abstract = {

BACKGROUND: Multimorbidity-having two or more coexisting chronic conditions-is highly prevalent, costly, and disabling to older adults. Questions remain regarding chronic diseases accumulation over time and whether this differs by racial and ethnic background. Answering this knowledge gap, this study identifies differences in rates of chronic disease accumulation and multimorbidity development among non-Hispanic white, non-Hispanic black, and Hispanic study participants starting in middle-age and followed up to 16 years.

METHODS AND FINDINGS: We analyzed data from the Health and Retirement Study (HRS), a biennial, ongoing, publicly-available, longitudinal nationally-representative study of middle-aged and older adults in the United States. We assessed the change in chronic disease burden among 8,872 non-Hispanic black, non-Hispanic white, and Hispanic participants who were 51-55 years of age at their first interview any time during the study period (1998-2014) and all subsequent follow-up observations until 2014. Multimorbidity was defined as having two or more of seven somatic chronic diseases: arthritis, cancer, heart disease (myocardial infarction, coronary heart disease, angina, congestive heart failure, or other heart problems), diabetes, hypertension, lung disease, and stroke. We used negative binomial generalized estimating equation models to assess the trajectories of multimorbidity burden over time for non-Hispanic black, non-Hispanic white, and Hispanic participants. In covariate-adjusted models non-Hispanic black respondents had initial chronic disease counts that were 28\% higher than non-Hispanic white respondents (IRR 1.279, 95\% CI 1.201, 1.361), while Hispanic respondents had initial chronic disease counts that were 15\% lower than non-Hispanic white respondents (IRR 0.852, 95\% CI 0.775, 0.938). Non-Hispanic black respondents had rates of chronic disease accumulation that were 1.1\% slower than non-Hispanic whites (IRR 0.989, 95\% CI 0.981, 0.998) and Hispanic respondents had rates of chronic disease accumulation that were 1.5\% faster than non-Hispanic white respondents (IRR 1.015, 95\% CI 1.002, 1.028). Using marginal effects commands, this translates to predicted values of chronic disease for white respondents who begin the study period with 0.98 chronic diseases and end with 2.8 chronic diseases; black respondents who begin the study period with 1.3 chronic diseases and end with 3.3 chronic diseases; and Hispanic respondents who begin the study period with 0.84 chronic diseases and end with 2.7 chronic diseases.

CONCLUSIONS: Middle-aged non-Hispanic black adults start at a higher level of chronic disease burden and develop multimorbidity at an earlier age, on average, than their non-Hispanic white counterparts. Hispanics, on the other hand, accumulate chronic disease at a faster rate relative to non-Hispanic white adults. Our findings have important implications for improving primary and secondary chronic disease prevention efforts among non-Hispanic black and Hispanic Americans to stave off greater multimorbidity-related health impacts.

}, keywords = {Chronic conditions, Comorbidity, Racial/ethnic differences}, issn = {1932-6203}, doi = {10.1371/journal.pone.0218462}, author = {Ana R Qui{\~n}ones and Anda Botoseneanu and Markwardt, Sheila and Corey L Nagel and Jason T Newsom and David A Dorr and Heather G. Allore} } @article {10115, title = {Sex differences in the association between salivary telomere length and multimorbidity within the US Health \& Retirement Study}, journal = {Age and Ageing}, volume = {48}, year = {2019}, pages = { 703{\textendash}710}, type = {Journal}, abstract = {Background Telomere length is associated with several physical and mental health conditions, but whether it is a marker of multimorbidity is unclear. We investigated associations between telomere length and multimorbidity by sex. Methods Data from adults (N = 5,495) aged >=50 years were taken from the US Health and Retirement Study (2008{\textendash}14). Telomere length was measured in 2008 from salivary samples. The cross-sectional associations between telomere length and eight chronic health conditions were explored using logistic regression, adjusting for confounders and stratified by sex. Logistic, ordinal and multinomial regression models were calculated to explore relationships between telomere length and multimorbidity (using a binary variable and a sum of the number of health conditions) and the type of multimorbidity (no multimorbidity, physical multimorbidity, or multimorbidity including psychiatric problems). Using multilevel logistic regression, prospective relationships between telomere length and incident multimorbidity were also explored. Results In cross-sectional analyses, longer telomeres were associated with reduced likelihood of lung disease and psychiatric problems among men, but not women. Longer telomeres were associated with lower risk of multimorbidity that included psychiatric problems among men (OR=0.521, 95\% CI: 0.284 to 0.957), but not women (OR=1.188, 95\% CI: 0.771 to 1.831). Prospective analyses suggested little association between telomere length and the onset of multimorbidity in men (OR=1.378, 95\% CI: 0.931 to 2.038) nor women (OR=1.224, 95\% CI: 0.825 to 1.815). Conclusions Although telomere length does not appear to be a biomarker of overall multimorbidity, further exploration of the relationships is merited particularly for multimorbidity including psychiatric conditions among men.}, keywords = {Comorbidity, Genetics, Telomeres, Women and Minorities}, issn = {0002-0729}, doi = {10.1093/ageing/afz071}, url = {https://academic.oup.com/ageing/article/48/5/703/5511442}, author = {Niedzwiedz, Claire L. and Katikireddi, Srinivasa Vittal and Pell, Jill P. and Smith, Daniel J.} } @article {8486, title = {Arthritis, Depression, and Falls Among Community-Dwelling Older Adults: Evidence From the Health and Retirement Study.}, journal = {J Appl Gerontol}, volume = {37}, year = {2018}, month = {2018 09}, pages = {1133-1149}, abstract = {

The aims of this study were to examine the association between different types of arthritis and falls and to investigate whether clinically significant depression symptoms (CSDS) moderate these relationships. The study used nationally representative data from the 2008 Health and Retirement Study ( n = 7,715, M age = 75, 62\% female, and 90\% White). Among the respondents, 42\% experienced at least one fall during the previous 2 years. About one third had some form of arthritis: 22\% osteoarthritis (OA), 4.8\% rheumatoid arthritis (RA), 2.3\% both OA and RA, and 7.9\% with other arthritis types. About one fifth of respondents had CSDS. OA and CSDS are associated with the odds of falling (17\% and 29\%, respectively), adjusting for socio-demographic characteristics, lifestyle, health conditions, and psychiatric medications. There was no statistically significant interaction between types of arthritis and CSDS. Health care providers should pay attention to managing arthritis, especially OA, and CSDS to prevent falls among older adults.

}, keywords = {Accidental Falls, Aged, Aged, 80 and over, Arthritis, Rheumatoid, Comorbidity, depression, Female, Health Surveys, Humans, Independent Living, Male, Osteoarthritis, United States}, issn = {1552-4523}, doi = {10.1177/0733464816646683}, url = {http://www.ncbi.nlm.nih.gov/pubmed/27178205}, author = {Lien Quach and Jeffrey A Burr} } @article {9512, title = {Chronic disease burden predicts food insecurity among older adults.}, journal = {Public Health Nutrition}, volume = {21}, year = {2018}, pages = {1737-1742}, abstract = {

OBJECTIVE: Increased out-of-pocket health-care expenditures may exert budget pressure on low-income households that leads to food insecurity. The objective of the present study was to examine whether older adults with higher chronic disease burden are at increased risk of food insecurity.

DESIGN: Secondary analysis of the 2013 Health and Retirement Study (HRS) Health Care and Nutrition Study (HCNS) linked to the 2012 nationally representative HRS.

SETTING: USA.

SUBJECTS: Respondents of the 2013 HRS HCNS with household incomes <300 \% of the federal poverty line (n 3552). Chronic disease burden was categorized by number of concurrent chronic conditions (0-1, 2-4, >=5 conditions), with multiple chronic conditions (MCC) defined as >=2 conditions.

RESULTS: The prevalence of food insecurity was 27{\textperiodcentered}8 \%. Compared with those having 0-1 conditions, respondents with MCC were significantly more likely to report food insecurity, with the adjusted odds ratio for those with 2-4 conditions being 2{\textperiodcentered}12 (95 \% CI 1{\textperiodcentered}45, 3{\textperiodcentered}09) and for those with >=5 conditions being 3{\textperiodcentered}64 (95 \% CI 2{\textperiodcentered}47, 5{\textperiodcentered}37).

CONCLUSIONS: A heavy chronic disease burden likely exerts substantial pressure on the household budgets of older adults, creating an increased risk for food insecurity. Given the high prevalence of food insecurity among older adults, screening those with MCC for food insecurity in the clinical setting may be warranted in order to refer to community food resources.

}, keywords = {Chronic conditions, Comorbidity, Food insecurity}, issn = {1475-2727}, doi = {10.1017/S1368980017004062}, author = {Jih, Jane and Stijacic-Cenzer, Irena and Hilary K Seligman and W John Boscardin and Thu T Nguyen and Christine S Ritchie} } @article {9816, title = {Food insecurity, comorbidity, and mobility limitations among older U.S. adults: Findings from the Health and Retirement Study and Health Care and Nutrition Study.}, journal = {Preventative Med}, volume = {114}, year = {2018}, month = {09/2018}, pages = {180-187}, abstract = {Both food insecurity and comorbidity have been identified as precursors to functional limitation in older adults, yet whether food insecurity modifies the progression from chronic disease to disability has not been assessed. We examined 5986 respondents age 50 and older drawn from the 2012-2014 Health and Retirement Study (HRS) and 2013 Health Care and Nutrition Study (HCNS). Mobility limitations reported in 2014 and change in mobility limitations from 2012 to 2014 were regressed on measures of food insecurity, number of chronic conditions, and their interaction terms using Poisson regression. Around 17.3\% of the sample was identified as food insecure. In 2012, respondents reported an average of 1.9 (SD = 1.5) chronic conditions and 2.4 mobility limitations (SD = 3.0). In 2014, individuals reported an average of 2.5 (SD = 3.1) mobility limitations. Food insecurity was associated with a greater number of mobility limitations (IRR = 1.20, 95\% CI: 1.11-1.29, p < .001) and more rapid increase in mobility limitations over the two-year observational period (IRR = 1.06, 95\% CI: 1.00-1.11, p = .047). Food security status also modified the association between comorbidity and both mobility limitation outcomes, with the food secure exhibiting a stronger positive association between chronic conditions and mobility limitations than the food insecure. The food insecure tended to have more mobility limitations than the food secure when few chronic conditions were reported. Our results suggest that food insecurity is associated with prevalence and change in mobility limitations among older adults.}, keywords = {Comorbidity, Disabilities, Food insecurity}, issn = {1096-0260}, doi = {10.1016/j.ypmed.2018.07.001}, author = {Nicholas J Bishop and Wang, Kaipeng} } @article {9158, title = {Multimorbidity and physical and cognitive function: performance of a new multimorbidity-weighted index.}, journal = {Journals of Gerontology Series A: Biological Sciences \& Medical Sciences}, volume = {73}, year = {2018}, pages = {225}, abstract = {

Background: Multimorbidity is an important health outcome but is difficult to quantify. We recently developed a multimorbidity-weighted index (MWI) and herein assess its performance in an independent nationally-representative cohort.

Methods: Health and Retirement Study (HRS) participants completed an interview on physician-diagnosed chronic conditions and physical functioning. We determined the relationship of chronic conditions on physical functioning and validated these weights with the original, independently-derived MWI. We then determined the association between MWI with physical functioning, grip strength, gait speed, basic and instrumental activities of daily living (ADL/IADL) limitations, and the modified Telephone Interview for Cognitive Status (TICS-m) in adjusted models.

Results: Among 20,509 adults, associations between chronic conditions and physical functioning varied several-fold. MWI values based on weightings in the HRS and original cohorts correlated strongly (Pearson{\textquoteright}s r=0.92) and had high classification agreement (Kappa statistic=0.80, p<0.0001). Participants in the highest vs. lowest MWI quartiles had weaker grip strength (-2.91 kg, 95\%CI: -3.51, -2.30), slower gait speed (-0.29 m/s, 95\%CI: -0.35, -0.23), more ADL (0.79, 95\%CI: 0.71, 0.87) and IADL (0.49, 95\%CI: 0.44, 0.55) limitations, and lower TICS-m (-0.59, 95\%CI: -0.77, -0.41) (all P<0.001). We observed monotonic graded relationships for all outcomes with increasing MWI quartiles.

Conclusion: A multimorbidity index weighted to physical functioning performed nearly identically in a nationally-representative cohort as it did in its development cohorts, confirming broad generalizability. MWI was strongly associated with subjective and objective physical and cognitive performance. Thus, MWI serves as a valid patient-centered measure of multimorbidity, an important construct in research and clinical practice.

}, keywords = {Cognition \& Reasoning, Comorbidity}, issn = {1758-535X}, doi = {10.1093/gerona/glx114}, author = {Melissa Y Wei and Mohammed U Kabeto and Kenneth M. Langa and Kenneth J Mukamal} } @article {9464, title = {Older Adults Undergoing Total Hip or Knee Arthroplasty: Chronicling Changes in Their Multimorbidity Profile in the Last Two Decades.}, journal = {Journal of Arthroplasty}, volume = {33}, year = {2018}, pages = {976-982}, abstract = {

BACKGROUND: Despite the ubiquitous use of total hip arthroplasty (THA) and total knee arthroplasty (TKA) in older adults, little is known about the multimorbidity (MM) profile of this patient population. This study evaluates the temporal trends of MM, hypothesizing that patients with MM have had an increasingly greater representation in THA and TKA patients over time.

METHODS: Data on a US representative sample of older adults from the linked Health and Retirement Study and Medicare data from 1993 to 2012 were used. The Health and Retirement Study is a biennial survey that collects data on a broad array of measures, including self-reported chronic conditions and geriatric syndromes, which were used to account for MM. Medicare data were used to identify fee-for-service Medicare beneficiaries who underwent THA (n~= 479) or TKA (n~= 998) during the study years, which were grouped into 3 periods: 1993-1999, 2000-2006, and 2007-2012. Multivariable logistic regression analysis was conducted to obtain age-, gender-, and race-adjusted time trends for MM.

RESULTS: Compared to the earliest study period, and for both THA and TKA patients, there were significantly fewer patients with stroke and/or poor cognitive performance in the most recent study period. In addition, more TKA than THA patients presented with 2+ chronic conditions. Nearly 70\% presented with co-occurring chronic conditions and geriatric syndromes, and this percentage did not change significantly over time.

CONCLUSION: The high representation of THA and TKA patients presenting with co-occurring chronic conditions and geriatric syndromes in this patient population warrants detailed exploration of the effects of geriatric syndromes on postoperative outcomes.

}, keywords = {Chronic conditions, Comorbidity, Functional limitations, Joint replacement}, issn = {1532-8406}, doi = {10.1016/j.arth.2017.11.014}, author = {Siran M Koroukian and Nicholas K Schiltz and David F Warner and Alison K Klika and Carlos A. Higuera-Rueda and Wael K. Barsoum} } @article {9336, title = {Complex multimorbidity and health outcomes in older adult cancer survivors }, journal = {Family Medicine and Community Health}, volume = {5}, year = {2017}, pages = {129-138}, abstract = {Objective: To characterize complex multimorbidity among cancer survivors and evaluate the association between cancer survivorship, time since cancer diagnosis, and self-reported fair/poor health, self-rated worse health in 2 years, and 2-year mortality. Methods: We used the 2010-2012 Health and Retirement Study. Cancer survivors were individuals who reported a (nonskin) cancer diagnosis 2 years or more before the interview. We defined complex multimorbidity as the co-occurrence of chronic conditions, functional limitations, and/or geriatric syndromes. In addition to descriptive analyses, we used logistic regression to evaluate the independent association between cancer survivor status and health outcomes. We also examined whether cancer survivorship differed by the number of years since diagnosis. Results: Among 15,808 older adults (age >=50 years), 11.8\% were cancer survivors. Compared with cancer-free individuals, a greater percentage of cancer survivors had complex multimorbidity: co-occurring chronic conditions, functional limitations, and geriatric syndromes. Cancer survivorship was significantly associated with self-reported fair/poor health, self-rated worse health in 2 years, and 2-year mortality. These effects declined with the number of years since diagnosis for fair/ poor health and mortality but not for self-rated worse health. Conclusion: Cancer survivor status is independently associated with more complex multimorbidity, and with worse health outcomes. These effects attenuate with time, except for patient perception of being in worse health. }, keywords = {Cancer screenings, Comorbidity, Health Care Outcomes}, issn = {2305-6983}, doi = {10.15212/FMCH.2017.0127}, url = {http://www.ingentaconnect.com/content/10.15212/FMCH.2017.0127http://www.ingentaconnect.com/content/cscript/fmch/2017/00000005/00000002/art00005http://www.ingentaconnect.com/content/cscript/fmch/2017/00000005/00000002/art00005}, author = {David F Warner and Nicholas K Schiltz and Kurt C Stange and Charles W Given and Owusu, Cynthia and Nathan A. Berger and Siran M Koroukian} } @article {8697, title = {Identifying Specific Combinations of Multimorbidity that Contribute to Health Care Resource Utilization: An Analytic Approach.}, journal = {Med Care}, volume = {55}, year = {2017}, month = {2017 03}, pages = {276-284}, abstract = {

BACKGROUND: Multimorbidity affects the majority of elderly adults and is associated with higher health costs and utilization, but how specific patterns of morbidity influence resource use is less understood.

OBJECTIVE: The objective was to identify specific combinations of chronic conditions, functional limitations, and geriatric syndromes associated with direct medical costs and inpatient utilization.

DESIGN: Retrospective cohort study using the Health and Retirement Study (2008-2010) linked to Medicare claims. Analysis used machine-learning techniques: classification and regression trees and random forest.

SUBJECTS: A population-based sample of 5771 Medicare-enrolled adults aged 65 and older in the United States.

MEASURES: Main covariates: self-reported chronic conditions (measured as none, mild, or severe), geriatric syndromes, and functional limitations. Secondary covariates: demographic, social, economic, behavioral, and health status measures.

OUTCOMES: Medicare expenditures in the top quartile and inpatient utilization.

RESULTS: Median annual expenditures were $4354, and 41\% were hospitalized within 2 years. The tree model shows some notable combinations: 64\% of those with self-rated poor health plus activities of daily living and instrumental activities of daily living disabilities had expenditures in the top quartile. Inpatient utilization was highest (70\%) in those aged 77-83 with mild to severe heart disease plus mild to severe diabetes. Functional limitations were more important than many chronic diseases in explaining resource use.

CONCLUSIONS: The multimorbid population is heterogeneous and there is considerable variation in how specific combinations of morbidity influence resource use. Modeling the conjoint effects of chronic conditions, functional limitations, and geriatric syndromes can advance understanding of groups at greatest risk and inform targeted tailored interventions aimed at cost containment.

}, keywords = {Activities of Daily Living, Age Factors, Aged, Aged, 80 and over, Comorbidity, Female, Health Behavior, Health Expenditures, Health Status, Humans, Machine learning, Male, Medicare, Retrospective Studies, Self Report, Socioeconomic factors, United States}, issn = {1537-1948}, doi = {10.1097/MLR.0000000000000660}, author = {Nicholas K Schiltz and David F Warner and Jiayang Sun and Paul M Bakaki and Avi Dor and Charles W Given and Kurt C Stange and Siran M Koroukian} } @article {8820, title = {The Impact of Disability and Social Determinants of Health on Condition-Specific Readmissions beyond Medicare Risk Adjustments: A Cohort Study.}, journal = {J Gen Intern Med}, volume = {32}, year = {2017}, month = {2017 01}, pages = {71-80}, abstract = {

BACKGROUND: Readmission rates after pneumonia, heart failure, and acute myocardial infarction hospitalizations are risk-adjusted for age, gender, and medical comorbidities and used to penalize hospitals.

OBJECTIVE: To assess the impact of disability and social determinants of health on condition-specific readmissions beyond current risk adjustment.

DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study of Medicare patients using 1) linked Health and Retirement Study-Medicare claims data (HRS-CMS) and 2) Healthcare Cost and Utilization Project State Inpatient Databases (Florida, Washington) linked with ZIP Code-level measures from the Census American Community Survey (ACS-HCUP). Multilevel logistic regression models assessed the impact of disability and selected social determinants of health on readmission beyond current risk adjustment.

MAIN MEASURES: Outcomes measured were readmissions <=30~days after hospitalizations for pneumonia, heart failure, or acute myocardial infarction. HRS-CMS models included disability measures (activities of daily living [ADL] limitations, cognitive impairment, nursing home residence, home healthcare use) and social determinants of health (spouse, children, wealth, Medicaid, race). ACS-HCUP model measures were ZIP Code-percentage of residents >=65~years of age with ADL difficulty, spouse, income, Medicaid, and patient-level and hospital-level race.

KEY RESULTS: For pneumonia, >=3 ADL difficulties (OR 1.61, CI 1.079-2.391) and prior home healthcare needs (OR 1.68, CI 1.204-2.355) increased readmission in HRS-CMS models (N = 1631); ADL difficulties (OR 1.20, CI 1.063-1.352) and {\textquoteright}other{\textquoteright} race (OR 1.14, CI 1.001-1.301) increased readmission in ACS-HCUP models (N = 27,297). For heart failure, children (OR 0.66, CI 0.437-0.984) and wealth (OR 0.53, CI 0.349-0.787) lowered readmission in HRS-CMS models (N = 2068), while black (OR 1.17, CI 1.056-1.292) and {\textquoteright}other{\textquoteright} race (OR 1.14, CI 1.036-1.260) increased readmission in ACS-HCUP models (N = 37,612). For acute myocardial infarction, nursing home status (OR 4.04, CI 1.212-13.440) increased readmission in HRS-CMS models (N = 833); {\textquoteright}other{\textquoteright} patient-level race (OR 1.18, CI 1.012-1.385) and hospital-level race (OR 1.06, CI 1.001-1.125) increased readmission in ACS-HCUP models (N = 17,496).

CONCLUSIONS: Disability and social determinants of health influence readmission risk when added to the current Medicare risk adjustment models, but the effect varies by condition.

}, keywords = {Activities of Daily Living, Cognitive Dysfunction, Comorbidity, Disability Evaluation, Female, Heart Failure, Humans, Logistic Models, Male, Myocardial Infarction, Patient Readmission, Pneumonia, Retrospective Studies, Risk Adjustment, Social determinants of health}, issn = {1525-1497}, doi = {10.1007/s11606-016-3869-x}, url = {http://link.springer.com/10.1007/s11606-016-3869-xhttp://link.springer.com/content/pdf/10.1007/s11606-016-3869-x.pdfhttp://link.springer.com/content/pdf/10.1007/s11606-016-3869-x.pdfhttp://link.springer.com/article/10.1007/s11606-016-3869-x/fulltext.html}, author = {Meddings, Jennifer and Reichert, Heidi and Shawna N Smith and Theodore J Iwashyna and Kenneth M. Langa and Timothy P Hofer and Laurence F McMahon} } @article {9206, title = {The impact of multimorbidity on grip strength in adults age 50 and older: Data from the Health and Retirement Survey (HRS)}, journal = {Archives of Gerontology and Geriatrics}, volume = {72}, year = {2017}, pages = {164-168}, abstract = {Background: Multimorbidity, the presence of two or more chronic diseases, is a public health concern. The measurement of grip strength has been proposed as a measure of overall body strength and is reliable and easy to measure. The purpose of this study was to investigate the relationship between the number of chronic diseases and common co-occurring chronic diseases with grip strength. Methods: A cross-sectional analysis was conducted of 5877 respondents (2744 = male, 3103 = female) from the 2008 Health and Retirement Study (HRS) who completed grip strength measurements (kg). Results: As the number of chronic diseases increased, an incremental decrease in grip strength occurred and became more pronounced with >=3 chronic diseases present (b = 3.1, 95\% CI = 2.3{\textendash}3.9, p < 0.001). No statistically significant relationship was identified between specific chronic diseases (except for stroke) and grip strength. Conclusion: Multimorbidity has a statistically significant negative relationship on grip strength. Grip strength should be considered as a physical performance measure to incorporate into the care of patients with multimorbidity.}, keywords = {Comorbidity, Grip strength, Health Conditions and Status}, issn = {01674943}, doi = {10.1016/j.archger.2017.05.011}, author = {Amy M Yorke and Amy B. Curtis and Shoemaker, Michael and Vangsnes, Eric} } @article {9294, title = {Increasing Burden of Complex Multimorbidity Across Gradients of Cognitive Impairment.}, journal = {American Journal of Alzheimer{\textquoteright}s Disease and Other Dementias}, year = {2017}, abstract = {

INTRODUCTION: This study evaluates the burden of multimorbidity (MM) across gradients of cognitive impairment (CI).

METHODS: Using data from the 2010 Health and Retirement Study, we identified individuals with no CI, mild CI, and moderate/severe CI. In addition, we adopted an expansive definition of complex MM by accounting for the occurrence and co-occurrence of chronic conditions, functional limitations, and geriatric syndromes.

RESULTS: In a sample of 18 913 participants (weighted n = 87.5 million), 1.93\% and 1.84\% presented with mild and moderate/severe CI, respectively. The prevalence of most conditions constituting complex MM increased markedly across the spectrum of CI. Further, the percentage of individuals presenting with 10 or more conditions was 19.9\%, 39.3\%, and 71.3\% among those with no CI, mild CI, and moderate/severe CI, respectively.

DISCUSSION: Greater CI is strongly associated with increased burden of complex MM. Detailed characterization of MM across CI gradients will help identify opportunities for health care improvement.

}, keywords = {Cognitive Ability, Comorbidity, Functional limitations}, issn = {1938-2731}, doi = {10.1177/1533317517726388}, author = {Siran M Koroukian and Nicholas K Schiltz and David F Warner and Kurt C Stange and Kathleen A Smyth} } @article {9019, title = {Multiple Chronic Conditions, Resilience, and Workforce Transitions in Later Life: A Socio-Ecological Model.}, journal = {The Gerontologist}, volume = {57}, year = {2017}, month = {2017 Apr 01}, pages = {269-281}, abstract = {

Purpose of the Study: Despite the growing prevalence of multiple chronic conditions (MCC), a problem that disproportionally affects older adults, few studies have examined the impact of MCC status on changes in workforce participation in later life. Recent research suggests that resilience, the ability to recover from adversity, may buffer the negative impact of chronic disease. Guided by an adapted socio-ecological risk and resilience conceptual model, this study examined the buffering effect of resilience on the relationship between individual and contextual risks, including MCC, and workforce transitions (i.e., leaving the workforce, working fewer hours, working the same hours, or working more hours).

Design and Methods: Using the Health and Retirement Study, this study pooled a sample of 4,861 older workers aged 51 and older with 2 consecutive biannual waves of data. Nonnested multinomial logistic regression analysis was applied.

Results: MCC are related to higher risk of transitioning out of the workforce. Resilience buffered the negative effects of MCC on workforce engagement and remained independently associated with increased probability of working the same or more hours compared with leaving work.

Implications: MCC are associated with movement out of the paid workforce in later life. Despite the challenges MCC impose on older workers, having higher levels of resilience may provide the psychological resources needed to sustain work engagement in the face of new deficits. These findings suggest that identifying ways to bolster resilience may enhance the longevity of productive workforce engagement.

}, keywords = {Comorbidity, Resilience, Retirement Planning and Satisfaction}, issn = {1758-5341}, doi = {10.1093/geront/gnv101}, author = {Kendra Jason and Dawn C Carr and Tiffany R Washington and Tandrea S Hilliard and Chivon A Mingo} } @article {8678, title = {Rates of Recovery to Pre-Fracture Function in Older Persons with Hip Fracture: an Observational Study.}, journal = {J Gen Intern Med}, volume = {32}, year = {2017}, month = {2017 Feb}, pages = {153-158}, abstract = {

BACKGROUND: Knowledge about expected recovery after hip fracture is essential to help patients and families set realistic expectations and plan for the future.

OBJECTIVES: To determine rates of functional recovery in older adults who sustained a hip fracture based on one{\textquoteright}s previous function.

DESIGN: Observational study.

PARTICIPANTS: We identified subjects who sustained a hip fracture while enrolled in the nationally representative Health and Retirement Study (HRS) using linked Medicare claims. HRS interviews subjects every 2~years. Using information from interviews collected during the interview preceding the fracture and the first interview 6 or more months after the fracture, we determined the proportion of subjects who returned to pre-fracture function.

MAIN MEASURES: Functional outcomes of interest were: (1) ADL dependency, (2) mobility, and (3) stair-climbing ability. We examined baseline characteristics associated with a return to: (1) ADL independence, (2) walking one block, and (3) climbing a flight of stairs.

KEY RESULTS: A total of 733 HRS subjects >=65~years of age sustained a hip fracture (mean age 84 {\textpm} 7~years, 77~\% female). Thirty-one percent returned to pre-fracture ADL function, 34~\% to pre-fracture mobility function, and 41~\% to pre-fracture climbing function. Among those who were ADL independent prior to fracture, 36~\% returned to independence, 27~\% survived but needed ADL assistance, and 37~\% died. Return to ADL independence was less likely for those >=85~years old (26~\% vs. 44~\%), with dementia (8~\% vs. 39~\%), and with a Charlson comorbidity score >2 (23~\% vs. 44~\%). Results were similar for those able to walk a block and for those able to climb a flight of stairs prior to fracture.

CONCLUSIONS: Recovery rates are low, even among those with higher levels of pre-fracture functional status, and are worse for patients who are older, cognitively impaired, and who have multiple comorbidities.

}, keywords = {Activities of Daily Living, Age Factors, Aged, Aged, 80 and over, Comorbidity, Dementia, Female, Geriatric Assessment, Hip Fractures, Humans, Longitudinal Studies, Male, Mobility Limitation, Recovery of Function, Walking}, issn = {1525-1497}, doi = {10.1007/s11606-016-3848-2}, author = {Victoria L. Tang and Rebecca L. Sudore and Irena Cenzer and W John Boscardin and Alexander K Smith and Christine S Ritchie and Margaret Wallhagen and Finlayson, Emily and Petrillo, Laura and Kenneth E Covinsky} } @article {6495, title = {Combinations of Chronic Conditions, Functional Limitations, and Geriatric Syndromes that Predict Health Outcomes.}, journal = {J Gen Intern Med}, volume = {31}, year = {2016}, month = {2016 Jun}, pages = {630-7}, chapter = {630}, abstract = {

BACKGROUND: The strategic framework on multiple chronic conditions released by the US Department of Health and Human Services calls for identifying homogeneous subgroups of older adults to effectively target interventions aimed at improving their health.

OBJECTIVE: We aimed to identify combinations of chronic conditions, functional limitations, and geriatric syndromes that predict poor health outcomes. DESIGN, SETTING AND PARTICIPANTS Data from the 2010-2012 Health and Retirement Study provided a representative sample of U.S. adults 50~years of age or older (n = 16,640).

MAIN MEASURES: Outcomes were: Self-reported fair/poor health, self-rated worse health at 2~years, and 2-year mortality. The main independent variables included self-reported chronic conditions, functional limitations, and geriatric syndromes. We conducted tree-based classification and regression analysis to identify the most salient combinations of variables to predict outcomes.

KEY RESULTS: Twenty-nine percent and 23~\% of respondents reported fair/poor health and self-rated worse health at 2~years, respectively, and 5~\% died in 2~years. The top combinations of conditions identified through our tree analysis for the three different outcome measures (and percent respondents with the outcome) were: a) for fair/poor health status: difficulty walking several blocks, depressive symptoms, and severe pain (> 80~\%); b) for self-rated worse health at 2~years: 68.5~years of age or older, difficulty walking several blocks and being in fair/poor health (60~\%); and c) for 2-year mortality: 80.5~years of age or older, and presenting with limitations in both ADLs and IADLs (> 40~\%).

CONCLUSIONS: Rather than chronic conditions, functional limitations and/or geriatric syndromes were the most prominent conditions in predicting health outcomes. These findings imply that accounting for chronic conditions alone may be less informative than also accounting for the co-occurrence of functional limitations and geriatric syndromes, as the latter conditions appear to drive health outcomes in older individuals.

}, keywords = {Activities of Daily Living, Age Distribution, Aged, Aged, 80 and over, Chronic disease, Comorbidity, Female, Geriatric Assessment, Health Status, Health Status Indicators, Humans, Longitudinal Studies, Male, Middle Aged, Mobility Limitation, Prognosis, Risk Factors, Self Report, Sex Distribution, Socioeconomic factors, Syndrome, United States}, issn = {1525-1497}, doi = {10.1007/s11606-016-3590-9}, url = {http://dx.doi.org/10.1007/s11606-016-3590-9}, author = {Siran M Koroukian and Nicholas K Schiltz and David F Warner and Jiayang Sun and Paul M Bakaki and Kathleen A Smyth and Kurt C Stange and Charles W Given} } @article {8345, title = {Comorbidities Among Persons With Incident Psychiatric Condition}, journal = {Gerontology and Geriatric Medicine}, volume = {2}, year = {2016}, publisher = {2}, abstract = {Objective: I sought to determine how medical comorbidities co-exist with incident psychiatric condition. Method: I used data from all 11 available waves (1992-2012) of the Health and Retirement Study (HRS). I identified 4,358 index participants with self-reported incident psychiatric condition. I collected comorbidity data from participants preceding, including, and succeeding that incident wave. Comorbidities assessed included high blood pressure (HBP), diabetes mellitus, cancer, lung disease, heart disease, stroke, and arthritis. Modified Poisson regression combined with log-linked binomial regression was used to estimate relative risks (RRs) of reporting a comorbidity preceding and following the incident wave. Multiple comparison testing dictated significance of RRs with p .007. Results: For the waves preceding the index wave, the RRs of reporting all comorbidities except HBP and cancer were significantly (p .007) increased. For the waves following incident psychiatric condition, the risks of reporting heart disease, diabetes, and lung disease were significantly (p .007) increased. These results were adjusted for participant age, race, gender, other comorbidities listed, and the wave in which a comorbidity was reported. Conclusion: The bidirectional association between a psychiatric condition and medical illnesses could only be statistically confirmed for lung disease, diabetes, and heart disease. It is of interest to determine how reporting a psychiatric condition may affect the sequelae of health care use and treatment outcomes for patients with either of these comorbidities or a combination of them.}, keywords = {Comorbidity, Health Conditions and Status, Older Adults, Psychiatry}, doi = { 10.1177/2333721416635001}, url = {http://ggm.sagepub.com/content/2/2333721416635001.abstract}, author = {Fluegge, Kyle R.} } @mastersthesis {8727, title = {Health and wellbeing of older adults in the United States and Japan: A comparative study}, volume = {M.P.H.}, year = {2016}, pages = {86}, school = {San Diego State University}, type = {Thesis}, abstract = {The global population is projected to reach 9.1 billion in 2050 due to an increase in the number of older adults. Older adults are living longer; however, life expectancy values vary by country. While a country{\textquoteright}s degree of economic development is a contributor to the health of its national population, life expectancy varies among economically developed countries as well. Social engagement has been studied as a factor contributing to longevity and the health of older adults. According to the convoy model of social relations, family members begin to play an increasingly integral role in the lives of older adults as they age. Literature has demonstrated preventive benefits of family engagement for the physical, psychological, and cognitive health of older adults. However, family engagement has also been linked to low health among older adults as a means of accommodating functional decline. Cultural values and attitudes have been shown to influence family engagement behaviors as well in both individualist and collectivist nations. This study examined the association of family engagement and self-rated health status (SHS) of older adults (ages 50 to 75 years) in the United State and Japan through a secondary cross-sectional analysis of the 2008 wave of the Health and Retirement Study and the 2007 Japanese Study of Aging and Retirement. Logistic regression found SHS, frequency of family engagement, and proximity of children{\textquoteright}s residence to be significantly associated with the survey country. In the combined sample, family contact of at least once a week (OR: 1.9, 95\% CI: 1.0-3.5), residence within 10 miles of their children (OR: 0.8, 95\% CI: 0.7-1.0), and residence with children (OR: 0.6, 95\% CI: 0.5-0.7) were significantly associated with SHS, even after controlling for age, gender, ethnicity, marital status, income, and comorbidities. Future research may consider a longitudinal analysis to observe whether family engagement demonstrates protective factors for maintaining high SHS over time. While these national surveys had been modeled after each other, increasing alignment of survey instruments for improved equivalence and comparability would strengthen the internal and external validity of findings.}, keywords = {Comorbidity, Cross-National, Health Conditions and Status, JSTAR, Older Adults, Racial/ethnic differences}, isbn = {9781339861340}, url = {http://proxy.lib.umich.edu/login?url=http://search.proquest.com/docview/1809116978?accountid=14667}, author = {Suzuki, Yukari} } @mastersthesis {8717, title = {Low-Intensity Physical Activity and Cardiometabolic Risk Factors among Older Adults with Multiple Chronic Conditions}, volume = {M.S.}, year = {2016}, month = {2016}, pages = {73}, school = {University of South Carolina}, type = {Thesis}, abstract = {Introduction Cardiovascular disease (CVD) is the leading cause of death among older adults in the Unites States and is driven largely by cardiometabolic risk factors including elevated blood pressure and blood glucose. Studies have found the protective effect of moderate intensity physical activity (MIPA) and vigorous intensity physical activity (VIPA) on cardiometabolic risk factor; however, the association between light physical activity (LIPA) and cardiometabolic risk factor among older adults is not clear. Objectives 1). Examine the association between LIPA and cardiometabolic risk factors. 2). Examine whether the association between LIPA and cardiometabolic risk factor is moderated by multiple chronic conditions. Methods Data from the Health and Retirement Study (HRS) were used for this study. We ascertained 2006 and 2008 HRS data from the Public Use Dataset, the RAND HRS Data File (Version N), and the HRS Biomarker Dataset. There were11890 participants aged 50 or older for cross-sectional analysis. Physical activity was converted to metabolic equivalent of tasks (METS) and outcome variables (systolic and diastolic blood pressure and HbA1c) were measured objectively. Mean levels of blood pressure and HbA1c were compared across physical activity intensity groups. Separate linear regression models were used to examine the association between LIPA and cardiometabolic risks adjusting for potential sociodemographic, behavioral, and clinical confounders. Results In the final study sample, 28.75\% were sedentary, 9.46\% regularly engaged in LIPA, 34.68\% engaged in MIPA, and 27.12\% engaged in VIPA. We did not find significant associations between LIPA and systolic blood pressure (B 0.235; 95\% confidence interval (CI), -1.127, 1.597), diastolic blood pressure (B = -0.167; 95\% CI, -0.954, 0.621), or HbA1c levels (B -0.009; 95\% CI, -0.049, 0.066). The average HbA1c was significantly lower only among individuals who engaged in MIPA (B -0.097; 95\% CI, -0.174, -0.020) and MIPA ( B -0.140; 95\% CI, -0.218, -0.063) in comparison to individuals who were categorized as in sedentary group Conclusion The findings from our study do not suggest that LIPA is independently associated with lower cardiometabolic risk factors among older adults. Associations between physical activity intensity and cardiometabolic risk factors among older adults with multiple chronic conditions need to be verified in studies using more objective measurement of physical activity.}, keywords = {Comorbidity, Health Conditions and Status, Heart disease, Older Adults, Physical activity, Risk Factors}, isbn = {9781339456591}, url = {http://proxy.lib.umich.edu/login?url=http://search.proquest.com/docview/1780691559?accountid=14667}, author = {Yueyao Li} } @article {8545, title = {Management of diabetes mellitus in older people with comorbidities.}, journal = {BMJ}, volume = {353}, year = {2016}, month = {2016 06 15}, pages = {i2200}, abstract = {

Diabetes mellitus is a chronic disease of aging that affects more than 20\% of people over 65. In older patients with diabetes, comorbidities are highly prevalent and their presence may alter the relative importance, effectiveness, and safety of treatments for diabetes. Randomized controlled trials have shown that intensive glucose control produces microvascular and cardiovascular benefits but typically after extended treatment periods (five to nine years) and with exposure to short term risks such as mortality (in one trial) and hypoglycemia. Decision analysis, health economics, and observational studies have helped to illustrate the importance of acknowledging life expectancy, hypoglycemia, and treatment burden when setting goals in diabetes. Guidelines recommend that physicians individualize the intensity of glucose control and treatments on the basis of the prognosis (for example, three tiers based on comorbidities and functional impairments) and preferences of individual patients. Very few studies have attempted to formally implement and study these concepts in clinical practice. To better meet the treatment needs of older patients with diabetes and comorbidities, more research is needed to determine the risks and benefits of intensifying, maintaining, or de-intensifying treatments in this population. This research effort should extend to the development and study of decision support tools as well as targeted care management.

}, keywords = {Aged, Aging, Blood Glucose, Comorbidity, Diabetes Mellitus, Type 2, Disease Management, Female, Glycemic Index, Guidelines as Topic, Health Services Needs and Demand, Humans, Hypoglycemic Agents, Male, Precision Medicine, Quality of Life}, issn = {1756-1833}, doi = {10.1136/bmj.i2200}, url = {https://www.ncbi.nlm.nih.gov/pubmed/27307175}, author = {Huang, Elbert S} } @article {8501, title = {One-Year Mortality After Hip Fracture: Development and Validation of a Prognostic Index.}, journal = {J Am Geriatr Soc}, volume = {64}, year = {2016}, month = {2016 09}, pages = {1863-8}, abstract = {

OBJECTIVES: To develop a prediction index for 1-year mortality after hip fracture in older adults that includes predictors from a wide range of domains.

DESIGN: Retrospective cohort study.

SETTINGS: Health and Retirement Study (HRS).

PARTICIPANTS: HRS participants who experienced hip fracture between 1992 and 2010 as identified according to Medicare claims data (N = 857).

MEASUREMENTS: Outcome measure was death within 1 year of hip fracture. Predictor measures were participant demographic characteristics, socioeconomic status, social support, health, geriatric symptoms, and function. Variables independently associated with 1-year mortality were identified, and best-subsets regression was used to identify the final model. The selected variables were weighted to create a risk index. The index was internally validated using bootstrapping to estimate model optimism.

RESULTS: Mean age at time of hip fracture was 84, and 76\% of the participants were women. There were 235 deaths (27\%) during the 1-year follow up. Five predictors of mortality were included in the final model: aged 90 and older (2 points), male sex (2 points), congestive heart failure (2 points), difficulty preparing meals (2 points), and not being able to drive (1 point). The point scores of the index were associated with 1-year mortality, with 0 points predicting 10\% risk and 7 to 9 points predicting 66\% risk. The c-statistic for the final model was 0.73, with an estimated optimism penalty of 0.01, indicating very little evidence of overfitting.

CONCLUSION: The prognostic index combines demographic, comorbidity, and function variables and can be used to differentiate between individuals at low and high risk of 1-year mortality after hip fracture.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Cause of Death, Cohort Studies, Comorbidity, Disability Evaluation, Female, Hip Fractures, Humans, Incidence, Longitudinal Studies, Male, Prognosis, Retrospective Studies, Risk Assessment, Survival Analysis, United States}, issn = {1532-5415}, doi = {10.1111/jgs.14237}, url = {http://www.ncbi.nlm.nih.gov/pubmed/27295578}, author = {Irena Cenzer and Victoria L. Tang and W John Boscardin and Christine S Ritchie and Margaret Wallhagen and Espaldon, Roxanne and Kenneth E Covinsky} } @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 {8684, title = {Racial and Ethnic Differences in End-of-Life Medicare Expenditures.}, journal = {Journal of the American Geriatrics Society}, volume = {64}, year = {2016}, pages = {1789-1797}, abstract = {

OBJECTIVES: To determine to what extent demographic, social support, socioeconomic, geographic, medical, and End-of-Life (EOL) planning factors explain racial and ethnic variation in Medicare spending during the last 6~months of life.

DESIGN: Retrospective cohort study.

SETTING: Health and Retirement Study (HRS).

PARTICIPANTS: Decedents who participated in HRS between 1998 and 2012 and previously consented to survey linkage with Medicare claims (N~=~7,105).

MEASUREMENTS: Total Medicare expenditures in the last 180~days of life according to race and ethnicity, controlling for demographic factors, social supports, geography, illness burden, and EOL planning factors, including presence of advance directives, discussion of EOL treatment preferences, and whether death had been expected.

RESULTS: The analysis included 5,548 (78.1\%) non-Hispanic white, 1,030 (14.5\%) non-Hispanic black, and 331 (4.7\%) Hispanic adults and 196 (2.8\%) adults of other race or ethnicity. Unadjusted results suggest that average EOL Medicare expenditures were $13,522 (35\%, P~<~.001) more for black decedents and $16,341 (42\%, P~<~.001) more for Hispanics than for whites. Controlling for demographic, socioeconomic, geographic, medical, and EOL-specific factors, the Medicare expenditure difference between groups fell to $8,047 (22\%, P~<~.001) more for black and $6,855 (19\%, P~<~.001) more for Hispanic decedents than expenditures for non-Hispanic whites. The expenditure differences between groups remained statistically significant in all models.

CONCLUSION: Individuals-level factors, including EOL planning factors do not fully explain racial and ethnic differences in Medicare spending in the last 6~months of life. Future research should focus on broader systemic, organizational, and provider-level factors to explain these differences.

}, keywords = {African Continental Ancestry Group, Aged, Aged, 80 and over, Cohort Studies, Comorbidity, Cross-Cultural Comparison, Ethnic Groups, European Continental Ancestry Group, Female, Health Care Surveys, Health Expenditures, Hispanic Americans, Humans, Life Support Care, Longitudinal Studies, Male, Medicare, Rate Setting and Review, Social Support, Socioeconomic factors, Terminal Care, United States}, issn = {1532-5415}, doi = {10.1111/jgs.14263}, author = {Byhoff, Elena and Tamara B Harris and Kenneth M. Langa and Theodore J Iwashyna} } @article {8503, title = {Skin Cancer in U.S. Elderly Adults: Does Life Expectancy Play a Role in Treatment Decisions?}, journal = {J Am Geriatr Soc}, volume = {64}, year = {2016}, month = {2016 08}, pages = {1610-5}, abstract = {

OBJECTIVES: To examine whether life expectancy influences treatment pattern of nonmelanoma skin cancer, or keratinocyte carcinoma (KC), the most common malignancy and the fifth most costly cancer to Medicare.

DESIGN: Nationally representative cross-sectional study.

SETTING: Nationally representative Health and Retirement Study linked to Medicare claims.

PARTICIPANTS: Treatments (N = 9,653) from individuals aged 65 and older treated for basal or squamous cell carcinoma between 1992 and 2012 (N = 2,702) were included.

MEASUREMENTS: Limited life expectancy defined according to aged 85 and older, medical comorbidities, Charlson Comorbidity Index score of 3 or greater, difficulty in at least one activity of daily living (ADL), and a Lee index of 13 or greater. Treatment type (Mohs micrographic surgery (MMS) (most intensive, highest cost), excision, or electrodesiccation and curettage (ED\&C) (least intensive, lowest cost)), according to procedure code.

RESULTS: Most KCs (61\%) were treated surgically. Rates of MMS (19\%), excision (42\%), and ED\&C (39\%) were no different in participants with limited life expectancy and those with normal life expectancy. For example, 19\% of participants with difficulty or dependence in ADLs, 20\% of those with a Charlson comorbidity score greater than 3, and 15\% of those in their last year of life underwent MMS; participants who died within 1 year of diagnosis were treated in the same way as those who lived longer.

CONCLUSION: A one-size-fits-all approach in which advanced age, health status, functional status, and prognosis are not associated with intensiveness of treatment appears to guide treatment for KC, a generally nonfatal condition. Although intensive treatment of skin cancer when it causes symptoms may be indicated regardless of life expectancy, persons with limited life expectancy should be given choices to ensure that the treatment matches their goals and preferences.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Carcinoma, Basal Cell, Carcinoma, Squamous Cell, Comorbidity, Cost-Benefit Analysis, Cross-Sectional Studies, Curettage, Decision Support Techniques, Disability Evaluation, Electrosurgery, Female, Humans, Keratinocytes, Life Expectancy, Male, Mohs Surgery, Prognosis, Skin Neoplasms}, issn = {1532-5415}, doi = {10.1111/jgs.14202}, url = {http://www.ncbi.nlm.nih.gov/pubmed/27303932}, author = {Linos, Eleni and Chren, Mary-Margaret and Irena Cenzer and Kenneth E Covinsky} } @article {8241, title = {Comorbidity and functional trajectories from midlife to old age: the Health and Retirement Study.}, journal = {J Gerontol A Biol Sci Med Sci}, volume = {70}, year = {2015}, month = {2015 Mar}, pages = {332-8}, publisher = {70}, abstract = {

BACKGROUND: The number of diseases and physical functioning difficulties tend to increase with age. The aim of this study was to examine the trajectories of physical functioning across age groups and whether the trajectories differ according to disease status in different population subgroups.

METHODS: Repeat data from a nationally representative population sample, the Health and Retirement Study, was used. Participants were 10,709 men and 13,477 women aged 60-107 years at baseline with biennial surveys from 1992 to 2010. Average length of follow-up was 10.3 years ranging from 0 to 18 years. Disease status and physical functioning was asked about at all study phases and 10 items were summed to obtain a physical functioning score (0-10).

RESULTS: Age modified the relationship between number of chronic diseases and physical functioning with older participants having more physical functioning difficulties with increasing number of diseases. An average 70-year-old participant with no diseases had 0.89 (95\% CI: 0.85-0.93) physical functioning difficulties, with one disease 1.72 (95\% CI: 1.69-1.76) difficulties, with two diseases 2.57 (95\% CI: 2.52-2.62) difficulties, and with three or more diseases 3.82 (95\% CI: 3.76-3.88) difficulties. Of the individual diseases memory-related diseases, stroke, pulmonary diseases, and arthritis were associated with significantly higher physical functioning difficulties compared with other diseases.

CONCLUSIONS: Comorbidity is associated with greater burden of physical functioning difficulties. Of the studied diseases, memory-related diseases, stroke, pulmonary diseases, and arthritis alone or in combination limit most physical functioning.

}, keywords = {Activities of Daily Living, Age Factors, Aged, Aged, 80 and over, Chronic disease, Comorbidity, Female, Health Status, Humans, Longitudinal Studies, Male, Middle Aged, Retirement, Socioeconomic factors, United States}, issn = {1758-535X}, doi = {10.1093/gerona/glu113}, url = {http://biomedgerontology.oxfordjournals.org/content/early/2014/07/23/gerona.glu113.abstract}, author = {Stenholm, Sari and Westerlund, Hugo and Head, Jenny and Hyde, Martin and Ichiro Kawachi and Pentti, Jaana and Mika Kivim{\"a}ki and Vahtera, Jussi} } @article {8313, title = {Functional impairment and hospital readmission in Medicare seniors.}, journal = {JAMA Intern Med}, volume = {175}, year = {2015}, note = {Times Cited: 0 0}, month = {2015 Apr}, pages = {559-65}, publisher = {175}, abstract = {

IMPORTANCE: Medicare currently penalizes hospitals for high readmission rates for seniors but does not account for common age-related syndromes, such as functional impairment.

OBJECTIVE: To assess the effects of functional impairment on Medicare hospital readmissions given the high prevalence of functional impairments in community-dwelling seniors.

DESIGN, SETTING, AND PARTICIPANTS: We created a nationally representative cohort of 7854 community-dwelling seniors in the Health and Retirement Study, with 22,289 Medicare hospitalizations from January 1, 2000, through December 31, 2010.

MAIN OUTCOMES AND MEASURES: Outcome was 30-day readmission assessed by Medicare claims. The main predictor was functional impairment determined from the Health and Retirement Study interview preceding hospitalization, stratified into the following 5 levels: no functional impairments, difficulty with 1 or more instrumental activities of daily living, difficulty with 1 or more activities of daily living (ADL), dependency (need for help) in 1 to 2 ADLs, and dependency in 3 or more ADLs. Adjustment variables included age, race/ethnicity, sex, annual income, net worth, comorbid conditions (Elixhauser score from Medicare claims), and prior admission. We performed multivariable logistic regression to adjust for clustering at the patient level to characterize the association of functional impairments and readmission.

RESULTS: Patients had a mean (SD) age of 78.5 (7.7) years (range, 65-105 years); 58.4\% were female, 84.9\% were white, 89.6\% reported 3 or more comorbidities, and 86.0\% had 1 or more hospitalizations in the previous year. Overall, 48.3\% had some level of functional impairment before admission, and 15.5\% of hospitalizations were followed by readmission within 30 days. We found a progressive increase in the adjusted risk of readmission as the degree of functional impairment increased: 13.5\% with no functional impairment, 14.3\% with difficulty with 1 or more instrumental activities of daily living (odds ratio [OR], 1.06; 95\% CI, 0.94-1.20), 14.4\% with difficulty with 1 or more ADL (OR, 1.08; 95\% CI, 0.96-1.21), 16.5\% with dependency in 1 to 2 ADLs (OR, 1.26; 95\% CI, 1.11-1.44), and 18.2\% with dependency in 3 or more ADLs (OR, 1.42; 95\% CI, 1.20-1.69). Subanalysis restricted to patients admitted with conditions targeted by Medicare (ie, heart failure, myocardial infarction, and pneumonia) revealed a parallel trend with larger effects for the most impaired (16.9\% readmission rate for no impairment vs 25.7\% for dependency in 3 or more ADLs [OR, 1.70; 95\% CI, 1.04-2.78]).

CONCLUSIONS AND RELEVANCE: Functional impairment is associated with increased risk of 30-day all-cause hospital readmission in Medicare seniors, especially those admitted for heart failure, myocardial infarction, or pneumonia. Functional impairment may be an important but underaddressed factor in preventing readmissions for Medicare seniors.

}, keywords = {Activities of Daily Living, Age Factors, Aged, Aged, 80 and over, Cohort Studies, Comorbidity, Female, Heart Failure, Humans, Income, Logistic Models, Male, Medicare, Myocardial Infarction, Patient Readmission, Pneumonia, Risk Assessment, Risk Factors, Sex Factors, United States}, issn = {2168-6114}, doi = {10.1001/jamainternmed.2014.7756}, author = {S. Ryan Greysen and Irena Cenzer and Andrew D. Auerbach and Kenneth E Covinsky} } @article {8154, title = {Multimorbidity redefined: prospective health outcomes and the cumulative effect of co-occurring conditions.}, journal = {Prev Chronic Dis}, volume = {12}, year = {2015}, note = {Times Cited: 0 0}, month = {2015 Apr 23}, pages = {E55}, publisher = {12}, abstract = {

INTRODUCTION: Multimorbidity is common among middle-aged and older adults; however the prospective effects of multimorbidity on health outcomes (health status, major health decline, and mortality) have not been fully explored. This study addresses this gap in the literature.

METHODS: We used self-reported data from the 2008 and 2010 Health and Retirement Study. Our study population included 13,232 adults aged 50 or older. Our measure of baseline multimorbidity in 2008 was based on the occurrence or co-occurrence of chronic conditions, functional limitations, and/or geriatric syndromes, as follows: MM0, no chronic conditions, functional limitations, or geriatric syndromes; MM1, occurrence (but no co-occurrence) of chronic conditions, functional limitations, or geriatric syndromes; MM2, co-occurrence of any 2 of chronic conditions, functional limitations, or geriatric syndromes; and MM3, co-occurrence of all 3 of chronic conditions, functional limitations, and geriatric syndromes. Outcomes in 2010 included fair or poor health status, major health decline, and mortality.

RESULTS: All 3 outcomes were significantly associated with multimorbidity. Compared with MM0 (respectively for fair or poor health and major health decline), the adjusted odds ratios (AORs) and 95\% confidence intervals were as follows: 2.61 (1.79-3.78) and 2.20 (1.42-3.41) for MM1; 7.49 (5.20-10.77) and 3.70 (2.40-5.71) for MM2; and 22.66 (15.64-32.83) and 4.72 (3.03-7.37) for MM3. Multimorbidity was also associated with mortality: an adult classified as MM3 was nearly 12 times (AOR, 11.87 [5.72-24.62]) as likely as an adult classified as MM0 to die within 2 years.

CONCLUSION: Given the strong and significant association between multimorbidity and prospective health status, major health decline, and mortality, multimorbidity may be used - both in clinical practice and in research - to identify older adults with heightened vulnerability for adverse outcomes.

}, keywords = {Aged, Aged, 80 and over, Alcohol Drinking, Body Mass Index, Chronic disease, Cognition Disorders, Comorbidity, Cross-Sectional Studies, Data Interpretation, Statistical, ethnicity, Female, Health Status Indicators, Humans, Interviews as Topic, Male, Middle Aged, Mobility Limitation, Outcome Assessment, Health Care, Prospective Studies, Recurrence, Retirement, Self Report, Smoking, Social Class, Syndrome, United States, Vulnerable Populations}, issn = {1545-1151}, doi = {10.5888/pcd12.140478}, author = {Siran M Koroukian and David F Warner and Owusu, Cynthia and Charles W Given} } @article {8142, title = {Depression and risk of hospitalization for pneumonia in a cohort study of older Americans.}, journal = {J Psychosom Res}, volume = {77}, year = {2014}, note = {Times Cited: 0 0}, month = {2014 Dec}, pages = {528-34}, publisher = {77}, abstract = {

OBJECTIVE: The aim of this study is to determine if depression is independently associated with risk of hospitalization for pneumonia after adjusting for demographics, medical comorbidity, health-risk behaviors, baseline cognition and functional impairments.

METHODS: This secondary analysis of prospectively collected data examined a population-based sample of 6704 Health and Retirement Study (HRS) (1998-2008) participants>50years old who consented to have their interviews linked to their Medicare claims and were without a dementia diagnosis. The eight-item Center for Epidemiologic Studies Depression Scale and/or International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) depression diagnoses were used to identify baseline depression. ICD-9-CM diagnoses were used to identify hospitalizations for which the principal discharge diagnosis was for bacterial or viral pneumonia. The odds of hospitalization for pneumonia for participants with depression relative to those without depression were estimated using logistic regression models. Population attributable fractions were calculated to determine the extent that hospitalizations for pneumonia could be attributable to depression.

RESULTS: After adjusting for demographic characteristics, clinical factors, and health-risk behaviors, depression was independently associated with increased odds of hospitalization for pneumonia (odds ratio [OR]: 1.28, 95\% confidence interval [95\%CI]: 1.08, 1.53). This association persisted after adjusting for baseline cognition and functional impairments (OR: 1.24, 95\%CI: 1.03, 1.50). In this cohort, 6\% (95\%CI: 2\%, 10\%) of hospitalizations for pneumonia were potentially attributable to depression.

CONCLUSION: Depression is independently associated with increased odds of hospitalization for pneumonia. This study provides additional rationale for integrating mental health care into medical settings in order to improve outcomes for older adults.

}, keywords = {Aged, Aged, 80 and over, Cohort Studies, Comorbidity, depression, Depressive Disorder, Female, Hospitalization, Humans, Logistic Models, Male, Middle Aged, Odds Ratio, Pneumonia, Risk Assessment, Risk Factors, United States}, issn = {1879-1360}, doi = {10.1016/j.jpsychores.2014.08.002}, author = {Dimitry S Davydow and Catherine L Hough and Zivin, Kara and Kenneth M. Langa and Wayne J Katon} } @article {8053, title = {Obesity and 1-year outcomes in older Americans with severe sepsis.}, journal = {Crit Care Med}, volume = {42}, year = {2014}, note = {Export Date: 21 April 2014 Source: Scopus Article in Press}, month = {2014 Aug}, pages = {1766-74}, publisher = {42}, abstract = {

OBJECTIVES: Although critical care physicians view obesity as an independent poor prognostic marker, growing evidence suggests that obesity is, instead, associated with improved mortality following ICU admission. However, this prior empirical work may be biased by preferential admission of obese patients to ICUs, and little is known about other patient-centered outcomes following critical illness. We sought to determine whether 1-year mortality, healthcare utilization, and functional outcomes following a severe sepsis hospitalization differ by body mass index.

DESIGN: Observational cohort study.

SETTING: U.S. hospitals.

PATIENTS: We analyzed 1,404 severe sepsis hospitalizations (1999-2005) among Medicare beneficiaries enrolled in the nationally representative Health and Retirement Study, of which 597 (42.5\%) were normal weight, 473 (33.7\%) were overweight, and 334 (23.8\%) were obese or severely obese, as assessed at their survey prior to acute illness. Underweight patients were excluded a priori.

INTERVENTIONS: None.

MEASUREMENTS AND MAIN RESULTS: Using Medicare claims, we identified severe sepsis hospitalizations and measured inpatient healthcare facility use and calculated total and itemized Medicare spending in the year following hospital discharge. Using the National Death Index, we determined mortality. We ascertained pre- and postmorbid functional status from survey data. Patients with greater body mass indexes experienced lower 1-year mortality compared with nonobese patients, and there was a dose-response relationship such that obese (odds ratio = 0.59; 95\% CI, 0.39-0.88) and severely obese patients (odds ratio = 0.46; 95\% CI, 0.26-0.80) had the lowest mortality. Total days in a healthcare facility and Medicare expenditures were greater for obese patients (p < 0.01 for both comparisons), but average daily utilization (p = 0.44) and Medicare spending were similar (p = 0.65) among normal, overweight, and obese survivors. Total function limitations following severe sepsis did not differ by body mass index category (p = 0.64).

CONCLUSIONS: Obesity is associated with improved mortality among severe sepsis patients. Due to longer survival, obese sepsis survivors use more healthcare and result in higher Medicare spending in the year following hospitalization. Median daily healthcare utilization was similar across body mass index categories.

}, keywords = {Aged, Aged, 80 and over, Body Mass Index, Cohort Studies, Comorbidity, Critical Illness, Delivery of Health Care, Female, Health Expenditures, Hospitalization, Humans, Male, Medicare, Middle Aged, Obesity, Sepsis, Survival Rate, Survivors, United States}, issn = {1530-0293}, doi = {10.1097/CCM.0000000000000336}, author = {Hallie C Prescott and Virginia W Chang and James M. O{\textquoteright}Brien Jr and Kenneth M. Langa and Theodore J Iwashyna} } @article {7683, title = {Burden of cirrhosis on older Americans and their families: analysis of the health and retirement study.}, journal = {Hepatology}, volume = {55}, year = {2012}, month = {2012 Jan}, pages = {184-91}, publisher = {55}, abstract = {

UNLABELLED: Prevalence of cirrhosis among older adults is expected to increase; therefore, we studied the health status, functional disability, and need for supportive care in a large national sample of individuals with cirrhosis. A prospective cohort of individuals with cirrhosis was identified within the longitudinal, nationally representative Health and Retirement Study. Cirrhosis cases were identified in linked Medicare data via ICD-9-CM (International Classification of Diseases, Ninth Revision, Clinical Modification) codes and compared to an age-matched cohort without cirrhosis. Two primary outcome domains were assessed: (1) patients{\textquoteright} health status (perceived health status, comorbidities, health care utilization, and functional disability as determined by activities of daily living and instrumental activities of daily living), and (2) informal caregiving (hours of caregiving provided by a primary informal caregiver and associated cost). Adjusted negative binomial regression was used to assess the association between cirrhosis and functional disability. A total of 317 individuals with cirrhosis and 951 age-matched comparators were identified. Relative to the comparison group, individuals with cirrhosis had worse self-reported health status, more comorbidities, and used significantly more health care services (hospitalizations, nursing home stays, physician visits; P < 0.001 for all bivariable comparisons). They also had greater functional disability (P < 0.001 for activities of daily living and instrumental activities of daily living), despite adjustment for covariates such as comorbidities and health care utilization. Individuals with cirrhosis received more than twice the number of informal caregiving hours per week (P < 0.001), at an annual cost of US $4700 per person.

CONCLUSION: Older Americans with cirrhosis have high rates of disability, health care utilization, and need for informal caregiving. Improved care coordination and caregiver support is necessary to optimize management of this frail population.

}, keywords = {Aged, Black People, Caregivers, Comorbidity, Cost of Illness, Databases, Factual, Disability Evaluation, Female, Health Care Costs, Health Status, Hispanic or Latino, Humans, Incidence, Liver Cirrhosis, Male, Medicaid, Medicare, Prevalence, Prospective Studies, Retirement, United States, White People}, issn = {1527-3350}, doi = {10.1002/hep.24616}, author = {M. O. Rakoski and Ryan J McCammon and John D Piette and Theodore J Iwashyna and J. A. Marrero and Lok, Anna S and Kenneth M. Langa and Volk, Michael L} } @article {7775, title = {Clinical complexity and mortality in middle-aged and older adults with diabetes.}, journal = {J Gerontol A Biol Sci Med Sci}, volume = {67}, year = {2012}, month = {2012 Dec}, pages = {1313-20}, publisher = {67}, abstract = {

BACKGROUND: Middle-aged and older adults with diabetes are heterogeneous and may be characterized as belonging to one of three clinical groups: a relatively healthy group, a group having characteristics likely to make diabetes self-management difficult, and a group with poor health status for whom current management targets have uncertain benefit.

METHODS: We analyzed waves 2004-2008 of the Health and Retirement Study and the supplemental Health and Retirement Study 2003 Diabetes Study. The sample included adults with diabetes 51 years and older (n = 3,507, representing 13.6 million in 2004). We investigated the mortality outcomes for the three clinical groups, using survival analysis and Cox proportional hazard models.

RESULTS: The 5-year survival probabilities were Relatively Healthy Group, 90.8\%; Self-Management Difficulty Group, 79.4\%; and Uncertain Benefit Group, 52.5\%. For all age groups and clinical groups, except those 76 years and older in the Uncertain Benefit Group, survival exceeded 50\%.

CONCLUSIONS: This study reveals the substantial survival of middle-aged and older adults with diabetes, regardless of health status. These findings have implications for the clinical management of and future research about diabetes patients with multiple comorbidities.

}, keywords = {Activities of Daily Living, Aged, Comorbidity, Diabetes Complications, Diabetes Mellitus, Female, Health Status, Humans, Male, Middle Aged, Proportional Hazards Models, Self Care}, issn = {1758-535X}, doi = {10.1093/gerona/gls095}, author = {Christine T Cigolle and Mohammed U Kabeto and Pearl G. Lee and Caroline S Blaum} } @article {7739, title = {Limited lung function: impact of reduced peak expiratory flow on health status, health-care utilization, and expected survival in older adults.}, journal = {Am J Epidemiol}, volume = {176}, year = {2012}, note = {Roberts, Melissa H Mapel, Douglas W United States Am J Epidemiol. 2012 Jul 15;176(2):127-34. Epub 2012 Jun 28.}, month = {2012 Jul 15}, pages = {127-34}, publisher = {176}, abstract = {

The authors examined whether peak expiratory flow (PEF) is a valid measure of health status in older adults. Survey and test data from the 2006 and 2008 cycles of the Health and Retirement Study, a longitudinal study of US adults over age 50 years (with biennial surveys initiated in 1992), were used to develop predicted PEF regression models and to examine relations between low PEF values and other clinical factors. Low PEF (<80\% of predicted value) was prevalent among persons with chronic conditions, including frequent pain, obstructive lung disease, heart disease, diabetes, and psychological distress. Persons with higher physical disability scores had substantially higher adjusted odds of having low PEF, on par with those for conditions known to be associated with poor health (cancer, heart disease, and stroke). In a multivariate regression model for difficulty with mobility, PEF remained an independent factor (odds ratio (OR) = 1.69, 95\% confidence interval (CI): 1.53, 1.86). Persons with low PEF in 2006 were more likely to be hospitalized (OR = 1.26, 95\% CI: 1.10, 1.43) within the subsequent 2 years and to estimate their chances of surviving for 10 or more years at less than 50\% (OR = 1.69, 95\% CI: 1.24, 2.30). PEF is a valid measure of health status in older persons, and low PEF is an independent predictor of hospitalization and poor subjective mortality assessment.

}, keywords = {Activities of Daily Living, Aged, Chronic disease, Cohort Studies, Comorbidity, Diabetes Mellitus, Female, Health Services, Health Status, Heart Diseases, Hospitalization, Humans, Incidence, Logistic Models, Longitudinal Studies, Lung Diseases, Male, Middle Aged, Neoplasms, Odds Ratio, Peak Expiratory Flow Rate, Population Surveillance, Stroke, United States}, issn = {1476-6256}, doi = {10.1093/aje/kwr503}, author = {Melissa H. Roberts and Douglas W Mapel} } @article {7710, title = {Predictors of self-report of heart failure in a population-based survey of older adults.}, journal = {Circ Cardiovasc Qual Outcomes}, volume = {5}, year = {2012}, month = {2012 May}, pages = {396-402}, publisher = {5}, abstract = {

BACKGROUND: Little research has been conducted on the predictors of self-report or patient awareness of heart failure (HF) in a population-based survey. The objective of this study was to (1) test the agreement between Medicare administrative and Health and Retirement Study (HRS) survey data and (2) determine predictors associated with self-report of HF, using a validated Medicare claims algorithm as the reference standard. We hypothesized that those who self-reported HF were more likely to have a higher number of HF-related claims.

METHODS AND RESULTS: Secondary data analysis was conducted using the 2004 wave of the HRS linked to 2002 to 2004 Medicare claims (n=5573 respondents aged >= 67 years). Concordance between self-report of HF in the HRS and Medicare claims was calculated. Logistic regression was performed to identify predictors associated with self-report HF. HF prevalence by self-report was 4.6\%. Self-report of HF and claims agreement was 87\% (κ=0.34). The presence of >1 HF inpatient claims was associated with greater odds of self-report (odds ratio [OR], 1.92; 95\% CI, 1.23-3.00). Greater odds of self-reporting HF was also associated with >= 4 HF claims (OR, 2.74; 95\% CI, 1.36-5.52). Blacks (OR, 0.28; 95\% CI, 0.14-0.55) and Hispanics (OR, 0.30; 95\% CI, 0.11-0.83) were less likely to self-report HF compared with whites in the final model.

CONCLUSIONS: Self-report of HF is an insensitive method for accurately identifying HF cases, especially in those with less-severe disease and who are nonwhite. There may be limited awareness of HF among older minority patients despite having clinical encounters during which HF is coded as a diagnosis.

}, keywords = {Age Factors, Aged, Aged, 80 and over, Algorithms, Awareness, Chi-Square Distribution, Comorbidity, Female, Health Knowledge, Attitudes, Practice, Health Status, Health Surveys, Heart Failure, Humans, Insurance Claim Review, Logistic Models, Male, Medicare, Odds Ratio, Patients, Predictive Value of Tests, Self Report, Socioeconomic factors, United States}, issn = {1941-7705}, doi = {10.1161/CIRCOUTCOMES.111.963116}, author = {Tanya R Gure and Ryan J McCammon and Christine T Cigolle and Todd M Koelling and Caroline S Blaum and Kenneth M. Langa} } @article {7712, title = {Spurious inferences about long-term outcomes: the case of severe sepsis and geriatric conditions.}, journal = {Am J Respir Crit Care Med}, volume = {185}, year = {2012}, note = {Iwashyna, Theodore J Netzer, Giora Langa, Kenneth M Cigolle, Christine K08 AG031837/AG/NIA NIH HHS/ K08 HL091249/HL/NHLBI NIH HHS/ K12 RR023250/RR/NCRR NIH HHS/ P30-AG028747/AG/NIA NIH HHS/ P60 DK-20572/DK/NIDDK NIH HHS/ R01 AG030155/AG/NIA NIH HHS/ U01 AG09740/AG/NIA NIH HHS/ UL1RR024986/RR/NCRR NIH HHS/ Am J Respir Crit Care Med. 2012 Apr 15;185(8):835-41. Epub 2012 Feb 9.}, month = {2012 Apr 15}, pages = {835-41}, publisher = {185}, abstract = {

RATIONALE: Survivors of critical illness suffer significant limitations and disabilities.

OBJECTIVES: Ascertain whether severe sepsis is associated with increased risk of so-called geriatric conditions (injurious falls, low body mass index [BMI], incontinence, vision loss, hearing loss, and chronic pain) and whether this association is measured consistently across three different study designs.

METHODS: Patients with severe sepsis were identified in the Health and Retirement Study, a nationally representative cohort interviewed every 2 years, 1998 to 2006, and in linked Medicare claims. Three comparators were used to assess an association of severe sepsis with geriatric conditions in survivors: the prevalence in the United States population aged 65 years and older, survivors{\textquoteright} own pre-sepsis levels assessed before hospitalization, or survivors{\textquoteright} own pre-sepsis trajectory.

MEASUREMENTS AND MAIN RESULTS: Six hundred twenty-three severe sepsis hospitalizations were followed a median of 0.92 years. When compared with the 65 years and older population, surviving severe sepsis was associated with increased rates of low BMI, injurious falls, incontinence, and vision loss. Results were similar when comparing survivors to their own pre-sepsis levels. The association of low BMI and severe sepsis persisted when controlling for patients{\textquoteright} pre-sepsis trajectories, but there was no association of severe sepsis with injurious falls, incontinence, vision loss, hearing loss, and chronic pain after such controls.

CONCLUSIONS: Geriatric conditions are common after severe sepsis. However, severe sepsis is associated with increased rates of only a subset of geriatric conditions, not all. In studying outcomes after acute illness, failing to measure and control for both preillness levels and trajectories may result in erroneous conclusions.

}, keywords = {Aged, Aged, 80 and over, Body Mass Index, Chronic pain, Cohort Studies, Comorbidity, Critical Illness, Disabled Persons, disease progression, Female, Geriatric Assessment, Hearing Disorders, Hospitalization, Humans, Incidence, Male, Musculoskeletal Diseases, Prognosis, Retrospective Studies, Risk Assessment, Sepsis, Survival Analysis, Survivors, Thinness, Time, Treatment Outcome, Urinary incontinence, Vision Disorders}, issn = {1535-4970}, doi = {10.1164/rccm.201109-1660OC}, author = {Theodore J Iwashyna and Netzer, Giora and Kenneth M. Langa and Christine T Cigolle} } @article {7711, title = {Triggers of hospitalization for venous thromboembolism.}, journal = {Circulation}, volume = {125}, year = {2012}, note = {Rogers, Mary A M Levine, Deborah A Blumberg, Neil Flanders, Scott A Chopra, Vineet Langa, Kenneth M 5R21HL093129-02/HL/NHLBI NIH HHS/ R01 HL095467/HL/NHLBI NIH HHS/ U01AG009740/AG/NIA NIH HHS/ Circulation. 2012 May 1;125(17):2092-9. Epub 2012 Apr 3.}, month = {2012 May 01}, pages = {2092-9}, publisher = {125}, abstract = {

BACKGROUND: The rate of hospitalization for venous thromboembolism (VTE) is increasing in the United States. Although predictors of hospital-acquired VTE are well-known, triggers of VTE before hospitalization are not as clearly defined. The objective of this study was to evaluate triggers of hospitalization for VTE.

METHODS AND RESULTS: A case-crossover study was conducted. Subjects were participants in the Health and Retirement Study, a nationally representative sample of older Americans. Data were linked to Medicare files for hospital and nursing home stays, emergency department visits, outpatient visits including physician visits, and home health visits from years 1991 to 2007 (n=16 781). The outcome was hospitalization for venous thromboembolism (n=399). Exposures during the 90-day period before hospitalization for VTE were compared with exposures occurring in 4 comparison periods. Infection was the most common trigger of hospitalization for VTE, occurring in 52.4\% of the risk periods before hospitalization. The adjusted incidence rate ratios (IRRs; 95\% confidence interval) were 2.90 (2.13, 3.94) for all infection, 2.63 (1.90, 3.63) for infection without a previous hospital or skilled nursing facility stay, and 6.92 (4.46, 10.72) for infection with a previous hospital or skilled nursing facility stay. Erythropoiesis-stimulating agents and blood transfusion were also associated with VTE hospitalization (IRR=9.33, 95\% confidence interval: 1.19, 73.42; IRR=2.57, 95\% confidence interval: 1.17, 5.64; respectively). Other predictors included major surgeries, fractures (IRR=2.81), immobility (IRR=4.23), and chemotherapy (IRR=5.70). These predictors, combined, accounted for a large proportion (69.7\%) of exposures before VTE hospitalization as opposed to 35.3\% in the comparison periods.

CONCLUSIONS: Risk prediction algorithms for VTE should be reevaluated to include infection, erythropoiesis-stimulating agents, and blood transfusion.

}, keywords = {Aged, Ambulatory Care Facilities, Comorbidity, Cross-Over Studies, Emergency Service, Hospital, Female, Hematinics, Home Care Services, Hospitalization, Humans, Immobilization, Incidence, Infections, Male, Medicare, Middle Aged, Office Visits, Postoperative Complications, Pulmonary Embolism, Risk Factors, Skilled Nursing Facilities, Transfusion Reaction, United States, Venous Thrombosis}, issn = {1524-4539}, doi = {10.1161/CIRCULATIONAHA.111.084467}, url = {http://www.ncbi.nlm.nih.gov/pubmed/22474264}, author = {Mary A M Rogers and Deborah A Levine and Neil Blumberg and Scott A Flanders and Vineet Chopra and Kenneth M. Langa} } @article {7646, title = {Consequences of stroke in community-dwelling elderly: the health and retirement study, 1998 to 2008.}, journal = {Stroke}, volume = {42}, year = {2011}, note = {Divani, Afshin A Majidi, Shahram Barrett, Anna M Noorbaloochi, Siamak Luft, Andreas R K24 HD062647-01/HD/NICHD NIH HHS/United States K24 HD062647-02/HD/NICHD NIH HHS/United States K24HD062647/HD/NICHD NIH HHS/United States R01 NS055808/NS/NINDS NIH HHS/United States R01 NS055808-01A2/NS/NINDS NIH HHS/United States R01 NS055808-02/NS/NINDS NIH HHS/United States R01 NS055808-03/NS/NINDS NIH HHS/United States R01 NS055808-04/NS/NINDS NIH HHS/United States Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov{\textquoteright}t United States Stroke; a journal of cerebral circulation Nihms297056 Stroke. 2011 Jul;42(7):1821-5. Epub 2011 May 19.}, month = {2011 Jul}, pages = {1821-5}, publisher = {42}, abstract = {

BACKGROUND AND PURPOSE: Stroke survivors are at risk of developing comorbidities that further reduce their quality of life. The purpose of this study was to determine the risk of developing a secondary health problem after stroke.

METHODS: We performed a case-control analysis using 6 biennial interview waves (1998 to 2008) of the Health and Retirement Study. We compared 631 noninstitutionalized individuals who had a single stroke with 631 control subjects matched for age, gender, and interview wave. We studied sleep problems, urinary incontinence, motor impairment, falls, and memory deficits among the 2 groups.

RESULTS: Stroke survivors frequently developed new or worsened motor impairment (33\%), sleep problems (up to 33\%), falls (30\%), urinary incontinence (19\%), and memory deficits (9\%). As compared with control subjects, the risk of developing a secondary health problem was highest for memory deficits (OR, 2.45; 95\% CI, 1.34 to 4.46) followed by urinary incontinence (OR, 1.86; 95\% CI, 1.31 to 2.66), motor impairment (OR, 1.61; 95\% CI, 1.16 to 2.24), falls (OR, 1.5; 95\% CI, 1.12 to 2.0), and sleep disturbances (OR, 1.49; 95\% CI, 1.09 to 2.03). In contrast, stroke survivors were not more likely to injure themselves during a fall (OR, 1.14; 95\% CI, 0.72 to 1.79). After adjusting for cardiovascular risk factors, social status, psychiatric symptoms, and pain, the risks of falling or developing sleep problems were not different from the control subjects.

CONCLUSIONS: The risk of developing a secondary health problem that can impact daily life is markedly increased after stroke. A better understanding of frequencies and risks for secondary health problems after stroke is necessary for designing better preventive and rehabilitation strategies.

}, keywords = {Activities of Daily Living, Aged, Case-Control Studies, Cohort Studies, Comorbidity, Female, Geriatrics, Humans, Male, Quality of Life, Retirement, Risk, Social Environment, Stroke}, issn = {1524-4628}, doi = {10.1161/STROKEAHA.110.607630}, author = {Afshin A Divani and Shahram Majidi and Anna M Barrett and Noorbaloochi, Siamak and Andreas R Luft} } @article {7650, title = {Lifecourse socioeconomic circumstances and multimorbidity among older adults.}, journal = {BMC Public Health}, volume = {11}, year = {2011}, note = {Tucker-Seeley, Reginald D Li, Yi Sorensen, Glorian Subramanian, S V England BMC public health BMC Public Health. 2011 May 14;11:313.}, month = {2011 May 14}, pages = {313}, publisher = {11}, abstract = {

BACKGROUND: Many older adults manage multiple chronic conditions (i.e. multimorbidity); and many of these chronic conditions share common risk factors such as low socioeconomic status (SES) in adulthood and low SES across the lifecourse. To better capture socioeconomic condition in childhood, recent research in lifecourse epidemiology has broadened the notion of SES to include the experience of specific hardships. In this study we investigate the association among childhood financial hardship, lifetime earnings, and multimorbidity.

METHODS: Cross-sectional analysis of 7,305 participants age 50 and older from the 2004 Health and Retirement Study (HRS) who also gave permission for their HRS records to be linked to their Social Security Records in the United States. Zero-inflated Poisson regression models were used to simultaneously model the likelihood of the absence of morbidity and the expected number of chronic conditions.

RESULTS: Childhood financial hardship and lifetime earnings were not associated with the absence of morbidity. However, childhood financial hardship was associated with an 8\% higher number of chronic conditions; and, an increase in lifetime earnings, operationalized as average annual earnings during young and middle adulthood, was associated with a 5\% lower number of chronic conditions reported. We also found a significant interaction between childhood financial hardship and lifetime earnings on multimorbidity.

CONCLUSIONS: This study shows that childhood financial hardship and lifetime earnings are associated with multimorbidity, but not associated with the absence of morbidity. Lifetime earnings modified the association between childhood financial hardship and multimorbidity suggesting that this association is differentially influential depending on earnings across young and middle adulthood. Further research is needed to elucidate lifecourse socioeconomic pathways associated with the absence of morbidity and the presence of multimorbidity among older adults.

}, keywords = {Aged, Chronic disease, Comorbidity, Cross-Sectional Studies, Female, Humans, Male, Middle Aged, Social Class, United States}, issn = {1471-2458}, doi = {10.1186/1471-2458-11-313}, author = {Reginald D. Tucker-Seeley and Li, Yi and Sorensen, Glorian and Subramanian, S V} } @article {7609, title = {Memory predicts changes in depressive symptoms in older adults: a bidirectional longitudinal analysis.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {66}, year = {2011}, month = {2011 Sep}, pages = {571-81}, publisher = {66B}, abstract = {

OBJECTIVES: Although research indicates that depressive symptoms and memory performance are related in older adults, the temporal associations between these variables remain unclear. This study examined whether depressive symptoms predicted later memory change and whether memory predicted later change in depressive symptoms.

METHODS: The sample consisted of more than 14,000 adults from the Health and Retirement Study, a biannual longitudinal study of health and retirement in Americans older than age 50 years. Measures of delayed recall and depressive symptoms served as the main study variables. We included age, sex, education, and history of vascular diseases as covariates.

RESULTS: Using dynamic change models with latent difference scores, we found that memory performance predicted change in depressive symptoms 2 years later. Depressive symptoms did not predict later change in memory. The inclusion of vascular health variables diminished the size of the observed relationship, suggesting that biological processes may partially explain the effect of memory on depressive symptoms.

IMPLICATIONS: Future research should explore both biological and psychological processes that may explain the association between worse memory performance and subsequent increases in depressive symptoms.

}, keywords = {Aged, Aged, 80 and over, Comorbidity, Dementia, Vascular, depression, Female, Geriatric Assessment, Humans, Longitudinal Studies, Male, Mental Recall, Middle Aged, Models, Psychological, Retirement, Statistics as Topic, United States}, issn = {1758-5368}, doi = {10.1093/geronb/gbr035}, author = {Jajodia, Archana and Borders, Ashley} } @article {7565, title = {Sources of variability in estimates of the prevalence of Alzheimer{\textquoteright}s disease in the United States.}, journal = {Alzheimers Dement}, volume = {7}, year = {2011}, month = {2011 Jan}, pages = {74-9}, publisher = {7}, abstract = {

BACKGROUND: The prevalence of Alzheimer{\textquoteright}s disease (AD) in the United States was estimated at 2.3 million in 2002 by the Aging, Demographics, and Memory Study (ADAMS), which is almost 50\% less than the estimate of 4.5 million in 2000 derived from the Chicago Health and Aging Project.

METHODS: We considered how differences in diagnostic criteria may have contributed to these differences in AD prevalence.

RESULTS: We identified several important differences in diagnostic criteria that may have contributed to the differing estimates of AD prevalence. Two factors were especially noteworthy. First, the Diagnostic and Statistical Manual of Mental Disorders III-R and IV criteria of functional limitation documented by an informant used in ADAMS effectively concentrated the diagnosis of dementia toward a relatively higher level of cognitive impairment. ADAMS separately identified a category of cognitive impairment not dementia and within that group there were a substantial number of cases with "prodromal" AD (a maximum of 1.95 million with upweighting). Second, a substantial proportion of dementia in ADAMS was attributed to either vascular disease (representing a maximum of 0.59 million with upweighting) or undetermined etiology (a maximum of 0.34 million), whereas most dementia, including mixed dementia, was attributed to AD in the Chicago Health and Aging Project.

CONCLUSION: The diagnosis of AD in population studies is a complex process. When a diagnosis of AD excludes persons meeting criteria for vascular dementia, when not all persons with dementia are assigned an etiology, and when a diagnosis of dementia requires an informant report of functional limitations, the prevalence is substantially lower and the diagnosed cases most likely have a relatively higher level of impairment.

}, keywords = {Aged, Aged, 80 and over, Alzheimer disease, Community Health Planning, Comorbidity, Dementia, Diagnosis, Differential, Female, Humans, Incidence, Male, Prevalence, United States}, issn = {1552-5279}, doi = {10.1016/j.jalz.2010.11.006}, author = {Robert S Wilson and David R Weir and Sue E Leurgans and Denis A Evans and Liesi Hebert and Kenneth M. Langa and Brenda L Plassman and Brent J. Small and David A Bennett} } @article {7654, title = {Subsidized housing not subsidized health: health status and fatigue among elders in public housing and other community settings.}, journal = {Ethn Dis}, volume = {21}, year = {2011}, note = {Parsons, Pamela L Mezuk, Briana Ratliff, Scott Lapane, Kate L K12 HD055881/HD/NICHD NIH HHS/United States UL1 RR031990-01/RR/NCRR NIH HHS/United States UL1RR031990/RR/NCRR NIH HHS/United States Comparative Study Research Support, N.I.H., Extramural United States Ethnicity and disease Nihms287854 Ethn Dis. 2011 Winter;21(1):85-90.}, month = {2011 Winter}, pages = {85-90}, publisher = {21}, abstract = {

OBJECTIVES: To estimate trends in the prevalence of fatigue among elders living in public housing or in the community; to compare health status of elders living in public housing to their community-dwelling counterparts.

DESIGN: Cross-sectional study.

SETTING: Community-dwelling elders who reported ever residing in public housing were compared to those living in other community settings.

PARTICIPANTS: Participants of the Health and Retirement Study (seven waves of interviews conducted from 1995 through 2006) interviewed in 2006 with complete data on housing status, self-report measures of health status and measures of functioning (n = 16,191).

MEASUREMENTS: Self-reported fatigue, functioning, and other health conditions. We also evaluated four functional indices: overall mobility, large muscle functioning, gross motor functioning, and fine motor functioning.

RESULTS: Those reporting having lived in public housing were twice as likely to rate their health as fair or poor relative to those with no public housing experience (57.3\% vs 26.9\%, respectively). Cardiac conditions, stroke, hypertension, diabetes, arthritis and psychiatric problems were all more prevalent in those living in public housing relative to community-dwelling elders not living in public housing. Fatigue was more prevalent in persons residing in public housing (26.7\%) as compared to other community-dwelling elders (17.8\%).

CONCLUSION: The health status of persons residing in public housing is poor. Fatigue and comorbid conditions are highly prevalent and more common in those living in public housing. Developing care models that meet the needs of this oft-neglected population is warranted.

}, keywords = {Aged, Chronic disease, Comorbidity, Cross-Sectional Studies, Fatigue, Female, Health Status Disparities, Humans, Male, Poverty, Prevalence, Public Housing, United States}, issn = {1049-510X}, url = {https://pubmed.ncbi.nlm.nih.gov/21462736/}, author = {Parsons, Pamela L and Briana Mezuk and Scott M Ratliff and Kate L Lapane} } @article {7437, title = {The role of health behaviors in mediating the relationship between depressive symptoms and glycemic control in type 2 diabetes: a structural equation modeling approach.}, journal = {Soc Psychiatry Psychiatr Epidemiol}, volume = {45}, year = {2010}, month = {2010 Jan}, pages = {67-76}, publisher = {45}, abstract = {

OBJECTIVES: We investigated the longitudinal association between depressive symptoms and glycemic control (HbA1c) in adults with type 2 diabetes, and the extent to which that association was explained by health behaviors.

METHODS: This study assessed data on 998 adults (aged 51 and above) with type 2 diabetes in the US nationally representative Health and Retirement Study and its diabetes-specific mail survey. Participants{\textquoteright} depressive symptoms and baseline health behaviors (exercise, body weight control, and smoking status) were collected in 1998. Follow-up health behaviors and the glycemic control outcome were measured at a 2- and 5-year intervals, respectively.

RESULTS: Nearly one in four of participants (23\%) reported moderate or high levels of depressive symptoms at baseline (CES-D score >or=3). Adults with higher levels of depressive symptoms at baseline showed lower scores on baseline and follow-up health behaviors as well as higher HbA1c levels at a 5-year follow-up. Structural equation models (SEM) reveal that health behaviors accounted for 13\% of the link between depressive symptoms and glycemic control.

CONCLUSIONS: The long-term relationship between depressive symptoms and glycemic control was supported in the present study. Health behaviors, including exercise, body weight control, and smoking status, explained a sizable amount of the association between depressive symptoms and glycemic control. More comprehensive diabetes self-care behaviors should be examined with available data. Other competing explicators for the link, such as endocrinological process and antidepressant effects, also warrant further examination.

}, keywords = {Adult, Aged, Blood Glucose, Body Weight, Comorbidity, depression, Diabetes Mellitus, Type 2, Female, Follow-Up Studies, Glycated Hemoglobin, Glycemic Index, Health Behavior, Health Surveys, Humans, Life Style, Longitudinal Studies, Male, Middle Aged, Models, Statistical, Self Care, Smoking, United States}, issn = {1433-9285}, doi = {10.1007/s00127-009-0043-3}, author = {Chiu, Ching-Ju and Linda A. Wray and Elizabeth A Beverly and Oralia G Dominic} } @article {7330, title = {The co-occurrence of chronic diseases and geriatric syndromes: the health and retirement study.}, journal = {J Am Geriatr Soc}, volume = {57}, year = {2009}, month = {2009 Mar}, pages = {511-6}, publisher = {57}, abstract = {

OBJECTIVES: To analyze the co-occurrence, in adults aged 65 and older, of five conditions that are highly prevalent, lead to substantial morbidity, and have evidence-based guidelines for management and well-developed measures of medical care quality.

DESIGN: Secondary data analysis of the 2004 wave of the Health and Retirement Study (HRS).

SETTING: Nationally representative health interview survey.

PARTICIPANTS: Respondents in the 2004 wave of the HRS aged 65 and older.

MEASUREMENTS: Self-reported presence of five index conditions (three chronic diseases (coronary artery disease, congestive heart failure, and diabetes mellitus) and two geriatric syndromes (urinary incontinence and injurious falls)) and demographic information (age, sex, race, living situation, net worth, and education).

RESULTS: Eleven thousand one hundred thirteen adults, representing 37.1 million Americans aged 65 and older, were interviewed. Forty-five percent were aged 76 and older, 58\% were female, 8\% were African American, and 4\% resided in a nursing home. Respondents with more conditions were older and more likely to be female, single, and residing in a nursing home (all P<.001). Fifty-six percent had at least one of the five index conditions, and 23\% had two or more. Of respondents with one condition, 20\% to 55\% (depending on the index condition) had two or more additional conditions.

CONCLUSION: Five common conditions (3 chronic diseases, 2 geriatric syndromes) often co-occur in older adults, suggesting that coordinated management of comorbid conditions, both diseases and geriatric syndromes, is important. Care guidelines and quality indicators, rather than considering one condition at a time, should be developed to address comprehensive and coordinated management of co-occurring diseases and geriatric syndromes.

}, keywords = {Accidental Falls, Activities of Daily Living, Aged, Aged, 80 and over, Angina Pectoris, Comorbidity, Cross-Sectional Studies, Diabetes Mellitus, Type 2, Female, Geriatric Assessment, Health Surveys, Heart Failure, Humans, Male, Myocardial Infarction, Sick Role, Syndrome, United States, Urinary incontinence}, issn = {1532-5415}, doi = {10.1111/j.1532-5415.2008.02150.x}, author = {Pearl G. Lee and Christine T Cigolle and Caroline S Blaum} } @article {7325, title = {Functional limitations, socioeconomic status, and all-cause mortality in moderate alcohol drinkers.}, journal = {J Am Geriatr Soc}, volume = {57}, year = {2009}, month = {2009 Jun}, pages = {955-62}, publisher = {57}, abstract = {

OBJECTIVES: To determine whether the survival benefit associated with moderate alcohol use remains after accounting for nontraditional risk factors such as socioeconomic status (SES) and functional limitations.

DESIGN: Prospective cohort.

SETTING: The Health and Retirement Study (HRS), a nationally representative study of U.S. adults aged 55 and older.

PARTICIPANTS: Twelve thousand five hundred nineteen participants were enrolled in the 2002 wave of the HRS.

MEASUREMENTS: Participants were asked about their alcohol use, functional limitations (activities of daily living, instrumental activities of daily living, and mobility), SES (education, income, and wealth), psychosocial factors (depressive symptoms, social support, and the importance of religion), age, sex, race and ethnicity, smoking, obesity, and comorbidities. Death by December 31, 2006, was the outcome measure.

RESULTS: Moderate drinkers (1 drink/d) had a markedly more-favorable risk factor profile, with higher SES and fewer functional limitations. After adjusting for demographic factors, moderate drinking (vs no drinking) was strongly associated with less mortality (odds ratio (OR)=0.50, 95\% confidence interval (CI)=0.40-0.62). When traditional risk factors (smoking, obesity, and comorbidities) were also adjusted for, the protective effect was slightly attenuated (OR=0.57, 95\% CI=0.46-0.72). When all risk factors including functional status and SES were adjusted for, the protective effect was markedly attenuated but still statistically significant (OR=0.72, 95\% CI=0.57-0.91).

CONCLUSION: Moderate drinkers have better risk factor profiles than nondrinkers, including higher SES and fewer functional limitations. Although these factors explain much of the survival advantage associated with moderate alcohol use, moderate drinkers maintain their survival advantage even after adjustment for these factors.

}, keywords = {Activities of Daily Living, Aged, Alcohol Drinking, Comorbidity, Education, Female, Humans, Income, Male, Obesity, Risk Factors, Sex Factors, Smoking, Socioeconomic factors}, issn = {1532-5415}, doi = {10.1111/j.1532-5415.2009.02184.x}, author = {Sei J. Lee and Rebecca L. Sudore and Brie A Williams and Lindquist, Karla and Helen L. Chen and Kenneth E Covinsky} } @article {7358, title = {Pain, functional limitations, and aging.}, journal = {J Am Geriatr Soc}, volume = {57}, year = {2009}, month = {2009 Sep}, pages = {1556-61}, publisher = {57}, abstract = {

OBJECTIVES: To examine the relationship between functional limitations and pain across a spectrum of age, ranging from mid life to advanced old age.

DESIGN: Cross-sectional study.

SETTING: The 2004 Health and Retirement Study (HRS), a nationally representative study of community-living persons aged 50 and older.

PARTICIPANTS: Eighteen thousand five hundred thirty-one participants in the 2004 HRS.

MEASUREMENTS: Participants who reported that they were often troubled by pain that was moderate or severe most of the time were defined as having significant pain. For each of four functional domains, subjects were classified according to their degree of functional limitation: mobility (able to jog 1 mile, able to walk several blocks, able to walk one block, unable to walk one block), stair climbing (able to climb several flights, able to climb one flight, not able to climb a flight), upper extremity tasks (able to do 3, 2, 1, or 0), and activity of daily living (ADL) function (able to do without difficulty, had difficulty but able to do without help, need help).

RESULTS: Twenty-four percent of participants had significant pain. Across all four domains, participants with pain had much higher rates of functional limitations than subjects without pain. Participants with pain were similar in terms of their degree of functional limitation to participants 2 to 3 decades older. For example, for mobility, of subjects aged 50 to 59 without pain, 37\% were able to jog 1 mile, 91\% were able to walk several blocks, and 96\% were able to walk one block without difficulty. In contrast, of subjects aged 50 to 59 with pain, 9\% were able to jog 1 mile, 50\% were able to walk several blocks, and 69\% were able to walk one block without difficulty. Subjects aged 50 to 59 with pain were similar in terms of mobility limitations to subjects aged 80 to 89 without pain, of whom 4\% were able to jog 1 mile, 55\% were able to walk several blocks, and 72\% were able to walk one block without difficulty. After adjustment for demographic characteristics, socioeconomic status, comorbid conditions, depression, obesity, and health habits, across all four measures, participants with significant pain were at much higher risk for having functional limitations (adjusted odds ratio (AOR)=2.85, 95\% confidence interval (CI)=2.20-3.69, for mobility; AOR=2.84, 95\% CI=2.48-3.26, for stair climbing; AOR=3.96, 95\% CI=3.43-4.58, for upper extremity tasks; and AOR=4.33; 95\% CI=3.71-5.06, for ADL function).

CONCLUSION: Subjects with pain develop the functional limitations classically associated with aging at much earlier ages.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Aging, Comorbidity, Cross-Sectional Studies, Disability Evaluation, Female, Geriatric Assessment, Health Behavior, Health Surveys, Humans, Life Style, Male, Middle Aged, Mobility Limitation, pain, Pain Measurement, Quality of Life, Risk Factors}, issn = {1532-5415}, doi = {10.1111/j.1532-5415.2009.02388.x}, author = {Kenneth E Covinsky and Lindquist, Karla and Dorothy D Dunlop and Yelin, Edward} } @article {7323, title = {Physician outpatient contacts and hospitalizations among cognitively impaired elderly.}, journal = {Alzheimers Dement}, volume = {5}, year = {2009}, month = {2009 Jan}, pages = {30-42}, publisher = {5}, abstract = {

BACKGROUND: This study examined how physician contacts and hospitalizations vary in relation to cognitive function level among community-residing older adults.

METHODS: Analysis of the 1998 wave of the Health and Retirement Survey (HRS) was conducted to create three levels of cognitive function among 6,991 older adults by using direct measures for self-respondents and proxy evaluations. Ordinary least square regression analyses were used to estimate the probability of physician outpatient contacts, number of hospitalizations, and nights hospitalized during the last 2 years.

RESULTS: Lower cognitive function level was found to be associated with decreasing levels of physician contacts and increasing levels of hospitalizations as well as nights hospitalized. In addition, lower cognitive function levels were consistently related to a variety of comorbidities. Moreover, many older adults with low cognitive function levels reported or were reported by their proxies as not having a diagnosis of a memory-related disease (MRD). Finally, having a diagnosis of an MRD was found to be associated with more physician contacts but fewer hospital nights compared with those who had never received such a diagnosis.

CONCLUSIONS: The findings suggest the need for increased outreach targeted at identification of community-dwelling older adults with decline in cognitive function who are in need of care but are underdiagnosed, underutilize physician care, and are overhospitalized.

}, keywords = {Aged, Aged, 80 and over, Alzheimer disease, Ambulatory Care, Cognition Disorders, Community-Institutional Relations, Comorbidity, Female, Hospitalization, Housing for the Elderly, Humans, Male, Memory Disorders, Physicians, Prevalence, Severity of Illness Index}, issn = {1552-5279}, doi = {10.1016/j.jalz.2008.05.2493}, author = {Caspi, Eilon and Nina M Silverstein and Frank Porell and Kwan, Ngai} } @article {7349, title = {Prevalence of depression among older Americans: the Aging, Demographics and Memory Study.}, journal = {Int Psychogeriatr}, volume = {21}, year = {2009}, note = {PMID: 19519984}, month = {2009 Oct}, pages = {879-88}, publisher = {21}, abstract = {

BACKGROUND: Previous studies have attempted to provide estimates of depression prevalence in older adults. The Aging, Demographics and Memory Study (ADAMS) is a population-representative study that included a depression assessment, providing an opportunity to estimate the prevalence of depression in late life in the U.S.A.

METHODS: The ADAMS sample was drawn from the larger Health and Retirement Study. A total of 851 of 856 ADAMS participants aged 71 and older had available depression data. Depression was measured using the Composite International Diagnostic Interview - Short Form (CIDI-SF) and the informant depression section of the Neuropsychiatric Inventory (NPI). We estimated the national prevalence of depression, stratified by age, race, sex, and cognitive status. Logistic regression analyses were performed to examine the association of depression and previously reported risk factors for the condition.

RESULTS: When combining symptoms of major or minor depression with reported treatment for depression, we found an overall depression prevalence of 11.19\%. Prevalence was similar for men (10.19\%) and women (11.44\%). Whites and Hispanics had nearly three times the prevalence of depression found in African-Americans. Dementia diagnosis and pain severity were associated with increased depression prevalence, while black race was associated with lower rates of depression.

CONCLUSIONS: The finding of similar prevalence estimates for depression in men and women was not consistent with prior research that has shown a female predominance. Given the population-representativeness of our sample, similar depression rates between the sexes in ADAMS may result from racial, ethnic and socioeconomic diversity.

}, keywords = {Aged, Aged, 80 and over, Alzheimer disease, Black People, Cohort Studies, Comorbidity, Cross-Sectional Studies, Depressive Disorder, Female, Health Status, Hispanic or Latino, Humans, Male, Neuropsychological tests, Personality Assessment, Sex Factors, Socioeconomic factors, United States, White People}, issn = {1041-6102}, doi = {10.1017/S1041610209990044}, author = {David C Steffens and Gwenith G Fisher and Kenneth M. Langa and Guy G Potter and Brenda L Plassman} } @article {7363, title = {Risk factors associated with injury attributable to falling among elderly population with history of stroke.}, journal = {Stroke}, volume = {40}, year = {2009}, month = {2009 Oct}, pages = {3286-92}, publisher = {40}, abstract = {

BACKGROUND AND PURPOSE: Stroke survivors are at high risk for falling. Identifying physical, clinical, and social factors that predispose stroke patients to falls may reduce further disability and life-threatening complications, and improve overall quality of life.

METHODS: We used 5 biennial waves (1998-2006) from the Health and Retirement Study to assess risk factors associated with falling accidents and fall-related injuries among stroke survivors. We abstracted demographic data, living status, self-evaluated general health, and comorbid conditions. We analyzed the rate ratio (RR) of falling and the OR of injury within 2 follow-up years using a multivariate random effects model.

RESULTS: We identified 1174 stroke survivors (mean age+/-SD, 74.4+/-7.2 years; 53\% female). The 2-year risks of falling, subsequent injury, and broken hip attributable to fall were 46\%, 15\%, and 2.1\% among the subjects, respectively. Factors associated with an increased frequency of falling were living with spouse as compared to living alone (RR, 1.4), poor general health (RR, 1.1), time from first stroke (RR, 1.2), psychiatric problems (RR, 1.7), urinary incontinence (RR, 1.4), pain (RR, 1.4), motor impairment (RR, 1.2), and past frequency of > or = 3 falls (RR, 1.3). Risk factors associated with fall-related injury were female gender (OR, 1.5), poor general health (OR, 1.2), past injury from fall (OR, 3.2), past frequency of > or = 3 falls (OR, 3.1), psychiatric problems (OR, 1.4), urinary incontinence (OR, 1.4), impaired hearing (OR, 1.6), pain (OR, 1.8), motor impairment (OR, 1.3), and presence of multiple strokes (OR, 3.2).

CONCLUSIONS: This study demonstrates the high prevalence of falls and fall-related injuries in stroke survivors, and identifies factors that increase the risk. Modifying these factors may prevent falls, which could lead to improved quality of life and less caregiver burden and cost in this population.

}, keywords = {Accidental Falls, Aged, Aged, 80 and over, Aging, Causality, Cohort Studies, Comorbidity, disease progression, Female, Health Status, Humans, Male, Marital Status, Mental Disorders, Movement Disorders, Prevalence, Risk Factors, Risk Reduction Behavior, Sex Distribution, Stroke, Urinary incontinence, Wounds and Injuries}, issn = {1524-4628}, doi = {10.1161/STROKEAHA.109.559195}, author = {Afshin A Divani and Vazquez, Gabriela and Anna M Barrett and Asadollahi, Marjan and Andreas R Luft} } @article {7225, title = {Depression and retirement in late middle-aged U.S. workers.}, journal = {Health Serv Res}, volume = {43}, year = {2008}, month = {2008 Apr}, pages = {693-713}, publisher = {43}, abstract = {

OBJECTIVE: To determine whether late middle-aged U.S. workers with depression are at an increased risk for retirement.

DATA SOURCE: Six biennial waves (1992-2002) of the Health and Retirement Study, a nationally representative panel survey of noninstitutionalized 51-61-year-olds and their spouses started in 1992.

STUDY DESIGN: Workers aged 53-58 years in 1994 were followed every 2 years thereafter, through 2002. Depression was coded as lagged time-dependent variables measuring active depression and severity of depression. The main outcome variable was a transition to retirement which was measured using two distinct definitions to capture different stages in the retirement process: (1) Retirement was defined as a transition out of the labor force in the sample of all labor force participants (N=2,853); (2) In addition a transition out of full time work was used as the retirement definition in the subset of labor force participants who were full time workers (N=2,288).

PRINCIPAL FINDINGS: In the sample of all labor force participants, the presence of active depression significantly increased the hazard of retirement in both late middle-aged men (adjusted OR: 1.37 [95 percent CI 1.05, 1.80]) and women (adjusted OR: 1.40 [95 percent CI 1.10, 1.78]). For women, subthreshold depression was also a significant predictor of retirement. In the sample of full time workers, the relationship between depression and retirement was considerably weaker for women yet remained strong for men.

CONCLUSIONS: Depression and depressive symptoms were significantly associated with retirement in late middle-aged U.S. workers. Policymakers must consider the potentially adverse impact of these labor market outcomes when estimating the cost of untreated depression and evaluating the value of interventions to improve the diagnosis and treatment of depression.

}, keywords = {Activities of Daily Living, Comorbidity, depression, Employment, Female, Humans, Male, Middle Aged, Retirement, Severity of Illness Index, Sex Factors, Socioeconomic factors, United States}, issn = {0017-9124}, doi = {10.1111/j.1475-6773.2007.00782.x}, author = {Jalpa A Doshi and Cen, Liyi and Daniel Polsky} } @article {7221, title = {Exploring the determinants of racial and ethnic disparities in total knee arthroplasty: health insurance, income, and assets.}, journal = {Med Care}, volume = {46}, year = {2008}, month = {2008 May}, pages = {481-8}, publisher = {46}, abstract = {

OBJECTIVE: To estimate national total knee arthroplasty (TKA) rates by economic factors, and the extent to which differences in insurance coverage, income, and assets contribute to racial and ethnic disparities in TKA use.

DATA SOURCE: US longitudinal Health and Retirement Study survey data for the elderly and near-elderly (biennial rounds 1994-2004) from the Institute of Social Research, University of Michigan.

STUDY DESIGN: The outcome is dichotomous, whether the respondent received first TKA in the previous 2 years. Longitudinal, random-effects logistic regression models are used to assess associations with lagged economic indicators.

SAMPLE: Sample was 55,469 person-year observations from 18,439 persons; 663, with first TKA.

RESULTS: Racial/ethnic disparities in TKA were more prominent among men than women. For example, relative to white women, odds ratios (ORs) were 0.94, 0.46, and 0.79, for white, black, and Hispanic men, respectively (P < 0.05 for black men). After adjusting for economic factors, racial/ethnic differences in TKA rates for women essentially disappeared, while the deficit for black men remained large. Among Medicare-enrolled elderly, those with supplemental insurance may be more likely to have first TKA compared with those without it, whether the supplemental coverage was private [OR: 1.27; 95\% confidence interval (CI): 0.82-1.96] or Medicaid (OR: 1.18; 95\% CI: 0.93-1.49). Among the near-elderly (age 47-64), compared with the privately insured, the uninsured were less likely (OR: 0.61; 95\% CI: 0.40-0.92) and those with Medicaid more likely (OR: 1.53; 95\% CI: 1.03-2.26) to have first TKA.

CONCLUSIONS: Limited insurance coverage and financial constraints explain some of the racial/ethnic disparities in TKA rates.

}, keywords = {Aged, Aged, 80 and over, Arthroplasty, Replacement, Knee, Comorbidity, ethnicity, Female, Healthcare Disparities, Humans, Income, Insurance, Health, Logistic Models, Longitudinal Studies, Male, Middle Aged, Sex Distribution, Socioeconomic factors, United States}, issn = {0025-7079}, doi = {10.1097/MLR.0b013e3181621e9c}, author = {Amresh D Hanchate and Zhang, Yuqing and David T Felson and Arlene S Ash} } @article {7217, title = {Impact of functional limitations and medical comorbidity on subsequent weight changes and increased depressive symptoms in older adults.}, journal = {J Aging Health}, volume = {20}, year = {2008}, month = {2008 Jun}, pages = {367-84}, publisher = {20}, abstract = {

OBJECTIVE: The primary goal of this study was to determine the effect of the onset of major medical comorbidity and functional decline on subsequent weight change and increased depressive symptoms.

METHODS: The sample included a prospective cohort of 53 to 63 year olds (n = 10,150) enrolled in the Health and Retirement Study. Separate lagged covariate models for men and women were used to study the impact of functional decline and medical comorbidity on subsequent increases in depressive symptoms and weight change 2 years later.

RESULTS: Functional decline and medical comorbidity were individual predictors of subsequent weight changes but not increased depressive symptoms. Most specific incident medical comorbidities or subtypes of functional decline predicted weight changes in both directions.

DISCUSSION: The elevated risk of weight gain subsequent to functional decline or onset of medical comorbidities may require the receipt of preventive measures to reduce further weight-related complications.

}, keywords = {Activities of Daily Living, Age Factors, Arthritis, Comorbidity, depression, Depressive Disorder, Diabetes Complications, Diabetes Mellitus, Disabled Persons, Female, Health Surveys, Heart Diseases, Humans, Hypertension, Lung Diseases, Male, Mental Disorders, Middle Aged, Neoplasms, Obesity, Risk Factors, Sex Factors, Stroke, United States, Weight Gain}, issn = {0898-2643}, doi = {10.1177/0898264308315851}, author = {Valerie L Forman-Hoffman and Kelly K Richardson and Jon W. Yankey and Stephen L Hillis and Robert B Wallace and Frederic D Wolinsky} } @article {7263, title = {Measurement differences in depression: chronic health-related and sociodemographic effects in older Americans.}, journal = {Psychosom Med}, volume = {70}, year = {2008}, month = {2008 Nov}, pages = {993-1004}, publisher = {70}, abstract = {

OBJECTIVE: To evaluate the influence of five chronic health conditions (high blood pressure, heart conditions, stroke, diabetes, and lung diseases) and four sociodemographic characteristics (age, gender, education, and race/ethnicity) on the endorsement patterns of depressive symptoms in a sample of community-dwelling older adults.

METHOD: Participants were adults aged >or=65 years from the 2004 Health and Retirement Study (n = 9448). Depressive symptoms were measured with a nine-item Center for Epidemiologic Studies-Depression scale. Measurement differences attributable to health and sociodemographic factors were assessed with a multidimensional model based on item response theory.

RESULTS: Evidence for unidimensionality was equivocal. We used a bifactor model to express symptom endorsement patterns as resulting from a general factor and three specific factors ("dysphoria," "psychosomatic," and "lack of positive affect"). Even after controlling for the effects of health on the psychosomatic factor, heart conditions, stroke, diabetes, and lung diseases had significant positive effects on the general factor. Significant effects due to gender and educational levels were observed on the "lack of positive affect" factor. Older adults self-identifying as Latinos had higher levels of general depression. On the symptom level, meaningful measurement noninvariance due to race/ethnic differences were found in the following five items: depressed, effort, energy, happy, and enjoy life.

CONCLUSIONS: The increased tendency to endorse depressive symptoms among persons with specific health conditions is, in part, explained by specific associations among symptoms belonging to the psychosomatic domain. Differences attributable to the effects of health conditions may reflect distinct phenomenological features of depression. The bifactor model serves as a vehicle for testing such hypotheses.

}, keywords = {Aged, Aged, 80 and over, Chronic disease, Cohort Studies, Comorbidity, Confounding Factors, Epidemiologic, Culture, depression, Diabetes Mellitus, Educational Status, ethnicity, Factor Analysis, Statistical, Female, Heart Diseases, Humans, Hypertension, Interviews as Topic, Lung Diseases, Male, Self-Assessment, Sex Factors, Stroke, United States}, issn = {1534-7796}, doi = {10.1097/PSY.0b013e31818ce4fa}, author = {Frances Margaret Yang and Richard N Jones} } @article {7173, title = {Beyond comorbidity counts: how do comorbidity type and severity influence diabetes patients{\textquoteright} treatment priorities and self-management?}, journal = {J Gen Intern Med}, volume = {22}, year = {2007}, month = {2007 Dec}, pages = {1635-40}, publisher = {22}, abstract = {

BACKGROUND: The majority of older adults have 2 or more chronic conditions and among patients with diabetes, 40\% have at least three.

OBJECTIVE: We sought to understand how the number, type, and severity of comorbidities influence diabetes patients{\textquoteright} self-management and treatment priorities.

DESIGN: Cross-sectional observation study.

PATIENTS: A total of 1,901 diabetes patients who responded to the 2003 Health and Retirement Study (HRS) diabetes survey.

MEASUREMENTS: We constructed multivariate models to assess the association between presence of comorbidities and each of 2 self-reported outcomes, diabetes prioritization and self-management ability, controlling for patient demographics. Comorbidity was characterized first by a count of all comorbid conditions, then by the presence of specific comorbidity subtypes (microvascular, macrovascular, and non-diabetes related), and finally by severity of 1 serious comorbidity: heart failure (HF).

RESULTS: 40\% of respondents had at least 1 microvascular comorbidity, 79\% at least 1 macrovascular comorbidity, and 61\% at least 1 non-diabetes-related comorbidity. Patients with a greater overall number of comorbidities placed lower priority on diabetes and had worse diabetes self-management ability scores. However, only macrovascular and non-diabetes-related comorbidities, but not microvascular comorbidities, were associated with lower diabetes prioritization, whereas higher numbers of microvascular, macrovascular, and non-diabetes-related conditions were all associated with lower diabetes self-management ability scores. Severe, but not mild, HF was associated with lower diabetes prioritization and self-management scores.

CONCLUSIONS: The type and severity of comorbid conditions, and not just the comorbidity count, influence diabetes patients{\textquoteright} self-management. Patients with severely symptomatic comorbidities and those with conditions they consider to be unrelated to diabetes may need additional support in making decisions about care priorities and self-management activities.

}, keywords = {Aged, Attitude to Health, Cohort Studies, Comorbidity, Cross-Sectional Studies, Diabetes Mellitus, Female, Health Priorities, Heart Failure, Humans, Male, Middle Aged, Self Care, Severity of Illness Index, United States}, issn = {1525-1497}, doi = {10.1007/s11606-007-0313-2}, author = {Eve A Kerr and Michele M Heisler and Sarah L. Krein and Mohammed U Kabeto and Kenneth M. Langa and David R Weir and John D Piette} } @article {7152, title = {Burden of common multiple-morbidity constellations on out-of-pocket medical expenditures among older adults.}, journal = {Gerontologist}, volume = {47}, year = {2007}, month = {2007 Aug}, pages = {423-37}, publisher = {47}, abstract = {

PURPOSE: On average, adults aged 60 years or older have 2.2 chronic diseases, contributing to the over 60 million Americans with multiple morbidities. We aimed to understand the financial implications of the most frequent multiple morbidities among older adults.

DESIGN AND METHODS: We analyzed Health and Retirement Study data, determining out-of-pocket medical expenses from 1998 and 2002 separately and examining differences in the impact of multiple-morbidity constellations on these expenses. We paid particular attention to the most common disease constellations - hypertension, arthritis, and heart disease.

RESULTS: An increasing prevalence of multiple morbidity (58\% compared with 70\% of adults had two or more chronic conditions in 1998 and 2002, respectively) was accompanied by escalating out-of-pocket expenditures (2,164 dollars in 1998, increasing by 104\% to 3,748 dollars in 2002). Individuals with two, three, and four chronic conditions had health care expenditure increases of 41\%, 85\%, and 100\%, respectively, over 4 years. Such patterns were particularly noticeable among the oldest old, those with higher educational attainment, and women, although having supplementary health insurance or Medicaid mitigated these expenses. Finally, there were significant differences in out-of-pocket expenditure levels among the multiple-morbidity combinations.

IMPLICATIONS: Increasing rates of multiple morbidities in conjunction with escalating health care costs and stable or declining incomes among elders warrant creative attention from providers, researchers, and policy makers. Further understanding how specific multiple-morbidity constellations impact out-of-pocket spending moves us closer to effective interventions to support vulnerable elders.

}, keywords = {Aged, Arthritis, Chronic disease, Comorbidity, Cost of Illness, Female, Financing, Personal, Health Expenditures, Health Surveys, Heart Diseases, Humans, Hypertension, Interviews as Topic, Male, Middle Aged, United States}, issn = {0016-9013}, doi = {10.1093/geront/47.4.423}, author = {Schoenberg, Nancy E. and Hyungsoo Kim and Edwards, William and Fleming, Steven T.} } @article {7158, title = {Geriatric conditions and disability: the Health and Retirement Study.}, journal = {Ann Intern Med}, volume = {147}, year = {2007}, month = {2007 Aug 07}, pages = {156-64}, publisher = {147}, abstract = {

BACKGROUND: Geriatric conditions, such as incontinence and falling, are not part of the traditional disease model of medicine and may be overlooked in the care of older adults. The prevalence of geriatric conditions and their effect on health and disability in older adults has not been investigated in population-based samples.

OBJECTIVE: To investigate the prevalence of geriatric conditions and their association with dependency in activities of daily living by using nationally representative data.

DESIGN: Cross-sectional analysis.

SETTING: Health and Retirement Study survey administered in 2000.

PARTICIPANTS: Adults age 65 years or older (n = 11 093, representing 34.5 million older Americans) living in the community and in nursing homes.

MEASUREMENTS: Geriatric conditions (cognitive impairment, falls, incontinence, low body mass index, dizziness, vision impairment, hearing impairment) and dependency in activities of daily living (bathing, dressing, eating, transferring, toileting).

RESULTS: Of adults age 65 years or older, 49.9\% had 1 or more geriatric conditions. Some conditions were as prevalent as common chronic diseases, such as heart disease and diabetes. The association between geriatric conditions and dependency in activities of daily living was strong and significant, even after adjustment for demographic characteristics and chronic diseases (adjusted risk ratio, 2.1 [95\% CI, 1.9 to 2.4] for 1 geriatric condition, 3.6 [CI, 3.1 to 4.1] for 2 conditions, and 6.6 [CI, 5.6 to 7.6] for > or =3 conditions).

LIMITATIONS: The study was cross-sectional and based on self-reported data. Because measures were limited by the survey questions, important conditions, such as delirium and frailty, were not assessed. Survival biases may influence the estimates.

CONCLUSIONS: Geriatric conditions are similar in prevalence to chronic diseases in older adults and in some cases are as strongly associated with disability. The findings suggest that geriatric conditions, although not a target of current models of health care, are important to the health and function of older adults and should be addressed in their care.

}, keywords = {Accidental Falls, Activities of Daily Living, Age Factors, Aged, Aged, 80 and over, Body Mass Index, Chronic disease, Cognition Disorders, Comorbidity, Cross-Sectional Studies, Disability Evaluation, Dizziness, Female, Geriatric Assessment, Geriatrics, Hearing Disorders, Humans, Male, Prevalence, Retirement, Urinary incontinence, Vision Disorders}, issn = {1539-3704}, doi = {10.7326/0003-4819-147-3-200708070-00004}, author = {Christine T Cigolle and Kenneth M. Langa and Mohammed U Kabeto and Zhiyi Tian and Caroline S Blaum} } @article {7133, title = {Urban neighborhoods and depressive symptoms among older adults.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {62}, year = {2007}, month = {2007 Jan}, pages = {S52-9}, publisher = {62}, abstract = {

OBJECTIVE: This study seeks to determine whether depressive symptoms among older persons systematically vary across urban neighborhoods such that experiencing more symptoms is associated with low socioeconomic status (SES), high concentrations of ethnic minorities, low residential stability and low proportion aged 65 years and older.

METHODS: Survey data are from the Study of Assets and Health Dynamics Among the Oldest Old (AHEAD), a 1993 U.S. national probability sample of noninstitutionalized persons born in 1923 or earlier (i.e. people aged 70 or older). Neighborhood data are from the 1990 Census at the tract level. Hierarchical linear regression is used to estimate multilevel models.

RESULT: The average number of depressive symptoms varies across Census tracts independent of individual-level characteristics. Symptoms are not significantly associated with neighborhood SES, ethnic composition, or age structure when individual-level characteristics are controlled statistically. However, net of individual-level characteristics, symptoms are positively associated with neighborhood residential stability, pointing to a complex meaning of residential stability for the older population.

DISCUSSION: This study shows that apparent neighborhood-level socioeconomic effects on depressive symptoms among urban-dwelling older adults are largely if not entirely compositional in nature. Further, residential stability in the urban neighborhood may not be emotionally beneficial to its aged residents.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Comorbidity, Cross-Sectional Studies, Depressive Disorder, Female, Health Status Indicators, Health Surveys, Humans, Incidence, Male, Minority Groups, Peer Group, Population Dynamics, Risk Factors, Social Environment, United States, Urban Population}, issn = {1079-5014}, doi = {10.1093/geronb/62.1.s52}, author = {Carol S Aneshensel and Richard G Wight and Miller-Martinez, Dana and Amanda L. Botticello and Arun S Karlamangla and Teresa Seeman} } @article {7131, title = {Weight and depressive symptoms in older adults: direction of influence?}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {62}, year = {2007}, month = {2007 Jan}, pages = {S43-51}, publisher = {62}, abstract = {

OBJECTIVE: . The purpose of this study was to clarify the direction of the relationship between changes in depressive symptoms and changes in weight in older adults. Methods. The sample included a prospective cohort of individuals aged 53-63 (n = 9,130) enrolled in the Health and Retirement Study. We used separate cross-lagged models for men and women in order to study the impact of weight change on subsequent increases in depressive symptoms 2 years later and vice versa.

RESULT: . Weight gain did not lead to increased depressive symptoms, and weight loss preceded increased depressive symptoms only in unadjusted models among men (odds ratio [OR] = 1.26, 95\% confidence interval [CI] = 1.04-1.53). Increased depressive symptoms were not predictive of subsequent weight loss, but they were predictive of subsequent weight gain in unadjusted models only (men: OR = 1.24, 95\% CI = 1.00-1.54; women: OR = 1.12, 95\% CI = 1.00-1.26). In adjusted models, baseline depressive symptoms predicted both weight loss and weight gain among both men and women. Increase in functional limitations and medical conditions were significant predictors of both weight loss and weight gain. Baseline functional limitations also predicted increased depressive symptoms. Discussion. Based on our findings, it is apparent that researchers need to examine the pathways between changes in weight and increases in depressive symptoms in the context of functional limitations and medical comorbidity.

}, keywords = {Activities of Daily Living, Age Factors, Aged, Aged, 80 and over, Body Mass Index, Cohort Studies, Comorbidity, Depressive Disorder, Female, Health Status Indicators, Health Surveys, Humans, Longitudinal Studies, Male, Middle Aged, Models, Statistical, Odds Ratio, Prospective Studies, Sex Factors, Statistics as Topic, United States, Weight Gain, Weight Loss}, issn = {1079-5014}, doi = {10.1093/geronb/62.1.s43}, author = {Valerie L Forman-Hoffman and Jon W. Yankey and Stephen L Hillis and Robert B Wallace} } @article {7023, title = {Long-term risk for depressive symptoms after a medical diagnosis.}, journal = {Arch Intern Med}, volume = {165}, year = {2005}, month = {2005 Jun 13}, pages = {1260-6}, publisher = {165}, abstract = {

BACKGROUND: This study examines the risk of development of significant depressive symptoms after a new diagnosis of cancer, diabetes, hypertension, heart disease, arthritis, chronic lung disease, or stroke.

METHODS: The study used 5 biennial waves (1992-2000) of the Health and Retirement Study to follow a sample of 8387 adults (aged 51 to 61 years and without significant depressive symptoms in 1992) from 1994 to 2000. Time-dependent Cox regression models estimated adjusted hazard ratios (HRs) for an episode of significant depressive symptoms after a new diagnosis for each of the 7 medical conditions.

RESULTS: Within 2 years of initial diagnosis, subjects with cancer had the highest hazard of depressive symptoms (HR, 3.55; 95\% confidence interval [CI], 2.79-4.52), followed by subjects with chronic lung disease (HR, 2.21; 95\% CI, 1.64-2.79) and heart disease (HR, 1.45; 95\% CI, 1.09-1.93). The hazard for depressive symptoms for most of these diseases decreased over time; however, subjects with heart disease continued to have a higher risk for depressive symptoms even 2 to 4 years and 4 to 8 years after diagnosis, and a significantly higher hazard for depressive symptoms developed for persons with arthritis 2 to 4 years after diagnosis (HR, 1.46; 95\% CI, 1.11-1.92).

CONCLUSION: The findings identify several high-risk patient groups who might benefit from depression screening and monitoring to improve health outcomes in this vulnerable population facing new medical illnesses.

}, keywords = {Chronic disease, Comorbidity, Depressive Disorder, Female, Humans, Male, Middle Aged, Prospective Studies, Risk, Time Factors}, issn = {0003-9926}, doi = {10.1001/archinte.165.11.1260}, author = {Daniel Polsky and Jalpa A Doshi and Marcus, Steven and Oslin, David and Rothbard, Aileen and Thomas, Niku and Thompson, Christy L.} } @article {7024, title = {Profiles of self-rated health in midlife adults with chronic illnesses.}, journal = {Nurs Res}, volume = {54}, year = {2005}, month = {2005 May-Jun}, pages = {167-77}, publisher = {54}, abstract = {

BACKGROUND: Self-rated health (SRH), an important indicator of cognitive appraisal of health, consistently predicts mortality, morbidity, and health services utilization. However, few explanations account for how these cognitive appraisals of health might differ within a population of midlife adults with chronic illnesses who may be at risk for further illnesses over time.

OBJECTIVES: The purpose of this study was two-fold: (a) to uncover classes of chronically ill midlife adults who shared unique profiles of characteristics that predicted SRH over time and (b) to reveal the predictive factors of SRH for each class over time.

METHODS: Using 5 waves of data (1992-2000) from the Health and Retirement Study, the sample included 6,335 respondents (ages 51 to 61 at baseline) who reported at least one chronic illness. Selected components of the Interaction Model of Client Health Behavior guided the inclusion of relevant predictors of SRH from the literature. Latent class regression was employed to simultaneously classify respondents and identify factors that predicted SRH for each class over time.

RESULTS: The final model reflected 3 distinct profiles of SRH over time: positive health, average health, and negative health. Four time-varying predictors differed significantly across the 3 classes: overweight, work limitation, depressed mood, and living with a partner. Three time-varying predictors--comorbidity, vigorous activity less than 3 times per week, and current smoking--had the same influence on all 3 classes.

DISCUSSION: The differential effects of these predictors on SRH over time distinguish these results from prior research. In future studies, profiles of SRH that are unique to each class could be used to develop class-specific targeted interventions to improve cognitive appraisal of health, whereas generic interventions would be based on the class-independent predictors of SRH.

}, keywords = {Chronic disease, Comorbidity, Data collection, Educational Status, Exercise, Female, Health Behavior, Health Status, Humans, Male, Marital Status, Middle Aged, Nursing Research, Smoking}, issn = {0029-6562}, doi = {10.1097/00006199-200505000-00004}, author = {Finnegan, Lorna and Marion, Lucy and Cox, Cheryl} } @article {6991, title = {Setting eligibility criteria for a care-coordination benefit.}, journal = {J Am Geriatr Soc}, volume = {53}, year = {2005}, month = {2005 Dec}, pages = {2051-9}, publisher = {53}, abstract = {

OBJECTIVES: To examine different clinically relevant eligibility criteria sets to determine how they differ in numbers and characteristics of individuals served.

DESIGN: Cross-sectional analysis of the 2000 wave of the Health and Retirement Study (HRS), a nationally representative longitudinal health interview survey of adults aged 50 and older.

SETTING: Population-based cohort of community-dwelling older adults, subset of an ongoing longitudinal health interview survey.

PARTICIPANTS: Adults aged 65 and older who were respondents in the 2000 wave of the HRS (n=10,640, representing approximately 33.6 million Medicare beneficiaries).

MEASUREMENTS: Three clinical criteria sets were examined that included different combinations of medical conditions, cognitive impairment, and activity of daily living/instrumental activity of daily living (ADL/IADL) dependency.

RESULTS: A small portion of Medicare beneficiaries (1.3-5.8\%) would be eligible for care coordination, depending on the criteria set chosen. A criteria set recently proposed by Congress (at least four severe complex medical conditions and one ADL or IADL dependency) would apply to 427,000 adults aged 65 and older in the United States. Criteria emphasizing cognitive impairment would serve an older population.

CONCLUSION: Several criteria sets for a Medicare care-coordination benefit are clinically reasonable, but different definitions of eligibility would serve different numbers and population groups of older adults.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Case Management, Chronic disease, Cognition Disorders, Comorbidity, Cross-Sectional Studies, Disability Evaluation, Disease Management, Eligibility Determination, Female, Geriatric Assessment, Health Surveys, Humans, Longitudinal Studies, Male, Medicare, Middle Aged, Retirement, United States}, issn = {0002-8614}, doi = {10.1111/j.1532-5415.2005.00496.x}, author = {Christine T Cigolle and Kenneth M. Langa and Mohammed U Kabeto and Caroline S Blaum} } @article {6918, title = {Extent and cost of informal caregiving for older Americans with symptoms of depression.}, journal = {Am J Psychiatry}, volume = {161}, year = {2004}, month = {2004 May}, pages = {857-63}, publisher = {161}, abstract = {

OBJECTIVE: The purpose of this study was to obtain nationally representative estimates of the additional time and cost associated with informal caregiving for older Americans with depressive symptoms.

METHOD: Data from the 1993 Asset and Health Dynamics Among the Oldest Old Study, a nationally representative survey of people age 70 years or older (N=6,649), were used to determine the weekly hours and imputed costs of informal caregiving for elderly people with no depressive symptoms in the last week, one to three depressive symptoms in the last week, and four to eight depressive symptoms in the last week.

RESULTS: Forty-four percent of survey respondents reported one to three depressive symptoms, and 18\% reported four to eight depressive symptoms. In multivariate regression analyses that adjusted for sociodemographics, caregiver network, and coexisting chronic health conditions, respondents with no depressive symptoms received an average of 2.9 hours per week of informal care, compared with 4.3 hours per week for those with one to three symptoms and 6.0 hours per week for those with four to eight symptoms. Caregiving associated with depressive symptoms in elderly Americans represented a yearly cost of about $9 billion.

CONCLUSIONS: Depressive symptoms in elderly persons are independently associated with significantly higher levels of informal caregiving, even after the effects of major coexisting chronic conditions are adjusted. The additional hours of care attributable to depressive symptoms represent a significant time commitment for family members and, therefore, a significant societal economic cost. Further research should evaluate the causal pathways by which depressive symptoms lead to high levels of caregiving and should examine whether successful treatment of depression reduces the need for informal care.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Caregivers, Comorbidity, Costs and Cost Analysis, Depressive Disorder, Fees and Charges, Female, Health Care Costs, Home Nursing, Humans, Longitudinal Studies, Male, Personality Inventory, Workload}, issn = {0002-953X}, doi = {10.1176/appi.ajp.161.5.857}, author = {Kenneth M. Langa and Marcia A. Valenstein and A. Mark Fendrick and Mohammed U Kabeto and Sandeep Vijan} } @article {6942, title = {Nonmetro residence and impaired vision among elderly Americans.}, journal = {J Rural Health}, volume = {20}, year = {2004}, month = {2004 Spring}, pages = {142-50}, publisher = {20}, abstract = {

PURPOSE: Nonmetro and metro elderly people are contrasted in their risk of having (relative to lacking) an impairment in distance vision and in near vision.

METHODS: Using the 1995-1996 panel (Wave 2) of the Asset and Health Dynamics Among the Oldest Old (AHEAD) Survey, the prevalence of 5 eye-threatening conditions (cardiovascular disease, cataract, diabetes, glaucoma, and hypertension), a variety of medical treatments for these conditions, the number of talks/visits with doctors in the 2 years before Wave 2, and several relevant demographic characteristics of the 6,817 respondents were controlled.

FINDINGS: Nonmetro and metro elders have the same risk of impairment in distance vision. After controlling for other factors, nonmetro elders have a higher risk than their metro peers of an uncorrected impairment in near vision (probably presbyopia).

CONCLUSIONS: Nonmetro elders may confront more impediments to updating their corrective lenses for presbyopia. Implications for public health policy are discussed.

}, keywords = {Aged, Aged, 80 and over, Cardiovascular Diseases, Cataract, Chronic disease, Comorbidity, Diabetes Mellitus, Humans, Hypertension, Prevalence, Risk Assessment, Rural Health, United States, Urban Health, Vision Disorders}, issn = {0890-765X}, doi = {10.1111/j.1748-0361.2004.tb00021.x}, author = {Nan E. Johnson} } @article {6943, title = {Nonmetro residence, hearing loss, and its accommodation among elderly people.}, journal = {J Rural Health}, volume = {20}, year = {2004}, month = {2004 Spring}, pages = {136-41}, publisher = {20}, abstract = {

BACKGROUND: No previous studies compare the prevalence of physiological hearing loss among older adults by nonmetro/metro residence. Also, there is little information on their relative successes in accommodating hearing loss with a hearing aid.

PURPOSE: This study sought to bridge these gaps by analyzing the 8,222 respondents to Wave 1 (1993-1994) of the national Asset and Health Dynamics Among the Oldest Old (AHEAD) Survey.

METHODS: Respondents were classified into 4 categories of hearing status: (1) physiologically normal hearing; and physiologically abnormal hearing with (2) full accommodation of lost hearing with a hearing aid, (3) partial accommodation, and (4) no hearing aid. A multinomial logistic regression was used to predict the odds of having any of the 3 statuses of physiologically abnormal hearing rather than normal hearing.

FINDINGS: Nonmetro residents had the same odds as metro residents of having no residual hearing loss when a hearing aid was worn (versus having physiologically normal hearing). But nonmetro residents had a much greater risk than their metro counterparts of having a hearing loss but no hearing aid or a residual hearing loss even when wearing an aid. The association of nonmetro residence with either of these latter hearing-loss statuses was greater than that of age, a more traditionally acknowledged hearing-risk factor.

CONCLUSION: Future studies should add nonmetro residence to the list of risk factors for negative hearing outcomes, especially since the percentage of elderly nonmetro residents is expected to grow over the next 2 decades.

}, keywords = {Aged, Aged, 80 and over, Comorbidity, Female, Health Surveys, Hearing aids, Hearing loss, Humans, Male, Memory Disorders, Odds Ratio, Rural Health, United States, Urban Population}, issn = {0890-765X}, doi = {10.1111/j.1748-0361.2004.tb00020.x}, author = {Nan E. Johnson} } @article {6881, title = {Health care utilization among older adults with arthritis.}, journal = {Arthritis Rheum}, volume = {49}, year = {2003}, month = {2003 Apr 15}, pages = {164-71}, publisher = {49}, abstract = {

OBJECTIVE: To evaluate the effect of arthritis on subsequent 2-year use of health care services and out-of-pocket costs among older adults and determine if comorbidities or economic resources mitigate that effect.

METHODS: Data were analyzed from 6230 participants interviewed in 1993 and 1995 in the Asset and Health Dynamic Survey Among the Oldest Old (AHEAD), a national probability sample of community-dwelling adults. Baseline arthritis status was ascertained from the report of an arthritis-related physician{\textquoteright}s visit or a joint replacement not associated with a hip fracture. The effect of baseline arthritis on the odds of subsequent 2-year health care utilization and high out-of-pocket expenses were estimated from multiple logistic regression controlling for demographic factors, comorbidity, and economic resources.

RESULTS: Older adults with arthritis are significantly more likely to have a physician visit (odds ratio [OR] 3.0), hospital admission (OR 1.6), outpatient surgery (OR 1.3), receive home health care (OR 1.6), and have out-of-pocket cost >5000 US dollars (OR 1.6) compared with contemporaries having similar demographics (age, sex, racial/ethnic group, marital status), comorbid conditions, and economic resources (education, income, wealth, health insurance), but not reporting arthritis.

CONCLUSIONS: Older adults with symptomatic arthritis reported greater medical utilization and cost compared with people not reporting arthritis. These disparities persisted after accounting for differences in demographics, comorbidities, and economic factors. These findings document greater economic burdens on a personal and societal level among people with arthritis. As individuals, older adults with arthritis spend more out-of-pocket dollars for health care than their contemporaries without arthritis. On a societal level, these findings of greater health care utilization among people with arthritis point to increasing future demands on the US health care system due to demographic increases in the numbers of older adults with arthritis and support policies aimed at improving arthritis prevention and treatment as well as reducing the economic disparities between those with and without arthritis.

}, keywords = {Aged, Aged, 80 and over, Ambulatory Surgical Procedures, Arthritis, Comorbidity, Cost of Illness, Female, Health Services, Home Care Services, Hospitals, Humans, Insurance, Health, Longitudinal Studies, Male, Nursing homes, Physicians{\textquoteright} Offices, Social Class}, issn = {0004-3591}, doi = {10.1002/art.11003}, author = {Dorothy D Dunlop and Larry M Manheim and Song, Jing and Rowland W Chang} } @article {6882, title = {Racial/ethnic differences in rates of depression among preretirement adults.}, journal = {Am J Public Health}, volume = {93}, year = {2003}, month = {2003 Nov}, pages = {1945-52}, publisher = {93}, abstract = {

OBJECTIVES: We estimated racial/ethnic differences in rates of major depression and investigated possible mediators.

METHODS: Depression prevalence rates among African American, Hispanic, and White adults were estimated from a population-based national sample and adjusted for potential confounders.

RESULTS: African Americans (odds ratio [OR] = 1.16, 95\% confidence interval [CI] = 0.93, 1.44) and Hispanics (OR = 1.44, 95\% CI = 1.02, 2.04) exhibited elevated rates of major depression relative to Whites. After control for confounders, Hispanics and Whites exhibited similar rates, and African Americans exhibited significantly lower rates than Whites.

CONCLUSIONS: Major depression and factors associated with depression were more frequent among members of minority groups than among Whites. Elevated depression rates among minority individuals are largely associated with greater health burdens and lack of health insurance, factors amenable to public policy intervention.

}, keywords = {Aged, Black or African American, Cohort Studies, Comorbidity, Demography, Depressive Disorder, Major, Diagnostic and Statistical Manual of Mental Disorders, Female, Hispanic or Latino, Humans, Male, Middle Aged, Minority Groups, Probability, Risk Factors, Socioeconomic factors, United States, White People}, issn = {0090-0036}, doi = {10.2105/ajph.93.11.1945}, author = {Dorothy D Dunlop and Song, Jing and Lyons, J.S. and Larry M Manheim and Rowland W Chang} } @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 {6832, title = {Breast cancer and women{\textquoteright}s labor supply.}, journal = {Health Serv Res}, volume = {37}, year = {2002}, month = {2002 Oct}, pages = {1309-28}, publisher = {37}, abstract = {

OBJECTIVE: To investigate the effect of breast cancer on women{\textquoteright}s labor supply. DATE SOURCE/STUDY SETTING: Using the 1992 Health and Retirement Study, we estimate the probability of working using probit regression and then, for women who are employed, we estimate regressions for average weekly hours worked using ordinary least squares (OLS). We control for health status by using responses to perceived health status and comorbidities. For a sample of married women, we control for spouses{\textquoteright} employer-based health insurance. We also perform additional analyses to detect selection bias in our sample.

PRINCIPAL FINDINGS: We find that the probability of breast cancer survivors working is 10 percentage points less than that for women without breast cancer. Among women who work, breast cancer survivors work approximately three more hours per week than women who do not have cancer. Results of similar magnitude persist after health status is controlled in the analysis, and although we could not definitively rule out selection bias, we could not find evidence that our results are attributable to selection bias.

CONCLUSIONS: For some women, breast cancer may impose an economic hardship because it causes them to leave theirjobs. However, for women who survive and remain working, this study failed to show a negative effect on hours worked associated with breast cancer. Perhaps the morbidity associated with certain types and stages of breast cancer and its treatment does not interfere with work.

}, keywords = {Breast Neoplasms, Comorbidity, Cost of Illness, Decision making, Employment, Family Characteristics, Female, Health Benefit Plans, Employee, Health Status, Humans, Marital Status, Middle Aged, Probability, Selection Bias, Survivors, United States, Women, Working}, issn = {0017-9124}, doi = {10.1111/1475-6773.01041}, author = {Cathy J. Bradley and Bednarek, Heather and David Neumark} } @article {6791, title = {Informal caregiving time and costs for urinary incontinence in older individuals in the United States.}, journal = {J Am Geriatr Soc}, volume = {50}, year = {2002}, month = {2002 Apr}, pages = {733-7}, publisher = {50}, abstract = {

OBJECTIVES: To obtain nationally representative estimates of the additional time, and related cost, of informal caregiving associated with urinary incontinence in older individuals.

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

SETTING: Community-dwelling older people.

PARTICIPANTS: National population-based sample of community-dwelling older people.

MEASUREMENTS: Weekly hours of informal caregiving, and imputed cost of caregiver time, for community-dwelling older people who reported (1) no unintended urine loss, (2) incontinence that did not require the use of absorbent pads, and (3) incontinence that required the use of absorbent pads.

RESULTS: Thirteen percent of men and 24\% of women reported incontinence. After adjusting for sociodemographics, living situation, and comorbidities, continent men received 7.4 hours per week of care, incontinent men who did not use pads received 11.3 hours, and incontinent men who used pads received 16.6 hours (P <.001). Women in these groups received 5.9, 7.6, and 10.7 hours (P <.001), respectively. The additional yearly cost of informal care associated with incontinence was $1,700 and $4,000 for incontinent men who did not and did use pads, respectively, whereas, for women in these groups, the additional yearly cost was $700 and $2,000. Overall, this represents a national annual cost of more than $6 billion for incontinence-related informal care.

CONCLUSIONS: The quantity of informal caregiving for older people with incontinence and its associated economic cost are substantial. Future analyses of the costs of incontinence, and the cost-effectiveness of interventions to prevent or treat incontinence, should consider the significant informal caregiving costs associated with this condition.

}, keywords = {Aged, Caregivers, Comorbidity, Confounding Factors, Epidemiologic, Female, Humans, Incontinence Pads, Male, Regression Analysis, Time Factors, United States, Urinary incontinence}, issn = {0002-8614}, doi = {10.1046/j.1532-5415.2002.50170.x}, author = {Kenneth M. Langa and Fultz, Nancy H. and Sanjay Saint and Mohammed U Kabeto and A. Regula Herzog} } @article {6697, title = {The racial crossover in comorbidity, disability, and mortality.}, journal = {Demography}, volume = {37}, year = {2000}, note = {RDA 2002-016}, month = {2000 Aug}, pages = {267-83}, publisher = {37}, abstract = {

This study analyzed one respondent per household who was age 70 or more at the time of the household{\textquoteright}s inclusion in Wave 1 (1993-1994) and whose survival status was determinable at Wave 2 (1995-1996) of the Survey on Asset and Health Dynamics Among the Oldest Old (AHEAD Survey). At age 76 at Wave 1, there was a racial crossover in the cumulative number of six potentially fatal diagnoses (chronic lung disease, cancer, heart disease, hypertension, diabetes, and stroke) from a higher cumulative average number for blacks to a higher average number for whites. Also, there was a racial crossover at age 86 in the cumulative average number of disabilities in the Advanced Activities of Daily Living (AADLs), from a higher average for blacks to a higher average for whites. Between Waves 1 and 2, there was a racial crossover in the odds of mortality from higher odds for blacks to higher odds for whites; this occurred at about age 81. The results are consistent with the interpretation that the racial crossover in comorbidity (but not the crossover in AADL disability) propelled the racial crossover in mortality.

}, keywords = {Activities of Daily Living, Age Factors, Aged, Aged, 80 and over, Birth Certificates, Black People, Chronic disease, Comorbidity, Cross-Over Studies, Death Certificates, Disabled Persons, Female, Humans, Male, United States, White People}, issn = {0070-3370}, author = {Nan E. Johnson} } @article {6592, title = {Distribution and association of chronic disease and mobility difficulty across four body mass index categories of African-American women.}, journal = {Am J Epidemiol}, volume = {145}, year = {1997}, month = {1997 May 15}, pages = {865-75}, publisher = {145}, abstract = {

A majority of African-American women over the age of 50 are obese, have at least one chronic disease, and experience mobility difficulty. Using self-reported data from the 1992 Health and Retirement Study of 1,150 African-American women aged 30-70 years, this report first compares chronic disease prevalence and severity, pain, sensory deficits, and mobility difficulty across four categories of body mass index and, second, investigates whether body mass index affects the association of chronic disease with mobility difficulty. Body mass index was categorized as low, medium, high, and severe, being equal to 19-24 (20\%), 25-29 (38\%), 30-34 (24\%), and 35 or over (18\%), respectively. There were few differences when comparing the medium category with either the low or high category. Those in the severe body mass index category, however, reported significantly more frequent and severe hypertension, diabetes, cancer, heart disease, arthritis, pain, sensory deficits, and mobility difficulty than did those in the medium body mass index category. Obesity did not appear to affect the association between chronic disease and mobility difficulty. The relatively high rates of mobility difficulty observed among the severe body mass index group appear to be more likely a result of relatively high chronic disease prevalence and severity than to a disproportionate impact of these on mobility.

}, keywords = {Activities of Daily Living, Black People, Body Mass Index, Chronic disease, Comorbidity, Cross-Sectional Studies, Female, Health Behavior, Humans, Michigan, Middle Aged, Obesity, Prevalence, Regression Analysis, Severity of Illness Index, Socioeconomic factors}, issn = {0002-9262}, doi = {10.1093/oxfordjournals.aje.a009046}, author = {Daniel O. Clark and Mungai, S.M.} } @article {6581, title = {The earnings, income, and assets of persons aged 51-61 with and without musculoskeletal conditions.}, journal = {J Rheumatol}, volume = {24}, year = {1997}, month = {1997 Oct}, pages = {2024-30}, publisher = {24}, abstract = {

OBJECTIVE: To describe the personal and family earnings, income, and assets of persons with musculoskeletal conditions.

METHODS: This study uses the Health and Retirement Survey, a national, community based probability sample of persons 51-61 years of age and their spouses in 1992 to estimate earnings, income, and assets (by kind) in the years immediately prior to the normal age of retirement.

RESULTS: Fifty-nine percent of persons 51-61 years of age (13.76 million) report one or more musculoskeletal condition; of these 38\% (8.74 million) also report at least one comorbid condition and 21\% (5.02 million) report no such comorbidity. Persons with musculoskeletal conditions and comorbidity report 18\% lower family earnings, 15\% lower family income, and 35\% fewer assets than the average among all persons these ages. Persons with musculoskeletal conditions and no comorbidity have earnings, incomes, and assets closer to the average among their peers.

CONCLUSION: Persons with musculoskeletal conditions and comorbidity have lower earnings and incomes now and fewer assets with which to face the future than the remainder of their peers.

}, keywords = {Comorbidity, Data collection, Disabled Persons, Economics, Female, Health Services Research, Humans, Income, Male, Middle Aged, Musculoskeletal Diseases, Retirement}, issn = {0315-162X}, url = {https://www.ncbi.nlm.nih.gov/pubmed/9330948}, author = {Yelin, Edward} }