Two‐Year Effects of Interdisciplinary Intervention for Hip Fracture in Older Taiwanese

OBJECTIVES: To explore the 2‐year outcomes of an interdisciplinary intervention for elderly patients with hip fracture. DESIGN: Randomized experimental design. SETTING: A 3,000‐bed medical center in northern Taiwan. PARTICIPANTS: Patients with hip fracture (N=162): 80 in the intervention group and 82 in the usual care control group. INTERVENTION: An interdisciplinary program of geriatric consultation, continuous rehabilitation, and discharge planning. MEASUREMENTS: Outcomes (clinical outcomes, self‐care ability, health‐related quality of life (HRQoL), service utilization, and depressive symptoms) were assessed 1, 3, 6, 12, 18, and 24 months after discharge. Self‐care ability (ability to perform activities of daily living (ADLs)) was measured using the Chinese Barthel Index. HRQoL was measured using the Medical Outcomes Study 36‐item Short Form Survey, Taiwan version (SF‐36). Depressive symptoms were measured using the Chinese Geriatric Depression Scale, short form. RESULTS: Subjects in the intervention group had significantly better ratios of hip flexion (β=5.43, P<.001), better performance on ADLs (β=9.22, P<.001), better recovery of walking ability (odds ratio (OR)=2.23, P<.001), fewer falls (OR=0.56, P=.03), fewer depressive symptoms (β=?1.31, P=.005), and better SF‐36 physical summary scores (β=6.08, P<.001) than the control group during the first 24 months after discharge. The intervention did not affect the peak force of the fractured limb's quadriceps, mortality, service utilization, or SF‐36 mental summary score. CONCLUSION: The interdisciplinary intervention for hip fracture benefited elderly persons with hip fracture by improving clinical outcomes, self‐care ability, and physical health–related outcomes and by decreasing depressive symptoms during the first 24 months after hospital discharge.     

Biopsychosocial Characteristics of Community‐Dwelling Older Adults with Limited Ability to Walk One‐Quarter of a Mile

OBJECTIVES: To establish nationally representative estimates of the prevalence of self‐reported difficulty and inability of older adults to walk one‐quarter of a mile and to identify the characteristics independently associated with difficulty or inability to walk one‐quarter of a mile. DESIGN: Cross‐sectional analysis of data from the 2003 Cost and Use Medicare Current Beneficiary Survey. SETTING: Community. PARTICIPANTS: Nine thousand five hundred sixty‐three community‐dwelling Medicare beneficiaries aged 65 and older, representing an estimated total population of 34.2 million older adults. MEASUREMENTS: Self‐reported ability to walk one‐quarter of a mile, sociodemographics, chronic conditions, body mass index, smoking, functional status. RESULTS: In 2003, an estimated 9.5 million older Medicare beneficiaries had difficulty walking one‐quarter of a mile, and 5.9 million were unable to do so. Of the 20.2 million older adults with no difficulty in activities of daily living (ADLs) or instrumental activities of daily living (IADLs), an estimated 4.3 million (21%) had limited ability to walk one‐quarter of a mile. Having difficulty or being unable to walk one‐quarter of a mile was independently associated with older age, female sex, non‐Hispanic ethnicity, lower educational level, Medicaid entitlement, most chronic medical conditions, current smoking, and being overweight or obese. CONCLUSION: Almost half of older adults and 20% of those reporting no ADL or IADL limitations report limited ability to walk one‐quarter of a mile. For functionally independent older adults, reported ability to walk one‐quarter of a mile can identify vulnerable older adults with greater medical problems and fewer resources and may be a valuable clinical marker in planning their care. Future work is needed to determine the association between ability to walk one‐quarter of a mile walk and subsequent functional decline and healthcare use.     

Traditional Chinese Medicine Use and Health in Community‐Dwelling Chinese‐American Older Adults in Chicago

Chinese people have practiced traditional Chinese medicine (TCM) for thousands of years, but there is a paucity of research regarding TCM use in Chinese older adult immigrants in the United States. This study aims to provide an overall estimate of TCM use for Chinese older adults in the United States and to examine associations between sociodemographic characteristics, health measures, and TCM use. Data were collected through the Population Study of Chinese Elderly in Chicago, a community‐based participant research study that surveyed 3,158 Chinese older adults aged 60 and older. TCM use was measured using an eight‐item scale that examined eight kinds of TCM. Seventy‐six percent of participants reported any use of TCM within the past year. After adjusting for potential confounding factors, health status was associated with greater use of acupuncture (odds ratio (OR) = 1.33, 95% confidence interval (CI) = 1.06–1.68) and massage therapy (OR = 1.53, 95% CI = 1.21–1.93), and quality of life was associated with less use of prescribed herbal products (OR 0.69, 95% CI = 0.55–0.87), tai chi (OR = 0.62, 95% CI = 0.50–0.78), and other traditional medicine (OR = 0.47, 95% CI = 0.40–0.56). These findings call for further investigation of TCM use by Chinese older adults, especially those with poor health and those with better quality of life. In the clinical setting, physicians should have awareness of TCM when treating Chinese older adults and look toward possible integration with Western medicine for more culturally appropriate, patient‐centered care.