Older Adults In Florida Research Articles

Racial and Ethnic Differences in Perceptions of, and Barriers to, Cost-of-Care Conversations Among Older Adults in Florida

Cost of care conversations (CoC) between patients and doctors have been shown to lower overall healthcare and patients’ costs. How, it is unclear why CoC are not occurring more frequently among high cost patients such as older adults. To address this important question, we conducted three race-stratified focus groups (n=10 Whites, n=9 African Americans, and n=8 Latino/Hispanics) to assess perceptions about, and barriers to, CoC in a convenient sample of adults ages ≥65 from Adult Centers in Tampa Bay, Florida. An inductive content analysis approach was utilized by research team members to analyze qualitative data. Findings indicated that CoC are not occurring. White participants perceived that CoC were not occurring because they did not have issues paying for care. African Americans perceived that CoC were not occurring because doctors are not trained to understand finances, insurance, and medical billing. Latinos/Hispanics perceived that doctors are meant to take care of patients, and receptionists, administrators and billing departments should handle CoC. Wait time and perceived stress/rush of doctors were identified as CoC barriers for whites, while doctors’ attitude was a barrier for Blacks/African Americans, and perceptions about CoC being “taboo” was a major barrier for Latinos/Hispanics. Overall, participants indicate that it is easier to have CoC if they had developed a good rapport with the doctor, had confidence in the doctor, and felt the doctor was interested in and cared about them. The findings suggest that promoting CoC among older adults will require addressing social and cultural concerns of racial/ethnic minority groups.

Healthcare Affordability and Associated Concerns Among Older Adults in Florida

Rising healthcare costs create significant financial burden for Americans and is a threat to the well-being of our growing, racially/ethnically diverse, older population. In a mixed method study, we assessed ability to afford care and ascertain concerns about healthcare cost in a racially diverse sample of Floridians ages ≥ 65. We surveyed 170 adults (40.4% White, 27.6% African Americans/Black and 31.8% Latino/Hispanic) and conducted three race-stratified focus groups (n=27). Most participants had Medicare coverage (97.1%) and 27% also had Medicaid. Approximately 11.6% of Whites had problems paying medical bills in the past 12 months versus 14.9% of African Americans/Blacks and 24.1% of Latino/Hispanics. Additionally, 13% of Whites, 19.2% of African Americans/Blacks and 20.4% of Hispanics reported not getting needed prescription drugs because they could not afford them. Approximately 45.7% either perceived that their doctor “never” takes into account costs for treatment or did not know whether costs were considered. Multiple regression analyses showed no statistically significant racial/ethnic differences in affordability problems. From the focus groups, healthcare cost concerns most frequently identified by participants were the high cost of prescriptions drug, rising co-pays and out of pocket expenses, and medical billing. Participants’ concerns about medical billing included understanding their bills, transparency in billing, timely posting of charges, and uncertainty about who to talk to about billing problems. Our findings suggest that routine discussions about healthcare costs with doctors or designated healthcare personnel should help ease financial burden and healthcare costs concerns among older adults.

Hospital use for non-traumatic dental conditions among older adults in Florida.

Older Americans are at risk of many oral diseases and conditions, but limited access to dental care may lead to the use of hospital emergency departments (EDs) or inpatient admissions. This study examined the use of hospitals for non-traumatic dental conditions (NTDCs) among persons aged ≥65years in the Florida. We analysed hospital use for NTDCs in Florida in 2018 from health department data sets. We calculated frequencies and rates of ED visits and hospital inpatient admissions, overall and by county, age, sex, race/ethnicity and principal payer. We also examined the source of hospital admission, primary diagnoses and charges. In 2018, there were 4894 ED visits and 747 inpatient admissions for NTDCs among persons aged ≥65years in Florida. The rate for ED visits was 112.30 per 100000 population and for hospital inpatient admissions was 17.14; rates varied widely among counties. Medicare was the most common primary payer. Referrals from EDs accounted for 76.2% of inpatient admissions for NTDCs by older adults. Total charges were $21.4 million for ED visits and $40.2 million for inpatient admissions. The most common principal diagnosis for ED visits for NTDCs was "periapical abscess without sinus tract" (K04.7; 26.2%) and for inpatient admissions was "inflammatory conditions of the jaw" (M27.2; 19.1%). Of the 747 inpatient admissions, two people died. Hospital use for NTDCs in Florida among persons aged ≥65years is a clinical and financial challenge. Public coverage for basic adult dental services may lead to more effective use of funds and better health outcomes.

Racial and Ethnic Differences in Alzheimer's Disease Knowledge Among Community-Dwelling Middle-Aged and Older Adults in Florida.

Objective: To compare Alzheimer's disease (AD) knowledge by race and ethnicity in a community sample of middle-aged and older adults aged 50 and over in Florida. Method: Data from HealthStreet, a University of Florida community engagement program, which uses community health workers to assess the health conditions, concerns, and knowledge of community members, was used (n = 842). A multivariate regression model was used to quantify differences in AD knowledge by race and ethnicity. Results: Older age and recruitment from Miami were associated with higher AD knowledge while being non-Hispanic Black, reporting male sex, having less than high school diploma, and reporting food insecurity were associated with lower AD knowledge. Discussion: Hispanics had comparable AD knowledge to non-Hispanic Whites and more knowledge than non-Hispanic Blacks after adjusting for other factors that could differentiate these groups. Almost half of the participants did not know hypertension is a risk factor for AD, highlighting a point of intervention.

Food Insecurity and Health-Related Quality of Life: A Cross-Sectional Analysis of Older Adults in Florida, U.S.

ABSTRACTIndividuals 65 years or older will comprise an estimated 20.0% of the U.S. population by 2030. This study investigated the association between food insecurity and health-related quality of life (HRQoL) among an older adult population (n = 234). HRQoL was measured using Healthy Days, a validated survey tool developed by the Centers of Disease Control and Prevention. Food-insecure individuals were more likely to report ≥14 physically unhealthy days (OR = 1.49, 95% CI 0.47–4.78) and ≥14 days with activity limitations (OR = 4.07, 95% CI 0.68–24.1). Although nonsignificant, the findings highlight food insecurity as a potentially important social determinant of health throughout the life course, including at an older age.

Prevalence of Multiple Chronic Conditions Among Older Adults in Florida and the United States: Comparative Analysis of the OneFlorida Data Trust and National Inpatient Sample.

BackgroundOlder patients with multiple chronic conditions are often faced with increased health care needs and subsequent higher medical costs, posing significant financial burden to patients, their caregivers, and the health care system. The increasing adoption of electronic health record systems and the proliferation of clinical data offer new opportunities for prevalence studies and for population health assessment. The last few years have witnessed an increasing number of clinical research networks focused on building large collections of clinical data from electronic health records and claims to make it easier and less costly to conduct clinical research.ObjectiveThe aim of this study was to compare the prevalence of common chronic conditions and multiple chronic conditions in older adults between Florida and the United States using data from the OneFlorida Clinical Research Consortium and the Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample (NIS).MethodsWe first analyzed the basic demographic characteristics of the older adults in 3 datasets—the 2013 OneFlorida data, the 2013 HCUP NIS data, and the combined 2012 to 2016 OneFlorida data. Then we analyzed the prevalence of each of the 25 chronic conditions in each of the 3 datasets. We stratified the analysis of older adults with hypertension, the most prevalent condition. Additionally, we examined trends (ie, overall trends and then by age, race, and gender) in the prevalence of discharge records representing multiple chronic conditions over time for the OneFlorida (2012-2016) and HCUP NIS cohorts (2003-2013).ResultsThe rankings of the top 10 prevalent conditions are the same across the OneFlorida and HCUP NIS datasets. The most prevalent multiple chronic conditions of 2 conditions among the 3 datasets were—hyperlipidemia and hypertension; hypertension and ischemic heart disease; diabetes and hypertension; chronic kidney disease and hypertension; anemia and hypertension; and hyperlipidemia and ischemic heart disease. We observed increasing trends in multiple chronic conditions in both data sources.ConclusionsThe results showed that chronic conditions and multiple chronic conditions are prevalent in older adults across Florida and the United States. Even though slight differences were observed, the similar estimates of prevalence of chronic conditions and multiple chronic conditions across OneFlorida and HCUP NIS suggested that clinical research data networks such as OneFlorida, built from heterogeneous data sources, can provide rich data resources for conducting large-scale secondary data analyses.

Association between race/ethnicity and disability status and receipt of vaccines among older adults in Florida

BackgroundIndividuals living with a disability or are a member of a certain racial/ethnic group may be at heightened risk for not receiving important vaccinations. ObjectiveThis study examined whether race/ethnicity and disability status are associated with the receipt of two vaccines (influenza and pneumococcal) among older adults living in Florida. MethodsUsing the 2011–2015 Florida Behavioral Risk Factor Surveillance System, a cross-sectional survey, we ran bivariate and multivariate analyses to determine the associations for race/ethnicity and disability status with receipt of vaccinations among individuals 65 years and older. Interactions between race/ethnicity and disability status were tested in each model. ResultsAmong our study sample, 68% received the pneumococcal vaccine in their lifetime and 54% of them received influenza vaccine in the past 12 months. Multivariate logistic regression indicated that Non-Hispanic Blacks and Hispanics were less likely to receive both vaccines compared to Non-Hispanic Whites. Older adults with a disability were more likely to receive influenza and pneumococcal vaccines compared to those without. A significant interaction was observed between race/ethnicity and disability status for predicting pneumococcal vaccination receipt. ConclusionsLarge proportions of older adults in Florida continue to go without needed vaccinations. Although race/ethnicity and disability status were shown to have some association with receipt of vaccines, having a regular source of care, employment and income also were shown to be important predictors.

Diabetes and depressive symptoms among Korean American older adults: The mediating role of subjective health perceptions

PurposeIn recognition of the impact of chronic diseases on mental health and the lack of research on Asian American subgroups, the present study examined subjective perceptions of health as a potential mediator in the association between diabetes and depressive symptoms in Korean American older adults. MethodsMultivariate analysis with data from 672 Korean American older adults in Florida explored the mediation model of health perceptions. ResultsThe presence of diabetes was associated with negative perceptions of health and elevated symptoms of depression. The proposed mediation model was also supported: negative perceptions of health served as an intervening step between diabetes and depressive symptoms. ConclusionsThe intervening role of health perceptions yields implications for developing health promotion interventions targeting older individuals with diabetes. Results suggest that even in the presence of chronic health conditions, mental well-being of older adults can be maintained by having optimistic beliefs and positive attitudes towards their own health.

Proactive aging: A longitudinal study of stress, resources, agency, and well-being in late life

Objectives: Using the Proactivity Model of Successful Aging, we examined how internal and external resources contribute to the maintenance of psychological well-being and social activities among older adults who experience normative stressors of aging. Outcome variables in this study are collectively referred to as quality of life (QOL). We also examined the mediating role of proactive adaptations between internal and external resources and QOL indicators. Method: Based on five annual interviews of a sample of 1000 community-dwelling older adults in Florida (effective N = 561), we tested the lagged effects of stressors on two indicators of QOL, four years later. In the full longitudinal model, using structural equations, we estimated the direct effects of internal and external resources on QOL, along with indirect effects through proactive adaptations. Results: Stressors negatively influenced QOL four years later. Internal and external resources led to better QOL four years later, both directly and indirectly through proactive adaptations of marshaling support and planning for the future. Conclusion: These findings lend support to the Proactivity Model of Successful Aging by documenting the value of proactive adaptations (i.e., exercise, planning ahead, and marshaling support) as proximate influences on QOL outcomes (i.e., depressive symptomatology and social activities). Findings suggest that older adults can maintain successful aging even in the face of health-related and social stressors by invoking accumulated resources to deal actively with the challenges of aging.

Short‐term involuntary examination of older adults in Florida

The elder population continues to grow rapidly in many countries. Florida's elder population is growing faster than most states', with over one-quarter of the Florida population projected to be aged 65 and over by 2025. Involuntary examination (i.e. emergency commitment) under a state's civil commitment law is one means by which older adults experience assessment for acute mental health care. In Florida, the civil commitment law permits the involuntary examination of an individual for up to 72 hours to determine whether the person meets standards for involuntary treatment. From calendar year 2001 through 2005, there were 531,091 involuntary examinations in Florida for 301,886 people of all ages. Thirteen percent were 60 years and older at the time of their examination. The purpose of this paper is to describe the characteristics of older adults subject to involuntary examination and the nature of their examinations. While these data permit a number of inferences, there is an expansive area of research and policy analysis that remains untapped and would permit better understanding of how older adults experience such examinations. These research and policy issues will also be discussed.

Moderating effects of psychosocial attributes on the association between risk factors and disability in later life

This study examined the roles of psychosocial attributes in the associations between potential risk factors (age, gender, marital status, education, and chronic conditions) and disability in later life, and in particular how neuroticism and social resources (social network, received support, and satisfaction with support) modify the linkages between risk factors and disability. The main and moderating effects were empirically tested using a sample of 444 community-dwelling older adults in Florida (M age = 72.3) who were cognitively intact. The likelihood of disability increased with advancing age, more chronic conditions, higher levels of neuroticism, more received support, and less satisfaction with support. In addition to the main effects, neuroticism and received support interacted with age and chronic conditions, strengthening the associations between risk factors and disability. Results suggested that personality and social support deserve greater attention as factors that can alter the disability process.

A Comparison of Antecedents of Homicide–Suicide and Suicide in Older Married Men

The authors compared characteristics of 27 older men who perpetrated a spousal homicide-suicide and 36 age-matched married men who committed suicide in west central Florida between 1988 and 1994. Data were collected as part of an ongoing retrospective study of homicide and suicide among older adults in Florida. Men who committed suicide had significantly more disease conditions than homicide-suicide perpetrators (P<0.0001). Half of the latter were in caregiving roles, vs. 17% of the suicides (chi(2)=5.40; P=0.027). Depression was a prominent premorbid feature of both groups, but none of the perpetrators tested positive for antidepressants postmortem.

Alcohol Abuse and Medication Misuse in Older Adults As Estimated by Service Providers

Staff providing services to older adults in Florida and North Carolina were asked to estimate the prevalence of alcohol abuse and among their clients. Although there, were high prevalence rates in both states, Florida estimates were greater, especially by staff offering on-site rather than in-home ser- vices. Estimates of direct ,care and administrative staff did not differ. Few staff received in-service training on substance abuse issues, despite ranking the topics of medication misuse and counseling older substance abusers as highest priority. Results are discussed in terms of the different samples and methodology used. Implications for further training and research are discussed.