Exploring the Intersection of Chronic Disease, Function, and Social Care in Adult Day Care Clients With Dementia

Abstract The interrelationships among dementia, concomitant disease, and social determinants of health are poorly understood and have critical implications for disease course, treatments, and caregiving needs. The aim of this study was to identify patterns of co-occurring chronic conditions among persons with dementia and the relationship of these patterns with clinical characteristics, demographic predictors and functional status. A latent class analysis (LCA) was conducted using data from 53 California adult day centers (n=3,053). Four distinct groups emerged: “dementia only”; “dementia +: > 2; + > 3; + >5 chronic conditions. Having dementia + >5 was associated (p <.001) with greater risk of falls, isolation, medication mismanagement, and reduced likelihood of using an adaptive device. Dementia in day center clients is complicated by clinical conditions, functional decline, and a need for supports that may be lacking. Center staff must be trained and resourced to manage the complex needs of persons with dementia.

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The Differential Impact of Multimorbidity Patterns and Subsequent Accumulation on Longitudinal Trajectories of Physical Function Decline in a Population-based Cohort of Older People

The Journals of Gerontology Series A ◽

10.1093/gerona/glab384 ◽

2021 ◽

Author(s):

Huiying Liu ◽

Xinyan Zhang ◽

Beizhuo Chen ◽

Boye Fang ◽

Vivian W Q Lou ◽

...

Keyword(s):

Physical Function ◽

Chronic Conditions ◽

Latent Class ◽

Negative Binomial ◽

Functional Decline ◽

Population Based ◽

Differential Impact ◽

Future Studies ◽

Longitudinal Trajectories ◽

Binomial Models

Abstract Background Although both the patterns and accumulation of multimorbidity are important for predicting physical function, studies have not simultaneously examined their impact on functional decline. This study aimed to associate multimorbidity patterns and subsequently developed conditions with longitudinal trajectories of functional decline, and it tested whether the effects of newly developed conditions on functional decline varied across distinct multimorbidity patterns. Methods We included 6,634 participants aged at least 60 years from the China Health and Retirement Longitudinal Survey. Latent class analysis identified multimorbidity patterns from 14 chronic conditions. Mixed negative binomial models estimated the changes in physical function measured across four waves as a function of multimorbidity patterns, subsequently developed conditions and their interactions. Results Five distinct patterns were identified three years before wave 1: stomach/arthritis (15.7%), cardiometabolic (6.7%), arthritis/hypertension (47.9%), hepatorenal/multi-system (18.3%), and lung/asthma (11.4%). The hepatorenal/multi-system and the lung/asthma pattern were associated with worse baseline physical function, and the hypertension/arthritis pattern was associated with greater decline of physical function. The effect of developing new conditions on decline of physical function over time was most evident for individuals from the cardiometabolic pattern. Discussion Considering both the combinations and progressive nature of multimorbidity is important for identifying individuals at greater risk of disability. Future studies are warranted to differentiate the factors responsible for the progression of chronic conditions in distinct multimorbidity patterns and investigate the potential implications for improved prediction of functional decline.

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OP0074 MULTIMORBIDITY CLUSTERS, DETERMINANTS AND TRAJECTORIES IN OSTEOARTHRITIS IN THE UK: FINDINGS FROM THE CLINICAL PRACTICE RESEARCH DATALINK

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.1488 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 49.1-50

Author(s):

S. Swain ◽

C. Coupland ◽

V. Strauss ◽

C. Mallen ◽

C. F. Kuo ◽

...

Keyword(s):

Chronic Conditions ◽

Index Date ◽

Latent Class ◽

Rapid Onset ◽

Practice Research ◽

Clinical Practice Research Datalink ◽

Research Support ◽

Gradual Onset ◽

The Uk ◽

Slow Onset

Background:Multimorbidity (≥2 chronic conditions) escalates the risk of adverse health outcomes. However, its burden in people with osteoarthritis (OA) remains largely unknown.Objectives:To identify the clusters of patients with multimorbidity and associated factors in OA and non-OA populations and to estimate the risk of developing multimorbidity clusters after the index date (after diagnosis).Methods:The study used the Clinical Practice Research Datalink – a primary care database from the UK. Firstly, age, sex and practice matched OA and non-OA people aged 20+ were identified to explore patterns and associations of clusters of multimorbidity within each group. Non-OA controls were assigned with same index date as that of matched OA cases. Secondly, multimorbidity trajectories for 20 years after the index date were examined in people without any comorbidities at baseline in both OA and non-OA groups. Latent class analysis was used to identify clusters and latent class growth modelling was used for cluster trajectories. The associations between clusters and age, sex, body mass index (BMI), alcohol use, smoking habits at baseline were quantified through multinomial logistic regression.Results:In total, 47 long-term conditions were studied in 443,822 people (OA- 221922; non-OA- 221900), with a mean age of 62 years (standard deviation ± 13 years), and 58% being women. The prevalence of multimorbidity was 76.6% and 68.9% in the OA and non-OA groups, respectively. In the OA group five clusters were identified including relatively healthy (18%), ‘cardiovascular (CVD) and musculoskeletal (MSK)’ (12.3%), metabolic syndrome (28.2%), ‘pain and psychological (9.1%), and ‘musculoskeletal’ (32.4%). The non-OA group had similar patterns except that the ‘pain+ psychological’ cluster was replaced by ‘thyroid and psychological’. (Figure 1) Among people with OA, ‘CVD+MSK’ and metabolic syndrome clusters were strongly associated with obesity with a relative risk ratio (RRR) of 2.04 (95% CI 1.95-2.13) and 2.10 (95% CI 2.03-2.17), respectively. Women had four times higher risk of being in the ‘pain+ psychological’ cluster than men when compared to the gender ratio in the healthy cluster, (RRR 4.28; 95% CI 4.09-4.48). In the non-OA group, obesity was significantly associated with all the clusters.Figure 1: Posterior probability distribution of chronic conditions across the clusters in Osteoarthritis (OA, n=221922) and Non-Osteoarthritis (Non-OA, n=221900) group. COPD- Chronic Obstructive Pulmonary Disease; CVD- Cardiovascular; MSK- MusculoskeletalOA (n=24139) and non-OA (n=24144) groups had five and four multimorbidity trajectory clusters, respectively. Among the OA population, 2.7% had rapid onset of multimorbidity, 9.5% had gradual onset and 11.6% had slow onset, whereas among the non-OA population, there was no rapid onset cluster, 4.6% had gradual onset and 14.3% had slow onset of multimorbidity. (Figure 2)Figure 2: Clusters of multimorbidity trajectories after index date in OA (n=24139) and Non-OA (n=24144)Conclusion:Distinct identified groups in OA and non-OA suggests further research for possible biological linkage within each cluster. The rapid onset of multimorbidity in OA should be considered for chronic disease management.Supported by:Acknowledgments:We would like to thank the University of Nottingham, UK, Beijing Joint Care Foundation, China and Foundation for Research in Rheumatology (FOREUM) for supporting the study.Disclosure of Interests:Subhashisa Swain: None declared, Carol Coupland: None declared, Victoria Strauss: None declared, Christian Mallen Grant/research support from: My department has received financial grants from BMS for a cardiology trial., Chang-Fu Kuo: None declared, Aliya Sarmanova: None declared, Michael Doherty Grant/research support from: AstraZeneca funded the Nottingham Sons of Gout study, Consultant of: Advisory borads on gout for Grunenthal and Mallinckrodt, Weiya Zhang Consultant of: Grunenthal for advice on gout management, Speakers bureau: Bioiberica as an invited speaker for EULAR 2016 satellite symposium

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E-bike user groups and substitution effects: evidence from longitudinal travel data in the Netherlands

Transportation ◽

10.1007/s11116-021-10195-3 ◽

2021 ◽

Author(s):

Mathijs de Haas ◽

Maarten Kroesen ◽

Caspar Chorus ◽

Sascha Hoogendoorn-Lanser ◽

Serge Hoogendoorn

Keyword(s):

The Netherlands ◽

Longitudinal Data ◽

Latent Class ◽

Good Alternative ◽

Substitution Effects ◽

Or Education ◽

Cross Sectional ◽

User Groups ◽

Using Data ◽

Mode Of Transport

AbstractIn recent years, the e-bike has become increasingly popular in many European countries. With higher speeds and less effort needed, the e-bike is a promising mode of transport to many, and it is considered a good alternative for certain car trips by policy-makers and planners. A major limitation of many studies that investigate such substitution effects of the e-bike, is their reliance on cross-sectional data which do not allow an assessment of within-person travel mode changes. As a consequence, there is currently no consensus about the e-bike’s potential to replace car trips. Furthermore, there has been little research focusing on heterogeneity among e-bike users. In this respect, it is likely that different groups exist that use the e-bike for different reasons (e.g. leisure vs commute travel), something which will also influence possible substitution patterns. This paper contributes to the literature in two ways: (1) it presents a statistical analysis to assess the extent to which e-bike trips are substituting trips by other travel modes based on longitudinal data; (2) it reveals different user groups among the e-bike population. A Random Intercept Cross-Lagged Panel Model is estimated using five waves of data from the Netherlands Mobility Panel. Furthermore, a Latent Class Analysis is performed using data from the Dutch national travel survey. Results show that, when using longitudinal data, the substitution effects between e-bike and the competing travel modes of car and public transport are not as significant as reported in earlier research. In general, e-bike trips only significantly reduce conventional bicycle trips in the Netherlands, which can be regarded an unwanted effect from a policy-viewpoint. For commuting, the e-bike also substitutes car trips. Furthermore, results show that there are five different user groups with their own distinct behaviour patterns and socio-demographic characteristics. They also show that groups that use the e-bike primarily for commuting or education are growing at a much higher rate than groups that mainly use the e-bike for leisure and shopping purposes.

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Abstract 002: Assessing Profiles Of Cardiometabolic Risk Among South Asians Living In The United States Using A Syndemic Framework And Acculturation

Circulation ◽

10.1161/circ.143.suppl_1.002 ◽

2021 ◽

Vol 143 (Suppl_1) ◽

Author(s):

Francisco A Montiel Ishino ◽

Katia M Canenguez ◽

Jeffrey H Cohen ◽

Belinda Needham ◽

Namratha Kandula ◽

...

Keyword(s):

Mental Health ◽

Latent Class ◽

Family Income ◽

South Asians ◽

Health Indicators ◽

The United States ◽

Sociocultural Factors ◽

Cultural Traditions ◽

Using Data ◽

Religiosity And Spirituality

Background: South Asians (SA) are the second largest US immigrant group and have excess cardiometabolic (CM) disease. While acculturation is associated with increased CM risk among immigrants and refugees, the role of acculturation on SA CM risk is relatively unknown. CM disease presents as a syndemic or synergistic epidemic involving multiple disease clusters as well as the biological, social, and psychological interactions from the acculturative process to worsen morbidity within subgroups. Methods: We used latent class analysis to identify SA CM risk based on acculturation subgroups using data from adults aged 40-84 in the Mediators of Atherosclerosis in South Asians Living in America study (N=771). The distal outcome of CM risk was constructed using hypertension, type 2 diabetes, and body mass index. Proxies of acculturation included years lived in the US, English proficiency, cuisine eaten at home, cultural traditions, ethnicity of friends, social and neighborhood support, and experienced discrimination; as well as mental health indicators, which included depression, trait anxiety, anger, and positive and negative spiritual coping. Covariates included demographic characteristics, family income, education, study site, exercise, smoking, alcohol use, religiosity and spirituality. Results: Four CM risk profiles and acculturation subgroups were identified: 1) lowest risk [73.8%] were the most integrated with both SA and US culture; 2) intermediate-low risk [13.4%] had high mental health distress and discrimination and separated from SA and US culture; 3) intermediate-high risk [8.9%] were more assimilated with US culture; and 4) highest risk [3.9%] were more assimilated with US culture [Figure]. Conclusion: Our approach identified distinct nuanced profiles of syndemic CM risk to understand how acculturation and sociocultural factors cluster with health in US South Asians. Our syndemic framework will further understanding of CM risk among SA to best design tailored prevention and intervention programs.

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Customers’ Mode Choice Behaviors of Express Service Based on Latent Class Analysis and Logit Model

Mathematical Problems in Engineering ◽

10.1155/2015/610673 ◽

2015 ◽

Vol 2015 ◽

pp. 1-8 ◽

Cited By ~ 2

Author(s):

Lian Lian ◽

Shuo Zhang ◽

Zhong Wang ◽

Kai Liu ◽

Lihuan Cao

Keyword(s):

Logit Model ◽

Choice Behavior ◽

Latent Class ◽

Latent Class Model ◽

Policy Research ◽

Multinomial Logit Model ◽

Class Model ◽

Taste Heterogeneity ◽

Using Data ◽

Service Choice

As the parcel delivery service is booming in China, the competition among express companies intensifies. This paper employed multinomial logit model (MNL) and latent class model (LCM) to investigate customers’ express service choice behavior, using data from a SP survey. The attributes and attribute levels that matter most to express customers are identified. Meanwhile, the customers are divided into two segments (penny pincher segment and high-end segment) characterized by their taste heterogeneity. The results indicate that the LCM performs statistically better than MNL in our sample. Therefore, more attention should be paid to the taste heterogeneity, especially for further academic and policy research in freight choice behavior.

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Gender Attitudes in Religious Schools: A Comparative Study of Religious and Secular Private Schools in Guatemala

Religions ◽

10.3390/rel9070219 ◽

2018 ◽

Vol 9 (7) ◽

pp. 219 ◽

Cited By ~ 2

Author(s):

Darin Mather

Keyword(s):

Private Schools ◽

Religious Beliefs ◽

Latent Class ◽

Catholic School ◽

Gender Attitudes ◽

Religious Schools ◽

School Students ◽

And Gender ◽

Using Data ◽

Insight Into

This study assesses the effect that private religious schools have on gender attitudes in students. Using data collected from twenty-one private schools in Guatemala, gender attitudes are assessed using latent class analysis. The results indicate that students’ gender attitudes can be categorized into three distinct profiles. These are non-egalitarian, publicly egalitarian, and generally egalitarian. Subsequent analysis reveals that religious schools and specific religious beliefs are correlated with different gender attitude profiles. For instance, Catholic school students are more likely to be generally egalitarian than students in evangelical or secular schools, and biblical literalists are most likely to be publicly egalitarian. Overall, this research highlights the need to develop new conceptual models to provide more accurate and nuanced descriptions of gender attitudes. It also provides new insight into correlations between religious schools and religious beliefs and gender attitudes formation.

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Using Profiles of Human and Social Capital to Understand Adult Immigrants’ Education Needs: A Latent Class Approach

Adult Education Quarterly ◽

10.1177/0741713618802271 ◽

2018 ◽

Vol 69 (1) ◽

pp. 3-23 ◽

Cited By ~ 3

Author(s):

Calonie M. K. Gray

Keyword(s):

Social Capital ◽

Adult Learners ◽

Latent Class ◽

Service Providers ◽

Education Needs ◽

International Assessment ◽

Using Data ◽

Adult Immigrants ◽

Human And Social Capital ◽

The U.S

With the U.S. adult education system providing education services to millions of immigrants annually, understanding the unique skills and assets among adult immigrant learners is important. Using data from the U.S. Program for the International Assessment of Adult Competencies, this study used data on immigrants ( n = 1,873) to identify latent classes along dimensions of human and social capital. Latent class analysis indicated five discrete profiles: High Opportunity, Upskill Ready, Satisfactorily Skilled, Motivated and Engaged, and Highly Skilled. The results provide support for using customized education approaches to capitalize on the collection of assets adult learners have while concurrently increasing education service providers’ capacity to serve.

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Assessing the Relationship Between Physical Health and Inmate Misconduct

Criminal Justice and Behavior ◽

10.1177/0093854818775467 ◽

2018 ◽

Vol 45 (10) ◽

pp. 1527-1546 ◽

Cited By ~ 8

Author(s):

Jessica M. Grosholz ◽

Daniel C. Semenza

Keyword(s):

Physical Health ◽

Physical Disability ◽

Chronic Conditions ◽

Correctional Facilities ◽

Program Participation ◽

Justice Statistics ◽

Inmate Misconduct ◽

General Strain ◽

Using Data ◽

The Relationship

Research reveals inmate misconduct results from various factors including age, gang membership, program participation, and mental illness. However, no research has examined the influence of physical illness on misconduct. Per general strain theory, we argue that poor physical health is a significant strain that may negatively affect behavior. Using data from the Bureau of Justice Statistics’ 2004 Survey of Inmates in State Correctional Facilities (SISCF), we investigate how acute illnesses, chronic conditions, and physical disabilities influence misconduct. Results suggest acute conditions increase the likelihood of general, serious, and nonserious misconduct in prison. Conversely, chronic ailments decrease the likelihood of all types of misconduct. We find moderate effects for physical disability. Experiencing acute health conditions while incarcerated significantly increases the likelihood of misconduct, suggesting that by appropriately addressing inmates’ acute ailments, it may be possible to concurrently improve inmate health and decrease misconduct to enhance the lives of those in prison.

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Psychological factors underpinning vaccine willingness in Israel, Japan and Hungary

10.1101/2021.05.24.21257465 ◽

2021 ◽

Author(s):

Robin Goodwin ◽

Menachem Ben-Ezra ◽

Masahito Takahashi ◽

Lan Anh Nguyen Luu ◽

Krisztina Borsfay ◽

...

Keyword(s):

Latent Class ◽

Systems Approach ◽

Vaccine Hesitancy ◽

Effective Vaccine ◽

Anticipated Regret ◽

Nationally Representative ◽

The Government ◽

Using Data ◽

The Individual ◽

Representative Samples

The rapid international spread of the SARS-CoV-2 virus 19 led to unprecedented attempts to develop and administer an effective vaccine. However, there is evidence of considerable vaccine hesitancy in some countries and sub-populations. We investigated willingness to vaccinate in three nations with historically different levels of vaccine willingness and attitudes to the COVID-19 vaccine rollout: Israel, Japan and Hungary. Employing an ecological-systems approach we analysed associations between demographic factors and health status, individual cognitions, normative pressures, trust in government, belief in COVID-19 myths and willingness to be vaccinated, using data from three nationally representative samples (Israel, N=1011 (Jan 2021); Japan, N= 997 (Feb 2021); Hungary, N=1131 (Apr 2021)). In Israel 74% indicated a willingness to vaccinate, but only 51% in Japan and 31% in Hungary. Results from multigroup regression analyses indicated greater vaccine willingness amongst those who perceived benefits to vaccination, anticipated regret if not vaccinated and trusted the government. Multi-group latent class analysis of ten COVID-19 (mis)beliefs identified three classes of myths, with concerns about the alteration of DNA (Israel), allergies (Hungary) and catching COVID-19 from the vaccine (Japan) specific to vaccine willingness for each culture. Rather than focusing primarily on disease threats, intervention campaigns should focus on increasing trust and addressing culturally specific myths while emphasising the individual and social group benefits of vaccination.

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Financial Burdens of Out-of-Pocket Spending Among Medicare Fee-for-Service Beneficiaries: Role of the “Big Four” Chronic Health Conditions

Medical Care Research and Review ◽

10.1177/10775587211032837 ◽

2021 ◽

pp. 107755872110328

Author(s):

Rashmita Basu ◽

Haiyong Liu

Keyword(s):

Cost Sharing ◽

Generalized Linear Model ◽

Chronic Conditions ◽

Community Dwelling ◽

Fee For Service ◽

Health Care Coverage ◽

Using Data ◽

Financial Burdens ◽

Big Four

While Medicare is the universal source of health care coverage for Americans aged 65 years or older, the program requires significant cost sharing in terms of out-of-pocket (OOP) spending. We conducted a retrospective study using data from 2016 to 2018 Medicare Current Beneficiary Surveys of elderly community-dwelling beneficiaries ( n = 10,431) linked with administrative data to estimate OOP spending associated with the “big four” chronic diseases (cardiovascular disease, cancer, diabetes, and chronic lung disease). We estimated a generalized linear model adjusting for predisposing, enabling, and need factors to estimate annual OOP spending. We found that beneficiaries with any of the “big four” chronic conditions spent 15% ( p < .001) higher OOP costs and were 56% more likely to spend ≥20% of annual income on OOP expenditure (adjusted odds ratio = 1.56; p < .001) compared with those without any of those conditions. OOP spending appears to be heterogeneous across disease types and changing by conditions over time.

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