TY - JOUR T1 - Management of diabetes mellitus in older people with comorbidities. JF - BMJ Y1 - 2016 A1 - Huang, Elbert S KW - Aged KW - Aging KW - Blood Glucose KW - Comorbidity KW - Diabetes Mellitus, Type 2 KW - Disease Management KW - Female KW - Glycemic Index KW - Guidelines as Topic KW - Health Services Needs and Demand KW - Humans KW - Hypoglycemic Agents KW - Male KW - Precision Medicine KW - Quality of Life AB -

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.

VL - 353 UR - https://www.ncbi.nlm.nih.gov/pubmed/27307175 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27307175?dopt=Abstract ER - TY - JOUR T1 - The prospective relationship between binge drinking and physician visits among older adults. JF - J Aging Health Y1 - 2010 A1 - Kristi Rahrig Jenkins A1 - Robert A. Zucker KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Aging KW - Alcoholic Intoxication KW - Female KW - Health Resources KW - Health Services Accessibility KW - Health Services Needs and Demand KW - Health Status Indicators KW - Humans KW - Linear Models KW - Male KW - Michigan KW - Multivariate Analysis KW - Patient Satisfaction KW - Physicians KW - Prospective Studies KW - Psychometrics KW - Risk Assessment KW - Risk Factors KW - Self Report AB -

OBJECTIVES: The objectives are to (a) determine if binge drinking is related to physician visits and (b) estimate the degree to which the relationship between binge drinking and physician visits can be explained by other health characteristics.

METHOD: Data on a sample of 4,960 older adults (70+ years of age in 2002) from the Health and Retirement Study (HRS) were used. Three linear regression models estimated the impact of binge drinking on physician visits.

RESULTS: In the fully adjusted models, binge drinking did have an effect on the number of physician visits by older adults, with more frequent binge drinkers having fewer physician visits. This negative relationship exists even when demographic as well as other current health characteristics are controlled.

DISCUSSION: The implications of these results are discussed in terms of more broadly communicating the risks associated with binge drinking and more effectively targeting interventions to older binge drinkers.

PB - 22 VL - 22 IS - 8 U1 - http://www.ncbi.nlm.nih.gov/pubmed/20693519?dopt=Abstract U3 - 20693519 U4 - Drunkenness/Alcohol Abuse/Elderly/Health/Physicians/Sociodemographic/Socioeconomic Differences/Factors/Intervention/Retirement ER - TY - JOUR T1 - Proximity to death and participation in the long-term care market. JF - Health Econ Y1 - 2009 A1 - Weaver, France A1 - Sally C. Stearns A1 - Edward C Norton A1 - Spector, William KW - Aged KW - Aged, 80 and over KW - Caregivers KW - Female KW - Health Services Needs and Demand KW - Home Care Services KW - Humans KW - Interviews as Topic KW - Longevity KW - Male KW - Models, Statistical KW - Nursing homes KW - Terminal Care KW - United States AB -

The extent to which increasing longevity increases per capita demand for long-term care depends on the degree to which utilization is concentrated at the end of life. We estimate the marginal effect of proximity to death, measured by being within 2 years of death, on the probabilities of nursing home and formal home care use, and we determine whether this effect differs by availability of informal care--i.e. marital status and co-residence with an adult child. The analysis uses a sample of elderly aged 70+ from the 1993-2002 Health and Retirement Study. Simultaneous probit models address the joint decisions to use long-term care and co-reside with an adult child. Overall, proximity to death significantly increases the probability of nursing home use by 50.0% and of formal home care use by 12.4%. Availability of informal support significantly reduces the effect of proximity to death. Among married elderly, proximity to death has no effect on institutionalization. In conclusion, proximity to death is one of the main drivers of long-term care use, but changes in sources of informal support, such as an increase in the proportion of married elderly, may lessen its importance in shaping the demand for long-term care.

PB - 18 VL - 18 IS - 8 N1 - PMID: 18770873 U1 - http://www.ncbi.nlm.nih.gov/pubmed/18770873?dopt=Abstract U2 - PMC3786420 U4 - Long-Term Care/Longevity/Nursing Homes/Home Nursing ER - TY - JOUR T1 - Racial and ethnic disparities in mobility device use in late life. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2008 A1 - Jennifer C. Cornman A1 - Vicki A Freedman KW - Aged KW - Cross-Sectional Studies KW - Demography KW - ethnicity KW - Female KW - Health Services Needs and Demand KW - Humans KW - Insurance, Health KW - Male KW - Self-Help Devices KW - Socioeconomic factors AB -

OBJECTIVE: Although racial and ethnic disparities in disability are well established and technology is increasingly used to bridge gaps between functional deficits and environmental demands, little research has focused on racial and ethnic disparities in device use. This study investigated whether use of mobility devices differs by race and ethnicity and explored several reasons for this difference.

METHODS: The sample included community-dwelling adults aged 65 and older from the 2002 and 2004 waves of the Health and Retirement Study. We used predisposing, need, and enabling factors to predict mobility device use alone and combined with personal care.

RESULT: Blacks had the highest rates of using mobility devices, followed by Hispanics and then Whites. Need and enabling factors explained differences between Blacks and Whites in wheelchair use but not cane use or use of devices without personal care. Other predisposing factors explained most differences between Hispanics and Whites.

DISCUSSION: Because minorities appear to be using mobility devices in proportion to underlying need, increasing device use by minorities may not reduce disparities in mobility disability. Efforts to address racial/ethnic disparities in mobility disability in late life, therefore, may need to focus on differences in underlying functional decline rather than the accommodation of it.

PB - 63B VL - 63 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/18332200?dopt=Abstract U3 - 18332200 U4 - Racial Differences/Ethnic Groups/Mobility/Physical Vulnerability ER - TY - JOUR T1 - Racial disparities in receipt of hip and knee joint replacements are not explained by need: the Health and Retirement Study 1998-2004. JF - J Gerontol A Biol Sci Med Sci Y1 - 2008 A1 - Steel, Nicholas A1 - Clark, Allan A1 - Iain A Lang A1 - Robert B Wallace A1 - David Melzer KW - Aged KW - Arthroplasty, Replacement, Hip KW - Arthroplasty, Replacement, Knee KW - Black or African American KW - Educational Status KW - Female KW - Health Services Needs and Demand KW - Humans KW - Male KW - Middle Aged KW - United States AB -

BACKGROUND: Hip and knee joint replacement rates vary by demographic group. This article describes the epidemiology of need for joint replacement, and of subsequent receipt of a joint replacement by those in need.

METHODS: Data from the Health and Retirement Study were used to assess need for hip or knee joint replacement in a total of 14,807 adults aged 60 years or older in 1998, 2000, and 2002 and receipt of needed surgery 2 years later. "Need" classification was based on difficulty walking, joint pain, stiffness, or swelling and receipt of treatment for arthritis, without contraindications to surgery.

RESULTS: Need in 2002 was greater in participants who were older than 74 years (vs 60-64: adjusted odds ratio 2.06; 95% confidence interval, 1.68-2.53), women (vs men: 1.81; 1.53-2.14), less educated (vs college educated: 1.27; 1.06-1.52), in the poorest third (vs richest: 2.20; 1.78-2.72), or obese (vs nonobese: 2.39; 2.02-2.81). One hundred sixty-eight participants in need received a joint replacement, with lower receipt in black or African American participants (vs white: 0.47; 0.26-0.83) or less educated (vs college educated: 0.65; 0.44-0.96). These differences were not explained by current employment, access to medical care, family responsibilities, disability, living alone, comorbidity, or exclusion of those younger than Medicare eligibility age.

CONCLUSIONS: After taking variations in need into consideration, being black or African American or lacking a college education appears to be a barrier to receiving surgery, whereas age, sex, relative poverty, and obesity do not. These disparities maintain disproportionately high levels of pain and disability in disadvantaged groups.

PB - 63A VL - 63 IS - 6 U1 - http://www.ncbi.nlm.nih.gov/pubmed/18559639?dopt=Abstract U3 - 18559639 U4 - DISABILITY/DISABILITY/Joint Replacement ER - TY - JOUR T1 - Use of preventive care by the working poor in the United States. JF - Prev Med Y1 - 2007 A1 - Joseph S. Ross A1 - Bernheim, Susannah M. A1 - Elizabeth H Bradley A1 - Teng, Hsun-Mei A1 - William T Gallo KW - Cost of Illness KW - Cross-Sectional Studies KW - Employment KW - Female KW - Health Promotion KW - Health Services Accessibility KW - Health Services Needs and Demand KW - Humans KW - Male KW - Mass Screening KW - Middle Aged KW - Patient Acceptance of Health Care KW - Poverty KW - Preventive Health Services KW - Risk Assessment KW - Socioeconomic factors KW - United States KW - Vulnerable Populations AB -

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

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

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

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

PB - 44 VL - 44 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/17196642?dopt=Abstract U4 - Poverty/Health Care Utilization/screening ER - TY - JOUR T1 - Insurance coverage and health care use among near-elderly women. JF - Womens Health Issues Y1 - 2006 A1 - Xiao Xu A1 - Patel, Divya A. A1 - Vahratian, Anjel A1 - Ransom, Scott B. KW - Attitude to Health KW - Female KW - Health Services Accessibility KW - Health Services Needs and Demand KW - Health Status KW - Humans KW - Insurance Coverage KW - Insurance, Health KW - Medically Uninsured KW - Middle Aged KW - Patient Acceptance of Health Care KW - Socioeconomic factors KW - United States KW - Women's Health KW - Women's Health Services AB -

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

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

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

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

PB - 16 VL - 16 IS - 3 N1 - Official publication of the Jacobs Institute of Women's Health U1 - http://www.ncbi.nlm.nih.gov/pubmed/16765290?dopt=Abstract U4 - Health Care Utilization/womens health/Health Insurance Coverage/WOMEN ER - TY - JOUR T1 - Racial differences in activities of daily living limitation onset in older adults with arthritis: a national cohort study. JF - Arch Phys Med Rehabil Y1 - 2005 A1 - Shih, Vivian C. A1 - Song, Jing A1 - Rowland W Chang A1 - Dorothy D Dunlop KW - Activities of Daily Living KW - Aged KW - Arthritis KW - Black or African American KW - Female KW - Geriatric Assessment KW - Health Behavior KW - Health Services Needs and Demand KW - Hispanic or Latino KW - Humans KW - Longitudinal Studies KW - Male KW - Predictive Value of Tests KW - Prospective Studies KW - Risk Factors KW - United States KW - White People AB -

OBJECTIVE: To investigate factors that predict the onset of limitations in activities of daily living (ADLs) in adults 65 years old or older who have arthritis, in order to develop public health programs for minorities (African and Hispanic Americans) and white Americans.

DESIGN: Longitudinal cohort study.

SETTING: National probability sample.

PARTICIPANTS: Older adults with arthritis (N=3541) who participated in the 1998 and 2000 Health and Retirement Study interviews and who had no baseline ADL limitations.

INTERVENTIONS: Not applicable.

MAIN OUTCOME MEASURE: Onset of ADL limitations was identified from reports of 1 or more ADL task limitations at 2-year follow-up.

RESULTS: Onset is most frequent among African Americans (24.4%), followed by Hispanics (22.2%), and whites (16.9%). Race specific multivariate analysis showed that the strongest risk factor predicting onset of limitations across all racial and ethnic groups is physical limitations. Low household income was significant for older minorities but not for whites. Comorbid cardiovascular disease was a unique multivariate risk factor among African Americans.

CONCLUSIONS: Physical limitation is a strong risk factor for ADL limitation onset that is shared by all racial and ethnic groups. Early identification and treatment of physical limitations may prevent the onset of ADL limitations and thus improve quality of life. Race specific public health interventions should be considered to reduce the development of ADL limitations among older adults with arthritis.

PB - 86 VL - 86 IS - 8 U1 - http://www.ncbi.nlm.nih.gov/pubmed/16084802?dopt=Abstract U4 - Activities of Daily Living/African-Americans/Hispanics ER - TY - JOUR T1 - The labor market consequences of race differences in health. JF - Milbank Q Y1 - 2003 A1 - John Bound A1 - Timothy A Waidmann A1 - Michael Schoenbaum A1 - Bingenheimer,Jeffrey B. KW - Adult KW - Age Distribution KW - Age Factors KW - Attitude to Health KW - Black or African American KW - Cross-Cultural Comparison KW - Data Interpretation, Statistical KW - Employment KW - Female KW - Health Services Needs and Demand KW - Health Status Indicators KW - Humans KW - Indians, North American KW - Male KW - Middle Aged KW - Sex Distribution KW - Sex Factors KW - Socioeconomic factors KW - United States KW - White People PB - 81 VL - 81 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/12941003?dopt=Abstract U4 - Racial Differences/Health Status/labor market behavior ER - TY - JOUR T1 - Racial disparities in joint replacement use among older adults. JF - Med Care Y1 - 2003 A1 - Dorothy D Dunlop A1 - Larry M Manheim A1 - Song, Jing A1 - Rowland W Chang KW - Aged KW - Aged, 80 and over KW - Arthroplasty, Replacement KW - Black or African American KW - Cohort Studies KW - Data Interpretation, Statistical KW - Health Services Accessibility KW - Health Services Needs and Demand KW - Health Status KW - Health Surveys KW - Hispanic or Latino KW - Humans KW - Interviews as Topic KW - Osteoarthritis KW - Sampling Studies KW - United States KW - White People AB -

BACKGROUND: Although joint replacement can restore function for arthritis patients with severe joint disease, this procedure has not been used equally across racial groups. Differences in joint replacement use are assessed from a national sample.

OBJECTIVE: This study evaluates the role of health conditions and economic access to explain differences in joint replacement among older black and Hispanic minorities relative to white persons.

DESIGN: Longitudinal (1993-1995) Asset and Health Dynamics Among the Oldest Old (AHEAD) study.

SETTING: National probability sample of US community-dwelling older adults.

PATIENT POPULATION: AHEAD participants (n = 6159) aged 69 to 103 years.

MEASUREMENTS: The outcome is subject-reported 2-year use of any arthritis-related joint-replacement. Independent variables are demographics, health needs (arthritis, other medical conditions, functional health), and economic access (income, assets, education, and health insurance).

RESULTS: Older minorities reported arthritis-related joint replacements (black: 0.98%; Hispanic: 0.97%, annually) less frequently compared with white persons (1.48% annually). Older minorities were significantly less likely to use joint replacement compared with white persons (OR, 0.37; 95% CI, 0.20, 0.71) controlling for demographics, and arthritis and other health needs. Disparities remained significant (OR, 0.46; 95% CI, 0.22, 0.98) after additionally controlling for economic medical access. Use was lower among people who depended solely on Medicare compared with those with supplemental health insurance (OR, 0.46; 95% CI, 0.22, 0.95).

CONCLUSIONS: These national data document low rates of arthritis-related joint replacement among older Hispanic persons comparable to black persons. Less use among older minorities compared with white persons is not explained by differences in health needs or economic access. Other cultural and attitudinal factors merit investigation to explain disparities.

PB - 41 VL - 41 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/12555056?dopt=Abstract U4 - Arthritis/Health Care/Racial disparities ER -