Jessica Sautter

Frailty and Mortality Among Chinese at Advanced Ages

OBJECTIVES This study investigates the factors associated with frailty and the association of frailty with mortality in a national sample of adults aged 65-109 in China. METHODS Using the 2002 wave of the Chinese Longitudinal Healthy Longevity Survey, we construct a frailty index (FI) based on 39 measures available in the data set. We use ordinal logistic regressions to examine the factors associated with the FI and use Weibull hazard regression to examine the association between frailty and 3-year mortality from 2002 to 2005. RESULTS Age, sex, ethnicity, urban-rural residence, economic condition, religious involvement, and daily exercise are significantly associated with levels of frailty. Hazard analyses further reveal that the FI is a robust predictor of mortality at advanced ages and that the relationship between frailty and mortality is independent of various covariates. Discussion The measurement and analysis of frailty have broad implications for public health initiatives designed to target individuals with the diminished capacity to effectively compensate for external stressors and to prevent further declines associated with aging and mortality. A key to healthy longevity is the prevention, postponement, and potential recovery from physical and cognitive deficits at advanced ages through enhanced medical interventions and treatments.

Burden and Well-Being Among a Diverse Sample of Cancer, Congestive Heart Failure, and Chronic Obstructive Pulmonary Disease Caregivers

CONTEXT Three important causes of death in the U.S. (cancer, congestive heart failure, and chronic obstructive pulmonary disease) are preceded by long periods of declining health; often, family members provide most care for individuals who are living with serious illnesses and are at risk for impaired well-being. OBJECTIVES To expand understanding of caregiver burden and psychosocial-spiritual outcomes among understudied groups of caregivers-cancer, congestive heart failure, and chronic obstructive pulmonary disease caregivers-by including differences by disease in a diverse population. METHODS The present study included 139 caregiver/patient dyads. Independent variables included patient diagnosis and function; and caregiver demographics, and social and coping resources. Cross-sectional analyses examined distributions of these independent variables between diagnoses, and logistic regression examined correlates of caregiver burden, anxiety, depressive symptoms, and spiritual well-being. RESULTS There were significant differences in patient functioning and caregiver demographics and socioeconomic status between diagnosis groups but few differences in caregiver burden or psychosocial-spiritual outcomes by diagnosis. The most robust social resources indicator of caregiver burden was desire for more help from friends and family. Anxious preoccupation coping style was robustly associated with caregiver psychosocial-spiritual outcomes. CONCLUSION Caregiver resources, not patient diagnosis or illness severity, are the primary correlates associated with caregiver burden. Additionally, caregiver burden is not disease specific to those examined here, but it is rather a relatively universal experience that may be buffered by social resources and successful coping styles.

Age and gender differences in linkages of sleep with subsequent mortality and health among very old Chinese

BACKGROUND Studies suggest that sleep quality and duration are significantly associated with mortality risk and health conditions, yet such studies are seldom conducted among very old adults. The objective of this study was to examine associations between self-reported sleep quality/duration and subsequent mortality/health among very old adults in China. A second objective determines whether these associations vary by age and gender. METHODS This study used data of the 2005 and 2008 waves from a large, representative survey with a total of 12,671 individuals in 22 provinces in mainland China, in which 3158 respondents were aged 90-99 and 2293 were centenarians. Two self-reported questions about sleep quality and duration were examined while adjusting for numerous socio-demographic, family/social support, health practices, and baseline health factors. RESULTS Hazard regressions showed that, when demographic factors are controlled for, Chinese elders who report poor and fair quality of sleep have 26% and 10% higher risk of death over the next three years compared to those with good sleep quality; those who sleep either 6h or less or 10h or more per day have an 18-22% higher mortality risk as compared to those who sleep 8h per day. The increased mortality risks of poorer sleep and too short or too long sleep duration are larger in men than in women and more robust in the oldest-old than in young elders. Logistic regressions show that poor sleep and daily sleep durations of 5h or less or 10h or more are also associated with worse health three years later. CONCLUSIONS Poorer sleep quality and too short or too long sleep duration are associated with higher subsequent mortality risk and lower odds of being in a healthy state among very old Chinese.

Socioeconomic status and the Black-White mortality crossover.

OBJECTIVES We investigated associations among age, race, socioeconomic status (SES), and mortality in older persons and whether low SES contributes to the Black-White mortality crossover (when elevated age-specific mortality rates invert). METHODS We used panel data from the North Carolina Established Populations for Epidemiologic Studies of the Elderly to test the main and interactive effects of SES on mortality. RESULTS Discrete-time hazard models showed that the association between low education and mortality did not vary by race or age and was only significant for men. For women, the effect of low income diminished with age and had little impact on the crossover. For men, low income varied by race and age, altering the Black-White crossover and producing low-high income crossovers at advanced ages. CONCLUSIONS Low education and income were associated with increased mortality risk for older adults, but only low income had a differential impact on the Black-White mortality crossover. A primary route to reducing mortality differentials in later life is to prevent the disproportionate selective mortality of Blacks and the poor earlier in the life course.

Concordance and Discordance of Self-Rated and Researcher-Measured Successful Aging: Subtypes and Associated Factors.

Objectives To investigate subtypes of successful aging (SA) based on concordance and discordance between self-rated and researcher-defined measures and their associations with demographic, psychosocial, and life satisfaction factors. Method We used multinomial logistic regression models to analyze 2013 cross-sectional survey data from 1,962 persons aged 65 and older in Shanghai that measured self-rated successful aging (SSA) with a single global assessment and researcher-defined successful aging (RSA) with a cumulative deficit index reflecting physical, physiological, cognitive, psychological, and social engagement domains. We generated four subtypes based on these two dichotomous variables: nonsuccessful aging (non-SA; meeting neither the criterion of RSA nor the criterion of SSA), RSA-only (meeting the criterion of RSA-only but not the criterion of SSA), SSA-only (meeting the criterion of SSA-only but not the criterion of RSA), and both-successful aging (both-SA; meeting both criteria of RSA and SSA). Results In the sample, 32% were nonsuccessful agers, 7% RSA-only, 34% SSA-only, and 27% successful agers. Female gender and older age were associated with lower likelihood of RSA-only and both-SA relative to non-SA, but with greater likelihood of SSA-only. Good socioeconomic conditions and social networks were associated with greater likelihood of SSA-only and both-SA relative to non-SA or RSA-only. Satisfaction with life domains was robustly and positively associated with good successful aging outcomes. Discussion Researcher-defined successful aging and self-rated successful aging are different measures with distinct social correlates. Subtypes of concordance and discordance provide a more holistic biopsychosocial conceptualization of successful aging.

Self-perceived uselessness and associated factors among older adults in China

BackgroundSelf-perceived uselessness is associated with poor health and high mortality among older adults in China. However, it is unclear which demographic, psychosocial, behavioral and health factors are associated with self-perceived uselessness.MethodsData came from four waves (2005, 2008, 2011 and 2014) of the largest nationwide longitudinal survey of the population aged 65 and older in China (26,624 individuals contributed 48,476 observations). This study aimed to systematically investigate factors associated with self-perceived uselessness based on the proposed REHAB framework that includes resources (R), environments (E), health (H), fixed attributes (A) and behaviors (B). Self-perceived uselessness was measured by a single item: “with age, do you feel more useless?” and coded by frequency: high (always and often), moderate (sometimes) and low (seldom and never). Multinomial logistic regression models with low frequency as the reference category were employed to identify REHAB risk factors associated with self-perceived uselessness.ResultsMost factors in the REHAB framework were associated with self-perceived uselessness, although some social environmental factors in the full model were not significant. Specifically, more socioeconomic resources were associated with reduced relative risk ratio (RRR) of high or moderate frequency of self-perceived uselessness relative to low frequency. More environmental family/social support was associated with lower RRR of high frequency of self-perceived uselessness. Cultural factors such as coresidence with children and intergenerational transfer were associated with reduced RRR of high frequency of self-perceived uselessness. Indicators of poor health status such as disability and loneliness were associated with greater RRR of high or moderate frequency of self-perceived uselessness. Fixed attributes of older age and Han ethnicity were associated with increased RRR of high frequency of self-perceived uselessness; whereas optimism and self-control were associated with reduced RRR. Behaviors including regular consumption of alcohol, regular exercise, social participation and leisure activities were associated with reduced RRR of high frequency of self-perceived uselessness.ConclusionsSelf-perceived uselessness was associated with a wide range of factors in the REHAB framework. The findings could have important implications for China to develop and target community health programs to improve self-perceived usefulness among older adults.

Health inputs and cumulative health deficits among the older Chinese

Using a health economics framework, we examined how both individual level investments at different life stages and current community-level environmental factors affect individual health stock and flows at old ages. We used a nationwide dataset from the 2002 and 2005 waves of the Chinese Longitudinal Healthy Longevity Survey, which included more than 15,000 adults aged 65 and older from 22 provinces in mainland China. We measured health stock with a cumulative health deficit index, a measure developed in geriatrics and gerontology that reflects deficits, illnesses, and functional impairment in numerous domains of health. The cumulative health deficit index has not been used in health economics before, but is a significant contribution because it captures the health stock concept very well and overcomes the problems of inconsistency resulting from the use of different measures of health stock in research. Our results show that several proxy measures for individual health investments in both childhood (nutritional status and parental survival status) and adulthood (family financial condition and access to healthcare) yielded positive returns to health stock measured by the cumulative health deficit index. Investments in social connections and healthy behaviors (religious involvement, alcohol use, and exercise) also produced positive returns in health stock. Current community-level factors such as air quality and labor force participation rate were significantly associated with levels of health deficits in old age as well. Yet, most of these individual investment and community environment variables did not significantly affect short-term health flows (improvement or deterioration in health status over three years). Our findings have important implications for developing preventive health programs in the context of population aging by focusing on policy-relevant predictors and a comprehensive indicator of health status in later life.

Population characteristics associated with pharmacy-based influenza vaccination in United States survey data

OBJECTIVES To examine the population characteristics associated with the health behavior of receiving an influenza vaccine from a pharmacy-based setting. DESIGN Secondary analysis of data from states that participated in an optional influenza module in the 2014 Behavioral Risk Factor Surveillance System, a state-based observational survey of U.S. adults. SETTING AND PARTICIPANTS Analytic sample of 28,954 respondents from 8 states and Puerto Rico who reported receiving an influenza vaccination in the past year. MAIN OUTCOME MEASURES The main outcome was a self-reported categoric variable indicating the setting of the most recent seasonal influenza vaccination: doctors office, pharmacy-based store, or other setting. RESULTS Multinomial logistic regression results showed that environmental, predisposing, enabling, and need factors in the Andersen model were salient features associated with odds of using pharmacy-based influenza vaccination settings instead of a doctors office. Residents of states that allowed pharmacists as immunizers before 1999 reported greater use of pharmacy-based store settings (odds ratio [OR] 1.31). Compared with young adults, individuals 65 years of age and older were more likely to choose a pharmacy-based store than a doctors office (OR 1.41) and less likely to use other community settings (OR 0.45). Compared with non-Hispanic whites, black respondents were less likely to use pharmacy-based store vaccination (OR 0.51), and multiracial and Hispanic respondents were more likely to use other settings (ORs 1.47 and 1.60, respectively). Enabling and need factors were also associated with setting. CONCLUSION Based on this dataset of selected states from 2014, almost one-fourth of U.S. adults who reported receiving an annual influenza vaccination did so from a pharmacy-based store; 35% reported using other community-based settings that may enlist pharmacists as immunizers. There were striking disparities in use of nontraditional vaccination settings by age and race or ethnicity. Pharmacists and pharmacies should address missed opportunities for vaccination by targeting outreach efforts based on environmental and predisposing characteristics.

Age Differential Effects of Severity of Visual Impairment on Mortality Among Older Adults in China

We use a population-based longitudinal survey in China from 2002 to 2005 to examine age differentials in the association between severity of visual impairment and mortality risk in older adults. Controlling for numerous factors and baseline health, a substantial age difference is found. Young-old women and men aged 65 to 79 with severe visual impairments have 161% (hazard ratio = 2.61) and 52% (hazard ratio = 1.52) higher risk of death respectively as compared to their unimpaired counterparts. Mild impairment does not increase mortality risk among young-old adults, while both mild and severe impairment increase mortality risk by 33% and 32% for women and 24% and 34% for men among the oldest-old as a whole when all factors are controlled for. We conclude that visual impairment is an independent predictor of mortality and severe visual impairment likely plays a stronger role in determining mortality risk among young-old adults than among the oldest-old.

Veteran Status, Sociodemographic Characteristics, and Healthcare Factors Associated with Visiting a Mental Health Professional

Using data from a nationally representative study of the community-dwelling U.S. population, we estimated the percentage of male veterans who visited a mental health professional in the past year, compared it to an estimate from non-veteran males, and examined factors associated with visiting a mental health professional. We found that 10.5% of male veterans visited a mental health professional in the past year, compared to only 5.6% of male non-veterans. In the regression models, veteran status, sociodemographic factors, and healthcare utilization were independently associated with visiting a mental health professional. These findings demonstrate the importance of using nationally representative data to assess the mental healthcare needs of veterans.