Nursing home admission for African Americans with Alzheimer's disease.

BACKGROUND: For African Americans with Alzheimer's disease (AD), little is known about the time to, and risk factors for, nursing home admission (NHA). Using Consortium To Establish a Registry for Alzheimer's Disease (CERAD) data, this study provides information on NHA for African Americans. METHODS: This longitudinal study followed subjects (N=122) for as long as 7 years and used survival analysis methodology and variable values at baseline and at follow-up to identify NHA risk factors. Studied were sociodemographic variables, physical symptom and disease status variables, the Blessed Dementia Rating Scale (including subscores), the Clinical Dementia Rating (CDR), and the Mini-Mental State Examination. RESULTS: Only 25% of African Americans with AD were estimated to have had a NHA by 3.4 years (confidence interval 2.1, 5.4). Being unmarried resulted in a five times earlier NHA (p< .01), and each unit increase in the CDR resulted in a 74% earlier NHA (p<.01). In the absence of the CDR, limitation in activities of daily living was associated with earlier NHA (p<.05). CONCLUSIONS: Findings suggest that African Americans with AD spend a substantial time in the community prior to NHA, a longer time than observed in similar studies among whites. This raises public health and clinical concern that African Americans with AD may be residing in the community with substantial unmet needs, and that their caregivers have potentially high levels of burden. The independent associations with time to NHA observed here, although few in number, are consistent with other related research.

Occupational hazard exposure and at risk drinking.

This study examined associations between workers' reported exposure to occupational hazards and at risk drinking. A sample of 15,907 working adults was drawn from the 1985 National Health Interview Survey (NHIS) (weighted sample represented 85,395,000 workers). This was the only year the NHIS included questions on both occupational hazard exposure and at risk drinking. Occupational hazard exposures included chemical/biological substances, physical hazards, injury risk, and mental stress. At risk drinking was defined as binge drinking and drinking and driving. Prevalence adjusted odds ratios were estimated. Sixty percent of workers reported exposure to one or more occupational hazards with considerable variation among and within occupations. In all, 31% reported binge drinking and 15% drove after drinking too much. In a multivariate analysis that controlled for background characteristics, workers who reported occupational hazard exposures were 1.2 to 1.4 times more likely to engage in binge drinking than workers without exposures. Similar results were found for drinking/driving. All multivariate results were statistically significant. Findings suggest workers who report occupational hazard exposures are at greater risk of both binge drinking and drinking/driving. Occupational and environmental health nurses can lead workplace initiatives to reduce occupational hazard exposure and, simultaneously, invest in health promotion efforts to curb at risk drinking among workers.

Time to nursing home admission for persons with Alzheimer's disease: the effect of health care system characteristics.

OBJECTIVE: To study the influence of state health care system characteristics on time to nursing home admission (NHA) for persons with Alzheimer's disease (AD). METHOD: Up to nine years of Consortium to Establish a Registry for Alzheimer's Disease (CERAD) data on 639 non-Latino White individuals were merged with longitudinal data from the 28 states in which the CERAD participants resided. The state variables reflected characteristics of each state's long-term care (LTC) system, including Medicaid LTC spending practices and the supply of LTC providers. Cox Proportional Hazards Models with time-varying covariates were used to evaluate the risk factors associated with time to NHA. RESULTS: There was differential influence of state variables by marital status. For unmarried non-Latino White persons with AD, a higher percentage of Medicaid LTC spending on home and community-based services (HCBS) was significantly associated with a longer time to NHA. For married persons, a greater number of home health agencies was associated with a longer time to NHA. Other associations also varied by marital status. CONCLUSION: Study findings support the utility of targeted continued expanded provision of HCBS by states and provide a basis for future research regarding the impact of changing state health care systems on LTC utilization for persons with AD.

Hip fracture incidence among elderly Hispanics.

OBJECTIVES: This study estimated hip fracture incidence for elderly Hispanics in the United States. METHODS: A cohort of Spanish-surnamed 1992 Medicare enrollees was followed for 2 years. Hip fractures were identified by inpatient diagnostic code. RESULTS: For Hispanic women, the national age-adjusted hip fracture rate was 7.3 per 1000 person-years; for men, the rate was 3.3. Rates varied markedly, with higher rates for the predominantly Mexican-American southwestern states than for Puerto Ricans. CONCLUSIONS: Nationally, the Hispanic population is at intermediate risk of hip fracture between Blacks and Whites, but geographic variation suggests that Mexican Americans are at higher risk than Puerto Ricans.

Older adults and assistive devices: use, multiple-device use, and need.

Responses of older adults ( greater than 65 years) from the 1990 National Health Interview Survey and Assistive Device Supplement are analyzed to determine if selected demographic and health variables are associated with the use of assistive devices, multiple-device use, and the expressed need for such devices. Bivariate and multi-variate analyses show that, in general, poorer health is consistently associated with the use of assistive devices, multiple-device use, and expressed need. Demographic characteristics, however, vary in their relationships to assistive device use and need. Findings support the importance of considering multiple-device use and expressed need in studying assistive devices and older adults.

Motor vehicle related injuries among American Indian and Alaskan Native youth, 1981-92: analysis of a national hospital discharge database.

OBJECTIVE: To describe national trends in hospitalizations for motor vehicle related injuries among children and youth (0-24 years) of the United States Indian Health Service (IHS) from 1981-92. DESIGN: Descriptive epidemiologic study of the E coded national hospital discharge database of the IHS. RESULTS: From 1981 to 1992, the age standardized annual incidence of motor vehicle related injury hospitalizations (per 100,000 population) among American Indian and Alaskan Native (AI/AN) youth decreased more than 65% from 269 to 93. Substantial declines in hospitalization rates for all age and sex groups, all IHS areas, and most injury types were seen over this time. Injuries to vehicle occupants accounted for 78% of all motor vehicle related injury hospitalizations. The annual incidence of hospitalization (per 100,000 population) ranged from 291 in the Billings (Wyoming/Montana) and Aberdeen (the Dakotas) areas to 38 in the Portland area (Pacific Northwest). CONCLUSIONS: National motor vehicle related injury hospitalization rates of AI/AN children and youth decreased significantly from 1981-92. This may be due to a reduction in the incidence of severe motor vehicle related trauma, changing patterns of medical practice, and changes in the use of services. Additional measures, such as passage and enforcement of tribal laws requiring the use of occupant restraints and stronger laws to prevent alcohol impaired driving, might further reduce the incidence of serious motor vehicle related injuries in this high risk population.

Hip fracture incidence among elderly Asian-American populations.

This study estimated national age- and sex-specific nontraumatic hip fracture incidence rates for elderly Chinese Americans, Japanese Americans, and Korean Americans. Based on a 50 percent sample of 1992 Medicare enrollees with the race/ethnicity code "Asian" and "other," cohorts of persons with distinctive Chinese (n = 24,366), Japanese (n = 28,762), and Korean (n = 5,470) names were followed passively for 2 years for a hospitalization with a diagnostic code indicating hip fracture. Cohorts of whites and blacks were followed for comparison. Year of immigration was deduced from the year of issuance of the Social Security number. Age-adjusted hip fracture incidence was lower for all three Asian-American groups than for whites. For females, the standardized fracture ratio relative to whites was 30.1 for Chinese, 73.2 for Japanese, and 52.8 for Koreans; for males, the standardized fracture ratio was 41.9 for Chinese, 58.1 for Japanese, and 90.7 for Koreans. Persons whose Social Security numbers were issued after the immigration Act of 1965 had an adjusted relative risk of 1.37 (95% confidence interval 1.05-1.78) compared with those in the US before that year, after adjustment for age, sex, and ethnic group.

Medical conditions differentially affect the development of IADL disability: implications for medical care and research.

Using The Longitudinal Study of Aging, we determined the independent effects of nine self-reported medical conditions on the likelihood of developing specific instrumental activities of daily living (IADLs) disabilities at three points in time. We controlled for demographic factors and self-reported health status. The various medical conditions differentially affect each specific IADL disability, and each IADL disability has its own set of predictors which, in general, do not vary over time. The differential effects of thse predictors need to be taken into consideration by researchers, clinicians, and policymakers when studying disability and when implementing and evaluating programs to reduce disability.

Change in the number of informal helpers of frail older persons.

Little is known of the extent to which helper networks of frail older persons change over time and what factors are associated with change. Few national estimates of the scope of change exist to aid policy planners. This study provides national estimates of changes in the size of the informal helping network of frail elderly by sociodemographic and functional status subgroups of this segment of the population. The data are drawn from the 1982-84 National Long Term Care Survey, which included longitudinal followup of 4,530 respondents living in the community at both times. Bivariate patterns of change over 2 years in the number of informal helpers were analyzed. Sociodemographic factors (sex, age group, and race) of the frail elderly may be more important influences on change in the number of helpers than functional status expressed in terms of their limitations in activities of daily living.

Do activities of daily living have a hierarchical structure? An analysis using the longitudinal study of aging.

BACKGROUND: It has long been thought that individual activities of daily living (ADLs) can be combined to form a hierarchy or Guttman scale. The purpose of this study is to determine if ADLs fit into a single hierarchical structure, and to examine how such a hierarchy should be evaluated. METHODS: We use data from the baseline year of the Longitudinal Study of Aging, a nationally representative survey of noninstitutionalized persons 70 years of age and older. For each of the 360 permutations of the ADLs within the Katz hierarchy, we calculate the standard measures of fit of ordered data to a Guttman scale: the coefficient of reproducibility, the minimum marginal reproducibility, the percentage improvement, and the coefficient scalability. RESULTS: We find that although the Katz hierarchy does satisfy the traditional requirements for scalability, many other ADL hierarchies also satisfy these criteria. Specifically, our analysis shows that there are 4 hierarchies at least as good as the Katz hierarchy, and 103 hierarchies which satisfy the minimum standard for scalability. CONCLUSIONS: We conclude that the typical scalogram methodology may not be sufficient to summarize data, and that a multiplicity of disability profiles may exist.

The relationship of visual and hearing impairments to disability: an analysis using the longitudinal study of aging.

BACKGROUND: Little is known about the relationships of visual impairment and hearing impairments to physical disability. The purpose of this work is to determine if persons 70 years of age and over with these impairments are at risk for increased disability in basic physical activities of daily living (ADLs) compared to persons without these impairments. METHODS: We used as our data source the baseline (1984) and the 1988 reinterview from the Longitudinal Study of Aging, a nationally representative survey of noninstitutionalized persons 70 years of age and older. To determine the relationships of visual impairment and hearing impairment to future four-year disability, we used multiple variable modeling, controlling for demographic variables, selected chronic conditions, and baseline disability. RESULTS: Persons with visual impairment were 1.37 (95% CI:1.20-1.57) times more likely to have increased disability in ADLs than those without visual impairment. Hearing impairment was not independently related to increased ADL disability. CONCLUSIONS: Visual impairment by itself is an independent risk factor for future ADL disability. In light of the enlarging older population, maneuvers to ameliorate visual impairment may help to minimize the increase in numbers of disabled persons.

Do falls predict institutionalization in older persons? An analysis of data from the Longitudinal Study of Aging.

Data from the Longitudinal Study of Aging (LSOA) were analyzed to estimate the subsequent risk of institutionalization associated with a report of one or more falls, and to determine if the association is affected by controlling for demographic traits, chronic conditions, and disabilities present at baseline. Risk was estimated at two time points, 2 years and 4 years after baseline interview. A report of multiple falls at baseline was associated with an increased risk of institutionalization at both 2 years (odds ratio [OR] 3.1; 1.9-5.3) and 4 years (OR 2.6; 1.6-4.4) of follow-up. The risk was decreased but remained significant in a model controlling for age, sex, marital status, and selected chronic conditions associated with both report of falls and institutionalization. However, multiple falls were not significantly associated with institutionalization when measures of disability (number of difficulties with activities of daily living) were added to the model. These analyses suggest that multiple falls should be regarded as an important sentinel event to alert caregivers to the presence of underlying disease and disability that may require intervention.

Selected issues in long-term care: profile of cognitive disability of nursing home residents and the use of informal and formal care by elderly in the community.

In summary, this section suggests that hospital care and physician office care are frequently used community health care services. There were relatively few differences by sex, age, or race in patterns of community health service use. There were differences by sex, age, race, and level of ADL disability in the number of informal helpers a frail elder used. Marital patterns appear to be an important underlying influence on the number of informal helpers. When a spouse is present, he or she becomes the primary and only helper in many instances. The number of informal helpers that a frail elder had was associated with an increased risk of mortality and institutionalization. Overall, there is somewhat more stability than change in the number of informal helpers over the 2-year period. This section, however, could not identify if the composition of the informal helper network remained the same over time.