Peter R. Gutierrez

Vision impairment and combined vision and hearing impairment predict cognitive and functional decline in older women.

Objectives: To determine the association between vision and hearing impairment and subsequent cognitive and functional decline in community‐residing older women.

Income-related differences in the use of evidence-based therapies in older persons with diabetes mellitus in for-profit managed care

OBJECTIVES: To determine whether income influences evidence‐based medication use by older persons with diabetes mellitus in managed care who have the same prescription drug benefit.

Modifiable risk factors predict functional decline among older women : A prospectively validated clinical prediction tool

OBJECTIVE: To identify modifiable predictors of functional decline among community‐residing older women and to derive and validate a clinical prediction tool for functional decline based only on modifiable predictors.

Binocular Visual-Field Loss Increases the Risk of Future Falls in Older White Women

OBJECTIVES: To examine the relationship between binocular visual field loss and the risk of incident frequent falls in older white women.

Item and Scale Differential Functioning of the Mini-mental State Exam Assessed Using the Differential Item and Test Functioning (dfit) Framework

Objectives:To illustrate the application of the Differential Item and Test Functioning (DFIT) method using English and Spanish versions of the Mini-Mental State Examination (MMSE). Subjects:Study participants were 65 years of age or older and lived in North Manhattan, New York. Of the 1578 study participants who were administered the MMSE 665 completed it in Spanish. Measures:The MMSE contains 20 items that measure the degree of cognitive impairment in the areas of orientation, attention and calculation, registration, recall and language, as well as the ability to follow verbal and written commands. Research Design:After assessing the dimensionality of the MMSE scale, item response theory person and item parameters were estimated separately for the English and Spanish sample using Samejimas 2-parameter graded response model. Then the DFIT framework was used to assess differential item functioning (DIF) and differential test functioning (DTF). Results:Nine items were found to show DIF; these were items that ask the respondent to name the correct season, day of the month, city, state, and 2 nearby streets, recall 3 objects, repeat the phrase no ifs, no ands, no buts, follow the command, “close your eyes,” and the command, “take the paper in your right hand, fold the paper in half with both hands, and put the paper down in your lap.” At the scale level, however, the MMSE did not show differential functioning. Conclusions:Respondents to the English and Spanish versions of the MMSE are comparable on the basis of scale scores. However, assessments based on individual MMSE items may be misleading.

Age‐Related Differences in Management of Heart Disease: A Study of Cardiac Medication Use in an Older Cohort

BACKGROUND: Previous studies have suggested suboptimal use of cardiac medications for secondary prevention after myocardial infarction (MI) and atrial fibrillation (AF), especially among older people.

Language and Regional Differences in Evaluations of Medicare Managed Care by Hispanics

OBJECTIVES This study uses the Consumer Assessments of Healthcare Providers and Systems (CAHPS((R))) survey to examine the experiences of Hispanics enrolled in Medicare managed care. Evaluations of care are examined in relationship to primary language (English or Spanish) and region of the country. DATA SOURCES CAHPS 3.0 Medicare managed care survey data collected in 2002. STUDY DESIGN The dependent variables consist of five CAHPS multi-item scales measuring timeliness of care, provider communication, office staff helpfulness, getting needed care, and health plan customer service. The main independent variables are Hispanic primary language (English or Spanish) and region (California, Florida, New York/New Jersey, and other states). Ordinary least squares regression is used to model the effect of Hispanic primary language and region on CAHPS scales, controlling for age, gender, education, and self-rated health. DATA COLLECTION/EXTRACTION METHODS The analytic sample consists of 125,369 respondents (82 percent response rate) enrolled in 181 Medicare managed care plans across the U.S. Of the 125,369 respondents, 8,463 (7 percent) were self-identified as Hispanic. The survey was made available in English and Spanish, and 1,353 Hispanics completed one in Spanish. PRINCIPAL FINDINGS Hispanic English speakers had less favorable reports of care than whites for all dimensions of care except provider communication. Hispanic Spanish speakers reported more negative experiences than whites with timeliness of care, provider communication, and office staff helpfulness, but better reports of care for getting needed care. Spanish speakers in all regions except Florida had less favorable scores than English-speaking Hispanics for provider communication and office staff helpfulness, but more positive assessments for getting needed care. There were greater regional variations in CAHPS scores among Hispanic Spanish speakers than among Hispanic English speakers. Spanish speakers in Florida had more positive experiences than Spanish speakers in other regions for most dimensions of care. CONCLUSIONS Hispanics in Medicare managed care face barriers to care; however, their experiences with care vary by language and region. Spanish speakers (except FL) have less favorable experiences with provider communication and office staff helpfulness than their English-speaking counterparts, suggesting language barriers in the clinical encounter. On the other hand, Spanish speakers reported more favorable experiences than their English-speaking counterparts with the managed care aspects of their care (getting needed care and plan customer service). Medicare managed care plans need to address the observed disparities in patient experiences among Hispanics as part of their quality improvement efforts. Plans can work with their network providers to address issues related to timeliness of care and office staff helpfulness. In addition, plans can provide incentives for language services, which have the potential to improve communication with providers and staff among Spanish speakers. Finally, health plans can reduce the access barriers faced by Hispanics, especially among English speakers.

Demographic and Socioeconomic Factors Associated with Blood Lead Levels Among Mexican-American Children and Adolescents in the United States

Objective. This study was designed to assess demographic and socioeconomic differences in blood lead levels (BLLs) among Mexican-American children and adolescents in the United States. Methods. We analyzed data from the Third National Health and Nutrition Examination Survey, 1988–1994, for 3,325 Mexican-American youth aged 1 to 17 years. The main study outcome measures included a continuous measure (μg/dL) of BLL and two dichotomous measures of BLL (⩾5 μg/dL and ⩾10 μg/dL). Results. The mean BLL among Mexican-American children in the United States was 3.45 μg/dL (95% confidence interval [CI] 3.07, 3.87); 20% had BLL ⩾5 μg/dL (95% CI 15%, 24%); and 4% had BLL ⩾10 μg/dL (95% CI 2%, 6%). In multivariate analyses, gender, age, generational status, home language, family income, education of head of household, age of housing, and source of drinking water were statistically significant independent predictors (p<0.05) of having higher BLLs and of having BLL ⩾5 μg/dL, whereas age, family income, housing age, and source of drinking water were significant predictors (p<0.05) of having BLL ⩾10 μg/dL. Conclusions. Significant differences in the risk of having elevated BLLs exist among Mexican-American youth. Those at greatest risk should be prioritized for lead screening and lead exposure abatement interventions.

Visual Field Loss and Risk of Fractures in Older Women

OBJECTIVES: To evaluate the associations between visual field loss and nonspine fractures.

Longitudinal Cohort Study of Patients with Birdshot Chorioretinopathy. V. Quality of Life at Baseline

PURPOSE To describe results of a vision-specific quality-of-life (QOL) questionnaire at baseline examination of 80 subjects in a longitudinal cohort study of birdshot chorioretinopathy and to identify relationships between these results and measures of visual function. DESIGN Single-center, cross-sectional study. METHODS The National Eye Institute Visual Function Questionnaire-25 (NEI VFQ-25) was administered to all subjects. NEI VFQ-25 composite scores were compared with best-corrected visual acuity (BCVA), symptoms, color confusion scores, and parameters from automated perimetry (mean deviation [MD], total deviation) for the better eye (with regard to the factor being studied) of each subject. Selected measures of visual function were compared with the 12 subscale scores. RESULTS The median composite score was 76.8 (range, 7.8 to 99.4). Worse composite scores were related to decreased BCVA (P = .030), but the correlation was weak, and subjects with normal BCVA (> or = 1.0) in both eyes had composite scores as low as 37.7. Lower composite scores were related to symptoms of blurry vision (P = .0097), nyctalopia (< .0001), poor contrast (P = .002), vibrating vision (P = .014), and poor peripheral vision (P = .007). Lower composite scores were related to worse MD (P = .005). Although nyctalopia and MD are related, each was associated with composites scores on multivariate analysis. Nyctalopia was associated with the largest number of subscales having decreased scores. CONCLUSIONS Birdshot chorioretinopathy has an impact on vision-specific QOL. BCVA alone does not explain decreased vision-specific QOL in our cohort; changes in automated perimetry and symptoms seem to be important contributors to alterations in QOL that are independent of BCVA changes.