Kimberly A. Skarupski

Neighborhood Social Cohesion and Disorder in Relation to Walking in Community-Dwelling Older Adults A Multilevel Analysis

Objectives: To examine the role of neighborhood social conditions and walking in community-dwelling older adults. Methods: A multi-level analysis of data from 4,317 older adults (mean age = 74.5; 73% black) from a geographically-defined urban community. Participants completed structured interviews including 14 questions on neighborhood conditions and self-reported walking. The neighborhood questions were summarized into individual-level measures of perceived neighborhood social cohesion and disorder. These measures were aggregated by neighborhood to construct neighborhood-level measures of social cohesion and disorder. Results: Neighborhood-level disorder, but not social cohesion, was significantly associated with walking, independent individual-level neighborhood perceptions and other correlates of walking. Further adjustment for race weakened this association to a marginally significant level. Discussion: Neighborhood conditions may shape walking behavior in older adults, especially conditions that reflect physical neglect or social threat. Promotion of walking behavior in older adults may require improvement of the safety and upkeep of the neighborhood environment.

Longitudinal association of vitamin B-6, folate, and vitamin B-12 with depressive symptoms among older adults over time

BACKGROUND B-vitamin deficiencies have been associated with depression; however, there is very little prospective evidence from population-based studies of older adults. OBJECTIVE We examined whether dietary intakes of vitamins B-6, folate, or vitamin B-12 were predictive of depressive symptoms over an average of 7.2 y in a community-based population of older adults. DESIGN The study sample consisted of 3503 adults from the Chicago Health and Aging project, an ongoing, population-based, biracial (59% African American) study in adults aged > or =65 y. Dietary assessment was made by food-frequency questionnaire. Incident depression was measured by the presence of > or =4 depressive symptoms from the 10-item version of the Center for Epidemiologic Studies Depression scale. RESULTS The logistic regression models, which used generalized estimating equations, showed that higher total intakes, which included supplementation, of vitamins B-6 and B-12 were associated with a decreased likelihood of incident depression for up to 12 y of follow-up, after adjustment for age, sex, race, education, income, and antidepressant medication use. For example, each 10 additional milligrams of vitamin B-6 and 10 additional micrograms of vitamin B-12 were associated with 2% lower odds of depressive symptoms per year. There was no association between depressive symptoms and food intakes of these vitamins or folate. These associations remained after adjustment for smoking, alcohol use, widowhood, caregiving status, cognitive function, physical disability, and medical conditions. CONCLUSION Our results support the hypotheses that high total intakes of vitamins B-6 and B-12 are protective of depressive symptoms over time in community-residing older adults.

Neighborhood-Level Cohesion and Disorder: Measurement and Validation in Two Older Adult Urban Populations

OBJECTIVES Drawing from collective efficacy and social disorganization theories, we developed and validated measures of neighborhood-level social processes. METHODS Data came from 2 large, population-based cohort studies of urban-dwelling older adults, the Chicago Neighborhood and Disability Study (CNDS, n = 3,882) and the Baltimore Memory Study (BMS, n = 1,140). Data on neighborhood social processes were collected from residents using a standardized instrument identical in the 2 studies. We used confirmatory factor analysis and descriptive statistics to explore reliability and validity of the neighborhood-level measures. RESULTS Confirmatory factor analysis indicated 2 latent factors: social cohesion and exchange (i.e., observations of and interactions with neighbors) and social and physical disorder (i.e., neighborhood problems and unsafe conditions). Neighborhood-level measures of cohesion and disorder showed moderate to high levels of internal consistency (alphas = .78 and .85 in CNDS and .60 and .88 in BMS). Inter-resident agreements were low (intra-neighborhood correlation coefficients = .08 and .11 in CNDS and .05 and .33 in BMS). Cohesion showed a modest, positive association with a composite measure of neighborhood socioeconomic status (SES). Disorder showed a strong, negative association with neighborhood SES. CONCLUSIONS Findings provide initial evidence of the reliability and construct validity of these neighborhood-level social process measures.

Mediterranean diet and depressive symptoms among older adults over time

ObjectiveTo examine whether adherence to a Mediterranean-based dietary pattern is predictive of depressive symptoms among older adults.DesignGeneralized estimating equation models were used to test the association between a Mediterranean-based dietary pattern and depressive symptoms over time. Models were adjusted for age, sex, race, education, income, widowhood, antidepressant use, total calorie intake, body mass index, smoking, alcohol consumption, number of self-reported medical conditions, cognitive function, and physical disability.SettingChicago, Illinois.ParticipantsCommunity-dwelling participants (n=3502) of the Chicago Health and Aging Project aged 65+ years (59% African American) who had no evidence of depression at the baseline.MeasurementsAdherence to a Mediterranean-based dietary pattern was assessed by the MedDietScore. Dietary evaluation was performed with a food frequency questionnaire at baseline and related to incident depression as measured by the presence of four or more depressive symptoms from the 10-item version of the Center for Epidemiologic Studies Depression scale.ResultsOver an average follow-up of 7.2 years, greater adherence to a Mediterranean-based diet was associated with a reduced number of newly occurring depressive symptoms (parameter estimate = −0.002, standard error = 0.001; p = 0.04). The annual rate of developing depressive symptoms was 98.6% lower among persons in the highest tertile of a Mediterranean-based dietary pattern compared with persons in the lowest tertile group.ConclusionOur results support the hypothesis that adherence to a diet comprised of vegetables, fruits, whole grains, fish, and legumes may protect against the development of depressive symptoms in older age.

Do depressive symptoms predict declines in physical performance in an elderly, biracial population?

Objective: We investigated whether depressive symptoms, assessed by the 10-item Center for Epidemiological Studies Depression Scale (CES-D), predicted change in physical function in elderly adults. Methods: Participants were from a biracial, population-based sample of adults aged 65 and older (N: 4069; 61% black; 61% female). Physical function was assessed as a summary performance measure of tandem stand, measured walk, and repeated chair stand (mean [standard deviation], 10.3 [3.5]; range, 0–15), commonly used measures of overall physical health in older adults. Generalized estimating equation models estimated physical function across 3 assessments over 5.4 years of follow up as a function of CES-D scores at baseline. Results: Adjusting for age, sex, race, and education, each 1-point higher CES-D score was associated with a 0.34-point lower absolute level of physical performance (p < .0001), but there was no evidence of a CES-D by time interaction (p = .84), indicating that depressive symptoms at baseline were not associated with greater physical performance decline over time. In secondary analyses, with CES-D scores modeled in 4 categories, overall physical performance showed a graded, inverse association across CES-D categories (p’s < .0001). However, we observed no threshold effect for depressive symptoms in relation to change in physical performance. Compared with the referent group (CES-D = 0), the 2 middle CES-D categories (CES-D = 1 or 2–3) evidenced some decline in physical performance over time, but the highest CES-D group (CES-D ≥4) showed no significant physical decline over time (p = .89). Conclusion: We observed a strong cross-sectional association between depressive symptoms and overall physical performance. Physical function declined over time, yet depressive symptoms did not consistently contribute to greater decline over an average of 5.4 years of follow up among older adults. Findings highlight the importance of longitudinal models in understanding the relation between depressive symptomatology and physical health. CES-D = Center for Epidemiological Studies Depression Scale; CHAP = Chicago Health and Aging Project; CI = confidence interval; GEE = generalized estimating equation; MMSE = Mini-Mental Status Examination.

Assessing the health needs of Chinese older adults: Findings from a community-based participatory research study in Chicago's Chinatown

The objective of this study is to examine the cultural views of healthy aging, knowledge and barriers to services, and perception of health sciences research among community-dwelling Chinese older adults in Chicagos Chinatown. This qualitative study is guided by the Precede-Proceed conceptual model with community-based participatory research design. Data analysis is based on eight focus group interviews with Chinese older (age 60+) adults (n = 78). We used a grounded theory framework to systematically guide the thematic structure of our data. Findings show participants described cultural conception of health in terms of physical function, psychological well-being, social support, and cognitive function. The availability, affordability, and cultural barriers towards health care services were major negative enabling factors that inhibit participants from fulfilling health needs. Perception and knowledge of health sciences research were also discussed. This study has implications for the delivery of culturally appropriate health care services to the Chinese aging population.

Neighborhood socioeconomic conditions are associated with psychosocial functioning in older black and white adults.

We examined neighborhood socioeconomic status (NSES) in relation to depressive symptoms, perceived stress, and hostility in 5770 community-dwelling older black and white adults (mean age=73 years; 62% female) from 3 contiguous neighborhoods covering 82 census block groups in Chicago, IL. NSES was an average of z-scores of four Census 2000 block-group variables: % public assistance, % households earning <

Change in MS-DRG assignment and hospital reimbursement as a result of centers for medicare & medicaid changes in payment for hospital-acquired conditions: Is it coding or quality?

25,000 annually, % with >college degree, and % owner-occupied dwellings valued >

Race differences in emotional adaptation of family caregivers

200,000. NSES was inversely related to hostility (beta=-0.305), stress (beta=-0.333), and depressive symptoms (beta=-0.223) (p<0.001) in multi-level mixed-effects regression models adjusted for age, sex, race, and the number of years in the neighborhood. With further adjustment for education, income, marital status, and health conditions, NSES remained associated with depressive symptoms (beta=-0.078) and hostility (beta=-0.133) (p<0.05); the association with hostility was strongest in non-black neighborhoods. Neighborhood social conditions contribute to the psychosocial well-being of older residents; research is needed to investigate pathways through which neighborhoods influence health outcomes in an aging population.

Depressive Symptoms and Cardiovascular Mortality in Older Black and White Adults: Evidence for a Differential Association by Race

Context In October 2008, the Centers for Medicare & Medicaid Services reduced payments to hospitals for a group of hospital-acquired conditions (HACs) not documented as present on admission (POA). It is unknown what proportion of Medicare severity diagnosis related group (MS-DRG) assignments will change when the International Classification of Disease, 9th Revision, Clinical Modification (ICD-9-CM) diagnosis code for the HAC is not taken into account even before considering the POA status. Objectives The primary objectives were to estimate the proportion of cases that change MS-DRG assignment when HACs are removed from the calculation, the subsequent changes in reimbursement to hospitals, and the attenuation in changes in MS-DRG assignment after factoring in those that may be POA. Last, we explored the effect of the numbers of ICD-9-CM diagnosis codes on MS-DRG assignment. Methods We obtained 2 years of discharge data from academic medical centers that were members of the University HealthSystem Consortium and identified all cases with 1 of 7 HACs coded through ICD-9-CM diagnosis codes. We calculated the MS-DRG for each case with and without the HAC and, hence, the proportion where MS-DRG assignment changed. Next, we used a bootstrap method to calculate the range in the proportion of cases changing assignment to account for POA status. Changes in reimbursement were estimated by using the 2008 MS-DRG weights payment formula. Results Of 184 932 cases with at least 1 HAC, 27.6% (n = 52 272) would experience a change in MS-DRG assignment without the HAC factored into the assignment. After taking into account those conditions that were potentially POA, 7.5% (n = 14 176) of the original cases would change MS-DRG assignment, with an average loss in reimbursement per case ranging from