James E. Lubben

Social Network, Cognitive Function, and Dementia Incidence Among Elderly Women

OBJECTIVES We examined whether social networks had a protective association with incidence of dementia among elderly women. METHODS We prospectively studied 2249 members of a health maintenance organization who were 78 years or older, were classified as free of dementia in 2001, and had completed at least 1 follow-up interview in 2002 through 2005. We used the Telephone Interview for Cognitive Status-modified, the Telephone Dementia Questionnaire, and medical record review to assess cognitive status. We used the Lubben Social Network Scale-6 to assess social network. We estimated hazard ratios for incident dementia with Cox proportional hazards models, adjusting for age at entry, education, hormone use, cognitive status scores, and health conditions. RESULTS We identified 268 incident cases of dementia during follow-up. Compared with women with smaller social networks, the adjusted hazard ratio for incident dementia in women with larger social networks was 0.74 (95% confidence interval=0.57, 0.97). CONCLUSIONS Our findings suggest that larger social networks have a protective influence on cognitive function among elderly women. Future studies should explore which aspects of social networks are associated with dementia risk and maintenance of cognitive health.

Social Isolation and Social Support: An Applied Perspective

Considerable empirical evidence substantiates the importance of social networks and support to health and well-being among the elderly. But considerably more research is necessary before successful interventions can be more generally implemented to positively alter an elders network. In this article, the authors discuss social supportand isolationfrom an appliedperspective. They have combined presentations originally made at a National Institute on Aging-sponsored symposium on applied gerontology held in August 1992. They make some general observations concerning the field of applied social relations in later life, describe the mental health aspects of these relations, list some fundamental principles and existing technology for this field, describe the use of a brief screening instrument for social isolation developed by one of the authors (Lubben), and explore varying domains of knowledge concerning elder soical relations. They conclude by outlining some areas that they see as requiring the attention of an applications perspective to social support and isolation m the near future.

Cognitive impairment and hospital use.

BACKGROUND An increasing number of older people are at higher risk of developing Alzheimers Disease or another dementias. The resultant cognitive impairment has been well identified as one of the risk factors for nursing home placement but it has not been well studied as a risk for hospitalization. METHODS To study the association between cognitive impairment and hospital use, this study examined data from a randomly selected cohort of community dwelling California elderly (California Senior Survey). The cohort was followed for one year (N = 940). RESULTS Only about 17 percent of the study population was in the mildly or moderately/severe impaired category. Those participants with cognitive impairment were almost twice as likely as those without any impairment to be hospitalized and to be hospitalized for six days or more. CONCLUSIONS Although the cause of the cognitive impairment and hospitalization was not determined in this study, the data support the importance of cognitive impairment as a risk factor for hospital use even after controlling for age, ADL, IADL, and prior hospitalizations. The causes for this need to be further examined so the burden of such care can be reduced.

Patient-Related Predictors of Rehabilitation Use for Community-Dwelling Older Americans

To determine patient factors that predict use of physical or occupational therapy (PT/OT) services by elderly people.

Benzodiazepine Use in Older, Community-Dwelling Southern Californians: Prevalence and Clinical Correlates

OBJECTIVE: To determine the use of benzodiazepines (BZDs) in an older, community-dwelling sample and to examine the sociodemographic and clinical correlates of BZD use. DESIGN: A cross-sectional study of 1752 elderly people (aged ≥65 y) who completed a mailed medication survey and a telephone health status survey. PARTICIPANTS: Participants were invited to participate in a large Medicare demonstration project on prevention by their private physicians, who were also enrolled in the larger study. Participants had to be English-speaking, could not have dementia or a terminal illness, and had to give informed consent to participate in the study. MAIN OUTCOME MEASURES: Sociodemographic and health status variables that predicted BZD use were examined. Sociodemographic variables included age, gender, ethnicity, education, and income. Health status variables included functional status, with measures of mental, social, and physical health. Influenza immunization status was used as an indicator for preventive health services use and self-reported chronic illness was used as a measure of comorbidity. RESULTS: Twenty percent of the participants used BZDs at least twice in the past year. We found that those who used BZDs were more than twice as likely to take ten or more drugs, two-and-a-half times more likely to have difficulty falling asleep, and over twice as likely to be depressed. BZD users were also more likely to be white, to have a college education, and to have received a recent influenza shot, but were not more likely to be women when controlled for health status. CONCLUSIONS: Further clinical research should explore the relationship between BZD use among older patients and the BZD-associated adverse clinical factors we observed, as well as the association between multiple drug use and potential adverse outcomes in older BZD users.

Health practices of the elderly poor.

The purpose of the present study was to describe the health practices of the elderly poor and to examine the association between specific health practices and subsequent hospital use. Data came from a sample of 931 Medicaid elderly living in California. Smoking, limited social networks, and lack of regular exercise significantly increased the odds of subsequent hospital utilization. Implications of these findings, which could benefit health promotion intervention and treatment programs for the elderly, were discussed.

Perceptions of health and use of ambulatory care: Differences between Korean and White elderly.

This study identifies whether culturally based differences in perceptions of health resulted in differences in ambulatory care use among the elderly. Methods:The authors conducted stratified Poisson regressions on data from a 1992 survey of older Koreans and Whites in Los Angeles County. The models included measures of demographics, health, functioning, income, insurance, social support, and culture (perceptions of health or other beliefs). Results:Descriptive findings showed older Koreans had more ambulatory physician visits, poorer functioning, and poorer perceptions of their health than Whites. Multivariate findings showed that positive perceptions of health independently reduced office visits for bothKoreans and Whites, but the effect was significantly smaller for Koreans. Other cultural differences also affected use. Discussion:The findings highlight differences between older Koreans and Whites’ responses to physical and socioeconomic conditions and the importance of cultural sensitivity in the health care delivery system.

Predicting Japanese American drinking behavior.

Empirical data on Japanese American drinking behavior are scarce. The present study was a random sample (N = 295) of households in Los Angeles with Japanese surnames. Japanese Americans born in the United States tended to drink less than those born in Japan. The study also observed significant gender differences in Japanese American drinking behavior which were attributed to ascribed social roles. Other demographic and social determinants of drinking were examined through two logistic regression models. The first model predicted drinking (as opposed to abstaining), while the other distinguished heavy drinkers from those who drank alcohol in more moderate amounts. Potential reference groups (e.g., parents, friends, church groups, etc.) were often significant in predicting whether and how much a Japanese American drank.

GENDER AND ETHNIC DIFFERENCES IN THE HEALTH PRACTICES OF THE ELDERLY POOR

Gender and ethnic differences in personal health practices were examined with a sample of 1021 Medicaid recipients aged 65 years and older. Six different health practices were examined including smoking, drinking, weight control, exercise, and social networks. Although gender differences were noted with respect to all of the health practices examined, neither men nor women were consistently favored in adhering to desired health practices. Perhaps most importantly, women were more apt than men to refrain from smoking and drinking which have been strongly linked to major health consequences. Ethnicity was also a factor in all of the health practices examined. Whereas Hispanic and Black elderly were very similar to White elderly, Asian elderly generally adhered to more desired health practices than did either Whites, Blacks, or Hispanics. The implications of these findings could benefit health promotion programs for the elderly.

An international approach to community health care for older adults.

Worldwide population ageing, concomitant increases in disability rates, and changes in family health care systems require an examination of current service delivery to optimize use of societal resources in the future. This article examines a community health care approach suggested by research conducted by the World Health Organization Kobe Centre for Health Development (WKC). The WKC approach, which uses a cross-national perspective, envisions a community health care system that integrates health and social services and spans health promotion, primary care, and long-term care. Prototypical approaches for organizing community health care include communal, marketplace, case management, and managed care. The ramifications of these approaches are examined from the perspectives of the older adult, the family, and formal service providers.