scholarly journals Black–White Disparities in Moves to Assisted Living and Nursing Homes Among Older Medicare Beneficiaries

2019 ◽  
Vol 75 (9) ◽  
pp. 1972-1982 ◽  
Author(s):  
Meghan Jenkins Morales ◽  
Stephanie A Robert
Keyword(s):  
Older Adults ◽  
Nursing Home ◽  
Nursing Homes ◽  
Assisted Living ◽  
Multinomial Logistic Regression ◽  
Living Arrangement ◽  
Community Dwelling ◽  
Housing Tenure ◽  
Medicare Beneficiaries ◽  
Nationally Representative

Abstract Objectives Investigate black-white disparities in older adults’ moves to assisted living and nursing homes and draw from the Andersen Healthcare Utilization Model to test explanations for any disparities. Methods Data are from a nationally representative sample of older community-dwelling Medicare beneficiaries from the 2015 (N = 5,212) National Health and Aging Trends Study (NHATS). We use stepwise multinomial logistic regression to examine black-white disparities in moves out of community housing to assisted living or a nursing home over 2 years, before and after adjusting for predisposing (age, gender), enabling (income, housing tenure, Medicaid, living arrangement) and need (activities of daily living [ADL] limitation, physical capacity, self-rated health, and dementia) factors. Results Black older adults are less likely to move to assisted living and are more likely to move to a nursing home compared to white older adults. Black-white disparities in moves to nursing homes are explained by black-white differences in enabling and need factors, whereas black-white disparities in moves to assisted living remain even after adjusting for enabling and need factors. Discussion Unmeasured factors related to systemic racism (e.g., residential racial segregation, racial discrimination) and/or black-white differences in care preferences might further explain black-white disparities in moves to assisted living and warrant further investigation.

scholarly journals Trajectories of Homebound Status in Medicare Beneficiaries Aged 65 and Older

2019 ◽  
Vol 60 (1) ◽  
pp. 101-111 ◽  
Author(s):  
Xiaoling Xiang ◽  
Jieling Chen ◽  
MinHee Kim
Keyword(s):  
Risk Factors ◽  
Older Adults ◽  
Activities Of Daily Living ◽  
Social Isolation ◽  
Daily Living ◽  
Multinomial Logistic Regression ◽  
Community Dwelling ◽  
Medicare Beneficiaries ◽  
Nationally Representative ◽  
Design And Methods

Abstract Background and Objectives The purpose of this study was to examine the trajectories of homebound status in older adults and to investigate the risk factors in shaping the pattern of these trajectories. Research Design and Methods The study sample was a nationally representative sample of Medicare beneficiaries aged 65 and older (N = 7,607) from the National Health and Aging Trends Study (Round 1–Round 7). Homebound state was defined as never or rarely went out the home in the last month. Homebound trajectories were identified using an enhanced group-based trajectory modeling that accounted for nonrandom attrition. Multinomial logistic regression was used to examine risk factors of homebound trajectories. Results Three trajectory groups were identified: the “never” group (65.5%) remained nonhomebound; the “chronic” group were largely persistently homebound (8.3%); and the “onset” group (26.2%) had a rapid increase in their risk of being homebound over the 7-year period. The following factors increased the relative risk for being on the “onset” and “chronic” versus the “never” trajectory: older age, Hispanic ethnicity, social isolation, past or current smoking, instrumental activities of daily living limitations, probable dementia, and use of a walker or wheelchair. Male sex and living alone were associated with a lower risk of being on the “chronic” trajectory, whereas depression and anxiety symptoms, chronic conditions, and activities of daily living limitations increased the risk. Discussion and Implications The progression of homebound status among community-dwelling older adults followed three distinct trajectories over a 7-year period. Addressing social isolation and other risk factors may prevent or delay the progression to homebound state.

scholarly journals The Effects of Housing Cost Burden and Housing Tenure on Moves to a Nursing Home Among Low- and Moderate-Income Older Adults

2020 ◽  
Vol 60 (8) ◽  
pp. 1485-1494
Author(s):  
Meghan Jenkins Morales ◽  
Stephanie A Robert
Keyword(s):  
Older Adults ◽  
Nursing Home ◽  
Nursing Homes ◽  
Affordable Housing ◽  
The United States ◽  
Community Dwelling ◽  
Housing Tenure ◽  
Housing Cost ◽  
Cost Burden ◽  
Housing Cost Burden

Abstract Background and Objectives In the United States, a growing number of older adults struggle to find affordable housing that can adapt to their changing needs. Research suggests that access to affordable housing is a significant barrier to reducing unnecessary nursing home admissions. This is the first empirical study we know of to examine whether housing cost burden (HCB) is associated with moves to nursing homes among older adults. Research Design and Methods Data include low- and moderate-income community-dwelling older adults (N = 3,403) from the nationally representative 2015 National Health and Aging Trends Study. HCB (≥30% of income spent on mortgage/rent) and housing tenure (owner/renter) are combined to create a 4-category housing typology. Multinomial logistic regression models test (a) if renters with HCB are most likely (compared with other housing types) to move to a nursing home over 3 years (2015–2018) and (b) if housing type interacts with health and functioning to predict moves to a nursing home. Results Across all models, renters with HCB had the greatest likelihood of moving to a nursing home. Moreover, self-rated health, physical capacity, and mental health were weaker predictors of nursing home moves for renters with HCB. Discussion and Implications Results suggest that older renters with HCB are most likely to experience unnecessary nursing home placement. The growing population of older renters experiencing HCB may not only signal a housing crisis, but may also challenge national efforts to shift long-term care away from nursing homes and toward community-based alternatives.

scholarly journals Driving Status and Transportation Disadvantage Among Medicare Beneficiaries

2018 ◽  
Vol 39 (9) ◽  
pp. 935-943 ◽  
Author(s):  
Miriam Ryvicker ◽  
Evan Bollens-Lund ◽  
Katherine A. Ornstein
Keyword(s):  
United States ◽  
Older Adults ◽  
Well Being ◽  
The United States ◽  
Community Dwelling ◽  
Medicare Beneficiaries ◽  
Coordination Strategies ◽  
Representative Study ◽  
Nationally Representative ◽  
Community Dwelling Older Adults

Transportation disadvantage may have important implications for the health, well-being, and quality of life of older adults. This study used the 2015 National Health Aging Trends Study, a nationally representative study of Medicare beneficiaries aged 65 and over ( N = 7,498), to generate national estimates of transportation modalities and transportation disadvantage among community-dwelling older adults in the United States. An estimated 10.8 million community-dwelling older adults in the United States rarely or never drive. Among nondrivers, 25% were classified as transportation disadvantaged, representing 2.3 million individuals. Individuals with more chronic medical conditions and those reliant on assistive devices were more likely to report having a transportation disadvantage ( p < .05). Being married resulted in a 50% decreased odds of having a transportation disadvantage ( p < .01). Some individuals may be at higher risk for transportation-related barriers to engaging in valued activities and accessing care, calling for tailored interventions such as ride-share services combined with care coordination strategies.

Influenza Immunization in Nursing Homes: Who Does Not Get Immunized and Whose Status Is Unknown?

2006 ◽  
Vol 27 (4) ◽  
pp. 388-396 ◽  
Author(s):  
Jill A. Marsteller ◽  
Ronald Tiggle ◽  
Robin Remsburg ◽  
Abigail Shefer ◽  
Barbara Bardenheier
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Nursing Home Resident ◽  
Outcome Measure ◽  
Multinomial Logistic Regression ◽  
Secondary Data ◽  
Nursing Facilities ◽  
Influenza Immunization ◽  
Immunization Status ◽  
Nationally Representative

Objective.To identify nursing home resident and facility characteristics associated with patients not receiving influenza immunization and having unknown immunization status.Design.Secondary data analysis using multinomial logistic regression of data from the National Nursing Home Survey, a nationally representative establishment-based survey.Setting.A total of 1,423 nursing facilities of all ownerships and certifications systematically sampled with probability proportional to number of beds.Patients.A total of 7,350 randomly sampled people aged 65 years or older residing in nursing homes between July and December 1999 (approximately 6 per facility).Main Outcome Measure.Immunization status of residents.Results.Fifteen percent of residents were not immunized and 19% had unknown immunization status. In multivariate analysis, lack of immunization and unknown immunization status were each separately associated with being newly admitted, with no or unknown pneumococcal immunization, and with facility failures to screen for immunization and to record inoculation in the medical record. High-risk status and staff immunization requirements had no effect. Separate analyses showed that residents with unknown immunization status are statistically significantly different from both those vaccinated and those not vaccinated.Conclusion.This study indicates that both resident and facility characteristics are associated with failure to be immunized for influenza. Facilities should consider targeting younger, newly admitted, and residential care residents for influenza immunization, since they are more likely to be missed. Further research into the barriers to immunization specific to nursing home resident choice or opportunity may be warranted.

scholarly journals Long-term individual and population functional outcomes in older adults with atrial fibrillation

2020 ◽  
Author(s):  
Anna L. Parks ◽  
Sun Y. Jeon ◽  
W. John Boscardin ◽  
Michael A. Steinman ◽  
Alexander K. Smith ◽  
...  
Keyword(s):  
Older Adults ◽  
Nursing Home ◽  
Functional Outcomes ◽  
Daily Living ◽  
Population Level ◽  
Community Dwelling ◽  
High Rate ◽  
Function Loss ◽  
Nationally Representative

AbstractBackgroundOlder adults with atrial fibrillation (AF) have multiple risk factors for disablement. Long-term function and the contribution of strokes to disability has not been previously characterized.MethodsWe performed a longitudinal, observational study in the nationally representative Health and Retirement Study (1992-2014). We included participants ≥65 years with Medicare claims who met incident AF diagnosis claims criteria. We examined the association of incident stroke with three functional outcomes: independence with activities of daily living (ADL) and instrumental activities of daily living (IADL) and community-dwelling. We fit separate logistic regression models with repeated measures adjusting for comorbidities and demographics to estimate the effect of stroke on function. We estimate the contribution of strokes to the overall population burden of functional impairment using the method of recycled predictions.ResultsAmong 3530 participants (median age 79 years, 53% women, median CHA2DS2-VASc 5), 262 had a stroke over 17,396 person-years. Independent of stroke and accounting for population comorbidities, annually, ADL dependence increased by 4.4%, IADL dependence increased by 3.9%, and nursing home residence increased by 1.2% (p<0.05 for all). Accounting for comorbidities, of those who experienced a stroke, 31.9% developed new ADL dependence, 26.5% developed new IADL dependence, and 8.6% newly moved to a nursing home (p<0.05 for all). Considering all causes of function loss, 1.7% of ADL disability-years, 1.2% of IADL disability-years, and 7.3% of nursing home years could be attributed to stroke over 7.4years.ConclusionOlder adults lose substantial function over time following AF diagnosis, independent of stroke. Stroke was associated with a significant decline in function and an increase in the likelihood of nursing home move, but stroke did not accelerate subsequent disability accrual. Because of the high background rate of functional loss, stroke was not the dominant determinant of population-level disability in older adults with AF.Impact statementWe certify that this work is novel. Little is known about long-term function (ADL, IADL, community-dwelling) among older adults with AF and the association with stroke. This nationally representative study finds a high rate of function loss independent of stroke, and among those who suffer a stroke, a dramatic and immediate decline in function. Because of the high rate of function loss independent of stroke and the relatively low rate of stroke, on a population level, stroke is not the dominant determinant of disability in older adults with AF.

scholarly journals Disability Trends Among Community-Dwelling Older Adults and Related Determinants of Disability

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 118-118
Author(s):  
Qiwei Li ◽  
Sarah Szanton
Keyword(s):  
Older Adults ◽  
Health Care Services ◽  
Study Data ◽  
Community Dwelling ◽  
Financial Strain ◽  
Medicare Beneficiaries ◽  
Care Services ◽  
Trend Data ◽  
Nationally Representative ◽  
Community Dwelling Older Adults

Abstract The growing aging population with disabilities poses challenges to caregiving and health care services but there is little recent data on disability trends. Some studies have shown that disability is decreasing while others have shown it increasing. Understanding these trends among community-dwelling older adults is critical for communities to allocate resources and develop policies. This study updates disability trend data among community-dwelling older adults using nationally representative National Health & Aging Trends Study data. Results revealed that about 30% of Medicare beneficiaries had at least one limitation of the activity of daily living (ADL) from 2011 to 2019. Age 75-79 (IRR=1.55), 80-84 (IRR= to 4.60), 85-89 (IRR=2.99), 90+ (IRR=4.60), female, (IRR=1.18), not a house owner (IRR=1.51), financial strain (IRR=1.71), and receiving Medicaid (IRR=1.84) are associated with a higher likelihood of becoming ADL limited or having more ADL limitations. We will discuss potential policy, intervention, and research implications.

Uitbraak COVID-19 in de verpleeghuiszorg

2020 ◽  
Keyword(s):  
Older Adults ◽  
Nursing Home ◽  
Nursing Homes ◽  
Long Term Care ◽  
Informal Caregivers ◽  
Rapid Review ◽  
Daily Routine ◽  
Term Care ◽  
Care Facilities

Long-term care for older adults is highly affect by the COVID-19 outbreak. The objective of this rapid review is to understand what we can learn from previous crises or disasters worldwide to optimize the care for older adults in long term care facilities during the outbreak of COVID-19. We searched five electronic databases to identify potentially relevant articles. In total, 23 articles were included in this study. Based on the articles, it appeared that nursing homes benefit from preparing for the situation as best as they can. For instance, by having proper protocols and clear division of tasks and collaboration within the organization. In addition, it is helpful for nursing homes to collaborate closely with other healthcare organizations, general practitioners, informal caregivers and local authorities. It is recommended that nursing homes pay attention to capacity and employability of staff and that they support or relieve staff where possible. With regard to care for the older adults, it is important that staff tries to find a new daily routine in the care for residents as soon as possible. Some practical tips were found on how to communicate with people who have dementia. Furthermore, behavior of people with dementia may change during a crisis. We found tips for staff how to respond and act upon behavior change. After the COVID-19 outbreak, aftercare for staff, residents, and informal caregivers is essential to timely detect psychosocial problems. The consideration between, on the one hand, acute safety and risk reduction (e.g. by closing residential care facilities and isolating residents), and on the other hand, the psychosocial consequences for residents and staff, were discussed in case of other disasters. Furthermore, the search of how to provide good (palliative) care and to maintain quality of life for older adults who suffer from COVID-19 is also of concern to nursing home organizations. In the included articles, the perspective of older adults, informal caregivers and staff is often lacking. Especially the experiences of older adults, informal caregivers, and nursing home staff with the care for older adults in the current situation, are important in formulating lessons about how to act before, during and after the coronacrisis. This may further enhance person-centered care, even in times of crisis. Therefore, we recommend to study these experiences in future research.

Multiple Physical Symptoms of Community-Dwelling Older People in Western China: Prevalence and Its Association with Frailty

Gerontology ◽  
2021 ◽  
pp. 1-9
Author(s):  
Shuli Jia ◽  
Wanyu Zhao ◽  
Yan Zhang ◽  
Lisha Hou ◽  
Xin Xia ◽  
...  
Keyword(s):  
Older Adults ◽  
Multinomial Logistic Regression ◽  
Physical Symptoms ◽  
Community Dwelling ◽  
Western China ◽  
Musculoskeletal Symptoms ◽  
Frailty Phenotype ◽  
The Past ◽  
Organ Systems ◽  
Multiple Symptoms

<b><i>Introduction:</i></b> Physical symptoms and frailty are common in older adults. A previous study has reported that multiple somatic symptoms are associated with frailty. In this study, we aimed to describe the picture of physical symptoms in older adults in western China and examine the relationship of multiple physical symptoms and frailty, as well as the sex difference of this relationship. <b><i>Methods:</i></b> Cross-sectional analyses were based on the West China Health and Aging Trend (WCHAT) study comprising 4,106 community-dwelling older adults (60–95 years). Frailty was assessed using the physical frailty phenotype (PFP). Participants’ experience of 28 different physical symptoms in the past 4 weeks was assessed. Physical symptoms were divided into several categories according to organ systems. Multinomial logistic regression analyses were performed to examine the association between frailty and multiple physical symptoms. <b><i>Results:</i></b> Nearly half of the subjects reported experiencing at least 1 physical symptom during the past 4 weeks. Musculoskeletal symptoms were the most prevalent symptoms. More than 5 physical symptoms were more likely to be frailty, even when all covariates were controlled. A significant association between multiple musculoskeletal symptoms and frailty also was found after adjusted for all covariates and multiple symptoms of other organ systems. Similar results were obtained for multiple cardiopulmonary symptoms. Furthermore, there were sex differences in these relationships. <b><i>Conclusion:</i></b> Multiple physical symptoms appear to have a detrimental impact on frailty in older adults. Compared with counting total symptoms, multiple symptoms of the same organ system may have a greater impact on frailty. Effective interventions and management of multiple physical symptoms are warranted to prevent frailty.

scholarly journals A Theoretical Framework for the Development of Views of One’s Own Aging

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 6-6
Author(s):  
Sarah Marrs ◽  
Jennifer Inker ◽  
Madeline McIntyre ◽  
Leland Waters ◽  
Tracey Gendron
Keyword(s):  
Older Adults ◽  
Medical Students ◽  
Assisted Living ◽  
Health Professions ◽  
Theoretical Framework ◽  
Community Dwelling ◽  
Mentoring Program ◽  
Term Care ◽  
Before And After ◽  
Students Attitudes

Abstract Senior mentoring programs have been established that provide medical students exposure to a community-dwelling older adult mentor. The goal of these programs is to expose students to healthy older adults, increase knowledge of geriatrics, and prepare them to care for an aging population. However, even while participating in a senior mentoring program, health professions students still demonstrate some discriminatory language towards older adults (e.g., Gendron, Inker, & Welleford, 2018). In fact, research suggests ageist practices occur, intentionally or not, among all health professions and within assisted living and long-term care facilities (e.g., Bowling, 1999; Dobbs et al., 2008; Kane & Kane, 2005). There is reason to believe that how we feel about other older adults is a reflection of how we feel about ourselves as aging individuals. As part of an evaluation of a Senior Mentoring program, we found that students’ attitudes towards older adults were not significantly improved (t (92) = .38, p = .70). To further explore this, we collected subsequent qualitative data. Specifically, we asked students to respond to the open-ended prompt before and after completing their senior mentoring program: How do you feel about your own aging? Our findings have revealed just how complex students’ views towards aging and elderhood are, pointing to a need to develop a theoretical framework for how these views are formed. Thus, the results of this qualitative grounded theory study illustrate the stages of development medical students’ progress through as they come to accept themselves as aging humans.

scholarly journals Patterns and predictive factors of loss of the independence trajectory among community-dwelling older adults

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Charlotte Bimou ◽  
Michel Harel ◽  
Cécile Laubarie-Mouret ◽  
Noëlle Cardinaud ◽  
Marion Charenton-Blavignac ◽  
...  
Keyword(s):  
Older Adults ◽  
Predictive Factors ◽  
Multinomial Logistic Regression ◽  
Cognitive Disorder ◽  
Community Dwelling ◽  
Functional Autonomy ◽  
Process Loss ◽  
Associated Risk Factors ◽  
Study Participants ◽  
Community Dwelling Older Adults

Abstract Background Independence is related to the aging process. Loss of independence is defined as the inability to make decisions and participate in activities of daily living (ADLs). Independence is related to physical, psychological, biological, and socioeconomic factors. An enhanced understanding of older people’s independence trajectories and associated risk factors would enable the develop early intervention strategies. Methods Independence trajectory analysis was performed on patients identified in the Unité de Prévention de Suivi et d’Analyse du Vieillissement (UPSAV) database. UPSAV cohort is a prospective observational study. Participants were 221 community-dwelling persons aged ≥75 years followed for 24 months between July 2011–November 2013 and benefits from a prevention strategy. Data were collected prospectively using a questionnaire. Independence was assessed using the “Functional Autonomy Measurement System (Système de Mesure de l’Autonomie Fonctionnelle (SMAF))”. Group-based trajectory modeling (GBTM) was performed to identify independence trajectories, and the results were compared with those of k-means and hierarchical ascending classifications. A multinomial logistic regression was performed to identify predictive factors of the independence trajectory. Results Three distinct trajectories of independence were identified including a “Stable functional autonomy (SFA) trajectory” (53% of patients), a “Stable then decline functional autonomy decline (SDFA) trajectory” (33% of patients) and a “Constantly functional autonomy decline (CFAD) trajectory” (14% of patients). Not being a member of an association, and previous fall were significantly associated of a SDFA trajectory (P < 0.01). Absence of financial and human assistance, no hobbies, and cognitive disorder were significantly associated with a CFAD trajectory (P < 0.01). Previous occupation and multiple pathologies were predictive factors of both declining trajectories SDFA and CFAD. Conclusions Community-living older persons exhibit distinct independence trajectories and the predictive factors. The evidence from this study suggests that the prevention and screening for the loss of independence of the older adults should be anticipated to maintaining autonomy.

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