%0 Journal Article %J JAMA Internal Medicine %D Forthcoming %T Development and External Validation of Models to Predict Need for Nursing Home Level of Care in Community-Dwelling Older Adults With Dementia. %A Deardorff, W James %A Jeon, Sun Y %A Barnes, Deborah E %A Boscardin, W John %A Kenneth M. Langa %A Covinsky, Kenneth E %A Mitchell, Susan L %A Lee, Sei J %A Smith, Alexander K %K Community-dwelling %K Dementia %K home care %K Nursing %X

IMPORTANCE: Most older adults living with dementia ultimately need nursing home level of care (NHLOC).

OBJECTIVE: To develop models to predict need for NHLOC among older adults with probable dementia using self-report and proxy reports to aid patients and family with planning and care management.

DESIGN, SETTING, AND PARTICIPANTS: This prognostic study included data from 1998 to 2016 from the Health and Retirement Study (development cohort) and from 2011 to 2019 from the National Health and Aging Trends Study (validation cohort). Participants were community-dwelling adults 65 years and older with probable dementia. Data analysis was conducted between January 2022 and October 2023.

EXPOSURES: Candidate predictors included demographics, behavioral/health factors, functional measures, and chronic conditions.

MAIN OUTCOMES AND MEASURES: The primary outcome was need for NHLOC defined as (1) 3 or more activities of daily living (ADL) dependencies, (2) 2 or more ADL dependencies and presence of wandering/need for supervision, or (3) needing help with eating. A Weibull survival model incorporating interval censoring and competing risk of death was used. Imputation-stable variable selection was used to develop 2 models: one using proxy responses and another using self-responses. Model performance was assessed by discrimination (integrated area under the receiver operating characteristic curve [iAUC]) and calibration (calibration plots).

RESULTS: Of 3327 participants with probable dementia in the Health and Retirement Study, the mean (SD) age was 82.4 (7.4) years and 2301 (survey-weighted 70%) were female. At the end of follow-up, 2107 participants (63.3%) were classified as needing NHLOC. Predictors for both final models included age, baseline ADL and instrumental ADL dependencies, and driving status. The proxy model added body mass index and falls history. The self-respondent model added female sex, incontinence, and date recall. Optimism-corrected iAUC after bootstrap internal validation was 0.72 (95% CI, 0.70-0.75) in the proxy model and 0.64 (95% CI, 0.62-0.66) in the self-respondent model. On external validation in the National Health and Aging Trends Study (n = 1712), iAUC in the proxy and self-respondent models was 0.66 (95% CI, 0.61-0.70) and 0.64 (95% CI, 0.62-0.67), respectively. There was excellent calibration across the range of predicted risk.

CONCLUSIONS AND RELEVANCE: This prognostic study showed that relatively simple models using self-report or proxy responses can predict need for NHLOC in community-dwelling older adults with probable dementia with moderate discrimination and excellent calibration. These estimates may help guide discussions with patients and families in future care planning.

%B JAMA Internal Medicine %G eng %R 10.1001/jamainternmed.2023.6548 %0 Journal Article %J Innovation in Aging %D 2023 %T Decision Making for Patients With Severe Dementia Versus Normal Cognition Near the End of Life. %A Nicholas, Lauren Hersch %A Halpern, Scott D %A David R Weir %A Baum, Micah Y %A Nolan, Marie %A Gallo, Joseph %A Kenneth M. Langa %K Advance care planning %K cognitive impairment %K family caregivers %X

BACKGROUND AND OBJECTIVES: The clinical progression of severe dementia frequently leads to situations where surrogate decision makers must quickly make choices about potentially burdensome treatments that offer limited clinical benefit. We examined whether the number of decision makers and their access to advance directives were related to treatment choice for patients with severe dementia in comparison to those with normal cognition.

RESEARCH DESIGN AND METHODS: We retrospectively linked survey responses about end-of-life treatment decisions to Medicare claims for Health and Retirement Study respondents dying between 2002 and 2015 whose next-of-kin reported a need for surrogate decision making. We estimated multivariable logistic regression models to study measures of aggressive care in the last 6 months of life; in-hospital death, burdensome transfers, and burdensome treatments.

RESULTS: Compared to patients who were cognitively normal near the end of life ( = 1 198), patients with severe dementia ( = 722) were less likely to experience burdensome treatments (18% [95% confidence interval {CI} 14-21] vs 32% [95% CI 29-35]), burdensome transfers (20% [95% CI 17-24] vs 30% [95% CI 27-33]), and in-hospital death (24% [95% CI 20-28] vs 30% [95% CI 26-33]) when surrogates were involved. Rates of burdensome treatments, transfers, or in-hospital death for decedents with severe dementia did not vary with single versus multiple decision makers or when decision makers were informed by advance directives. However, among decedents with normal cognition, a single decision maker informed by an advance directive was associated with the lowest rates of burdensome treatments and in-hospital death.

DISCUSSION AND IMPLICATIONS: Surrogate decision makers made similar choices around end-of-life care for patients with severe dementia regardless of the number of decision makers and availability of advance directives. However, both advance directives and single decision makers were associated with less aggressive care for cognitively normal decedents.

%B Innovation in Aging %V 7 %P igad081 %G eng %N 7 %R 10.1093/geroni/igad081 %0 Journal Article %J J of the American Geriatric Society %D 2023 %T The devil's in the details: Variation in estimates of late-life activity limitations across national cohort studies. %A Ankuda, Claire K %A Covinsky, Kenneth %A Freedman, Vicki A %A Kenneth M. Langa %A Aldridge, Melissa D %A Yee, Cynthia %A Kelley, Amy S %K Activities of Daily Living %K Cohort Studies %K Disabled Persons %K Medicare %K Self Care %X

BACKGROUND: Assessing activity limitations is central to aging research. However, assessments of activity limitations vary, and this may have implications for the populations identified. We aim to compare measures of activities of daily living (ADLs) and their resulting prevalence and mortality across three nationally-representative cohort studies: the National Health and Aging Trends Study (NHATS), the Health and Retirement Survey (HRS), and the Medicare Current Beneficiary Survey (MCBS).

METHODS: We compared the phrasing and context of questions around help and difficulty with six self-care activities: eating, bathing, toileting, dressing, walking inside, and transferring. We then compared the prevalence and 1-year mortality for difficulty and help with eating and dressing.

RESULTS: NHATS, HRS, and MCBS varied widely in phrasing and framing of questions around activity limitations, impacting the proportion of the population found to experience difficulty or receive help. For example, in NHATS 12.4% [95% confidence interval (CI) 11.5%-13.4%] of the cohort received help with dressing, while in HRS this figure was 6.4% [95% CI 5.7%-7.2%] and MCBS 5.3% [95% CI 4.7%-5.8%]. When combined with variation in sampling frame and survey approach of each survey, such differences resulted in large variation in estimates of the older population of older adults with ADL disability.

CONCLUSIONS: In order to take late-life activity limitations seriously, we must clearly define the measures we use. Further, researchers and clinicians seeking to understand the experience of older adults with activity limitations should be careful to interpret findings in light of the framing of the question asked.

%B J of the American Geriatric Society %V 71 %P 858-868 %G eng %N 3 %R 10.1111/jgs.18158 %0 Journal Article %J JAMA Internal Medicine %D 2022 %T Development and External Validation of a Mortality Prediction Model for Community-Dwelling Older Adults With Dementia. %A Deardorff, W James %A Barnes, Deborah E %A Jeon, Sun Y %A Boscardin, W John %A Kenneth M. Langa %A Covinsky, Kenneth E %A Mitchell, Susan L %A Whitlock, Elizabeth L %A Smith, Alexander K %A Lee, Sei J %K community dwelling %K Dementia %K mortality risk %X

Importance: Estimating mortality risk in older adults with dementia is important for guiding decisions such as cancer screening, treatment of new and chronic medical conditions, and advance care planning.

Objective: To develop and externally validate a mortality prediction model in community-dwelling older adults with dementia.

Design, Setting, and Participants: This cohort study included community-dwelling participants (aged ≥65 years) in the Health and Retirement Study (HRS) from 1998 to 2016 (derivation cohort) and National Health and Aging Trends Study (NHATS) from 2011 to 2019 (validation cohort).

Exposures: Candidate predictors included demographics, behavioral/health factors, functional measures (eg, activities of daily living [ADL] and instrumental activities of daily living [IADL]), and chronic conditions.

Main Outcomes and Measures: The primary outcome was time to all-cause death. We used Cox proportional hazards regression with backward selection and multiple imputation for model development. Model performance was assessed by discrimination (integrated area under the receiver operating characteristic curve [iAUC]) and calibration (plots of predicted and observed mortality).

Results: Of 4267 participants with probable dementia in HRS, the mean (SD) age was 82.2 (7.6) years, 2930 (survey-weighted 69.4%) were female, and 785 (survey-weighted 12.1%) identified as Black. Median (IQR) follow-up time was 3.9 (2.0-6.8) years, and 3466 (81.2%) participants died by end of follow-up. The final model included age, sex, body mass index, smoking status, ADL dependency count, IADL difficulty count, difficulty walking several blocks, participation in vigorous physical activity, and chronic conditions (cancer, heart disease, diabetes, lung disease). The optimism-corrected iAUC after bootstrap internal validation was 0.76 (95% CI, 0.75-0.76) with time-specific AUC of 0.73 (95% CI, 0.70-0.75) at 1 year, 0.75 (95% CI, 0.73-0.77) at 5 years, and 0.84 (95% CI, 0.82-0.85) at 10 years. On external validation in NHATS (n = 2404), AUC was 0.73 (95% CI, 0.70-0.76) at 1 year and 0.74 (95% CI, 0.71-0.76) at 5 years. Calibration plots suggested good calibration across the range of predicted risk from 1 to 10 years.

Conclusions and Relevance: We developed and externally validated a mortality prediction model in community-dwelling older adults with dementia that showed good discrimination and calibration. The mortality risk estimates may help guide discussions regarding treatment decisions and advance care planning.

%B JAMA Internal Medicine %V 182 %P 1161-1170 %G eng %N 11 %R 10.1001/jamainternmed.2022.4326 %0 Journal Article %J The Journals of Gerontology, Series B %D 2022 %T Differential trends in disability among rich and poor adults in the US and England from 2002 to 2016. %A Choi, Hwa Jung %A Robert F. Schoeni %A Andrew Steptoe %A Cho, Tsai-Chin %A Kenneth M. Langa %K ADL limitation %K Disability trend %K ELSA %K health disparity %K IADL limitation %X

OBJECTIVE: Disability in the US has not improved in recent decades. Comparing temporal trends in disability prevalence across different income groups, both within and between the US and England, would inform public policy aimed at reducing disparities in disability.

METHODS: Using the Health and Retirement Study (HRS) and the English Longitudinal Study of Ageing (ELSA), we estimated annual percent change from 2002 to 2016 in disability among community dwelling adults (197,021 person-years of observations). Disability was defined based on self-report of limitations with five instrumental activities of daily living (IADLs) and six activities of daily living (ADLs). We examined the trends by age and income quintile and adjusted for individual-level sociodemographic status and survey design.

RESULTS: The adjusted annual percent change (AAPC) in disability prevalence declined significantly in both countries for ages 75 and older during 2002--2016. For ages 55-64 and 65-74, disability prevalence was unchanged in the US but declined in England. Both countries experienced a widening gap in disability between low- and high-income adults among the younger age groups. For example, for those ages 55-64 in each country, there was no significant improvement in disability for the low-income group but a significant improvement for the high-income group (AAPC=-3.60 95% CI [-6.57,-0.63] for the US; AAPC=-6.06 95% CI [-8.77,-3.35] for England).

DISCUSSION: Improvements in disability were more widespread in England than in the US between 2002 and 2016. In both countries, the disparity in disability between low- and high-income adults widened for middle-aged adults. Policies targeted at preventing disability among low-income adults should be a priority in both countries.

%B The Journals of Gerontology, Series B %V 77 %P S189-S198 %G eng %N Supplement_2 %R 10.1093/geronb/gbac029 %0 Journal Article %J Journal of General Internal Medicine %D 2021 %T Development, Validation, and Performance of a New Physical Functioning–Weighted Multimorbidity Index for Use in Administrative Data %A Melissa Y Wei %A Jamie E Luster %A Ratz, David %A Kenneth J Mukamal %A Kenneth M. Langa %K Medicaid %K Medicare %K multimorbidity index %K physical functioning %B Journal of General Internal Medicine %V 36 %P 2427–2433 %G eng %R 10.1007/s11606-020-06486-7 %0 Journal Article %J Journal of General Internal Medicine %D 2021 %T Development, Validation, and Performance of a New Physical Functioning-Weighted Multimorbidity Index for Use in Administrative Data. %A Wei, Melissa Y %A Luster, Jamie E %A Ratz, David %A Mukamal, Kenneth J %A Kenneth M. Langa %K Activities of Daily Living %K multimorbidity %B Journal of General Internal Medicine %V 36 %P 2427-2433 %G eng %N 8 %R 10.1007/s11606-020-06486-7 %0 Journal Article %J Journal of Pain and Symptom Management %D 2021 %T Does it Matter Who Decides? Outcomes of Surrogate Decision-Making for Community-Dwelling, Cognitively Impaired Older Adults Near the End of Life. %A Micah Y. Baum %A Gallo, Joseph J %A Nolan, Marie T %A Kenneth M. Langa %A Halpern, Scott D %A Macis, Mario %A Lauren Hersch Nicholas %K end-of-life decisions %K Family %K surrogate decision-making %X

CONTEXT: Cognitively impaired older adults frequently need surrogate decision-making near the end-of-life. It is unknown whether differences in the surrogate's relationship to the decedent are associated with different end-of-life treatment choices.

OBJECTIVES: To describe differences in end-of-life care for community dwelling, cognitively impaired older adults when children and spouses are involved in decision-making.

METHODS: Retrospective observational study.

RESULTS: Among 742 community-dwelling adults with cognitive impairment (mild cognitive impairment or dementia) prior to death, children participated in end-of-life decisions for 615 patients (83%) and spouses participated in decisions for 258 patients (35%), with both children and spouses participating for 131 patients (18%). When controlling for demographic characteristics, decedents with only a spouse decision-maker were less likely to undergo a life-sustaining treatment than decedents with only children decision-makers (P < 0.05). There was no difference in the probability of in-hospital death or burdensome transfers across facilities across decedent-decision-maker relationships. Differences in rates of life-sustaining treatment were greater when we restricted to decedents with dementia.

CONCLUSION: Decedents with cognitive impairment or dementia were less likely to receive life-sustaining treatments when spouses versus children were involved with end-of-life treatment decisions but were no less likely to experience other measures of potentially burdensome end-of-life care.

%B Journal of Pain and Symptom Management %V 62 %P 1126-1134 %G eng %N 6 %R 10.1016/j.jpainsymman.2021.06.009 %0 Journal Article %J Research on Aging %D 2019 %T Does home equity affect decisions on long-term care insurance purchases? Evidence from the United States. %A Richard A Hirth %A Acharya, Yubraj %A Helen G Levy %A Kenneth M. Langa %K Decision making %K Homeownership %K Long-term care insurance %X The low uptake of private long-term care insurance (LTCI) by the elderly in the United States, despite visible risks, has left economists puzzled. Prior studies have hypothesized that home equity can be a substitute for LTCI and hence may partly explain the low uptake. We test this hypothesis empirically. We utilize exogenous variation in house prices at the level of the metropolitan statistical area (MSA) as an instrument for home equity for individuals residing in that MSA and data from the Health and Retirement Study. In the most robust specifications, we find no evidence that the elderly change their decision on LTCI based on variation in their home equity, and even specifications requiring stronger identification assumptions imply only small effect magnitudes. Home equity as a substitute for LTCI does not appear to be a major contributing factor to low LTCI take up. %B Research on Aging %V 41 %8 07/2019 %G eng %N 6 %1 http://www.ncbi.nlm.nih.gov/pubmed/30803354?dopt=Abstract %R 10.1177/0164027519830078 %0 Journal Article %J American Journal of Geriatric Psychiatry %D 2017 %T Distress Associated with Dementia-Related Psychosis and Agitation in Relation to Healthcare Utilization and Costs. %A Donovan T Maust %A Helen C Kales %A Ryan J McCammon %A Frederic C. Blow %A Amanda N Leggett %A Kenneth M. Langa %K Dementia %K Depressive symptoms %K Healthcare %K Stress %X

OBJECTIVES: Explore the relationship between behavioral and psychological symptoms of dementia (BPSD; specifically, delusions, hallucinations, and agitation/aggression) and associated caregiver distress with emergency department (ED) utilization, inpatient hospitalization, and expenditures for direct medical care.

DESIGN/SETTING/PARTICIPANTS: Retrospective cross-sectional cohort of participants with dementia (N = 332) and informants from the Aging, Demographics, and Memory Study, a nationally representative survey of U.S. adults >70 years old.

MEASUREMENTS: BPSD of interest and associated informant distress (trichotomized as none/low/high) were assessed using the Neuropsychiatric Inventory (NPI). Outcomes were determined from one year of Medicare claims and examined according to presence of BPSD and associated informant distress, adjusting for participant demographics, dementia severity, and comorbidity.

RESULTS: Fifty-eight (15%) participants with dementia had clinically significant delusions, hallucinations, or agitation/aggression. ED visits, inpatient admissions, and costs were not significantly higher among the group with significant BPSD. In fully adjusted models, a high level of informant distress was associated with all outcomes: ED visit incident rate ratio (IRR) 3.03 (95% CI: 1.98-4.63; p < 0.001), hospitalization IRR 2.78 (95% CI: 1.73-4.46; p < 0.001), and relative cost ratio 2.00 (95% CI: 1.12-3.59; p = 0.02).

CONCLUSIONS: A high level of informant distress related to participant BPSD, rather than the symptoms themselves, was associated with increased healthcare utilization and costs. Effectively identifying, educating, and supporting distressed caregivers may help reduce excess healthcare utilization for the growing number of older adults with dementia.

%B American Journal of Geriatric Psychiatry %V 25 %P 1074-1082 %8 2017 Oct %G eng %N 10 %1 http://www.ncbi.nlm.nih.gov/pubmed/28754586?dopt=Abstract %R 10.1016/j.jagp.2017.02.025 %0 Journal Article %J Psychosom Med %D 2016 %T Dispositional Optimism and Incidence of Cognitive Impairment in Older Adults. %A Katerina A B Gawronski %A Eric S Kim %A Kenneth M. Langa %A Laura D Kubzansky %K Aged %K Aged, 80 and over %K Cognitive Dysfunction %K Female %K Humans %K Incidence %K Male %K Optimism %K Protective factors %K United States %X

OBJECTIVE: Higher levels of optimism have been linked with positive health behaviors, biological processes, and health conditions that are potentially protective against cognitive impairment in older adults. However, the association between optimism and cognitive impairment has not been directly investigated. We examined whether optimism is associated with incident cognitive impairment in older adults.

METHODS: Data are from the Health and Retirement Study. Optimism was measured by using the Life Orientation Test-R and cognitive impairment with a modified version of the Telephone Interview for Cognitive Status derived from the Mini-Mental State Examination. Using multiple logistic regression models, we prospectively assessed whether optimism was associated with incident cognitive impairment in 4624 adults 65 years and older during a 4-year period.

RESULTS: Among participants, 312 women and 190 men developed cognitive impairment during the 4-year follow-up. Higher optimism was associated with decreased risk of incident cognitive impairment. When adjusted for sociodemographic factors, each standard deviation increase in optimism was associated with reduced odds (odds ratio [OR] = 0.70, 95% confidence interval [CI] = 0.61-0.81) of becoming cognitively impaired. A dose-response relationship was observed. Compared with those with the lowest levels of optimism, people with moderate levels had somewhat reduced odds of cognitive impairment (OR = 0.78, 95% CI = 0.59-1.03), whereas people with the highest levels had the lowest odds of cognitive impairment (OR = 0.52, 95% CI = 0.36-0.74). These associations remained after adjusting for health behaviors, biological factors, and psychological covariates that could either confound the association of interest or serve on the pathway.

CONCLUSIONS: Optimism was prospectively associated with a reduced likelihood of becoming cognitively impaired. If these results are replicated, the data suggest that potentially modifiable aspects of positive psychological functioning such as optimism play an important role in maintaining cognitive functioning.

%B Psychosom Med %V 78 %P 819-28 %8 2016 09 %G eng %U https://www.ncbi.nlm.nih.gov/pubmed/27284699 %N 7 %1 http://www.ncbi.nlm.nih.gov/pubmed/27284699?dopt=Abstract %R 10.1097/PSY.0000000000000345 %0 Journal Article %J Stroke %D 2015 %T Does Stroke Contribute to Racial Differences in Cognitive Decline? %A Deborah A Levine %A Mohammed U Kabeto %A Kenneth M. Langa %A Lynda D Lisabeth %A Mary A M Rogers %A Andrzej T Galecki %K African Continental Ancestry Group %K Aged %K Aged, 80 and over %K Cognition Disorders %K European Continental Ancestry Group %K Female %K Humans %K Longitudinal Studies %K Male %K Risk Factors %K Stroke %X

BACKGROUND AND PURPOSE: It is unknown whether blacks' elevated risk of dementia is because of racial differences in acute stroke, the impact of stroke on cognitive health, or other factors. We investigated whether racial differences in cognitive decline are explained by differences in the frequency or impact of incident stroke between blacks and whites, controlling for baseline cognition.

METHODS: Among 4908 black and white participants aged ≥65 years free of stroke and cognitive impairment in the nationally representative Health and Retirement Study with linked Medicare data (1998-2010), we examined longitudinal changes in global cognition (modified version of the Telephone Interview for Cognitive Status) by race, before and after adjusting for time-dependent incident stroke followed by a race-by-incident stroke interaction term, using linear mixed-effects models that included fixed effects of participant demographics, clinical factors, and cognition, and random effects for intercept and slope for time.

RESULTS: We identified 34 of 453 (7.5%) blacks and 300 of 4455 (6.7%) whites with incident stroke over a mean (SD) of 4.1 (1.9) years of follow-up (P=0.53). Blacks had greater cognitive decline than whites (adjusted difference in modified version of the Telephone Interview for Cognitive Status score, 1.47 points; 95% confidence interval, 1.21 to 1.73 points). With further adjustment for cumulative incidence of stroke, the black-white difference in cognitive decline persisted. Incident stroke was associated with a decrease in global cognition (1.21 points; P<0.001) corresponding to ≈7.9 years of cognitive aging. The effect of incident stroke on cognition did not statistically differ by race (P=0.52).

CONCLUSIONS: In this population-based cohort of older adults, incident stroke did not explain black-white differences in cognitive decline or impact cognition differently by race.

%B Stroke %I 46 %V 46 %P 1897-902 %8 2015 Jul %G eng %U http://stroke.ahajournals.org/content/early/2015/05/20/STROKEAHA.114.008156.abstract %N 7 %1 http://www.ncbi.nlm.nih.gov/pubmed/25999389?dopt=Abstract %4 dementia/Medicare/stroke/African American/cognitive status/decline %$ 999999 %R 10.1161/STROKEAHA.114.008156 %0 Journal Article %J PLoS One %D 2014 %T Death certificates underestimate infections as proximal causes of death in the U.S. %A Govindan, Sushant %A Shapiro, Letitia %A Kenneth M. Langa %A Theodore J Iwashyna %K Cause of Death %K Death Certificates %K Hospitalization %K Humans %K Infections %K Medicare %K United States %X

BACKGROUND: Death certificates are a primary data source for assessing the population burden of diseases; however, there are concerns regarding their accuracy. Diagnosis-Related Group (DRG) coding of a terminal hospitalization may provide an alternative view. We analyzed the rate and patterns of disagreement between death certificate data and hospital claims for patients who died during an inpatient hospitalization.

METHODS: We studied respondents from the Health and Retirement Study (a nationally representative sample of older Americans who had an inpatient death documented in the linked Medicare claims from 1993-2007). Causes of death abstracted from death certificates were aggregated to the standard National Center for Health Statistics List of 50 Rankable Causes of Death. Centers for Medicare and Medicaid Services (CMS)-DRGs were manually aggregated into a parallel classification. We then compared the two systems via 2×2, focusing on concordance. Our primary analysis was agreement between the two data sources, assessed with percentages and Cohen's kappa statistic.

RESULTS: 2074 inpatient deaths were included in our analysis. 36.6% of death certificate cause-of-death codes agreed with the reason for the terminal hospitalization in the Medicare claims at the broad category level; when re-classifying DRGs without clear alignment as agreements, the concordance only increased to 61%. Overall Kappa was 0.21, or "fair." Death certificates in this cohort redemonstrated the conventional top 3 causes of death as diseases of the heart, malignancy, and cerebrovascular disease. However, hospitalization claims data showed infections, diseases of the heart, and cerebrovascular disease as the most common diagnoses for the same terminal hospitalizations.

CONCLUSION: There are significant differences between Medicare claims and death certificate data in assigning cause of death for inpatients. The importance of infections as proximal causes of death is underestimated by current death certificate-based strategies.

%B PLoS One %I 9 %V 9 %P e97714 %8 2014 %G eng %N 5 %1 http://www.ncbi.nlm.nih.gov/pubmed/24878897?dopt=Abstract %2 PMC4039437 %4 Medicare claims/Infection/death certificate/cause of death/survey methods %$ 999999 %R 10.1371/journal.pone.0097714 %0 Journal Article %J J Psychosom Res %D 2014 %T Depression and risk of hospitalization for pneumonia in a cohort study of older Americans. %A Dimitry S Davydow %A Catherine L Hough %A Zivin, Kara %A Kenneth M. Langa %A Wayne J Katon %K Aged %K Aged, 80 and over %K Cohort Studies %K Comorbidity %K depression %K Depressive Disorder %K Female %K Hospitalization %K Humans %K Logistic Models %K Male %K Middle Aged %K Odds Ratio %K Pneumonia %K Risk Assessment %K Risk Factors %K United States %X

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.

%B J Psychosom Res %I 77 %V 77 %P 528-34 %8 2014 Dec %G eng %N 6 %1 http://www.ncbi.nlm.nih.gov/pubmed/25139125?dopt=Abstract %2 PMC4259844 %4 Depression/Pneumonia/Hospitalization/Outcome assessment (health care)/health Care Utilization/mental Health %$ 999999 %R 10.1016/j.jpsychores.2014.08.002 %0 Journal Article %J Alzheimers Dement %D 2014 %T Development and validation of a brief dementia screening indicator for primary care. %A Deborah E Barnes %A Alexa S. Beiser %A Anne Lee %A Kenneth M. Langa %A Alain Koyama %A Sarah R Preis %A John Neuhaus %A Ryan J McCammon %A Kristine Yaffe %A Seshadri, Sudha %A Mary Haan %A David R Weir %K Aged %K Cohort Studies %K Dementia %K Female %K Humans %K Male %K Mass Screening %K Predictive Value of Tests %K Primary Health Care %K Proportional Hazards Models %K Risk Assessment %X

BACKGROUND: Detection of "any cognitive impairment" is mandated as part of the Medicare annual wellness visit, but screening all patients may result in excessive false positives.

METHODS: We developed and validated a brief Dementia Screening Indicator using data from four large, ongoing cohort studies (the Cardiovascular Health Study [CHS]; the Framingham Heart Study [FHS]; the Health and Retirement Study [HRS]; the Sacramento Area Latino Study on Aging [SALSA]) to help clinicians identify a subgroup of high-risk patients to target for cognitive screening.

RESULTS: The final Dementia Screening Indicator included age (1 point/year; ages, 65-79 years), less than 12 years of education (9 points), stroke (6 points), diabetes mellitus (3 points), body mass index less than 18.5 kg/m(2) (8 points), requiring assistance with money or medications (10 points), and depressive symptoms (6 points). Accuracy was good across the cohorts (Harrell's C statistic: CHS, 0.68; FHS, 0.77; HRS, 0.76; SALSA, 0.78).

CONCLUSIONS: The Dementia Screening Indicator is a simple tool that may be useful in primary care settings to identify high-risk patients to target for cognitive screening.

%B Alzheimers Dement %I 10 %V 10 %P 656-665.e1 %8 2014 Nov %G eng %U http://www.scopus.com/inward/record.url?eid=2-s2.0-84893186546andpartnerID=40andmd5=3b617dce24578e022db389d90ad9ddd1 %N 6 %1 http://www.ncbi.nlm.nih.gov/pubmed/24491321?dopt=Abstract %2 PMC4119094 %4 Dementia/Primary care/Risk prediction modeling/Screening/Cognitive Impairment %$ 999999 %R 10.1016/j.jalz.2013.11.006 %0 Journal Article %J Alzheimers Dement %D 2013 %T Dementia and out-of-pocket spending on health care services. %A Delavande, Adeline %A Michael D Hurd %A Martorell, Paco %A Kenneth M. Langa %K Aged %K Dementia %K Female %K Financing, Personal %K Health Expenditures %K Humans %K Male %X

BACKGROUND: High levels of out-of-pocket (OOP) spending for health care may lead patients to forego needed services and medications as well as hamper their ability to pay for other essential goods. Because it leads to disability and the loss of independence, dementia may put patients and their families at risk for high OOP spending, especially for long-term care services.

METHODS: We used data from the Aging, Demographics, and Memory Study, a nationally representative subsample (n = 743) of the Health and Retirement Study, to determine whether individuals with dementia had higher self-reported OOP spending compared with those with cognitive impairment without dementia and those with normal cognitive function. We also examined the relationship between dementia and utilization of dental care and prescription medications-two types of health care that are frequently paid for OOP. Multivariate and logistic regression models were used to adjust for the influence of potential confounders.

RESULTS: After controlling for demographics and comorbidities, those with dementia had more than three times the yearly OOP spending compared with those with normal cognition ($8216 for those with dementia vs. $2570 for those with normal cognition, P < .01). Higher OOP spending for those with dementia was mainly driven by greater expenditures on nursing home care (P < .01). Dementia was not associated with the likelihood of visiting the dentist (P = .76) or foregoing prescription medications owing to cost (P = .34).

CONCLUSIONS: Dementia is associated with high levels of OOP spending but not with the use of dental care or foregoing prescription medications, suggesting that excess OOP spending among those with dementia does not "crowd out" spending on these other health care services.

%B Alzheimers Dement %I 9 %V 9 %P 19-29 %8 2013 Jan %G eng %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/23154049?dopt=Abstract %3 23154049 %4 Out of pocket costs/health Care/Long Term Care/Dementia/dental Care/COMORBIDITY/health care services %$ 69685 %R 10.1016/j.jalz.2011.11.003 %0 Journal Article %J BMC Medicine %D 2013 %T Depression, antidepressant medications, and risk of Clostridium difficile infection. %A Mary A M Rogers %A M. Todd Greene %A Vincent B Young %A Sanjay Saint %A Kenneth M. Langa %A John Y Kao %A David M. Aronoff %K Antidepressants %K Clostridium %K Depressive symptoms %K Infection %K Older Adults %X

BACKGROUND: An ancillary finding in previous research has suggested that the use of antidepressant medications increases the risk of developing Clostridium difficile infection (CDI). Our objective was to evaluate whether depression or the use of anti-depressants altered the risk of developing CDI, using two distinct datasets and study designs.

METHODS: In Study 1, we conducted a longitudinal investigation of a nationally representative sample of older Americans (n = 16,781), linking data from biennial interviews to physician and emergency department visits, stays in hospital and skilled nursing facilities, home health visits, and other outpatient visits. In Study 2, we completed a clinical investigation of hospitalized adults who were tested for C. difficile (n = 4047), with cases testing positive and controls testing negative. Antidepressant medication use prior to testing was ascertained.

RESULTS: The population-based rate of CDI in older Americans was 282.9/100,000 person-years (95% confidence interval (CI)) 226.3 to 339.5) for individuals with depression and 197.1/100,000 person-years for those without depression (95% CI 168.0 to 226.1). The odds of CDI were 36% greater in persons with major depression (95% CI 1.06 to 1.74), 35% greater in individuals with depressive disorders (95% CI 1.05 to 1.73), 54% greater in those who were widowed (95% CI 1.21 to 1.95), and 25% lower in adults who did not live alone (95% CI 0.62 to 0.92). Self-reports of feeling sad or having emotional, nervous or psychiatric problems at baseline were also associated with the later development of CDI. Use of certain antidepressant medications during hospitalization was associated with altered risk of CDI.

CONCLUSIONS: Adults with depression and who take specific anti-depressants seem to be more likely to develop CDI. Older adults who are widowed or who live alone are also at greater risk of CDI.

%B BMC Medicine %V 11 %P 121 %8 2013 May 07 %G eng %R 10.1186/1741-7015-11-121 %0 Report %D 2013 %T Documentation of Biomarkers in the 2006 and 2008 Health and Retirement Study %A Eileen M. Crimmins %A Jessica Faul %A Jung K Kim %A Heidi M Guyer %A Kenneth M. Langa %A Mary Beth Ofstedal %A Amanda Sonnega %A Robert B Wallace %A David R Weir %K Health Conditions and Status %K Healthcare %K Methodology %X Biomarkers refer to the general range of physiological, metabolic, biochemical, endocrine and genetic measures that can be obtained in living organisms. The term is most commonly used to refer to one-time biochemical or hematological measures made on blood or other available bodily fluids, but perhaps the term should be used for a broader range of measures. In 2006 and 2008, HRS included the following biomarkers measurements, administered in this order: Saliva collection for DNA extraction; Blood spot collection for cholesterol, hemoglobin A1C, CRP and cystatin C analysis (results for C-reactive protein and cystatin C are forthcoming). This report describes the following for each of the measures listed above: Rationale and key citations; Sample description; Measure description; Equipment; Protocol description; Special instructions. %I Institute for Social Research, University of Michigan %C Ann Arbor, Michigan %G eng %4 Biomarker data/survey Methods/health measures %$ 62720 %0 Journal Article %J Crit Care Med %D 2012 %T Depressive symptoms in spouses of older patients with severe sepsis. %A Dimitry S Davydow %A Catherine L Hough %A Kenneth M. Langa %A Theodore J Iwashyna %K Age Factors %K Aged %K depression %K Female %K Hospitalization %K Humans %K Male %K Multivariate Analysis %K Prospective Studies %K Psychiatric Status Rating Scales %K Sepsis %K Sex Factors %K Spouses %K Time Factors %K United States %X

OBJECTIVE: To examine whether spouses of patients with severe sepsis are at increased risk for depression independent of the spouse's presepsis history, whether this risk differs by sex, and is associated with a sepsis patient's disability after hospitalization.

DESIGN: Prospective longitudinal cohort study.

SETTING: Population-based cohort of U.S. adults over 50 yrs old interviewed as part of the Health and Retirement Study (1993-2008).

PATIENTS: Nine hundred twenty-nine patient-spouse dyads comprising 1,212 hospitalizations for severe sepsis.

MEASUREMENTS AND MAIN RESULTS: Severe sepsis was identified using a validated algorithm in Medicare claims. Depression was assessed with a modified version of the Center for Epidemiologic Studies Depression Scale. All analyses were stratified by gender. The prevalence of substantial depressive symptoms in wives of patients with severe sepsis increased by 14 percentage points at the time of severe sepsis (from 20% at a median of 1.1 yrs presepsis to 34% at a median of 1 yr postsepsis) with an odds ratio of 3.74 (95% confidence interval: 2.20, 6.37), in multivariable regression. Husbands had an 8 percentage point increase in the prevalence of substantial depressive symptoms, which was not significant in multivariable regression (odds ratio 1.90, 95% confidence interval 0.75, 4.71). The increase in depression was not explained by bereavement; women had greater odds of substantial depressive symptoms even when their spouse survived a severe sepsis hospitalization (odds ratio 2.86, 95% confidence interval 1.06, 7.73). Wives of sepsis survivors who were disabled were more likely to be depressed (odds ratio 1.35 per activities of daily living limitation of sepsis survivor, 95% confidence interval 1.12, 1.64); however, controlling for patient disability only slightly attenuated the association between sepsis and wives' depression (odds ratio 2.61, 95% confidence interval 0.93, 7.38).

CONCLUSIONS: Older women may be at greater risk for depression if their spouse is hospitalized for severe sepsis. Spouses of patients with severe sepsis may benefit from greater support and depression screening, both when their loved one dies and when their loved one survives.

%B Crit Care Med %V 40 %P 2335-41 %8 2012 Aug %G eng %N 8 %1 http://www.ncbi.nlm.nih.gov/pubmed/22635049?dopt=Abstract %2 PMC3670798 %4 sepsis/DISABILITY/DISABILITY/HOSPITALIZATION/medicare claims/depression/Depressive Symptoms/respondent incentives/Spousal care/WOMEN %$ 69450 %R 10.1097/CCM.0b013e3182536a81 %0 Journal Article %J Arch Intern Med %D 2011 %T Development and validation of a brief cognitive assessment tool: the sweet 16. %A Tamara G Fong %A Richard N Jones %A James L Rudolph %A Frances Margaret Yang %A Tommet, Douglas %A Habtemariam, Daniel %A Edward R Marcantonio %A Kenneth M. Langa %A Sharon K Inouye %K Aged %K Aged, 80 and over %K Cognition Disorders %K Cohort Studies %K Dementia %K Female %K Humans %K Male %K Neuropsychological tests %K Surveys and Questionnaires %X

BACKGROUND: Cognitive impairment is often unrecognized among older adults. Meanwhile, current assessment instruments are underused, lack sensitivity, or may be restricted by copyright laws. To address these limitations, we created a new brief cognitive assessment tool: the Sweet 16.

METHODS: The Sweet 16 was developed in a cohort from a large post-acute hospitalization study (n=774) and compared with the Mini-Mental State Examination (MMSE). Equipercentile equating identified Sweet 16 cut points that correlated with widely used MMSE cut points. Sweet 16 performance characteristics were independently validated in a cohort from the Aging, Demographics, and Memory Study (n=709) using clinical consensus diagnosis, the modified Blessed Dementia Rating Scale, and the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE).

RESULTS: The Sweet 16 correlated highly with the MMSE (Spearman r, 0.94; P<.001). Validated against the IQCODE, the area under the curve was 0.84 for the Sweet 16 and 0.81 for the MMSE (P=.06). A Sweet 16 score of less than 14 (approximating an MMSE score <24) demonstrated a sensitivity of 80% and a specificity of 70%, whereas an MMSE score of less than 24 showed a sensitivity of 64% and a specificity of 86% against the IQCODE. When compared with clinical diagnosis, a Sweet 16 score of less than 14 showed a sensitivity of 99% and a specificity of 72% in contrast to an MMSE score with a sensitivity of 87% and a specificity of 89%. For education of 12 years or more, the area under the curve was 0.90 for the Sweet 16 and 0.84 for the MMSE (P=.03).

CONCLUSIONS: The Sweet 16 is simple, quick to administer, and will be available open access. The performance of the Sweet 16 is equivalent or superior to that of the MMSE.

%B Arch Intern Med %I 171 %V 171 %P 432-7 %8 2011 Mar 14 %G eng %N 5 %1 http://www.ncbi.nlm.nih.gov/pubmed/21059967?dopt=Abstract %3 21059967 %4 Older people/Cognition/reasoning/Correlation analysis/Medical diagnosis/Dementia/Hospitalization %$ 25220 %R 10.1001/archinternmed.2010.423 %0 Journal Article %J Am J Geriatr Psychiatry %D 2010 %T Depression among older adults in the United States and England. %A Zivin, Kara %A David J Llewellyn %A Iain A Lang %A Sandeep Vijan %A Mohammed U Kabeto %A Erin M Miller %A Kenneth M. Langa %K Aged %K Aged, 80 and over %K depression %K England %K Female %K Health Behavior %K Health Status %K Health Surveys %K Humans %K Male %K Prevalence %K Risk Factors %K United States %K White People %X

CONTEXT: Depression negatively affects health and well being among older adults, but there have been no nationally representative comparisons of depression prevalence among older adults in England and the United States.

OBJECTIVE: The authors sought to compare depressive symptoms among older adults in these countries and identify sociodemographic and clinical correlates of depression in these countries.

DESIGN AND SETTING: The authors assessed depressive symptoms in non-Hispanic whites aged 65 years and older in 2002 in two nationally representative, population-based studies: the U.S. Health and Retirement Study and English Longitudinal Study of Ageing.

PARTICIPANTS: A total of 8,295 Health and Retirement Study respondents and 5,208 English Longitudinal Study of Ageing respondents.

MAIN OUTCOME MEASURES: The authors measured depressive symptoms using the eight-item Center for Epidemiologic Studies Depression Scale. The authors determined whether depressive symptom differences between the United States and England were associated with sociodemographic characteristics, chronic health conditions, and health behaviors.

RESULTS: Significant depressive symptoms (Center for Epidemiologic Studies Depression Scale score ≥4) were more prevalent in English than U.S. adults (17.6% versus 14.6%, adjusted Wald test F([1, 1593]) = 11.4, p < 0.001). Adjusted rates of depressive symptoms in England were 19% higher compared with the United States (odds ratio: 1.19, 95% confidence interval: 1.01-1.40). U.S. adults had higher levels of education, and net worth, but lower levels of activities of daily living/instrumental activities of daily living impairments, tobacco use, and cognitive impairment, which may have contributed to relatively lower levels of depressive symptoms in the United States.

CONCLUSIONS: Older adults in the United States had lower rates of depressive symptoms than their English counterparts despite having more chronic health conditions. Future cross-national studies should identify how depression treatment influences outcomes in these populations.

%B Am J Geriatr Psychiatry %I 11 %V 18 %P 1036-44 %8 2010 Nov %G eng %N 11 %1 http://www.ncbi.nlm.nih.gov/pubmed/20808088?dopt=Abstract %2 PMC3786867 %4 Aged, 80 and over/Depression/Health Behavior/Health Status/Health Surveys/Prevalence/Risk Factors/epidemiology %$ 25240 %R 10.1097/JGP.0b013e3181dba6d2 %0 Journal Article %J J Gerontol A Biol Sci Med Sci %D 2010 %T Differences in functional impairment across subtypes of dementia. %A Tanya R Gure %A Mohammed U Kabeto %A Brenda L Plassman %A John D Piette %A Kenneth M. Langa %K Activities of Daily Living %K Aged %K Alzheimer disease %K Dementia %K Dementia, Vascular %K Humans %X

BACKGROUND: Dementia is a cause of disability in later life. Despite the importance of functional status to the diagnosis of dementia, limited information exists on differences in functional limitations by dementia subtype. We conducted a cross-sectional analysis using the Aging, Demographics, and Memory Study (ADAMS) to determine the extent of functional impairment among older adults with dementia due to different etiologies.

METHODS: The ADAMS sample consisted of 856 individuals aged 71 years and older originally surveyed as part of the Health and Retirement Study. Based on a comprehensive in-person cognitive evaluation, respondents were assigned to diagnostic categories of normal cognition, cognitive impairment not demented, and demented. Dementia subtypes were grouped into three categories: vascular dementia (VaD), Alzheimer's dementia (AD), and dementia due to other etiologies. For 744 of the 856 respondents, a proxy informant completed a questionnaire asking whether the respondent had difficulty completing instrumental activities of daily living and activities of daily living (ADLs).

RESULTS: Of 744 ADAMS participants, 263 had dementia: 199 (70.5%) with AD, 42 (16.9%) with VaD, and 22 (12.6%) were demented due to other etiologies. After adjustment for demographics, chronic illnesses, and dementia severity, participants with VaD (odds ratio [OR] 5.74; 95% confidence interval [CI] 2.60-12.69) and other etiologies of dementia (OR 21.23; 95% CI 7.25-62.16) were more likely to have greater than or equal to four ADL limitations compared with those with AD.

CONCLUSIONS: VaD is associated with significantly more ADL limitations than AD. These physical limitations should be considered when designing adult day care programs, which adequately accommodate the needs of non-AD patients.

%B J Gerontol A Biol Sci Med Sci %I 65A %V 65 %P 434-41 %8 2010 Apr %G eng %N 4 %1 http://www.ncbi.nlm.nih.gov/pubmed/20018827?dopt=Abstract %2 PMC2844058 %4 Aging/Dementia/Demographics/Memory/Older people/Alzheimers disease/Questionnaires/Disability/Disability %$ 22700 %R 10.1093/gerona/glp197 %0 Journal Article %J Ageing Soc %D 2009 %T Does caring for your spouse harm one's health? Evidence from a United States nationally-representative sample of older adults. %A Kristi Rahrig Jenkins %A Mohammed U Kabeto %A Kenneth M. Langa %X

The purpose of this article is to investigate the relationship between spousal care-giving and declines in functioning and self-rated health among older care-givers. The authors used data from the 2000 and 2002 waves of the United States Health and Retirement Study, a biennial longitudinal survey of a nationally representative cohort of adults aged 50 or more years. Two outcomes were examined, declines in functioning and declines in self-rated health. Care-givers were classified into three groups: no care-giving, less than 14 hours of care-giving per week, and 14 or more hours care-giving per week. To assess declines in functioning, two summary scores were created of limitations in basic and instrumental Activities of Daily Living. To assess declines in self-rated health, we compared responses from 2000 and 2002. In the fully adjusted models, care-giving hours did not have an independent effect on declines in functioning or self-rated health. The relationship between care-giving hours and declines in functioning and self-rated health is probably attributable to socio-demographic characteristics, mainly age. The findings suggest that spousal care-giving does not of itself harm functional health or perceived health among older adult care-givers. Understanding the differential effects of these socio-economic characteristics with care-giving hours on health will be useful in promoting the health of older adult care-givers and treating their disorders.

%B Ageing Soc %I 29 %V 29 %P 277-293 %8 2009 Feb %G eng %N 2 %L newpubs20090908/Jenkinsetal.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/24567660?dopt=Abstract %4 Couples/Caregiving/Health Status--ADL limitations %$ 20260 %R 10.1017/S0144686X08007824 %0 Journal Article %J J Gen Intern Med %D 2008 %T Degree of disability and patterns of caregiving among older Americans with congestive heart failure. %A Tanya R Gure %A Mohammed U Kabeto %A Caroline S Blaum %A Kenneth M. Langa %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Caregivers %K Coronary Disease %K Cross-Sectional Studies %K Disabled Persons %K Female %K Health Surveys %K Heart Failure %K Hospitalization %K Humans %K Male %K Nursing homes %K United States %X

OBJECTIVES: Although congestive heart failure (CHF) is a common condition, the extent of disability and caregiving needs for those with CHF are unclear. We sought to determine: (1) prevalence of physical disability and geriatric conditions, (2) whether CHF is independently associated with disability, (3) rates of nursing home admission, and (4) formal and informal in-home care received in the older CHF population.

METHODS: We used cross-sectional data from the 2000 wave of the Health and Retirement Study. We compared outcomes among three categories of older adults: (1) no coronary heart disease (CHD), (2) CHD, without CHF, and (3) CHF. Compared to those without CHF, respondents reporting CHF were more likely to be disabled (P < 0.001) and to have geriatric conditions (P < 0.001). Respondents reporting CHF were more likely to have been admitted to a nursing home (P < 0.05). CHF respondents were more functionally impaired than respondents without CHF.

RESULTS: The adjusted average weekly informal care hours for respondents reporting CHF was higher than for those reporting CHD but without CHF and those reporting no CHD (6.7 vs 4.1 vs 5.1, respectively; P < 0.05). Average weekly formal caregiving hours also differed among the three groups (1.3 CHF vs 0.9 CHD without CHF vs 0.7 no CHD; P > 0.05).

CONCLUSIONS: CHF imposes a significant burden on patients, families, and the long-term care system. Older adults with CHF have higher rates of disability, geriatric conditions, and nursing home admission.

%B J Gen Intern Med %I 23 %V 23 %P 70-6 %8 2008 Jan %G eng %N 1 %L newpubs20071203_Gure_JGIM.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/18030537?dopt=Abstract %2 PMC2173919 %4 Heart Diseases/DISABILITY/DISABILITY/Caregiving %$ 18210 %R 10.1007/s11606-007-0456-1 %0 Report %D 2008 %T Documentation of Physical Measures, Anthropometrics and Blood Pressure in the Health and Retirement Study %A Eileen M. Crimmins %A Heidi M Guyer %A Kenneth M. Langa %A Mary Beth Ofstedal %A Robert B Wallace %A David R Weir %K Health Conditions and Status %K Healthcare %K Methodology %X The assessment of physical performance is an important component of the evaluation of functioning of older persons. The HRS has employed a set of standardized assessments of lung function, grip strength, balance, and walking speed. In addition, HRS collected measures of blood pressure, height, weight, and waist circumference. In 2006, HRS included the following measurements, administered in this order: Blood pressure; Lung function; Hand grip strength; Balance tests; Timed walk; Height; Weight; Waist circumference. This report describes the following for each of the measures listed above: Rationale and key citations; Sample description; Measure description; Equipment; Protocol description; Special instructions %I Institute for Social Research, University of Michigan %C Ann Arbor, Michigan %G eng %4 health measures/survey Methods/Physical Activity %$ 62710 %0 Journal Article %J Journal of the American Geriatrics Society %D 2005 %T Differences in Amount of Informal Care Received by Non-Hispanic Whites and Latinos in a Nationally Representative Sample of Older Americans %A Weiss, Carlos O. %A Hector M González %A Mohammed U Kabeto %A Kenneth M. Langa %K Healthcare %K Women and Minorities %X The objective of this study was to evaluate informal (unpaid) care and its broad determinants for Latinos in a nationally representative sample. A cross-sectional analysis of the 1993 Asset and Health Dynamics Study, a national probability sample of 7,443 older adults aged 70 and older, was performed to determine the independent effect of Latino ethnicity on the receipt of informal care by disabled older individuals. Self-reported race/ethnicity was used to predict the mean daily hours of informal care received for activity of daily living (ADL) or instrumental activity of daily living (IADL) assistance after adjustment for predisposing, need, and enabling variables. There was a significant association between informal home care and ethnic group, with 44.3 of Latinos receiving informal care, compared with 33.9 of African Americans and 24.6 of non-Hispanic whites (Po.001). After adjustment, Latinos received 11.0 weekly hours of informal care, compared with 7.5 hours for non-Hispanic whites and 6.3 hours for African Americans (Po.001). The results from this nationally representative sample indicate that Latinos receive significantly more hours of informal care on average than African Americans or non-Hispanic whites for ADL and IADL disability. Clinicians should be alert to the significant amount of informal care and possible associated strain in caregivers of older Latinos. %B Journal of the American Geriatrics Society %I 53 %V 53 %P 146-151 %G eng %N 1 %L pubs_2005_Weiss_etal.pdf %4 Hispanic Americans/Caregiving %$ 16030