TY - JOUR T1 - Housing status, mortgage debt and financial burden as barriers to health among older adults in the U.S JF - Housing and Society Y1 - 2022 A1 - Mehdipanah, Roshanak A1 - Martin, Jaclyn A1 - Eisenberg, Alexa K. A1 - Amy J Schulz A1 - Lewis B Morgenstern A1 - Kenneth M. Langa KW - health KW - Housing KW - housing tenure KW - mortgage KW - Older adult AB - ABSTRACT We examine relations between housing status, mortgage, financial burden, and healthy aging among older U.S. adults. We combine cross-sectional data from 2012 to 2014 Health and Retirement Study cohorts. Using regression models, we examined associations between owners and renters, mortgage and non-mortgage holders, financial strain, and difficulty paying bills, and poor self-rated health (SRH), heart condition (HC) and hospitalization (past two years). We find that compared to owners, renters had greater likelihood of poor SRH and hospitalization. Regardless of tenure, financial strain was associated with greater likelihood of poor SRH, HC and hospitalization, while difficulty paying bills was associated with poor SRH and HC. Mortgage holders had lower likelihood of poor SRH. Accounting for mortgage status, financial strain was associated with greater likelihood of poor SRH, HC and hospitalization, while difficulty paying bills was associated with poor SRH and HC. Associations between tenure or mortgage status and health were not modified by either financial burden factors. We conclude that there need to be more robust and inclusive programs that assist older populations with housing could improve self-rated health, with particular attention to renters, mortgage holders and those experiencing financial burden. VL - 49 SN - 0888-2746 IS - 1 ER - TY - JOUR T1 - Methods and Early Recruitment of a Community-Based Study of Cognitive Impairment Among Mexican Americans and Non-Hispanic Whites: The BASIC-Cognitive Study JF - Journal of Alzheimer's Disease Y1 - 2020 A1 - Emily Briceño A1 - Mehdipanah, Roshanak A1 - Gonzales, Xavier A1 - Steven G Heeringa A1 - Deborah A Levine A1 - Kenneth M. Langa A1 - Garcia, Nelda A1 - Longoria, Ruth A1 - Lewis B Morgenstern KW - Caregivers KW - Dementia KW - Epidemiology KW - Health Resources KW - mexican american KW - mild cognitive impairment AB - Background: As the Mexican American (MA) population grows and ages, there is an urgent need to estimate the prevalence of cognitive impairment or dementia (CID), cognitive trajectories, and identify community resource needs. The Brain Attack Surveillance in Corpus Christi (BASIC)-Cognitive project is a population-based study to address these issues among older MAs and non-Hispanic whites (NHW) and their informal care providers. Objective: Present the methodology and initial recruitment findings for the BASIC-Cognitive project. Method: Random, door-to-door case ascertainment is used in Nueces County, Texas, to recruit community-dwelling and nursing home residents ≥65 and informal care providers. Households are identified from a two-stage area probability sample, using Census data to aim for equal balance of MAs and NHWs. Individuals with cognitive screens indicative of possible CID complete neuropsychological assessment (Harmonized Cognitive Assessment Protocol from the Health and Retirement Study). Informal care providers complete comprehensive interview and needs assessment. Study pairs repeat procedures at 2-year follow-up. Asset and concept mapping are performed to identify community resources and study care providers’ perceptions of needs for individuals with CID. Results: 1,030 age-eligible households were identified, or 27% of households for whom age could be determined. 1,320 individuals were age-eligible, corresponding to 1.3 adults per eligible household. Initial recruitment yielded robust participation in the MA eligible population (60% of 689 individuals that completed cognitive screening). Conclusion: The BASIC-Cognitive study will provide critical information regarding the prevalence of CID in MAs, the impact of caregiving, and allocation of community resources to meet the needs of this population. VL - 73 SN - 1875-8908 UR - https://content.iospress.com/articles/journal-of-alzheimers-disease/jad190761 IS - 1 ER - TY - JOUR T1 - Mild cognitive impairment and receipt of procedures for acute ischemic stroke in older adults JF - Journal of Stroke and Cerebrovascular Diseases Y1 - 2020 A1 - Deborah A Levine A1 - Andrzej T Galecki A1 - Mohammed U Kabeto A1 - Nallamothu, Brahmajee K. A1 - Zahuranec, Darin B. A1 - Lewis B Morgenstern A1 - Lynda D Lisabeth A1 - Bruno J Giordani A1 - Kenneth M. Langa KW - Aging KW - cognitive impairment KW - Health policy/outcomes research KW - Ischemic stroke AB - Background and purpose Older patients with pre-existing mild cognitive impairment (MCI) receive less evidence-based care after acute myocardial infarction, however, whether they receive less care after acute ischemic stroke (AIS) is unknown. We compared receipt of guideline-concordant procedures after AIS between older adults with pre-existing MCI and normal cognition. Methods Prospective study of 591 adults ≥65 hospitalized for AIS between 2000 and 2014, and followed through 2015 using data from the nationally representative Health and Retirement Study, Medicare and American Hospital Association. We assessed pre-existing MCI (modified Telephone Interview for Cognitive Status score of 7–11) and normal cognition (score of 12–27). Primary outcome was a composite quality measure representing the number of 4 procedures (carotid imaging, cardiac monitoring, echocardiogram, and rehabilitation assessment) received within 30 days after AIS (ordinal scale with values of 0, 1, 2, 3–4). Results Among survivors of AIS, 26.9% had pre-existing MCI (62.9% were women, with a mean [SD] age of 82.4 [7.7] years), and 73.1% had normal cognition (51.4% were women, with a mean age of 78.4 [7.2] years). Patients with pre-existing MCI, compared to cognitively normal patients, had 39% lower cumulative odds of receiving the composite quality measure (unadjusted cumulative odds ratio, OR, 0.61 [95% CI, 0.43–0.87]; P=0.006). However, this association became non-significant after adjusting for patient and hospital factors (adjusted cumulative OR, 0.83 [95% CI, 0.56–1.24]; P=0.37). Lower cumulative odds of receiving the composite quality measure were associated with older patient age (adjusted cumulative OR per 1-year older age, 0.97 [95% CI, 0.95–0.99]; P=0.01) and Southern hospitals (adjusted cumulative OR for South vs North, 0.54 [95% CI, 0.31–0.94]; P=0.03). Conclusions Differences in receipt of guideline-concordant procedures after AIS exist between patients with pre-existing MCI and normal cognition. These differences were largely explained by patient and regional factors associated with receiving less AIS care. VL - 29 SN - 1052-3057 IS - 10 ER - TY - JOUR T1 - Mild Cognitive Impairment and Receipt of Treatments for Acute Myocardial Infarction in Older Adults JF - Journal of General Internal Medicine Y1 - 2020 A1 - Deborah A Levine A1 - Kenneth M. Langa A1 - Andrzej T Galecki A1 - Mohammed U Kabeto A1 - Lewis B Morgenstern A1 - Zahuranec, Darin B. A1 - Bruno J Giordani A1 - Lynda D Lisabeth A1 - Nallamothu, Brahmajee K. KW - Cognitive Ability KW - Heart disease KW - Medicare/Medicaid/Health Insurance AB - Background Older adults with mild cognitive impairment (MCI) should receive evidence-based treatments when indicated. Providers and patients may overestimate the risk of dementia in patients with MCI leading to potential under-treatment. However, the association between pre-existing MCI and receipt of evidence-based treatments is uncertain. Objective To compare receipt of treatments for acute myocardial infarction (AMI) between older adults with pre-existing MCI and cognitively normal patients. Design Prospective study using data from the nationally representative Health and Retirement Study, Medicare, and American Hospital Association. Participants Six hundred nine adults aged 65 or older hospitalized for AMI between 2000 and 2011 and followed through 2012 with pre-existing MCI (defined as modified Telephone Interview for Cognitive Status score of 7–11) and normal cognition (score of 12–27). Main Measures Receipt of cardiac catheterization and coronary revascularization within 30 days and cardiac rehabilitation within 1 year of AMI hospitalization. Key Results Among the survivors of AMI, 19.2% had pre-existing MCI (55.6% were women and 44.4% were male, with a mean [SD] age of 82.3 [7.5] years), and 80.8% had normal cognition (45.7% were women and 54.3% were male, with a mean age of 77.1 [7.1] years). Survivors of AMI with pre-existing MCI were significantly less likely than those with normal cognition to receive cardiac catheterization (50% vs 77%; P < 0.001), coronary revascularization (29% vs 63%; P < 0.001), and cardiac rehabilitation (9% vs 22%; P = 0.001) after AMI. After adjusting for patient and hospital factors, pre-existing MCI remained associated with lower use of cardiac catheterization (adjusted hazard ratio (aHR), 0.65; 95% CI, 0.48–0.89; P = 0.007) and coronary revascularization (aHR, 0.55; 95% CI, 0.37–0.81; P = .003), but not cardiac rehabilitation (aHR, 1.01; 95% CI, 0.49–2.07; P = 0.98). Conclusions Pre-existing MCI is associated with lower use of cardiac catheterization and coronary revascularization but not cardiac rehabilitation after AMI. VL - 35 UR - https://link.springer.com/article/10.1007%2Fs11606-019-05155-8#citeas JO - J GEN INTERN MED ER - TY - JOUR T1 - Vascular health, diabetes, APOE and dementia: the Aging, Demographics, and Memory Study. JF - Alzheimers Res Ther Y1 - 2010 A1 - David J Llewellyn A1 - Iain A Lang A1 - Fiona E Matthews A1 - Brenda L Plassman A1 - Mary A M Rogers A1 - Lewis B Morgenstern A1 - Gwenith G Fisher A1 - Mohammed U Kabeto A1 - Kenneth M. Langa AB -

INTRODUCTION: Evidence from clinical samples and geographically limited population studies suggests that vascular health, diabetes and apolipoprotein epsilon4 (APOE) are associated with dementia.

METHODS: A population-based sample of 856 individuals aged 71 years or older from all contiguous regions of the United States received an extensive in-home clinical and neuropsychological assessment in 2001-2003. The relation of hypertension, diabetes, heart disease, stroke, medication usage, and APOE epsilon4 to dementia was modelled using adjusted multivariable logistic regression.

RESULTS: Treated stroke (odds ratio [OR] 3.8, 95% confidence interval [CI] 2.0, 7.2), untreated stroke (OR 3.5, 95% CI 1.7, 7.3), and APOE epsilon4 (OR 2.8, 95% CI 1.7, 4.5) all increased the odds of dementia. Treated hypertension was associated with lower odds of dementia (OR 0.5, 95% CI 0.3, 1.0). Diabetes and heart disease were not significantly associated with dementia. A significant interaction was observed between APOE epsilon4 and stroke (P = 0.001).

CONCLUSIONS: Data from the first dementia study that is representative of the United States population suggest that stroke, the APOE epsilon4 allele and their interaction are strongly associated with dementia.

PB - 2 VL - 2 UR - http://alzres.com/content/2/3/19 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/20576093?dopt=Abstract U2 - PMC2919699 U4 - Dementia/Vascular dementia/Stroke ER -