scholarly journals Multimorbidity: Constellations of Conditions across Subgroups of Midlife and Older Individuals, and Related Medicare Expenditures

2017 ◽  
Vol 7 (1) ◽  
pp. 33-43 ◽  
Author(s):  
Siran M. Koroukian ◽  
Nicholas K. Schiltz ◽  
David F. Warner ◽  
Jiayang Sun ◽  
Kurt C. Stange ◽  
...  
Keyword(s):  
Older Adults ◽  
Activities Of Daily Living ◽  
Chronic Conditions ◽  
Daily Living ◽  
Functional Limitations ◽  
Upper Body ◽  
Multiple Chronic Conditions ◽  
Fee For Service ◽  
Geriatric Syndromes ◽  
Older Individuals

Introduction: The Department of Health and Human Services’ 2010 Strategic Framework on Multiple Chronic Conditions called for the identification of common constellations of conditions in older adults. Objectives: To analyze patterns of conditions constituting multimorbidity (CCMM) and expenditures in a US representative sample of midlife and older adults (50–64 and ≥65 years of age, respectively). Design: A cross-sectional study of the 2010 Health and Retirement Study (HRS; n=17,912). The following measures were used: (1) count and combinations of CCMM, including (i) chronic conditions (hypertension, arthritis, heart disease, lung disease, stroke, diabetes, cancer, and psychiatric conditions), (ii) functional limitations (upper body limitations, lower body limitations, strength limitations, limitations in activities of daily living, and limitations in instrumental activities of daily living), and (iii) geriatric syndromes (cognitive impairment, depressive symptoms, incontinence, visual impairment, hearing impairment, severe pain, and dizziness); and (2) annualized 2011 Medicare expenditures for HRS participants who were Medicare fee-for-service beneficiaries ( n=5,677). Medicaid beneficiaries were also identified based on their self-reported insurance status. Results: No large representations of participants within specific CCMM categories were observed; however, functional limitations and geriatric syndromes were prominently present with higher CCMM counts. Among fee-for-service Medicare beneficiaries aged 50–64 years, 26.7% of the participants presented with ≥10 CCMM, but incurred 48% of the expenditure. In those aged ≥65 years, these percentages were 16.9% and 34.4%, respectively. Conclusion: Functional limitations and geriatric syndromes considerably add to the MM burden in midlife and older adults. This burden is much higher than previously reported.

scholarly journals Differences in Self-Rated Memory by Race/Ethnicity

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 551-551
Author(s):  
Yujin Franco ◽  
Joseph Saenz ◽  
Yuri Jang ◽  
Jessica Ho
Keyword(s):  
Older Adults ◽  
Activities Of Daily Living ◽  
Chronic Conditions ◽  
Daily Living ◽  
Functional Limitations ◽  
Religious Practice ◽  
Cultural Factors ◽  
Race Ethnicity ◽  
Social And Cultural Factors ◽  
Memory Status

Abstract Self-rated memory is an important dimension of well-being among older adults that has also been linked to cognitive impairment over the long term. However, few studies based on nationally-representative samples have examined differences in self-rated memory by race/ethnicity. This study explores differences in self-rated memory across non-Hispanic White, non-Hispanic Black, and Hispanic older adults in the United States. Data were drawn from the 2011 wave of the National Health and Aging Trends Study (NHATS). The sample consisted of older adults aged 65 and older (N=4,753 non-Hispanic Whites, N=1,442 non-Hispanic Blacks, and N=388 Hispanics). Logistic regression was used to examine the association between having poor/fair self-rated memory and race/ethnicity, controlling for socio-demographic characteristics (age, gender, education level, income, and marital status), chronic conditions (heart attack, hypertension, diabetes, stroke, and depressive symptoms), objective memory status, functional limitations (activities of daily living and instrumental activities of daily living), and other social and cultural factors (economic vulnerability, religious practice, and limited English proficiency). I find that non-Hispanic Blacks and Hispanics have significantly higher odds of reporting poor/fair self-rated memory than non-Hispanic Whites. Compared to non-Hispanic Whites, Blacks and Hispanics had 33% and 56% higher odds of reporting poor/fair self-rated memory, respectively, controlling for sociodemographic characteristics, chronic conditions, objective memory status, functional limitations, and social and cultural factors. These results provide evidence that understanding differences in self-rated memory across racial/ethnic groups may have important implications for health professionals, particularly in relation to conducting and interpreting cognitive screening assessments.

Abstract 251: Geriatric Syndromes Associated With Reduced Anticoagulant Use in Older Adults With Atrial Fibrillation

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Sachin J Shah ◽  
Margaret C Fang ◽  
Sun Jeon ◽  
Steven Gregorich ◽  
Kenneth Covinsky
Keyword(s):  
Atrial Fibrillation ◽  
Older Adults ◽  
Activities Of Daily Living ◽  
Daily Living ◽  
Stroke Risk ◽  
Geriatric Syndrome ◽  
Fee For Service ◽  
Geriatric Syndromes ◽  
Cross Sectional ◽  
Representative Study

Background: While guidelines recommend focusing primarily on stroke risk when considering anticoagulants in atrial fibrillation (AF), physicians report that geriatric syndromes (e.g., falls, disability) are important when considering anticoagulants. However, little is known about the prevalence of geriatric syndromes in older adults with AF or the association with anticoagulant use. Methods: We performed a cross-sectional analysis of the 2014 Health and Retirement Study, a nationally representative study of older adults. We included patients ≥67 years with 2 years of continuous Medicare fee-for-service enrollment and 1 inpatient or 2 outpatient AF diagnosis claims. We evaluated five geriatric syndromes: falls, activities of daily living impairment (ADL), instrumental activities of daily living impairment (IADL), cognitive impairment, and incontinence. We measured their prevalence and associations with anticoagulant use via log-binomial regression models adjusting for CHA2DS2-VASc score. Results: In this study of 779 patients with AF (median age 80 years, median CHA2DS2-VASc score 4), 83% (CI 79-86%) had ≥1 geriatric syndrome. Adjusting for stroke risk, lower rates of anticoagulant use were reported in those with ADL dependency (RR 0.87, CI 0.79-99), IADL dependency (RR 0.86, CI 0.77-0.98), and dementia (RR 0.72, CI 0.60-0.86). Conclusion: Most older patients with AF have at least one geriatric syndrome, and geriatrics syndromes are associated with less anticoagulant use. The high prevalence of geriatric syndromes may explain the lower than expected anticoagulants use in older adults. Since the benefits and harms of anticoagulants in this group are ill-defined, it is unclear if lower anticoagulant use is appropriate.

Informal Caregivers of elderly people: an european review

1992 ◽  
Vol 12 (03) ◽  
pp. 369-380 ◽  
Author(s):  
Gilbert Dooghe
Keyword(s):  
Older Adults ◽  
Activities Of Daily Living ◽  
Chronic Conditions ◽  
Daily Living ◽  
Functional Limitations ◽  
Good Health ◽  
Age Group ◽  
Mental Disabilities ◽  
Growing Age ◽  
European Review

Europe is experiencing a rapid increase in the numbers and proportions of the very old, and the number of older adults with chronic or longstanding diseases and functional limitations is rising. Between 1980 and 2025, the population aged 80 years and over is projected to increase 2·15 times, from in million in 1980 to 23·7 million. As those aged 80 years and over have been the most rapidly growing age-group, it is evident that the prevalence of physical and mental disabilities is of concern. Many suffer from chronic conditions which compromise daily living, although a substantial group are in good health and with little disability.203 Nevertheless as the average age increases, more people need some form of assistance with the activities of daily living, such as bathing, dressing, eating, preparing meals and errands (ADL). Reaching the age of 80 years does not necessarily mean losing one's independence; nevertheless the risk increases with age.

scholarly journals Number of chronic conditions and associated functional limitations among older adults: cross-sectional findings from the longitudinal aging study in India

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Palak Sharma ◽  
Priya Maurya ◽  
T. Muhammad
Keyword(s):  
Older Adults ◽  
Heart Disease ◽  
Activities Of Daily Living ◽  
Lung Disease ◽  
Chronic Conditions ◽  
Daily Living ◽  
Functional Limitations ◽  
Older Men ◽  
Psychiatric Disease ◽  
Related Disease

Abstract Background Chronic conditions reduce the likelihood of physical functioning among older adults. However, the contribution of most prevalent diseases and multimorbidity to different measures of functional limitations is relatively underexplored among Indian older adults. The present study explores the prospective association between number of chronic conditions and limitations in activities of daily living (ADL) and instrumental activities of daily living (IADL) among older adults in India. Methods This study utilized data from the nationally representative Longitudinal Ageing Study in India (LASI-2017-18). The effective sample size was 31,464 older adults aged 60 years and above. Descriptive statistics along with cross-tabulation were presented in the study. Additionally, binary logistic regression analysis was used to fulfil the objectives. The outcome variables were dichotomized; high representing no difficulty in ADL/IADL and low representing a difficulty in at least one ADL/IADL. The chronic conditions included hypertension, diabetes, neurological/psychiatric disease, lung disease, heart diseases, stroke, and bone-related disease. The number of chronic diseases was categorized into no disease, single, two and three plus based on number of reported disease. Results 26.36% of older women and 20.87% of older men had low ADL and the figures for low IADL were 56.86 and 38.84% for older men and women respectively. The likelihood of low ADL (AOR: 1.698, CI:1.544, 1.868) and low IADL (AOR: 1.197; CI: 1.064, 1.346) was higher among womenthan men. With increasing age, the prevalence of low ADL increased among older adults. Respondents with pre-existing chronic conditions had higher likelihood of low ADL and IADL. Older adults with hypertension, psychiatric disease, heart disease, stroke and bone-related disease had significantly higher odds of reporting low IADL. The chances of low ADL and IADL were 2.156 (CI: 1.709, 2.719) and 2.892 (CI: 2.067, 4.047) times respectively higher among older adults with more than three chronic conditions. After controlling for socio-economic and health-related covariates, it was found that men with more than three pre-existing chronic conditions had higher odds of low ADL than women. On the other hand, low IADL were found higher among women with more than three pre-existing chronic conditions. Conclusions The present study demonstrates a significant burden of functional limitations among older individuals and that there is a strong association between pre-existing chronic conditions and functional disability. Those with hypertension, diabetes, psychiatric disorders, heart disease, stroke, lung disease or bone-related diseases should be effectively monitored to predict future functional limitations, which may lead to worsening health.

scholarly journals Meanings of Care Convoys: The Structure, Function, and Adequacy of Care Networks Among Frail, Community-Dwelling Older Adults

2019 ◽  
Vol 30 (4) ◽  
pp. 583-597
Author(s):  
Deborah Lambotte ◽  
An-Sofie Smetcoren ◽  
G. A. Rixt Zijlstra ◽  
Jan De Lepeleire ◽  
Liesbeth De Donder ◽  
...  
Keyword(s):  
Older Adults ◽  
Activities Of Daily Living ◽  
Daily Living ◽  
Community Dwelling ◽  
Older Individuals ◽  
Structured Interviews ◽  
Wide Range ◽  
Relational Aspect ◽  
Health Care Monitoring ◽  
Community Dwelling Older Adults

Researchers propose that the convoy of care model should be used to study care networks of frail, older individuals. Care convoys are defined as the evolving collection of individuals who may or may not have close personal connections to the recipient or to one another, but who provide care, including help with activities of daily living (ADLs) and instrumental activities of daily living (IADLs), socio-emotional care, skilled health care, monitoring, and advocacy. This study reports on community-dwelling older adults’ experiences of their care convoy, how care convoys change over time, and perceived (positive) outcomes. A qualitative analysis among 65 semi-structured interviews with frail, community-dwelling older adults demonstrates a great variety in the composition of care convoys. Participants were often actively involved in their care convoy and valued the social/relational aspect of care. Care and support covered a wide range of activities, with some activities being provided by specific types of caregivers. Participants expressed the adequacy of their care convoy in terms of satisfaction and sufficiency. Noteworthy, participants who were satisfied with their care convoy did not necessarily receive sufficient help. Policies and practice should recognize the relational aspect of care, the complex interplay between all actors, and the dynamic character of care convoys.

scholarly journals Fresh and Lean Pork Intake in Relation to Functional Limitations Among U.S. Older Adults, 2005–2016 (P18-002-19)

2019 ◽  
Vol 3 (Supplement_1) ◽  
Author(s):  
Ruopeng An ◽  
Sharon Nickols-Richardson ◽  
Reginald Alston ◽  
Sa Shen ◽  
Caitlin Clarke
Keyword(s):  
Older Adults ◽  
Activities Of Daily Living ◽  
Measurement Errors ◽  
Daily Living ◽  
Functional Limitations ◽  
Functional Limitation ◽  
Preliminary Evidence ◽  
Cross Sectional ◽  
Pork Consumption ◽  
Lean Pork

Abstract Objectives This study assessed fresh and lean pork intake in relation to functional limitations among U.S. older adults 65 years and older. Methods Nationally-representative sample (N = 27,117) from 2005–2016 National Health and Nutrition Examination Survey (NHANES) were analyzed. Logistic regressions were performed to estimate the odds ratios of activities of daily living limitation (ADLs), instrumental activities of daily living limitation (IADLs), leisure and social activities limitation (LSAs), lower extremity mobility limitation (LEM), general physical activities limitation (GPAs), and any functional limitation with respect to daily pork, fresh pork, and fresh lean pork consumption, adjusting for individual charteristics including sex, age, race/ethnicity, education, marital status, obesity, smoking, self-rated health, chronic conditions, and survey wave. Results Approximately 21%, 18%, and 16% of older adults consumed pork, fresh pork, and fresh lean pork, respectively. The rates of ADL, IADLs, LSAs, LEM, GPAs, and any functional limitations were 22%, 32%, 23%, 22%, 66%, and 70% among NHANES older adults, respectively. A daily increase in pork consumption by 1 ounce-equivalent was associated with a reduction in the odds of ADLs by 12% (OR = 0.88; 95% CI = 0.78, 0.98), IADLs by 10% (OR = 0.90, 95% CI = 0.82, 0.99), and any functional limitation by 7% (OR = 0.93, 95% CI = 0.86, 0.99). A daily increase in fresh pork consumption by 1 ounce-equivalent was associated with a reduction in the odds of ADLs by 13% (OR = 0.87; 95% CI = 0.78, 0.97), IADLs by 10% (OR = 0.90, 95% CI = 0.82, 0.99), GPAs by 8% (OR = 0.92; 95% CI = 0.85, 0.99), and any functional limitation by 8% (OR = 0.92, 95% CI = 0.85, 0.99). Similar effects were found for fresh lean pork consumption on ADLs, IADLs, GPAs, and any functional limitation. No association between pork consumption and LSAs or LEM was identified. Conclusions This study found some preliminary evidence linking fresh and fresh lean pork consumption to reduced risk of functional limitations. This study has limitations pertaining to measurement errors and cross-sectional study design. Future studies with longitudinal/experimental designs are warranted to examine the influence of fresh and lean pork consumption on functional limitations among older adults. Funding Sources National Pork Board.

scholarly journals Association of late-life depression with cognitive impairment: evidence from a cross-sectional study among older adults in India

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
T. Muhammad ◽  
Trupti Meher
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Activities Of Daily Living ◽  
Urban Areas ◽  
Daily Living ◽  
Short Form ◽  
Late Life ◽  
Older Individuals ◽  
Late Life Depression ◽  
Increased Risk

Abstract Background Late-life depression (LLD) is considered as a prodrome to dementia and plays a major role in the development of long-term cognitive disabilities. We aimed to estimate the prevalence and correlates of LLD and cognitive impairment and to explore their associations among older adults in India. Methods Data for this study was derived from the Longitudinal Ageing Study in India (LASI) Wave 1 (2017-18). The total sample included 31,464 (15,098 male and 16,366 female) older individuals aged 60 years and above. Cognitive impairment measured from various domains derived from the cognitive module of the Health and Retirement Study (HRS), and major depression measured by the CIDI-SF (Composite International Diagnostic Interview- Short Form) were the outcome variables. Descriptive, bivariate, and multivariable analyses were performed to fulfill the objectives of the study. Results The overall prevalence of LLD and cognitive impairment for the current sample was 8.7% and 13.7 % respectively. Among older individuals who have rated their health status as poor were 2.59 times more likely to suffer from LLD [OR: 2.59, CI: 2.24–2.99] as compared to their counterparts. The older adults who had difficulty in activities of daily living (ADL) and instrumental activities of daily living (IADL) were 74% and 69 % more likely to suffer from LLD. Similarly, older adults who were depressed had higher odds of cognitive impairment [OR: 1.22, CI: 1.01–1.48] compared to their counterparts. Also, older adults who were depressed and belonged to rural areas were 2.58 times [AOR: 2.58, CI: 1.95–3.41] more likely to be cognitively impaired than those who were not depressed and resided in urban areas. Conclusions Depression is linked to an increased risk of cognitive decline and dementia; therefore, failing to diagnose and treat LLD in later life may have significant health implications. Moreover, treatment under the care of a cognitive neurologist or geriatric psychiatrist is recommended for people with LLD and cognitive disability due to both the disorders' complex existence.

scholarly journals Gait Speed and Instrumental Activities of Daily Living in Older Adults After Hospitalization: A Longitudinal Population-Based Study

2021 ◽  
Author(s):  
Juraj Sprung ◽  
Mariana Laporta ◽  
David S Knopman ◽  
Ronald C Petersen ◽  
Michelle M Mielke ◽  
...  
Keyword(s):  
Older Adults ◽  
Activities Of Daily Living ◽  
Functional Status ◽  
Gait Speed ◽  
Daily Living ◽  
Functional Limitations ◽  
Parameter Estimate ◽  
Population Based ◽  
Instrumental Activities

Abstract Background Hospitalization can impair physical and functional status of older adults, but it is unclear whether these deficits are transient or chronic. This study determined the association between hospitalization of older adults and changes in long-term longitudinal trajectories of two measures of physical and functional status: gait speed (GS) and Instrumental Activities of Daily Living measured with Functional Activities Questionnaire (FAQ). Methods Linear mixed effects models assessed the association between hospitalization (non-elective vs. elective, and surgical vs. medical) and outcomes of GS and FAQ score in participants (>60 years old) enrolled in the Mayo Clinic Study of Aging who had longitudinal assessments. Results Of 4,902 participants, 1,879 had ≥1 hospital admission. Median GS at enrollment was 1.1 m/s. The slope of the annual decline in GS before hospitalization was -0.015 m/s. The parameter estimate [95%CI] for additional annual change in GS trajectory after hospitalization was -0.009 [-0.011 to -0.006] m/s, P<0.001. The accelerated GS decline was greater for medical vs. surgical hospitalizations (-0.010 vs. -0.003 m/s, P=0.005), and non-elective vs. elective hospitalizations (-0.011 vs -0.006 m/s, P=0.067). The odds of a worsening FAQ-score increased on average by 4% per year. Following hospitalization, odds of FAQ-score worsening further increased (multiplicative annual increase in odds ratio per year [95%C] following hospitalization was 1.05 [1.03, 1.07], P<0.001). Conclusions Hospitalization of older adults is associated with accelerated long-term decline in GS and functional limitations, especially after non-elective admissions and those for medical indications. However, for most well-functioning participants these changes have little clinical significance.

Timing of onset and self-management of multiple chronic conditions: A qualitative examination taking a lifespan perspective

2018 ◽  
Vol 16 (3) ◽  
pp. 173-189 ◽  
Author(s):  
Allison R Heid ◽  
Andrew R Gerber ◽  
David S Kim ◽  
Stefan Gillen ◽  
Seran Schug ◽  
...  
Keyword(s):  
Older Adults ◽  
Social Life ◽  
Chronic Conditions ◽  
Self Management ◽  
Multiple Chronic Conditions ◽  
Older Individuals ◽  
Structured Interviews ◽  
Targeted Interventions ◽  
Timing Of Onset ◽  
Management Behaviors

Objectives Over two-thirds of older individuals live with multiple chronic conditions, yet chronic diseases are often studied in silos. Taking a lifespan approach to understanding the development of multiple chronic conditions in the older population helps to further elucidate opportunities for targeted interventions that address the complexities of multiple chronic conditions. Methods Semi-structured interviews were conducted with 38 older adults (age 64+) diagnosed with at least two chronic health conditions. Content analysis was used to build understanding of how older adults discuss the timing of diagnoses and subsequent self-management of multiple chronic conditions. Results Findings highlight the complex process by which illnesses unfold in the context of individuals’ lives and the subsequent engagement and/or disengagement in self-management behaviors. Two primary themes were evident regarding timing of illnesses: illnesses were experienced within the context of social life events and/or health events, and illnesses were not predominantly seen as connected to one another by patients. Self-management behaviors were described in response to onset of each illness. Discussion Findings provide insight into how older adults understand their experience of multiple chronic conditions and change in self-management behaviors over time. In order for practitioners to ignite behavioral changes, a person’s history and life experiences must be considered.

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