A Facility-Level Analysis of Nursing Home Compare's Five-Star Rating and Maryland's Family Satisfaction with Care Survey.

BACKGROUND AND OBJECTIVES: Nursing facilities care for individuals with cognitive and/or physical disabilities. Poor quality is associated with greater disease and mortality. Quality comprises many factors and different stakeholders value different factors. This study aimed to compare two care quality frameworks, one based on observable factors and one on family satisfaction. RESEARCH DESIGN AND METHODS: We merged publicly available 2021 Maryland nursing facility data. The Maryland Health Care Commission surveys long-term care residents' family satisfaction across seven domains. Centers for Medicare and Medicaid Services' (CMS) 5-star ratings aggregate inspections, staffing, and quality measures. We used univariate and bivariate statistics to compare the frameworks. RESULTS: The data set included 220 facilities and 4,610 survey respondents. The average facility rating was 7.70/10 and overall 77% of respondents would recommend the facility. Eighty-six percent of respondents from 5-star facilities, 79% from 4-star facilities, and 76% from 3-star facilities would recommend the facility compared to 65% from 1-star facilities (p < .001, p < .01, and p < .05, respectively). Four or 5-star facilities received significantly higher ratings (8.33, p < .001; 7.75, p < .05, respectively) than 1-star facilities (7.07). DISCUSSION AND IMPLICATIONS: Our results corroborated earlier findings of strong associations between CMS ratings and satisfaction at the extremes of the 5-star system. These associations are inconsistent across family-reported domains. This suggests overlap between the frameworks. CMS ratings address care quality; family satisfaction measures quality of life and care quality. High satisfaction is associated with high care quality and quality of life; lower satisfaction is associated with lower care quality.

Problem-solving in technology-rich environments and cancer screening in later life.

Routine cancer screening is widely recognized as an effective preventive strategy to reduce cancer mortality - the second leading cause of death in the US. However, cancer screening requires a complex array of tasks such as seeking up-to-date guidelines, making appointments, planning hospital visits, and communicating with health care professionals. Importantly, modern health care largely relies on technology to disseminate the latest information and administer the system. Yet, little is known about the technology-related skills that are relevant to regular cancer screening. This study examined the association between problem-solving skills in the technology-rich environment and cancer screening in later life. Using 2012/2014 Program for International Assessment of Adult Competencies data, binary logistic regressions with survey weights were used to estimate the association between problem-solving skills in the technology-rich environment and four cancer screening behaviors among the corresponding target populations aged between 45 and 74 years old (n = 1374 for cervical screening; n = 1373 for breast screening; n = 1166 for prostate screening; n = 2563 for colon screening). Results showed that greater problem-solving skills in the technology-rich environment scores (0-500 points) were significantly and positively associated with prostate cancer screening (odds ratio = 1.005, P < 0.05) among men, but not with colon (men and women) or cervical or breast (women) cancer screenings. Improvement in problem-solving skills in the technology-rich environment may promote specific cancer screening behaviors. Our findings inform future policy discussions and interventions that seek to improve cancer screening among a vulnerable section of older populations.

Literacy skills, language use, and online health information seeking among Hispanic adults in the United States.

OBJECTIVE: Online health information is underutilized among Hispanics with low English proficiency in the U.S. This study examines the association between a unique measure of general English literacy, language use, and online health information seeking among Hispanic adults. METHODS: Data for Hispanics ages 25-65 (N = 700) come from the 2012/2014 Program for International Assessment of Adult Competencies (PIAAC). Binary logistic regression models were used to predict online health information seeking as a function of literacy skill scores (0-500 points) and primary language use (Spanish vs. other). RESULTS: Literacy (Odds-Ratio = 1.012, p <  0.001) was a positive predictor, while speaking Spanish at home (Odds-Ratio = 0.352, p <  0.01) was a negative predictor of online health information seeking. CONCLUSION: Literacy skills and language use appear to be separate contributors of online health information seeking among Hispanic adults. PRACTICE IMPLICATIONS: Online health information providers should be aware of literacy skills and Spanish language use as barriers to online health information seeking among Hispanics, particularly those who have both limited literacy skills and predominantly Spanish language use.

Problem Solving in Technology-Rich Environments and Self-Rated Health Among Adults in the U.S.: An Analysis of the Program for the International Assessment of Adult Competencies.

Problem-solving skills in the context of technologically complex modern societies have become increasingly important to health management in later life. This study is designed to investigate the associations between problem-solving skills in technology-rich environments (PSTRE) and health, and to explore whether age differences exist. Using data from the 2012/2014 Program for the International Assessment of Adult Competencies (PIAAC), we used logistic regression to examine the relationship between PSTRE and self-reported health among a representative sample of American adults aged 35 years and older (N = 3,260). Overall, greater PSTRE (odds ratio [OR] = 1.012, p < .001) was significantly associated with better self-rated health even after adjusting for the sociodemographic characteristics. Yet, PSTRE was only partially predictive of health in some age groups. Our findings highlight the potential of PSTRE to reduce health disparities among middle-aged and older adults living in modern technology and information-rich societies.

Numeracy and Preventive Health Care Service Utilization among Middle-Aged and Older Adults in the U.S.

Objectives: Determine whether a specific numeracy skill cut-point(s) reflects an empirical threshold in the context of preventive health service utilization, and identify associations between numeracy and preventive health services utilization among middle-aged and older adults in the United States.Methods: A nationally representative sample (n = 2,989) of adults 45 years and older from the International Assessment of Adult Competencies (PIAAC) was analyzed. Binary logistic regression was used to examine the utilization of dental checkup, vision screening, influenza vaccination, and osteoporosis screening, using multiple numeracy level classifications.Results: A dichotomous classification of numeracy skill levels (low vs. moderate to high proficiency) was associated with dental checkup utilization, but vision screening, influenza vaccination, and osteoporosis screening.Conclusions: Middle-aged and older adults with sufficient numeracy skills are more likely to have had a dental check up in the past 12 months. Findings suggest that numeracy may be more relevant for long-term vs. short-term risk assessment in determining preventive health care service utilization.Clinical Implications: Two-level numeracy categories are recommended in preventive health contexts. Numeracy proficiency-sensitive risk communication by health care providers and education programs may enhance awareness of preventive health care and promote the utilization of specific preventive health service utilization among older adults.

Neighborhood Cohesion, Disorder, and Physical Function in Older Adults: An Examination of Racial/Ethnic Differences.

Objectives: This study examined the link between neighborhood social cohesion, disorder, and physical function in older adults, and identified potential racial/ethnic differences in these associations. Method: Data come from the National Health and Aging Trends Study (NHATS; N = 5,619). A series of linear regression models were used to predict physical function. Subgroup analyses and neighborhood/race interactions were used to examine differences. Results: Neighborhood disorder was associated with poorer physical function (p < .05), while neighborhood cohesion was not (p = .06). Although tests of interactions were not significant, subgroup analyses showed that neighborhood disorder, and not social cohesion, was associated with poorer physical function only in Whites. Discussion: Disadvantaged neighborhood social environment may contribute to differences in physical function among older adults. Racial and ethnic differences warrant closer investigation in studies of neighborhoods and functional health.

The Roles of Education, Literacy, and Numeracy in Need for Health Information during the Second Half of Adulthood: A Moderated Mediation Analysis.

We examine complex pathways that link health information seeking behavior with education and health literacy (decomposed into general literacy and numeracy), and how these pathways differ by perceived health status (need) among a nationally representative sample of Americans age 50 and older (n = 2,750). Data come from the Program for International Assessment of Adult Competencies (PIAAC). Multi-group structural equation models were used to examine the use of eight health information sources (newspapers, magazines, internet, radio, TV, books, friends/family, and health professionals). Findings partially support the long-standing notion that health seeking behaviors are directly linked to educational attainment, and provide some of the first nationally representative evidence for how education functions through distinct health literacy components to shape health information seeking behaviors by health status. Findings from this moderated mediation analysis point to the importance of examining, and addressing, health literacy disparities in access to and use of health information.