Impact of self-assessed health status and physical and functional limitations on healthcare utilization and mortality among older cancer survivors in US.

PURPOSE: The purpose of this study was to examine the impact of physical limitations, functional limitations and self-assessed health status on mortality and healthcare utilization among older cancer survivors. METHODS: National Medicare Current Beneficiary Survey (MCBS) cost and use data from 2008 to 2013 were used for analysis. Physical limitations, Activities of Daily Living (ADL), and Instrumental Activities of Daily Living (IADL) were assessed on multiple questions, and self-assessed health was measured on a five-point scale (1-5: Excellent-Poor). Multivariable logistic regression and Poisson regression models were used for hospitalization, re-hospitalization and mortality rates based on three follow up years. RESULTS: This study included 17,715 cancer patients with a mean age of 75 years and 57% females. Cancer survivors with poor self-assessed health had a higher rate of hospitalizations (adjusted Odds Ratio: aOR: 1.60, 95% Confidence Interval: CI: 1.47-1.72, p < 0.001) relative to non-cancer participants. Compared to participants with no history of cancer, cancer survivors with IADL (aOR: 1.41, 95% CI: 1.25-1.58, p < 0.001) or with poor self-assessed health (aOR: 1.39, 95% CI: 1.21-1.60, p < 0.001) were more likely to have a higher number of hospital readmissions within 30 days of a prior hospitalization. Three-year mortality rate was significantly higher among cancer survivors with poor self-assessed health (Hazard Ratio: 2.81, 95% CI: 2.81-2.82, p < 0.001). CONCLUSION: Self-assessed health and physical and functional limitations significantly and independently impact healthcare utilization and mortality among older cancer survivors. Healthcare providers should incorporate formal assessments of both self-assessed health and functional status among older cancer survivors in their clinical practice. IMPLICATION FOR CANCER SURVIVORS: Self-reported health status is a valuable and independent predictor of healthcare utilization and mortality among cancer survivors.

Is Colorectal Cancer Screening Associated with Stages of Weight Control Among Korean Americans Aged 50-75 Years Old?: Implications for Weight Control Practice.

OBJECTIVE: To examine the associations of colorectal cancer (CRC) screening with stages of weight control among Korean Americans (KAs) using the transtheoretical model and provide implications for their weight control practice. METHODS: A quantitative, cross-sectional survey was employed to collect data on current weight control behaviors and intentions, CRC screening history, previous cancer diagnosis, body mass index, number of chronic conditions, perceived health status, health insurance, and sociodemographics. Purposive sampling was implemented to recruit KA participants in the Atlanta metropolitan area in the USA from May 2015 to February 2016. A total of 433 KAs aged 50 to 75 years completed a self-report survey questionnaire. Descriptive and bivariate analyses and multiple logistic regressions were performed using Stata Version 14/MP software. RESULTS: Applying the stages of the transtheoretical model 53% were positioned in the first two stages (precontemplation and contemplation) of weight control with 47% being in the last two stages (action and maintenance). Participants who had been screened for CRC were more likely to be in the last two stages of weight control compared with those who had not been screened (OR = 2.49; p = 0.003). CONCLUSIONS: The findings suggest that preventive healthcare such as CRC screening may provide the opportunity for health education interventions to help encourage weight control efforts and behaviors in the KA community. Future research is warranted to investigate the underlying mechanism behind the link between CRC screening and weight control to guide the development of interventions for eliminating health disparities.

National study of chronic disease self-management: 6-month and 12-month findings among cancer survivors and non-cancer survivors.

OBJECTIVE: This study examined the applicability of the Stanford Chronic Disease Self-Management Program (CDSMP) for cancer survivors and compared outcomes among cancer survivors and participants with other chronic diseases (non-cancer survivors). METHODS: Participants were older adults (n = 1170) enrolled in the National Study of CDSMP. Detailed information about physical and psychosocial health status and health and healthcare behaviors was collected from participants (n = 116 cancer survivors and n = 1054 non-cancer survivors) via self-report before CDSMP participation and at 6-month and 12-month follow-ups. Linear and generalized linear mixed models were used to assess baseline-to-6-month and baseline-to-12-month changes. RESULTS: Among cancer survivors, general health, depression, and sleep significantly improved from baseline to 6 months. These significant changes were sustained at 12 months. Communication with physician, medication compliance, pain, days in poor physical health, days in poor mental health, and days kept from usual activities and physical activity also improved significantly from baseline to 12 months. Among non-cancer survivors, all outcomes except medication compliance and stress improved significantly from baseline to 6 months. At 12 months, medication compliance also improved significantly. CONCLUSIONS: Findings suggest that participation in CDSMP, an evidence-based chronic disease self-management intervention not specifically tailored for cancer survivorship, may significantly improve physical and psychosocial health status and key health and healthcare behaviors among cancer survivors. Additional research is needed to elucidate cancer survivors' unique needs and examine the benefits of tailored versions of CDSMP. Nevertheless, CDSMP, available at scale nationally and internationally, is a promising intervention for cancer survivors and should be considered a valuable component of survivorship care.

The relationship between waterpipe smoking and body weight: population-based findings from Syria.

INTRODUCTION: Cigarette smoking has well known effects on body weight, with current smokers weighing less than never-smokers, and cessation producing weight gain. Use of waterpipe (or "hookah") is increasing in many parts of the world but its effects on body weight are not known. METHODS: We compared body mass index (BMI) among 2,536 adults (age ≥ 18 years old), who were never, former, current nondaily, or current daily waterpipe smokers, drawn from 2 representative, population-based household surveys of adults in Aleppo, Syria. RESULTS: Overall, 84.1% (n = 2,134) never-smoked waterpipe, 4.6% (n = 116) were former smokers, 9.9% (n = 251) were current nondaily smokers, and 1.4% (n = 35) were current daily smokers. Mean BMI of the sample was 30.2 kg/m(2) (SD = 6.3). Adjusted for cigarette smoking, number of chronic diseases, age, gender, income, and marital status, daily waterpipe users were 2.26 BMI units greater than never-smokers (beta = 2.26, 95% CI = 0.79-3.72), and had nearly threefold odds of being obese (odds ratio = 2.87, 95% CI = 1.06-7.76). Nondaily and former waterpipe users were similar to never-smokers in terms of BMI and obesity risk. CONCLUSION: Results indicate that daily waterpipe users, compared to never-users, have higher BMI, translating into 6 extra kilograms of weight on average, and are 3 times as likely to be obese.

Correlates of initiating colorectal cancer screening beginning at age 50.

This study examined (a) differences in rates of initiating colorectal cancer screening across age groups, and (b) factors associated with initiation of colorectal cancer screening among persons age 50-75. Data from 1,699 adults age 50-75 were analyzed from a random sample of households in an eight-county region surrounding the Brazos Valley in Texas. Bivariate descriptive analyses were performed. Logistic regression was employed to assess relationships between demographic, health status, and healthcare utilization variables and having initiated colorectal cancer examination. Having more than a high school education (OR = 1.48, p = 0.002), having insurance (OR = 1.76, p = 0.007), being obese (OR = 1.58, p = 0.015), and having a routine health check-up within the past 2 years (OR = 3.39, p < 0.001) were associated with an increased likelihood of having a colorectal cancer examination. The findings suggest that routine interactions with health care providers may encourage persons to initiate colorectal cancer screening according to guidelines.

Health and health care utilization among obese and diabetic baby boomers and older adults.

PURPOSE: Examine how sociodemographic, health, behavioral, and health care utilization factors are associated with being obese or having diabetes among baby boomers and older adults. DESIGN: Cross-sectional data were drawn from the 2007-2008 National Health and Nutrition Examination Survey. SETTING: United States. SUBJECTS: A sample of 3439 baby boomers and older adults included (mean age, 62 years). MEASURES: Covariates included sociodemographics, health outcomes, behaviors, and inpatient and outpatient health care utilization. ANALYSIS: Multinomial logistic regression was used to explore which similar or different covariates were associated with different health states between baby boomers and older adults. RESULTS: Approximately 8% of baby boomers and 10% of older adults had the twin diagnoses of obesity and diabetes. Having both obesity and diabetes was more common among baby boomers and older adults who were African-American (odds ratio [OR] = 1.79, p = .029 for baby boomers; OR = 3.45, p < .001 for older adults), perceived their general health as fair/poor (OR = 7.67, p < .001; OR = 4.13, p < .001), and utilized outpatient care more often (OR = 8.28, p < .001; OR = 5.35, p = .004). Being obese only was observed less among baby boomers who were current smokers (OR = .45, p < .001), whereas it was observed more among older adults who were former smokers (OR = 1.25, p = .046). Having diabetes only was observed more among baby boomers who had hypertension (OR = 2.44, p = .01), whereas it was observed more among older adults who had very high cholesterol (OR = 2.31, p = .029). CONCLUSION: Identifying chronic disease risk factors during middle age is important for ameliorating further complications in later life. Knowing more about the correlates of obesity and diabetes among different age groups can help health care planners better target preventive health care services.

Physicians' discussions about body weight, healthy diet, and physical activity with overweight or obese elderly patients.

OBJECTIVE: To investigate the correlates of physician-patient discussions about body weight, healthy diet, and physical activity. METHOD: Subjects were 635 adults (≥65 years; mean 72.8 years) who had an increased body mass index (BMI≥25 kg/m2) and participated in a self-administered community survey. Logistic regression analyses were performed. RESULTS: While approximately half of study participants reported having discussed healthy diets (51%) and physical activity (52%) with their physician, only 42% of those who were overweight or obese reported being recognized as such by their physician. Being moderately or severely obese, more chronic conditions, and more frequent physician visits increased the likelihood of being recognized as overweight or obese and reporting lifestyle discussions. DISCUSSION: The health care provider is important in recognizing older patient's weight problems and discussing practical lifestyle changes. Tools for more proactive screening and implementation of follow-up behavioral counseling can help the health care providers better address obesity prevention in clinical practice.

Factors associated with tobacco smoking practices among middle-aged and older women in Texas.

This study examines middle-aged and older women's smoking practices and identifies factors associated with tobacco use and cessation in this population. Data of 593 women were analyzed from a seven-county random household sample in Texas. Sequential multinomial logistic regression compared associations with having never smoked, having quit smoking, and currently smoking. Compared to smokers, never smokers and past smokers were significantly more likely to be older, more educated, of better general health, and report past-year physician visits and fewer depressive symptoms. Mental health and smoking are interrelated, indicating the need for addressing depression in smoking-cessation efforts for aging women.

The longitudinal effects of behavioral, health, and socio-demographic factors on body mass index among older Chinese adults.

OBJECTIVES: To examine the effects of behavioral, health, and socio-demographic factors on being overweight or obese among older Chinese adults. METHODS: This research uses panel data from the China Health and Nutrition Survey, which was designed to examine how social and economic transformation affected the health and nutritional status of residents. For these analyses, we used all available information on adults aged 60 years or older surveyed in 1997, 2000, 2004, and 2006 (N = 3,591). Body mass index (BMI) was dichotomized as normal (18.5-24.9 kg/m(2)) and overweight (25.0-29.9 kg/m(2))/obese (≥30 kg/m(2)). Generalized estimating equations were used to estimate population-averaged (marginal) effects. RESULTS: The combined prevalence of overweight or obese was approximately 33%. Moderate or heavy non-leisure physical activities (OR = 0.39; 95% CI = 0.32-0.49) and smoking (OR = 0.69; 95% CI = 0.57-0.84) decreased the odds of being overweight or obese, while drinking alcohol (OR = 1.25; 95% CI = 1.05-1.50) increased the odds. For individuals in all income levels, the amount of non-leisure physical activity strongly affected the BMI among the older Chinese adults. CONCLUSIONS: Active lifestyle interventions may help counter what could otherwise be a growing obesity epidemic in China.

Utilization of screening mammography among middle-aged and older women.

AIMS: This study examines patterns of screening mammogram use, investigating the relationship of screening with demographic, health status, and healthcare factors. METHODS: Data from 1242 women aged ?41 were obtained from a random sample of mailed surveys to community households in an eight-county region in Central Texas in 2010. The dependent variable was the timing of the participants' most recent screening mammography (in the past 12 months, between 1 and 2 years, or >2 years). Predictor variables included demographic, health status, and healthcare access factors. Multinomial logistic regression identified variables associated with screening mammography practices. RESULTS: The majority of women reported having at least one mammogram during their lifetime (93.0%) and having a mammography within the past 2 years (76.2%). Participants who reported not having a routine checkup in the past 12 months (odds ratio [OR] 0.12, p<0.001), having a lapse of insurance in the past 3 years (OR 2.95, p<0.05), and living in a health provider shortage area (OR 1.42, p<0.05) were less likely to be screened within the past 2 years. CONCLUSIONS: Routine healthcare plays a major role in preventive screening, which indicates screening mammography practices can be enhanced by improving participation in routine checkups with medical providers, continuity of insurance coverage, and women's access to healthcare. Interventions to encourage screening mammography may be particularly needed for women who have experienced a lapse in insurance or have not had a checkup in the past year.

BMI and lifestyle changes as correlates to changes in self-reported diagnosis of hypertension among older Chinese adults.

Nutrition transition theory attributes increased prevalence of high blood pressure to excess body weight associated with lifestyle changes in recent decades. We examined the association of changes in self-reported hypertension diagnoses with changes in body mass index (BMI), health-related behaviors, health status, and social risk factors among older Chinese adults from 1997 to 2006. Data from the longitudinal China Health and Nutrition Survey (CHNS) were analyzed for adults who were age 60 years and older, had a BMI exceeding 18.6 kg/m(2), and reported no diagnosis of hypertension at baseline (n = 1928). Logistic regression models identified factors contributing to staying nonhypertensive or developing hypertension over time. Approximately 17.8% (n = 324) of study participants developed self-reported hypertension, whereas 83.2% (n = 1604) remained without hypertension. Those who stayed overweight or obese or became overweight or obese were more likely to report a new hypertension diagnosis. Incident diagnoses were also observed among those who developed acute conditions, sustained memory loss, or increased their income, whereas remaining nonhypertensive was more likely among rural residents and those who became more physically active and quit drinking alcohol. Study findings provided partial support for the nutrition transition theory whereby changing demographics and lifestyle factors were associated with increases in incident hypertension.

Variations in body mass index among older Americans: the roles of social and lifestyle factors.

OBJECTIVE: To investigate the correlates of body mass index (BMI) among a national sample of older adults in the United States. METHOD: Data used in these analyses were part of the 2003-2004 National Health and Nutrition Examination Survey (NHANES). Generalized ordered logistic regression was used to analyze difference between normal weight, overweight, moderately obese, and severely obese adults (n = 1,143) above the age of 65 years. RESULTS: A higher BMI was more common among those with greater activities of daily living (ADL) limitations, greater use of prescription medicines (≥ 7), greater number of cardiovascular-related disorders (1 or ≥ 2), and those aged 65 to 74 years. DISCUSSION: The findings acknowledge relationships between health characteristics, disability, and BMI among a national sample of older adults. These results suggest that prevention and management of health conditions, basic ADL, and BMI may be reasonable targets for intervention.