Predictor Of Poor Health Outcomes Research Articles

Predictors of Poor Health Outcomes in Midlife and Older Adults with Diabetes in the 2018-2020 Health and Retirement Study

Predictors of Poor Health Outcomes in Midlife and Older Adults with Diabetes in the 2018-2020 Health and Retirement Study

Beyond MACE: a multidimensional approach to outcomes in clinical trials for older adults with stable ischemic heart disease.

The global population of older adults is expanding rapidly resulting in a shift towards managing multiple chronic diseases that coexist and may be exacerbated by cardiovascular illness. Stable ischemic heart disease (SIHD) is a predominant contributor to morbidity and mortality in the older adult population. Although results from clinical trials demonstrate that chronological age is a predictor of poor health outcomes, the current management approach remains suboptimal due to insufficient representation of older adults in randomized trials and the inadequate consideration for the interaction between biological aging, concurrent geriatric syndromes, and patient preferences. A shift towards a more patient-centered approach is necessary for appropriately and effectively managing SIHD in the older adult population. In this review, we aim to demonstrate the distinctive needs of older adults who prioritize holistic health outcomes like functional capacity, cognitive abilities, mental health, and quality of life alongside the prevention of major adverse cardiovascular outcomes reported in cardiovascular clinical trials. An individualized, patient-centered approach that involves shared decision-making regarding outcome prioritization is needed when any treatment strategy is being considered. By prioritizing patients and addressing their unique needs for successful aging, we can provide more effective care to a patient population that exhibits the highest cardiovascular risks.

Functional outcome and frailty in colorectal surgery patients.

Frailty is a recognized risk and predictor of poor health outcomes in older patients undergoing surgery. A significant proportion of elderly patients undergoing colorectal cancer-related surgery are nevertheless not routinely assessed for frailty in current clinical practice in Australia. We examined the preoperative use of the Clinical Frailty Scale (CFS) to predict post-operative functional outcomes in geriatric patients undergoing colorectal cancer surgery. This retrospective observational cohort study included elderly colorectal cancer patients (n = 227) who underwent elective major colorectal surgery from 2016 to 2020 at Nepean Hospital, Australia. CFS was calculated retrospectively from medical records and the relationship between CFS and functional outcome factors was analysed. Frail patients (n = 111) had a significant postoperative functional decline as demonstrated by discharge to supported care (57% vs. 0.9%), Barthel Index change (P<0.05) and inability to self-manage stoma (P<0.05) compared to non-frail patients (n = 116). Multivariate analysis with adjustment for age, comorbidities as measured by Charlson Comorbidities Index (CCI), and cognitive impairment, demonstrated frailty was the most significant independent predictor of discharge to supported care (OR 109.3). Cognitive impairment and an increased CCI were also found to be important predictors. Preoperative frailty is significantly associated with postoperative functional decline and postoperative adverse outcomes, highlighting the potential utility of CFS in preoperative frailty assessment.

Validation, Recalibration, and Predictive Accuracy of Published V̇O 2max Prediction Equations for Adults Ages 50-96 Yr.

Maximal oxygen uptake ( ) is the criterion measure of cardiorespiratory fitness. Lower cardiorespiratory fitness is a strong predictor of poor health outcomes, including all-cause mortality. Because testing is resource intensive, several non-exercise-based V˙O 2max prediction equations have been published. We assess these equations' ability to predict measured V˙O 2max , recalibrate these equations, and quantify the association of measured and predicted V˙O 2max with all-cause mortality. Baltimore Longitudinal Study of Aging participants with valid V˙O 2max tests were included ( n = 1080). Using published V˙O 2max prediction equations, we calculated predicted V˙O 2max and present performance metrics before and after recalibration (deriving new regression estimates by regressing measured V˙O 2max on Baltimore Longitudinal Study of Aging covariates). Cox proportional hazards models were fit to quantify associations of measured, predicted, and recalibration-predicted values of V˙O 2max with mortality. Mean age and V˙O 2max were 69.0 ± 10.4 yr and 21.6 ± 5.9 mL·kg -1 ·min -1 , respectively. The prediction equations yielded root mean square error values ranging from 4.2 to 20.4 mL·kg -1 ·min -1 . After recalibration, these values decreased to 3.9-4.2 mL·kg -1 ·min -1 . Adjusting for all covariates, all-cause mortality risk was 66% lower for the highest quartile of measured V˙O 2max relative to the lowest. Predicted V˙O 2max variables yielded similar estimates in unadjusted models but were not robust to adjustment. Measured V˙O 2max is an extremely strong predictor of all-cause mortality. Several published V˙O 2max prediction equations yielded the following: 1) reasonable performance metrics relative to measured V˙O 2max especially when recalibrated, and 2) all-cause mortality hazard ratios similar to those of measured V˙O 2max , especially when recalibrated, yet 3) were not robust to adjustment for basic demographic covariates likely because these were used in the equation for predicted V˙O 2max .

Rate of Social Isolation by Geographic Location Among Older Adults: AAA LongROAD Study.

Introduction: Social isolation is a modifiable risk factor for negative health outcomes among older adults. This work assessed the relationship between geography (i.e., urban vs. non-urban residence) and social isolation in a cohort of older drivers.Methods: The AAA LongROAD cohort with 2,989 older adult drivers from across the country were included. Social isolation was measured at baseline and at two subsequent annual follow-ups using PROMIS v2.0 Social Isolation 4a. The effect of geographic location with social isolation was assessed through with multivariable regression using a generalized estimating equation model.Results: The rate of social isolation in urban areas was 21% lower (adjusted RR 0.79, 95% CI 0.46, 1.36) compared to non-urban areas after adjusting for covariates, though not significant.Discussion: Social isolation is a predictor of poor health outcomes and geographic considerations have been lacking in the literature. The panel data in this analysis provides more evidence for causality though the under-representation of non-urban areas potentially reduces the power for the results.Conclusions: It is important to understand the needs and risk of social isolation in various geographic settings to ensure resources and interventions are appropriately modified for a greater public health impact.

The effects of an acute resistance exercise bout on appetite and energy intake in healthy older adults

Ageing is associated with reductions in appetite and food intake leading to unintentional weight loss. Such weight loss, particularly through muscle mass reduction, is associated with muscle weakness and functional decline, which represent predictors of poor health outcomes and contribute to frailty in older adults. Exercise-induced anorexia is an established phenomenon in young adults; however appetite and energy intake (EI) responses to resistance exercise are unknown in older adults. Twenty healthy older adults (68 ± 5 years, BMI 26.2 ± 4.5 kg m−2) undertook two 5-h experimental trials. Participants rested for 30 min before being provided with a standardised breakfast (196 kcal, 75.2% carbohydrate, 8.9% protein and 15.9% fat). Participants then rested for 1-h before completing: 1-h resistance exercise bout followed by 2-h of rest (RE) or, a control condition (CON) where participants rested for 3 h, in a randomised crossover design. Appetite perceptions were measured throughout both trials and on cessation, an ad libitum meal was provided to assess EI. A repeated-mesures ANOVA revealed no significant condition x time interaction for subjective appetite (p = 0.153). However, area under the curve for appetite was significantly lower in the RE compared with CON (49 ± 8 mm h−1 vs. 52 ± 9 mm h−1, p = 0.007, d = 0.27). There was no difference in EI (RE = 681 ± 246 kcal; CON = 673 ± 235 kcal; p = 0.865), suggesting that resistance exercise does not affect EI 2 h post-exercise in older adults despite a significant but modest reduction in appetite over a 5-h period. In conclusion, resistance exercise may be an appropriate means for optimising muscle mass adaptations without attenuating acute EI of older adults.

Developing a sensor-based mobile application for in-home frailty assessment: a qualitative study

BackgroundFrailty syndrome disproportionately affects older people, including 15% of non-nursing home population, and is known to be a strong predictor of poor health outcomes. There is a growing interest in incorporating frailty assessment into research and clinical practice, which may provide an opportunity to improve in home frailty assessment and improve doctor patient communication.MethodsWe conducted focus groups discussions to solicit input from older adult care recipients (non-frail, pre-frail, and frail), their informal caregivers, and medical providers about their preferences to tailor a mobile app to measure frailty in the home using sensor based technologies. Focus groups were recorded, transcribed, and analyzed thematically.ResultsWe identified three major themes: 1) perspectives of frailty; 2) perceptions of home based sensors; and 3) data management concerns. These relate to the participants’ insight, attitudes and concerns about having sensor-based technology to measure frailty in the home. Our qualitative findings indicate that knowing frailty status is important and useful and would allow older adults to remain independent longer. Participants also noted concerns with data management and the hope that this technology would not replace in-person visits with their healthcare provider.ConclusionsThis study found that study participants of each frailty status expressed high interest and acceptance of sensor-based technologies. Based on the qualitative findings of this study, sensor-based technologies show promise for frailty assessment of older adults with care needs. The main concerns identified related to the volume of data collected and strategies for responsible and secure transfer, reporting, and distillation of data into useful and timely care information. Sensor-based technologies should be piloted for feasibility and utility. This will inform the larger goal of helping older adults to maintain independence while tracking potential health declines, especially among the most vulnerable, for early detection and intervention. Keywords: Frailty, wearable, health services.

Childhood adversity and cortisol habituation to repeated stress in adulthood

BackgroundChildhood adversity is a robust predictor of poor health outcomes in adulthood and hypothalamic-pituitary-adrenocortical (HPA) axis dysfunction may be a key mechanism explaining this association. However, little is known about the influence childhood adversity may exhibit on adult HPA axis habituation (i.e., decreased cortisol output in response to a repeated stressor), where HPA axis dysfunction can be inferred if habituation deviates from normal patterns. MethodsThe current study used data from a larger study that examined the effects of stress management interventions on cortisol habituation to repeated stress. Eighty-three adults reported childhood adversity with the Adverse Childhood Experience scale and completed the Trier Social Stress Test (TSST) twice (48 h apart) scheduled after a 6-wk intervention period. Salivary cortisol was assessed pre-stressor and +25, +35, and +60 mins post-stressor onset during both visits. ResultsResults indicated that childhood adversity was associated with a marginally larger decrease in total cortisol from visit 1 to visit 2 among men (i.e., habituation), but not women (i.e. non-habituation). ConclusionsThese findings suggest that childhood adversity may alter HPA axis habituation to repeated stress later in life, with possible sex differences. Future research should investigate whether HPA axis habituation to repeated stress may be a pathway through which childhood adversity affects adult health, and how it may affect men and women differently.

The effects of age on clinical characteristics, hospitalization and mortality of patients with influenza-related illness at a tertiary care centre in Malaysia.

BackgroundAge is an established risk factor for poor outcomes in individuals with influenza‐related illness, and data on its influence on clinical presentations and outcomes in the South‐East Asian settings are scarce. The aim of this study was to determine the above among adults with influenza‐related upper respiratory tract infection at a teaching hospital in Malaysia.MethodsA retrospective case‐note analysis was conducted on a cohort of 3935 patients attending primary care at the University Malaya Medical Centre, Malaysia from February 2012 till May 2014 with URTI symptoms. Demographics, clinical characteristics, medical and vaccination history were obtained from electronic medical records, and mortality data from the National Registration Department. Comparisons were made between those aged <25, ≥25 to <65 and ≥65 years.Results470 (11.9%) had PCR‐confirmed influenza virus infection. Six (1.3%) received prior influenza vaccination. Those aged ≥65 years were more likely to have ≥2 comorbidities (P < .001) and were less likely to present with fever (P = .004). One‐third of those aged ≥65 years experienced hospitalization, intensive care admission or death within a year compared to 10% in the ≥25 to <65 years. Age ≥65 years was an independent predictor of hospitalization and death (OR = 9.97; 95% CI = 3.11‐31.93) compared to those aged <25 years.ConclusionOlder patients in our cohort were more likely to have comorbidities and present with atypical features, with older age being an independent predictor of poor health outcomes. Our findings will now inform future health policies on older persons and economic modelling of adult vaccination programmes.

Questioning the use of adverse childhood experiences (ACEs) questionnaires

Adverse childhood experiences (ACEs) are increasingly recognized as important predictors of poor health outcomes. In response, there is increasing application of ACEs questionnaires in clinical practice and population health surveys. Such efforts are often justified as approaches to identify ACEs, components of trauma-informed care, and/or measures to determine prevalence within epidemiological research. Unfortunately, such measures are often used without evaluating the strengths and limitations of the measures themselves. One of the most commonly used ACEs questionnaires is a ten-question version (ACEs-10), that is composed of two clusters - one asking about different types of child maltreatment, and the other asking select questions about household challenges. Unfortunately, both this questionnaire and its derivatives have substantial drawbacks that warrant careful consideration about their use. Problems include limited item coverage, collapsing of items and response options, a simplistic scoring approach, and the lack of psychometric assessment. These deficiencies are inconsistent with the standards expected for use of measures in healthcare services and research. Given these deficiencies, we recommend that these limitations are addressed before further use of ACEs-10, and its derivatives, for either clinical or research purposes.

Precarity and health: Theorizing the intersection of multiple material-need insecurities, stigma, and illness among women in the United States

Material-need insecurities (including insecurities in basic resources such as income, food, housing, and healthcare) are widespread in the United States (US) and may be important predictors of poor health outcomes. How material-need insecurities besides food insecurity are experienced, however, remains under-researched, including how multiple material-need insecurities might intersect and converge on the individual. Here we used qualitative methods to investigate experiences with multiple material-need insecurities among 38 food-insecure women aged over 50 years living with or at risk for HIV in the US. Our aims were: (1) to understand the co-experience of material-need insecurities beyond food insecurity; (2) to elucidate how multiple material-need insecurities might intersect; and (3) to discover how this intersection might be detrimental to health. During November 2017–July 2018, we conducted semi-structured interviews at three sites across the US (Northern California, Georgia, North Carolina) and analyzed the data using an inductive-deductive approach. We identified a common and complex picture of multiple material-need insecurities, stigma, and illness among participants across all three sites. There were five primary themes: (1) insecure income arising from a combination of precarious wage labor and federal disability benefits; (2) resultant experiences of uncertainty, compromised quality, insufficiency, and having to use socially unacceptable coping strategies across finances, food, housing, and healthcare; (3) participants’ disempowerment arising from their engagement with social safety net institutions; (4) closely related experiences of intersectional stigma and discrimination; and (5) negative implications for health across a wide range of illnesses. By employing the sociological concept of precarity—a term denoting the contemporary convergence of insecure wage labor and retraction of the welfare state—we combine these themes into a unifying framework of precarity and health. This framework may prove useful for testing how the widespread intersection of multiple material-need insecurities interacts with stigma and discrimination to negatively impact physical and mental health.

THE ROLE OF PERCEIVED SOCIAL SUPPORT AND PRUDENT DIET INTAKE ON ALLOSTATIC LOAD AMONG OLDER ADULTS

Allostatic load (AL), an index of multisystem physiological dysregulation due to chronic stress, has been identified as a predictor of poor health outcomes in late life. Research suggests that perceived social support (PSS) improves health outcomes by buffering the negative effects of stress on wellbeing and increasing health promoting behaviours including consumption of a healthy prudent diet (i.e., fruits, vegetables, lean meats, nuts, and seeds). Research to date has independently demonstrated that higher PSS and prudent diet intake have an effect on AL. A paucity of research, however, has examined how dietary consumption and PSS interact to effect AL in older adults. The objective of this study was to examine the interaction between PSS and prudent diet pattern on AL in 164 non-demented, community-dwelling older adults (Mage= 68.5(.52), 64% female). PSS and diet intake were measured using the Perceived Social Support Scale and the EPIC-Norfolk Food Frequency Questionnaire, respectively. AL was composed of 16 biomarkers stemming from neuroendocrine, metabolic, inflammatory, and cardiovascular systems, stratified by sex. Controlling for age and usual daily energy intake, higher prudent diet consumption (B=-2.04, p=.001), but not PSS, was associated with lower AL. Moderation analysis revealed that higher prudent diet intake was associated with lower AL only for those with low PSS (B=-.83, p=.0006) and mean level of PSS (B=-.43, p=.02). These findings suggest that chronic biological stress may be mitigated by consuming a healthy diet specifically for older adults with lower social support and may further inform intervention strategies to promote healthy aging.

Mindfulness training and systemic low-grade inflammation in stressed community adults: Evidence from two randomized controlled trials.

Mindfulness interventions have garnered significant attention as a complementary health treatment for many physical and psychological conditions. While some research has shown that mindfulness training can decrease psychological and physiological stress responses, it remains unclear whether mindfulness training impacts inflammation—a predictor of poor health outcomes. In addition, little research has examined the active components of mindfulness that may drive health-related improvements. Here, we provide data from two 3-arm randomized controlled trials that examined the effect of mindfulness training on inflammation in stressed community adults. Specifically, we examined whether training individuals to have an accepting attitude towards present moment experiences is a key emotion regulation skill that can lead to decreases in inflammation. Both studies randomly assigned participants to one of three conditions: mindfulness training that taught both attention monitoring and acceptance skills (Monitor+Accept); mindfulness training teaching monitoring without the acceptance component (Monitor Only); or a control condition. Study 1 employed a novel 2-week smartphone-based intervention and Study 2 employed a standard 8-week Mindfulness-Based Stress Reduction (MBSR) intervention. We hypothesized that Monitor+Accept training would lead to reductions in the inflammatory biomarker C-Reactive Protein (CRP) compared to Monitor Only training and control groups. Contrary to this hypothesis, we found that Monitor+Accept mindfulness training did not lead to reductions in CRP. Exploratory analyses combining study subsamples, however, suggest that both mindfulness interventions may reduce CRP in populations at risk for systemic inflammation—midlife-to-older adults and individuals with high BMI. Overall, the present studies contribute significantly to the question of whether mindfulness interventions can reduce systemic markers of low-grade inflammation.

P123 A Qualitative Investigation into Nutrition Literacy Assessment in Outpatient Clinics

Background Nutrition literacy is a unique subset of health literacy, a leading predictor of poor health outcomes. Understanding a patient's nutrition literacy may help dietitians provide interventions tailored to a patient's nutrition knowledge weaknesses. While tools exist to evaluate nutrition literacy, it is unclear whether dietitians currently assess patients for nutrition literacy. Objective To examine nutrition literacy assessment among practicing outpatient dietitians, barriers to implementing a nutrition literacy survey into clinical practice, and possible solutions to these barriers. Study Design, Settings, Participants Semi-structured interviews, divided into four sampling frames, with dietitians (n = 28) from multiple outpatient settings were conducted across two Midwestern states. Similar interviews were conducted with outpatient clinic managers (n = 7), providing a wider viewpoint. Measurable Outcome/Analysis Questions addressed clinic work flow, assessing nutrition literacy, and barriers to implementing a survey into practice. All interviews were transcribed, coded, and analyzed by trained study personnel. Results All dietitians stated they use no nutrition literacy assessment tools in clinical practice; subjective assessments are used. Barriers to survey implementation included time to complete the survey (79%/n = 22 of interviewees), logistics in administering the survey (75%/n = 21), patient motivation (75%/n = 21), literacy levels of patients (54%/n = 15), and clinic staff support (32/n = 9). Clinic managers stated barriers to survey implementation included patient motivation (86%/n = 6), devoting staff to a non-revenue generating task (71%/n = 5), logistics in administering the survey (71%/n = 5), and time to complete the survey (57%/n = 4). Solutions include survey administration prior to the patient's appointment (79% of dietitians/n = 22, 86% of managers/n = 6), motivating patients to complete the survey prior to their visit (29%/n = 8, 100%/n = 7), and reducing survey length (21%/n = 6, 43%/n = 3). Conclusion While multiple barriers to evaluating nutrition literacy in clinical settings exist, potential solutions to these barriers exist. Further research on the implementation of nutrition literacy assessment in the outpatient clinic setting is needed.

Disability, quality of life and all-cause mortality in older Mexican adults: association with multimorbidity and frailty

BackgroundMultimorbidity and frailty are relevant conditions among older adult population. There is growing evidence about their association with poor health outcomes like disability, worst quality of life, and death. Nonetheless, the independent associations of both conditions have been studied, and few evidence exists about an interaction between them. Our aims were to assess the association of frailty and multimorbidity with the disability, quality of life and all-cause mortality as well as to analyze a potential interaction between these conditions.MethodsAnalytical samples included 1410 respondents for disability and quality of life, and 1792 for mortality. We performed a longitudinal analysis with older Mexican adults aged 50, using data collected from the WHO’s Study on global AGEing and Adult Health Waves 1 and 2. Disability was measured using the World Health Organization Disability Assessment Schedule (WHODAS 2.0), and quality of life using the WHOQOL (WHO Quality of Life) instrument. All-cause mortality was determined by reviewing death certificates. Associations of frailty and multimorbidity with disability, quality of life and mortality were estimated using linear regression and Cox proportional hazards models.ResultsMultimorbidity assessed through three patterns (cardiopulmonary, vascular-metabolic, and mental-musculoskeletal) was associated with the three outcomes in this study. Cardiopulmonary and mental-musculoskeletal patterns increased the WHODAS mean score (β = 5.05; p < 0.01 and β = 5.10; p < 0.01, respectively) and decreased WHOQOL score (β = − 1.81; p < 0.01 and β = − 2.99; p < 0.01, respectively). Vascular-metabolic was associated with mortality (HR = 1.47; p = 0.04), disability (β = 3.27; p < 0.01) and quality of life (β = − 1.30; p = 0.02). Frailty was associated with mortality (pre-frail: HR = 1.48; p = 0.02 and frail: HR = 1.68; p = 0.03), disability (pre-frail: β = 5.02; p < 0.01; frail: β = 13.29; p < 0.01) and quality of life (pre-frail: β = − 2.23; p < 0.01; frail: β = − 4.38; p < 0.01). Interaction terms of frailty and multimorbidity were not statistically significant.ConclusionsMultimorbidity and frailty are important predictors of poor health outcomes. These results highlight the importance of carrying out health promotion and prevention actions as well as specific interventions aimed at older adults who suffer from multimorbidity and frailty, in such a way that deleterious effects on health can be avoided.

A Risk Scoring System for the Prediction of Functional Deterioration, Institutionalization, and Mortality Among Medicare Beneficiaries.

We sought to develop a risk scoring system for predicting functional deterioration, institutionalization, and mortality. Identifying predictors of poor health outcomes informs clinical decision-making, service provision, and policy development to address the needs of persons at greatest risk for poor health outcomes. This is a cohort study with 21,257 community-dwelling Medicare beneficiaries 65 yrs and older who participated in the 2001-2008 Medicare Current Beneficiary Survey. Derivation of the model was conducted in 60% of the sample and validated in the remaining 40%. Multinomial logistic regression model generated β coefficients, which were used to create a risk scoring system. Our outcome was instrumental activity of daily living stage transitions (stable/improved function and functional deterioration), institutionalization, or mortality for 2 yrs of follow-up. A total of 18 factors were identified for functional deterioration (P < 0.05). In the derivation cohort, the likelihood of functional deterioration ranged from 6.27% to 33.51%, risk of institutionalization from 0.07% to 12.13%, and risk of mortality from 2.13% to 31.83%, in comparison with stable/improved function. A risk scoring system predicting Medicare beneficiaries' risk of functional deterioration, institutionalization, and mortality based on demographic and clinical indicators may feasibly be developed with implications for healthcare delivery.

Frailty in surgical patients.

To describe the current definitions, aetiology, assessment tools and clinical implications of frailty in modern surgical practice. Frailty is a critical issue in modern surgical practice due to its association with adverse health events and poor post-operative outcomes. The global population is rapidly ageing resulting in more older patients presenting for surgery. With this, the number of frail patients presenting for surgery is also increasing. Despite the identification of frailty as a significant predictor of poor health outcomes, there is currently no consensus on how to define, measure and diagnose this important syndrome. Relevant references were identified through keyword searches of the Cochran, MEDLINE and EMbase databases. Despite the lack of a gold standard operational definition, frailty can be conceptualised as a state of increased vulnerability resulting from a decline in physiological reserve and function across multiple organ systems, such that the ability to withstand stressors is impaired. Multiple studies have shown a strong association between frailty and adverse peri-operative outcomes. Frailty may be assessed using multiple tools; however, the ideal tool for use in a clinical setting has yet to be identified. Despite the association between frailty and adverse outcomes, few interventions have been shown to improve outcomes in these patients. Frailty encompasses a group of individuals at high risk of adverse post-operative outcomes. Further work exploring ways to optimally assess and target interventions towards these patients should be the focus of ongoing research.

The association between health literacy and self-management abilities in adults aged 75 and older, and its moderators.

PurposeLow health literacy is an important predictor of poor health outcomes and well-being among older adults. A reason may be that low health literacy decreases older adults’ self-management abilities. We therefore assessed the association between health literacy and self-management abilities among adults aged 75 and older, and the impact of demographic factors, socioeconomic factors, and health status on this association.MethodsWe used data of 1052 older adults, gathered for a previously conducted randomized controlled trial on Embrace, an integrated elderly care model. These data pertained to health literacy, self-management abilities, demographic background, socioeconomic situation, and health status. Health literacy was measured by the validated three-item Brief Health Literacy Screening instrument. Self-management abilities were measured by the validated Self-Management Ability Scale (SMAS-30).ResultsAfter adjustment for confounders, self-management abilities were poorer in older adults with low health literacy (β = .34, p < .001). This was more pronounced in medium- to high-educated older adults than in low-educated older adults. Sex, age, living situation, income, presence of chronic illness, and mental health status did not moderate the association between health literacy and self-management abilities.ConclusionsLow health literacy is associated with poor self-management abilities in a wide range of older adults. Early recognition of low health literacy among adults of 75 years and older and interventions to improve health literacy might be very beneficial for older adults.

Anxiety, depression and timing of insulin treatment among people with type 2 diabetes: Nine-year follow-up of the Nord-Trøndelag Health Study, Norway

BackgroundDepression and anxiety have been found to be predictors of poor health outcomes in diabetes, but mechanisms are still unclear. AimsTo examine whether symptoms of anxiety and depression were associated with timing of initiating insulin therapy. MethodsA cohort study of insulin-naive particpants with type 2 dabetes completed the Hospital Anxiey and Depression Scale, HADS-A (n = 731) and/or the HADS-D (n = 768) in the communy-based Nord-Trøndelag Health Study (1995-1997). Information on insulin initiation was retrieved from the Norwegian Prescription Database from January 1, 2004 to November 21, 2012. Cox regression analyses were used to estimate the association between symptoms of anxiety, depression and time to insulin initiation. ResultsAt baseline, 19% reported anxiety symptoms (score≥8) and 18% depressive symptoms (score≥8). After a mean follow-up of 4.4 (SD 3.6) years, 337 (40%) participants had started insulin therapy. After adjustment for sociodemographic and clinical variables, anxiety symptoms were associated with later initiation of insulin therapy (HR 0.70, 95% CI 0.49–0.99), while depressive symptoms were not. Considering groups simultaneously, having both elevated depressive and elevated anxiety symptoms was associated with later time to insulin initiation (HR 0.62, 95% CI 0.39–0.99), while having only anxiety symptoms (without depressive) HR 0.81, 95% CI 0.50–1.32) or only depressive symptoms (without anxiety) (HR 1.08, 95% CI 0.68–1.72) were not. ConclusionsAnxiety was associated with a later initiation of insulin, while depressive symptoms were not. Persons with both elevated levels of anxiety and depression were also less likely to start insulin therapy. These results need further testing in other prospective studies.

Bit by bit: using design-based research to improve the health literacy of adolescents.

BackgroundAlthough a low health literacy level has been found to be among the most powerful predictors of poor health outcomes, there is very little research focused on assessing and improving the health literacy skills of adolescents, particularly those from socioeconomically disadvantaged backgrounds. The vast majority of existing research focuses solely on reading comprehension, despite the fact that health literacy is actually a multifaceted concept, which entails many different types of skills.ObjectiveThe aim of this paper is to first mine existing literature to identify the many different skills that have been posited to constitute health literacy, and then, using this collection of skills as an overarching structure, to highlight the challenges that disadvantaged youth participating in our HackHealth after-school program encounter as they identify and articulate their health-related information needs, search for health-related information online, assess the relevance and credibility of this information, and manage and make use of it.MethodsWe utilized the design-based research method to design, implement, and revise our HackHealth program. To collect data regarding HackHealth participants’ health literacy skills and associated challenges, we used a variety of methods, including participant observation, surveys, interviews, focus groups, and logging of Web browser activities. We also collected data through specialized instructional activities and data collection forms that we developed for this purpose. Quantitative and qualitative techniques were used to analyze this data, as well as all of the artifacts that each student produced, including their final projects.ResultsWe identified the various challenges that the 30 HackHealth participants faced in completing various health-related information activities during the course of the program. Based on these findings, we describe important implications for working with youth from socioeconomically disadvantaged backgrounds, how to assess and improve their health literacy skills, and offer specific recommendations for health literacy instruction aimed at this population.ConclusionsWith an increased societal focus on health and a shift from viewing patients as passive recipients of medical care to viewing them as active arbiters of their own health, today’s youth need to possess an array of health literacy skills to ensure that they can live long and healthy lives. Working with adolescents to help them develop and practice these skills will also help to break the cycle between poor health literacy and poor health outcomes, thereby reducing health disparities and improving the long-term outlook for the health of our nation.