Staying home or going places: Mobility factors of older minority women's daily trip making in the United States

122 Background: Almost 60% of breast cancer in the U.S. occur in women aged >65, but these women are less likely to receive guideline-concordant care. Given existing treatment disparities by race/ethnicity, older minority women may be especially prone to potential gaps in breast cancer care. Hospitals serving higher proportions of minority patients are at risk to deliver suboptimal care, but how site of care impacts aging patients with breast cancer is not well defined. We sought to evaluate the association between race/ethnicity and breast cancer treatment delays in older women treated at minority-serving hospitals (MSH) vs non-MSHs. Methods: Women >65 years old with non-metastatic breast cancer diagnosed from 2010-2017 were identified in the National Cancer Database using data from Commission on Cancer (CoC)-accredited hospitals. Treatment delay was defined as >90 days from diagnosis to first treatment (surgery, chemotherapy, endocrine therapy). MSHs were defined as the top decile of hospitals serving predominantly Black or Hispanic patients. Multivariable logistic regression models adjusted for patient, disease, and hospital characteristics were used to determine the odds of treatment delay for women at MSHs vs non-MSHs across racial/ethnic groups. Results: 529,128 women (84.5% non-Hispanic White, 3.3% Hispanic White, 9.6% non-Hispanic Black, 0.1% Hispanic Black, 0.2% Native American, 2.5% Asian/Pacific Islander) were identified among 41 MSHs and 1,146 non-MSHs. Overall, time to treatment was <90 days in >95% of women (mean 33.4 days; standard deviation 26.4 days). Older women regardless of race at MSHs were more likely to suffer treatment delays than those at non-MSHs (odds ratio 1.31; 95% confidence interval 1.22-1.41). Compared to non-Hispanic White women, all minority groups had a higher likelihood of treatment delay regardless of MSH status (Table). Conclusions: Although most older women with non-metastatic breast cancer treated at CoC hospitals received care in a timely fashion, minorities and those treated at MSHs were more likely to experience treatment delays. Effective interventions addressing barriers to timely care at MSHs and among racial/ethnic minorities are needed. [Table: see text]

The 2001 National Household Travel Survey: A look into the travel patterns of older Americans

OBJECTIVES The study tested a behavioral and structural barriers model of breast cancer screening, while seeking to determine age effects of behavioral barriers, in order to identify the factors that inhibit screening among older, minority women. 405 older African-American women eligible for a federally funded cancer screening program were enrolled in the study. Participants were administered an intake questionnaire and followed for 3 months to determine mammography use. Three months after enrollment in the program, 79% had not received breast cancer screening. The oldest cohort had significantly lower rates of mammography (just 16% of screened women were > or = 60, p<0.05). Behavioral barriers (knowledge/information deficits, cancer risk perception, cancer fears) inhibited mammography in the oldest group; their breast cancer information deficits included less knowledge of breast cancer risk, treatment, and survivability (all p<0.001). Older women, with greater breast cancer risk than younger cohorts, should be targeted as a high need population for cancer screening. Even when financial and insurance barriers are removed mammography rates are 1/3 those of women <50. Since failure to be screened is related to knowledge and information barriers, health care providers have the potential to educate their older patients and subsequently increase the likelihood they will have regular cancer screening.

This analysis uses the 1984 Survey on Aging (SOA) supplement to the National Health Interview Survey (NHIS) to compare the relative impacts of poverty and health on the propensity of unmarried older black, Hispanic, and non-Hispanic white women to live with family. The results reveal that for blacks and Hispanics, economics are more significant than health in determining whether a woman lives with her children. Our findings also show that black unmarried elderly females are more likely than similar non-Hispanic white women to head their households. The literature and our findings suggest that black and Hispanic older women have fewer options in living arrangements than non-Hispanic older women in the event of diminished health.

Since the initial scientific statement on Secondary Prevention of Coronary Heart Disease (CHD) in the Elderly was published in 2002,1 several trends have continued that make an update highly appropriate. First, the graying of the US population and those of other industrialized countries has progressed unabated because more adults are surviving into their senior years. The number of Americans aged ≥75 years was estimated at 18.6 million in 2010, representing ≈6% of the population,2 and it is expected to double by 2050. The population aged ≥85 years is growing the most rapidly, with numbers expected to reach 19.5 million by 2040. In 2008, 67% of the 811 940 cardiovascular deaths in the United States occurred in people aged ≥75 years.3 In parallel to this increase in the older adult demographic, the number of Americans with CHD has increased to an estimated 16.3 million, more than half of whom are >65 years of age.3 Similarly, 7 million have had a stroke, the incidence of which approximately doubles with successive age decades after 45 to 54 years.3 Peripheral artery disease (PAD) affects 8 to 10 million Americans, the majority of whom are >65 years of age. Between 2015 and 2030, annual US costs related to atherosclerotic cardiovascular disease (ASCVD) are projected to increase from $84.8 billion to $202 billion.3 Moreover, given that ASCVD often undermines functional capacity and independence and increases reliance on long-term care, indirect expenses related to ASCVD are also expected to increase. Thus, the need for effective secondary prevention measures in the older adult population with known ASCVD has never been greater. Notably, the 2011 American Heart Association (AHA)/American College of Cardiology Foundation (ACCF) updated guidelines for secondary prevention of CHD broadened …

Keeping mammography referral appointments: motivation, health beliefs, and access barriers experienced by older minority women

This study examined the impact of the residential environment on the health-related quality of life (HRQOL) and other health-related factors among older women in urban and rural areas. This study included 423 older adults living in urban and rural areas, of whom 236 older women met the inclusion criteria. The HRQOL, physical function, body composition, pain, mental and sleep status, and cognitive function were measured and compared between the two groups by region. Correlation and multiple regression analyses were used to investigate the factors influencing HRQOL. Older rural women had a significantly worse educational history, grip strength, knee extension strength, sit-and-reach distance, one-leg standing, gait speed, and muscle mass as well as significantly better results for the Timed Up and Go tests and fat mass than older urban women. However, no significant differences in the HRQOL were found between regions. Pain intensity and central sensitization-related symptom (CSS) severity were identified as the key factors influencing the HRQOL across both regions. Despite a poorer physical function in older rural women, pain intensity and CSS severity were the main factors influencing the HRQOL in both urban and rural areas. Thus, approaches targeting pain and CSS could be beneficial for improving the HRQOL in community-dwelling older women. Improving the physical function is particularly important for older rural women.

The Missing Women of Sande: A Necessary Exercise in Museum Decolonization

We aimed to investigate the correlation between spinal sarcopenia, spinal sagittal balance (SSB), and spinal function in older women living in rural areas versus those of the older urban women in our previous study. Twenty-five older rural-dwelling women aged more than 70 years were compared with 24 older urban-dwelling women from our previous study. Demographic variables, conventional and spinal sarcopenic indices, variable functional outcome parameters, occupational state, and exercise participation rate were evaluated. We also measured the isometric back extensor strength, radiological parameters for SSB on whole-spine radiography, and volumetric parameters of the lumbar extensor muscle on computed tomography. There were no significant intergroup differences in demographic variables or the prevalence of sarcopenia. Older women in rural areas had greater handgrip strength than those in urban areas (22.7&plusmn;3.7 kg v 20.0&plusmn;3.4 kg, p=0.010). However, their mean lumbar lordosis angle was lower (31.7&plusmn;15.3&deg; v 42.3&plusmn;11.2&deg;, p=0.012). Isometric back extensor strength was lower in rural women than in urban women. The vocational activity participation rate of rural women was significantly higher (84% v 12.5%, p<0.001), whereas their exercise participation rate was significantly lower (60% v 92%, p<0.001). Older women in rural areas had greater handgrip strength and vocational participation rates but lower back extensor strength and exercise participation rates. Therefore, more attention is needed for healthcare services to support their spinal health and exercise habits.

Homelessness among older African American women is emerging as a serious social problem. The increasing cost of living, diminishing community resources, and shrinking retirement benefits, as well as reduced social services are resulting in greater numbers of older minority women becoming homeless. This investigation explores the relevance of faith and spirituality to an advocacy assessment designed to help participants resolve issues that operate as barriers to their leaving and staying out of homelessness. A substudy of a larger research and development project was undertaken, in which qualitative interview methods were used to illuminate the role of faith and spirituality resources in the lives of 84 older homeless African American women. Comparative thematic analysis of illustrative cases was undertaken to better understand the role of faith and spirituality in the women's lives and in how they used faith and spirituality in coping with homelessness. Five dimensions of faith and spirituality, (a) identity and beliefs; (b) affiliation and membership; (c) involvement; (d) practices; and (e) benefits, served as promising resources in understanding life spaces of homeless minority women and identified promising advocacy strategies. Two cases describe the realities of homelessness for older minority women endeavoring to transition out of homelessness and illustrate how faith and spirituality can buffer stress, facilitate coping, and sustain motivation. How older homeless African American women use their faith and spiritual resources to cope with demands of homelessness, challenges of transition, and recovery from the multiple traumas resulting from being homeless makes the assessment of faith and spirituality an important part of the advocacy process.

Background: The population of Korea is aging rapidly. The older population varies in characteristics in accordance with a wide-range of circumstances; therefore, categorizing the overall older population as a homogeneous group, could misrepresent their issues. For that reason, the study of older people should be focused on the diversity of characteristics among the older population. The aims of this study were to examine and identify the factors related to life satisfaction in older Korean women living alone. This study was a cross-sectional survey design. The participants comprised of 243 older women over the age of 65, who met eligibility criteria. Measures: Measures were a demographic characteristics form, the Health Self-Rating Scale, the Self-Esteem Scale (RSES), the Korean Geriatric Depression Scale Short Form, and the Life Satisfaction Instrument. Results: Degrees of the perceived health status, self-esteem, and depression were higher than the median. Life satisfaction was lower than the median. Predictors that determine life satisfaction in older Korean women living alone were depression, perceived health status, self-esteem, and monthly allowance. All these predictors, or factors, had an explanatory power of 48.2% for life satisfaction among older Korean women living alone. Of all these predictor factors, depression had the largest impact. Conclusions: The major factor influencing the life satisfaction in older Korean women living alone was depression. These findings suggest that there is a need to develop nursing strategies aimed at decreasing depression in order to increase life satisfaction in older women living alone.

The objective of this study was to estimate the association of depressive and anxiety symptoms with the risk of cardiovascular disease (CVD) in middle-aged and older Chinese women and to further evaluate whether the association was influenced by sociodemographic factors. This cross-sectional study included 9544 women aged 40 to 70 years from the eastern, central, and western regions of China in 2018. Logistic regression models were utilized to examine odds ratios (ORs) and their 95% confidence intervals (CIs) for depressive and anxiety symptoms with CVD risk. Depressive (OR = 1.89) and anxiety symptoms (OR = 1.55) were independently associated with an increased risk of CVD after adjusting for potential confounders. Stratified analyses found that depressive symptoms were only significantly associated with higher risk of CVD in women aged over 50 years and with lower levels of education and household income, whereas anxiety symptoms were only significantly associated with an elevated risk of CVD in women aged 60 to 70 years, and living in rural areas, and with lower levels of education and household income. Our findings emphasize the improvement of recognizing and managing depressive and anxiety symptoms to reduce the risk of CVD in middle-aged and older women, particularly in older women of low socioeconomic status.

BackgroundEmerging research indicates that binge eating (BE; consuming unusually large amounts of food in one siting while feeling a loss of control) is prevalent among older women. Yet, health correlates of BE in older adult populations are poorly understood. The original study aimed to investigate BE prevalence, frequency, and health correlates in a sample of older adult women. Based on results from this first study, we then sought to replicate findings in two additional samples of older adult women from separate studies.MethodUsing self-reported frequencies of BE from three separate samples of older women with very different demographics, we compared BE prevalence, frequency, and health correlates among older women. Study 1 (N = 185) includes data collected online (86% White; 59% overweight/obese status). Study 2 (N = 64) was conducted in person at a local food pantry (65% Hispanic; 47% household income < $10,000/year). Study 3 (N = 100) comprises data collected online (72% White; 50% Masters/Doctoral Degree).ResultsPer DSM-5 frequency criterion of BE at least weekly, we found prevalence rates ranging from 19 to 26% across the three samples. Correlates of BE frequency included elevated negative mood, worry, BMI, and less nutritious food consumption.ConclusionsAcross three very different samples in terms of race/ethnicity, education, food security status, measurements, and sampling methodology, we found fairly consistent rates of self-reported BE at least weekly (19–26%). Results suggest that BE is related to negative health indices among older women and support the need for more research in this population.

Narrative strategy can strengthen social work practice, given its usefulness in revealing how social forces influence people’s experiences with situations that can compromise their well-being. In this paper, a product of long-term developmental research, the authors consider the versatility of narrative strategy to address homelessness among older African-American women, a growing segment of the homeless population in the United States. After considering homelessness as a social issue, and the distress it can produce, often resulting in serious health and mental health problems among older minority women, the authors examine vulnerability from a narrative perspective, offer background on their long-term narrative research and summarise their observations about the nature of narrative practice in working with members of vulnerable populations. The authors develop a thematic framework for conceptualising narrative as a practice research tool for social workers and other human service professionals. For each of the four narrative themes (involving plight, efficacy, hope and recovery), useful in helping people who are vulnerable, the authors document the distinctive focus of each one, and they then conclude the paper with implications for helping people who are vulnerable.

Purpose: The purpose of this study was to investigate osteoporosis prevalence and factors influencing health-related quality of life (HRQoL) among older Korean women with osteoporosis. Methods: The study design was a retrospective study using secondary data analysis. Data for 1,355 women aged 65 and older from the Korea National Health and Nutrition Examination Survey (KNHANES) 2015 to 2016 were included. Linear regression analysis was conducted for influential factors on HRQoL, measured by the Euro Quality of Life-5D (EQ-5D). Results: The prevalence of osteoporosis was 41.3% in older Korean women. The EQ-5D index score was lower in older women with osteoporosis (0.83) than those without osteoporosis (0.86). Lower HRQoL in older Korean women with osteoporosis was associated with lower household income, perceived health status as bad, comorbidity, activity restriction, and stress. Conclusion: The findings indicate that the prevalence of osteoporosis was high in older Korean women. In addition, healthcare professionals need to consider individual conditions such as economic status, perceived health status, other chronic diseases, activity restriction and level of stress for improvement of HRQoL in older Korean women with osteoporosis.