Health Care Utilization and Unmet Needs in Chinese Older Adults With Multimorbidity and Functional Impairment

ObjectivesChina has the world's largest aging population, of which 46% have multimorbidity and 38% have functional impairment. Older adults with multimorbidity often suffer functional impairment as well; however, it is not clear how current health care services have been used in this population. This study aimed to compare health care utilization among Chinese older adults at different levels of chronic disease and functional impairment.DesignA cross-sectional design. Multivariate 2-part models were used to examine the probability and frequency of health care utilization.Setting and ParticipantsData were from 5166 adults aged 65 or older from the 2015 wave of the China Health and Retirement Longitudinal Study. The sample included 22% without any chronic condition, 27% with 1 chronic condition, 44% with multimorbidity, and 7% with multimorbidity and functional impairment.MeasuresHealth care utilization included outpatient visits, inpatient visits, and unmet hospitalization needs.ResultsAs the number of chronic conditions and functional impairments increased, older adults tend to access health care more. Older adults with both multimorbidity and functional impairment tend to use health care services most, but still reported the highest level of unmet hospitalization needs among all groups.Conclusions and ImplicationsChinese older adults with multimorbidity and functional impairment may have experienced multiple barriers in accessing health care. Social programs should be created to make health care more accessible among older adults. The health care delivery system could be oriented to home-based medical care, which have been found effective in delivering high-quality care and reducing health care costs.     

Improving intergenerational health care communication

The relationship between health care providers and their older adult patients may suffer from miscommunication problems stemming from agist stereotyping. Stereotypes of older adults by younger adults may be revealed through patronizing speech--or elder-speak, which is the overaccommodation of speech interaction. Over- and underaccommodation strategies based on these stereotypes are often used by young health care providers when communicating with older adults. As the population ages and the demand for health care services increases, health care providers must improve their communicative effectiveness with their older patients. Attention to the individual needs of health care consumers, cognizance of age or role stereotyping, and proper training of health care providers would increase communicative effectiveness and enhance the patient-provider relationship.     

Living With the Health and Social Inequities of a Disability: A Critical Feminist Study

Clients living at home with chronic disabling conditions together with their caregivers, service providers, and policymakers face major challenges in optimizing health care. In this critical feminist interpretive study we examined the experiences of women receiving home care for chronic disabling conditions. Five themes emerged: struggling with the embodied limitations of disabling chronic conditions; actively seeking health; struggling with service limitations; seeking ways to manage; and living with isolation and marginalization. Having done this study, we learned that home care services do not always contribute sufficiently to the overall health and well-being of women living with chronic disabling conditions and, in fact, may negatively impact upon their health.     

Priorities of Health Care Outcomes for the Elderly

ObjectivesPhysicians are uncertain about what medical services should be provided to older and/or disabled patients. Better understanding of health outcome prioritization among health care providers and recipients may help the process of decision- and policy-making. For this purpose, surveys were conducted on priorities of health care outcomes for the elderly.DesignSurvey research.SettingFour groups of health care providers and four groups of health care recipients.ParticipantsA total of 2512 health care providers and 4277 recipients.MeasurementsQuestionnaires were sent to more than 8000 health care providers and more than 9000 health care recipients: geriatricians, physicians who commonly see older patients or work in long term care facilities, staff members and participants in adult day care, patients in outpatient geriatric clinics, family members of patients with dementia, and community-dwelling older adults. The questionnaire asked the subjects to rank 12 measures of health care outcomes.ResultsThe mean response rate was 49%. All health care provider groups considered “improvement of quality of life” the most important. In contrast, in health care recipient groups, “effective treatment of illness,” “improvement of physical function,” and “reduction of carer burden” were given high priority, whereas “improvement of quality of life” was perceived as less important. All the groups, including health care providers and recipients, ranked “reduction of mortality” the least important, followed by “avoiding institutional care.” Stratification analysis showed that the results did not differ by sex, nursing care level, or the existence of relatives who required nursing care, whereas age slightly influenced the order of high-ranked measures.ConclusionPriorities of health care services and their differences between providers and recipients should be taken into account in the health care of older patients and the design of health care policies and research.     

Weighty Concerns: The Growing Prevalence of Obesity among Older Adults

The prevalence of obesity among older adults has increased during the past 20 years and will affect both medical and social services. Along with an increased risk of cardiovascular disease, diabetes, and several cancers, obesity is associated with increased risk of physical and cognitive disability. However, relatively little attention has been given to the issue of weight management among community-dwelling older adults. Intentional weight loss in obese older adults has not been widely advocated by health care providers due to the uncertainty of whether the benefits outweigh the risks. Limited data in older adults show that intentional weight loss is effective in improving diabetes, cardiovascular risk factors, and physical function. This review describes the changes in body composition associated with aging, the consequences of obesity in older adults, and the effect of intentional weight loss on chronic disease risk factors and physical function. Recommendations for weight loss in obese older adults that minimize the likelihood of adverse effects on muscle mass, bone density, or other aspects of nutritional status are reviewed. Specific recommendations for macronutrient intake, in particular protein, and selected micronutrients, vitamin D and B-12, as well as dietary fiber, and fluid intake as part of a hypocaloric diet and recommendations for physical activity are described. As part of the health professionals team, dietetics practitioners need to be able to guide and manage weight loss treatment options on an individual basis by evaluating the potential benefits against the potential risks in obese older adults.     

Food Insecurity,Dietary Quality,and Health Care Utilization in Lower-Income Adults: A Cross-Sectional Study

BackgroundFood insecurity and poor nutrition are prevalent in the United States and associated with chronic diseases. Understanding relationships among food insecurity, diet, and health care utilization can inform strategies to reduce health disparities.ObjectiveOur aim was to determine associations between food security status and inpatient and outpatient health care utilization and whether they differed by dietary quality in lower-income adults.DesignThis was a cross-sectional study of data from the 2009-2016 National Health and Nutrition Examination Survey.Participants/settingParticipants were 13,956 lower-income (<300% federal poverty level) adults 18 years and older in the United States.Main outcome measuresSelf-reported health care utilization in the past 12 months included no usual source of care, any outpatient visit, any mental health service use, and any hospitalization.Statistical analysesMultiple logistic regression was used to study the association between food insecurity and health care utilization. Analyses were stratified by diet-related comorbidities to account for potential confounding and mediation of health care utilization, and by dietary quality.ResultsIn a sample of lower-income adults <300% federal poverty level, 4,319 participants (27.4%) were food insecure, 2,208 (15.0%) were marginally food secure, and 7,429 (57.6%) were food secure. Food insecurity was associated with having no usual source of care (adjusted odds ratio [aOR] 1.30; 95% CI 1.11 to 1.52), any mental health service use (aOR 2.02; 95% CI 1.61 to 2.52), and any hospitalization (aOR 1.19; 95% CI 1.01 to 1.41). Food-insecure adults were more likely to report no outpatient visits if they had diet-related comorbidities (aOR 1.45; 95% CI 1.10 to 1.92) or the lowest dietary quality (aOR 1.53; 95% CI 1.06 to 2.23). Marginal food security was associated with having no usual source of care (aOR 1.22; 95% CI 1.04 to 1.44).ConclusionsAdults with food insecurity were more likely to be hospitalized, use mental health services, and have no usual source of care. Food-insecure participants with diet-related comorbidities or poor diet were less likely to have outpatient visits. Hospitalizations and mental health visits represent underused opportunities to identify and address food insecurity and dietary intake in lower-income patients.     

Fibromyalgia, cognitive problems and independence: physical activity may be useful in home health care

Home health care providers often deal with older clients who have cognitive deficits. Cognitive problems have a negative impact on independence. Certain chronic pain conditions present with cognitive dysfunction as a co-morbidity. Fibromyalgia syndrome is one such condition. Home health care providers need to know that mild-moderate exercise may positively affect fibromyalgia-related cognitive deficits at very low cost. All of the above is discussed in this paper along with advice concerning the provision of exercise for older, home bound people.     

Association Between Dietary Quality and Mortality in Older Adults: A Review of the Epidemiological Evidence

The population is aging worldwide. Delayed mortality is associated with an increased burden of chronic health conditions, many of which have a dietary component. A literature search was conducted to retrieve and review relevant articles considering quality of diets in association with mortality in older adults aged 60 years and older. In the studies we reviewed, diet quality defined using either a priori methods, which characterize dietary patterns based on existing dietary guidelines, or a posteriori methods, which define dietary patterns through statistical methods met review criteria. Sixteen articles met criteria for review. Generally, dietary patterns that demonstrated greater adherence to diets that emphasized whole fruits and vegetables, whole grains, low-fat dairy, lean meats, and legumes and nuts were inversely associated with mortality. However, a priori methods have not yet demonstrated associations between diet and mortality in older adults in the United States. Development of new methods based on regional variations in dietary intake may offer the best approach to assess associations with mortality.     

Dietary Beliefs and Management of Older American Indians With Type 2 Diabetes

ObjectivesThis qualitative study examined dietary-related beliefs and self-management among older American Indians with type 2 diabetes mellitus (T2DM).DesignSemistructured in-person interviews were conducted and digitally recorded.SettingSoutheastern American Indian tribal community.ParticipantsA total of 28 noninstitutionalized older tribal members aged >60 years.Phenomenon of InterestStudy participants’ beliefs and experiences with dietary practices and management related to T2DM.AnalysisTranscribed qualitative interviews were coded using an inductive content analysis approach.ResultsFour themes regarding T2DM dietary beliefs and T2DM dietary management emerged from the analyses: diet changes, portion control, health care professional and family influence, and barriers to healthy eating. Study participants described how their beliefs, practices, and experiences in these 4 areas related to T2DM.Conclusions and ImplicationsAmerican Indian older adults face a variety of challenges to dietary management of T2DM. Future research efforts can focus on assessing how social support can be leveraged to facilitate healthy diets for American Indians with T2DM. Clinicians and diabetes educators and Native communities have an instrumental role in identifying culturally appropriate messages and programs to help persons effectively manage T2DM.     

Protein Source and Muscle Health in Older Adults: A Literature Review

Research shows that higher dietary protein of up to 1.2 g/kg_bodyweight/day may help prevent sarcopenia and maintain musculoskeletal health in older individuals. Achieving higher daily dietary protein levels is challenging, particularly for older adults with declining appetites and underlying health conditions. The negative impact of these limitations on aging muscle may be circumvented through the consumption of high-quality sources of protein and/or supplementation. Currently, there is a debate regarding whether source of protein differentially affects musculoskeletal health in older adults. Whey and soy protein have been used as the most common high-quality proteins in recent literature. However, there is growing consumer demand for additional plant-sourced dietary protein options. For example, pea protein is rapidly gaining popularity among consumers, despite little to no research regarding its long-term impact on muscle health. Therefore, the objectives of this review are to: (1) review current literature from the past decade evaluating whether specific source(s) of dietary protein provide maximum benefit to muscle health in older adults; and (2) highlight the need for future research specific to underrepresented plant protein sources, such as pea protein, to then provide clearer messaging surrounding plant-sourced versus animal-sourced protein and their effects on the aging musculoskeletal system.     

Nutrition education among low-income older adults: a randomized intervention trial in Congregate Nutrition sites.

Nutritional well-being among older adults is critical for maintaining health, increasing longevity, and decreasing the impact of chronic illness. However, few well-controlled studies have examined nutritional behavior change among low-income older adults. A prospective, controlled, randomized design examined a five session nutrition education module delivered to limited-resource older adults (N = 703) in Congregate Nutrition sites by Cooperative Extension agents. Experimental group participants were significantly more likely than control group participants to increase multivitamin use, to increase calcium supplement use, to read labels of dietary supplements, to carry a supplement and/or medication list, and to discuss such use with their health care professional. The study addresses weaknesses in the literature by using a theoretically derived education component, implementing the intervention within a setting regularly used by low-income older adults, employing randomized assignment to intervention and control conditions, and using hierarchical linear modeling to deal with "nested" data.     

Changes in physical activity and short-term changes in health care charges: a prospective cohort study of older adults

BACKGROUND: Better understanding the impact of changes in physical activity behavior on short-term health care charges may inform resource allocation decisions to increase population levels of physical activity. This study examines the prospective relationship of changes in physical activity status on short-term changes in health care charges for older adults. METHODS: A prospective cohort study was done on a stratified random sample of 2,393 adults aged 50 and older enrolled in a Minnesota health plan, predicting changes in resource use between two periods (September 1994 to August 1995 and September 1996 to August 1997) based on billed health care charges. RESULTS: After adjustment for age, gender, comorbidity, smoking status, and body mass index, all physical activity states had declining health care charges, relative to those who were consistently inactive. Subjects who increased their physical activity from 0-1 to 3+ days/week had significant declines in their mean annualized total charges (-2,202 dollars, P < 0.01) relative to those who remained inactive. CONCLUSIONS: Increased physical activity among older adults is associated with lower health care charges within 2 years, relative to charges for those who were persistently inactive. These cost savings may justify investments in effective interventions to increase physical activity in older adults.     

Living with the health and social inequities of a disability: a critical feminist study

Clients living at home with chronic disabling conditions together with their caregivers, service providers, and policymakers face major challenges in optimizing health care. In this critical feminist interpretive study we examined the experiences of women receiving home care for chronic disabling conditions. Five themes emerged: struggling with the embodied limitations of disabling chronic conditions; actively seeking health; struggling with service limitations; seeking ways to manage; and living with isolation and marginalization. Having done this study, we learned that home care services do not always contribute sufficiently to the overall health and well-being of women living with chronic disabling conditions and, in fact, may negatively impact upon their health.     

The Psychosocial Impact of the COVID-19 Pandemic on Chronic Care Patients

ObjectivesThe COVID-19 pandemic has had a profound and pervasive impact on psychosocial health and disrupted care systems world-wide. Our research aims to assess the psychosocial impact of the pandemic and related changes in chronic care provision on patients with chronic obstructive pulmonary disease (COPD) and heart failure.DesignA qualitative survey using semi-structured interviews was held among patients with COPD and heart failure.Setting and ParticipantsUsing randomized sampling, 23 patients with COPD, heart failure, or both were recruited to participate in semi-structured interviews. Interviews were held by phone or videocall. The survey was held during the summer of 2021, when strict national containment strategies were widely implemented but gradually loosened and vaccination was ongoing.MethodsInductive coding using Gioia's approach was used to analyze the data in Atlas.Ti 9.1 software. Using an iterative approach, the data were synthesized in a data structure and data table, which was analyzed using an interpretative approach.ResultsWe found 3 aggregate dimensions in which the COVID-19 pandemic has a negative impact on psychosocial health of patients with chronic disease: (1) perceived vulnerability to disease, (2) influence of health policy, and (3) a mismatch of supply and demand of health care. In these dimensions, the impact of the COVID-19 crisis was found to have a negative impact on psychosocial well-being, compounded by national strategies to contain the pandemic and a disruption of chronic care for patients.Conclusions and ImplicationsHealth care providers should be aware of a multidimensional nature of psychosocial distress for chronic disease patients due to the COVID-19 crisis. Future practice and health policy could be improved by increasing awareness among health care providers, promote regular attention for psychosocial well-being of patients, provision of clear information related to the pandemic, and strategies to secure continuity of care. Results of this study might be further explored in larger studies.     

Vitamin and Mineral Supplements: Barriers and Challenges for Older Adults

ABSTRACT

Older adults are particularly vulnerable to deficiencies of calcium, vitamin D, and vitamin B₁₂. Despite the availability of fortified foods in the United States, intakes of these nutrients among the elderly remain inadequate. Dietary supplements may be a convenient way to improve nutritional status within this population group. This article provides practical and evidence-based recommendations regarding the use of single vitamin/mineral and multivitamin/mineral (MVM) supplements in older adults and provides details on calcium and vitamin D, B₁₂, E, and K. Some single-nutrient supplements have shown benefits for preventing or reducing risks for chronic diseases. Although MVM supplements have not been shown to prevent several major chronic diseases, they do substantially increase vitamin and mineral intakes and blood concentrations, thus improving overall micronutrient status. Older adults who use MVM and/or vitamin/mineral supplements to foster better nutritional and health status should read labels carefully and consult their health care provider to ensure appropriate dietary supplement use.     

Learning your ABDs: Variation in health care utilization across Kansas Medicaid disability groups

BackgroundState Medicaid programs provide critical health care access for persons with disabilities and older adults. Aged, Blind and Disabled (ABD) programs consist of important disability subgroups that Medicaid programs are not able to readily distinguish.Objective/hypothesisThe purpose of this project was to create an algorithm based principally on eligibility and claims data to distinguish disability subgroups and characterize differences in demographic characteristics, disease burden, and health care expenditures.MethodsWe created an algorithm to distinguish Kansas Medicaid enrollees as adults with intellectual or developmental delays (IDD), physical disabilities (PD), severe mental illness (SMI), and older age.ResultsFor fiscal year 2009, our algorithm separated 101,464 ABD enrollees into the following disability subgroups: persons with IDD (19.6%), persons with PD (21.0%), older adults (19.7%), persons with SMI (32.8%), and persons not otherwise classified (6.9%). The disease burden present in the IDD, PD, and SMI subgroups was higher than for older adults. Home- and community-based services expenditures were common and highest for persons with IDD and PD. Older adults and persons with SMI had their highest expenditures for long-term care. Mean Medicaid expenditures were consistently higher for adults with IDD followed by adults with PD.ConclusionsThere are substantial differences between disability subgroups in the Kansas Medicaid ABD population with respect to demographics, disease burden, and health care expenditures. Through this algorithm, state Medicaid programs have the opportunity to collaborate with the most closely aligned service providers reflecting needed services for each disability subgroup.     

A comparison of urban and non-urban African American older adults on health-related characteristics

ABSTRACT

Although residential geographic health disparities have been noted in the previous literature, studies are specifically lacking on intra-group health comparisons of African American older adults by residential geography. The purpose of this study was to determine if health-related characteristics of African American older adults varied by residential geography. Socioeconomic demographics, medical conditions, primary care use, and self-ratings of general health, social activity, and physical activity were compared in a community-dwelling sample of 327 urban and non-urban African American older adults. Urban and non-urban African American older adults were compared on health-related factors. Compared to urban African American older adults, those in non-urban areas had lower incomes, lower self-ratings of general health, social activity, and physical activity, and a higher frequency of arthritis and gastroenterological and urological conditions. Despite poorer general health and medical conditions, non-urban African American older adults were less likely to visit the doctor when needed. Study findings suggest residential geography may be an underappreciated underlying contributing factor to inter-group health disparities between African American and white older adults and not race alone. Therefore, social workers in public health, health care, and clinical settings should be aware of the interaction between race and residential geography.     

A survey of emergency department staff about challenges and recommendations for emergency department care of extended care facility patients

ObjectivesExtended care facility (ECF) patients who transfer to emergency departments (EDs) can pose problems when complicated health problems require extra resources. Higher numbers of older patients are projected to use EDs, so we aimed to identify problems now to implement solutions before they worsen in the future.DesignThis was a prospective survey research study.SettingED in a safety net teaching hospital in the Midwest.ParticipantsED personnel.MeasurementsConfidential, anonymous survey collected views and opinions of ED personnel about problematic issues related to emergency care of ECF residents. The survey targeted communication problems, patient satisfaction concerns, difficult characteristics of patient population, need for education, need for research—and solicited open-ended remarks.ResultsED staff reported concern about flawed communication and poor documentation from the ECF. Based on job title, divergent viewpoints were reported about pharmacological challenges and comfort levels in managing older patients in the ED. Top training priorities were special needs of older adults, detecting abuse in older adults, and specific medical and psychosocial issues associated with older adults. Increased communication among all levels of geriatric care is recommended, especially from extended care facility staff before patient arrival at the ED.ConclusionBecause population projections predict an increasing trend of older adults, health care providers must think ahead and prepare for future medical needs. This survey was an inexpensive and effective way to identify next steps. We plan to use the survey results to initiate collaboration with ED staff, EMS providers, and ECF staff to identify specific actions to improve acute care for elderly patients—for the present and the future.