TY - JOUR T1 - Coordinated Care Experiences Among Middle-Aged and Older Adults with Multiple Chronic Conditions: Characteristics, Correlates, and Consequences for Health and Healthcare Utilization. JF - The Gerontologist Y1 - Forthcoming A1 - Qin, Weidi A1 - Kalesnikava, Viktoryia A1 - Dang, Linh A1 - Sneed, Rodlescia S A1 - Messina, Rossella A1 - Rucci, Paola A1 - Mezuk, Briana KW - Affordable Care Act KW - doctor-patient communication KW - Health Services KW - multimorbidity KW - survey research AB -

BACKGROUND AND OBJECTIVES: While coordinated care (CC) seeks to improve patient experiences and ultimately health outcomes, evidence from empirical research on the impacts of CC is mixed. This study examined the relationship between CC and healthcare outcomes over a four-year period among older adults with multiple chronic conditions.

RESEARCH DESIGN AND METHODS: This observational cohort study is based on data come from the 2016-2020 Health and Retirement Study. Analysis is limited to respondents with 2+ chronic conditions who completed an experimental module on CC in 2016 (n = 906). Three domains of CC were assessed: perceptions, informal (family/friends) and formal (healthcare staff) tangible support, and technical support (using a "patient portal"). The longitudinal relationship between CC and health (e.g., pain, functioning, self-rated health) and healthcare (e.g., doctor visits, hospitalization, care satisfaction) outcomes was investigated using mixed-effects models.

RESULTS: Better perceptions of CC were associated with lower odds of functional difficulties (Odds ratio (OR)=0.92; 95% CI=0.88-0.99) and greater satisfaction with care (B=0.04, 95% CI=0.02-0.05). Receipt of more informal tangible support was associated with 2.97 higher odds of ADL limitations (95% CI: 1.69-5.22) and 1.77 higher odds of hospitalization (95% CI=1.32-2.38). Use of technical support was associated with better self-rated health and greater satisfaction with care.

DISCUSSION AND IMPLICATIONS: The longitudinal relationship between CC and health is multi-faceted. While positive perceptions and more technical support have beneficial effects on health outcomes, higher utilization of tangible support may reflect a higher demand among older adults with more complex healthcare needs.

ER - TY - JOUR T1 - Work expectations, depressive symptoms, and passive suicidal ideation among older adults: Evidence from the Health and Retirement Study. JF - The Gerontologist Y1 - 2022 A1 - Mezuk, Briana A1 - Dang, Linh A1 - Jurgens, David A1 - Jacqui Smith KW - depression KW - Employment AB -

BACKGROUND AND OBJECTIVES: Employment and work transitions (e.g., retirement) influence mental health. However, how psychosocial contexts such as anticipation and uncertainty about work transitions, irrespective of the transitions themselves, relate to mental health is unclear. This study examined the relationships of work expectations with depressive symptoms, major depression episodes (MDE), and passive suicidal ideation over a 10-year period among the "Baby Boom" cohort of the Health and Retirement Study.

RESEARCH DESIGN AND METHODS: Analysis was limited to 13,247 respondents aged 53 - 70 observed from 2008 to 2018. Past-year depressive symptoms, MDE, and passive suicidal ideation were indexed using the Composite International Diagnostic Interview-Short Form. Expectations regarding working full-time after age 62 were assessed using a probability scale (zero to 100%). Mixed effect logistic regressions with time-varying covariates were used to assess the relationship of work expectations with mental health, accounting for demographics, health status, and functioning, and stratified by baseline employment status.

RESULTS: At baseline, higher work expectations were inversely associated with depressive symptoms. Longitudinally, higher expectations were associated with lower odds of depressive symptoms (Odds Ratio (OR) = 0.93, 95% CI: 0.91, 0.94). This association was more pronounced among respondents not working at baseline (ORNot working=0.93 vs. ORWorking=0.96). Greater uncertainty (i.e., expectations near 50%) was also inversely associated with depressive symptoms. Results were similar for past-year MDE and passive suicidal ideation.

DISCUSSION AND IMPLICATIONS: Expectations (overall likelihood and uncertainty), as indicators of psychosocial context, provide insight into the processes that link work transitions with depression risk.

VL - 62 IS - 10 ER - TY - JOUR T1 - Shades of blue and gray: A comparison of the Center for Epidemiologic Studies Depression Scale and the Composite International Diagnostic Interview for Assessment of Depression Syndrome in later life. JF - Gerontologist Y1 - 2020 A1 - Dang, Linh A1 - Dong, Liming A1 - Briana Mezuk KW - Depressive symptoms AB -

BACKGROUND AND OBJECTIVES: Psychiatric research lacks the equivalent of a thermometer, that is, a tool that accurately measures mental disorder regardless of context. Instead, the psychometric properties of scales that purport to assess psychopathology must be continuously evaluated. To that end, this study evaluated the diagnostic agreement between the eight-item Center for Epidemiologic Studies Depression Scale (CESD-8) and the Composite International Diagnostic Interview-short form (CIDI-SF) in the Health and Retirement Study (HRS).

RESEARCH DESIGN AND METHODS: Data come from 17,613 respondents aged >50 from the 2014 wave of the HRS. Kappa coefficients were used to assess the agreement between the 2 instruments on depression classification across a range of thresholds for identifying case status, including variation across subgroups defined by age, race/ethnicity, and gender.

RESULTS: The point prevalence of depression syndrome estimated by the CESD was higher than that estimated by the CIDI-SF (CESD: 9.9%-19.5% depending on the cutoff applied to the CESD vs CIDI-SF: 7.7%). Assuming CIDI-SF as the gold standard, the CESD yielded a sensitivity of 56.2%-70.2% and specificity of 84.7%-94.0% across the range of cutoffs. The agreement on depression classification was weak (κ = 0.32-0.44).

DISCUSSION AND IMPLICATIONS: Depression cases identified by the CESD have poor agreement with those identified by the CIDI-SF. Conceptually, psychological distress as measured by the CESD is not interchangeable with depression syndrome as measured by the CIDI-SF. Population estimates of depression among older adults based on the CESD should be interpreted with caution.

U1 - http://www.ncbi.nlm.nih.gov/pubmed/31112598?dopt=Abstract ER -