The relationship between cognitive function and non-prescribed therapy use in older adults.

OBJECTIVES: To examine the association of cognitive function with use of non-prescribed therapies for managing acute and chronic conditions, and to determine whether use of non-prescribed therapies changes over time in relation to baseline cognitive function. METHODS: 200 community-dwelling adults aged 65 and older were recruited from three counties in south central North Carolina. Repeated measures of daily symptoms and treatment were collected on three consecutive days at intervals of at least one month. The Mini-Mental State Examination, the primary cognitive measure, was collected as part of the baseline survey. Data were collected on the daily use of common non-prescribed therapies (use of prayer, ignore symptoms, over-the-counter remedies, food and beverage therapies, home remedies, and vitamin, herb, or supplements) on each of the three days of the follow-up interviews for up to six consecutive months. RESULTS: Older adults with poorer cognitive function were more likely to pray and ignore symptoms on days that they experienced acute symptoms. Poorer cognitive function was associated with increased use of home remedies for treating symptoms related to existing chronic conditions. CONCLUSIONS: Cognitive function may play a role in why older patients use some non-prescribed therapies in response to acute and chronic conditions.

Actuation of mobility intentions among the young-old: an event-history analysis.

PURPOSE: Although migration decision making is central to understanding later-life migration, the critical step between migration intentions and mobility outcomes has received only limited empirical attention. We address two questions: How often are intended moves actuated? What factors condition the likelihood that mobility intentions will be actuated? DESIGN AND METHODS: We employ data from the 1994-2002 Health and Retirement Study, which is a nationally representative panel targeting households containing persons aged 53 to 63 years at baseline. Event-history techniques are used to examine the link between reported mobility intentions at baseline and mobility outcomes across the study period, net of relevant controls. We conduct separate household-level analyses for couple and noncouple households and recognize three types of moves: local, family oriented, and nonlocal. RESULTS: Findings confirm the utility of mobility expectations as a predictor of future mobility. More importantly, results highlight the complex nature of later-life mobility. The actuation of mobility intentions appears to operate differently in couple than in noncouple households. Moreover, our findings suggest that the role of several key variables depends on the type of move under consideration. IMPLICATIONS: The ability to identify potential "retirement migrants" may be of practical importance for state and local government officials as well as developers interested in recruiting or retaining young-old residents. Our study offers insight on the interpretation of stated mobility intentions. Moreover, consistent with early theoretical work in the field, our analysis suggests that empirical studies must account for heterogeneity among older movers in order to avoid misleading results.

Predictors of non-local moves among older adults: a prospective study.

OBJECTIVES: The goal of this article was to test a series of established predictors of the hazard of moving for persons primarily in their 50s and 60s. We tested demographic covariates, resources, travel experience, and community and person ties using a prospective design. METHODS: We employed data from the Health and Retirement Study, 1994 to 2002, based on a representative sample of households containing at least one member aged 51 to 61 in 1992. We employed measures available in the Health and Retirement Study to construct a series of Cox proportional hazards models that examined the causes of non-local moves. RESULTS: Community and person ties emerged as important predictors of non-local moves. DISCUSSION: Travel experience, when measured by regular vacationing and second homes, may increase community ties to a destination. The life-course model must be modified in its explanation of the importance of community and person ties, and of life transitions, as motivators of migration.

In retirement migration, who counts? A methodological question with economic policy implications.

PURPOSE: We examine the methodological and economic policy implications of three operations of retirement migration. DESIGN AND METHODS: We compared the traditional age-based definition of retirement migration and two retirement-based definitions, based on degree of labor-force participation and retirement income, by using the 2000 U.S. Census Public Use Microdata Sample. RESULTS: The age-based definition overestimated the number of retired migrants, although the ranking of host and donor states remained relatively stable; nevertheless, states revealed different rates of change in inmigration and outmigration and income streams declined. IMPLICATIONS: Retirement-based definitions are more useful and precise for those researchers considering the economic implication of retirement migration.

The effects of sleep loss and fatigue on resident-physicians: a multi-institutional, mixed-method study.

PURPOSE: To identify and model the effects of sleep loss and fatigue on resident-physicians' professional lives and personal well-being. METHOD: In 2001-02, 149 residents at five U.S. academic health centers and from six specialties (obstetrics-gynecology, emergency medicine, family medicine, internal medicine, pediatrics, surgery) were recruited for the study. Residents were all in good standing in their programs. In a mixed-methods design, focus groups consisted of an average of seven (range, three to 14) individuals in the same year of training and residency program, for a total of 60 interns and 89 senior residents. Trained moderators conducted focus groups using a standardized, semistructured discussion guide. Participants also completed a 30-item quantitative questionnaire assessing sleepiness and workplace sleep attitudes that included the Epworth Sleepiness Scale (ESS). RESULTS: Residents described multiple adverse effects of sleep loss and fatigue on learning and cognition; job performance, including professionalism and task performance; and personal life, including personal well-being and relationships with spouse or significant other and family. Only 16% of the sample scored within the "normal" range on the ESS; 84% scored in the range for which clinical intervention is indicated. Sleepiness was consistent across institution, specialty, years of training, age, gender, marital status, and having children. CONCLUSIONS: More residents perceived that sleep loss and fatigue had major impact on their personal lives during residency, leaving many personal and social activities and meaningful personal pleasures deferred or postponed. Sleep loss and fatigue also had major impact on residents' abilities to perform their work. This finding further substantiates the growing concern about the potential impact on professional development. These observations should be taken into account in developing new training guidelines and educational interventions for housestaff.

Oral health disparities among the elderly: interdisciplinary challenges for the future.

The elderly, like other population groups, have experienced varying levels of oral health among their diverse demographic subgroups. For those in poverty, experiencing social isolation, residing in long-term care institutions, and with complex medical illness, oral health care may be unreachable. Various models of training, education, and community, public, and professional collaboration have been proposed, yet few strategies have been implemented. Interdisciplinary approaches that bring interested partners together as equal stakeholders may create faster tracks in improving access to health care for those geriatric patients who lack it. This article explores past and present recommendations for interdisciplinary collaborations, reviews the current and future needs of the geriatric population, discusses educational models and content, and expresses the need for leadership to address oral health disparities in the elderly. Finally, strategies for making improvements in the existing oral health disparities are discussed.

Older adults' self-management of daily symptoms: complementary therapies, self-care, and medical care.

OBJECTIVES: To describe older adults' use of complementary therapies, self-care practices, and medical care to treat daily symptoms and to delineate gender, ethnic, age, and education differences. METHOD: A total of 200 African American and White participants (age 65+) selected using a site-based procedure complete a baseline interview and up to six sets of three daily follow-up interviews at monthly intervals. The percent of older adults using a therapy and the frequency with which therapies are used are considered. RESULTS: The use of complementary therapies to treat daily symptoms, though important, is substantially less than the use of self-care practices and medical care. Participants differed by age, ethnicity, and education in the use of therapies. DISCUSSION: In considering the percentage of individuals who use a therapy and the frequency with which therapies are used, this analysis adds a new dimension to understanding how older adults manage daily symptoms. Older adults are selective in their use of health self-management.

Daily use of complementary and other therapies for symptoms among older adults: study design and illustrative results.

OBJECTIVE: This article describes research designed to specify complementary therapies used among older adults by obtaining daily use data and the specific purposes for use. DESIGN: Two hundred African American and White participants completed a baseline interview and up to six sets of three daily-diary interviews at monthly intervals. RESULTS: Participants provided retrospective information on complementary therapy use and information on the use of therapies for specific symptoms experienced across 3,070 person days. Retrospective information indicated that most participants used complementary therapies (e.g., 85.0% used home remedies in the past year). The use of complementary or other therapies and the number of days the therapies were used varied for specific symptoms. For example, home remedies were used on 86 (9.1%) of the 944 person days for which joint pain was reported. DISCUSSION: The daily-diary design provides detailed information for delineating how elders include complementary and other therapies in their health self-management.

Complementary therapy use and health self-management among rural older adults.

OBJECTIVES: This article describes dimensions of complementary therapy use among rural older adults, employs these dimensions to delineate sets of complementary therapy use, and describes the personal characteristics related to each set of complementary therapy use. METHODS: Data are from in-depth interviews conducted with 62 African American and White rural older adults. RESULTS: Three dimensions of complementary therapy use are delineated: types of therapies used, mindfulness in therapy use, and sharing information with conventional health care providers. The intersection of these dimensions indicates 5 patterned sets of complementary therapy use among rural older adults: (a) mindful use of only home remedies; (b) mindful use of home remedies and contemporary supplements; (c) mindful use of home remedies, contemporary supplements, and complementary practices; (d) nonmindful use of home remedies and contemporary supplements; and (e) use of conventional care only. Involvement in the 5 sets of therapy use is related to sex, ethnicity, educational attainment, and migration. DISCUSSION: Understanding how older adults include sets of complementary therapies in their health self-management is important for improving their health care resources, expectations, awareness, and priorities.

Strategies Resident-Physicians Use to Manage Sleep Loss and Fatigue.

Our purpose is to examine strategies or countermeasures resident-physicians used in dealing with the effects of sleep loss and fatigue during residency training. A total of 149 residents across five sites and six specialty areas were recruited for the study. Focus groups consisted of an average of 7 individuals in the same year of training and residency program, and included 60 interns and 89 senior residents. Trained moderators conducted focus groups using a semi-structured discussion guide. Transcripts were analyzed using the grounded theory tradition. The range of strategies adopted was: Chemical, Dietary, Sleep Management, Behavioral, and Cognitive. Residents exhibited a trial-and-error approach to identifying management strategies. None mentioned searching the scientific literature or consulting local sleep medicine experts. Residents relied on putative countermeasures even when they were aware of their negative effects. Our results document the need to educate resident physicians on self-care strategies during residency training.