scholarly journals Hospitalization Trajectories in Home- and Community-Based Services Recipients: The Influence of Physician and Social Care Density

2020 ◽  
Author(s):  
Min Hee Kim ◽  
Xiaoling Xiang
Keyword(s):  
Older Adults ◽  
Primary Care Physicians ◽  
Social Care ◽  
Group Membership ◽  
Multinomial Logistic Regression ◽  
Community Based ◽  
Resource Density ◽  
Increased Risk ◽  
Trajectory Group ◽  
Community Based Services

Abstract Objectives Repeated hospitalizations among older adults receiving Home- and Community-Based Services (HCBS) may indicate unmet medical and social needs. This study examined all-cause hospitalization trajectories and the association between area-level resource density for medical and social care and the trajectory group membership. Methods The study participants included 11,223 adults aged 60 years or older who were enrolled in public HCBS programs in Michigan between 2008 and 2012. Data sources included the Michigan interRAI-Home Care, Dartmouth Atlas of Health Care Data, the American Community Survey, and the County Business Patterns from the Census Bureau. The group-based trajectory modeling was used to identify trajectories of hospitalization over 15 months. Correlates of the trajectories were examined using multinomial logistic regression. Results Four distinct hospitalization trajectory groups emerged: “never” (43.1%)—individuals who were rarely hospitalized during the study period, “increasing” (19.9%)—individuals who experienced an increased risk of hospitalization, “decreasing” (21.6%)—individuals with a decreased risk, and “frequent” (15.8%)—individuals with frequent hospitalizations. Older adults living in areas with a higher number of social service organizations for older adults and persons with disability were less likely to be on the “frequent” trajectory relative to the “decreasing” trajectory. The density of primary care physicians was not associated with the trajectory group membership. Discussion Area-level social care resource density contributes to changes in 15-month hospitalization risks among older adult recipients of HCBS.

Community-Based Aging Services

2020 ◽  
Author(s):  
Jan Ivery
Keyword(s):  
Older Adults ◽  
Health Status ◽  
Social Workers ◽  
Healthy Aging ◽  
Community Based ◽  
Limited Mobility ◽  
Age In Place ◽  
Increased Risk ◽  
Aging Services ◽  
Community Based Services

As individuals age, their physical community continues to be a primary entry point of intervention because of their attachment to place, social connections, and limited mobility to travel as far and as often as they would like or desire. The environment provides a context for understanding an older adult’s social interactions and the availability of and access to supportive services that reduce isolation and increased risk for reduced health status. When individuals age in place, social workers need to understand how community-based services can work with older adults in their community where they have lived for some time and have developed social networks. This knowledge will better assist social workers in their ability to effectively connect clients with appropriate resources. Unfortunately, it is not uncommon for an older adult’s environment to not reflect or adapt to their changing health status and physical mobility. Healthy aging (also referred to as age-friendly) and NORC (naturally occurring retirement communities) initiatives have emerged as examples of how to provide supportive, community-based services that will enable older adults to remain engaged in their community as they experience changes in their health status, mobility, and financial security. These community-level interventions emphasize the adaptability to an older adult’s changing lifestyle factors that influence how they navigate their community. These initiatives engage older adults in planning and implementing strategies to connect older adults with services and activities that promote aging in place. Social workers play a very important role in the provision of community-based aging services because they can serve as a bridge between older adults and the local, state, and federal level programs that may be available to them.

scholarly journals Group-Based Trajectory Analysis of Physical Activity Change in a US Weight Loss Intervention

2018 ◽  
Vol 15 (11) ◽  
pp. 840-846 ◽  
Author(s):  
Christopher C. Imes ◽  
Yaguang Zheng ◽  
Dara D. Mendez ◽  
Bonny J. Rockette-Wagner ◽  
Meghan K. Mattos ◽  
...  
Keyword(s):  
Physical Activity ◽  
Body Mass Index ◽  
Weight Loss ◽  
Body Mass ◽  
Behavioral Treatment ◽  
Group Membership ◽  
Multinomial Logistic Regression ◽  
Step Count ◽  
Weight Loss Intervention ◽  
Trajectory Group

Background: The obesity epidemic is a global concern. Standard behavioral treatment including increased physical activity, reduced energy intake, and behavioral change counseling is an effective lifestyle intervention for weight loss. Purpose: To identify distinct step count patterns among weight loss intervention participants, examine weight loss differences by trajectory group, and examine baseline factors associated with trajectory group membership. Methods: Both groups received group-based standard behavioral treatment while the experimental group received up to 30 additional, one-on-one self-efficacy enhancement sessions. Data were analyzed using group-based trajectory modeling, analysis of variance, chi-square tests, and multinomial logistic regression. Results: Participants (N = 120) were mostly female (81.8%) and white (73.6%) with a mean (SD) body mass index of 33.2 (3.8) kg/m2. Four step count trajectory groups were identified: active (>10,000 steps/day; 11.7%), somewhat active (7500–10,000 steps/day; 28.3%), low active (5000–7500 steps/day; 27.5%), and sedentary (<5000 steps/day; 32.5%). Percent weight loss at 12 months increased incrementally by trajectory group (5.1% [5.7%], 7.8% [6.9%], 8.0% [7.4%], and 13.63% [7.0%], respectively; P = .001). At baseline, lower body mass index and higher perceived health predicted membership in the better performing trajectory groups. Conclusions: Within a larger group of adults in a weight loss intervention, 4 distinct trajectory groups were identified and group membership was associated with differential weight loss.

scholarly journals Trajectories of Hospital Readmission After A Fall Injury for Older Adults Living in Aged Care or The Community

2020 ◽  
Vol 5 (5) ◽  
Author(s):  
Rebecca Mitchell ◽  
Brian Draper ◽  
Jacqueline Close ◽  
Lara Harvey ◽  
Henry Brodaty ◽  
...  
Keyword(s):  
Older Adults ◽  
Hospital Readmission ◽  
Hospital Admissions ◽  
Group Membership ◽  
Hospital Readmissions ◽  
Care Facility ◽  
Aged Care ◽  
Community Living ◽  
Fall Injury ◽  
Trajectory Group

IntroductionFall injuries are one of the leading causes of hospitalisation for adults aged ≥65 years. Distinguishing key characteristics of older adults who are either living in aged care or in the community who have multiple hospital readmissions after a fall injury may inform targeted approaches to the prevention of hospital readmissions. Objectives and ApproachTo examine trajectories of hospital readmission of older adults living in aged care or the community after a fall injury hospitalisation and to identify factors predictive of trajectory group membership. A group-based trajectory analysis of hospital readmissions of adults aged ≥65 years who had a fall injury hospitalisation during 2008-09 in New South Wales, Australia was conducted. Linked hospitalisation and aged care data were examined for a 5 year period to 2013. Group-based trajectory models were derived based on number of subsequent readmissions following the index admission. Multinominal logistic regression examined predictors of trajectory group membership. ResultsThere were 24,729 fall injury hospitalisations; 78.8% of fallers were living in the community and 21.2% in aged care. Five distinct trajectory groups were identified for community-living (i.e. Moderate-declining, Chronic, Low-constant, Low-declining, and High users) and four trajectory groups for aged care residents (i.e. Low, Moderate-declining, Moderate-chronic, and High users). Key predictors of trajectory group membership for both community-living and aged care residents were age group, number of comorbidities, and dementia status. For aged care residents, depression, assistance with activities of daily living, and number of subsequent fall injury admissions were also predictors of group membership, with time to move to an aged care facility a predictor of group membership for community-living. Conclusion / ImplicationsIdentifying trajectories of ongoing hospital use informs targeting of strategies to reduce hospital admissions and design of services to allow community-living individuals to remain as long as possible within their own residence.

Characteristics and Factors Associated With Intimate Partner Violence–Related Homicide Post-Release From Jail or Prison

2019 ◽  
pp. 088626051988819
Author(s):  
Cynthia Fraga Rizo ◽  
Annelise Mennicke ◽  
Tonya Van Deinse
Keyword(s):  
Intimate Partner Violence ◽  
Partner Violence ◽  
Correctional Facility ◽  
Intimate Partner ◽  
Correctional Institutions ◽  
Community Based ◽  
Homicide Victimization ◽  
Increased Risk ◽  
Informal Supports ◽  
Community Based Services

Intimate partner violence (IPV) victimization and perpetration are common experiences among incarcerated people. Despite knowledge regarding the challenges of re-integrating post-release from jail or prison, including an increased risk of homicide victimization, there is a dearth of research focused on IPV-related homicides post-release from a correctional facility. To address this gap, the current study used 2003-2015 data from the National Violent Death Reporting System from 27 states to examine the characteristics and circumstances surrounding IPV-related homicides soon after the homicide victim was released from jail or prison. Of the 126 post-release homicides, 13.5% were related to IPV. Post-release homicides involving either a female victim or perpetrator were more likely to be IPV-related. In the case of many of the IPV-related homicides, there was evidence of prior IPV as well as potential bystanders (including formal and informal supports) who were aware of the risk for IPV escalation and possible lethality. Compared with non-IPV post-release homicides, those related to IPV were more likely to occur in the victim’s home, have been immediately preceded by a physical fight, and have occurred by means other than firearm. These findings highlight the importance of enhancing the capacity of correctional facilities and community-based services to assess for and respond to risk of IPV and IPV-related lethality for individuals leaving correctional institutions.

scholarly journals ELDER ABUSE AMID THE OPIOID EPIDEMIC: APS CASES IN RURAL AMERICA

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S763-S763
Author(s):  
Pamela B Teaster ◽  
Karen A Roberto ◽  
Jyoti Savla
Keyword(s):  
Older Adults ◽  
Elder Abuse ◽  
Standard Errors ◽  
Opioid Misuse ◽  
Rural America ◽  
Opioid Use ◽  
Care Needs ◽  
Community Based ◽  
Community Based Services ◽  
Physical Care

Abstract Older adults are hidden victims of the opioid crises, suffering abuse at the hands of those who seek resources to support their addiction. Using APS data from 2015-2017 provided by the Kentucky Department for Community-Based Services, we used a logistic regression model with robust standard errors to examine whether substantiated cases of elder abuse were associated with opioid misuse by perpetrators. Overall, 9% of the 462 substantiated cases over the three-year period involved perpetrators were substance users. The percentage of these cases rose from 5% in 2015 to 13% in 2016 before dropping to 7% of elder abuse cases in 2017. Opioid use was most prevalent among perpetrators of financial abuse of older adults with cognitive and/or physical care needs. The current study offers a first look at empirical linkages between opioid misuse and elder abuse and revealed consistencies across cases that call for further investigation.

scholarly journals THE INTERSECTION OF ETHICS AND VULNERABLE ELDERS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S238-S238
Author(s):  
Pamela B Teaster ◽  
Georgia Anetzberger
Keyword(s):  
Older Adults ◽  
Social Services ◽  
Ethical Issues ◽  
Elder Abuse ◽  
Cognitive Status ◽  
Ethical Challenges ◽  
Community Based ◽  
Conducting Research ◽  
Definition Of ◽  
Community Based Services

Abstract Researchers, practitioners and policymakers are daily confronted with multiple and competing situations regarding vulnerable older adults and the complex issues that they face in all aspects of their lives. Challenges can arise in the provision of social services, dispensing justice, conducting research, or addressing legal issues. The purpose of this symposium is to discuss dilemmas that vulnerable older adults and concerned others face by elucidating current and future challenges facing this population, particularly in the realms of compromised health (cognitive impairment); effective status (gender); care arrangements (home and community-based services); and abuse, neglect, and exploitation. Teaster and Anetzberger discuss relevant ethical theories and principles as well as a definition of vulnerability. Santos and Nichols-Hadeed report on ethical issues embedded in vulnerable elders’ cognitive status. Bowland and Halaas highlight the intersection of ethics, gender and vulnerable elders. Niles-Yokum and Beaumaster discuss the nexus of ethics and the provision of home and community based services for vulnerable older adults. Heisler considers vulnerabilities of older adults and ethical challenges when addressing elder abuse. Throughout the papers, we weave the ethical principles of autonomy, beneficence, nonmaleficence, and justice.

scholarly journals Durable HIV Suppression Among People Who Inject Drugs From a Community-Based Cohort Study in Baltimore, Maryland, 1997–2017

2019 ◽  
Vol 188 (12) ◽  
pp. 2086-2096 ◽  
Author(s):  
Becky L Genberg ◽  
Gregory D Kirk ◽  
Jacquie Astemborski ◽  
Hana Lee ◽  
Noya Galai ◽  
...  
Keyword(s):  
Cohort Study ◽  
Viral Suppression ◽  
People Who Inject Drugs ◽  
Transition Probabilities ◽  
Multinomial Logistic Regression ◽  
Hiv Treatment ◽  
Community Based ◽  
Risk Of Death ◽  
Increased Risk ◽  
Durable Viral Suppression

Abstract People who inject drugs (PWID) face disparities in human immunodeficiency virus (HIV) treatment outcomes and may be less likely to achieve durable viral suppression. We characterized transitions into and out of viral suppression from 1997 to 2017 in a long-standing community-based cohort study of PWID, the AIDS Link to Intravenous Experience (ALIVE) Study, analyzing HIV-positive participants who had made a study visit in or after 1997. We defined the probabilities of transitioning between 4 states: 1) suppressed, 2) detectable, 3) lost to follow-up, and 4) deceased. We used multinomial logistic regression analysis to examine factors associated with transition probabilities, with a focus on transitions from suppression to other states. Among 1,061 participants, the median age was 44 years, 32% were female, 93% were African-American, 59% had recently injected drugs, and 28% were virologically suppressed at baseline. Significant improvements in durable viral suppression were observed over time; however, death rates remained relatively stable. In adjusted analysis, injection drug use and homelessness were associated with increased virological rebound in earlier time periods, while only age and race were associated with virological rebound in 2012–2017. Opioid use was associated with an increased risk of death following suppression in 2012–2017. Despite significant improvements in durable viral suppression, subgroups of PWID may need additional efforts to maintain viral suppression and prevent premature mortality.

scholarly journals Use of Informal Support as a Predictor of Home- and Community-Based Services Utilization

2020 ◽  
Vol 76 (1) ◽  
pp. 133-140
Author(s):  
Kristen N Robinson ◽  
Heather L Menne ◽  
Raphael Gaeta
Keyword(s):  
Older Adults ◽  
Informal Caregivers ◽  
Behavioral Model ◽  
Study Data ◽  
Informal Support ◽  
Health Services Use ◽  
Community Based ◽  
Logistic Regression Models ◽  
Andersen Behavioral Model ◽  
Community Based Services

Abstract Objectives Home- and community-based services (HCBS) help older adults remain living safely in their homes by delaying or preventing the need for institutionalization. This analysis is guided by the Andersen Behavioral Model of Health Services Use to examine the association between informal support and use of HCBS. Method Health and Retirement Study data from 2011 and 2012 are used in the bivariate analyses and multivariate logistic regression models to examine differences in HCBS utilization among extremely vulnerable older adults who have informal caregivers and those who do not. Results For extremely vulnerable older adults who report difficulties with any instrumental or basic activities of daily living, use of HCBS is not strongly associated with access to informal caregivers. However, for this same population of extremely vulnerable older adults, those who live alone have roughly 3 times the odds of using any HCBS compared to those who do not live alone. Discussion Among already vulnerable older adults, this study revealed that living alone is an important enabling factor of the Andersen Behavioral Model as applied in HCBS research. Further investigation is needed to see if more resources should be allocated to senior centers and local providers to identify vulnerable older adults who live alone and may have unmet needs.

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