Measures of chronic conditions and diseases associated with aging in the national social life, health, and aging project.

OBJECTIVES: This paper presents a description of the methods used in the National Social Life, Health, and Aging Project to detect the presence of chronic conditions and diseases associated with aging. It also discusses the validity and distribution of these measures. METHODS: Markers associated with common chronic diseases and conditions of aging were collected from 3,005 community-dwelling older adults living in the United States, aged 57-85 years, during 2006. Dried blood spots, physical function tests, anthropometric measurements, self-reported history, and self-rated assessments were used to detect the presence of chronic conditions associated with aging or of risk factors associated with the development of chronic diseases. RESULTS: The distribution of each measure, disaggregated by age group and gender, is presented. CONCLUSIONS: This paper describes the methodology used as well as the distribution of each of these measures. In addition, we discuss how the measures used in the study relate to specific chronic diseases and conditions associated with aging and how these measures might be used in social science analyses.

Elder mistreatment in the United States: prevalence estimates from a nationally representative study.

OBJECTIVES: The National Social Life, Health and Aging Project is the first population-based, nationally representative study to ask older adults about their recent experience of mistreatment. This article provides estimates of mistreatment by family members and examines the association of mistreatment with demographic and health characteristics. METHODS: We selected community-residing participants aged 57 to 85 using a multistage area probability design. Of those eligible, 3,005 participated in the study, for a weighted response rate of 75.5%. We asked respondents if in the past year they had experienced mistreatment in the following domains: verbal, financial, and physical. We asked those who reported mistreatment about their relationship to the person responsible. RESULTS: In all, 9% of older adults reported verbal mistreatment, 3.5% financial mistreatment, and 0.2% physical mistreatment by a family member. Odds of verbal mistreatment were higher for women and those with physical vulnerabilities and were lower for Latinos than for Whites. Odds of financial mistreatment were higher for African Americans and lower for Latinos than for Whites and were lower for those with a spouse or romantic partner than for those without partners. DISCUSSION: Few older adults report mistreatment by family members, with older adults quite insulated from physical mistreatment.

Older women's attitudes, behavior, and communication about sex and HIV: a community-based study.

OBJECTIVES: To examine the effects of race and marriage on the sexual attitudes, behavior, and patient-physician communication about sexuality and HIV/AIDS among older women. METHODS: This was a cross-sectional survey of 55 community-residing women aged 58-93. RESULTS: 57% of respondents had engaged in sexual activity since the 60th birthday. Nearly 60% of single women who had been sexually active in the previous 10 years reported that they had not used a condom; 21% of women with a current sexual partner agreed that condom use is not necessary "if you can no longer get pregnant." African American women were significantly more likely to report making changes in their sexual behavior due to HIV (53% vs. 19% white, p = 0.02). Married and African American women were more likely to discuss sex with a physician (80% vs. 47%; p = 0.03 and 75% vs. 46%, p = 0.05, respectively). African Americans were more likely to have had a physician initiate such a discussion (69% vs. 38%, p = 0.04). CONCLUSIONS: Older women in this sample were sexually active, engaged in potentially risky sexual behavior, and believed that physicians should address issues of sexuality. Older African American women were significantly more likely than white women to report HIV-related changes in their behavior and to discuss sex with a physician. This community-based study corroborates clinical research and suggests both a gap and a disparity in older women's dialogue with physicians. It also indicates the need for more broadly generalizable data on issues pertinent to older women's sexual health.

Health literacy as a predictor of follow-up after an abnormal Pap smear: a prospective study.

BACKGROUND: Low literacy influences cervical cancer screening knowledge, and is a possible contributor to racial disparities in cervical cancer. OBJECTIVE: To examine the hypothesis that literacy predicts patient adherence to follow-up recommendations after an abnormal Pap smear. DESIGN: A prospective, continuity clinic-based study. PARTICIPANTS: From a sample of 538 women undergoing literacy testing at the time of Pap smear screening, we studied 68 women with abnormal Pap smear diagnoses. MEASUREMENTS: Literacy was assessed using the Rapid Evaluation of Adult Literacy in Medicine (REALM). We also measured other proxies for literacy, including educational attainment and physician estimates of patients' literacy level. Outcome measures included on-time and 1-year follow-up and duration of time to follow-up after an abnormal Pap smear. RESULTS: Only one-third of the cohort adhered to follow-up recommendations. At 1 year, 25% of the women had not returned at all. Patients with inadequate literacy (as assessed by the REALM) were less likely to follow up within 1 year, although this result was not statistically significant (adjusted odds ratio [OR]=3.8, 95% confidence interval [CI]: 0.8 to 17.4). Patients subjectively assessed by their physician to have low literacy skills were significantly less likely to follow up within 1 year (adjusted OR=14, 95% CI: 3 to 65). Less than high school education (hazard ratio (HR)= 2.3; 95% CI: 1.2, 4.6) and low physician-estimated literacy level (HR=3.4, 95% CI: 1.4, 8.2), but not objective literacy level, were significant predictors of duration of time to follow-up, adjusting for recommended days to follow-up and other factors. CONCLUSIONS: Among women with an abnormal Pap smear, those perceived by their physician to have low literacy were significantly more likely to fail to present for follow-up.

Biomechanical activity devices to index wandering behavior in dementia.

Valid and reliable measures of wandering are needed to study this troubling behavior. Although researchers have used various perspectives, definitions, and approaches to study wandering, spontaneous ambulation is a key characteristic across all views. Biomechanical activity devices for capturing movement provide one way to index wandering. This study examined four devices with ambulatory nursing home residents with dementia (N = 178) who wore devices simultaneously during four observations. Among the Actillume, StepWatch, Step Sensor, and TriTrac-R3D, the StepWatch yielded data from the highest proportion of observations, explained the most variance (63.9 percent) among all instruments, and was acceptable to nursing staff. Although the Step Sensor was the staff's preferred device, its performance was least acceptable for research purposes. Results support use of the StepWatch in future studies of wandering.