Measuring Social Participation in the Health and Retirement Study.

BACKGROUND AND OBJECTIVES: Large data sets have the potential to reveal useful information regarding social participation; however, most data sets measure social participation via individual items without a global assessment of social participation. RESEARCH DESIGN AND METHODS: We used data from the Health and Retirement Study (HRS) to assess whether 8 items from questionnaire pertaining to social participation (religious attendance, caring for an adult, activities with grandchildren, volunteering, charity work, education, social clubs, nonreligious organizations) formed a reliable, cohesive scale and to explore the predictive validity of this scale. We included respondents 65 years and older in the HRS who returned the psychosocial questionnaire in 2010 and 2012 with responses to the social participation items (n = 4,317 and n = 3,978). Three scales were explored: SoPart-30 using the original scoring; SoPart-10 using modified scoring; and SoPart-5 using dichotomous scoring. RESULTS: Five items were retained as a single factor for each scale, and graded response models and Mokken scale analysis confirmed the scale items with the SoPart-10 scale having the highest reliability (alpha = 0.74). DISCUSSION AND IMPLICATIONS: Results suggest that a scale derived from the social participation items in the HRS may be useful in characterizing general social participation levels and identifying modifiable factors that can promote it in older populations.

Chamomile Consumption and Mortality: A Prospective Study of Mexican Origin Older Adults.

PURPOSE: Approximately 20% of adults use some kind of herbal; however, little data exists from population-based study or clinical trials to support effectiveness of most herbal products. Chamomile is a commonly used herb among older adults of Mexican origin. We examined the effects of herbal chamomile consumption on mortality among older adults of Mexican origin. METHODS AND DESIGN: A sample from the Hispanic Established Populations for Epidemiologic Study of the Elderly, a population-based study of noninstitutionalized Mexican Americans aged 65 and older from five Southwestern states (Texas, California, New Mexico, Colorado, and Arizona). We included all men and women from 2000 to 2007 (n = 1,677). RESULTS: Chamomile was used by 14% of the sample. Cox proportional hazards regression analyses showed that chamomile was associated with a decreased risk of mortality in the total sample (hazard ratio [HR] 0.71, 95% confidence interval [CI] 0.55-0.92) and for women (HR 0.67, 95% CI 0.49-0.92) but not for men. In models adjusted for sociodemographic variables, health behaviors, and chronic conditions, chamomile remained significantly associated with reduced mortality in women (HR 0.72, 95% CI 0.53-0.98). IMPLICATIONS: The use of chamomile shows protective effects against mortality in this sample of older adults of Mexican origin for women. Further research is warranted in other populations to determine if these effects are consistent.

Stability and Change in Activities of Daily Living Among Older Mexican Americans.

BACKGROUND: Longitudinal studies of activities of daily living (ADL) in older adults have identified numerous factors associated with declining ability. Analyses based on population averages may not observe distinct subgroups whose ADL trajectories differ. METHODS: We used latent class models to identify subgroups of trajectories in a sample from the Hispanic Established Populations for Epidemiologic Study of the Elderly, a population-based study of noninstitutionalized Mexican Americans aged 65 and older from five Southwestern states (n = 2584). RESULTS: Three distinct trajectories of ADL limitations were identified and characterized as stable, delayed, and rapid ADL increase. Sex (female), diabetes, and arthritis were associated with increased odds of membership in the delayed and rapid groups compared with the stable group. Stroke had a differential magnitude of effect on ADL limitations across the stable (ß = 1.11, p < .001), delayed (ß = 0.52, p < .001), and rapid groups (ß = 0.12, p < .05). Hip fracture was associated with increased limitations in the stable group (ß = 1.27, p < .001) but not in the rapid group. Church attendance was associated with fewer limitations in all groups with a larger effect in the stable group (ß = -0.87, p < .001) compared with the rapid group (ß = -0.10, p < .05). CONCLUSIONS: Substantial heterogeneity exists in changes in ADL disability over time among older Mexican Americans. Attempts at maintaining function may benefit from targeting reductions in comorbidities and acute health events associated with disability.

Partnering With Patients, Families, and Communities.

BACKGROUND AND OBJECTIVES: Collaborating with patients, families, and communities is a core principle of family medicine. However, the health care system in the United States has grown increasingly complex, fragmented, and difficult to navigate. This system, focused on disease-specific care delivered by specialists, often treats patients as the objects of care rather than as partners in care. Family Medicine for America's Health (FMAHealth) offers an opportunity to challenge the status quo in collaborative care through enhanced patient outreach and community engagement. With a central focus on improving health and achieving the Triple Aim, the FMAHealth initiative recognizes that successful transformation of the US health care system requires collaborative partnerships between clinicians, patients, families, and communities. Patient and population-level outcomes can be improved through shared decision making; application of new technology; and authentic partnerships with patient, families, and communities. Broader collaboration in practice transformation, research, and policymaking can lead to identification of common goals and mutually embraced transformation. The discipline of family medicine aspires to encourage patients, families, and communities to demand change as consumers, as citizens, and as voters.

The impact of PSA screening on prostate cancer mortality and overdiagnosis of prostate cancer in the United States.

BACKGROUND: The study assessed the impact of prostate-specific antigen (PSA) testing in the United States by comparing the rates of PSA testing in U.S. counties to the rates of prostate biopsies and newly treated prostate cancer and to deaths from prostate cancer. METHODS: We examined the association between the percentage of men aged 66-74 from a nationally representative 5% Medicare sample who received PSA testing in each U.S. county in 1997 and the percent of men who received prostate biopsies or treatment for newly diagnosed prostate cancer in 1997 as well as mortality from prostate cancer and from all other causes from 1998 to 2007. RESULTS: Analyses of 1,067 U.S. counties showed a significant relationship between the rate of PSA testing and both the rate of men undergoing treatment for prostate cancer and prostate cancer mortality (both p < .001) but no relationship with mortality from other causes. For every 100,000 men receiving a PSA test in 1997, an additional 4,894 men underwent prostate biopsy and 1,597 additional men underwent prostate cancer treatment in 1997, and 61 fewer men died from prostate cancer during 1998-2006. Analyses stratified by age and race produced similar results. CONCLUSIONS: PSA testing was associated with modest reductions in prostate cancer mortality and large increases in the number of men overdiagnosed with and overtreated for prostate cancer. The results are similar to those obtained by the large European randomized prospective trial of PSA testing.

Social support, stressors, and frailty among older Mexican American adults.

BACKGROUND: There is little research on the effects of stressors and social support on frailty. Older Mexican Americans, in particular, are at higher risk of medical conditions, such as diabetes, that could contribute to frailty. Given that the Mexican American population is rapidly growing in the United States, it is important to determine whether there are modifiable social factors related to frailty in this older group. METHOD: To address the influence of social support and stressors on frailty among older Mexican Americans, we utilized five waves of the Hispanic Established Populations for the Epidemiologic Study of the Elderly (Hispanic EPESE) to examine the impact of stressors and social support on frailty over a 12-year period. Using a modified version of the Fried and Walston Frailty Index, we estimated the effects of social support and stressors on frailty over time using trajectory modeling (SAS 9.2, PROC TRAJ). RESULTS: We first grouped respondents according to one of three trajectories: low, progressive moderate, and progressive high frailty. Second, we found that the effects of stressors and social support on frailty varied by trajectory and by type of stressor. Health-related stressors and financial strain were related to increases in frailty over time, whereas social support was related to less-steep increases in frailty. CONCLUSION: Frailty has been hypothesized to reflect age-related physiological vulnerability to stressors, and the analyses presented indicate partial support for this hypothesis in an older sample of Mexican Americans. Future research needs to incorporate measures of stressors and social support in examining those who become frail, especially in minority populations.

Association of care by hospitalists on discharge destination and 30-day outcomes after acute ischemic stroke.

OBJECTIVES: The use of hospitalists is increasing. Hospitalists have been associated with reductions in length of stay and associated costs while not negatively impacting outcomes. We examine care for stroke patients because it requires complex care in the hospital and has high post discharge complications. We assessed the association of care provided by a hospitalist with length of stay, discharge destination, 30-day mortality, 30-day readmission, and 30-day emergency department visits. METHODS: This study used the 5% Medicare sample from 2002 to 2006. Models included demographic variables, prior health status, type of admission and hospital, and region. Multinomial logit models, generalized estimating equations, Cox proportional hazard models, and propensity score analyses were explored in the analysis. RESULTS: After adjusting models for covariates, hospitalists were associated with increased odds of discharge to inpatient rehabilitation or other facilities compared with discharge home (Odds Ratio, 1.24; 95% CI, 1.07-1.43 and Odds Ratio, 1.34; 95% CI 1.05-1.69, respectively). Mean length of stay was 0.37 days lower for patients in hospitalist care compared to nonhospitalist care. This reduction in length of stay was not appreciably changed after adjusting for discharge destination. Hospitalist care was not associated with differences in 30-day emergency department use or mortality. Readmission rates were higher for patients in hospitalist care (Hazard, 1.30; 95% CI, 1.11-1.52). CONCLUSIONS: Hospitalists are associated with reduced length of stay and higher rates of discharge to inpatient rehabilitation. The higher readmission rates should be further explored.