%0 Journal Article %J BMJ Open %D 2017 %T Likelihood that expectations of informal care will be met at onset of caregiving need: a retrospective study of older adults in the USA. %A Abrahamson, Kathleen %A Hass, Zachary %A Laura Sands %K Caregiving %K Community-dwelling %K Marriage %K Social Support %X

BACKGROUND: Ageing adults are likely to expect informal caregiving assistance from a friend or family member, reflecting the reality that most long-term care (LTC) is provided by family and friends. The purpose of the study was to determine the likelihood that expectations of care will be unmet at the onset of functional disability, and the factors that impact that likelihood.

METHODS: Community-dwelling respondents from biannual repeated assessments (2006-2010) of the Health and Retirement Study over age 65 who expressed a caregiving expectation prior to need were included in the final analytical sample (n=1352). Logistic regression and change models were specified to address impact of variables on unmet expectations.

RESULTS: Expectations of care were unmet for almost one-third (32%) of the sample, among whom 30% were not receiving needed care. Unmet expectations were associated with being unmarried, older and having a higher number of ADL deficits. Change over time in the number of predictor variables influenced the likelihood of unmet expectations.

CONCLUSIONS: Unplanned dependence on formal care systems and/or having unmet care needs places elders at risk of negative outcomes. Knowledge of factors that impact whether expected care is eventually received provides robust evidence for counselling individuals regarding the need to plan for additional LTC services.

%B BMJ Open %V 7 %P e017791 %G eng %N 12 %1 http://www.ncbi.nlm.nih.gov/pubmed/29259058?dopt=Abstract %R 10.1136/bmjopen-2017-017791 %0 Journal Article %J The Journals of Gerontology, Series A: Biological Sciences and Medical Sciences %D 2005 %T Black-White Disparities in Functional Decline in Older Persons: The role of cognitive function %A Sandra Y. Moody-Ayers %A Kala M. Mehta %A Lindquist, Karla %A Laura Sands %A Kenneth E Covinsky %K Demographics %K Health Conditions and Status %X Background. Black elders have a greater frequency of functional decline than do white elders. The impact of cognitive function on explaining black white disparities in functional decline has not been extensively explored. Methods. To compare the extent to which different risk domains (comorbidity, smoking, socioeconomic status (SES), self-rated health, and cognitive function) explain more frequent functional decline in black elders, we studied 779 black and 4892 white community-dwelling adults aged 70 and older from the Assets and Health Dynamics Among the Oldest Old (AHEAD), a population-based cohort study begun in 1993. Our primary outcome was worse functional status at 2 years than at baseline. We used logistic regression to compare the unadjusted with the adjusted black white odds ratios (ORs) after adjusting for each risk domain. Results. At baseline black participants aged 70 79 had higher rates of smoking, diabetes, and hypertension; lower SES; and worse cognitive function than did white participants (p .05 for all). The mean cognitive score was 15.7 in black and 21.8 in white participants (p .01). Black participants had a higher frequency of 2-year functional decline than did white participants (10.9 vs 4.7 ; OR = 2.61, 95 confidence interval CI , 1.69 4.03 adjusted for age and sex). Adjustment for comorbidity and smoking did not significantly change the black white OR, whereas self-rated health and SES accounted for about half the risk. Adjustment for cognitive function accounted for nearly all the associated decline (OR = 1.10, 95 CI, 0.67 1.79). Among participants aged 80 and over, those who were black had significantly lower risk for functional decline after adjustment for cognitive function (OR = 0.61, 95 CI, 0.38 0.96 vs OR = 1.08, 95 CI, 0.70 1.66 adjusted for age and sex only). Conclusions. Cognitive function mediated the higher frequency of functional decline among black elders. Efforts to understand cognitive function may enhance our understanding of black white disparities in health outcomes. %B The Journals of Gerontology, Series A: Biological Sciences and Medical Sciences %I 60 %V 60 %P 933-939 %G eng %N 6 %L pubs_2005_MoodyAyersJoG.pdf %4 Cognitive Function/Health Physical/Racial Differences %$ 13132 %0 Journal Article %J J Gerontol A Biol Sci Med Sci %D 2003 %T Additive effects of cognitive function and depressive symptoms on mortality in elderly community-living adults. %A Kala M. Mehta %A Kristine Yaffe %A Kenneth M. Langa %A Laura Sands %A Whooley, Mary %A Kenneth E Covinsky %K Aged %K Cognition %K depression %K Female %K Humans %K Male %K Mortality %K Proportional Hazards Models %K Risk Factors %X

BACKGROUND: Poor cognitive function and depressive symptoms are common in the elderly, frequently coexist, and are interrelated. Both risk factors are independently associated with mortality. Few studies have comprehensively described how the combination of poor cognitive function and depressive symptoms affect the risk for mortality. Our aim was to examine whether the combination of varying levels of cognitive function and depressive symptoms affect the risk of mortality in community-living elderly adults.

METHODS: We studied 6301 elderly adults (mean age, 77 years; 62% women; 81% white) enrolled in the Asset and Health Dynamics Among the Oldest Old (AHEAD) study, a prospective study of community-living participants conducted from 1993 to 1995. Cognitive function and depressive symptoms were measured using two validated measures developed for the AHEAD study. On each measure, participants were divided into tertiles representing the best, middle, and worst scores, and then placed into one of nine mutually exclusive groups ranging from best functioning on both measures to worst functioning on both measures. Mortality rates were assessed in each of the nine groups. Cox proportional hazards models were used to control for potentially confounding characteristics such as demographics, education, income, smoking, alcohol consumption, comorbidity, and baseline functional impairment.

RESULTS: During 2 years of follow-up, 9% (548) of the participants died. Together, cognitive function and depressive symptoms differentiated between elderly adults at markedly different risk for mortality, ranging from 3% in those with the best function on both measures to 16% in those with the worst function on both measures (p <.001). Furthermore, for each level of cognitive function, more depressive symptoms were associated with higher mortality rates, and for each level of depressive symptoms, worse cognitive function was associated with higher mortality rates. In participants with the best cognitive function, mortality rates were 3%, 5%, and 9% in participants with low, middle, and high depressive symptoms, respectively (p <.001 for trend). The corresponding rates were 6%, 7%, and 12% in participants with the middle level of cognitive function (p <.001 for trend), and 10%, 13%, and 16% in participants with the worst level of cognitive function (p <.001 for trend). After adjustment for confounders, participants with the worst function on both measures remained at considerably higher risk for death than participants with the best function on both measures (adjusted hazard ratio, 3.1; 95% confidence interval, 2.0-4.7).

CONCLUSIONS: Cognitive function and depressive symptoms can be used together to stratify elderly adults into groups that have significantly different rates of death. These two risk factors are associated with an increased risk in mortality in a progressive, additive manner.

%B J Gerontol A Biol Sci Med Sci %I 58A %V 58 %P M461-7 %8 2003 May %G eng %N 5 %L pubs_2003_Mehta_KJoG.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/12730257?dopt=Abstract %4 Cognitive Function/Depressive Symptoms/Mortality %$ 8680 %R 10.1093/gerona/58.5.m461 %0 Journal Article %J J Gen Intern Med %D 2001 %T Self-restriction of medications due to cost in seniors without prescription coverage. %A Michael A Steinman %A Laura Sands %A Kenneth E Covinsky %K Aged %K Aged, 80 and over %K Cohort Studies %K Cross-Sectional Studies %K Female %K Humans %K Insurance, Pharmaceutical Services %K Male %K Prescription Fees %K Risk Factors %K Socioeconomic factors %K Treatment Refusal %K United States %X

OBJECTIVE: Little is known about patients who skip doses or otherwise avoid using their medications because of cost. We sought to identify which elderly patients are at highest risk of restricting their medications because of cost, and how prescription coverage modifies this risk.

DESIGN AND PARTICIPANTS: Cross-sectional study from the 1995-1996 wave of the Survey of Asset and Health Dynamics Among the Oldest Old, a population-based survey of Americans age 70 years and older.

MEASUREMENTS: Subjects were asked the extent of their prescription coverage, and whether they had taken less medicine than prescribed for them because of cost over the prior 2 years. We used bivariate and multivariate analyses to identify risk factors for medication restriction in subjects who lacked prescription coverage. Among these high-risk groups, we then examined the effect of prescription coverage on rates of medication restriction.

MAIN RESULTS: Of 4,896 seniors who regularly used prescription medications, medication restriction because of cost was reported by 8% of subjects with no prescription coverage, 3% with partial coverage, and 2% with full coverage (P <.01 for trend). Among subjects with no prescription coverage, the strongest independent predictors of medication restriction were minority ethnicity (odds ratio [OR], 2.9 compared with white ethnicity; 95% confidence interval [95% CI], 2.0 to 4.2), annual income <$10,000 (OR, 3.8 compared with income > or =$20,000; 95% CI, 2.4 to 6.1), and out-of-pocket prescription drug costs >$100 per month (OR, 3.3 compared to costs < or =$20; 95% CI, 1.5 to 7.2). The prevalence of medication restriction in members of these 3 risk groups was 21%, 16%, and 13%, respectively. Almost half (43%) of subjects with all 3 risk factors and no prescription coverage reported restricting their use of medications. After multivariable adjustment, high-risk subjects with no coverage had 3 to 15 times higher odds of medication restriction than subjects with partial or full coverage (P <.01).

CONCLUSIONS: Medication restriction is common in seniors who lack prescription coverage, particularly among certain vulnerable groups. Seniors in these high-risk groups who have prescription coverage are much less likely to restrict their use of medications.

%B J Gen Intern Med %I 16 %V 16 %P 793-9 %8 2001 Dec %G eng %N 12 %L pubs_2001_Steinman_MJGenIntMed.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/11903757?dopt=Abstract %4 Aged, 80 and Over/Cohort Studies/Cross Sectional Studies/Female/Insurance, Pharmaceutical Services/Prescription Fees/Risk Factors/Socioeconomic Factors/Support, U.S. Government--non PHS/Support, U.S. Government--PHS/Treatment Refusal %$ 4300 %R 10.1111/j.1525-1497.2001.10412.x