Going It Alone: Advance Directive Discordance in Older Married Couples

2019 ◽  
Vol 39 (12) ◽  
pp. 1274-1283 ◽  
Author(s):  
Catheryn S. Koss ◽  
Donna Jensen
Keyword(s):  
Advance Directive ◽  
Married Couples ◽  
Study Data ◽  
Joint Decision ◽  
Self Rated Health ◽  
Study Results ◽  
Low Education ◽  
Advance Care ◽  
Race Ethnicity ◽  
Retirement Study

Contrary to expectations of joint decision-making, a substantial minority of older married couples report only one spouse possessing an advance directive. Using Health and Retirement Study data, the authors examined advance directive discordance among heterosexual married couples in which at least one spouse had completed an advance directive. It was predicted that spouses who differed in age, self-rated health, or race/ethnicity would be more apt to adopt individualistic as opposed to relational motivational stances, resulting in higher odds of nonmatching advance directive status. Heterogamy did not account for discordance, but couples in which one or both spouses attended some college were more likely to report advance directive concordance. In contrast, couples in which one or both spouses were non-White were more likely to display advance directive discordance. Study results raise concerns about the effectiveness and reach of advance care planning promotion efforts among low-education and non-White older married adults.

scholarly journals Advance Directives and Factors Associated with the Completion in Patients with Heart Failure

2021 ◽  
Vol 18 (4) ◽  
pp. 1780
Author(s):  
JinShil Kim ◽  
Mi-Seung Shin ◽  
Albert Youngwoo Jang ◽  
Shinmi Kim ◽  
Seongkum Heo ◽  
...  
Keyword(s):  
Heart Failure ◽  
Advance Directive ◽  
Hospice Care ◽  
Study Data ◽  
Future Research ◽  
Factors Associated ◽  
Patients With Heart Failure ◽  
Ventilation Support ◽  
Advance Care ◽  
Early Discussion

Advance directive (AD) has been underutilized among patients with heart failure (HF). This study was performed to explore the ADs and examine factors associated with the completion of an AD survey in patients with HF. In a descriptive, correlational study, data on end-of-life values, treatment directives, and proxy (Korean-Advance Directive (K-AD) questionnaire) and factors associated with K-AD completion were collected among HF patients during outpatient visits. Of 67 patients (age, 67 years; male, 61.2%), 52.2% completed all or part of the K-AD. Among values, comfortable death was the most preferred (n = 15) followed by avoiding family burden (n = 6). In those completers, preferences for hospice care, cardiopulmonary resuscitation, ventilation support, and hemodialysis were 68.6%, 42.9%, 28.6%, and 28.6%, respectively. Female sex (odds ratio (OR) = 0.167), poorer HF prognosis (OR = 0.156), and better functional status (OR = 0.905) were associated with less likelihood of completing the AD survey. The findings suggest that in-depth AD discussion needs to be started earlier in patients with HF to facilitate completion of AD, especially in female patients. Future research should investigate if early discussion of ADs as part of advance care planning with integration into standard care of HF facilitates the documentation of ADs.

scholarly journals Self-Rated Health Trajectories among Married Americans: Do Disparities Persist over 20 Years?

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Terceira A. Berdahl ◽  
Julia McQuillan
Keyword(s):  
Social Class ◽  
Multilevel Models ◽  
White Men ◽  
The United States ◽  
Or Education ◽  
Self Rated Health ◽  
Study Results ◽  
Married Individuals ◽  
Race Ethnicity ◽  
Nationally Representative

The purpose of this study is to understand self-rated health (SRH) trajectories by social location (race/ethnicity by gender by social class) among married individuals in the United States. We estimate multilevel models of SRH using six observations from 1980 to 2000 from a nationally representative panel of married individuals initially aged 25–55 (Marital Instability Over the Life Course Study). Results indicate that gender, race/ethnicity, and social class are associated with initial SRH disparities. Women are less healthy than men; people of color are less healthy than whites; lower educated individuals are less healthy than higher educated individuals. Women’s health declined slower than men’s but did not differ by race/ethnicity or education. Results from complex intersectional models show that white men with any college had the highest initial SRH. Only women with any college had significantly slower declines in SRH compared to white men with any college. For married individuals of all ages, most initial SRH disparities persist over twenty years. Intersecting statuses show that education provides uneven health benefits across racial/ethnic and gender subgroups.

scholarly journals Relationship between trajectories of post-stroke disability and self-rated health (NeuroAdapt): protocol for a prospective observational study

BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e049944
Author(s):  
Sarah K Schäfer ◽  
Robert Fleischmann ◽  
Bettina von Sarnowski ◽  
Dominic Bläsing ◽  
Agnes Flöel ◽  
...  
Keyword(s):  
Observational Study ◽  
Prospective Observational Study ◽  
Tertiary Care ◽  
Functional Health ◽  
Care Hospital ◽  
Duration Of Symptoms ◽  
Post Stroke ◽  
Self Rated Health ◽  
Modifying Factors ◽  
Study Results

IntroductionStroke is the leading neurological cause of adult long-term disability in Europe. Even though functional consequences directly related to neurological impairment are well studied, post-stroke trajectories of functional health according to the International Classification of Functioning, Disability and Health are poorly understood. Particularly, no study investigated the relationship between post-stroke trajectories of activities of daily living (ADL) and self-rated health (SRH). However, such knowledge is of major importance to identify patients at risk of unfavourable courses. This prospective observational study aims to investigate trajectories of ADL and SRH, and their modifying factors in the course of the first year after stroke.Methods and analysisThe study will consecutively enrol 300 patients admitted to a tertiary care hospital with acute ischaemic stroke or transient ischaemic attack (TIA; Age, Blood Pressure, Clinical Features, Duration of symptoms, Diabetes score ≥3). Patient inclusion is planned from May 2021 to September 2022. All participants will complete an interview assessing ADL, SRH, mental health, views on ageing and resilience-related concepts. Participants will be interviewed face-to-face 1–5 days post-stroke/TIA in the hospital; and will be followed up after 6 weeks, 3 months, 6 months and 12 months via telephone. The 12-month follow-up will also include a neurological assessment. Primary endpoints are ADL operationalised by modified Rankin Scale scores and SRH. Secondary outcomes are further measures of ADL, functional health, physical activity, falls and fatigue. Views on ageing, social support, resilience-related concepts, affect, frailty, illness perceptions and loneliness will be examined as modifying factors. Analyses will investigate the bidirectional relationship between SRH and ADL using bivariate latent change score models.Ethics and disseminationThe study has been approved by the institutional review board of the University Medicine Greifswald (Ref. BB 237/20). The results will be disseminated through scientific publications, conferences and media. Moreover, study results and potential implications will be discussed with patient representatives.Trial registration numberNCT04704635.

scholarly journals A Longitudinal Study of Retirement Transition and Advance Directive Completion

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 441-441
Author(s):  
Catheryn Koss
Keyword(s):  
End Of Life ◽  
Advance Directives ◽  
Advance Directive ◽  
Multinomial Logistic Regression ◽  
Statistical Significance ◽  
Optimal Time ◽  
Retirement Transition ◽  
Multistep Process ◽  
Study Participants ◽  
Retirement Study

Abstract Advance directives (AD) help to ensure patients’ wishes are honored and contribute to improved end-of-life care. According to normative life course theory, retirement is a significant role change that signals a transition into the third age and its socially prescribed activities. To the extent that ACP is viewed as something to do when one reaches a more advanced stage in life, retirement may spark recognition that planning for incapacity and the end of life is now personally relevant and appropriate. This study tested whether transitioning from work to retirement prompted AD completion. The sample included Health and Retirement Study participants 65 and older who, in 2012, had no ADs and were not completely retired (N = 919). Retirement was operationalized as both a categorical status and as a multistep process. Three waves of data were analyzed using multinomial logistic regression to test associations between retirement transition and advance directive completion. By 2014, 21% had completed ADs and another 17% completed them by 2016. Those who completely retired between 2012 and 2014 were almost twice as likely to complete ADs between 2014 and 2016. Graduated increase in level of retirement between 2012 and 2014 was associated with higher odds of new AD possession in 2016, but did not reach statistical significance at p < .05. These results suggest the period following retirement may be an optimal time to encourage patients and clients who have not already done so to complete advance directives.

scholarly journals The Differential Effects of Caregiving Intensity on Overnight Hospitalization in the Previous 2 Years

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 76-76
Author(s):  
Kylie Meyer ◽  
Zachary Gassoumis ◽  
Kathleen Wilber
Keyword(s):  
Health Services ◽  
Fixed Effects ◽  
Regression Models ◽  
P Value ◽  
Logistic Regression Models ◽  
Spousal Caregiving ◽  
Health Insurance Status ◽  
Race Ethnicity ◽  
Self Assessed Health ◽  
Retirement Study

Abstract Caregiving for a spouse is considered a major stressor many Americans will encounter during their lifetimes. Although most studies indicate caregiving is associated with experiencing diminished health outcomes, little is known about how this role affects caregivers’ use of acute health services. To understand how spousal caregiving affects the use of acute health services, we use data from the Health and Retirement Study. We apply fixed effects (FE) logistic regression models to examine odds of experiencing an overnight hospitalization in the previous two years according to caregiving status, intensity, and changes in caregiving status and intensity. Models controlled for caregiver gender, age, race, ethnicity, educational attainment, health insurance status, the number of household residents, and self-assessed health. Overall, caregivers were no more likely to experience an overnight hospitalization compared to non-caregivers (OR 0.92; CI 0.84 to 1.00; p-value=0.057). However, effects varied according to the intensity of caregiving and the time spent in this role. Compared to non-caregivers, for example, spouses who provided care to someone with no need for assistance with activities of daily living had lower odds of experiencing a hospitalization (OR 0.77; CI 0.66 to 0.89). In contrast, caregivers who provided care to someone with dementia for 4 to <6 years had 3.29 times the odds of experiencing an overnight hospitalization (CI 1.04 to 10.38; p-value=0.042). Findings indicate that, although caregivers overall appear to use acute health services about as much as non-caregivers, large differences exist between caregivers. Results emphasize the importance of recognizing diversity within caregiving experiences.

scholarly journals Is Childhood Socioeconomic Status Related to Coronary Heart Disease? Evidence From the Health and Retirement Study (1992-2012)

2017 ◽  
Vol 3 ◽  
pp. 233372141769667 ◽  
Author(s):  
Minjee Lee ◽  
M. Mahmud Khan ◽  
Brad Wright
Keyword(s):  
Socioeconomic Status ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Later Life ◽  
Study Data ◽  
Health And Retirement Study ◽  
Increased Risk ◽  
Childhood Socioeconomic Status ◽  
Nationally Representative ◽  
Retirement Study

Objective: We investigated the association between childhood socioeconomic status (SES) and coronary heart disease (CHD) in older Americans. Method: We used Health and Retirement Study data from 1992 to 2012 to examine a nationally representative sample of Americans aged ≥50 years ( N = 30,623). We modeled CHD as a function of childhood and adult SES using maternal and paternal educational level as a proxy for childhood SES. Results: Respondents reporting low childhood SES were significantly more likely to have CHD than respondents reporting high childhood SES. Respondents reporting both low childhood and adult SES were 2.34 times more likely to have CHD than respondents reporting both high childhood and adult SES. People with low childhood SES and high adult SES were 1.60 times more likely than people with high childhood SES and high adult SES to report CHD in the fully adjusted model. High childhood SES and low adult SES increased the likelihood of CHD by 13%, compared with high SES both as a child and adult. Conclusion: Childhood SES is significantly associated with increased risk of CHD in later life among older adult Americans.

scholarly journals Managing overlap of primary study results across systematic reviews: practical considerations for authors of overviews of reviews

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Carole Lunny ◽  
Dawid Pieper ◽  
Pierre Thabet ◽  
Salmaan Kanji
Keyword(s):  
Case Studies ◽  
Systematic Reviews ◽  
Data Extraction ◽  
Methodological Approach ◽  
Study Data ◽  
Primary Study ◽  
Eligibility Criteria ◽  
Overlapping Data ◽  
Study Results ◽  
Yield Trends

Abstract Background Overviews often identify and synthesise a large number of systematic reviews on the same topic, which is likely to lead to overlap (i.e. duplication) in primary studies across the reviews. Using a primary study result multiple times in the same analysis overstates its sample size and number of events, falsely leading to greater precision in the analysis. This paper aims to: (a) describe types of overlapping data that arise from the same primary studies reported across multiple reviews, (b) describe methods to identify and explain overlap of primary study data, and (c) present six case studies illustrating different approaches to manage overlap. Methods We first updated the search in PubMed for methods from the MOoR framework relating to overlap of primary studies. One author screened the studies titles and abstracts, and any full-text articles retrieved, extracted methods data relating to overlap of primary studies and mapped it to the overlap methods from the MOoR framework. We also describe six case studies as examples of overviews that use specific overlap methods across the steps in the conduct of an overview. For each case study, we discuss potential methodological implications in terms of limitations, efficiency, usability, and resource use. Results Nine methods studies were found and mapped to the methods identified by the MOoR framework to address overlap. Overlap methods were mapped across four steps in the conduct of an overview – the eligibility criteria step, the data extraction step, the assessment of risk of bias step, and the synthesis step. Our overview case studies used multiple methods to reduce overlap at different steps in the conduct of an overview. Conclusions Our study underlines that there is currently no standard methodological approach to deal with overlap in primary studies across reviews. The level of complexity when dealing with overlap can vary depending on the yield, trends and patterns of the included literature and the scope of the overview question. Choosing a method might be dependent on the number of included reviews and their primary studies. Gaps in evaluation of methods to address overlap were found and further investigation in this area is needed.

scholarly journals Prevalence of and Factors Associated With Extramarital Sex Among Nigerian Men

2009 ◽  
Vol 4 (2) ◽  
pp. 124-134 ◽  
Author(s):  
Kola Oyediran ◽  
Uche C. Isiugo-Abanihe ◽  
Bamikale J. Feyisetan ◽  
Gbenga P. Ishola
Keyword(s):  
Hiv Infection ◽  
Condom Use ◽  
Sexual Debut ◽  
Married Couples ◽  
Consistent Condom ◽  
Factors Associated ◽  
Extramarital Sex ◽  
Study Results ◽  
The Family ◽  
Gender Based

This study used data on currently married and cohabiting men aged 15 to 64 years from the 2003 Nigeria Demographic and Health Survey to examine the prevalence of and factors associated with extramarital sex. The results show that 16% engaged in extramarital sex in the 12 months preceding the survey and had an average of 1.82 partners. The results also show statistically significant association between extramarital sex and ethnicity, religion, age, age at sexual debut, education, occupation, and place of residence. Based on the study results, it could be concluded that significant proportions of Nigerians are exposed to HIV infection through extramarital sex. A fundamental behavioral change expected in the era of HIV/AIDS is the inculcation of marital fidelity and emotional bonding between marital partners. The promotion of condom use among married couples should be intensified to protect women, a large number of whom are exposed to HIV infection from their spouses who engage in unprotected extramarital sex. And, because of gender-based power imbalances within the family, a large number of the women are unable to negotiate consistent condom use by their partners.

Do intraday week effect in currencies hourly trading reflect leverage and asymmetric anomalies? Policy implications for traders

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Wajid Shakeel Ahmed ◽  
Muhammad Sohaib ◽  
Jamal Maqsood ◽  
Ateeb Siddiqui
Keyword(s):  
Emerging Economies ◽  
Garch Model ◽  
Study Data ◽  
Policy Implications ◽  
Asymmetric Effect ◽  
Data Set ◽  
Content Type ◽  
Study Results ◽  
Rational Choices ◽  
Trading Pattern

Purpose The purpose of this study is to determine if intraday week (IDW) effect of the currencies reflect leverage and asymmetric impact in currencies market. The study data set comprises of intraday patterns of 15 currencies from developed and emerging economies. Design methodology approach The study applies the exponential generalized autoregressive conditional heteroscedasticity (E-GARCH) model technique to observe the IDW leverage and asymmetric effect after introducing hourly dummies variables, namely, IDWmon, IDWwed, IDWfrid and IDWfrid-mon. Findings The study results favor the propositions and confirm that IDW effect do exist in the international forex markets in relation to hourly trading pattern for respective currencies. Mostly, currencies do depreciate on Monday and Wednesday compared to the rest of the days. However, on the last trading day, i.e. Friday currencies observe an appreciation pattern which is for both economies. The results have an evidence of leverage and asymmetric effect confirmed by the E-GARCH model as a result of press releases and influence by micro-factors in the currency markets. Practical implications The study believes to have theoretical connection related to the better understanding of currencies trend for developed and emerging economies, as the IDW effect exists. Moreover, confirmation of both the leverage and asymmetric effect in observed currencies would be able to assist the investors in making rational choices during the trading hours and would confirm considerable profits through profit incentivized strategies. Originality value The study not only add knowledge to the previous study work in relation to the hourly trading pattern of currencies with reference to the IDW effects but also highlights the leverage and asymmetric effect in currencies that will help in formulating future trading strategies particular to emerging economies.

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