Exploring the Association of Metabolic Syndrome with In-Hospital Survival of Older Patients Hospitalized with COVID-19: Beyond Chronological Age.

BACKGROUND: Despite the variability and complexity of geriatric conditions, few COVID-19 reports of clinical characteristic prognostication provide data specific to oldest-old adults (over age 85), and instead generally report broadly as 65 and older. OBJECTIVE: To examine metabolic syndrome criteria in adults across 25 hospitals with variation in chronological age. DESIGN AND PARTICIPANTS: This cohort study examined 39,564 hospitalizations of patients aged 18 or older with COVID-19 who received inpatient care between March 13, 2020, and February 28, 2022. EXPOSURE: ICU admission and/or in-hospital mortality. MAIN MEASURES: Metabolic syndrome criteria and patient demographics were examined as risk factors. The main outcomes were admission to ICU and hospital mortality. KEY RESULTS: Oldest old patients (≥ 85 years) hospitalized with COVID-19 accounted for 7.0% (2758/39,564) of all adult hospitalizations. They had shorter ICU length of stay, similar overall hospitalization duration, and higher rates of discharge destinations providing healthcare services (i.e., home health, skilled nursing facility) compared to independent care. Chronic conditions varied by age group, with lower proportions of diabetes and uncontrolled diabetes in the oldest-old cohort compared with young-old (65-74 years) and middle-old (75-84 years) groups. Evaluations of the effect of metabolic syndrome and patient demographics (i.e., age, sex, race) on ICU admission demonstrate minimal change in the magnitude of effect for metabolic syndrome on ICU admission across the different models. CONCLUSIONS: Metabolic syndrome measures are important individual predictors of COVID-19 outcomes. Building on prior examinations that metabolic syndrome is associated with death and ARDS across all ages, this analysis supports that metabolic syndrome criteria may be more relevant than chronological age as risk factors for poor outcomes attributed to COVID-19.

Profile of Caregiving Activities and Association With Physical Health Among Dementia Spousal Caregivers.

Background and Objectives: This study aims to identify patterns of caregiving intensity and assess associations between caregiving intensity and multidimensional physical health indicators and health behaviors among spousal caregivers of persons with Alzheimer's disease and related dementia. Research Design and Methods: Using data from 152 spousal caregivers aged 65 and older, the intensity of their caregiving experience was measured as the number and frequency of health- and medical-related helping activities for their care recipient. Multidimensional health indicators included self-reported fatigue, sleep disturbance, physical functioning, pain interference, general health, and the number of chronic conditions from the electronic health records. Self-reported health promotion behaviors were assessed as health responsibility, physical activity, nutrition, interpersonal relations, and stress management. Results: Two distinct caregiving intensity patterns, high-intensity (37.5%) and low-intensity (62.5%) caregiving, were identified with cluster analysis. Caregivers in the high-intensity caregiving cluster reported feeling more tired (t = 2.25, p < .05), experiencing more sleep disturbance (t = 3.06, p < .01), and performing less physical activity (t = 2.05, p < .05) compared with caregivers in the low-intensity group. Discussion and Implications: Future studies are needed to develop effective interventions to address caregiving intensity and its consequences on the health of spousal caregivers of persons with dementia.

Multimorbidity Patterns, Hospital Uses and Mortality by Race and Ethnicity Among Oldest-Old Patients.

BACKGROUNDS: Adults aged 85 years and older ("oldest-old") are perceived as survivors resilient to age-related risk factors. Although considerable heterogeneity has been often observed in this population, less is known about the unmet needs in health and healthcare service utilization for diverse patients in healthcare systems. We examined racial-ethnic variation in patterns of multimorbidity associated with emergency department (ED), clinic visits, and mortality among the oldest-old patients with multimorbidity. METHODS: Administrative and clinical data from an integrated healthcare system for five years included 25,801 oldest-old patients with two or more chronic conditions. Hierarchical cluster analysis identified patterns of multimorbidity by four racial-ethnic groups (White, Black, Hispanic, & Other). Clusters associated with ED and clinic visits, and mortality were analyzed using generalized estimation equations and proportional hazards survival model, respectively. RESULTS: Hypothyroidism, Alzheimer's disease and related dementia, bone & joint conditions, metabolism syndrome, and pulmonary-vascular clusters were commonly observed across the groups. While most clusters were significantly associated with ED and clinic visits among White patients, bone & joint conditions cluster was the most significantly associated with ED and clinic visits among Black (RR = 1.32, p <.01 for ED; RR = 1.67, p <.0001 for clinic) and Hispanic patients (RR = 1.36, p <.0001 for ED; RR = 1.39, p <.0001 for clinic). Similar patterns were observed in the relationship between multimorbidity clusters and mortality. CONCLUSIONS: Patterns of multimorbidity and its significant association with the uses of ambulatory and emergency care varied by race-ethnicity. More studies are needed to explore barriers when minoritized patients are faced with the use of hospital services.

Readmissions and postdischarge mortality by race and ethnicity among Medicare beneficiaries with multimorbidity.

BACKGROUND: Disparities in readmission risk and reasons they might exist among diverse complex patients with multimorbidity, disability, and unmet social needs have not been clearly established. These characteristics may be underestimated in claims-based studies where individual-level data are limited. We sought to examine the risk of readmissions and postdischarge mortality by race and ethnicity after rigorous adjustment for multimorbidity, physical functioning, and sociodemographic and lifestyle characteristics. METHODS: We used Health and Retirement Study (HRS) data linked to Medicare claims. To obtain ICD-9-CM diagnostic codes to compute the ICD-coded multimorbidity-weighted index (MWI-ICD) we used Medicare Parts A and B (inpatient, outpatient, carrier) files between 1991-2015. Participants must have had at least one hospitalization between January 1, 2000 and September 30, 2015 and continuous enrollment in fee-for-service Medicare Part A 1-year prior to hospitalization. We used multivariable logistic regression to assess the association of MWI-ICD with 30-day readmissions and mortality 1-year postdischarge. Using HRS data, we adjusted for age, sex, BMI, smoking, physical activity, education, household net worth, and living arrangement/marital status, and examined for effect modification by race and ethnicity. RESULTS: The final sample of 10,737 participants had mean ± SD age 75.9 ± 8.7 years. Hispanic adults had the highest mean MWI-ICD (16.4 ± 10.1), followed by similar values for White (mean 14.8 ± 8.9) and Black (14.7 ± 8.9) adults. MWI-ICD was associated with a higher odds of readmission, and there was no significant effect modification by race and ethnicity. For postdischarge mortality, a 1-point increase MWI-ICD was associated with a 3% higher odds of mortality (OR = 1.03, 95% CI: 1.03-1.04), which did not significantly differ by race and ethnicity. CONCLUSIONS: Multimorbidity was associated with a monotonic increased odds of 30-day readmission and 1-year postdischarge mortality across all race and ethnicity groups. There was no significant difference in readmission or mortality risk by race and ethnicity after robust adjustment.

The community-based LIVE WELL Initiative: Improving the lives of older adults.

A collaborative partnership among community-based organizations (CBOs) could strengthen local services and enhance the capacity of a community to provide services as well as meet the diverse needs of older adults. The United Way of Tarrant County developed the LIVE WELL Initiative, partnering with six CBOs to provide nine evidence-based or evidence-informed health interventions to improve the health and lower healthcare costs of vulnerable individuals at risk for poor health. The nine programs include specific target areas, such as falls prevention, chronic disease self-management, medication management, and diabetes screening and education. A total of 63,102 clients, nearly 70% of whom were older adults, were served through the Initiative. Significant improvements in self-reported health status were observed among served clients. The percentage of clients reporting self-rated health as good, very good, and excellent increased from 47.5% at baseline to 61.1% at follow-up assessment. The mean healthy days improved from 16.9 days at baseline to 20.6 days at follow-up assessment. Additional improvements in program-specific outcomes demonstrated significant impacts of targeted intervention focus among served clients by program. The findings of this study emphasize that the impact of a collaborative partnership with multiple CBOs could promote health and well-being for older adults.

The impact of a nutrition counseling program on the use of hospital services for Meals on Wheels clients.

Home-delivered meals have shown considerable promise in overcoming nutritional challenges among homebound older adults facing food insecurity and the risk of diabetes, while nutrition counseling provides knowledge and skills for diabetes management. The purpose of this study was to identify the impact of a program combining nutrition counseling with home-delivered meals by examining the use of hospital services 6 months before and after participating in the program. This study included 1009 clients who are at risk for diabetes and who received home-delivered meals and nutrition counseling via Meals on Wheels in Fort Worth, Texas. Hospital service data were extracted from a regional claims database. Generalized linear models were performed to examine changes in use of hospital services 6 months before and after program participation. The mean number of emergency department visits and hospitalizations decreased from 0.69 to 0.50 (p < .001) and from 0.35 to 0.22 (p < .001), respectively. The findings of this study indicate that combining structured nutritional counseling with home-delivered meals may contribute to reducing healthcare use among older adults facing the challenges of diabetes and food insecurity.

A Collaborative Implementation Strategy to Increase Falls Prevention Training Using the Age-Friendly Health Systems Approach.

Falls in the home and in community environments are the leading cause of injuries and long-term disabilities for the aging population. The purpose of this study was to examine outcomes of a partnership among an academic institution, government agency, community organizations, and emergency management services to implement a falls prevention training program using an Age-Friendly Health Systems approach. In this prospective study, partners identified gaps in services and targeted and non-targeted delivery areas for implementation of an evidence-based falls prevention intervention addressing the 4Ms of Age-Friendly Health Systems-Mobility, Medications, Mentation, and What Matters. Descriptive statistics were calculated for program implementation and participant demographic variables, and paired t-test analysis compared scores for self-assessed general health and falls efficacy prior to and after program participation. Twenty-seven falls prevention classes were implemented, with over half (52%) in targeted areas. A total of 354 adults aged 50 and older participated, with N = 188 participants (53%) completing the program by attending at least five of eight sessions. Of completers, 35% resided in targeted areas. The results showed a statistically significant improvement in falls efficacy by program completers in targeted and non-targeted areas. However, there was no statistically significant difference in self-rated health. Overall, the findings of this study indicate that collaboration to deliver falls prevention training can be effective in reaching at-risk older adults. By mobilizing collaborative partnerships, limited resources can be allocated towards identifying at-risk older adults and improving community-based falls prevention education.

Personality and compliance with COVID-19 protective measures among older Americans: Moderating effects of age, gender, and race/ethnicity.

Following the growing evidence that personality is related to various health behaviors, we examined whether personality traits were related to compliance with COVID-19 protective measures and evaluated the extent to which associations were moderated by age, gender, or race/ethnicity among older adults during a summer 2020 surge of COVID-19 cases in the United States. Data were from the 2020 Health and Retirement Study COVID-19 module. Multivariate ordinary least squares regression analyses were computed adjusting for health, psychosocial, and sociodemographic factors. Results indicated the significant associations between personality traits and compliance with COVID-19 measures varied by age, gender, and race/ethnicity. Specifically, the associations of agreeableness with wearing a mask and frequent handwashing were less pronounced among older compared with younger individuals. The association between extraversion and wearing masks was stronger for men than for women. The associations of agreeableness with handwashing and physical distancing were weaker for Hispanic older adults, whereas the associations of extraversion with physical distancing and using sanitizers were stronger for Hispanic older adults than for their non-Hispanic White counterparts. Implications regarding behavioral science underlying the current pandemic and future public health crises are discussed.

Successful Aging in East Asia: Comparison Among China, Korea, and Japan.

OBJECTIVES: Heterogeneity in successful aging has been found across countries. Yet, comparable evidence is sparse except in North America and Europe. Extending prior research, this study examined the prevalence and correlates of successful aging in East Asia: China, Korea, and Japan. METHOD: We used harmonized data sets from national surveys. A total of 6,479 participants (aged between 65 and 75) were analyzed. Using Rowe and Kahn's (1987, 1997) model, successful aging was defined as having no major diseases, no difficulty performing activities of daily living, obtaining a median or higher score on tests of cognitive function, and being actively engaged. RESULTS: The average prevalence of successful agers was 17.6%. There were variations in the global and specific measures of successful aging within and across countries, even after controlling for individual sociodemographic factors (age, gender, and education). The odds of aging successfully were highest in Japan and lowest in China, especially in the rural areas. Being younger and males were associated with a higher likelihood of successful agers in both global and specific measures. DISCUSSION: This study observed heterogeneity in successful aging in East Asia. To identify policy implications, future research should explore potential societal factors influencing individuals' opportunities for successful aging.

Factors affecting time between symptom onset and emergency department arrival in stroke patients.

BACKGROUND AND PURPOSE: Delays in seeking care compromise diagnosis, treatment options, and outcomes in ischemic strokes. This study identified factors associated with time between stroke symptom onset and emergency department (ED) arrival at a private nonprofit medical center serving a large rural catchment area in central Texas, with the goal of identifying symptomatic, demographic, and historical factors that might influence seeking care. METHODS: Demographic and clinical data from a large tertiary care center's Get With The Guidelines (GWTG) database were evaluated in 1874 patients presenting to the ED with a diagnosis of transient ischemic attack (TIA), intracranial hemorrhage, subarachnoid hemorrhage, or ischemic stroke. The dependent variable was time between discovery of stroke symptoms and presentation at the hospital (time-to-ED). Factors entered into regression models predicting time-to-ED within 4 h or categorical time-to-ED. RESULTS: The average time from symptom onset to presentation was 15.0 h (sd = 23.2), with 43.6% of the sample presenting within 4 h of symptom onset. Results suggested that female gender (Odds Ratio [OR] = 0.70; 95% Confidence Interval [CI] 0.23-0.74), drug abuse (OR = 0.41; CI 0.23-0.74), and diabetes were significantly associated with longer time to presentation. CONCLUSIONS: A combination of demographics, stroke severity, timing, and health history contributes to delays in presenting for treatment for ischemic stroke. Stroke education concentrating on symptom recognition may benefit from a special focus on high-risk individuals as highlighted in this study.

Evaluation of REACH-TX: A Community-Based Approach to the REACH II Intervention.

BACKGROUND AND OBJECTIVES: Family caregiving interventions have been proven efficacious at reducing dementia caregiver's stress and burden, yet translation of evidence-based interventions into community-based support service programs requires modification to the original intervention protocol. In collaboration with community partners, the REACH-TX program was developed based on the REACH II (Resources for Enhancing Alzheimer's Caregiver Health) intervention. REACH-TX maintains the integrity of the multicomponent skill-based REACH II intervention but requires significantly fewer therapeutic contacts between the family caregiver and the dementia care specialist. This study presents an evaluation of REACH-TX implemented by the Alzheimer's Association North Central Texas Chapter. RESEARCH DESIGN AND METHODS: REACH-TX was provided to 1,522 caregivers between November 2011 and December 2017. The number of therapeutic contacts scheduled for caregivers was determined by the Risk Appraisal Measure (RAM) and ranged from 1 to 23. The rate of follow-up data on outcome measures collected was 59.0% (n = 898). All five domains of the REACH II quality-of-life measure (burden, depression, social support, self-care, and problem behaviors) were assessed at baseline and at 6 months. Caregivers (n = 53) participating in the program more than once allowed us to investigate the long-term impact of the first exposure to REACH-TX and the value of repeating the program. Generalized linear models were used to assess changes in quality of life after adjusting for covariates. RESULTS: Caregivers who completed the program showed significant improvements from baseline to 6 months on all five domains of quality of life, as evidenced by the follow-up data. Furthermore, caregivers who enrolled a second time in REACH-TX showed significant improvement in burden and social support scores. DISCUSSION AND IMPLICATIONS: This evaluation of REACH-TX suggests that REACH II evidence-based intervention can be translated into a valuable and sustainable community-based service for family caregivers. Additional translational research is needed to overcome the challenges of conducting standardized outcome assessments of caregiving services.

Erratum to: Evaluation of REACH-TX: A Community-Based Approach to the REACH II Intervention.

[This corrects the article DOI: 10.1093/geroni/igz022.].

Assessment of eHealth behaviors in national surveys: a systematic review of instruments.

Objectives: To conduct a systematic review of instruments used in national surveys of eHealth behaviors. Materials and Methods: Major databases and websites of federal agencies were searched with pre-determined inclusion and exclusion criteria. National surveys with measures of eHealth behaviors were identified. The survey instruments were retrieved, and their measures of eHealth behaviors were categorized and critiqued. Results: We located 13 national surveys containing eHealth behavior assessment questions that were administered from 1999 to 2017. Most surveys were conducted annually or biennially and typically covered topics on searching health information, obtaining social support, communicating with healthcare providers, and buying medicine online; recent surveys included items related to personal health management and use of mobile tools. There were redundant measures of searching health information online but insufficient measures of use of mobile apps, social media, and wearable devices. Discussion: Future assessment of eHealth behaviors should reflect the growing varieties of behaviors enabled by technology development and reflect the current mobile ownership patterns in diverse social groups. More studies also need to include longitudinal surveys, integrative and standardized measures, and better designs to allow data linkage and comparison. Conclusion: The existing survey instruments covering eHealth behaviors are rather limited compared to fast technological progress. We call for more national surveys on eHealth behaviors that are more responsive to technology development; we also advocate for more analysis and dissemination of existing national data on eHealth behaviors for evidence-based health policies.

Subjective well-being in centenarians: a comparison of Japan and the United States.

OBJECTIVE: The present study examined the cultural differences and similarities in the levels and predictors of subjective well-being in Japanese and American centenarians. METHOD: We analyzed data on cognitively intact Japanese (N = 59) and American (N = 125) participants from the Tokyo and Georgia Centenarian Studies, respectively. The Philadelphia Geriatric Center Morale Scale was used to measure subjective well-being, while sociodemographic, social, and health resources were assessed as potential predictors. RESULTS: The American participants reported higher scores on well-being (satisfaction with social relations and psychological comfort). However, cultural differences in the levels of well-being disappeared after we controlled for its predictors. The regression models revealed that health resources (cognitive function, hearing problems, and activities of daily living) were strong predictors of well-being in both countries. Social resources (living with others) were strongly associated with one dimension of well-being (attitude toward one's aging) among the Japanese participants. DISCUSSION: The findings support the existing lifespan and cross-cultural literature, indicating that declines in health impose certain limitations on adaptive capacity in oldest-old age irrespective of cultures, and that social embeddedness is valued in Eastern cultures. The authors speculate that cultural values, i.e. personal autonomy versus relational harmony, play an important role for well-being in oldest-old age.

Multiple chronic condition profiles and survival among oldest-old male patients with hip fracture.

To improve understanding of survival among very elderly male patients with surgically repaired hip fractures, this study applied classification techniques to multiple chronic conditions (MCC) then modeled survival by latent class. Veterans Health Administration (VHA)'s electronic medical records on male inpatients age 85-100 years (n=896) with hip fracture diagnosis and repair were used. MCC defined by Charlson and Elixhauser disorders, medications, demographic covariates, and 5 years follow-up survival were included. Latent Class Analysis (LCA) identified three classes based on patterns of MCC, medications, and demographic covariates: Low-comorbidity (16%), High-longevity (55%), and High-comorbidity (29%). Overall, survival censored at 5 years post-op averaged 717days. The Low-comorbidity group was more likely to be Hispanic, less disabled per VHA determination of eligibility for care, with less risk of postoperative emergency department (ED) visit, and taking no prescription medications. The High-longevity group had longer survival. The High-comorbidity group had more MCC, more prescription medications and shorter survival than the other two groups. Accelerated failure time (AFT) modeled associations between MCC and 5-year survival by class. In AFT models, fewer days until first postoperative ED visit was significantly associated with survival across the three classes. About one in male hip fractured veteran patients over the age of 85 had high levels of MCC and ED use and experienced shorter survival. Hip fracture patients with MCC may merit enhanced post-discharge management. Close investigation targeted to MCC and hip fractures is needed to optimize clinical practices for oldest-old patients in community healthcare systems as well as VHA.

Has the Digital Health Divide Widened? Trends of Health-Related Internet Use Among Older Adults From 2003 to 2011.

OBJECTIVES: To examine the trend of health-related Internet use (HRIU) among older adults. METHODS: We analyzed data from the 2003, 2005, and 2011-2012 iterations of the National Cancer Institute (NCI)-sponsored Health Information National Trends Survey (HINTS). HRIU was measured by 4 online behaviors: seeking health information, buying medicine, connecting with people with similar health problems, and communicating with doctors. RESULTS: Internet use and HRIU among older adults increased substantially from 2003 to 2011 with more significant increases in seeking health information and communicating with doctors online. Overall, the digital health divide between different demographic groups has narrowed, especially in terms of gender, racial/ethnic group, rural/urban residence, and various health statuses; however, age, education, and household income remain persistent predictors of the digital divide. Those in the oldest group (75 or older), those with less than a high school education, and those with very low income (<$25,000/year) continuously lagged behind their counterparts in all aspects of HRIU. CONCLUSIONS: Despite an overall increase in HRIU and a narrowed digital divide, significant variations in HRIU in different demographic groups persisted; therefore, we call for more senior-friendly online resources and culturally appropriate interventions to bridge the digital health divide for vulnerable older adults.

Factors Associated With Injurious Falls in Residential Care Facilities.

OBJECTIVE: Despite a growing literature on the epidemiology of falls, little is known about injurious falls in residential care facilities (RCFs). Addressing this gap, this study examined demographic, interpersonal, institutional, and community factors associated with injurious falls in RCFs. METHOD: We conducted analyses using a nationally representative sample ( n = 733,309) of RCF residents (2010) examining whether or not a resident experienced a fall that resulted in any injury (past year). RESULTS: Overall, 15% of RCF residents experienced an injurious fall. Residents needing assistance with activities of daily living were more likely to experience injurious falls (adjusted-OR = 1.85), whereas males (adjusted-OR = 0.74) and those residing in smaller facilities (adjusted-OR = 0.68) were less likely. Other resident sociodemographic characteristics, payment status, social connectedness, and rurality were not significant independent predictors. DISCUSSION: Research further exploring multifactorial fall prevention screening and treatment programs in RCFs is recommended for reducing injurious falls in this understudied setting.

Protective and Risk Factors for 5-Year Survival in the Oldest Veterans: Data from the Veterans Health Administration.

OBJECTIVES: To characterize physical and mental diseases and use of healthcare services and identify factors associated with mortality in the oldest individuals using the Veterans Health Administration (VHA). DESIGN: Retrospective study with 5-year survival follow-up. SETTING: VHA, system-wide. PARTICIPANTS: Veterans using the VHA aged 80 and older as of October 2008 (N = 721,588: n = 665,249 aged 80-89, n = 56,118 aged 90-99, n = 221 aged 100-115). MEASUREMENTS: Demographic characteristics, physical and mental diseases, healthcare services, and 5-year survival were measured. RESULTS: Accelerated failure time models identified protective and risk factors associated with mortality according to age group. During 5 years of follow-up, 44% of participants died (survival rate: 59% aged 80-89, 32% aged 90-99, 15% aged ≥100). In the multivariable model, protective effects for veterans aged 80-99 were female sex, minority race or ethnicity, being married, having certain physical and mental diagnoses (hypertension, cataract, dyslipidemia, posttraumatic stress disorder, bipolar disorder), having urgent care visits, having invasive surgery, and having few (1-3) prescriptions. Risk factors were lower VHA priority status, physical and mental conditions (diabetes mellitus, anemia, congestive heart failure, dementia, anxiety, depression, smoking, substance abuse disorder), hospital admission, and nursing home care. For those aged 100 and older, being married, smoking, hospital admission, nursing home care, invasive surgery, and prescription use were significant risk factors; only emergency department (ED) use was protective. CONCLUSION: Although the data are limited to VHA care (thus missing Medicare services), this study shows that many veterans served by the VHA live to advanced old age despite multiple chronic conditions. Further study is needed to determine whether a comprehensive, coordinated care system like VHA is associated with greater longevity for very old persons.

Socioecological factors and positive aspects of caregiving: findings from the REACH II intervention.

OBJECTIVE: Taking a socioecological perspective, this study assessed the relationship of intrapersonal, interpersonal, and organizational factors to positive aspects of caregiving (PAC) for 642 dementia caregivers by racial/ethnic group from the baseline data of the multisite Resources for Enhancing Alzheimer's Caregiver Health II (REACH II) intervention. METHODS: Nine intrapersonal indicators, 4 interpersonal indicators, and 12 organizational indicators were used. Blocked-multiple regression analyses by three racial/ethnic groups were computed to examine significant factors related to PAC among caregivers after controlling for memory and behavioral problems. RESULTS: Data showed a significant difference in PAC and significantly different indicators of PAC by racial/ethnic group. Hispanic caregivers reported the highest level of PAC while White participants showed the lowest scores on the measure of PAC. Education, marital status, and using formal transportation services were significant predictors for PAC among Hispanic caregivers; age, education, caregiving duration, and received social support were significant for PAC among African American caregivers; and sex, education, being a spousal caregiver, satisfaction with social support, using help from homemaker and visiting nurse services, and participating in support groups were significant among White caregivers. CONCLUSION: Findings indicate that PAC varies significantly across the three studied racial/ethnic groups of family caregivers and that intrapersonal, interpersonal, and organizational factors relate uniquely to PAC. Additional investigations of PAC could serve an important role in the development of family caregiving supports and services.

A Model Home-Delivered Meals Program to Support Transitions from Hospital to Home.

Meals On Wheels, Inc. of Tarrant County (MOWI) collaborated with local community-based organizations and hospitals to provide home-delivered meals and an evidence-based medication management intervention as a care transition service. The model program was designed to address risk factors commonly associated with preventable hospital readmissions. MOWI staff provided meals to 121 patients recently discharged from an inpatient hospitalization or emergency department visit from March 2013 through March 2014. A total of 18,010 meals were delivered to the 121 clients. On average, clients received 6.25 meals per week with meal delivery starting, on average, 8.95 days postdischarge. Ninety-three of the 121 clients also elected to receive the HomeMeds program. Client self-report of health care utilization (e.g., hospital readmission) at three months and six months was lower than expected given client characteristics. Positive changes in the Emergent Care Assessment and resolution of medication alerts provide additional evidence of a positive effect of the home-delivered meals program. More research is needed to document the benefits of home-based care supports following hospitalization.