%0 Journal Article %J American Journal of Public Health %D 2015 %T Preparaci n de los adultos mayores en los Estados Unidos para hacer frente a los desastres naturales: encuesta a escala nacional %A Tala M. Al-rousan %A Linda M. Rubenstein %A Robert B Wallace %K Demographics %K Health Conditions and Status %K Public Policy %X We sought to determine natural disaster preparedness levels among older US adults and assess factors that may adversely affect health and safety during such incidents. We sampled adults aged 50 years or older (n = 1304) from the 2010 interview survey of the Health and Retirement Study. The survey gathered data on general demographic characteristics, disability status or functional limitations, and preparedness-related factors and behaviors. We calculated a general disaster preparedness score by using individual indicators to assess overall preparedness. Participant (n = 1304) mean age was 70 years (SD = 9.3). Only 34.3 reported participating in an educational program or reading materials about disaster preparation. Nearly 15 reported using electrically powered medical devices that might be at risk in a power outage. The preparedness score indicated that increasing age, physical disability, and lower educational attainment and income were independently and significantly associated with worse overall preparedness. Despite both greater vulnerability to disasters and continuous growth in the number of older US adults, many of the substantial problems discovered are remediable and require attention in the clinical, public health, and emergency management sectors of society. %B American Journal of Public Health %I 105 %V 105 %P S614 %G eng %N S4 %R 10.2105/AJPH.2013.301559s %0 Journal Article %J Am J Public Health %D 2014 %T Preparedness for natural disasters among older US adults: a nationwide survey. %A Tala M. Al-rousan %A Linda M. Rubenstein %A Robert B Wallace %K Aged %K Aged, 80 and over %K Disaster Planning %K Female %K Humans %K Male %K Middle Aged %K Surveys and Questionnaires %K United States %X

OBJECTIVES: We sought to determine natural disaster preparedness levels among older US adults and assess factors that may adversely affect health and safety during such incidents.

METHODS: We sampled adults aged 50 years or older (n = 1304) from the 2010 interview survey of the Health and Retirement Study. The survey gathered data on general demographic characteristics, disability status or functional limitations, and preparedness-related factors and behaviors. We calculated a general disaster preparedness score by using individual indicators to assess overall preparedness.

RESULTS: Participant (n = 1304) mean age was 70 years (SD = 9.3). Only 34.3% reported participating in an educational program or reading materials about disaster preparation. Nearly 15% reported using electrically powered medical devices that might be at risk in a power outage. The preparedness score indicated that increasing age, physical disability, and lower educational attainment and income were independently and significantly associated with worse overall preparedness.

CONCLUSIONS: Despite both greater vulnerability to disasters and continuous growth in the number of older US adults, many of the substantial problems discovered are remediable and require attention in the clinical, public health, and emergency management sectors of society.

%B Am J Public Health %V 104 %P 506-11 %8 2014 Mar %G eng %U http://dx.doi.org/10.2105/AJPH.2013.301559 %N 3 %1 http://www.ncbi.nlm.nih.gov/pubmed/24432877?dopt=Abstract %4 disaster preparedness/public policy/emergency management %$ 999999 %& 506 %R 10.2105/AJPH.2013.301559 %0 Journal Article %J BMC Public Health %D 2011 %T A prospective cohort study of long-term cognitive changes in older Medicare beneficiaries. %A Frederic D Wolinsky %A Suzanne E Bentler %A Jason Hockenberry %A Michael P Jones %A Paula A Weigel %A Kaskie, Brian %A Robert B Wallace %K Aged %K Aged, 80 and over %K Aging %K Cognition %K Cognition Disorders %K Cohort Studies %K Female %K Humans %K Interviews as Topic %K Male %K Medicare %K Mental Health %K Outcome Assessment, Health Care %K Prospective Studies %K Regression Analysis %K Risk Factors %K United States %X

BACKGROUND: Promoting cognitive health and preventing its decline are longstanding public health goals, but long-term changes in cognitive function are not well-documented. Therefore, we first examined long-term changes in cognitive function among older Medicare beneficiaries in the Survey on Assets and Health Dynamics among the Oldest Old (AHEAD), and then we identified the risk factors associated with those changes in cognitive function.

METHODS: We conducted a secondary analysis of a prospective, population-based cohort using baseline (1993-1994) interview data linked to 1993-2007 Medicare claims to examine cognitive function at the final follow-up interview which occurred between 1995-1996 and 2006-2007. Besides traditional risk factors (i.e., aging, age, race, and education) and adjustment for baseline cognitive function, we considered the reason for censoring (entrance into managed care or death), and post-baseline continuity of care and major health shocks (hospital episodes). Residual change score multiple linear regression analysis was used to predict cognitive function at the final follow-up using data from telephone interviews among 3,021 to 4,251 (sample size varied by cognitive outcome) baseline community-dwelling self-respondents that were ≥ 70 years old, not in managed Medicare, and had at least one follow-up interview as self-respondents. Cognitive function was assessed using the 7-item Telephone Interview for Cognitive Status (TICS-7; general mental status), and the 10-item immediate and delayed (episodic memory) word recall tests.

RESULTS: Mean changes in the number of correct responses on the TICS-7, and 10-item immediate and delayed word recall tests were -0.33, -0.75, and -0.78, with 43.6%, 54.9%, and 52.3% declining and 25.4%, 20.8%, and 22.9% unchanged. The main and most consistent risks for declining cognitive function were the baseline values of cognitive function (reflecting substantial regression to the mean), aging (a strong linear pattern of increased decline associated with greater aging, but with diminishing marginal returns), older age at baseline, dying before the end of the study period, lower education, and minority status.

CONCLUSIONS: In addition to aging, age, minority status, and low education, substantial and differential risks for cognitive change were associated with sooner vs. later subsequent death that help to clarify the terminal drop hypothesis. No readily modifiable protective factors were identified.

%B BMC Public Health %I 11 %V 11 %P 710 %8 2011 Sep 20 %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/21933430?dopt=Abstract %2 PMC3190354 %4 Cognition/Cognitive decline/public policy/Medicare/cognitive Function/TICS Scale %$ 25100 %R 10.1186/1471-2458-11-710 %0 Journal Article %J J Gerontol A Biol Sci Med Sci %D 2010 %T Prior hospitalization and the risk of heart attack in older adults: a 12-year prospective study of Medicare beneficiaries. %A Frederic D Wolinsky %A Suzanne E Bentler %A Li Liu %A Michael P Jones %A Kaskie, Brian %A Jason Hockenberry %A Elizabeth A Chrischilles %A Kara B Wright %A John F Geweke %A Maksym Obrizan %A Robert L. Ohsfeldt %A Gary E Rosenthal %A Robert B Wallace %K Aged %K Educational Status %K Female %K Hospitalization %K Humans %K Male %K Marital Status %K Medicare %K Myocardial Infarction %K Patient Discharge %K Proportional Hazards Models %K Prospective Studies %K Risk Factors %K Sex Factors %K United States %X

BACKGROUND: We investigated whether prior hospitalization was a risk factor for heart attacks among older adults in the survey on Assets and Health Dynamics among the Oldest Old.

METHODS: Baseline (1993-1994) interview data were linked to 1993-2005 Medicare claims for 5,511 self-respondents aged 70 years and older and not enrolled in managed Medicare. Primary hospital International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) 410.xx discharge codes identified postbaseline hospitalizations for acute myocardial infarctions (AMIs). Participants were censored at death or postbaseline managed Medicare enrollment. Traditional risk factors and other covariates were included. Recent postbaseline non-AMI hospitalizations (ie, prior hospitalizations) were indicated by a time-dependent marker, and sensitivity analyses identified their peak effect.

RESULTS: The total number of person-years of surveillance was 44,740 with a mean of 8.1 (median = 9.1) per person. Overall, 483 participants (8.8%) suffered postbaseline heart attacks, with 423 participants (7.7%) having their first-ever AMI. As expected, significant traditional risk factors were sex (men); race (whites); marital status (never being married); education (noncollege); geography (living in the South); and reporting a baseline history of angina, arthritis, diabetes, and heart disease. Risk factors were similar for both any postbaseline and first-ever postbaseline AMI analyses. The time-dependent recent non-AMI hospitalization marker did not alter the effects of the traditional risk factors but increased AMI risk by 366% (adjusted hazards ratio = 4.66, p < .0001). Discussion. Our results suggest that some small percentage (<3%) of heart attacks among older adults might be prevented if effective short-term postdischarge planning and monitoring interventions were developed and implemented.

%B J Gerontol A Biol Sci Med Sci %I 65 %V 65 %P 769-77 %8 2010 Jul %G eng %N 7 %1 http://www.ncbi.nlm.nih.gov/pubmed/20106961?dopt=Abstract %2 PMC2904597 %4 HOSPITALIZATION/heart disease/risk Factors/Medicare/Public Policy %$ 23090 %R 10.1093/gerona/glq003 %0 Journal Article %J Ann Intern Med %D 2008 %T Prevalence of cognitive impairment without dementia in the United States. %A Brenda L Plassman %A Kenneth M. Langa %A Gwenith G Fisher %A Steven G Heeringa %A David R Weir %A Mary Beth Ofstedal %A James R Burke %A Michael D Hurd %A Guy G Potter %A Willard L Rodgers %A David C Steffens %A John J McArdle %A Robert J. Willis %A Robert B Wallace %K Aged %K Aged, 80 and over %K Cognition Disorders %K Dementia %K disease progression %K Humans %K Longitudinal Studies %K Prevalence %K United States %X

BACKGROUND: Cognitive impairment without dementia is associated with increased risk for disability, increased health care costs, and progression to dementia. There are no population-based prevalence estimates of this condition in the United States.

OBJECTIVE: To estimate the prevalence of cognitive impairment without dementia in the United States and determine longitudinal cognitive and mortality outcomes.

DESIGN: Longitudinal study from July 2001 to March 2005.

SETTING: In-home assessment for cognitive impairment.

PARTICIPANTS: Participants in ADAMS (Aging, Demographics, and Memory Study) who were age 71 years or older drawn from the nationally representative HRS (Health and Retirement Study). Of 1770 selected individuals, 856 completed initial assessment, and of 241 selected individuals, 180 completed 16- to 18-month follow-up assessment.

MEASUREMENTS: Assessments, including neuropsychological testing, neurologic examination, and clinical and medical history, were used to assign a diagnosis of normal cognition, cognitive impairment without dementia, or dementia. National prevalence rates were estimated by using a population-weighted sample.

RESULTS: In 2002, an estimated 5.4 million people (22.2%) in the United States age 71 years or older had cognitive impairment without dementia. Prominent subtypes included prodromal Alzheimer disease (8.2%) and cerebrovascular disease (5.7%). Among participants who completed follow-up assessments, 11.7% with cognitive impairment without dementia progressed to dementia annually, whereas those with subtypes of prodromal Alzheimer disease and stroke progressed at annual rates of 17% to 20%. The annual death rate was 8% among those with cognitive impairment without dementia and almost 15% among those with cognitive impairment due to medical conditions.

LIMITATIONS: Only 56% of the nondeceased target sample completed the initial assessment. Population sampling weights were derived to adjust for at least some of the potential bias due to nonresponse and attrition.

CONCLUSION: Cognitive impairment without dementia is more prevalent in the United States than dementia, and its subtypes vary in prevalence and outcomes.

%B Ann Intern Med %I 148 %V 148 %P 427-34 %8 2008 Mar 18 %G eng %N 6 %L newpubs20080528_AnnIntMed.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/18347351?dopt=Abstract %2 PMC2670458 %4 Cognitive Functioning/Dementia/Health Risk/PREVALENCE %$ 18530 %R 10.7326/0003-4819-148-6-200803180-00005 %0 Journal Article %J Neuroepidemiology %D 2007 %T Prevalence of dementia in the United States: the aging, demographics, and memory study. %A Brenda L Plassman %A Kenneth M. Langa %A Gwenith G Fisher %A Steven G Heeringa %A David R Weir %A Mary Beth Ofstedal %A James R Burke %A Michael D Hurd %A Guy G Potter %A Willard L Rodgers %A David C Steffens %A Robert J. Willis %A Robert B Wallace %K Age Distribution %K Aged %K Aged, 80 and over %K Cohort Studies %K Dementia %K Female %K Geriatric Assessment %K Health Surveys %K Humans %K Logistic Models %K Male %K Prevalence %K Sex Distribution %K United States %X

AIM: To estimate the prevalence of Alzheimer's disease (AD) and other dementias in the USA using a nationally representative sample.

METHODS: The Aging, Demographics, and Memory Study sample was composed of 856 individuals aged 71 years and older from the nationally representative Health and Retirement Study (HRS) who were evaluated for dementia using a comprehensive in-home assessment. An expert consensus panel used this information to assign a diagnosis of normal cognition, cognitive impairment but not demented, or dementia (and dementia subtype). Using sampling weights derived from the HRS, we estimated the national prevalence of dementia, AD and vascular dementia by age and gender.

RESULTS: The prevalence of dementia among individuals aged 71 and older was 13.9%, comprising about 3.4 million individuals in the USA in 2002. The corresponding values for AD were 9.7% and 2.4 million individuals. Dementia prevalence increased with age, from 5.0% of those aged 71-79 years to 37.4% of those aged 90 and older.

CONCLUSIONS: Dementia prevalence estimates from this first nationally representative population-based study of dementia in the USA to include subjects from all regions of the country can provide essential information for effective planning for the impending healthcare needs of the large and increasing number of individuals at risk for dementia as our population ages.

%B Neuroepidemiology %I 29 %V 29 %P 125-32 %8 2007 %G eng %N 1-2 %L newpubs20071203_ADAMSprevalence.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/17975326?dopt=Abstract %4 aging/Dementia/Epidemiology %$ 18200 %R 10.1159/000109998 %0 Journal Article %J J Am Geriatr Soc %D 2002 %T Prevalence and correlates of depressive symptoms in a community sample of people suffering from heart failure. %A Carolyn L. Turvey %A Schultz, K. %A Arndt, Stephan %A Robert B Wallace %A A. Regula Herzog %K Aged %K depression %K Female %K Heart Failure %K Humans %K Longitudinal Studies %K Male %K Prevalence %K United States %X

OBJECTIVES: To examine the rates and correlates of depressive symptoms and syndromal depression in people with self-reported heart failure participating in a community study of people aged 70 and older.

DESIGN: Cross-sectional.

SETTING: Community-based epidemiological study of older people from the continental United States.

PARTICIPANTS: Six thousand one hundred twenty-five older people participating in the longitudinal study of Assets and Health Dynamics. Participants had to be born in 1923 or earlier.

MEASUREMENTS: The short-form Composite International Diagnostic Interview assessed syndromal depression, and a revised version of the Center for Epidemiologic Studies-Depression scale assessed depressive symptoms. Medical illness was based on self-report. The authors compared the rates of syndromal depression and individual depressive symptoms in people with self-reported heart failure (n = 199) with those in people with other heart conditions (n = 1,856) and with no heart conditions (n = 4,070).

RESULTS: Eleven percent of those with heart failure met criteria for syndromal depression, compared with 4.8% of people with other heart conditions and 3.2% of those with no heart conditions. The association between heart failure and depression held even after controlling for disability, reported fatigue and breathlessness, and number of comorbid chronic illnesses.

CONCLUSION: Community-living older people with self-reported heart failure were at approximately twice the risk for syndromal depression of the rest of the community. Although fatigue and functional disability were also related to depression in this sample, these variables did not account for the association between syndromal depression and self-reported heart failure.

%B J Am Geriatr Soc %I 50 %V 50 %P 2003-8 %8 2002 Dec %G eng %N 12 %1 http://www.ncbi.nlm.nih.gov/pubmed/12473012?dopt=Abstract %4 Heart Diseases/Depression %$ 12932 %R 10.1046/j.1532-5415.2002.50612.x %0 Journal Article %J J Gerontol A Biol Sci Med Sci %D 1999 %T Prevalence and severity of urinary incontinence in older African American and Caucasian women. %A Fultz, Nancy H. %A A. Regula Herzog %A Trivellore E. Raghunathan %A Robert B Wallace %A Diokno, A.C. %K Aged %K Aged, 80 and over %K Black or African American %K Female %K Humans %K Prevalence %K Risk Factors %K United States %K Urinary incontinence %K White People %X

BACKGROUND: Few studies have investigated the prevalence and severity of urinary incontinence in older African American women. Comparisons of findings with those for older Caucasian women could provide important clues to the etiology of urinary incontinence and be used in planning screening programs and treatment services.

METHODS: Data are from the first wave of the Asset and Health Dynamics Among the Oldest Old (AHEAD) study. A nationally representative sample of noninstitutionalized adults 70 years of age and older was interviewed. African Americans were oversampled to ensure that there would be enough minority respondents to compare findings across racial groups.

RESULTS: A statistically significant relationship was found between race and urinary incontinence in the previous year: 23.02% of the Caucasian women reported incontinence, compared with 16.17% of the African American women. Other factors that appear to increase the likelihood of incontinence include education, age, functional impairment, sensory impairment, stroke, body mass, and reporting by a proxy. Race was not related to the severity (as measured by frequency) of urine loss among incontinent older women.

CONCLUSION: This study identifies or confirms important risk factors for self-reported urinary incontinence in a national context, and suggests factors leading to protection from incontinence. Race is found to relate to incontinence, with older African American women reporting a lower prevalence.

%B J Gerontol A Biol Sci Med Sci %I 54A %V 54 %P M299-303 %8 1999 Jun %G eng %N 6 %L pubs_1997_Fultz_NJGSeriesB.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/10411017?dopt=Abstract %4 Aged, 80 and Over/Blacks/Statistics and Numerical Data/Female/Human/Prevalence/Risk Factors/Support, U.S. Government--PHS/United States/Epidemiology/Urinary Incontinence/Ethnology/Whites %$ 4495 %R 10.1093/gerona/54.6.m299