Cognitive Impairment Trends Among Older Adults in a Medicaid Home and Community-Based Service Program

Abstract Cognitive impairment (CI) is an important risk factor for nursing home admission, but little is known about CI among older adults in Medicaid HCBS programs. Racial and ethnic group CI disparities are found among community-dwelling older adults, but these CI trends have not been explored in Medicaid HCBS populations. In this study, we determined how CI is associated with older adults’ racial and ethnic group identification and educational attainment in Connecticut’s Medicaid HCBS program. The study cohort includes program enrollees age >65 during January-March 2019 (N=3,520). CI measures include: Cognitive Performance Scale (CPS), ranging from 0-8 (cognitively intact to very severe impairment); and a dichotomous measure incorporating Alzheimer’s disease or other dementia diagnosis (ADRD) and CPS score signifying moderate or severe CI. Study cohort characteristics: 75.7% female; age, mean(sd)=79.1(8.2); Non-Hispanic White=47.8%; Non-Hispanic Black=15.9%; Non-Hispanic Other=2.7%; Hispanic=33.6%; HS education=21.7%; mean(sd) CPS score=2.7(1.9); 36.1% with ADRD/high CPS2 score. In multivariate regression models adjusting for age and sex, CPS scores were not independently associated with race and ethnicity, and the likelihood of having ADRD/high CPS scores did not differ by race and ethnicity (all p-values >0.05). In these same models, persons with more than high school education had significantly lower CPS scores (b=-.12; p<.001), and significantly lower likelihood of having ADRD/high CPS scores (AOR=0.61; p<.001), than persons with less than high school education. We conclude that educational level is independently associated with CI, but race and ethnicity are not in this cohort. Policy and practice implications will be discussed.

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eHealth Literacy and Caregiver Burden Among Chinese Caregivers of Older Adults With Cognitive Impairment: Does Education Matter?

Journal of Applied Gerontology ◽

10.1177/0733464820957151 ◽

2020 ◽

pp. 073346482095715

Author(s):

Kaipeng Wang ◽

Xiang Gao ◽

Fei Sun ◽

Nicholas J. Bishop

Keyword(s):

High School ◽

Older Adults ◽

Cognitive Impairment ◽

Caregiver Burden ◽

Literacy Education ◽

School Education ◽

High School Education ◽

Care Recipient ◽

Ehealth Literacy ◽

Chinese Caregivers

eHealth literacy is a critical factor that influences caregivers’ well-being. The purpose of this study is to examine the association between eHealth literacy, education, and caregiver burden among Chinese caregivers of older adults with cognitive impairment. Data came from structured interviews with 300 primary family caregiver–care recipient dyads in Wuhan, China. We used logistic regression to examine the association between eHealth literacy, education, and caregiver burden. An interaction effect between eHealth literacy and education on caregiver burden was identified. eHealth literacy was positively associated with caregiver burden among caregivers with less than a high school education, but not among those with a high school education or above. eHealth literacy is salient in the burden experienced by caregivers with low education. eHealth literacy needs to be enhanced with health information verification from health professionals and programs to support caregiving efficacy to realize its positive impact on caregivers’ mental health.

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Residential exposure to natural outdoor environments and general health among older adults in Shanghai, China

International Journal for Equity in Health ◽

10.1186/s12939-019-1081-4 ◽

2019 ◽

Vol 18 (1) ◽

Cited By ~ 6

Author(s):

Baishi Huang ◽

Ye Liu ◽

Zhiqiang Feng ◽

Jamie R. Pearce ◽

Ruoyu Wang ◽

...

Keyword(s):

High School ◽

Older Adults ◽

Elementary School ◽

Junior High School ◽

School Education ◽

High School Education ◽

Green Spaces ◽

Self Rated Health ◽

Outdoor Environments ◽

Non Local

Abstract Background Exposure to natural outdoor environments (NOE) has been shown to be beneficial to older adults’ health and functioning, yet this assertion has rarely been tested in China. We investigated the relationships between exposure to NOE and older adults’ self-rated health in Shanghai, China and examined whether these relationships varied by sex, age, education and hukou status. Method This cross-sectional study used micro-data sample of the 2010 Shanghai population census, including 7962 older adults nested within 3345 neighbourhoods. Self-rated health was the outcome variable. Four NOE exposure indicators were calculated for each neighbourhood: the amount of surrounding greenness/blueness and proximity to large green/blue spaces. Multilevel logistic regression was employed to explore the association between natural outdoor environment exposure and self-rated health, adjusting for individual-level and neighbourhood-level covariates. Stratified analyses were used to examine variations by sex, age, education and hukou status. Results Older adults living in neighbourhoods with higher surrounding greenness and higher proximity to both green spaces and blue spaces were more likely to report good health. Residential surrounding blueness was not significantly related to self-rated health. Females, those aged 60–69 years, those who had elementary school or junior high school education and those with non-local hukou benefit more from residential surrounding greenness, and those aged 70–79 years and who had elementary school or junior high school education benefit more from residential proximity to blue spaces. Conclusions Higher residential greenness and proximity to both green spaces and blue spaces were associated with better self-rated health, particularly for females, younger older adults, the low educated and non-local hukou holders. Our findings suggest that urban green spaces and urban blue spaces have different effects on health among Chinese older adults and that the assessment of exposure matters to the investigation of NOE-health relationships.

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Association between serum zinc levels and basic physical functioning: secondary data analysis of NHANES 2011–14

BMC Nutrition ◽

10.1186/s40795-021-00461-z ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Jen-Tzer Gau ◽

Bhakti Chavan ◽

Yang Li ◽

Brian C. Clark ◽

Zelalem T. Haile

Keyword(s):

High School ◽

Older Adults ◽

Physical Functioning ◽

Serum Zinc ◽

High Serum ◽

School Education ◽

High School Education ◽

Cross Sectional ◽

Serum Zn ◽

Low Serum

Abstract Background Serum zinc (Zn) levels have been shown to be associated with functional status; however, it is not clear whether this association differs by other sociodemographic characteristics. We examined the association between serum Zn levels and physical functioning difficulty in a representative sample of older adults in the US. Design and methods A cross-sectional study was conducted on participants 50 years and older from the 2011–12 and 2013–14 National Health and Nutrition Examination Surveys (n = 1136). Serum Zn levels were analyzed as tertiles. The main outcome of interest was physical functioning difficulty, defined as self-reported difficulty of basic physical functioning that included walking, transferring, dressing, and feeding. Results Mean Zn levels (SE) were 0.67(0.1), 0.81(0.1), and 0.98(0.1) μg/mL in the low, middle, and high Zn groups, respectively. Approximately 24.9% participants reported physical functioning difficulty. In the multivariable model, we found a significant multiplicative interaction between sex and serum Zn (P for interaction =0.028) and between education and serum Zn (P for interaction = 0.001) on basic physical functioning difficulty. The stratified analysis revealed that among men, compared to those with low serum Zn, the odds of having physical functioning difficulty were lower in men who had high serum Zn [aOR 0.43 (95% CI: 0.25–0.76)]. For women, compared to those with low serum Zn the odds of having physical functioning difficulty were higher in women who had middle serum Zn [aOR 2.67 (1.58–4.50)]. Among individuals with less than high school education, the odds of having physical functioning difficulty were lower in those who had middle serum Zn compared to those who had low serum Zn [aOR 0.48 (0.26–0.89)]. However, the odds of having physical functioning difficulty were higher in those who had middle serum Zn compared to those who had low serum Zn for individuals with high school [aOR 5.72 (1.92–17.00)] and beyond high school education [aOR 1.77 (1.05–2.97)], respectively. Conclusion Sex and educational attainment interact with serum Zn levels to influence basic physical functioning difficulty in older adults.

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Life Course Socioeconomic Disadvantage and the Aging Immune System: Findings From the Health and Retirement Study

The Journals of Gerontology Series B ◽

10.1093/geronb/gbaa144 ◽

2020 ◽

Author(s):

Grace A Noppert ◽

Rebecca C Stebbins ◽

Jennifer B Dowd ◽

Robert A Hummer ◽

Allison E Aiello

Keyword(s):

High School ◽

Older Adults ◽

Life Course ◽

Early Life ◽

Parental Education ◽

Socioeconomic Disadvantage ◽

School Education ◽

High School Education ◽

Health And Retirement Study ◽

Retirement Study

Abstract Objectives Previous research has documented a consistent association between current socioeconomic status (SES) and cytomegalovirus (CMV). Early life is likely a critical period for CMV exposure and immune development, but less is known about early-life socioeconomic factors and CMV, particularly in older age populations. Using data from the Health and Retirement Study, we investigated the association between life course socioeconomic disadvantage and immune response to CMV among older adults. Methods Using ordered logit models, we estimated associations between several measures of socioeconomic disadvantage and the odds of being in a higher CMV Immunoglobulin G (IgG) response category in a sample of 8,168 respondents aged older than 50 years. Results We found a significant association between educational attainment and CMV IgG response. Those with less than a high school education had 2.00 (95% confidence interval [CI]: 1.67–2.40) times the odds of being in a higher CMV category compared to those with a college degree or greater. In addition, we also observed a significant association with parental education and CMV response. Individuals with parents having 8 years or less of schooling had 2.32 (95% CI: 2.00–2.70) times the odds of higher CMV response compared to those whose parents had greater than high school education. Discussion CMV IgG levels in older adults are associated with both early-life and adult SES. Life course socioeconomic disadvantage may contribute to disparities in immunological aging.

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Do social inequalities in smoking differ by immigration status in young adults?

European Journal of Public Health ◽

10.1093/eurpub/ckaa165.831 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

J Kalubi ◽

Z Tchouaga ◽

A Ghenadenik ◽

J O'Loughlin ◽

K L Frohlich

Keyword(s):

High School ◽

Young Adults ◽

Vocational Training ◽

Social Inequalities ◽

Preventive Intervention ◽

School Education ◽

High School Education ◽

Social Gradient ◽

Current Smoking ◽

The Difference

Abstract Background Tobacco use accounts for half the difference in life expectancy across groups of low and high socioeconomic status. The objective was to assess whether social inequalities in smoking in Canada-born young adults are also apparent among same-age immigrants, a group often viewed as disadvantaged and vulnerable to multiple health issues. Methods Data were drawn from the Interdisciplinary Study of Inequalities in Smoking, a longitudinal investigation of social inequalities in smoking in Montreal, Canada. The sample included 2,077 young adults age 18-25 (56.6% female; 18.9% immigrants). Immigrants had been in Canada 11.6 (SD 6.4) years on average. The association between level of education and current smoking was examined separately in immigrants and non-immigrants in multivariate logistic regression analyses controlling for covariates. Results Twenty percent of immigrants were current smokers compared to 24% of non-immigrants. In immigrants, relative to those who were university-educated, the adjusted odds ratio (OR) (95% confidence interval) for current smoking was 1.2 (0.6, 2.3) among those with pre-university or vocational training, and 1.5 (0.7, 2.9) among those with high school education only. In non-immigrants, the adjusted ORs were 1.9 (1.4, 2.5) among those with pre-university or vocational training and 4.0 (2.9, 5.5) among those with high school education. Conclusions Despite a mean of over 10 years in Canada, young adults who immigrated to Canada did not manifest the strong social gradient in smoking apparent in non-immigrants. Identification of factors that protect immigrants from manifesting marked social inequalities in smoking could inform the development of smoking preventive intervention sensitive to social inequalities in smoking. Key messages A social gradient in smoking apparent in Canada-born young adults was not observed in same-age immigrants. Factors that protect immigrants against social inequalities in smoking should be identified.

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Impact of Race and Socioeconomics Disparities on Survival in Young-Onset Colorectal Adenocarcinoma—A SEER Registry Analysis

Cancers ◽

10.3390/cancers13133262 ◽

2021 ◽

Vol 13 (13) ◽

pp. 3262

Author(s):

Mark M. Aloysius ◽

Hemant Goyal ◽

Niraj J. Shah ◽

Kumar Pallav ◽

Nimy John ◽

...

Keyword(s):

High School ◽

Marital Status ◽

Colorectal Adenocarcinoma ◽

Private Insurance ◽

School Education ◽

Cox Proportional Hazards Model ◽

High School Education ◽

Cancer Specific Survival ◽

Young Onset ◽

The Impact

Introduction: We aimed to assess the impact of socio-economic determinants of health (SEDH) on survival disparities within and between the ethnic groups of young-onset (<50 years age) colorectal adenocarcinoma patients. Patients and Methods: Surveillance, epidemiology, and end results (SEER) registry was used to identify colorectal adenocarcinoma patients aged between 25–49 years from 2012 and 2016. Survival analysis was performed using the Kaplan–Meir method. Cox proportional hazards model was used to determine the hazard effect of SEDH. American community survey (ACS) data 2012–2016 were used to analyze the impact of high school education, immigration status, poverty, household income, employment, marital status, and insurance type. Results: A total of 17,145 young-onset colorectal adenocarcinoma patients were studied. Hispanic (H) = 2874, Non-Hispanic American Indian/Alaskan Native (NHAIAN) = 164, Non-Hispanic Asian Pacific Islander (NHAPI) = 1676, Non-Hispanic black (NHB) = 2305, Non-Hispanic white (NHW) = 10,126. Overall cancer-specific survival was, at 5 years, 69 m. NHB (65.58 m) and NHAIAN (65.67 m) experienced worse survival compared with NHW (70.11 m), NHAPI (68.7), and H (68.31). High school education conferred improved cancer-specific survival significantly with NHAPI, NHB, and NHW but not with H and NHAIAN. Poverty lowered and high school education improved cancer-specific survival (CSS) in NHB, NHW, and NHAPI. Unemployment was associated with lowered CSS in H and NAPI. Lower income below the median negatively impacted survival among H, NHAPI NHB, and NHW. Recent immigration within the last 12 months lowered CSS survival in NHW. Commercial health insurance compared with government insurance conferred improved CSS in all groups. Conclusions: Survival disparities were found among all races with young-onset colorectal adenocarcinoma. The pattern of SEDH influencing survival was unique to each race. Overall higher income levels, high school education, private insurance, and marital status appeared to be independent factors conferring favorable survival found on multivariate analysis.

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