Multimorbidity among Diverse Communities in New England: Findings from the Healthy Aging Data Reports

Abstract The risk for multimorbidity increases with age. Community burden of comorbidities in New England (NE) was assessed by comparing state and community rates of two measures (having no comorbidities and having 4 or more) among Medicare beneficiaries age 65+ in CT, MA, NH, and RI. Data sources were the Medicare Current Beneficiary Summary File (2014-2017) and the American Community Survey (2014-2018). Small area estimation techniques were used to calculate age-sex adjusted community rates. Multimorbidity was measured as people with zero or with 4 or more of the following chronic conditions: Alzheimer’s disease, asthma, atrial fibrillation, cancer (breast, colorectal, lung, and prostate), kidney disease, COPD, depression, diabetes, congestive heart failure, hypertension, hyperlipidemia, ischemic heart disease, osteoporosis, arthritis, and stroke. Rates for 4+ conditions: RI 63.8% (45.76-70.69%), CT 61.8% (47.82-70.05%), MA 60.7% (40-74.96%), NH 54.4% (36.67-62.99%). Results were mapped, showing the statewide and regional distribution of rates. Rates were much higher for having 4+ chronic conditions than not having any comorbidities. RI had the highest rates of 4+ and in MA the highest chronic disease rates were found in lower socioeconomic communities. CT has the highest number of diverse older residents and dual-eligible beneficiaries for Medicare and Medicaid in NE. The rates show late-life health disparities that have implications for independent living, quality of life, and mortality suggesting the need for policies to provide equitable access to care and resources to disadvantaged NE communities.

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User-Centered Design Enhances Usability of an mHealth System for Users with Dexterity Impairments (Preprint)

10.2196/preprints.23794 ◽

2020 ◽

Author(s):

Kuntal Chowdhary ◽

Daihua Xie Yu ◽

Gede Pramana ◽

Andrea Fairman ◽

Brad Edward Dicianno ◽

...

Keyword(s):

User Interface ◽

Mobile Health ◽

Chronic Conditions ◽

Independent Living ◽

Health Interventions ◽

Self Management ◽

User Centered Design ◽

Entire Study ◽

Efficiency And Effectiveness ◽

User Centered

BACKGROUND Mobile health (mHealth) systems have been shown to be useful in supporting self-management by promoting adherence to schedules and longitudinal health interventions, especially in people with disabilities (PwD). The Interactive Mobile Health and Rehabilitation (iMHere) System was developed to empower PwD and those with chronic conditions with supports needed for self-management and independent living. Since the first iteration of the iMHere 1.0 app, several studies have evaluated accessibility and usability of the system. Potential opportunities to improve and simplify the user interface (UI) were identified, and the iMHere modules were redesigned accordingly. OBJECTIVE The aim of this study was to evaluate the usability of the redesigned modules within iMHere 1.0. METHODS This study evaluated the original and redesigned MyMeds and SkinCare modules. To assess the participants’ dexterity levels, the Purdue Pegboard Test (PPBT) was administered. Participants were then asked to perform a set of tasks using both the original and redesigned MyMeds and SkinCare modules to assess efficiency and effectiveness. Usability was measured using the Telehealth Usability Questionnaire (TUQ) to evaluate 10 new accessibility features that were added to the redesigned app. Participants were also asked which version they preferred. RESULTS Twenty-four participants with disabilities and varied degrees of dexterity impairments completed the entire study protocol. Participants displayed improved efficiency and effectiveness of use when using the redesigned modules, as compared to the original modules. Participants also reported improved usability and preferred the redesigned modules. CONCLUSIONS This study demonstrated that the iMHere System became more efficient, effective, and usable for individuals with dexterity impairments after redesigning it according to user-centered principles.

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Patients’ Perceptions of Integrated Care Among Medicare Beneficiaries by Level of Need for Health Services

Medical Care Research and Review ◽

10.1177/10775587211067897 ◽

2022 ◽

pp. 107755872110678

Author(s):

Nancy Song ◽

Molly Frean ◽

Christian T. Covington ◽

Maike Tietschert ◽

Emilia Ling ◽

...

Keyword(s):

Integrated Care ◽

Health Care Providers ◽

Chronic Conditions ◽

Health Management ◽

Least Square ◽

Sensitivity Analyses ◽

Medicare Beneficiaries ◽

Care Providers ◽

Factors Affecting ◽

Ordinary Least Square Regression

Requirements for integrating care across providers, settings, and over time increase with patients’ needs. Health care providers’ ability to offer care that patients experience as integrated may vary among patients with different levels of need. We explore the variation in patients’ perceptions of integrated care among Medicare beneficiaries based on the beneficiary’s level of need using ordinary least square regression for each of four high-need groups: beneficiaries (a) with complex chronic conditions, (b) with frailties, (c) below 65 with disability, and (d) with any (of the first three) high needs. We control for beneficiary demographics and other factors affecting integrated care, and we conduct sensitivity analyses controlling for multiple individual chronic conditions. We find significant positive associations with level of need for provider support for self-directed care and medication and home health management. Controlling for multiple individual chronic conditions reduces effect sizes and number of significant relationships.

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Quality of life in people living with HIV-associated neurocognitive disorder: A scoping review study

PLoS ONE ◽

10.1371/journal.pone.0251944 ◽

2021 ◽

Vol 16 (5) ◽

pp. e0251944

Author(s):

Kate Alford ◽

Stephanie Daley ◽

Sube Banerjee ◽

Jaime H. Vera

Keyword(s):

Quality Of Life ◽

Cognitive Impairment ◽

Scoping Review ◽

Chronic Conditions ◽

Healthy Aging ◽

Cognitive Disorder ◽

World Health ◽

People Living With Hiv ◽

Living With Hiv

Quality of life (QoL) is recognized as an essential end point in the disease management of chronic conditions such as HIV with calls to include good QoL as a ‘fourth 90’ in the 90-90-90 testing and treatment targets introduced by World Health Organization in 2016. Cognitive impairments impact a broad spectrum of experiences and are a common issue effecting people living with HIV (PLWH). Despite this, few studies have examined QoL in PLWH who also have a cognitive disorder. This study aimed to synthesize and describe what is known about QoL in those living with HIV-associated neurocognitive disorders (HAND). A scoping review of peer-reviewed literature was conducted to identify how QoL has been investigated and measured in PLWH with HAND, and how PLWH with HAND report and describe their QoL. We searched PsychInfo, Medline, Scopus, and Web of Science along with hand-searching reference lists from relevant studies found. Included studies were those published in English after 1st January 2003 which included PLWH with cognitive impairment not due to other pre-existing conditions. Fifteen articles met criteria for inclusion. Two studies measured QoL as a primary aim, with others including QoL assessment as part of a broader battery of outcomes. The MOS-HIV and SF-36 were the most commonly used measures of overall QoL, with findings generally suggestive of poorer overall QoL in PLWH with HAND, compared to PLWH without cognitive impairment. Studies which examined dimensions of QoL focused exclusively on functionality, level of independence, and psychological QoL domains. There is a considerable dearth of research examining QoL in PLWH with HAND. The initiatives which advocate for healthy aging and improved QoL in PLWH must be extended to include and understand the experiences those also living with cognitive impairment. Research is needed to understand the broad experiential impacts of living with these two complex, chronic conditions, to ensure interventions are meaningful to patients and potential benefits are not missed.

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Chinese Herbal Medicine in the Management of Atherosclerosis-Related Chronic Conditions in an Aging Population

Complementary and Alternative Medicine ◽

10.4018/978-1-5225-7039-4.ch028 ◽

2019 ◽

pp. 593-615

Author(s):

Enoch Chan ◽

Sai Wang Seto ◽

Tsoi Ming Au Yeung ◽

Gabriel Hoi Huen Chan

Keyword(s):

Herbal Medicine ◽

Chinese Herbal Medicine ◽

Heart Attack ◽

Chronic Conditions ◽

Chronic Condition ◽

Healthy Aging ◽

The Elderly ◽

Chinese Herbal ◽

Mainstream Healthcare ◽

The Cost

Chronic conditions are important problems for an aging society. They impede on healthy aging and increases the cost of living due to increased medical cost. The most prevalent chronic conditions faced by the elderly population are hypertension, high cholesterol and diabetes mellitus. They increase the risk of developing atherosclerosis, a chronic condition which causes heart attack and stroke. This chapter provides a review on existing therapeutics for the treatment of cardiovascular disease, and briefly discusses their side effects. This chapter also provides a brief introduction to Traditional Chinese Medicine (TCM), and its development in ancient China. This will be followed by a discussion on the recent research on the use of Chinese herbal medicine (CHM) in the treatment of cardiovascular diseases, and the potentials and challenges of incorporating CHM in mainstream healthcare system.

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