ADL Difficulties Research Articles

Socioeconomic status and depression in later life: longitudinal mediation effects of activities of daily living

BackgroundSocioeconomic status (SES) is associated with both depression and activities of daily living (ADL and IADL). However, the role of ADL as a biological mechanism in the relationship between SES and late-life depression, examined through longitudinal data, remains understudied. This study explored the longitudinal mediation effects of basic ADL or IADL on the SES-depression link in older adults.MethodsData from the China Health and Retirement Longitudinal Study (N = 4104) were utilized. Mediation analysis was performed using parallel process latent growth curve modeling.ResultsThe average age of participants was 57.76 years, and 55.7% being females. Significant linear growth over time was observed in ADL, IADL, and depression. Adjusting for covariates, SES was positively linked to the initial levels (intercepts) of ADL (βiADL=-0.100[-0.143, -0.057]), IADL (βiIADL=-0.140[-0.185, -0.095]), and depression (βiDEP=-0.103[-0.158, -0.048]). However, SES showed no significant correlation with the rate of change (slopes) in ADL, IADL, or depression (P > 0.05). The intercepts of ADL (βiDEP = 0.566[0.503, 0.629]) and IADL (βiDEP = 0.607[0.544, 0.670]) were positively correlated with the depression intercept but negatively with the depression slope. Conversely, the slopes of ADL and IADL were positively associated with the depression slope. These results suggest a negative indirect relationship between SES and the initial level of depression, but a positive indirect relationship with the rate of increase in depression through ADL (or IADL) intercept.ConclusionsHigher SES is associated with a lower initial risk of depression and ADL difficulties. However, this same higher SES may relate to a faster increase in ADL difficulties and depression among middle-aged and older adults. The findings underscore the need for increased governmental healthcare funding and improved healthcare accessibility. Additionally, maintaining adequate sleep and physical activity can help prevent disability and reduce depression risk later in life, particularly among older adults with lower SES.

Social support moderates association between area deprivation index and changes in physical health among adults in the Baltimore Study of Black Aging (BSBA)

ABSTRACT Despite the association of neighborhood quality with poorer adult health, limited research has explored the association between neighborhood disadvantage, e.g. Area Deprivation Index (ADI), and older Black adults’ health, prospectively. This observational study examined the association between ADI and changes in longitudinal physical health within older Black adults. The analytic sample (n = 317) included data from waves 1 & 2 of the Baltimore Study of Black Aging: Patterns of Cognitive Aging (BSBA-PCA). Study variables included the Area Deprivation Index (ADI), objective (e.g. average heart rate) and subjective (e.g. activities of daily living) measures of physical health. Multiple linear regression models were conducted controlling for sociodemographic and social support characteristics. Participants living in more disadvantaged neighborhoods, based on national and state ADIs, were more likely to have a decreasing heart rate even after adjusting for covariates. Likewise, participants reporting increasing levels of ADL difficulty were living in a neighborhood with greater disadvantage based on national and state ADI rankings. Significant social support received and ADI (national and state) interactions were observed for average heart rate. The findings suggest that research on the effect of neighborhood quality and social support can enhance our understanding of its impact on older Black adults’ health prospectively.

FINDINGS FROM NSHAP: SOCIAL CONNECTEDNESS, HEALTH INDICATORS, MEDICATION EFFECTS, AND PREDICTING MORTALITY

Abstract The National Social Life, Health, and Aging Project’s broad range of both social measures, and objective and self-reported health measures enable detailed analysis of the intersections between these fundamental aspects of older adults’ lives. The papers in this symposium explore various aspects of these topics from different angles. The first explores employment as an important form of social participation, establishing that full-time employment among respondents is associated with better cognitive function, and less ADL and IADL difficulties. The second examines how social isolation affects men and women differently. Social Networks are the focus of the third paper and compare family to friendship ties. Using NSHAP’s unique medication log, Wilder examines sleep disturbances and the prevalence of respondents taking medications with somnolence as an adverse event, demonstrating the need for more research into how this might affect older adults’ health and well-being. Li uses NSHAP data to develop machine learning models to predict 10-year mortality of older adults in the US which perform with better accuracy than logistic regression.

Gender differences in the association between cardiovascular diseases and major depressive disorder among older adults in India.

Despite the global disease burden associated with the co-occurrence of cardiovascular diseases (CVDs) and depression, depression remains underdiagnosed and undertreated in the CVD population, especially among older adults in India. As such, this study examines (1) the association between single and multiple CVDs and major depressive disorder among older Indians; (2) whether this association is mediated by older adults' self-rated health and functional limitations; and (3) whether these associations vary for older men and women. Data come from the 2017-18 wave 1 of the Longitudinal Ageing Study in India. Multivariable logistic regression is used to explore the association between CVDs and major depressive disorder among older men and women. The Karlson-Holm-Breen (KHB) method is used to examine the mediation effects of self-rated health and functional difficulties in the observed associations. Overall, 5.08% of the older adults had multiple CVDs. Older women (9.71%) had a higher prevalence of major depressive disorder compared to men (7.50%). Multiple CVDs were associated with greater odds of major depressive disorder after adjusting the potential covariates (adjusted odds ratio [AOR]: 1.49; 95% confidence interval [CI]: 1.10-2.00). Older men with multiple CVDs had a greater risk of major depressive disorder (AOR: 1.64; 95% CI: 1.05-2.57) relative to women with CVDs (AOR: 1.39; 95% CI: 0.93-2.08). The association between multiple CVDs and depression was mediated by self-rated health (34.03% for men vs. 34.55% for women), ADL difficulty (22.25% vs. 15.42%), and IADL difficulty (22.90% vs. 19.10%). One in five older Indians with multiple CVDs reports major depressive disorder, which is three times more common than the prevalence of depressive disorder in older adults without CVDs. This association is attenuated by self-rated health and functional limitations. Moreover, these associations are more pronounced in older men relative to older women. These findings depart from prior inferences that men with CVDs are less psychologically distressed than their female counterparts. Moreover, the findings underscore the importance of gender-specific approaches to interventions and therapeutics for CVD-related mental health.

Prevalence of early and late onset of chronic diseases and multimorbidity and its association with physical, mental and functional health among older Indian adults

BackgroundIdentifying people with early and late onset of chronic conditions might help target the subpopulations that are more vulnerable to negative mental, physical and functional health outcomes. The current study aimed to examine the association of early and late onset of chronic single and multiple morbidities with self-perceived physical and mental health, functional limitations and physical inactivity among older Indian adults.MethodsCross-sectional study was conducted using data from the Longitudinal Ageing Study in India (LASI) Wave 1 (2017–2018). The total sample size for the present study was 31,386 older adults age 60 years or older. Multivariable binary logistic regression analysis was used to establish the association between the outcomes (poor perceived physical/mental health, functional difficulty and physical inactivity) and explanatory variables (early [ = < 50 years of age] and late [> 50 years]) onset of chronic illnesses such as hypertension, diabetes, heart attack, heart disease, stroke, cancer, lung disease, arthritis, osteoporosis and psychiatric disease).ResultsOverall, 24.21% of the sample population had poor self-perceived physical health, whereas 8.67% of participants had poor self-perceived mental health. The prevalence of difficulty in ADL, difficulty in IADL, and physical inactivity was 23.77%, 48.36%, and 68.9%, respectively. Odds of poor perceived mental health were higher for the respondents with early as well as late onset of hypertension, stroke, and arthritis; while individuals with late onset of diabetes, and heart disease had higher odds of poor perceived mental health than those without chronic disease. Individuals with early onset of single morbidity were more likely to report ADL difficulty (adjusted odds ratio [AOR]: 1.33, confidence interval [CI]: 1.06–1.67); while those with late onset of single (AOR: 1.34, CI: 1.17–1.53) and multimorbidity (AOR: 1.91, CI: 1.63–2.24) were more likely to report ADL difficulty compared with individuals without morbidity. Individuals with early as well as late-onset of multimorbidity had more than two times higher odds of reporting poor physical health, poor mental health and IADL difficulty compared with individuals without chronic disease.ConclusionsThe present study revealed that early and/or late onset of chronic single and/or multiple morbidities significantly predicted poor self-perceived physical and mental health, functional limitations and physical inactivity among older Indian adults. The findings further suggest that late onset of chronic diseases such as cancer and stroke and multi-morbidity had stronger associations with physical inactivity that may help identify high risk groups for screening and support.

National Prevalence of Social Isolation and Loneliness in Adults with Chronic Obstructive Pulmonary Disease.

Rationale: Social isolation and loneliness are gaining recognition for their role in health outcomes, yet they have not been defined in people with chronic obstructive pulmonary disease (COPD). Objective: To determine the national prevalence of and characteristics associated with social isolation and loneliness in people with COPD. Methods: This is a cross-sectional study of community-dwelling adults aged ⩾50 years in the nationally representative HRS (Health and Retirement Study) (2016-2018). Participants self-reported COPD and supplemental oxygen use and were categorized into three groups: 1) no COPD; 2) COPD; and 3) COPD on oxygen. Social isolation was defined using a nine-item scale indicating minimal household contacts, social network interaction, and community engagement. Loneliness was measured using the 3-Item UCLA Loneliness Scale. Multivariable logistic regression defined prevalence and associated characteristics for both. Results: Participants (n = 10,384) were on average 68 years old (standard deviation, ±10.5), 54% female, 10% Black, 11% self-reported COPD, and 2% self-reported supplemental oxygen. Overall, 12% were socially isolated, 12% lonely, and 3% both socially isolated and lonely. People with COPD had a higher adjusted prevalence of social isolation (no COPD: 11%; COPD: 16%; COPD on oxygen: 20%; P < 0.05) and loneliness (no COPD: 11%; COPD: 18%; COPD on oxygen: 22%; P < 0.001). In those with COPD, characteristics associated with social isolation (P < 0.05) included sex (men: 22%; women: 13%), non-Hispanic White ethnicity (White: 19%; Black: 7%), low net worth (<$6,000: 32%; $81,001-$239,000: 10%), depression (depression: 24%; no depression: 14%), having difficulty with one or more activities of daily living (one or more difficulty: 22%; no difficulty: 14%), and current cigarette use (current: 24%; never: 13%). Characteristics associated with loneliness (P < 0.05) included younger age (50-64 yr: 22%; 75-84 yr: 12%), being single (single: 32%; married: 12%), depression (depression: 36%; no depression: 13%), having difficulty with one or more activities of daily living (one or more difficulty: 29%; no difficulty: 15%), diabetes (diabetes: 26%; no diabetes: 17%), and heart disease (heart disease 23%; no heart disease: 17%). Conclusions: Nearly one in six adults with COPD experience social isolation, and one in five experience loneliness, with almost twice the prevalence among those on supplemental oxygen compared with the general population. Demographic and clinical characteristics identify those at highest risk to guide clinical and policy interventions.

On the road again: Factors associated with family/friend caregiver-provided transportation

IntroductionMany older adults rely on family/friend caregivers to provide transportation following decreasing and/or ceasing driving. Because caregiving is related to negative mental and physical health outcomes, providing consistent transportation could be challenging. However, we need to first understand the predictors of providing transportation before we can begin assessing its implications. Therefore, the aim of this study was to add to the literature that is beginning to examine family/friend caregiver-provided transportation and its associations. MethodsData came from Round 7 of the National Health and Aging Trends Study (NHATS) and the linked National Survey of Caregiving (NSOC; n = 1103 dyads). Ordinal regression analyses assessed how care recipient transportation, disability, and demographic factors were associated with the frequency of family/friend caregiver-provided transportation. ResultsLess frequent care recipient driving, assisting with shopping, mobility, and bills/banking needs, coresidence, and not being homebound were associated with higher odds of more family/friend caregiver-provided transportation. Caregivers also expected lower odds of providing transportation to care recipients with greater ADL difficulties and with a high school degree or less or a bachelor's degree compared to those with some graduate school or higher. ConclusionsResults of this study suggest that various determinants are related to the odds of family/friend caregiver-provided transportation. This can provide direction for needed targeted interventions, such as services and supports. More research is necessary to help maintain and/or improve mobility in older adulthood and decrease reliance on family/friend caregivers.

FACTORS ASSOCIATED WITH FRID USE IN OLDER BLACK AND WHITE MEN AND WOMEN: THE HEALTH ABC STUDY

Abstract Medications that increase falls, fall-risk increasing drugs (FRIDs), are common in older adults. Two FRID definitions, the CDC Steadi-Rx and Swedish National Board of Health and Welfare, are widely accepted. We hypothesized that FRID use risk factors vary by definition in 1,352 community-dwelling older adults in the Health, Aging, and Body Composition Study (Health ABC; 2007–2008 clinic visit; 83.4±2.8 years; 54.1% women; 34.9% Black). FRID use by either definition was associated with chronic health conditions, medical care including non-FRID use, higher BMI and depression scores, and less walking exercise (all p &amp;lt; 0.05). Steadi-Rx FRID use was also associated with more falls, ADL difficulty, and better cognitive scores. Using stepwise multivariate Poisson regression adjusting for demographics, lifestyle/behavior factors, and comorbidity, a 1-unit increase in BMI and depression score was associated with an approximately 2% mean FRID count increase for both definitions and 7% mean FRID count increase per 1-unit increase in non-FRID count. Both definitions had a 40% and 15% lower mean FRID count, respectively, with hypertension and cardiovascular disease (CVD) history. Better cognitive scores were associated with 1% mean increase in Steadi-Rx FRID count and a mean decrease of 13% and 33% FRID count, respectively, with cancer history and having primary healthcare. In identically adjusted logistic regression, FRID use (yes/no) was associated in a consistent direction with BMI, depression score, non-FRID count, hypertension, CVD, having primary healthcare, and also less likely with low-vs-high income (OR=0.18[0.06–0.50]). Risk factors differ by FRID definition, with Steadi-Rx identifying more predictors than the Swedish definition.

CULTURAL AND SOCIAL ACTIVITIES AND MENTAL HEALTH AMONG INDIGENOUS OLDER ADULTS IN THE UNITED STATES

Abstract Although the number and percentage of indigenous older adults are growing, little is known about the risk and protective factors associated with mental health among this population. We estimated regression models for mental health using data from the 2017-2020 needs assessment of indigenous elders (aged 55+) administered by the University of North Dakota, which included 19,143 indigenous elders, including 17,184 American Indians, 1,521 Alaska Natives, and 438 Native Hawaiians. The Mental Health Index (MHI) was used, with five questions: during the past month, how much of the time (1) were you a happy person, (2) have you felt calm and peaceful, (3) have you been a very nervous person, (4) have you felt downhearted and blue, and (5) have you felt so down in the dumps that nothing could cheer you up? The answers for MHI-5 were standardized on a 0-100 scale, where higher scores indicate optimal mental health. Having ADL and/or IADL difficulties was associated with worse mental health. Frequent engagement in social activities was positively associated with mental health. Data also suggest that those engaged in cultural practice all the time compared to people who engaged in cultural practice less frequently had higher levels of MHI-5, controlling for other variables. These findings underscore the importance of cultural activities, as well as social activities and physical health, in the management of mental health.

Perceived impacts of COVID-19 on wellbeing among US working-age adults with ADL difficulty

BackgroundThe COVID-19 pandemic has disproportionately impacted people with disabilities. Working-age adults with ADL difficulty may face unique challenges and heightened health risks because of the pandemic. It is critical to better understand the impacts of COVID-19 on social, financial, physical, and mental wellbeing among people with disabilities to inform more inclusive pandemic response policies. ObjectiveThis study compares perceived COVID-19 physical and mental health, social, and financial impacts for US working-age adults with and without ADL difficulty. MethodsWe analyzed data from a national survey of US working-age adults (aged 18–64) conducted in February and March 2021 (N = 3697). We used logistic regression to compare perceived COVID-19-related impacts on physical and mental health, healthcare access, social relationships, and financial wellbeing among those with and without ADL difficulty. ResultsAdults with ADL difficulty were more likely to report negative COVID-19 impacts for many but not all outcomes. Net of covariates, adults with ADL difficulty had significantly greater odds of reporting COVID-19 infection (OR = 2.1) and hospitalization (OR = 6.7), negative physical health impacts (OR = 2.0), and negative impacts on family relationships (OR = 1.6). However, they had significantly lower odds of losing a friend or family member to COVID-19 (OR = 0.7). There were no significant differences in perceived impacts on mental health, ability to see a doctor, relationships with friends, or financial wellbeing. ConclusionsWorking-age adults with ADL difficulty experienced disproportionate health and social harm due to the COVID-19 pandemic. To address these disparities, public health response efforts and social policies supporting pandemic recovery must include disability perspectives.

Objectively measured sleep and physical function: Associations in low-income older adults with disabilities

ObjectiveLate-life sleep health has been tied to physical function, but little is known about these associations among socially disadvantaged populations. DesignWe determined cross-sectional associations of sleep with physical function in low-income, predominantly Black older adults with disabilities. ParticipantsOne hundred thirty-six older adults (mean age 76.0 years, 83.8% women, 82.4% Black). MeasurementsPrimary predictors were actigraphic total sleep time (TST), wake after sleep onset (WASO), and subjective sleep complaints. Outcomes were objective physical performance (Short Physical Performance Battery (SPPB)) and participant-reported difficulties in basic and instrumental activities of daily living (ADLs and IADLs). ResultsIn regression models adjusted for potential confounders, both longer TST and greater WASO were associated with lower SPPB scores and increased IADL difficulty. Participants with a mean TST in the longest (>7.5 hours) vs. intermediate (6.3-7.5 hours) tertile had 27% higher odds of additional IADL difficulty (incident rate ratio = 1.27, 95% confidence interval [CI] 1.03, 1.58). Each additional 10 minutes of WASO was associated with 0.13 point lower SPPB scores (B = −0.13, 95% CI −0.25, −0.01) and increased IADL difficulty (B = 0.02, 95% CI 0.0003, 0.04). Sex moderated the associations of WASO with IADL and ADL difficulties: associations were stronger for males. Subjective sleep complaints were not statistically significantly associated with function. ConclusionsAmong disabled, low-income, mostly Black older adults, objective measures of long sleep and greater WASO are associated with poorer physical function. Effect sizes for the associations were modest; however, findings may have important implications given the significant consequences of decreased function on quality of life and caregiving demands.

Coping repertoires and psychological well-being of Chinese older immigrants in the United States

Objectives This study examines (1) the overall structures of multifaceted coping resources, that is, coping repertoires, among Chinese older immigrants in the United States, (2) the optimal coping repertoire that is associated with best psychological outcomes of these older immigrants, and (3) the most effective coping repertoire in different adversities. Method Using data from 2,923 Chinese older immigrants in Chicago, Latent Class Analysis (LCA) was performed to identify the overall coping repertoires of U.S. Chinese older adults. Negative binomial and logistic regressions were used to examine associations between coping repertoires and depression and Quality of Life (QoL), respectively. We further tested whether coping repertories moderate the relationships between adversities in health, economic, and social domains, and the two psychological outcomes. Results LCA revealed four types of coping repertories: low-resource (43%), spouse-oriented (32%), community-oriented (15%), and multi-source coping (10%). Overall, Chinese older immigrants who had the multi-source coping repertoire reported the best psychological outcomes. The community-oriented and multi-source coping repertories had significantly stronger buffering effects on psychological well-being among individuals with IADL difficulties or low acculturation. However, spouse-oriented coping intensified the association between ADL difficulties and depression, and community-oriented coping intensified the association between poorer subjective health and lower quality of life. Conclusion This study revealed overall low coping repertories of Chinese older immigrants, suggesting the most optimal coping repertories should consist of both intrinsic and extrinsic coping sources. The findings further show that relying on limited sources might be harmful to older immigrants’ mental health.

Greater Social Engagement and Greater Gray Matter Microstructural Integrity of Aging Adults

Social engagement reflects habitual social roles in aging adults and may protect against dementia. Cross-sectional associations of social engagement (SE) index with gray matter (GM) microstructure was studied in regions of interest relevant to social cognition among community-dwelling older adults [n=293, mean age: 82.8 years (SD: 2.8), 43% males] using linear regression models. Greater SE was significantly related to lower mean diffusivity (MD) (greater GM microstructural integrity) [shown as standardized estimate (p-value)] in: left middle frontal gyrus-orbital part: -0.168 (0.005), left caudate nucleus: -0.141 (0.02), left temporal pole-middle temporal gyrus: -0.136 (0.03), right middle frontal gyrus: -0.160 (0.006), right superior frontal gyrus-orbital part: -0.187 (0.002), right middle frontal gyrus, orbital part: -0.124 (0.04), adjusted for demographic attributes. Associations were robust to adjustment for hearing or ADL difficulty. Findings were generally stronger in females than in males. Social engagement may prevent GM integrity loss and build brain reserve in dementia-related regions. Part of a symposium sponsored by Brain Interest Group.

Leveraging Existing Data from CMS-Linked Cohort Studies for the Advancement and Translation of Frailty Research

As population aging is accelerating rapidly, there is growing concern on how to best provide patient-centered care for the most vulnerable. Establishing a predictable and affordable cost structure for healthcare services is key to improving quality, accessibility, and affordability. One such effort is the “frailty” adjustment model implemented by the Centers for Medicare & Medicaid Services (CMS) that adjusts payments to a Medicare managed care organization based on functional impairment of its beneficiaries. Earlier studies demonstrated added value of this frailty adjuster for prediction of Medicare expenditures independent of the diagnosis-based risk adjustment. However, we hypothesize that further improvement is possible by implementing more rigorous frailty assessment rather than relying on self-report of ADL difficulties as used for the frailty adjuster. This is supported by the consensus and clinical observations that neither multimorbidity nor disability alone is sufficient for frailty identification. This symposium consists of four talks that leverage data from three CMS-linked cohort studies to investigate the utility of assessment of the frailty phenotype for predicting healthcare utilization and costs. Talk 1 and 2 use data from the NHATS cohort to assess healthcare utilization by frailty status in the general population and the homebound subset. Talk 3 and 4 use data from the MrOS study and the SOF study to investigate the impact of frailty phenotype on healthcare costs. Taken together, their findings highlight the potential of incorporating phenotypic frailty assessment into CMS risk adjustment to improve the planning and management of care for frail older adults.

Sensor-Based and Patient-Based Assessment of Daily-Living Physical Activity in People with Parkinson's Disease: Do Motor Subtypes Play a Role?

The benefits of daily-living physical activity are clear. Nonetheless, the relationship between physical activity levels and motor subtypes of Parkinson’s disease (PD), i.e., tremor dominant (TD) and postural instability gait difficulty (PIGD), have not been well-studied. It is also unclear if patient perspectives and motor symptom severity are related to objective, sensor-based assessment of daily-living activity in those subtypes. To address these questions, total daily-living physical activity was quantified in 73 patients with PD and 29 healthy controls using a 3D-accelerometer worn on the lower back for at least three days. We found that individuals with the PIGD subtype were significantly less active than healthy older adults (p = 0.007), unlike individuals with the TD subtype. Among the PIGD subtype, higher daily physical activity was negatively associated with more severe ON bradykinesia (rS = -0.499, p = 0.002), motor symptoms (higher ON MDS-UPDRS (Unified Parkinson’s Disease Rating Scale motor examination)-III scores), gait difficulties (rS = -0.502, p = 0.002), motor complications (rS = 0.466, p = 0.004), and balance (rS = 0.519, p = 0.001). In contrast, among the TD subtype, disease-related characteristics were not related to daily-living physical activity. Intriguingly, physical activity was not related to self-report of ADL difficulties (scores of the MDS-UPDRS Parts I or II) in both motor subtypes. These findings highlight the importance of objective daily-living physical activity monitoring and suggest that self-report does not necessarily reflect objective physical activity levels. Furthermore, the results point to important differences in factors related to physical activity in PD motor subtypes, setting the stage for personalized treatment programs.

Are Disability Rates among People with Diabetes Increasing in Germany? A Decomposition Analysis of Temporal Change between 2004 and 2015.

Objectives: We investigated changes in the prevalence of disabilities among individuals with type 2 diabetes and analyzed the contribution of comorbidities on this change. Methods: Data were drawn from the Survey of Health, Ageing, and Retirement in Europe (SHARE). We estimated predicted probabilities of impaired (instrumental) activities of daily living (IADL and ADL) by means of logistic regression. Multivariate decomposition was employed for analyzing the impact of comorbidities on changes in disability rates. Results: Among people with diabetes, ADL difficulties rose significantly from 11.3% (2004) to 19.1% (2015), while IADL difficulties increased among younger diabetics from 11.5% to 18.3%. Decomposition analysis revealed that the parallel increase in comorbidities contributed to the rise in disabilities. Discussion: We found disability rates among people with diabetes in Germany to be increasing over time, pointing toward a growing demand of tertiary prevention for these individuals to maintain functional health and quality of life.

Latent Class Analysis to Determine Patients with Advanced Heart Failure at Highest Risk of Poor Outcomes (RP314)

•Examine the relationship between readily available clinical data and poor outcomes such as multiple hospitalization and death for patients with advanced heart failure.•Discuss the use of latent class analytic techniques for finding subgroups or phenotypes within a group of subjects. Predicting prognosis for patients with advanced heart failure (HF) is difficult. Most prediction models don't use regularly captured clinical data. To find a phenotype of patients with advanced HF that might be associated with poor outcomes. Latent class analysis was conducted using secondary data from a 6-site cluster RCT of an intervention to improve communication with advanced HF patients who had implantable cardioverter defibrillators (ICDs). Nine baseline measures were included: hospitalizations in the year before enrollment, HF severity (NYHA class), HF etiology, ICD indication (primary/secondary), functional status (ADLs), symptom burden (>2), comorbidities (>2), depression, and anxiety. Model fit criteria were compared for models testing 1 to 5 latent classes. Two groups of patients emerged: Class1 - “Healthier” - N=352 (62.5%) and Class2 - “More Sick” N=211 (37.5%). Class1 was more likely to be male (76% vs. 61%, p<0.001), married (58% vs. 50%, p<0.05), ischemic (48% vs. 39%, p<0.05) and less severe HF (NYHA class I or II) (12% vs. 2%, p<0.001), and to report no hospitalizations in the prior year (21% vs. 8%, p<0.001). Class2 was more likely to report ADL difficulty (93% vs. 26%, p<0.001), symptom burden (100% vs. 51%, p<0.001), comorbidities (86% vs. 74%, p<0.002), depression (28% vs. 1%, p<0.001), anxiety (30% vs. <1%, p<0.001), and have Medicaid (32% vs. 24%, p<0.05). Differences were not detected for age, race, ethnicity, or education. Patients in Class2 reported more hospitalizations (2.8 vs. 2.2, p<0.02) and were more likely to die (26% vs. 17%, p<0.01). We found a phenotype of advanced HF patients who were more likely to experience multiple hospitalizations and death based on readily available clinical data.

Difficulties in activities of daily living are associated with stigma in patients with Parkinson's disease who are candidates for deep brain stimulation.

Objective:Parkinson’s disease (PD) is often accompanied by stigma, which could contribute to a worse prognosis. The objective of this study is to identify the variables associated with stigma in PD patients who are candidates for deep brain stimulation (DBS).Methods:We investigated sociodemographic and clinical variables associated with stigma in a sample of 54 PD patients indicated for DBS. The independent variables were motor symptoms assessed by the Movement Disorder Society‐sponsored revision of the Unified Parkinson Disease Rating Scale (MDS-UPDRS III), depressive symptoms measured by the Hospital Anxiety and Depression Scale, age, disease duration and the presence of a general medical condition. The Mobility, Activities of daily living and Emotional well-being domains of the 39-item Parkinson’s Disease Questionnaire (PDQ-39) were also investigated as independent variables, and the Stigma domain of the PDQ-39 scale was considered the outcome variable.Results:After multiple linear regression analysis, activities of daily living remained associated with the Stigma domain (B = 0.42 [95%CI 0.003-0.83], p = 0.048). The full model accounted for 15% of the variance in the Stigma domain (p = 0.03).Conclusions:Although causal assumptions are not appropriate for cross-sectional studies, the results suggest that ADL difficulties could contribute to greater stigma in PD patients with refractory motor symptoms who are candidates for DBS.

Patient-reported measures of well-being in older multiple myeloma patients: use of secondary data source

BackgroundChanges in well-being of patients with multiple myeloma (MM) before and after diagnosis have not been quantified.AimsExplore the use of secondary data to examine the changes in the well-being of older patients with MM.MethodsWe used the Health and Retirement Study (HRS), linked to Medicare claims to identify older MM patients. We compared patient-reported measures (PRM), including physical impairment, sensory impairment, and patient experience (significant pain, self-rated health, depression) in the interviews before and after MM diagnosis using McNemar’s test. We propensity-matched each MM patient to five HRS participants without MM diagnosis based on baseline characteristics. We compared the change in PRM between the MM patients and their matches.ResultsWe identified 92 HRS patients with MM diagnosis (mean age = 74.6, SD = 8.4). Among the surviving patients, there was a decline in well-being across most measures, including ADL difficulty (23% to 40%, p value = 0.016), poor or fair self-rated health (38% to 61%, p value = 0.004), and depression (15% to 30%, p value = 0.021). Surviving patients reported worse health than participants without MM across most measures, including ADL difficulty (40% vs. 27%, p value = 0.04), significant pain (38% vs. 22%, p value = 0.01), and depression (29% vs. 11%, p value = 0.003).DiscussionSecondary data were used to identify patients with MM diagnosis, and examine changes across multiple measures of well-being. MM diagnosis negatively affects several aspects of patients’ well-being, and these declines are larger than those experienced by similar participants without MM.ConclusionThe results of this study are valuable addition to understanding the experience of patients with MM, despite several data limitations.

Course of depressive symptoms and associated factors in people aged 65+ in Europe: A two-year follow-up

BackgroundThe epidemiology of depressive disorders presents notable differences among European countries. The objectives of the study are to determine the prevalence, incidence, persistence and remission rates of depressive symptoms and to identify risk factors and differences between four European regions. MethodProspective cohort design using data from waves 5 and 6 (2013–15) of the Survey of Health, Ageing and Retirement in Europe. Sample size included 31,491 non-institutionalized adults aged 65+. Depressive symptoms were assessed using the EURO-D. ResultsThe prevalence of depressive symptoms (EURO-D ≥4) was 29.8% and 31.5%in waves 5 and 6, respectively. The risk factors associated depressive symptoms were poorer self-rated health, loneliness, impairment in ADL, female gender and financial difficulties. Incidence was 6.62 (99.9% CI: 6.61–6.63)/100 person-years and the persistence and remission rates were 9.22 and 5.78, respectively. Regarding the differences between European regions, the incidence (4.93 to 7.43) and persistence (5.14 to 11.86) rates followed the same ascending order: Northern, Eastern, Continental and Southern. The remission presented higher rates in the Eastern and Southern (6.60–6.61) countries than in the Northern and Continental (4.45–5.31) ones. LimitationsThe EURO-D scale is unable to distinguish between clinically relevant depressive symptoms and major depression. ConclusionThe risk factors related to the incidence of depressive symptoms differed across European regions. In countries of eastern and southern Europe the most important predictors were female gender and impairment in ADL. Poorer self-rated health and older age were more relevant in the Northern countries, and chronic diseases were a key factor in the Continental region.