Diabetes Prevalence Among Underserved Older Adults in the US: The Case of Native Hawaiians and Pacific Islanders

Abstract The effects of chronic diabetes among older adults in the United States represent ongoing challenges in diagnosis, treatment, comorbidities, amputations, and the increased risk of death. These challenges are made more complicated among underserved populations due to limited access to healthcare, medication costs, and later diagnosis of the condition. These issues are particularly true for the NHPI population, which has high rates of lifetime diabetes, greater levels of poverty, and inadequate health insurance. Useful statistics about diabetes among the NHPI have been difficult to obtain due to their small population size and lack of inclusion in federal health surveys. While early work by Panapasa examined prevalence among NHPI males in California, no reliable measures of diabetes among older NHPI’s existed at the national level. Released in 2017, the 2014 Native Hawaiian Pacific Islander National Health Interview Survey represents the first representative survey of the health and socio-economic correlates for this population, allowing the examination of health conditions such as diabetes at the national level. This presentation will examine the prevalence of diabetes among NHPI’s aged 60 and older and the impacts of this disease on overall health and quality of life. The paper will use the NHPI-NHIS to examine the use and access to diabetic medications and overall access to affordable health care. The paper will examine differences by age group, gender, immigration status, and ethnicity. While we know the overall prevalence of diabetes is high, this paper will offer new information on differentials within the older NHPI population.

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Older Adults in the United States and COVID-19: A Qualitative Study of Perceptions, Finances, Coping, and Emotions

Frontiers in Public Health ◽

10.3389/fpubh.2021.660536 ◽

2021 ◽

Vol 9 ◽

Author(s):

R. Turner Goins ◽

Elizabeth Anderson ◽

Hannah Minick ◽

Heather Daniels

Keyword(s):

Mental Health ◽

United States ◽

Older Adults ◽

News Media ◽

Emotional Health ◽

The United States ◽

Stress Appraisal ◽

Risk Of Death ◽

Increased Risk ◽

Precautionary Measures

Introduction: Older adults have the poorest coronavirus (COVID-19) prognosis with the highest risk of death due to complications, making their COVID-19 experiences particularly important. Guided by the stress-appraisal-coping theoretical model, we sought to understand COVID-related perceptions and behaviors of older adults residing in the United States.Materials and Methods: We used convenience sampling to recruit persons with the following inclusion criteria: Aged ≥ 65 years, English fluency, and U.S. residency. Semi structured in-depth interviews were conducted remotely and audio recorded between April 25, 2020 and May 7, 2020. Interviews were professionally transcribed with a final study sample of 43. A low-inference qualitative descriptive design was used to provide a situated understanding of participants' life experiences using their naturalistic expressions.Results: The mean age of participants was 72.4 ± 6.7. Slightly over half were female (55.8%), 90.6% were White, and 18.6% lived alone. The largest percentages of participants resided in a rural area (27.9%) or small city (25.6%). We identified four themes, including (1) risk perception, (2) financial impact, (3) coping, and (4) emotions. Most participants were aware of their greater risk for poor COVID-19 outcomes but many did not believe in their increased risk. Financial circumstances because of the pandemic varied with largely no financial impacts, while others reported negative impacts and a few reported positive impacts. Coping was problem- and emotion-focused. Problem-focused coping included precautionary efforts and emotion-focused coping included creating daily structure, pursuing new and/or creative activities, connecting with others in new ways, and minimizing news media exposure. Overall, emotional health was negatively affected by the pandemic although some participants reported positive emotional experiences.Conclusions: Perceiving themselves as high risk for COVID-19 complications, older adults used precautionary measures to protect themselves from contracting the virus. The precautionary measures included social isolation, which can negatively affect mental health. Older adults will need to be resourceful and draw on existing resources to cope, such as engaging in creative activities and new strategies to connect with others. Our findings underscore the importance of the preservation of mental health during extended periods of isolation by taking advantage of low-to-no-cost existing resources.

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Biopsychosocial Patterning of Multimorbidity and Its Consequences

The Oxford Handbook of Integrative Health Science ◽

10.1093/oxfordhb/9780190676384.013.14 ◽

2018 ◽

pp. 220-236

Author(s):

Elliot Friedman ◽

Beth LeBreton ◽

Lindsay Fuzzell ◽

Elizabeth Wehrpsann

Keyword(s):

Quality Of Life ◽

Older Adults ◽

Functional Outcomes ◽

The United States ◽

Chronic Medical Conditions ◽

Quality Of Life Research ◽

Increased Risk ◽

Over Time

By many estimates the majority of adults over age 65 have two or more chronic medical conditions (multimorbidity) and are consequently at increased risk of adverse functional outcomes. Nonetheless, many older adults with multimorbidity are able to maintain high levels of function and retain good quality of life. Research presented here is designed to understand the influences that help ensure better functional outcomes in these older adults. This chapter presents findings that draw on data from the Midlife in the United States study. The independent and interactive contributions of diverse factors to multimorbidity and changes in multimorbidity over time are reviewed. The degree that multimorbidity increases risk of cognitive impairment and disability is examined. The role of inflammation as a mediator is considered. Multimorbidity is increasingly the norm for older adults, so better understanding of factors contributing to variability in multimorbidity-related outcomes can lead to improved quality of life.

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Retirement Without God: Activism and Community Among Secular People Over 60

Innovation in Aging ◽

10.1093/geroni/igaa057.1426 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 441-441

Author(s):

Joseph Blankholm

Keyword(s):

United States ◽

Older Adults ◽

Social Movement ◽

Generational Differences ◽

Crucial Role ◽

National Level ◽

The United States ◽

Ethnographic Research ◽

Vast Literature

Abstract There are more than 1,400 nonbeliever communities in the United States and well over a dozen organizations that advocate for secular people on the national level. Together, these local and national groups comprise a social movement that includes atheists, agnostics, humanists, freethinkers, and other kinds of nonbelievers. Despite the fact that retired people over 60 dedicate most of the money and energy needed to run these groups, the increasingly vast literature on secular people and secularism has paid them almost no attention. Relying on more than one hundred interviews (including dozens with people over 60), several years of ethnographic research, and a survey of organized nonbelievers, this paper demonstrates the crucial role that people over 60 play in the American secular movement today. It also considers the reasons older adults are so important to these groups, the challenges they face in trying to recruit younger members and combat stereotypes about aging leadership, and generational differences that structure how various types of nonbeliever groups look and feel. This paper reframes scholarly understandings of very secular Americans by focusing on people over 60 and charts a new path in secular studies.

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Higher sRAGE Levels Predict Mortality in Frail Older Adults with Cardiovascular Disease

Gerontology ◽

10.1159/000512287 ◽

2021 ◽

pp. 1-9

Author(s):

Lee Butcher ◽

Jose Antonio Carnicero ◽

Karine Pérès ◽

Marco Colpo ◽

David Gomez Cabrero ◽

...

Keyword(s):

Older Adults ◽

Cox Regression ◽

Population Based ◽

Blood Levels ◽

Roc Curve Analysis ◽

Baseline Serum ◽

Frailty Status ◽

Risk Of Death ◽

Survival Difference ◽

Increased Risk

Introduction: The evidence that blood levels of the soluble receptor for advanced glycation end products (sRAGE) predict mortality in people with cardiovascular diseases (CVD) is inconsistent. To clarify this matter, we investigated if frailty status influences this association. Methods: We analysed data of 1,016 individuals (median age, 75 years) from 3 population-based European cohorts, enrolled in the FRAILOMIC project. Participants were stratified by history of CVD and frailty status. Mortality was recorded during 8 years of follow-up. Results: In adjusted Cox regression models, baseline serum sRAGE was positively associated with an increased risk of mortality in participants with CVD (HR 1.64, 95% CI 1.09–2.49, p = 0.019) but not in non-CVD. Within the CVD group, the risk of death was markedly enhanced in the frail subgroup (CVD-F, HR 1.97, 95% CI 1.18–3.29, p = 0.009), compared to the non-frail subgroup (CVD-NF, HR 1.50, 95% CI 0.71–3.15, p = 0.287). Kaplan-Meier analysis showed that the median survival time of CVD-F with high sRAGE (>1,554 pg/mL) was 2.9 years shorter than that of CVD-F with low sRAGE, whereas no survival difference was seen for CVD-NF. Area under the ROC curve analysis demonstrated that for CVD-F, addition of sRAGE to the prediction model increased its prognostic value. Conclusions: Frailty status influences the relationship between sRAGE and mortality in older adults with CVD. sRAGE could be used as a prognostic marker of mortality for these individuals, particularly if they are also frail.

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Mortality in traffic accidents with older adults in Colombia

Revista de Saúde Pública ◽

10.1590/s1518-8787.2017051006405 ◽

2017 ◽

Vol 51 (0) ◽

Cited By ~ 2

Author(s):

Angela Maria Segura Cardona ◽

Doris Cardona Arango ◽

Dedsy Yajaira Berbesí Fernández ◽

Alejandra Agudelo Martínez

Keyword(s):

Older Adults ◽

Traffic Accident ◽

Traffic Accidents ◽

Adult Population ◽

Years Of Life Lost ◽

Distribution Profile ◽

Safety Measures ◽

Risk Of Death ◽

Increased Risk ◽

Age Range

ABSTRACT OBJECTIVE To analyze the traffic accident mortality in the Colombian older adults during the 1998-2012 period and show the loss of productive years and mortality from this cause. METHODS Quantitative study of the trend analysis of deaths in Colombia in traffic accidents, from 1998 to 2012, according to death records and population projected by the Colombian National Administrative Department of Statistics. Frequency distribution profile of the deceased, death rates per hundred thousand inhabitants, potential years of life lost and calculation of excess mortality by age in the over 60 were made. RESULTS In the study period 100,758 deaths occurred in traffic accidents, 6,717 annual average, of which 18.5% occurred in people aged 60 years and over. The predominated deaths were men; the risk of dying was 32.15 per hundred thousand people in this age range, with double risk of dying those under 60 years. CONCLUSIONS The young population has a higher proportion of deaths, but those over 60 years are at increased risk of death, leading to the need to turn our gaze to the improvement of road infrastructure and standards, to educate the population in self-care and compliance with safety measures and prepare society for an ever more adult population, more numerous and more prone to take risks.

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The Prevalence of Frailty in Cancer Patients and Mortality Prediction With a Novel Frailty Index Based Clinical Algorithm-A Multicenter, Prospective, Observational Study

10.21203/rs.3.rs-34820/v1 ◽

2020 ◽

Author(s):

Xi Jin ◽

Yue Ren ◽

Li Shao ◽

Zengqing Guo ◽

Chang Wang ◽

...

Keyword(s):

Cancer Patients ◽

Frailty Index ◽

National Level ◽

Laboratory Data ◽

Mortality Prediction ◽

Prediction Algorithm ◽

Tumor Type ◽

Risk Of Death ◽

Increased Risk ◽

Chinese Cancer Patients

Abstract Purpose To investigate the prediction capacity and status of frailty in Chinese cancer patients in national level, through establishing a novel prediction algorithm. Methods The percentage of frailty in different ages, provinces and tumor type groups of Chinese cancer patients were revealed. The predictioncapacity of frailty on mortality of Chinese cancer patients was analyzed by FI-LAB that is composed of routine laboratory data from accessible blood test and calculated as the ratio of abnormal factors in 22 variables. Establishment of a novel algorithm MCP(mortality of cancer patients)to predict the five-year mortality in Chinese cancer patients was accomplished and its prediction capacity was tested in the training and validation sets using ROC analysis. ResultsWe found that the increased risk of death in cancer patients can be successfully identified through FI-LAB. The univariable and multivariable Cox regression were used to evaluate the effect of frailty on death. In the 5-year follow-up, 20.6% of the 2959 participants (age = 55.8 ± 11.7 years; 43.5% female) were dead while the mean FI-LAB score in baseline was 0.23 (standard deviation = 0.13; range = 0 to 0.73).Frailty (after adjusting for gender, age, and other confounders) could be directly correlated with increased risk of death, with a hazard ratio of 12.67 (95% confidence interval CI: 7.19, 22.31) in comparison with those without frailty. In addition, MCP algorithm presented an area under the ROC (AUC) of 0.691 (95% CI: 0.659-0.684) and 0.648 (95% CI: 0.613-0.684) in the training and validation set, respectively. Conclusion Frailty is common in cancer patients and FI-LAB has high prediction capacity on mortality. The MCP algorithm is a good supplement for frailty evaluation and mortality prediction in cancer patients.

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Concomitant Use of Gabapentinoids with Opioids Is Associated with Increased Mortality and Morbidity among Dialysis Patients

American Journal of Nephrology ◽

10.1159/000507725 ◽

2020 ◽

Vol 51 (6) ◽

pp. 424-432 ◽

Cited By ~ 1

Author(s):

Salina P. Waddy ◽

Adan Z. Becerra ◽

Julia B. Ward ◽

Kevin E. Chan ◽

Chyng-Wen Fwu ◽

...

Keyword(s):

The United States ◽

Future Research ◽

Dialysis Patients ◽

Mortality And Morbidity ◽

Medication Prescription ◽

Risk Of Death ◽

Increased Risk ◽

Stage Renal Disease ◽

End Stage ◽

Dialysis Discontinuation

Background: The opioid epidemic is a public health emergency and appropriate medication prescription for pain remains challenging. Physicians have increasingly prescribed gabapentinoids for pain despite limited evidence supporting their use. We determined the prevalence of concomitant gabapentinoid and opioid prescriptions and evaluated their associations with outcomes among dialysis patients. Methods: We used the United States Renal Data System to identify patients treated with dialysis with Part A, B, and D coverage for all of 2010. Patients were grouped into 4 categories of drugs exposure status in 2010: (1) no prescriptions of either an opioid or gabapentinoid, (2) ≥1 prescription of an opioid and no prescriptions of gabapentinoids, (3) no prescriptions of an opioid and ≥1 prescription of gabapenbtinoids, (4) ≥1 prescription of both an opioid and gabapentinoid. Outcomes included 2-year all-cause death, dialysis discontinuation, and hospitalizations assessed in 2011 and 2012. Results: The study population included 153,758 dialysis patients. Concomitant prescription of an opioid and gabapentin (15%) was more common than concomitant prescription of an opioid and pregabalin (4%). In adjusted analyses, concomitant prescription of an opioid and gabapentin compared to no prescription of either was associated with increased risk of death (hazard ratio [HR] 1.16, 95% CI 1.12–1.19), dialysis discontinuation (HR 1.14, 95% CI 1.03–1.27), and hospitalization (HR 1.33, 95% CI 1.31–1.36). Concomitant prescription of an opioid and pregabalin compared to no prescription of either was associated with increased mortality (HR 1.22, 95% CI 1.16–1.28) and hospitalization (HR 1.37, 95% CI 1.33–1.41), but not dialysis discontinuation (HR 1.13, 95% CI 0.95–1.35). Prescription of opioids and gabepentinoids compared to only being prescribed opioids was associated with higher risk of hospitalizations, but not mortality, or dialysis discontinuation. Conclusions: Concomitant prescription of opioids and gabapentinoids among US dialysis patients is common, and both drugs have independent effects on outcomes. Future research should prospectively investigate the potential harms of such drugs and identify safer alternatives for treatment of pain in end-stage renal disease patients.

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Opioid Use and the Risk of Falls, Fall Injuries and Fractures among Older Adults: A Systematic Review and Meta-Analysis

The Journals of Gerontology Series A ◽

10.1093/gerona/glaa038 ◽

2020 ◽

Vol 75 (10) ◽

pp. 1989-1995 ◽

Cited By ~ 3

Author(s):

Aya Yoshikawa ◽

Gilbert Ramirez ◽

Matthew Lee Smith ◽

Margaret Foster ◽

Anas K Nabil ◽

...

Keyword(s):

Older Adults ◽

Meta Analysis ◽

Effect Sizes ◽

Opioid Use ◽

Fall Injuries ◽

Risk Of Death ◽

Management Interventions ◽

Risk Estimates ◽

Increased Risk ◽

Risk Of Falls

Abstract Background There is increasing concern about opioid use as a pain treatment option among older adults. Existing literature implies an association between opioid use and fracture, increasing the risk of death and disabilities; yet, this relationship with other fall-related outcomes has not been fully explored. We performed a meta-analysis to evaluate the associations between opioid use and adverse health outcomes of falls, fall injuries, and fractures among older adults. Methods A systematic literature search was conducted using nine databases: Medline, Embase, CINAHL, PsycInfo, Global Health, Northern Light Sciences Conference Abstracts, Cochrane CENTRAL, WHO International Clinical Trials Registry Platform, and ClinicalTrials.gov. We log-transformed effect sizes (relative risk [RR], odds ratio [OR], and hazard ratio [HR]) to compute pooled risk estimates comparable across the studies. The random-effects model was applied to calculate the pooled risk estimates due to heterogeneity. Meta-regressions explored differences in risk estimates by analysis method, study design, setting, and study quality. Results Thirty studies, providing 34 relevant effect sizes, met the inclusion criteria for this meta-analysis. Overall, opioid use was significantly associated with falls, fall injuries, and fractures, with effect sizes ranging from 0.15 to 0.71. In meta-regressions, no selected factors explained heterogeneity. Conclusion While heterogeneity is present, results suggest an increased risk of falls, fall injuries, and fractures among older adults who used opioids. Findings highlight the need for opioid education and nonopioid-related pain management interventions among older adults to decrease fall-related risk.

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THE EFFECTS OF FRAILTY, POLYPHARMACY, AND COGNITION ON HEALTH OUTCOMES: A STUDY ON INTERRAI RESIDENTIAL CARE DATA

Innovation in Aging ◽

10.1093/geroni/igz038.330 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S86-S86

Author(s):

Macy Zou ◽

Ronald Kelly ◽

Betty Chinda ◽

Mckenzie Braley ◽

Tony Zhang ◽

...

Keyword(s):

Older Adults ◽

Health Outcomes ◽

Residential Care ◽

Frailty Index ◽

Interactive Effects ◽

Deficit Accumulation ◽

Emergency Visits ◽

Ongoing Research ◽

Risk Of Death ◽

Increased Risk

Abstract Frailty Index (FI), polypharmacy and cognition status are significant health concerns in older adults. We conducted this study to investigate the interplay of frailty, polypharmacy, and cognition, in determining health outcomes. InterRAI Residential Care (RAI-RC MDS2.0) data were retrieved from residential care homes in Surrey, BC, Canada. Older residents (65+ years) who had RAI-RC records between 2016 and 2018 were used in the analysis (n=976). A deficit accumulation-based FI was generated using 36 variables. Information on polypharmacy and cognition were obtained by accounting the total number of medications and the cognitive performance scale. Information on falls, emergency visits, and mortality were followed. Multivariate Cox proportional hazard models were used to examine the effects of these variables on different outcomes. The FI showed a near Gaussian distribution (median= 0.370 mean= 0.372 SD= 0.143), and increased linearly with age on a logarithm scale (R=0.75, p<0.001). Residents with cognitive impairment showed a higher level of the FI (KW= 863.3, p<0.001). A higher FI was associated with an increased risk of death (HR=15.2 p=0.006) and emergency visits (HR=2.72 p=0.048), adjusting for age, sex, medications, and education levels. Frailty, polypharmacy, and cognition levels are associated and have interactive effects on health outcomes. Ongoing research is to validate the findings with large samples in different health settings, and to understand the underlying processes of the effect. The close relationships between frailty, polypharmacy, and cognition with health outcomes call for effective integrated strategies for healthcare of older adults with multiple complex health problems.

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370. Comparing Trends and Outcomes among HIV-Infected vs. HIV Uninfected Patients with Tuberculosis: A 5-Year Experience Within the Florida Department of Health in Hillsborough County

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.443 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S194-S194

Author(s):

Shylah M Moore-Pardo ◽

Anteneh Addisu ◽

Tea Reljic ◽

Sadaf Aslam ◽

Beata Casanas

Keyword(s):

United States ◽

The United States ◽

Homeless Persons ◽

Sputum Smear ◽

Foreign Born ◽

Female Ratio ◽

Risk Of Death ◽

Increased Risk ◽

The Difference ◽

Hiv Negative

Abstract Background Although the rate of tuberculosis (TB) has significantly declined in the United States, elimination has plateaued. Florida is one of the states with the greatest number of cases. The majority of cases occur in foreign-born individuals. Human immunodeficiency virus (HIV) is also a major contributor. HIV-TB coinfection leads to reciprocal interactions with significant clinical impact. We aim to compare the risk factors, clinical findings, and outcomes among HIV-infected vs. HIV uninfected patients. Methods A retrospective cohort study of TB cases over a 5 year period (2012–2017) was conducted. All patients with HIV co-infection with age- and gender-matched HIV negative controls were included. The diagnosis of TB was made via clinical, microbiological, radiological, and/or PCR based methods. SPSS was used for statistical data analysis. Results A total of 411 TB cases were identified and 66 patients (33 HIV-infected plus 33 HIV un-infected) were eligible for inclusion. The median age was 49 years (range 22–70). The male to female ratio was 21:12 and 50% of patients had TB symptoms; the rest had abnormal imaging or lab finding. Cases were confirmed via positive sputum smear, culture, or PCR (Figures 1–3). Only 11 patients were lost to follow-up, thus 83.3% completed therapy. A total of 5 persons died (Table 1). Conclusion The rate of HIV-TB coinfection in the United States was 5.3% in 2018; higher among injection drugs users, homeless persons, inmates, and alcoholics. In our study, the rate of HIV-TB coinfection was slightly higher (8%). The difference was not statistically significant in regards to foreign born, homelessness, and incarceration. Only 3 patients admitted to injection drug use and 9 used alcohol (all HIV negative). Traditionally, HIV-TB coinfected patients have extra-pulmonary TB with higher rates of negative sputum and are at increased risk of death. In our cohort, the difference was statistically significant (P = 0.009) only for cavitary TB (predominated in HIV un-infected) but no difference in outcomes was observed between the two groups. These findings suggest changing trends in HIV-TB coinfection which may be partly related to our setting and demographics but may be attributed to better access to care and antiretroviral therapy at large. Disclosures All authors: No reported disclosures.

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