Actor and partner effects of self-rated health on life satisfaction among family caregiver couples

ObjectivesThis study examined the dyadic effects of self-rated health on the life satisfaction of family caregivers. The effects of the use of long-term care services were also explored to investigate whether support through care services is associated with the life satisfaction of family caregivers.MethodsThe data were drawn from the sixth wave (2016) of the Korean Longitudinal Study of Aging. Caregivers who used long-term care services for older family members, and spouses of the caregivers, were identified. A total of 81 married caregiver couples were analyzed using the actor-partner interdependence model.ResultsThe study showed that better self-rated health of caregivers was associated with higher levels of life satisfaction (B = 8.87, p < 0.001). Better self-rated health of the caregivers was also associated with higher life satisfaction of their spouses (B = 6.01, p < 0.05). In addition, the results suggested that the use of long-term care services for patients was associated with the life satisfaction of both caregivers (B = 14.57, p < 0.01) and their spouses (B = 12.51, p < 0.05).DiscussionOur findings suggested mutual influences among family caregivers on their life satisfaction. In addition, long-term care services for patients may improve the life satisfaction of other family members. More support through long-term care services for people with care needs is required to increase the life satisfaction of family caregivers. The diverse relationships among family caregivers should be taken into consideration when developing policies and interventions.     

Gender differences regarding opinions on long-term care arrangements: A study of community-dwelling older adults

BackgroundNumerous studies have attempted to identify predictors of institutionalization in the general population. Gender studies have led to inconsistent results. Some authors argued that older women were more likely than older men to use long-term care services, while others failed to highlight a specific gender effect on the use of long-term care services. The aim of this study was to assess the effects of gender on the preferences of older citizens for long-term care using a panel of disability situations.MethodsWe used a set of ten vignettes displaying disability situations with or without an able-bodied spouse present and used a population-based survey to inquire about appropriate long-term care. Participants were 3102 community-dwelling persons aged 68–83 years included in the representative Lausanne cohort 65+ study in January 2017. Multinomial logistic regression analyses were used to explore the effect of gender on long-term care choices by older men and women, controlling for the respondent's age and living arrangement.ResultsThe respondents’ choices shifted toward institutionalization when the disorder severity increased in vignettes and when there was no spouse able to help. Men were more likely to choose a home setting with caregiving only by spouse even when the level of disability increased. Women chose help from professionals, sheltered homes, or institutionalization more quickly than men.ConclusionsExploring gender preferences for long-term care arrangements is critical for improving and planning long-term care services.     

Clinical characteristics and long-term health in celiac disease patients diagnosed in early childhood: Large cohort study

BackgroundEarly detection of celiac disease could theoretically prevent most of the disease-associated complications, but long-term effects of this approach are unclear.AimsTo investigate features at diagnosis and adulthood health in celiac disease patients diagnosed in early childhood in 1965–2014.MethodsMedical data on 978 pediatric patients were collected and study questionnaires sent to 559 adult patients who were diagnosed in childhood. Results were compared between patients diagnosed in early (≤3.0 years) and later (3.1-17.9 years) childhood.ResultsEarly diagnosed patients (n=131) had more often total villous atrophy (37% vs 25%, p=0.001), gastrointestinal presentation (61% vs 47%, p<0.001), growth disturbances (70% vs 32%, p=0.001) and severe symptoms (30% vs 9%, p<0.001) and were less often screen-detected (10% vs 27%, p<0.001) at diagnosis than those diagnosed later (n=847).Among 239 adult responders, early diagnosed patients (n=36) had fewer comorbidities (33% vs 53%, p=0.034) but considered their health less often good/excellent (69% vs 84%, p=0.029). The groups were comparable in current age, dietary adherence, symptoms and health-related quality of life.ConclusionDespite more severe initial presentation, the long-term health in early diagnosed patients was mostly comparable or even better to those diagnosed later in childhood. Poorer self-perceived health suggests a need for support during the transition to adulthood care.     

Gender,self-rated health and functional decline among community-dwelling older adults

ObjectiveThis paper examines the association between self-rated health (SRH) and functional decline (FD) in older Ghanaian cohorts and investigates whether the effect differs by gender and also modified by marital status.MethodsThe study used cross-sectional survey data (N = 1200) from an Aging, Health, Psychological Wellbeing and Health-seeking Behavior Study (AHPWHB) study conducted in between August 2016 and January 2017. A four-level gendered-stratified logit modeling estimated the SRH-FD association and the interaction terms.ResultsOverall, 23% of male respondents and 34% of women revealed significant FD (p < 0.001). The fully-adjusted model showed that SRH status was a strong predictor of FD across genders but the effect was most pronounced among men. Compared with excellent/very good SRH, fair and poor SRH (β = 0.160; p < 0.05) and (β = 1.700; p < 0.001) for women and (β = 2.202; p < 0.001) and (β= 2.356; p < 0.001) for men respectively were significantly associated with increased FD. However, good (β = − 1.760; p < 0.001), fair (β = − 2.800; p < 0.001) and poor SRH (β = −2.088; p < 0.001) decreased FD if an older woman was married compared with unmarried women with excellent/very good SRH.ConclusionThe strength of SRH-FDs association largely differed with gender and also moderated by marital status for women. Improving the SRH and marital quality could be protective of functional abilities, independence and quality of life for older people.     

Educational intervention on physical restraint use in long-term care facilities – Systematic review and meta-analysis

“Physical restraint” formerly used as a measure of protection for psychiatric patients is now widely used. However, existing studies showed that physical restraint not only has inadequate effect of protection but also has negative effects on residents. To analyzes the impact of educational program on the physical restraint use in long-term care facilities. Design: A systematic review with meta-analysis and meta-regression. Eight databases, including Cochrane Library, ProQuest, PubMed, EMBASE, EBSCO, Web of Science, Ovid Medline and Physiotherapy Evidence Database (PEDro), were searched up to January 2017. Eligible studies were classified by intervention and accessed for quality using the Quality Assessment Tool for quantitative studies. Sixteen research articles were eligible in the final review; 10 randomize control trail studies were included in the analysis. The meta-analysis revealed that the use of physical restraint was significantly less often in the experimental (education) group (OR = 0.55, 95% CI: 0.39 to 0.78, p < 0.001) compared to the control group. Meta-regression revealed the period of post education would have decreased the effect of the restraint educational program (β: 0.08, p = 0.002); instead, the longer education period and more times of education would have a stronger effect of reducing the use of physical restraint (β: ?0.07, p < 0.001; β: ?0.04, p = 0.056). The educational program had an effect on the reduced use of physical restraint. The results of meta-regression suggest that long-term care facilities should provide a continuous education program of physical restraint for caregivers.     

Mediating effect of social support on the relationship between illness concealment and depression symptoms in patients with pulmonary arterial hypertension

BackgroundDepression symptoms are common in patients with pulmonary arterial hypertension (PAH). Social support may mediate the effect of illness concealment on depression symptoms.ObjectiveTo examine the relationships between illness concealment, dimensions of social support, and depression symptoms and the mediating effect of the dimensions of social support on depression symptoms in PAH patients.MethodsA cross-sectional design and convenience sampling were applied. Data were collected with three questionnaires and analyzed with hierarchical regression and the PROCESS macro.ResultsNinety-seven participants were enrolled (mean age 50 ± 14 years). In total, 8% had a Patient Health Questionnaire (PHQ)-9 score ≥15. Hierarchical regression analysis showed that education level (β = 0.28, p < 0.05), illness concealment (β = 0.21, p < 0.05), and emotional support (β = 0.29, p < 0.01) were determinants of depression symptoms. Emotional support mediated the relationship between illness concealment and depression symptoms.ConclusionsEmotional support can help patients reduce the effect of illness concealment on depression symptoms.     

The relationship between pulse pressure,insulin resistance,and beta cell function in non-diabetic Korean adults

AimsThe present study was conducted to assess the association of pulse pressure (PP) with insulin resistance and beta cell function in Korean non-diabetic populations.MethodsThis study used the data from the 2015 Korean National Health and Nutrition Examination Survey including 4380 adults, aged 20 or older.ResultsA multivariate analysis revealed that systolic blood pressure (SBP) (β = 0.089, 95% confidence interval [CI], 0.004–0.011; p < 0.001), diastolic blood pressure (DBP) (β = ?0.057, 95% CI ?0.014 to ?0.003; p = 0.002), and PP (β = 0.069, 95% CI 0.004–0.011; p < 0.001) were significant factors determining the homeostasis model assessment of insulin resistance (HOMA-IR). SBP (β = 0.070, 95% CI, 0.113–0.420; p = 0.001), DBP (β = ?0.068, 95% CI ?0.676 to ?0.203; p < 0.001), and PP (β = 0.050, 95% CI 0.115–0.422; p = 0.001) were significant factors determining the homeostasis model assessment of beta cell function (HOMA-B). In the analysis of covariance test, after adjusting for related variables (except age), the quartiles of PP were not associated with HOMA-IR (p = 0.191) and were inversely associated with HOMA-B (p < 0.001). However, when further adjusting for age, the quartiles of PP were positively associated with both HOMA-IR (p < 0.001) and HOMA-B (p = 0.027).ConclusionPP was positively associated with insulin resistance and beta cell function in non-diabetic Korean adults.     

The enduring effect of education-socioeconomic differences in disability trajectories from age 85 years in the Newcastle 85+ Study

ObjectiveLittle is known about disability progression in very old age despite this being vital for care planning. We investigate whether distinct trajectories of disability are evident from age 85 to 90 and their association with socio-economic status (SES).MethodsThe Newcastle 85+ Study recruited people born in 1921 through participating general practices in Newcastle and North Tyneside. Participants underwent a health assessment (HA) at baseline, 18, 36 and 60 months and a GP record review (GPRR) at baseline, 36 and 60 months. Disability was measured via difficulty in 17 Activities of Daily Living. Trajectory identification was assessed by gender stratified, mortality adjusted, group-based trajectory modelling (GBTM) and the impact of life-course SES (level of education; occupational class; deprivation) on trajectory membership evaluated (adjusting for confounding variables).Results851 participants agreed to HA and GPRR, 840 (98.7%) with complete disability data. Four distinct trajectories were evident for both sexes. A disability-free trajectory between age 85 and 90 was identified in men only (9% of the sample). The most disabled trajectories had severe disability at age 85 progressing to profound disability by age 90. After adjusting for confounders education remained significant; men and women with most education being less likely to be in the most disabled trajectory (Men: OR = 0.80, 95% CI 0.65–0.98; women: OR = 0.59, 95% CI 0.42–0.83).ConclusionDistinct disability trajectories are evident in the very old and these are influenced by education, suggesting SES disadvantages cumulate throughout the life-course to create health and mortality inequalities later.     

Impacts of the COVID-19 pandemic on unmet social needs,self-care,and outcomes among people with diabetes and poor glycemic control

AimsThe purpose of this study was to examine whether pandemic exposure impacted unmet social and diabetes needs, self-care behaviors, and diabetes outcomes in a sample with diabetes and poor glycemic control.MethodsThis was a cross-sectional analysis of participants with diabetes and poor glycemic control in an ongoing trial (n = 353). We compared the prevalence of unmet needs, self-care behaviors, and diabetes outcomes in successive cohorts of enrollees surveyed pre-pandemic (prior to March 11, 2020, n = 182), in the early stages of the pandemic (May–September, 2020, n = 75), and later (September 2020–January 2021, n = 96) stratified by income and gender. Adjusted multivariable regression models were used to examine trends.ResultsMore participants with low income reported food insecurity (70% vs. 83%, p < 0.05) and needs related to access to blood glucose supplies (19% vs. 67%, p < 0.05) during the pandemic compared to pre-pandemic levels. In adjusted models among people with low incomes, the odds of housing insecurity increased among participants during the early pandemic months compared with participants pre-pandemic (OR 20.2 [95% CI 2.8–145.2], p < 0.01). A1c levels were better among participants later in the pandemic than those pre-pandemic (β = ?1.1 [95% CI ?1.8 to ?0.4], p < 0.01), but systolic blood pressure control was substantially worse (β = 11.5 [95% CI 4.2–18.8, p < 0.001).ConclusionAdults with low-incomes and diabetes were most impacted by the pandemic. A1c may not fully capture challenges that people with diabetes are facing to manage their condition; systolic blood pressures may have worsened and problems with self-care may forebode longer-term challenges in diabetes control.     

Disability and Health Care Use in Patients with Crohn's Disease: A Spouse Control Study

Objectives: Studies reported from tertiary referral centers suggest that patients with Crohn's disease (CD) have a high rate of long-term disability. This study investigated whether this is true for less selected patient groups. Methods: 106 outpatients who were diagnosed to have had CD between 1974 and 1985 were invited with their partners (n = 83) for a structured interview that addressed issues of lifestyle and quality of life. In addition, patient and insurance records were reviewed to compare the use of health care services and work disability of patients with CD with those of their partners. Results: Twenty percent of patients and 8% of their partners believed that illness had affected their partnership, 17% versus 11% thought it had compromised their professional career, and 28% versus 10% believed it affected the overall quality of life. A significant impact of illness on these parameters ( P < 0.001) occurred only if they were evaluated with the use of an analog scale. Differences between patients and their partners in the use of health care services and in work disability became insignificant after 6 yr of observation ( p = 0.1415 and p = 0.4341). Conclusions: Most patients with CD and their partners experience a similar satisfaction with life. As time progresses, a decline in disability often can be observed.     

Age modify the associations of obesity,physical activity,vision and grip strength with functional mobility in Irish aged 50 and older

ObjectiveTo estimate whether the associations of obesity, physical activity, vision and grip strength with functional mobility were modified by age.MethodsData from The Irish Longitudinal Study on Ageing (2009–2012) were analyzed and 5001 individuals were included in this study. Mobility was assessed by the timed up and go test (TUG-test). Main exposure variables were obesity, physical activity, visual acuity and grip strength at baseline. Multiple linear regression models were fitted to assess the associations of baseline main exposure variables with 2-year follow-up functional mobility and potential confounders were adjusted. Stratified analyses by age were used to assess the interaction between main exposures and age on functional mobility.ResultsMultiple linear regression models identified significant interactions of obesity (P < 0.001), vigorous physical activity (P = 0.001), vision (P < 0.001) and grip strength (P < 0.001) with age on functional mobility. Stratified analyses suggested that the risk effect of obesity on functional mobility was greater in middle-aged group (β = 0.025, P < 0.001) than in older group (β = 0.016, P = 0.017). The protective effects of high level of physical activity and grip strength on functional mobility were stronger in older group (β = −0.023, P = 0.004 for physical activity; β = −0.002, P < 0.001 for grip strength) than in middle-aged group (β = −0.012, P = 0.008 for physical activity; β = −0.0015, P < 0.001 for grip strength). The benefit of better vision on functional mobility was observed in middle-aged group only (β = −0.032, P = 0.002).ConclusionNon-obesity, higher level of physical activity, vision and grip strength at baseline were associated with better mobility performance among middle-aged and older Irish. And these associations were modified by age.     

Institutional care for long-term mechanical ventilation in Canada: A national survey

INTRODUCTION:No national Canadian data define resource requirements and care delivery for ventilator-assisted individuals (VAIs) requiring long-term institutional care. Such data will assist in planning health care services to this population.OBJECTIVE:To describe institutional and patient characteristics, prevalence, equipment used, care elements and admission barriers for VAIs requiring long-term institutional care.METHODS:Centres were identified from a national inventory and snowball referrals. The survey weblink was provided from December 2012 to April 2013. Weekly reminders were sent for six weeks.RESULTS:The response rate was 84% (54 of 64), with 44 adult and 10 pediatric centres providing data for 428 VAIs (301 invasive ventilation; 127 noninvasive ventilation [NIV]), equivalent to 1.3 VAIs per 100,000 population. An additional 106 VAIs were on wait lists in 18 centres. More VAIs with progressive neuromuscular disease received invasive ventilation than NIV (P<0.001); more VAIs with chronic obstructive pulmonary disease (P<0.001), obesity hypoventilation syndrome (P<0.001) and central hypoventilation syndrome (P=0.02) required NIV. All centres used positive pressure ventilators, 21% diaphragmatic pacing, 15% negative pressure and 13% phrenic nerve stimulation. Most centres used lung volume recruitment (55%), manually (71%) and mechanically assisted cough (55%). Lack of beds and provincial funding were common admission barriers.CONCLUSIONS:Variable models and care practices exist for institutionalized care of Canadian VAIs. Patient prevalence was 1.3 per 100,000 Canadians.     

Financial difficulty and biopsychosocial predictors of loneliness: A cross-sectional study of community dwelling older adults

AimTo investigate the interplay of sociodemographic, health, functional and psychosocial factors in predicting loneliness in community dwelling older adults accessing home support services and long-term aged residential care.MethodsOlder New Zealanders (age 65+), who had their first interRAI Home Care assessment between July 2014 and June 2016, were included. The outcome variable was the binary interRAI item “Lonely”. The predictor variables included sociodemographics, hearing, vision, self-reported health, activities of daily living, social interaction and support, and depression.ResultsData from 51,239 assessments of older adults (mean age: 82.3 years; female: 61%; European: 87.3%) were analysed. Loneliness was reported in 21%. A stepwise logistic regression model explained 12.1% of the variance and was statistically significant (Chi² = 3501.0.8, df = 22; p < 0.001). The factors with the largest odds ratios (OR > 1.5) were depression, living alone, being Asian, financial difficulty and not in a relationship. Functional impairment was negatively associated with loneliness.ConclusionsDetermining the predictors of older adults’ loneliness is complex, multi-factorial, with each factor having a small, additive effect on the development of loneliness. Depression, social factors and financial difficulty are the strongest predictors but much of the variance remains unexplained. These factors could be targeted as modifiable risk factors for addressing loneliness in older adults.     

Living with HIV but without medical care: barriers to engagement

This cross-sectional study examined factors associated with the receipt of HIV medical care among people who know their HIV status and are not newly diagnosed with HIV. Interviews were conducted with 1133 HIV-positive individuals between October 2003 and July 2005 who enrolled in 1 of 10 outreach programs across the country. The sample was predominantly non-white (86%), male (59%), and unstably housed (61%), with a past history of cocaine use (68%). Twelve percent had received no HIV medical care in the 6 months prior to the interview. Those with no care were similar to those who received some HIV care in sociodemographic characteristics, but in multivariate analysis were less likely to have a case manager (p < 0.001) or use mental health services (p < .001), had lower mental health status scores (p < 0.05), were more likely to be active drug users (p < 0.01), had greater unmet support service needs (p < 0.05) and reported that health beliefs were a barrier to care (p < 0.001). Interventions to engage people in HIV medical care need to address barriers to care through linkages with mental health, substance abuse treatment and support services, and address the health beliefs that deter people from seeking care.     

Factors influencing the use of mobility technology in community-based long-term care

OBJECTIVES: This article adapts a framework commonly used to model personal long-term care services to examine factors influencing the use of mobility-related assistive devices, both in isolation and in combination with personal care. METHODS: The authors analyze data from Phase 2 of the 1994-1995 National Health Interview Survey Disability Supplements to compare predictors of equipment use with those for personal care and rank the probabilities of using particular combinations according to health needs, access, and personal and family characteristics. RESULTS: The authors find that underlying health needs are the dominant factor related to the type of care arrangement used. The typical person with a mobility-related disability is most likely to use equipment alone; only at younger ages or at greater levels of severity are other arrangements expected to dominate. DISCUSSION: Research on the dynamic acquisition process, with attention to age and trajectories of disability severity, is needed to fully understand the integration of technology and personal care.     

Health and long-term care use trajectories of older disabled women

PURPOSE: I examined health and long-term care use trajectories of a sample of chronically disabled older women eligible for both Medicare and Medicaid by exploring their use data in order to understand and anticipate the increasing demand on the health and long-term care delivery systems as aging female baby boomers reach age 65 and older. DESIGN AND METHODS: A sample of older disabled women in Ohio who completed preadmission review was divided into three groups on the basis of the setting in which they received their initial long-term care services. RESULTS: I was able to establish a long-term care career for the sample members beginning with receiving long-term care in the community, followed by a transition stage in which care was received in the community and in a nursing home, and finally by a stage at which they entered and remained in a nursing home. As the sample members proceeded along their long-term care career and their health and disability status worsened, I found a clear shift in the kind of care needed from hospital and home care to nursing home care. There was also a shift in the major payer, from Medicare to Medicaid. IMPLICATIONS: As the baby boomers age, a much larger number of women will be disabled and need health and long-term care services. For a considerable number of these women, Medicaid gradually becomes the major payer for care, an issue that needs close observation.     

Hyponatremia in systemic lupus erythematosus patients: Relation to disease activity and fatigue

Aim of the workTo investigate the relation of hyponatremia to disease activity and fatigue in systemic lupus erythematosus (SLE) patients.Patients and methodsThe present study included 30 SLE patients with hyponatremia and 70 with normal serum sodium (Na) level. SLE disease activity index and the Functional Assessment of Chronic Illness Therapy (FACIT)-Fatigue score were assessed.ResultsThe gender, age and disease duration of SLE patients with hyponatremia (26 females and 4 males; mean age 37.8 ± 9.3 years, 10.9 ± 5.1 years) were comparable with those without (60 females and 10 males; 36.9 ± 11.8 years, 11.1 ± 6.02; p = 0.71 and p = 0.9 respectively). SLE patients with hyponatremia showed significantly increased SLEDAI (14.2 ± 3.85 vs 3.86 ± 3.59; p < 0.001), ESR (55.2 ± 18.2 vs 14.70 ± 3.5 mm/1st h; p < 0.001) and CRP (30.97 ± 4.4 vs 5.17 ± 2.6 mg/dl; p < 0.001) and lower FACIT-Fatigue (21.99 ± 2.1 vs 35.87 ± 4.81; p < 0.001) compared to patients without. Serum Na levels significantly correlated with the FACIT-fatigue score (r = 0.99, p < 0.01), platelets (r = 0.22; p = 0.03), white blood cells count (r = 0.31, p < 0.001) and inversely with SLEDAI (r = ?0.27, p = 0.01), ESR (r = ?0.71; p < 0.001), CRP (r = ?0.86, p < 0.001), anti-ds-DNA (r = 0.54, p < 0.001), C3 (r = ?0.29, p = 0.01) and C4 (r = ?0.2, p = 0.04). On regression, CRP (β = 0.3), SLEDAI (β = 0.28) and consumed C4 (β = ?0.07) were significant independent risk factors for hyponatremia (p < 0.0001, p = 0.0005, p = 0.02 respectively). The optimal cut-off values to predict hyponatremia was a SLEDAI score ≥11 (90% sensitivity and 96% specificity), and ESR ≥ 17.5 mm/1st h (100% sensitivity and 80% specificity) and a CRP of ≥10.5 mg/dl (100% sensitivity and 97% specificity).ConclusionHyponatremia in SLE patients is associated with higher disease activity and more perceived fatigue. Hyponatremia could reflect severe inflammation and could be considered as one of the predisposing factors of fatigue.     

The multiple mediating effects of health literacy and self-care confidence between depression and self-care behaviors in patients with heart failure

BackgroundPrevious researchers have found that depression can influence self-care behaviors of patients with heart failure (HF). However, the specific path of depression on self-care behaviors remains unclear.ObjectivesTo determine the multiple mediating effects of health literacy and self-care confidence between depression and self-care behaviors in patients with HF.MethodsA cross sectional study on HF patients (n = 310) was conducted at a tertiary hospital in China. The Chinese versions of the Hospital Anxiety and Depression Scale (HADS-D), Health Literacy Scale for Patients with Chronic Disease and Self-care of Heart Failure Index (C-SCHFI) were used to assess depression, health literacy, self-care confidence and self-care behaviors of the HF patients respectively.ResultsDepression had significant negative correlations with health literacy (r = -0.40, P < 0.01), self-care confidence (r = -0.41, P < 0.01), self-care maintenance (r = -0.18, P < 0.01) and management (r = -0.19, P < 0.01). After controlling for covariates, mediation modeling analysis showed that health literacy and self-care confidence were mediating variables between depression and self-care management and all the three paths were significant. A higher level of depression debilitated health literacy (β = -0.23, P < 0.001), and a higher degree of health literacy was associated with better self-care confidence (β = 0.31, P < 0.001) which contributed to better self-care management (β = 0.43, P < 0.001). Total mediation effect was -0.1940 with 95% CI from -0.2702 to -0.1266. However, self-care confidence did not mediate between depression and self-care maintenance.ConclusionHealth literacy and self-care confidence exert a multiple mediating effect on the relationship between depression and self-care management. The relationship between variables should be considered when developing the tailored interventions for patients with HF to enhance their self-care behaviors.