scholarly journals COMPARATIVE PERFORMANCE OF FOUR CLAIMS-BASED FRAILTY MEASURES IN THE UNITED STATES MEDICARE DATA

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S684-S685
Author(s):  
Dae H Kim ◽  
Elisabetta Patorno ◽  
Ajinkya Pawar ◽  
Hemin Lee ◽  
Sebastian Schneeweiss ◽  
...  
Keyword(s):  
United States ◽  
Health Outcomes ◽  
Activities Of Daily Living ◽  
Gait Speed ◽  
Daily Living ◽  
Correlation Coefficients ◽  
The United States ◽  
Medicare Data ◽  
C Statistic ◽  
Age And Sex

Abstract Background: There has been increasing effort to measure frailty in the United States Medicare data. The performance of claims-based frailty measures has not been compared. Methods: This retrospective cohort study included 2,326 community-dwelling Medicare beneficiaries who participated in the 2008 assessment of the Health and Retirement Study. The claims-based frailty measures developed by Davidoff, Faurot, Segal, and Kim were compared against clinical measures of frailty (gait speed, grip strength) using correlation coefficients and health outcomes (e.g., mortality, hospitalization, activities-of-daily-living disabilities) over 2 years using C-statistics. Results: The Davidoff, Faurot, Segal, and Kim indices were negatively correlated with gait speed (-0.19, -0.33, -0.37, and -0.37, respectively), but age and sex adjustment variably attenuated the correlation to -0.17, -0.22, -0.18, and -0.33, respectively. The corresponding correlation coefficients with grip strength were -0.17, -0.27, -0.35, and -0.24, which attenuated to -0.09, -0.14, -0.05, and -0.23 after age and sex adjustment, respectively. The models that included age, sex, and each of Davidoff, Faurot, Segal, and Kim indices showed C-statistics of 0.67, 0.71, 0.71, 0.75 for mortality (versus C-statistic for age and sex: 0.66); 0.59, 0.64, 0.63, 0.70 for hospitalization (versus C-statistic for age and sex: 0.58); and 0.64, 0.63, 0.63, 0.70 for activities-of-daily-living disabilities (versus C-statistic for age and sex: 0.61), respectively. Conclusions: The choice of a claims-based frailty measure results in a meaningful variation in the identification of frail older adults at high risk for adverse health outcomes. Claims-based frailty measures that included demographic variables offer limited risk adjustment beyond age and sex.

scholarly journals Age of Migration and the Health Status of Older Latinos: Findings From the Health and Retirement Study

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 454-454
Author(s):  
Blakelee Kemp ◽  
Marc Garcia
Keyword(s):  
United States ◽  
Health Outcomes ◽  
Activities Of Daily Living ◽  
Early Life ◽  
Daily Living ◽  
Life Experiences ◽  
The United States ◽  
Latino Men ◽  
Physical Health Outcomes ◽  
Retirement Study

Abstract Life course research emphasizes the importance of considering how early life experiences set individuals on specific trajectories over time with implications across multiple health domains. Life experiences of older Latinos are shaped by where they were born and, for the foreign-born, when they immigrated to the United States. Prior research examining the extent to which age of migration is associated with health has largely been limited to regional studies. To address this gap in knowledge, we use nationally representative data from the Health and Retirement Study to examine associations between age of migration and multiple physical health outcomes among older Latinos residing in the United States. We examine 2010 prevalence and follow-up incidence to 2016 of cardiovascular issues, diabetes, one or more activities of daily living (ADLs), one or more instrumental activities of daily living (IADLs), cognitive issues, and mortality incidence. Preliminary results indicate similar health profiles across Latinos who migrated in early life (<18), during adulthood (18-34), and during later adulthood (35+). Most health profiles were similar among Latino men and women except for prevalence and incidence of experiencing difficulties with at least one ADL. Latino women who migrated in later-adulthood have higher prevalence of ADLs and women who migrated early in life (>18) have higher ADL incidence than Latino men who migrated during the same life course periods. A greater understanding of the how immigrant experiences influence physical health outcomes offers important insights into the development of actionable and culturally appropriate social and health policies.

Introduction

2021 ◽  
pp. 1-5
Author(s):  
Richard Schweid
Keyword(s):  
United States ◽  
Activities Of Daily Living ◽  
Home Health Care ◽  
Daily Living ◽  
Current System ◽  
Well Being ◽  
The Elderly ◽  
The United States ◽  
Home Health ◽  
Turnover Rates

This introductory chapter provides an overview of home health care in the United States. Most Americans over sixty-five want to grow old at home, but the reality is that to do so, the majority of them will eventually need someone to help with what are called activities of daily living, those things basic to maintaining life, like eating, bathing, and using the toilet, and with the instrumental activities of daily living, such as cooking and cleaning. The millions of women employed as aides to help the elderly with these tasks in the United States are treated as menial laborers, paid minimum wage, often with no benefits, although the job they are doing is critically important to both our personal well-being and that of society as a whole. Given the low pay and stressful work, it is not surprising that home health aides have one of the highest turnover rates of any job. This book then analyzes what is wrong in the current system of providing home care to the elderly and how those deficiencies might be remedied.

scholarly journals Different Combinations of Mobility Metrics Derived From a Wearable Sensor Are Associated With Distinct Health Outcomes in Older Adults

2019 ◽  
Vol 75 (6) ◽  
pp. 1176-1183 ◽  
Author(s):  
Aron S Buchman ◽  
Robert J Dawe ◽  
Sue E Leurgans ◽  
Thomas A Curran ◽  
Timothy Truty ◽  
...  
Keyword(s):  
Older Adults ◽  
Health Outcomes ◽  
Activities Of Daily Living ◽  
Gait Speed ◽  
Daily Living ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Adverse Health Outcomes ◽  
Backward Elimination ◽  
Cox Proportional Hazards Models

Abstract Background Gait speed is a robust nonspecific predictor of health outcomes. We examined if combinations of gait speed and other mobility metrics are associated with specific health outcomes. Methods A sensor (triaxial accelerometer and gyroscope) placed on the lower back, measured mobility in the homes of 1,249 older adults (77% female; 80.0, SD = 7.72 years). Twelve gait scores were extracted from five performances, including (a) walking, (b) transition from sit to stand, (c) transition from stand to sit, (d) turning, and (e) standing posture. Using separate Cox proportional hazards models, we examined which metrics were associated with time to mortality, incident activities of daily living disability, mobility disability, mild cognitive impairment, and Alzheimer’s disease dementia. We used a single integrated analytic framework to determine which gait scores survived to predict each outcome. Results During 3.6 years of follow-up, 10 of the 12 gait scores predicted one or more of the five health outcomes. In further analyses, different combinations of 2–3 gait scores survived backward elimination and were associated with the five outcomes. Sway was one of the three scores that predicted activities of daily living disability but was not included in the final models for other outcomes. Gait speed was included along with other metrics in the final models predicting mortality and activities of daily living disability but not for other outcomes. Conclusions When analyzing multiple mobility metrics together, different combinations of mobility metrics are related to specific adverse health outcomes. Digital technology enhances our understanding of impaired mobility and may provide mobility biomarkers that predict distinct health outcomes.

scholarly journals Religious Participation and Mortality Risk in Mexico

2018 ◽  
Vol 75 (5) ◽  
pp. 1053-1061 ◽  
Author(s):  
Terrence D Hill ◽  
Joseph L Saenz ◽  
Sunshine M Rote
Keyword(s):  
United States ◽  
Activities Of Daily Living ◽  
Cognitive Functioning ◽  
Mortality Risk ◽  
Daily Living ◽  
The United States ◽  
Religious Participation ◽  
Religious Activities ◽  
Health Selection ◽  
All Cause Mortality

Abstract Objectives Although research suggests that religious involvement tends to favor longevity, most of this work has been conducted in the United States. This article explores the association between religious participation and all-cause mortality risk in Mexico. Methods We used data from the 2003–2015 Mexican Health and Aging Study (n = 14,743) and Cox proportional hazard regression models to assess the association between religious participation and all-cause mortality risk. Results Our key finding is that older Mexicans who participate once or more per week in religious activities tend to exhibit a 19% reduction in the risk of all-cause mortality than those who never participate. This estimate persisted with adjustments for health selection (chronic disease burden, activities of daily living, instrumental activities of daily living, cognitive functioning, and depressive symptoms), several potential mediators (social support, smoking, and drinking), and a range of sociodemographic characteristics. Although we observed considerable health selection due to physical health and cognitive functioning, we found no evidence of mediation. Discussion Our results confirm that religious participation is associated with lower all-cause mortality risk among older adults in Mexico. Our analyses contribute to previous research by replicating and extending the external validity of studies conducted in the United States, Israel, Denmark, Finland, and Taiwan.

scholarly journals Caregiving, Recovery, and Death After Incident ADL/IADL Disability Among Older Adults in the United States

2019 ◽  
Vol 39 (4) ◽  
pp. 393-397 ◽  
Author(s):  
Claire K. Ankuda ◽  
Deborah A. Levine ◽  
Kenneth M. Langa ◽  
Katherine A. Ornstein ◽  
Amy S. Kelley
Keyword(s):  
United States ◽  
Older Adults ◽  
Activities Of Daily Living ◽  
Daily Living ◽  
Functional Disability ◽  
The United States ◽  
Levels Of Care ◽  
Iadl Disability ◽  
And Function ◽  
At Home

This study assesses patterns of caregiving, death, and recovery after incident disability in older adults. We used the Health and Retirement Study to follow of a cohort of adults age ≥65 years in the United States with incident disability in activities of daily living (ADLs) or instrumental activities of daily living (IADLs; n = 8,713). Rates of care and function state were assessed biennially: deceased, nursing home dwelling, at home with paid help, at home with both paid and unpaid help, at home with unpaid help, at home with no assistance and recovered. In the 2 years after incident disability, 22.1% recovered and 46.8% died. Transitions between care and function states occurred frequently, with more than 20% of the cohort living at home with no assistance despite disability at least once. This study demonstrates the high levels of care and function state fluctuation and unmet needs after functional disability.

scholarly journals Mexican American Immigrants Demonstrate Better Functional Stroke Outcomes Compared With Mexican American Nonimmigrants

Stroke ◽  
2020 ◽  
Vol 51 (10) ◽  
pp. 3129-3132 ◽  
Author(s):  
Cecilia N. Hollenhorst ◽  
River Gibbs ◽  
Sehee Kim ◽  
Charles Agyemang ◽  
Lynda Lisabeth ◽  
...  
Keyword(s):  
United States ◽  
Activities Of Daily Living ◽  
Mexican Americans ◽  
Functional Outcomes ◽  
Daily Living ◽  
Mexican American ◽  
The United States ◽  
Mean Difference ◽  
Cognitive Outcomes ◽  
Neurological Outcomes

Background and Purpose: We analyzed differences in 90-day poststroke outcomes between Mexican Americans born in the United States (nonimmigrant) compared with those born outside the United States (immigrant). Methods: We performed a retrospective analysis of prospective data from the population-based Brain Attack Surveillance in Corpus Christi project. We identified stroke cases from 2008 to 2016 and quantified functional, cognitive, and neurological outcomes. Associations between outcome scores and immigration status were analyzed using weighted linear regression models. Results: Eighty-three Mexican American stroke cases (n=935) were immigrants, and 852 stroke cases were nonimmigrants. Average length of stay in the United States for immigrants was 47 years. Immigrants were older (69 versus 66 years), more likely men (60% versus 49%), had less education on average, and were more likely to have atrial fibrillation compared with nonimmigrants. No differences in other comorbidities existed between groups. After adjustment for confounders, immigrants had better functional outcomes (activities of daily living/instrumental activities of daily living; mean difference, −0.22; P =0.02; 1–4, higher scores worse) and no difference in neurological outcomes (log-National Institutes of Health Stroke Scale; mean difference, −0.15; P =0.15; 0–44, higher scores worse) or cognitive outcomes (3 Mini-Mental State Examination; mean difference, −0.79; P =0.64; 0–100, lower scores worse). Conclusions: Long-term Mexican American immigrants in this community display better stroke functional outcomes than nonimmigrant Mexican Americans and comparable neurological and cognitive outcomes.

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