Obesity and Polypharmacy among African American Older Adults: Gender as the Moderator and Multimorbidity as the Mediator

Despite high prevalence of obesity and polypharmacy among African American (AA) older adults, little information exists on the associations between the two in this population. This study explored the association between obesity and polypharmacy among AA older adults who were residing in poor urban areas of South Los Angeles. We also investigated role of gender as the moderator and multimorbidity as the mediator of this association. In a community-based study in South Los Angeles, 308 AA older adults (age ≥ 55 years) were entered into this study. From this number, 112 (36.4%) were AA men and 196 (63.6%) were AA women. Polypharmacy (taking 5+ medications) was the dependent variable, obesity was the independent variable, gender was the moderator, and multimorbidity (number of chronic medical conditions) was the mediator. Age, educational attainment, financial difficulty (difficulty paying bills, etc.), income, marital status, self-rated health (SRH), and depression were the covariates. Logistic regressions were used for data analyses. In the absence of multimorbidity in the model, obesity was associated with higher odds of polypharmacy in the pooled sample. This association was not significant when we controlled for multimorbidity, suggesting that multimorbidity mediates the obesity-polypharmacy link. We found significant association between obesity and polypharmacy in AA women not AA men, suggesting that gender moderates such association. AA older women with obesity are at a higher risk of polypharmacy, an association which is mainly due to multimorbidity. There is a need for screening for inappropriate polypharmacy in AA older women with obesity and associated multimorbidity.

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Associations between Polypharmacy, Self-Rated Health, and Depression in African American Older Adults; Mediators and Moderators

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16091574 ◽

2019 ◽

Vol 16 (9) ◽

pp. 1574 ◽

Cited By ~ 8

Author(s):

Mohsen Bazargan ◽

James Smith ◽

Mohammed Saqib ◽

Hamid Helmi ◽

Shervin Assari

Keyword(s):

Older Adults ◽

African American ◽

Los Angeles ◽

Older Women ◽

Community Based ◽

South Los Angeles ◽

Self Rated Health ◽

Dependent Variables ◽

Independent Variable ◽

Logistic Regressions

Background. Despite the prevalence of multimorbidity among African American (AA) older adults, little information exists on correlates of polypharmacy (using 5+ medications) in AA older adults. There is more information available regarding the link between polypharmacy and physical aspects of health than subjective ones. Aims. In a local sample of AA older adults in Los Angeles, this study investigated the association of polypharmacy with self-rated health (SRH) and depression. We also explored gender differences in these links. Methods. This community-based study was conducted in south Los Angeles. A total number of 708 AA older adults (age ≥ 55 years) were entered into this study. From this number, 253 were AA men and 455 were AA women. Polypharmacy was the independent variable. Self-rated health (SRH) and depression were the dependent variables. Age, educational attainment, financial difficulty (difficulty paying bills, etc.), and marital status were covariates. Gender was the moderator. Multimorbidity, measured as the number of chronic diseases (CDs), was the mediator. Logistic regressions were applied for data analysis. Results. Polypharmacy was associated with worse SRH and depression. Multimorbidity fully mediated the association between polypharmacy and depressive symptoms. Multimorbidity only partially mediated the association between polypharmacy and poor SRH. Gender moderated the association between polypharmacy and SRH, as polypharmacy was associated with poor SRH in women but not men. Gender did not alter the association between polypharmacy and depression. Conclusions. AA older women with polypharmacy experience worse SRH and depression, an association which is partially due to the underlying multimorbidity. There is a need for preventing inappropriate polypharmacy in AA older adults, particularly when addressing poor SRH and depression in AA older women with multimorbidity.

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Emergency Department Utilization among Underserved African American Older Adults in South Los Angeles

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16071175 ◽

2019 ◽

Vol 16 (7) ◽

pp. 1175 ◽

Cited By ~ 7

Author(s):

Mohsen Bazargan ◽

James Smith ◽

Sharon Cobb ◽

Lisa Barkley ◽

Cheryl Wisseh ◽

...

Keyword(s):

Older Adults ◽

Emergency Department ◽

African American ◽

Los Angeles ◽

Continuity Of Care ◽

Chronic Conditions ◽

Male Gender ◽

Multiple Chronic Conditions ◽

South Los Angeles ◽

Ed Visits

Objectives: Using the Andersen’s Behavioral Model of Health Services Use, we explored social, behavioral, and health factors that are associated with emergency department (ED) utilization among underserved African American (AA) older adults in one of the most economically disadvantaged urban areas in South Los Angeles, California. Methods: This cross-sectional study recruited a convenience sample of 609 non-institutionalized AA older adults (age ≥ 65 years) from South Los Angeles, California. Participants were interviewed for demographic factors, self-rated health, chronic medication conditions (CMCs), pain, depressive symptoms, access to care, and continuity of care. Outcomes included 1 or 2+ ED visits in the last 12 months. Polynomial regression was used for data analysis. Results: Almost 41% of participants were treated at an ED during the last 12 months. In all, 27% of participants attended an ED once and 14% two or more times. Half of those with 6+ chronic conditions reported being treated at an ED once; one quarter at least twice. Factors that predicted no ED visit were male gender (OR = 0.50, 95% CI = 0.29–0.85), higher continuity of medical care (OR = 1.55, 95% CI = 1.04–2.31), individuals with two CMCs or less (OR = 2.61 (1.03–6.59), second tertile of pain severity (OR = 2.80, 95% CI = 1.36–5.73). Factors that predicted only one ED visit were male gender (OR = 0.45, 95% CI = 0.25–0.82), higher continuity of medical care (OR = 1.39, 95% CI = 1.01–2.15) and second tertile of pain severity (OR = 2.42, 95% CI = 1.13–5.19). Conclusions: This study documented that a lack of continuity of care for individuals with multiple chronic conditions leads to a higher rate of ED presentations. The results are significant given that ED visits may contribute to health disparities among AA older adults. Future research should examine whether case management decreases ED utilization among underserved AA older adults with multiple chronic conditions and/or severe pain. To explore the generalizability of these findings, the study should be repeated in other settings.

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Insomnia Symptoms among African-American Older Adults in Economically Disadvantaged Areas of South Los Angeles

Brain Sciences ◽

10.3390/brainsci9110306 ◽

2019 ◽

Vol 9 (11) ◽

pp. 306 ◽

Cited By ~ 2

Author(s):

Mohsen Bazargan ◽

Nadia Mian ◽

Sharon Cobb ◽

Roberto Vargas ◽

Shervin Assari

Keyword(s):

Older Adults ◽

African American ◽

Los Angeles ◽

Linear Regression ◽

Pain Intensity ◽

Economically Disadvantaged ◽

Financial Difficulty ◽

South Los Angeles ◽

Insomnia Symptoms ◽

African American Older Adults

Background. Although psychosocial and health factors impact insomnia symptoms, less is known about these effects in economically disadvantaged African-American older adults. Aims. This study investigated social and health determinants of insomnia symptoms among economically disadvantaged African-American older adults. Methods. This survey enrolled 398 African-American older adults (age ≥ 65 years) from economically disadvantaged areas of South Los Angeles. Gender, age, educational attainment, financial difficulty, number of chronic diseases, self-rated health, pain intensity, and depression were covariates. Total insomnia, insomnia symptoms, and insomnia impact were our outcomes. Linear regression was applied for data analysis. Results. Based on linear regression, higher financial difficulty (B = 0.48, 95% CI = 0.35–0.61), smoking status (B = 1.64, 95% CI = 0.13–3.16), higher pain intensity (B = 0.39, 95% CI = 0.11–0.67), higher number of chronic diseases (B = 0.34, 95% CI = 0.05–0.64), and more depressive symptoms (B = 0.35, 95% CI = 0.12–0.57) were associated with a higher frequency of insomnia symptoms. Based on a logistic regression model, lower age (B = 0.91, 95% CI = 0.91–1.00) and high financial difficulty (OR = 1.15, 95% CI = 1.08–1.24), pain (OR = 2.08, 95% CI = 1.14–3.80), chronic disease (OR = 1.27, 95% CI = 1.07–1.51) and depression (OR = 2.38, 95% CI = 1.22–4.65) were associated with higher odds of possible clinical insomnia. We also found specific predictors for insomnia symptoms and insomnia impact. Conclusions. Among African-American older adults in economically disadvantaged areas of South Los Angeles, insomnia symptoms co-occur with other economic, physical, and mental health challenges such as financial difficulty, smoking, multimorbidity, pain, and depression. There is a need to address sleep as a component of care of economically disadvantaged African-American older adults who have multiple social and health challenges.

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Medication Complexity among Disadvantaged African American Seniors in Los Angeles

Pharmacy ◽

10.3390/pharmacy8020086 ◽

2020 ◽

Vol 8 (2) ◽

pp. 86

Author(s):

Edward Adinkrah ◽

Mohsen Bazargan ◽

Cheryl Wisseh ◽

Shervin Assari

Keyword(s):

Older Adults ◽

African American ◽

Los Angeles ◽

Low Income ◽

Living Arrangements ◽

Healthcare Providers ◽

Multiple Chronic Conditions ◽

Health Maintenance ◽

South Los Angeles ◽

African American Older Adults

Background. Several publications highlight data concerning multiple chronic conditions and the medication regimen complexity (MRC) used in managing these conditions as well as MRCs’ association with polypharmacy and medication non-adherence. However, there is a paucity of literature that specifically details the correlates of MRC with multimorbidity, socioeconomic, physical and mental health factors in disadvantaged (medically underserved, low income) African American (AA) seniors. Aims. In a local sample in South Los Angeles, we investigated correlates of MRC in African American older adults with chronic disease(s). Methods. This was a community-based survey in South Los Angeles with 709 African American senior participants (55 years and older). Age, gender, continuity of care, educational attainment, multimorbidity, financial constraints, marital status, and MRC (outcome) were measured. Data were analyzed using linear regression. Results. Higher MRC correlated with female gender, a higher number of healthcare providers, hospitalization events and multimorbidity. However, there were no associations between MRC and age, level of education, financial constraint, living arrangements or health maintenance organization (HMO) membership. Conclusions. Disadvantaged African Americans, particularly female older adults with multimorbidity, who also have multiple healthcare providers and medications, use the most complex medication regimens. It is imperative that MRC is reduced particularly in African American older adults with multimorbidity.

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Chronic Respiratory Disease and Health-Related Quality of Life of African American Older Adults in an Economically Disadvantaged Area of Los Angeles

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16101756 ◽

2019 ◽

Vol 16 (10) ◽

pp. 1756 ◽

Cited By ~ 4

Author(s):

Mohsen Bazargan ◽

James L. Smith ◽

Paul Robinson ◽

John Uyanne ◽

Ruqayyah Abdulrahoof ◽

...

Keyword(s):

Older Adults ◽

African American ◽

Los Angeles ◽

Urban Areas ◽

Economically Disadvantaged ◽

Disadvantaged Area ◽

Related Quality ◽

Health Related ◽

African American Older Adults

Background. Most of the attention of policy makers, program planners, clinicians, and researchers in the area of physical health disparities among African American older adults has been traditionally focused on cardiometabolic disease and cancer. Among a long list of chronic medical conditions, chronic respiratory conditions (CRCs), such as asthma, chronic bronchitis, and emphysema, have received less attention. Purpose. This study investigated whether CRCs contribute to physical and mental health-related quality of life (HRQoL) of African American older adults who live in economically disadvantaged urban areas, and whether these effects are due to demographic factors, socioeconomic status (SES), health behaviors, and comorbid medical and mental conditions. Methods. This community-based study recruited 617 African American older adults (age ≥ 65 years) from Service Planning Areas (SPA) 6, an economically disadvantaged area in South Los Angeles. Structured face-to-face interviews were used to collect data on demographic factors (age and gender), SES (educational attainment and financial difficulty), living arrangements, marital status, health behaviors (cigarette smoking and alcohol drinking), health (CRC, number of comorbid medical conditions, depressive symptoms, and pain intensity), and physical and mental HRQoL (Physical and Mental Component Summary Scores; PCS and MCS; SF-12). Linear regressions were used to analyze the data. Results. The presence of CRCs was associated with lower PCS and MCS in bivariate analysis. The association between CRCs and PCS remained significant above and beyond all confounders. However, the association between CRCs and MCS disappeared after controlling for confounders. Conclusion. For African American older adults living in economically disadvantaged urban areas, CRCs contribute to poor physical HRQoL. Evaluation and treatment of CRCs in African American older adults may be a strategy for reduction of disparities in HRQoL in this population. As smoking is the major modifiable risk factor for CRCs, there is a need to increase accessibility of smoking cessation programs in economically disadvantaged urban areas. More research is needed on the types, management, and prognosis of CRCs such as asthma, chronic bronchitis, and emphysema in African American older adults who reside in low-income and resource limited urban areas.

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Depressive Symptoms among Economically Disadvantaged African American Older Adults in South Los Angeles

Brain Sciences ◽

10.3390/brainsci9100246 ◽

2019 ◽

Vol 9 (10) ◽

pp. 246 ◽

Cited By ~ 3

Author(s):

Meghan C. Evans ◽

Sharon Cobb ◽

James Smith ◽

Mohsen Bazargan ◽

Shervin Assari

Keyword(s):

Older Adults ◽

African American ◽

Depressive Symptoms ◽

Los Angeles ◽

Educational Attainment ◽

Marital Status ◽

Pain Intensity ◽

Economically Disadvantaged ◽

South Los Angeles ◽

Financial Difficulties

Background: Although social, behavioral, and health factors correlate with depressive symptoms, less is known about these links among economically disadvantaged African American (AA) older adults. Objective: To study social, behavioral, and health correlates of depressive symptoms among economically disadvantaged AA older adults. Methods: This survey was conducted in South Los Angeles between 2015 and 2018. A total number of 740 AA older adults (age ≥55 years) were entered to this study. Independent variables were gender, age, educational attainment, financial difficulties, living alone, marital status, smoking, drinking, chronic medical conditions (CMCs), and pain intensity. The dependent variable was depressive symptoms. Linear regression model was used to analyze the data. Results: Age, financial difficulties, smoking, CMCs, and pain intensity were associated with depressive symptoms. Gender, educational attainment, living arrangement, marital status, and drinking were not associated with depressive symptoms. Conclusion: Factors such as age, financial difficulties, smoking, CMCs, and pain may inform programs that wish to screen high risk economically disadvantaged AA older adults for depressive symptoms.

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Influenza Vaccination among Underserved African-American Older Adults

BioMed Research International ◽

10.1155/2020/2160894 ◽

2020 ◽

Vol 2020 ◽

pp. 1-9

Author(s):

Mohsen Bazargan ◽

Cheryl Wisseh ◽

Edward Adinkrah ◽

Hoorolnesa Ameli ◽

Delia Santana ◽

...

Keyword(s):

Older Adults ◽

African American ◽

Los Angeles ◽

Influenza Vaccination ◽

Vaccine Uptake ◽

Depression Symptoms ◽

South Los Angeles ◽

Flu Vaccination ◽

African American Older Adults

Background. Racial disparities in influenza vaccination among underserved minority older adults are a public health problem. Understanding the factors that impact influenza vaccination behaviors among underserved older African-Americans could lead to more effective communication and delivery strategies. Aims. We aimed to investigate rate and factors associated with seasonal influenza vaccination among underserved African-American older adults. We were particularly interested in the roles of demographic factors, socioeconomic status, and continuity and patient satisfaction with medical care, as well as physical and mental health status. Methods. This community-based cross-sectional study recruited 620 African-American older adults residing in South Los Angeles, one of the most under-resources areas within Los Angeles County, with a population of over one million. Bivariate and multiple regression analyses were performed to document independent correlates of influenza vaccination. Results. One out of three underserved African-American older adults aged 65 years and older residing in South Los Angeles had never been vaccinated against the influenza. Only 49% of participants reported being vaccinated within the 12 months prior to the interview. One out of five participants admitted that their health care provider recommended influenza vaccination. However, only 45% followed their provider’s recommendations. Multivariate logistic regression shows that old-old (≥75 years), participants who lived alone, those with a lower level of continuity of care and satisfaction with the accessibility, availability, and quality of care, and participants with a higher number of depression symptoms were less likely to be vaccinated. As expected, participants who indicated that their physician had advised them to obtain a flu vaccination were more likely to be vaccinated. Our data shows that only gender was associated with self-report of being advised to have a flu shot. Discussion. One of the most striking aspects of this study is that no association between influenza vaccination and being diagnosed with chronic obstructive pulmonary disease or other major chronic condition was detected. Our study confirmed that both continuity of care and satisfaction with access, availability, and quality of medical care are strongly associated with current influenza vaccinations. We documented that participants with a higher number of depression symptoms were less likely to be vaccinated. Conclusion. These findings highlight the role that culturally acceptable and accessible usual source of care van play as a gatekeeper to facilitate and implement flu vaccination among underserved minority older adults. Consistent disparities in influenza vaccine uptake among underserved African-American older adults, coupled with a disproportionate burden of chronic diseases, places them at high risk for undesired outcomes associated with influenza. As depression is more chronic/disabling and is less likely to be treated in African-Americans, there is a need to screen and treat depression as a strategy to enhance preventive care management such as vaccination of underserved African-American older adults. Quantification of associations between lower vaccine uptake and both depression symptoms as well as living alone should enable health professionals target underserved African-American older adults who are isolated and suffer from depression to reduce vaccine-related inequalities.

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Eye Examination Recency among African American Older Adults with Chronic Medical Conditions

Healthcare ◽

10.3390/healthcare8020094 ◽

2020 ◽

Vol 8 (2) ◽

pp. 94

Author(s):

Mohsen Bazargan ◽

Tavonia Ekwegh ◽

Sharon Cobb ◽

Edward Adinkrah ◽

Shervin Assari

Keyword(s):

Older Adults ◽

African American ◽

Los Angeles ◽

Medical Care ◽

Care Providers ◽

Middle Aged ◽

South Los Angeles ◽

Self Rated Health ◽

Eye Examination ◽

African American Older Adults

Background: Pervasive racial and economic inequalities have a disproportionate impact on health care utilization among African Americans. One area where we see such disparities is in the recency of eye examinations among the economically disadvantaged. However, our current understanding of the barriers and facilitators of eye examinations in underserved African-American older adults is limited. Aims: Building on Andersen’s model of health service use and using an exploratory approach; we tested various demographic, social, and health factors that were associated with eye examination among underserved middle-aged and older adults in South Los Angeles. We examined predisposing characteristics, enabling factors, and need-for-care characteristics. Methods: With a cross-sectional design, we conducted this survey on a convenience sample of (n = 740) non-institutionalized African-American older adults who were 55+ years old and residing in South Los Angeles, CA, USA. Data were collected on demographic factors, continuity of care, access to care, self-rated health, chronic medical conditions, and depressive symptoms. The outcome was recency of eye examination. Multivariate regression was used for data analysis. Results: 59% of the participants had received at least one eye examination during the last 12 months. A total of 17% had an eye examination within the last two years. Notably, 26% of diabetic participants did not have an eye examination within the last two years. One out of four participants indicated that, within the last two years, no provider ever recommended that they receive an eye examination. Age, education, continuity of medical care, accessibility of medical care, satisfaction with medical care, providers’ recommendation for eye examination, self-rated health, and a diagnosis of hypertension and diabetes mellitus were predictors of eye examination recency. Overall, our analysis indicates that these enabling factors accounted for most of the variance in the recency of eye examinations. Conclusion: A large proportion of underserved African-American middle-aged and older adults in South Los Angeles do not comply with the recommended annual eye examination. This is, in part, because about one-third of them have not received an eye exam recommendation from their health care providers. However, a wide range of factors such as age, education, continuity of care, satisfaction with access, self-rated health, and a diagnosis of hypertension and diabetes mellitus, also influence whether or not African-American middle-aged and older adults receive an eye examination. Programs should address a wide range of multi-level factors to tackle this health inequality.

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Marijuana Use among African American Older Adults in Economically Challenged Areas of South Los Angeles

Brain Sciences ◽

10.3390/brainsci9070166 ◽

2019 ◽

Vol 9 (7) ◽

pp. 166 ◽

Cited By ~ 4

Author(s):

Sharon Cobb ◽

Mohsen Bazargan ◽

James Smith ◽

Homero E. del Pino ◽

Kimberly Dorrah ◽

...

Keyword(s):

Older Adults ◽

African American ◽

Los Angeles ◽

Cigarette Smoking ◽

Alcohol Drinking ◽

Living Alone ◽

Financial Strain ◽

Chronic Medical Conditions ◽

South Los Angeles ◽

African American Older Adults

Purpose: This study explored demographic, social, behavioral, and health factors associated with current marijuana use (MU) among African American older adults who were residing in economically challenged areas of south Los Angeles. Methods: This community-based study recruited a consecutive sample of African American older adults (n = 340), age ≥ 55 years, residing in economically challenged areas of South Los Angeles. Interviews were conducted to collect data. Demographics (age and gender), socioeconomic status (educational attainment, income, and financial strain), marital status, living alone, health behaviors (alcohol drinking and cigarette smoking), health status (number of chronic medical conditions, body mass index, depression, and chronic pain), and current MU were collected. Logistic regression was used to analyze the data. Results: Thirty (9.1%) participants reported current MU. Age, educational attainment, chronic medical conditions, and obesity were negatively associated with current MU. Gender, income, financial strain, living alone, marital status, smoking cigarettes, drinking alcohol, depression, and pain did not correlate with MU. Conclusion: Current MU is more common in younger, healthier, less obese, less educated African American older adults. It does not seem that African American older adults use marijuana for the self-medication of chronic disease, pain, or depression. For African American older adults, MU also does not co-occur with cigarette smoking and alcohol drinking. These results may help clinicians who provide services for older African Americans in economically challenged urban areas.

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The Role of Race in Relations of Social Support to Hippocampal Volumes Among Older Adults

Research on Aging ◽

10.1177/01640275211017268 ◽

2021 ◽

pp. 016402752110172

Author(s):

Desirée C. Bygrave ◽

Constance S. Gerassimakis ◽

Denée T. Mwendwa ◽

Guray Erus ◽

Christos Davatzikos ◽

...

Keyword(s):

Social Support ◽

Older Adults ◽

African American ◽

Disease Risk ◽

Total Sample ◽

Hippocampal Volume ◽

Brain Pathology ◽

Resonance Imaging ◽

African American Older Adults

Evidence suggests social support may buffer brain pathology. However, neither its association with hippocampal volume, a marker of Alzheimer’s disease risk, nor the role of race in this association has been fully investigated. Multiple regression analyses examined relations of total social support to magnetic resonance imaging-assessed gray matter (GM) hippocampal volumes in the total sample ( n = 165; mean age = 68.48 year), and in race-stratified models of African American and White older adults, adjusting for select covariates. Results showed greater social support was associated with greater GM hippocampal volumes among African American older adults only ( p < .01). Our findings suggest greater total social support may play a role in supporting the hippocampus, particularly among African American older adults, who had lower hippocampal volumes than their White counterparts. Further research is needed to test these questions longitudinally and examine which aspects of social support may promote hippocampal integrity, specifically.

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