Evaluating racial disparities in healthcare system utilization and caregiver burden among older adults with dementia

2021 ◽  
pp. 1-14
Author(s):  
Carolina Pereira ◽  
Ashley LaRoche ◽  
Beth Arredondo ◽  
Erika Pugh ◽  
Elizabeth Disbrow ◽  
...  
Keyword(s):  
Older Adults ◽  
Racial Disparities ◽  
Healthcare System ◽  
Caregiver Burden ◽  
System Utilization

scholarly journals Clinical, behavioural and social factors associated with racial disparities in COVID-19 patients from an integrated healthcare system in Georgia: a retrospective cohort study

BMJ Open ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. e044052
Author(s):  
Felipe Lobelo ◽  
Alan Bienvenida ◽  
Serena Leung ◽  
Armand Mbanya ◽  
Elizabeth Leslie ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Racial Disparities ◽  
Clinical Outcomes ◽  
Healthcare System ◽  
Retrospective Cohort ◽  
Chronic Obstructive ◽  
Integrated Healthcare ◽  
Icu Admission ◽  
Hospitalised Patients

ObjectivesTo identify sociodemographic, clinical and behavioural drivers of racial disparities and their association with clinical outcomes among Kaiser Permanente Georgia (KPGA) members with COVID-19.DesignRetrospective cohort of patients with COVID-19 seen from 3 March to 29 October 2020. We described the distribution of underlying comorbidities, quality of care metrics, demographic and social determinants of health (SDOH) indicators across race groups. We also described clinical outcomes in hospitalised patients including length of stay, intensive care unit (ICU) admission, readmission and mortality. We performed multivariable analyses for hospitalisation risk among all patients with COVID-19 and stratifyied by race and sex.SettingKPGA, an integrated healthcare system.Participants5712 patients who all had laboratory-confirmed COVID-19. Of them, 57.8% were female, 58.4% black, 29.5% white, 8.5% Hispanic and 3.6% Asian.ResultsBlack patients had the highest proportions of living in neighborhoods under the federal poverty line (12.4%) and in more deprived locations (neighbourhood deprivation index=0.4). Overall, 14.4% (n=827) of this cohort was hospitalised. Asian patients had the highest rates of ICU admission (53.1%) and mechanical ventilation (21.9%). Among all patients, Hispanics (adjusted 1.60, 95% CI (1.08, 2.37)), blacks (1.43 (1.13, 1.83)), age in years (1.03 (1.02, 1.04)) and living in a zip code with high unemployment (1.08 (1.03, 1.13)) were associated with higher odds of hospitalisation. COVID-19 patients with chronic obstructive pulmonary disease (2.59 (1.67, 4.02)), chronic heart failure (1.79 (1.31, 2.45)), immunocompromised (1.77 (1.16, 2.70)), with glycated haemoglobin >8% (1.68 (1.19, 2.38)), depression (1.60 (1.24, 2.06)), hypertension (1.5 (1.21, 1.87)) and physical inactivity (1.25 (1.03, 1.51)) had higher odds of hospitalisation.ConclusionsBlack and Hispanic KPGA patients were at higher odds of hospitalisation, but not mortality, compared with other race groups. Beyond previously reported sociodemographics and comorbidities, factors such as quality of care, lifestyle behaviours and SDOH indicators should be considered when designing and implementing interventions to reduce COVID-19 racial disparities.

scholarly journals A Clinical Bridge between Family Caregivers and Older Adults: The Contribution of Patients’ Frailty and Optimism on Caregiver Burden

2021 ◽  
Vol 18 (7) ◽  
pp. 3406
Author(s):  
Alberto Sardella ◽  
Vittorio Lenzo ◽  
Angela Alibrandi ◽  
Antonino Catalano ◽  
Francesco Corica ◽  
...  
Keyword(s):  
Older Adults ◽  
Family Caregivers ◽  
Caregiver Burden ◽  
Frailty Index ◽  
Dispositional Optimism ◽  
Related Factors ◽  
Life Orientation Test ◽  
Life Orientation ◽  
Frailty Status ◽  
Personal Time

The association between caregiver burden and the physical frailty of older adults has been the object of previous studies. The contribution of patients’ dispositional optimism on caregiver burden is a poorly investigated topic. The present study aimed at investigating whether older adults’ multidimensional frailty and optimism might contribute to the burden of their family caregivers. The Caregiver Burden Inventory was used to measure the care-related burden of caregivers. The multidimensional frailty status of each patient was evaluated by calculating a frailty index, and the revised Life Orientation Test was used to evaluate patients’ dispositional optimism. The study involved eighty family caregivers (mean age 64.28 ± 8.6) and eighty older patients (mean age 80.45 ± 7.13). Our results showed that higher frailty status and lower levels of optimism among patients were significantly associated with higher levels of overall burden and higher burden related to the restriction of personal time among caregivers. Patients’ frailty was additionally associated with caregivers’ greater feelings of failure, physical stress, role conflicts, and embarrassment. Understanding the close connection between patient-related factors and the burden of caregivers appears to be an actual challenge with significant clinical, social, and public health implications.

scholarly journals Mental healthcare in older adults with schizophrenia: results from 118 French public psychiatric departments

2015 ◽  
Vol 27 (10) ◽  
pp. 1749-1750 ◽  
Author(s):  
Delphine Raucher-Chéné ◽  
Nicolas Hoertel ◽  
Céline Béra-Potelle ◽  
Sarah Terrien ◽  
Sarah Barrière ◽  
...  
Keyword(s):  
Older Adults ◽  
Bipolar Disorder ◽  
Life Expectancy ◽  
Healthcare System ◽  
Psychiatric Illness ◽  
Mental Healthcare ◽  
Geriatric Psychiatry

The increased life expectancy in people with severe and persistent psychiatric illness, such as schizophrenia or bipolar disorder, has been predicted to substantially affect mental healthcare system (Bartels et al., 2002) that must adapt to meet the needs of older adults (Jeste et al., 1999). Development of specialized geriatric psychiatry services is thus needed.

scholarly journals Are Disagreements in Caregiver and Patient Assessment of Patient Health Associated with Increased Caregiver Burden in Caregivers of Older Adults with Cancer?

2017 ◽  
Vol 22 (11) ◽  
pp. 1383-1391 ◽  
Author(s):  
Tina Hsu ◽  
Matthew Loscalzo ◽  
Rupal Ramani ◽  
Stephen Forman ◽  
Leslie Popplewell ◽  
...  
Keyword(s):  
Older Adults ◽  
Caregiver Burden ◽  
Patient Assessment ◽  
Patient Health

scholarly journals Adaptation and validation of the Caregiver Burden Inventory for use with caregivers of elderly individuals

2015 ◽  
Vol 23 (1) ◽  
pp. 130-138 ◽  
Author(s):  
Daiany Borghetti Valer ◽  
Marinês Aires ◽  
Fernanda Lais Fengler ◽  
Lisiane Manganelli Girardi Paskulin
Keyword(s):  
Older Adults ◽  
Correlation Coefficient ◽  
Caregiver Burden ◽  
Pearson Correlation ◽  
Intraclass Correlation ◽  
Expert Committee ◽  
Five Dimensions ◽  
Social And Emotional ◽  
Back Translation ◽  
Student’S T

OBJECTIVE: to adapt and validate the Caregiver Burden Inventory for use with caregivers of older adults in Brazil.METHOD: methodological study involving initial translation, synthesis of translations, back translation, expert committee review, pre-testing, submission of the final version to the original authors, and assessment of the inventory's psychometric properties. The inventory assesses five dimensions of caregiver burden: time-dependence, developmental, physical, social and emotional dimensions.RESULTS: a total of 120 family caregivers took part in the study. All care-receivers were older adults dependent on assistance to perform activities of daily living, and lived in the central region of the city of Porto Alegre, RS, Brasil. Cronbach's alpha value for the inventory was 0.936, and the Pearson correlation coefficient for the relationship between the scores obtained on the Caregiver Burden Inventory and the Burden Interview was 0.814. The intraclass correlation coefficient was 0.941, and the value of Student's T-test comparing test and retest scores was 0.792.CONCLUSION: the instrument presented adequate reliability and the suitability of its items and factors was confirmed in this study.

scholarly journals Examining Rural and Racial Disparities in the Relationship Between Loneliness and Social Technology Use Among Older Adults

2021 ◽  
Vol 9 ◽  
Author(s):  
Kaileigh A. Byrne ◽  
Reza Ghaiumy Anaraky ◽  
Cheryl Dye ◽  
Lesley A. Ross ◽  
Kapil Chalil Madathil ◽  
...  
Keyword(s):  
Older Adults ◽  
Racial Disparities ◽  
Technology Use ◽  
Social Engagement ◽  
Social Contact ◽  
Primary Study ◽  
Social Technology ◽  
Study Results ◽  
The Relationship ◽  
Rural Older Adults

Loneliness, the subjective negative experience derived from a lack of meaningful companionship, is associated with heightened vulnerability to adverse health outcomes among older adults. Social technology affords an opportunity to cultivate social connectedness and mitigate loneliness. However, research examining potential inequalities in loneliness is limited. This study investigates racial and rural-urban differences in the relationship between social technology use and loneliness in adults aged 50 and older using data from the 2016 wave of the Health and Retirement Study (N = 4,315). Social technology use was operationalized as the self-reported frequency of communication through Skype, Facebook, or other social media with family and friends. Loneliness was assessed using the UCLA Loneliness scale, and rural-urban differences were based on Beale rural-urban continuum codes. Examinations of race focused on differences between Black/African-American and White/Caucasian groups. A path model analysis was performed to assess whether race and rurality moderated the relationship between social technology use and loneliness, adjusting for living arrangements, age, general computer usage. Social engagement and frequency of social contact with family and friends were included as mediators. The primary study results demonstrated that the association between social technology use and loneliness differed by rurality, but not race. Rural older adults who use social technology less frequently experience greater loneliness than urban older adults. This relationship between social technology and loneliness was mediated by social engagement and frequency of social contact. Furthermore, racial and rural-urban differences in social technology use demonstrated that social technology use is less prevalent among rural older adults than urban and suburban-dwelling older adults; no such racial differences were observed. However, Black older adults report greater levels of perceived social negativity in their relationships compared to White older adults. Interventions seeking to address loneliness using social technology should consider rural and racial disparities.

Abstract P127: Racial Disparities in Risk Factor Control in Older Adults with Diabetes: The Atherosclerosis Risk in Communities (ARIC) Study

Circulation ◽  
2015 ◽  
Vol 131 (suppl_1) ◽  
Author(s):  
Christina Parrinello ◽  
Ina Rastegar ◽  
Job G Godino ◽  
Michael D Miedema ◽  
Kunihiro Matsushita ◽  
...  
Keyword(s):  
Risk Factors ◽  
Older Adults ◽  
Risk Factor ◽  
Racial Disparities ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Lipid Lowering ◽  
Tight Control ◽  
Risk Factor Control ◽  
Atherosclerosis Risk In Communities

Background: Racial disparities in risk factor control have been documented in middle-aged adults, but much less is known about older adults with diabetes. Our findings will inform clinical guidelines on appropriate risk factor control in older adults with diabetes. Methods: In 2011-13, 6,538 ARIC participants attended visit 5, and 4,988 provided data on all key covariates used in these analyses. Of these, 31% had diagnosed diabetes (N=1,561, 72% white, mean age=75 years) and were included in this study. Tight control of risk factors was defined according to American Diabetes Association guidelines: hemoglobin A1c <7%; low-density lipoprotein cholesterol <100 mg/dL; systolic blood pressure (BP) <140 mmHg and diastolic BP <80 mmHg. We evaluated risk factor control overall and by race. We used logistic regression and predictive margins to assess independent associations of race with tight risk factor control. Results: Among older adults with diabetes, 64% used glucose-lowering medication, 70% lipid-lowering medication and 82% BP-lowering medication. Only 5% of participants did not take medication for any of these risk factors. Tight control was observed in 72% for glucose, 64% for lipids and 70% for BP. Only 34% had tight control of all three. A higher proportion of whites than blacks consistently achieved tight control ( Figure ). In multivariable analyses of persons with diabetes who were treated for risk factors, racial disparities in tight control of lipids and BP remained significant: adjusted prevalence ratios and 95% CIs (white vs black) were 1.04 (0.91, 1.17) for glucose, 1.21 (1.08-1.34) for lipids, 1.15 (1.03-1.26) for BP, and 1.33 (0.95, 1.70) for tight control of all three risk factors. Conclusions: Our results highlight racial disparities in risk factor control in older adults with diabetes that were not explained by demographic or clinical characteristics. Further studies are needed to elucidate the determinants of disparities in risk factor control and strategies to address these.

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