Shifting Place of Death Among Children With Complex Chronic Conditions in the United States, 1989-2003

Abstract Objectives Family is largely overlooked in research on factors associated with place of death among older adults. We determine if family caregiving at the end of life is associated with place of death in the United States and Europe. Methods We use the Harmonized End of Life data sets developed by the Gateway to Global Aging Data for the Survey of Health, Ageing and Retirement in Europe (SHARE) and the Health and Retirement Study (HRS). We conducted multinomial logistic regression on 7,113 decedents from 18 European countries and 3,031 decedents from the United States to determine if family caregiving, defined based on assistance with activities of daily living, was associated with death at home versus at a hospital or nursing home. Results Family caregiving was associated with reduced odds of dying in a hospital and nursing home, relative to dying at home in both the United States and Europe. Care from a spouse/partner or child/grandchild was both more common and more strongly associated with place of death than care from other relatives. Associations between family caregiving and place of death were generally consistent across European welfare regimes. Discussion This cross-national examination of family caregiving indicates that family-based support is universally important in determining where older adults die. In both the United States and in Europe, most care provided during a long-term illness or disability is provided by family caregivers, and it is clear families exert tremendous influence on place of death.

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Children with complex chronic conditions: an evaluation from the standpoint of academic publications

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20210674 ◽

2021 ◽

Vol 8 (3) ◽

pp. 594

Author(s):

Karinne M. Carvalho ◽

Mariana S. N. De Carvalho ◽

Rafaela L. Grando ◽

Livia A. De Menezes

Keyword(s):

Chronic Conditions ◽

Family Income ◽

The United States ◽

Scientific Production ◽

Access To Treatment ◽

Complex Chronic Conditions ◽

Use Of Technology ◽

Wide Range ◽

Academic Publications ◽

New Research

Children with complex chronic conditions (CCC) belong to a distinct pediatric group, characterized by the (potential) manifestation of a wide range of pathologies requires long-term multidisciplinary health care, alongside recurrent hospitalizations and, in many cases, dependent on the use of technology for life maintenance. The need to seek, organize and disseminate bibliographic information on CCC led us to chart the scientific production on this theme, and a complete search of the academic publications was conducted in two scientific databases, the Web of Science and Scopus. The results indicate a significant growth in CCC research over the years, matching both, the increased number of cases and the consequent rise in life expectancy of these children. The scientific production on CCC is concentrated in the United States of America, reflecting and discussing the access to the health system of that country. We observed that the main thematic areas of the publications were related to hospitalization, health needs, coordination of care and oral health. Children have inequitable levels of access to treatment for CCC, according to family income, place of residence, educational level, race/ethnicity, evidencing the urgent need for formulation and implementation of public policies that address this portion of the population. Thus, it is expected that the present study will serve as a bridge guide for the development of potential new research projects, actions to promote and stimulate studies on this relevant theme and so far, neglected.

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The Association of Mobile Health Applications with Self-Management Behaviors among Adults with Chronic Conditions in the United States

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph181910351 ◽

2021 ◽

Vol 18 (19) ◽

pp. 10351

Author(s):

Hao Wang ◽

Amy F. Ho ◽

R. Constance Wiener ◽

Usha Sambamoorthi

Keyword(s):

United States ◽

Chronic Conditions ◽

Healthcare Providers ◽

The United States ◽

Personal Health Records ◽

Self Management ◽

Personal Health ◽

Health Records ◽

Mhealth Apps ◽

Management Behaviors

Background: Mobile applications related to health and wellness (mHealth apps) are widely used to self-manage chronic conditions. However, research on whether mHealth apps facilitate self-management behaviors of individuals with chronic conditions is sparse. We aimed to evaluate the association of mHealth apps with different types of self-management behaviors among patients with chronic diseases in the United States. Methods: This is a cross-sectional observational study. We used data from adult participants (unweighted n = 2340) of the Health Information National Trends Survey in 2018 and 2019. We identified three self-management behaviors: (1) resource utilization using electronic personal health records; (2) treatment discussions with healthcare providers; and (3) making healthcare decisions. We analyzed the association of mHealth apps to self-management behaviors with multivariable logistic and ordinal regressions. Results: Overall, 59.8% of adults (unweighted number = 1327) used mHealth apps. Adults using mHealth apps were more likely to use personal health records (AOR = 3.11, 95% CI 2.26–4.28), contact healthcare providers using technology (AOR = 2.70, 95% CI 1.93–3.78), and make decisions on chronic disease management (AOR = 2.59, 95% CI 1.93–3.49). The mHealth apps were associated with higher levels of self-management involvement (AOR = 3.53, 95% CI 2.63–4.72). Conclusion: Among individuals with chronic conditions, having mHealth apps was associated with positive self-management behaviors.

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Identifying Predictive Characteristics of Opioid Medication Use among a Nationally Representative Sample of United States Older Adults with Pain and Comorbid Hypertension or Hypercholesterolemia

Healthcare ◽

10.3390/healthcare8030341 ◽

2020 ◽

Vol 8 (3) ◽

pp. 341

Author(s):

David R. Axon ◽

Shannon Vaffis ◽

Srujitha Marupuru

Keyword(s):

United States ◽

Older Adults ◽

Representative Sample ◽

Chronic Conditions ◽

Functional Limitation ◽

The United States ◽

Medical Expenditure ◽

Opioid Use ◽

Nationally Representative ◽

Opioid Users

The prevalence of older adults with pain and comorbid cardiovascular conditions is increasing in the United States (U.S.). This retrospective, cross-sectional database study used 2017 Medical Expenditure Panel Survey data and hierarchical logistic regression models to identify predictive characteristics of opioid use among a nationally representative sample of older U.S. adults (aged ≥50 years) with pain in the past four weeks and comorbid hypertension (pain–hypertension group) or hypercholesterolemia (pain–hypercholesterolemia group). The pain–hypertension group included 2733 subjects (n = 803 opioid users) and the pain–hypercholesterolemia group included 2796 subjects (n = 795 opioid users). In both groups, predictors of opioid use included: White race versus others, Hispanic versus non-Hispanic ethnicity, 1 versus ≥5 chronic conditions, little/moderate versus quite a bit/extreme pain, good versus fair/poor perceived mental health, functional limitation versus no functional limitation, smoker versus non-smoker, and Northeast versus West census region. In addition, Midwest versus West census region was a predictor in the pain–hypertension group, and 4 versus ≥5 chronic conditions was a predictor in the pain–hypercholesterolemia group. In conclusion, several characteristics of older U.S. adults with pain and comorbid hypertension or hypercholesterolemia were predictive of opioid use. These characteristics could be addressed to optimize individuals’ pain management and help address the opioid overdose epidemic.

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Trends in Place of Death for Individuals With Deaths Attributed to Advanced Chronic or End-Stage Kidney Disease in the United States

Journal of Pain and Symptom Management ◽

10.1016/j.jpainsymman.2020.08.001 ◽

2021 ◽

Vol 61 (1) ◽

pp. 112-120.e1

Author(s):

Sarah H. Cross ◽

Joshua R. Lakin ◽

Mallika Mendu ◽

Ernest I. Mandel ◽

Haider J. Warraich

Keyword(s):

United States ◽

Kidney Disease ◽

The United States ◽

Place Of Death ◽

End Stage Kidney Disease ◽

End Stage

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Trends in Place of Death for Individuals With Cardiovascular Disease in the United States

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2019.08.1015 ◽

2019 ◽

Vol 74 (15) ◽

pp. 1943-1946 ◽

Cited By ~ 6

Author(s):

Sarah H. Cross ◽

Brystana G. Kaufman ◽

Robert J. Mentz ◽

Arif H. Kamal ◽

Donald H. Taylor ◽

...

Keyword(s):

United States ◽

Cardiovascular Disease ◽

The United States ◽

Place Of Death

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The Digital Health Revolution and People with Disabilities: Perspective from the United States

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17020381 ◽

2020 ◽

Vol 17 (2) ◽

pp. 381 ◽

Cited By ~ 4

Author(s):

Mike Jones ◽

Frank DeRuyter ◽

John Morris

Keyword(s):

United States ◽

Mobile Health ◽

Chronic Conditions ◽

Digital Health ◽

Wearable Sensors ◽

Healthcare Delivery ◽

People With Disabilities ◽

The United States ◽

Models Of Care ◽

Health Technologies

This article serves as the introduction to this special issue on Mobile Health and Mobile Rehabilitation for People with Disabilities. Social, technological and policy trends are reviewed. Needs, opportunities and challenges for the emerging fields of mobile health (mHealth, aka eHealth) and mobile rehabilitation (mRehab) are discussed. Healthcare in the United States (U.S.) is at a critical juncture characterized by: (1) a growing need for healthcare and rehabilitation services; (2) maturing technological capabilities to support more effective and efficient health services; (3) evolving public policies designed, by turns, to contain cost and support new models of care; and (4) a growing need to ensure acceptance and usability of new health technologies by people with disabilities and chronic conditions, clinicians and health delivery systems. Discussion of demographic and population health data, healthcare service delivery and a public policy primarily focuses on the U.S. However, trends identified (aging populations, growing prevalence of chronic conditions and disability, labor shortages in healthcare) apply to most countries with advanced economies and others. Furthermore, technologies that enable mRehab (wearable sensors, in-home environmental monitors, cloud computing, artificial intelligence) transcend national boundaries. Remote and mobile healthcare delivery is needed and inevitable. Proactive engagement is critical to ensure acceptance and effectiveness for all stakeholders.

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