The modifying effect of positive emotion on the relationship between cognitive impairment and disability among older Mexican Americans: a cohort study.

OBJECTIVE: To determine if positive emotion modifies the relationship between cognitive impairment and activities of daily living disability status over 10 years in Mexican American adults aged 75 years and older. METHODS: A retrospective cohort design using data from the Hispanic established populations for the epidemiologic studies of the elderly. About 2674 participants aged 75 years and older were included and followed over 10 years. Cognition was measured using the mini-mental state examination, positive emotion was measured using four questions from the Center for Epidemiologic Studies Depression Scale, and disability was measured using seven activities of daily living items. A series of generalized estimating equations models were used, with the initial analysis including those with disability at baseline and subsequent analyses excluding disability at baseline. RESULTS: Positive emotion and cognitive impairment consistently decreased and increased risk for activities of daily living disability, respectively. Positive emotion was a significant modifier in the cross-sectional analysis, and was not a statistically significant modifier in the longitudinal or predictive series analysis. CONCLUSIONS: Positive emotion and cognitive impairment differentially affect the risk of developing activities of daily living disability. Further research is needed to explore the interaction of positive emotion and cognitive impairment, and to identify appropriate interventions that address the specific cognitive and emotional needs of older Mexican Americans. Implications for rehabilitation Promoting emotional well-being may be protective against incident disability for older adults. Cognitive impairment significantly predicts incident disability in activities of daily living and should be considered an early indicator of impending disability for older adults.

Social Disparities in Early Intervention Service Use and Provider-Reported Outcomes.

OBJECTIVE: To describe social disparities in early intervention (EI) service use and provider-reported outcomes. METHODS: Secondary data analysis of administrative data to ascertain EI service use of all EI and discipline-specific services and child and family characteristics. Adjusted logistic regression models estimated the odds of receiving each type of core EI service. Adjusted median regression models estimated differences in EI intensity for each type of core EI service. Adjusted ordinal regression models estimated the association between each type of EI therapy service and provider estimates of children's global functional improvement. RESULTS: Children with a diagnosis (b = 0.8, SE = 0.2) and those whose caregiver had 12 years of education or less (b = 0.6, SE = 0.3) had higher EI intensity. Black, non-Hispanic (BNH) children had nearly 75% lower odds of receiving physical therapy (PT) (odds ratio [OR] = 0.3, 95% confidence interval [CI], 0.1-0.7) and greater odds of receiving speech therapy (ST) (OR = 3.4, 95% CI, 1.3-9.3) than their white, non-Hispanic (WNH) peers. BNH children who received PT received about an hour less per month (b = -0.7, SE = 0.4) than their WNH peers. Hispanic children (b = 1.0, SE = 0.3) and those with higher family income (b = 0.7, SE = 0.3) received greater intensity of PT compared with their peers who are WNH and from low-income families. Publically insured children had lower intensity of occupational therapy (b = -0.5, SE = 0.3) and ST (b = -0.6, SE = 0.3). Greater intensity of EI services was not associated with greater provider-perceived improvement. CONCLUSION: Results suggest disparities, by race and family income, in receipt of EI therapy services. These findings highlight opportunities to customize and coordinate care for improved EI access and care quality.