scholarly journals Modes of Transportation to Medical and Primary Care Among Older Adults

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 128-128
Author(s):  
Zainab Suntai ◽  
Kefentse Kubanga ◽  
Emmanuel Adanu ◽  
Abhay Lidbe
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Public Transportation ◽  
The United States ◽  
Older Adulthood ◽  
Post Secondary ◽  
Logistic Regression Models ◽  
Care Services ◽  
Lower Socioeconomic ◽  
Transportation Modes

Abstract Transportation is an increasingly meaningful concern for older adults as physical, cognitive, and psychological changes in older adulthood impact mobility and accessibility. While several studies have examined the modes of transportation used among older adults, few have explored specifically how older adults are accessing primary care/medical care services. As such, this study aimed to determine the specific modes of transportation used among older adults for primary care visits. Data were derived from the 2018 National Health and Aging Trends Study (NHATS), an annual longitudinal panel survey of older adults aged 65 and older living in the United States. Descriptive analyses were conducted to examine the prevalence of several modes of access and logistic regression models were used to predict the likelihood of using the two most prevalent transportation modes, based on sociodemographic and socioeconomic factors. Results showed that 70% of older adults drive themselves to their doctor, 34.8% rely on a family member, friend, or paid person, 2.4% have a home visit, 2.1% use public transportation, 1.5% walk to their doctor and 1.1% use a taxi. Additionally, having higher income, being of younger age, being White, and having post-secondary education was associated with driving oneself to the doctor. These results indicate that while most older adults are still self-reliant on transportation to medical providers, those with lower socioeconomic status are particularly at risk of losing driving independence. Transportation-related interventions should therefore consider targeting individuals with lower economic capital by proving financial assistance, ride-share programs, and other innovative approaches.

scholarly journals Examining Fall Recurrence Risk of Homebound Hispanic Older Adults Receiving Home Care Services

2017 ◽  
Vol 15 (1) ◽  
pp. 20-26
Author(s):  
Guillermina R. Solis ◽  
Jane Dimmitt Champion
Keyword(s):  
Older Adults ◽  
Home Care ◽  
Home Health Care ◽  
Fall Risk ◽  
Health Care Services ◽  
Home Care Services ◽  
Recurrence Risk ◽  
The United States ◽  
Care Services ◽  
Risk Of Fall

Introduction: Unintentional falls and injuries is a major problem among older adults and the fourth cause of death in the United States. A previous fall event doubles the risk of recurrence and lessens the person’s quality of life. Hispanic older adults have higher rates of disability and lower independent functioning due to poor medical health and risk for fall recurrence. Most fall studies focus on fall risk with few studies on fall recurrence in older adults receiving home health care services unrelated to fall incident. Method: A descriptive pilot study of 30 homebound Hispanic older adults receiving home care services who reported a fall within 3 months was conducted by a multidisciplinary team to evaluate risk of fall recurrence. Results: A heightened risk for fall recurrence was identified with high number of chronic illnesses, high intake of medications, vision problems, and prevalence of urinary incontinence. Conclusion: Findings highlight significant number of intrinsic factors for fall risk recurrence and injuries in a Hispanic older adults population that is homebound and receiving home care services. A multidisciplinary evaluation and culturally appropriate interventions to lessen the risk of fall recurrence are recommended.

scholarly journals Acceptability and Results of Dementia Screening Among Older Adults in the United States

2017 ◽  
Vol 15 (1) ◽  
pp. 51-55 ◽  
Author(s):  
Amanda Harrawood ◽  
Nicole R. Fowler ◽  
Anthony J. Perkins ◽  
Michael A. LaMantia ◽  
Malaz A. Boustani
Keyword(s):  
United States ◽  
Older Adults ◽  
Primary Care ◽  
The United States ◽  
Cognitive Screening ◽  
Cross Sectional ◽  
Community Screening ◽  
Positive Screen ◽  
Dementia Screening ◽  
Primary Care Patients

Objectives: To measure older adults acceptability of dementia screening and assess screening test results of a racially diverse sample of older primary care patients in the United States. Design: Cross-sectional study of primary care patients aged 65 and older. Setting: Urban and suburban primary care clinics in Indianapolis, Indiana, in 2008 to 2009. Participants: Nine hundred fifty-four primary care patients without a documented diagnosis of dementia. Measurements: Community Screening Instrument for Dementia, the Mini-Mental State Examination, and the Telephone Instrument for Cognitive Screening. Results: Of the 954 study participants who consented to participate, 748 agreed to be screened for dementia and 206 refused screening. The overall response rate was 78.4%. The positive screen rate of the sample who agreed to screening was 10.2%. After adjusting for demographic differences the following characteristics were still associated with increased likelihood of screening positive for dementia: age, male sex, and lower education. Patients who believed that they had more memory problems than other people of their age were also more likely to screen positive for dementia. Conclusion: Age and perceived problems with memory are associated with screening positive for dementia in primary care.

scholarly journals Double Whammy for Older Smokers: Marginalized by Tobacco Control and Valued by the Tobacco Industry

2019 ◽  
Vol 41 (8) ◽  
pp. 1137-1151 ◽  
Author(s):  
Janine K. Cataldo
Keyword(s):  
United States ◽  
Older Adults ◽  
Tobacco Control ◽  
Health Disparity ◽  
Tobacco Industry ◽  
The United States ◽  
Tobacco Policy ◽  
Lower Socioeconomic Status ◽  
Lower Socioeconomic ◽  
Tobacco Addiction

In the last 20 years, the United States has made stunning progress reducing the rate of adult smoking. However, the smallest reduction is among older adults. Compared to younger smokers, older smokers are more likely to be lower socioeconomic status (SES), have several tobacco related comorbidities, and are less likely to be treated for tobacco addiction yet, in tobacco policy, they are not considered a marginalized group. The tobacco industry’s interest in older smokers contrasts with the lack of interest shown by tobacco control. A double whammy is a set of two bad events or situations that have an effect at the same time. The purposes of this article are to use the health disparity paradigm to (a) discuss the “double whammy” of marginalization by tobacco control and valuation by the tobacco industry on the health of older smokers and (b) provide strategies to promote health equity for older smokers.

scholarly journals Implementation of an Opioid and Benzodiazepine Deprescribing Program for Older Adults in an Outpatient Setting

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 906-906
Author(s):  
Lori Armistead ◽  
Jan Busby-Whitehead ◽  
Stefanie Ferreri ◽  
Cristine Henage ◽  
Tamera Hughes ◽  
...  
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
At Risk ◽  
Older Adult ◽  
Adult Population ◽  
Primary Care Providers ◽  
The United States ◽  
Outpatient Setting ◽  
Care Providers ◽  
Risk Of Falls

Abstract The United States spends $50 billion each year on 2.8 million injuries and 800,000 hospitalizations older adults (age 65 years and older) incur as the result of falls. Chronic use of central nervous system (CNS)-active medications, such as opioid and/or benzodiazepine (BZD) medications, increases the risk of falls and falls-related injuries in this older adult population. This Centers for Disease Control and Prevention (CDC)-funded randomized control trial uses electronic health record (EHR) data from primary care outpatient clinics to identify older adult patients at risk for falls due to chronic opioid or BZD use. The primary program aim is to test the efficacy of a targeted consultant pharmacist service to reduce the dose burden of these medications in the targeted population. Impact of this intervention on the risk of falls in this population will also be assessed. Licensed clinical pharmacists will review at-risk patients’ medical records weekly and make recommendations through the EHR to primary care providers for opioid or BZD dose adjustments, alternate medications, and/or adjunctive therapies to support deprescribing for approximately 1265 patients in the first two cohorts of intervention clinics. One thousand three hundred eighty four patients in the control clinics will receive usual care. Outcome measures will include reduction or discontinuation of opioids and BZDs and falls risk reduction as measured by the Stop Elderly Accidents, Death and Injuries (STEADI) Questionnaire. Primary care provider adoption of pharmacists’ recommendations and satisfaction with the consult service will also be reported.

Progress and trends in the utilization and adoption of palliative care in patients with terminal gynecologic cancer in the United States: A study of 4,264 women.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 11606-11606
Author(s):  
Anthony Milki ◽  
Amandeep Kaur Mann ◽  
Daniel Stuart Kapp ◽  
John K. Chan
Keyword(s):  
Palliative Care ◽  
Terminal Illness ◽  
Private Insurance ◽  
Gynecologic Cancer ◽  
The United States ◽  
Cancer Type ◽  
Median Income ◽  
Logistic Regression Models ◽  
Lower Socioeconomic ◽  
Chi Squared

11606 Background: To determine the factors associated with the utilization of palliative care (PC) in patients with metastatic gynecologic cancer who died while hospitalized. Methods: Data were extracted from the National Inpatient Sample (NIS) database for patients with cervical, uterine, and ovarian cancers from 2005 to 2011. Chi-squared and logistic regression models were employed for statistical analyses. Results: Of 4264 women with gynecologic cancer, 983 (23.0%) utilized PC (median age: 66 years). 2633 (61.8%), 1034 (24.3%), and 597 (14.0%) patients had ovarian, uterine, and cervical cancer, respectively. The majority were white (57.9%), and the remainder were black (12.6%), Hispanic (7.8%), and Asian (3.1%). 24.9, 23.9, 23.6, and 25.2% were low, low-middle, middle-high, and high with respect to median income. Medicare, Medicaid, and private insurance was found in 46.7, 10.8, and 37.6% of patients. 36.9, 21.0, 18.0, and 24.1% of patients were treated in hospitals in the South, West, Midwest, and Northeast. 11.3, 23.9, and 64.2% of patients were treated in small, medium, and large hospitals, designated as teaching (53.1%) and nonteaching (46.3%) institutions. The utilization of PC increased from 5.2% in 2005 to 30.4% in 2011. Older age (OR: 1.34; 95% CI: 1.10-1.64; P = 0.01), high SES (OR: 1.37; 95% CI: 1.09-1.72; P = 0.01), privately insured (OR: 1.81; 95% CI: 1.46-2.24; P < 0.001), treatment at Western (OR: 1.94; 95% CI: 1.56-2.41; P < 0.001) and Midwestern hospitals (OR: 1.43; 95% CI: 1.15-1.77; P = 0.001), and depression (OR: 1.34; 95% CI: 1.00-1.80; P = 0.05) were associated with higher PC use. However, race, cancer type, hospital teaching status, and hospital location were not associated with PC use. Conclusions: The use of inpatient palliative care has increased significantly over the study period. The lower utilization of palliative care for terminal illness associated with younger, lower socioeconomic status, Southern and smaller volume hospitals warrants further attention.

scholarly journals Disseminating the Otago Exercise Program in the United States: Perceived and Actual Physical Performance Improvements From Participants

2016 ◽  
Vol 37 (1) ◽  
pp. 79-98 ◽  
Author(s):  
Tiffany E. Shubert ◽  
Matthew Lee Smith ◽  
Luohua Jiang ◽  
Marcia G. Ory
Keyword(s):  
United States ◽  
Older Adults ◽  
Physical Performance ◽  
Functional Performance ◽  
Exercise Program ◽  
The United States ◽  
Functional Mobility ◽  
Self Report ◽  
Timed Up And Go ◽  
Logistic Regression Models

The Otago Exercise Program (OEP) is an evidence-based fall prevention program disseminated internationally. Little is known about the implementation or effectiveness of the OEP in the United States. The purposes were to (a) identify characteristics of older adults enrolled in OEP, and (b) examine perceived and actual functional performance changes after participation in 8 weeks of the program. Baseline and 8-week functional and self-report data were collected on 210 older adults from 2013 to 2015. Linear mixed models and general estimating equations logistic regression models adjusted for socio-demographic factors were performed to assess changes. At 8 weeks, scores dramatically improved on self-report and physical performance tests: Timed Up-and-Go ( p < .001), 30-Second Chair Rise ( p < .001), and Four-Stage Balance ( p < .001). Findings support that participation in the U.S. OEP as part of a plan of care can result in significant improvements in objective functional mobility, balance measures, and self-reported ability.

scholarly journals The Role of Primary Care Physicians (DLP) in Community Care

2018 ◽  
Vol 1 (1) ◽  
pp. 3
Author(s):  
Dhanasari Vidiawati Trisna Sanyoto ◽  
Nur Afrainin Syah
Keyword(s):  
Primary Care ◽  
Family Medicine ◽  
Primary Care Physicians ◽  
Medical Training ◽  
The United States ◽  
Care Physician ◽  
Main Body ◽  
Family Doctors ◽  
Postgraduate Medical Training ◽  
Care Services

Dokter Layanan Primer (DLP) or Primary Care Physician (PCP) is a newly introduced term by the Indonesian government in 2013 since the enforcement of Medical Education Law 20/2013. DLP is a physician who solidifies his/ her education and career in primary care. They have postgraduate medical training in primary care and are experts in this field. In most countries, to be a generalist physician practising at primary care facilities such as health centres and primary care clinics, medical school graduates have to take postgraduate medical training to be proficient in terms of knowledge and skills in primary care services. Family medicine is the main body of knowledge of the primary care postgraduate training program in those countries even though their graduates are called differently among countries. These physicians are called family doctors or family physicians in the United States of America (USA), general practitioners (GPs) in Commonwealth countries, huisarts in the Netherlands. In Indonesia, where social, economic, and cultural diversity is very high in various regions, in addition to Family Medicine, Community Medicine and Public Health....

scholarly journals IDENTIFYING THE TRAJECTORIES OF MULTIMORBIDITY AND THEIR CORRELATES AMONG KOREAN OLDER ADULTS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S697-S697
Author(s):  
Sun Ah Lee ◽  
Hey Jung Jun ◽  
Susanna Joo ◽  
Hye Won Chai
Keyword(s):  
Older Adults ◽  
Depressive Symptoms ◽  
Chronic Diseases ◽  
Psychological Health ◽  
Social Engagement ◽  
Multinomial Logistic Regression ◽  
Growth Mixture Modeling ◽  
Older Adulthood ◽  
Logistic Regression Models ◽  
Nationally Representative

Abstract Multimorbidity, the co-existence of two or more chronic diseases, has become prevalent among the older population. This study focused on identifying different patterns of multimorbidity trajectories across older adulthood and examining their predictors. We used six waves of the Korean Longitudinal Study of Aging (KLoSA), a nationally representative longitudinal data collected every two years from 2006 to 2016. The sample was older adults aged 65 years and older in 2006 (N=1,668). Multimorbidity was measured as the self-reported number of medically-diagnosed chronic diseases, and Growth Mixture Modeling was used to examine multimorbidity trajectories. Identified patterns of multimorbidity trajectories were then used as outcome variables in multinomial logistic regression models. Independent variables were socio-demographic, psychological, health-related behavioral and interpersonal factors at baseline. At Wave1, 76% of the sample had no or one chronic disease and 24% had two or more. At Wave6, 49% had none or one and 51% had two or more. Results identified four patterns of multimorbidity trajectory: “maintaining-low” (59.1%; reference), “maintaining-high” (7.3%), “moderately increasing”(26.4%), and “rapidly increasing” (7.2%). In terms of the correlates of these patterns, female older adults and respondents with higher depressive symptoms were more likely to be in the “maintaining-high” group. In addition, respondents who had less frequent meetings with friends, neighbors or relatives were more likely to be in the “rapidly increasing” group. The findings suggest that there are distinct patterns of multimorbidity trajectories across older adulthood, and interventions focusing on depressive symptoms or social engagement may be useful in preventing the increase in multimorbidity.

scholarly journals Evaluation of comprehensive care for older adults in primary care services

2020 ◽  
Vol 54 ◽  
pp. 6 ◽  
Author(s):  
Nádia Placideli ◽  
Elen Rose Lodeiro Castanheira ◽  
Adriano Dias ◽  
Pedro Alcântara Da Silva ◽  
Josiane Lozigia Fernandes Carrapato ◽  
...  
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Health Care ◽  
Sao Paulo ◽  
Service Performance ◽  
Comprehensive Care ◽  
Noncommunicable Diseases ◽  
São Paulo ◽  
Care Services ◽  
Primary Care Services

OBJECTIVE: To evaluate the performance of comprehensive care for older adults in primary care services in the Brazilian Unified Health System in the state of São Paulo, Brazil. METHODS: A total of 157 primary care services from five health regions in midwestern São Paulo responded, from October to December 2014, the pre-validated 2014 questionnaire for primary care services assessment and monitoring. We selected 155 questions, based on national policies and guidelines on this theme. The responses indicate the service performance in older adults’ care, clustered into three areas of analysis: health care for active and healthy aging (45 indicators, d1), chronic noncommunicable diseases care (89 indicators, d2), and support network in aging care (21 indicators, d3). Performance was measured by the sum of positive (value 1) or negative (value 0) responses for each indicator. Services were clustered according to k-means of the performance scores of each domain. After weighting the domains (Z tests), we estimated the associations between the scores of each domain and independent management variables (typology, planning and evaluation of services), with simple and multiple linear regression. RESULTS: Chronic noncommunicable diseases care (d2) showed, for all clusters, better average performance (55.7) than domains d1 (35.4) and d3 (39.2). Service performance in the general area of planning and evaluation associates with the performance of older adults’ care. CONCLUSIONS: The evaluated services had incipient implementation of comprehensive care for older adults. The evaluation framework can contribute to processes to improve the quality of primary health care.

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