Weather-Related Disaster in a Diverse Cohort of Aging Adults

Abstract As climate change contributes to increasing frequency and intensity of weather-related disasters, it is critical to define characteristics that increase risk of poor health outcomes during and after events. Given the aging of the United States (US) population and over-representation of older adults in disaster-prone areas, disaster-related impacts on older adults present a growing public health challenge. We linked data from the REGARDS study, a cohort of 30,107 Black and White adults (mean age 65 years at baseline, 2003-2007), with community data from the National Establishment Time Series database and longitudinal weather-related disaster data from the Spatial Hazard Events and Losses Database for the US. We calculated disaster exposure for each year for the county in which the respondents lived from 2003 – 2015: 84% of county-years showed at least some impacts, including 16% of counties experiencing medium impacts ($10- $50 property damage per capita or 2 fatalities) and 12% severe (greater than $50 per capital or 3 fatalities); this mirrors that of the continental US (77% some impact, 15% medium, 13% severe). REGARDS participants exposed to moderate or severe disasters were more likely to be Black and low socioeconomic status compared to those who were not exposed. For community characteristics, higher disaster exposure was associated with a greater density of resources including ambulatory care, food stores, social services, and destinations for daily living. Our approach showcases how disaster preparedness systems need better data about specific individual-and community-level factors that increase risk among older adults to better serve communities.

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Polypharmacy in Older Adults Hospitalized for Heart Failure

Circulation Heart Failure ◽

10.1161/circheartfailure.120.006977 ◽

2020 ◽

Vol 13 (11) ◽

Cited By ~ 1

Author(s):

Ozan Unlu ◽

Emily B. Levitan ◽

Evgeniya Reshetnyak ◽

Jerard Kneifati-Hayek ◽

Ivan Diaz ◽

...

Keyword(s):

Heart Failure ◽

Older Adults ◽

Racial Differences ◽

The United States ◽

Negative Effects ◽

Real World Data ◽

American Hospital ◽

American Hospital Association ◽

Annual Survey ◽

Regards Study

Background: Despite potential harm that can result from polypharmacy, real-world data on polypharmacy in the setting of heart failure (HF) are limited. We sought to address this knowledge gap by studying older adults hospitalized for HF derived from the REGARDS study (Reasons for Geographic and Racial Differences in Stroke). Methods: We examined 558 older adults aged ≥65 years with adjudicated HF hospitalizations from 380 hospitals across the United States. We collected and examined data from the REGARDS baseline assessment, medical charts from HF-adjudicated hospitalizations, the American Hospital Association annual survey database, and Medicare’s Hospital Compare website. We counted the number of medications taken at hospital admission and discharge; and classified each medication as HF-related, non-HF cardiovascular-related, or noncardiovascular-related. Results: The vast majority of participants (84% at admission and 95% at discharge) took ≥5 medications; and 42% at admission and 55% at discharge took ≥10 medications. The prevalence of taking ≥10 medications (polypharmacy) increased over the study period. As the number of total medications increased, the number of noncardiovascular medications increased more rapidly than the number of HF-related or non-HF cardiovascular medications. Conclusions: Defining polypharmacy as taking ≥10 medications might be more ideal in the HF population as most patients already take ≥5 medications. Polypharmacy is common both at admission and hospital discharge, and its prevalence is rising over time. The majority of medications taken by older adults with HF are noncardiovascular medications. There is a need to develop strategies that can mitigate the negative effects of polypharmacy among older adults with HF.

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Disaster Preparedness Among Older Japanese Adults With Long-Term Care Needs and Their Family Caregivers

Disaster Medicine and Public Health Preparedness ◽

10.1017/dmp.2016.53 ◽

2016 ◽

Vol 11 (1) ◽

pp. 31-38 ◽

Cited By ~ 9

Author(s):

Tomoko Wakui ◽

Emily M. Agree ◽

Tami Saito ◽

Ichiro Kai

Keyword(s):

Older Adults ◽

Family Caregivers ◽

Disaster Preparedness ◽

Long Term Care ◽

Community Support ◽

The United States ◽

Great East Japan Earthquake ◽

Care Needs ◽

Term Care

AbstractObjectiveIn the 2011 Great East Japan Earthquake, as in Hurricanes Katrina and Rita in the United States, older individuals were at the greatest risk of mortality. Much concern has been raised about developing plans to reduce these risks, but little information has been provided about preparedness, and the key role played by caregivers has been largely unexplored. The aims of this study were thus to examine the preparedness of family caregivers of older adults with long-term care needs and to identify the characteristics of older adults and their caregivers that are associated with poor preparedness and greater concern about disasters.MethodsShortly after the Great East Japan Earthquake, the second wave of the Fukui Longitudinal Caregiver Study was administered to the family caregivers of older Japanese individuals with long-term care needs. The sample included 952 caregivers from 17 municipalities in Fukui prefecture. Logistic regression analyses were used to identify the factors associated with self-assessed preparedness, evacuation planning, and caregivers’ concerns about preparedness.ResultsThe majority (75%) of the caregivers had no concrete plans for evacuation in an emergency, and those caring for persons with dementia were 36% less likely to have any plan. In multivariate models, caregivers who were more experienced and wealthier and who reported more family and community support were more likely to feel well prepared. Caregivers with poor health or limited financial resources or who were responsible for older persons with mobility difficulties reported higher levels of anxiety about their disaster preparedness.ConclusionsThis study indicates that most caregivers are ill prepared to respond in emergencies and that caregiver resources, community support, and the needs of older care recipients influence both preparedness and concern about disasters. Education for caregivers and the development of community support programs could provide important sources of assistance to this vulnerable group. (Disaster Med Public Health Preparedness. 2017;11:31–38)

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Examining the role of ageing-in-place organisations in building older adults’ disaster resilience

Ageing and Society ◽

10.1017/s0144686x20000653 ◽

2020 ◽

pp. 1-26

Author(s):

Claire Pendergrast ◽

Basia Belza ◽

Ann Bostrom ◽

Nicole Errett

Keyword(s):

Older Adults ◽

Social Services ◽

Health And Safety ◽

The United States ◽

Local Context ◽

Disaster Resilience ◽

Structured Interviews ◽

Ageing In Place ◽

Building Activities

Abstract Older adults are more susceptible to adverse health outcomes during and after a disaster compared with their younger counterparts. Ageing-in-place organisations such as senior centres and Villages provide social services and programming for older adults and may support older adults’ resilience to disasters. This study examines the role of ageing-in-place organisations in building disaster resilience for older adults. Semi-structured interviews were conducted with a purposive sample of 14 ageing-in-place organisation leaders in King County, Washington in the United States of America. The sample included representatives of five government-run senior centres, seven non-profit senior centres and two Villages. Interviews were audio-recorded and professionally transcribed. We used a combined inductive and deductive approach to code and thematically analyse the data. Ageing-in-place organisation leadership recognise disasters as a threat to older adults’ health and safety, and they see opportunities to provide disaster-related support for older adults, though the type and extent of participation in resilience-building activities reflected each organisation's unique local context. Organisations participate in a variety of disaster-related activities, though respondents emphasised the importance of collaborative and communication-focused efforts. Findings suggest that ageing-in-place organisations may be best equipped to support older adults’ disaster resilience by serving as a trusted source of disaster-related information and providing input on the appropriateness of disaster plans and messages for the unique needs of older adults ageing-in-place.

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Racial segregation and cognitive function among older adults in the United States: Findings from the REasons for Geographic and Racial Differences in Stroke (REGARDS) study

The Journals of Gerontology Series B ◽

10.1093/geronb/gbab107 ◽

2021 ◽

Author(s):

Joy Bohyun Jang ◽

Margaret T Hicken ◽

Megan Mullins ◽

Michael Esposito ◽

Ketlyne Sol ◽

...

Keyword(s):

United States ◽

High School ◽

Older Adults ◽

Cognitive Function ◽

Cognitive Decline ◽

Racial Differences ◽

The United States ◽

High School Education ◽

Age Related ◽

Regards Study

Abstract Objectives Residential segregation is one of the fundamental features of health disparities in the United States. Yet little research has examined how living in segregated metropolitan areas is related to cognitive function and cognitive decline with age. We examined the association between segregation at the Metropolitan Statistical Area (MSA) level and trajectories of age-related cognitive function. Method Using data from Black and White older adults in the REasons for Geographic and Racial Differences in Stroke (REGARDS) study (n=18,913), we employed linear growth curve models to examine how living in racially segregated MSAs at baseline, measured by the degree of Non-Hispanic Black [NHB] isolation and NHB dissimilarity, was associated with trajectories of age-related cognitive function and how the associations varied by race and education. Results Living in MSAs with greater levels of isolation was associated with lower cognitive function (b=-0.093, p<0.05) but was not associated with rates of change in cognitive decline with age. No effects of living in isolated MSAs were found for those with at least a high school education, but older adults with less than a high school education had lower cognitive function in MSAs with greater isolation (b=-0.274, p<0.05). The degree of dissimilarity was not associated with cognitive function. The association between segregation and cognitive function did not vary by race. Discussion Metropolitan segregation was associated with lower cognitive function among older adults, especially for those with lower education living in racially isolated MSAs. This suggests complex associations between individual socioeconomic status, place, and cognitive health.

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A Mixed-Methods Evaluation of a Nurse-Led Community-Based Health Home for Ethnically Diverse Older Adults With Multimorbidity in the Adult Day Health Setting

Policy Politics & Nursing Practice ◽

10.1177/1527154419864301 ◽

2019 ◽

Vol 20 (3) ◽

pp. 131-144

Author(s):

Tina Sadarangani ◽

Lydia Missaelides ◽

Emily Eilertsen ◽

Harini Jaganathan ◽

Bei Wu

Keyword(s):

Older Adults ◽

Mixed Methods ◽

Social Services ◽

Registered Nurse ◽

The United States ◽

Nutritional Risk ◽

Emergency Department Utilization ◽

Care Utilization ◽

Community Based ◽

Health Home

Multimorbidity affects 75% of older adults (aged 65 years and older) in the United States and increases risk of poor medical outcomes, especially among the poor and underserved. The creation of a Medicaid option allowing states to establish health homes under the Affordable Care Act was intended to enhance coordinated care for Medicaid beneficiaries with multimorbidity. The Community-Based Health Home (CBHH) model uses the infrastructure of the Adult Day Health Center (ADHC) to serve as a health home to improve outcomes for medically complex vulnerable adults. Between 2017 and 2018, we used a sequential explanatory mixed-methods approach to (a) quantitatively examine changes in depression, fall risk, loneliness, cognitive function, nutritional risk, pain classification, and health care utilization over the course of 12 months in the program and (b) qualitatively explore the perspectives of key stakeholders (registered nurse navigators, participants, ADHC administrators, and caregivers) to identify the most effective components of CBHH. Using data integration techniques, we identified components of CBHH that were most likely driving outcomes. After 12 months in CBHH, our racially diverse sample ( N = 126), experienced statistically significant ( p < .05) reductions in loneliness, depression, nutritional risk, poorly controlled pain, and emergency department utilization. Stakeholders who were interviewed ( n = 40) attributed positive changes to early clinical intervention by the registered nurse navigators, communication with providers across settings, and a focus on social determinants of health, in conjunction with social stimulation and engagement provided by the ADHC. CBHH positions the ADHC as the locus of an effective health home site and is associated with favorable results. CBHH also demonstrates the unique capacity and skill of registered nurses in integrating health and social services across community settings. Continued exploration of CBHH among diverse populations with multimorbidity is warranted.

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Engaging Isolated and Underserved Older Adults in 4Ms Care: Age-Friendly Care, PA

Innovation in Aging ◽

10.1093/geroni/igab046.1223 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 315-315

Author(s):

Diane Berish ◽

Terry Fulmer

Keyword(s):

Older Adults ◽

Social Services ◽

Care Delivery ◽

The United States ◽

Outcome Data ◽

Policy Implications ◽

American Hospital ◽

American Hospital Association ◽

Clinician Training ◽

State College

Abstract Older adults, the largest segment of the US rural population, face significant disparities in health and healthcare compared to their non-rural peers, including more chronic health conditions, financial challenges, and social isolation. They have limited access to healthcare and social services for prevention, management and treatment of chronic conditions. Age-Friendly Care-PA, a partnership between Primary Health Network and Penn State College of Nursing, aims to reduce these disparities in care and services for rural older adults through co-designing their Geriatric Workforce Enhancement Program. Age-Friendly Health Systems, an initiative of the John A Hartford Foundation and the Institute for Healthcare Improvement, in partnership with the American Hospital Association and the Catholic Health Association of the United States, equips providers, older adults, and their care partners with the support necessary to address What Matters, Medication, Mentation, and Mobility. This symposium describes how the 4Ms are integrated into clinician training and competencies, older adult education, operations, care delivery, and quality improvement. Year two outcome data will be shared. Drs. Hupcey and Fick will provide an overview of the project and its reach. Dr. Berish will describe the process of engaging stakeholders in co-developing our 4M metrics and the data generated. Jenny Knecht, CRNP, will describe a pilot study to extend the reach and acceptability of telehealth to hard-to-reach older persons. Finally, Dr. Garrow will detail a new initiative focused on equity in care. Our discussant, Dr. Terry Fulmer will lead a discussion of this work as well as next steps and policy implications.

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Meanings and experiences associated with computer use of older immigrant adults of lower socioeconomic status

Canadian Journal of Occupational Therapy ◽

10.1177/0008417418754395 ◽

2018 ◽

Vol 85 (2) ◽

pp. 146-157 ◽

Cited By ~ 1

Author(s):

Lynne C. Andonian

Keyword(s):

Older Adults ◽

Socioeconomic Status ◽

Low Socioeconomic Status ◽

Social Participation ◽

Personal Growth ◽

Computer Use ◽

The United States ◽

Occupational Engagement ◽

Engagement Strategies ◽

Occupational Therapy Interventions

Background. Immigrant older adults are a substantial demographic composing 12% to 30% of older adults in the United States and Canada, yet no research has addressed the meanings associated with computer use for low-socioeconomic-status and immigrant older adults. Purpose. The study explored the meanings, occupational engagement, and experiences associated with computer use. Method. A mixed-methods approach, qualitative participatory action research (photovoice) and survey (Computer Proficiency Questionnaire), was used. Data collection consisted of narratives, focus groups, and Likert scale responses for nine participants. Findings. The participants expressed the meanings they associated with computer use as freedom, personal growth, and engagement. Computers promote occupational engagement in social participation, education, and leisure. Implications. The findings of personal growth may inform occupational therapy interventions using computers to enable adjustment to changes related to aging and wellness. Social participation and education were motivators for computer use, which may inform computer engagement strategies for this population.

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Refining Evidence-Based Treatments for Late-Life Depression

GeroPsych ◽

10.1024/1662-9647/a000127 ◽

2015 ◽

Vol 28 (2) ◽

pp. 67-76

Author(s):

Grace C. Niu ◽

Patricia A. Arean

Keyword(s):

Older Adults ◽

Mental Illness ◽

Brain Plasticity ◽

Late Life ◽

Aging Population ◽

The United States ◽

Future Research ◽

Evidence Based ◽

Late Life Depression ◽

Evidence Based Treatments

The recent increase in the aging population, specifically in the United States, has raised concerns regarding treatment for mental illness among older adults. Late-life depression (LLD) is a complex condition that has become widespread among the aging population. Despite the availability of behavioral interventions and psychotherapies, few depressed older adults actually receive treatment. In this paper we review the research on refining treatments for LLD. We first identify evidence-based treatments (EBTs) for LLD and the problems associated with efficacy and dissemination, then review approaches to conceptualizing mental illness, specifically concepts related to brain plasticity and the Research Domain Criteria (RDoc). Finally, we introduce ENGAGE as a streamlined treatment for LLD and discuss implications for future research.

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