Elderly Taiwanese who spend more on fruits and vegetables and less on animal-derived foods use less medical services and incur lower medical costs

AbstractA higher intake of fruits and vegetables (F&V) compared with animal-derived foods is associated with lower risks of all-cause-, cancer- and CVD-related mortalities. However, the association between consumption patterns and medical costs remains unclear. The effects of various food group costs on medical service utilisation and costs were investigated. The study cohort was recruited through the Elderly Nutrition and Health Survey in Taiwan between 1999 and 2000 and followed-up for 8 years until 2006. It comprised free-living elderly participants who provided a 24-h dietary recall. Daily energy-adjusted food group costs were estimated. Annual medical service utilisation and costs for 1445 participants aged 65–79 years were calculated from the National Health Insurance claim data. Generalised linear models were used to appraise the associations between the food group costs and medical service utilisation and costs. Older adults with the highest F&V cost tertile had significantly fewer hospital days (30 %) and total medical costs (19 %), whereas those in the highest animal-derived group had a higher number of hospital days (28 %) and costs (83 %) as well as total medical costs (38 %). Participants in the high F&V and low animal-derived cost groups had the shortest annual hospitalisation stays (5·78 d) and lowest costs (NT$38 600) as well as the lowest total medical costs (NT$75 800), a mean annual saving of NT$45 200/person. Older adults who spend more on F&V and less on animal-derived foods have a reduced medical-care system burden. This provides opportunities for nutritionally related healthcare system investment strategies.

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Displacement of Household Foods by Fortified Blended Flours versus Lipid-based Supplements in Complementary Feeding of Children Aged 6–23 Months in Burkina Faso (OR21-03-19)

Current Developments in Nutrition ◽

10.1093/cdn/nzz034.or21-03-19 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

Cited By ~ 1

Author(s):

Ilana Cliffer ◽

William Masters ◽

Beatrice Rogers

Keyword(s):

Burkina Faso ◽

International Development ◽

Fruits And Vegetables ◽

Linear Models ◽

Food Group ◽

Cereal Grains ◽

Feeding Time ◽

Food Frequency ◽

Diet Diversity ◽

Nutrient Density

Abstract Objectives Lipid-based nutritional supplements (LNS) and fortified blended flours (FBF) are widely used to increase the nutrient density of children's diets and improve their health, but studies of supplementation have shown relatively modest improvements in linear growth. One mediating factor could be displacement of other foods. This study used food frequency data from a supplementation trial that compared FBF to a lipid-based product. We hypothesized that FBFs, which are typically boiled and fed to the infant as porridge, would displace starchy staples more often than lipid-based supplements, which can be eaten directly by the child. Methods We re-analyzed data from a cost-effectiveness trial designed to compare impacts on anthropometry among infants aged 6–23 months in Burkina Faso of three FBFs versus one LNS. Using food frequency dietary data from a single 24-hour recall period from the original study (n = 1612 children, observed once over 18-month study period), we fit logistic regression models to estimate differences in intake of each food group (grains, legumes and nuts, dairy, flesh foods, fruits and vegetables, vitamin A rich foods, and eggs), and used linear models to test for differences in a diet diversity score between children who received FBF and those who received LNS. We also tested for differences in breastfeeding time using the sub-sample for which that outcome was observed (n = 193). Results Children who consumed FBF were 54% less likely to consume the family's cereal grains than those who were fed LNS (OR = 0.46; 95% CI: 0.29, 0.73). Intake of other foods, diet diversity and breastfeeding time did not differ significantly between the two study arms. Conclusions Fortified blended flours displaced the household's own cereal grains more than lipid-based supplements did, with no difference in the child's consumption of other more nutrient-rich family foods. Given limited stomach capacity and feeding time, providing fortified cereals can help improve children's overall diet quality in settings where children would otherwise be fed nutrient-poor starchy staples. Funding Sources United States Agency for International Development, Office of Food for Peace. Supporting Tables, Images and/or Graphs

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Medical costs associated with childhood maltreatment history among Japanese older people

European Journal of Public Health ◽

10.1093/eurpub/ckz187.029 ◽

2019 ◽

Vol 29 (Supplement_4) ◽

Author(s):

A Isumi ◽

T Fujiwara ◽

H Kato ◽

T Tsuji ◽

D Takagi ◽

...

Keyword(s):

Older Adults ◽

Older People ◽

Childhood Maltreatment ◽

Linear Models ◽

Later Life ◽

Medical Costs ◽

Evaluation Study ◽

Population Based ◽

Emotional Neglect ◽

Emotionally Abused

Abstract Background Childhood maltreatment can have a significant impact on health across the life course, but its impact on health care costs in later life is unknown in Japan. This study aims to assess additional medical costs of Japanese older people with childhood maltreatment history. Methods Data from the Japan Gerontological Evaluation Study (JAGES) 2013, a population-based cohort of independent people aged 65 years or older across Japan were used and linked uniquely with the database of health insurance claims for residents of a city with more than 1.5 million citizens, aged 75 years or younger (N = 978). Average annual medical costs for April 2012 and March 2013 and April 2013 and March 2014 were calculated and compared between those who experienced childhood maltreatment and those who did not, using generalized linear models. Results 4.5% of our sample witnessed their father physically abusing their mother, 1.9% were physically abused, 10.6% were emotionally neglected, and 5.7% were emotionally abused in their childhood. Average medical costs of those with any childhood maltreatment (N = 176, 18.0% of the sample) were significantly higher than those without maltreatment (549,468JPY vs. 413,013JPY (1USD is equivalent to 110JPY); p = 0.007). When examining the effect of each type of maltreatment, average costs of those with emotional neglect were higher than the counterpart (573,481JPY vs. 412,082JPY; p = 0.008). Average costs of those who experienced physical abuse were also higher than those who did not (726,254JPY vs 431,106JPY; p = 0.035). The effect of any childhood maltreatment remained statistically significant after older adults’ age and gender were controlled (p = 0.03). Conclusions Our findings suggest that childhood maltreatment is strongly associated with additional medical costs among older Japanese. If it was truly causal, it can be estimated that additional medical costs associated with childhood maltreatment can be more than 333 billion JPY per year nationwide. Key messages Average annual medical costs of older adults with any childhood maltreatment history were significantly 116,098 JPY greater than those with no maltreatment history. As for each type of childhood maltreatment, emotional neglect tends to increase medical costs in late adulthood.

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Environmental Influences of Extreme Heat on the Health of Older Adults: A Retrospective Study

Innovation in Aging ◽

10.1093/geroni/igaa057.897 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 280-280

Author(s):

Mei Liu ◽

Carol Buller ◽

Barbara Polivka ◽

Terri Woodburn ◽

Mark Jakubauskas ◽

...

Keyword(s):

Older Adults ◽

Chronic Conditions ◽

Environmental Influence ◽

Emergency Department Visits ◽

Extreme Heat ◽

Extreme Weather Events ◽

Study Cohort ◽

Outpatient Visits ◽

Extreme Heat Event ◽

Heat Event

Abstract Studies have suggested that extreme weather events have differential effects by age. By leveraging electronic medical records, we aim to analyze the environmental influence of extreme heat on the health of older adults. From our healthcare system’s de-identified data warehouse, we extracted a retrospective cohort of 108,192 patients who were ≥65 years of age as of 1/1/2018 with pre-existing chronic conditions including diabetes, COPD, cardiovascular disease, or kidney disease. Extreme heat event period was defined as 5/1/2018 to 9/1/2018 (79 days with temperature ≥90o; 15 days of moderately poor/poor air quality index (AQI) [≥75] values) and the comparison period was defined as 5/1/2019 to 9/1/2019 (51 days with temperature ≥90o; 0 days with moderately poor/poor AQI values) in the Kansas City area. We randomly partitioned the study cohort into two sets and demonstrated the two patient sets were statistically similar (p>0.05) with respect to their demographic and underlying health conditions. Finally, we compared the respiratory, cardiovascular, and renal health outcomes between the 2018 and the 2019 cohorts. Most patients were Caucasians, female and had comorbid conditions. Results showed significantly higher number of all-cause emergency department visits (p=0.04) and outpatient visits (p=<.001) during the extreme heat event period in 2018. Analyses also showed significantly higher number of outpatient visits due to upper respiratory diseases (p=0.008) and acute renal failure (p=0.01) in 2018. In conclusion, extreme heat increased use of healthcare services in older adults with chronic conditions.

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Socio-economic consequences of mental distress: quantifying the impact of self-reported mental distress on the days of incapacity to work and medical costs in a two-year period: a longitudinal study in Germany

BMC Public Health ◽

10.1186/s12889-021-10637-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Gerhard Müller ◽

Manuela Bombana ◽

Monika Heinzel-Gutenbrenner ◽

Nikolaus Kleindienst ◽

Martin Bohus ◽

...

Keyword(s):

Mental Disorders ◽

Mental Distress ◽

Linear Models ◽

Longitudinal Research ◽

Depression Scale ◽

Routine Data ◽

Medical Costs ◽

First Year ◽

Second Year ◽

The Impact

Abstract Background Mental disorders are related to high individual suffering and significant socio-economic burdens. However, it remains unclear to what extent self-reported mental distress is related to individuals’ days of incapacity to work and their medical costs. This study aims to investigate the impact of self-reported mental distress for specific and non-specific days of incapacity to work and specific and non-specific medical costs over a two-year span. Method Within a longitudinal research design, 2287 study participants’ mental distress was assessed using the Hospital Anxiety and Depression Scale (HADS). HADS scores were included as predictors in generalized linear models with a Tweedie distribution with log link function to predict participants’ days of incapacity to work and medical costs retrieved from their health insurance routine data during the following two-year period. Results Current mental distress was found to be significantly related to the number of specific days absent from work and medical costs. Compared to participants classified as no cases by the HADS (2.6 days), severe case participants showed 27.3-times as many specific days of incapacity to work in the first year (72 days) and 10.3-times as many days in the second year (44 days), and resulted in 11.4-times more medical costs in the first year (2272 EUR) and 6.2-times more in the second year (1319 EUR). The relationship of mental distress to non-specific days of incapacity to work and non-specific medical costs was also significant, but mainly driven from specific absent days and specific medical costs. Our results also indicate that the prevalence of presenteeism is considerably high: 42% of individuals continued to go to work despite severe mental distress. Conclusions Our results show that self-reported mental distress, assessed by the HADS, is highly related to the days of incapacity to work and medical costs in the two-year period. Reducing mental distress by improving preventive structures for at-risk populations and increasing access to evidence-based treatments for individuals with mental disorders might, therefore, pay for itself and could help to reduce public costs.

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Intergenerational Relationships, Social Support, and Psychological Well-Being Among Korean Older Adults

Innovation in Aging ◽

10.1093/geroni/igaa057.1608 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 498-498

Author(s):

Yooumi Lee ◽

Janet Wilmoth

Keyword(s):

Social Support ◽

Older Adults ◽

Depressive Symptoms ◽

Living Arrangements ◽

Linear Models ◽

Depression Scale ◽

Adult Child ◽

Intergenerational Relationships ◽

Well Being ◽

Psychological Well Being

Abstract This study investigates whether intergenerational relationships and social support improve the psychological well-being of Korean older adults. We examine whether intergenerational relationships and social support directly influence psychological well-being and the extent to which they mediate the distressing consequences of life events such as declining health and recent widowhood. Using longitudinal data from the 2006 to 2016 Korean Longitudinal Study of Aging, we explore depression trajectories among individuals who are 60 or older with at least one living adult child at baseline. Specifically, we converted data from 5,383 older adults into a person-period file with 24,726 observations over a ten-year period. Then we estimated linear growth curve models of depression trajectories separately for men and women using the Center for Epidemiologic Studies Depression Scale (CES-D). Results from the hierarchical linear models indicate that declining health and recent widowhood are positively related to depressive symptoms. Satisfactory intergenerational relationships and social support in the form of personal interactions and proximate living arrangements with adult children decrease depressive symptoms of older parents, especially among women. We conclude that the psychological benefits of intergenerational relationships and social support are contingent upon the vulnerability of older adults and discuss the implications for public policy.

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Dairy Product Intake and Long-Term Risk for Frailty among French Elderly Community Dwellers

Nutrients ◽

10.3390/nu13072151 ◽

2021 ◽

Vol 13 (7) ◽

pp. 2151

Author(s):

Berna Rahi ◽

Hermine Pellay ◽

Virginie Chuy ◽

Catherine Helmer ◽

Cecilia Samieri ◽

...

Keyword(s):

Older Adults ◽

Dairy Product ◽

Food Group ◽

Community Dwelling ◽

Physical Frailty ◽

Frailty Phenotype ◽

Cross Sectional ◽

Sectional Analysis ◽

Community Dwelling Older Adults

Dairy products (DP) are part of a food group that may contribute to the prevention of physical frailty. We aimed to investigate DP exposure, including total DP, milk, fresh DP and cheese, and their cross-sectional and prospective associations with physical frailty in community-dwelling older adults. The cross-sectional analysis was carried out on 1490 participants from the Three-City Bordeaux cohort. The 10-year frailty risk was examined in 823 initially non-frail participants. A food frequency questionnaire was used to assess DP exposure. Physical frailty was defined as the presence of at least 3 out of 5 criteria of the frailty phenotype: weight loss, exhaustion, slowness, weakness, and low physical activity. Among others, diet quality and protein intake were considered as confounders. The baseline mean age of participants was 74.1 y and 61% were females. Frailty prevalence and incidence were 4.2% and 18.2%, respectively. No significant associations were observed between consumption of total DP or DP sub-types and frailty prevalence or incidence (OR = 1.40, 95%CI 0.65–3.01 and OR = 1.75, 95%CI 0.42–1.32, for a total DP consumption >4 times/d, respectively). Despite the absence of beneficial associations of higher DP consumption on frailty, older adults are encouraged to follow the national recommendations regarding DP.

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Health and social care service utilisation and associated expenditure among community-dwelling older adults with depressive symptoms

Epidemiology and Psychiatric Sciences ◽

10.1017/s2045796020001122 ◽

2021 ◽

Vol 30 ◽

Author(s):

Shiyu Lu ◽

Tianyin Liu ◽

Gloria H. Y. Wong ◽

Dara K. Y. Leung ◽

Lesley C. Y. Sze ◽

...

Keyword(s):

Older Adults ◽

Depressive Symptoms ◽

Symptom Severity ◽

Social Care ◽

Late Life ◽

Community Dwelling ◽

Service Utilisation ◽

Late Life Depression ◽

Social Care Service ◽

Health And Social Care

Abstract Aims Late-life depression has substantial impacts on individuals, families and society. Knowledge gaps remain in estimating the economic impacts associated with late-life depression by symptom severity, which has implications for resource prioritisation and research design (such as in modelling). This study examined the incremental health and social care expenditure of depressive symptoms by severity. Methods We analysed data collected from 2707 older adults aged 60 years and over in Hong Kong. The Patient Health Questionnaire-9 (PHQ-9) and the Client Service Receipt Inventory were used, respectively, to measure depressive symptoms and service utilisation as a basis for calculating care expenditure. Two-part models were used to estimate the incremental expenditure associated with symptom severity over 1 year. Results The average PHQ-9 score was 6.3 (standard deviation, s.d. = 4.0). The percentages of respondents with mild, moderate and moderately severe symptoms and non-depressed were 51.8%, 13.5%, 3.7% and 31.0%, respectively. Overall, the moderately severe group generated the largest average incremental expenditure (US$5886; 95% CI 1126–10 647 or a 272% increase), followed by the mild group (US$3849; 95% CI 2520–5177 or a 176% increase) and the moderate group (US$1843; 95% CI 854–2831, or 85% increase). Non-psychiatric healthcare was the main cost component in a mild symptom group, after controlling for other chronic conditions and covariates. The average incremental association between PHQ-9 score and overall care expenditure peaked at PHQ-9 score of 4 (US$691; 95% CI 444–939), then gradually fell to negative between scores of 12 (US$ - 35; 95% CI - 530 to 460) and 19 (US$ -171; 95% CI - 417 to 76) and soared to positive and rebounded at the score of 23 (US$601; 95% CI -1652 to 2854). Conclusions The association between depressive symptoms and care expenditure is stronger among older adults with mild and moderately severe symptoms. Older adults with the same symptom severity have different care utilisation and expenditure patterns. Non-psychiatric healthcare is the major cost element. These findings inform ways to optimise policy efforts to improve the financial sustainability of health and long-term care systems, including the involvement of primary care physicians and other geriatric healthcare providers in preventing and treating depression among older adults and related budgeting and accounting issues across services.

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Gender Differences in Phytoestrogens and the Relationship with Speed of Processing in Older Adults: A Cross-Sectional Analysis of NHANES, 1999–2002

Nutrients ◽

10.3390/nu11081780 ◽

2019 ◽

Vol 11 (8) ◽

pp. 1780 ◽

Cited By ~ 1

Author(s):

Alwerdt ◽

Patterson ◽

Sliwinski

Keyword(s):

Older Adults ◽

Gender Differences ◽

Cognitive Aging ◽

Linear Models ◽

Speed Of Processing ◽

Cross Sectional ◽

Health And Nutrition ◽

Performance Results ◽

Sectional Analysis ◽

The Relationship

Sex hormone changes in adults are known to play a part in aging, including cognitive aging. Dietary intake of phytoestrogens can mimic estrogenic effects on brain function. Since sex hormones differ between genders, it is important to examine gender differences in the phytoestrogen–cognition association. Therefore, the goal of this study is to examine the relationship between urinary phytoestrogens and speed of processing (SOP) and the variation of the association between genders in older adults. Participants were drawn from the 1999–2002 National Health and Nutrition Examination Survey and included 354 individuals aged 65–85 years old. General linear models (GLMs) were used to test for significant gender differences in the relationship between phytoestrogens and SOP. Results from the GLMs showed significant gender differences in the relationship between genistein and SOP. Higher levels of genistein were associated with better SOP in women. This relationship was reversed in men: higher genistein levels were associated with worse performance. Results indicate that there are distinct gender differences in the relationship between genistein and SOP. These results emphasize the importance of considering gender differences when devising dietary and pharmacologic interventions that target phytoestrogens to improve brain health.

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Medical Care for a Mass Gathering: The Suwa Onbashira Festival

Prehospital and Disaster Medicine ◽

10.1017/s1049023x00005161 ◽

2007 ◽

Vol 22 (5) ◽

pp. 431-435 ◽

Cited By ~ 18

Author(s):

Kazuyuki Yazawa ◽

Yukihiro Kamijo ◽

Ryuichi Sakai ◽

Masahiko Ohashi ◽

Mafumi Owa

Keyword(s):

Medical Care ◽

Medical Records ◽

Medical Service ◽

Medical Problems ◽

Medical Care System ◽

Mass Gatherings ◽

Emergency Medical ◽

Cervical Spine Fractures ◽

First Time ◽

Care System

AbstractIntroduction:The Suwa Onbashira Festival is held every six years and draws approximately one million spectators from across Japan. Men ride the Onbashira pillars (logs) down steep slopes.At each festival, several people are crushed under the heavy log. During the 2004 festival, for the first time, a medical care system that coordinated a medical team, an emergency medical service, related agencies, and local hospitals was constructed.Objective:The aims of this study were to characterize the spectrum of injuries and illness and to evaluate the medical care system of this festival.Methods:The festival was held 02 April–10 May 2004. The medical records of all of the patients who presented to an on-site medical tent or who were treated at the scene and transported to hospitals over a 12-day period were reviewed.The following items were evaluated: (1) the emergency medical system at the festival; (2) the environmental circumstances; and (3) patient data.Results:All medical usage rates are reported as patients per 10,000 attendees (PPTT). A total 1.8 million spectators attended the festival during the 12-day study period; a total of 237 patients presented to the medical tent (1.32 PPTT), and 63 (27%) were transferred to hospitals (0.35 PPTT). Of the total, 135 (57%) suffered from trauma—two were severely injured with pelvic and cervical spine fractures; and 102 (43%) had medical problems including heat-related illness.Conclusions:Comprehensive medical care is essential for similar mass gatherings. The appropriate triage of patients can lead to efficient medical coverage.

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