Sadhna Diwan

The Incremental Effect of Dementia‐Related Problem Behaviors on the Time to Nursing Home Placement in Poor, Frail, Demented Older People

OBJECTIVES: To examine the incremental effect of dementia‐related problem behaviors (DRPBs) on the risk of and time to nursing home placement (NHP) in poor, frail, demented older people.

Regional Variations in Dietary Intake and Body Mass Index of First-generation Asian-Indian Immigrants in the United States

Asian Indians (AIs) have considerable within-group diversity in education levels, socioeconomic status, language, and diet based on the region of origin in India. The objective of this study was to determine if dietary intake patterns vary based on region of origin among first generation AI immigrants and if these differences influence body mass index (BMI). AI men and women (n=237), over 40 years, in southern US participated in a telephone survey. Responses to the Block food frequency questionnaire suggest that the diet of the study participants was low in dietary fiber while dietary fat intake was within guidelines. Intake of individual foods varied by region of origin. BMI also varied by region of origin (P<.05), with individuals from the north having a higher BMI (26.3) compared to those from the south and west (24.3). Regression analysis showed BMI to be significantly related to total fat intake, physical activity, and north region. Results suggest that dietary advice and lifestyle recommendations should be individualized.

Nutrient intake of first generation Gujarati Asian Indian immigrants in the U.S.

Objective: To examine the nutrient intake of Gujarati Asian Indian immigrants in the U.S. and the influence of length of residence in the U.S. and socioeconomic status (SES) on their macronutrient intake. Methods: Subjects were male (n = 90) and female (n = 99) Gujarati Asian Indian immigrants over the age of 45. Each participant completed a 24-hour dietary recall. Dietary recalls were analyzed using Food Processor nutrient analysis software. Participants were classified into recent immigrants (<10 years length of residence in the U.S.) and long-term immigrants (>10 years length of residence in the U.S.) and into low, medium and high education groups, based on highest level of education achieved, to examine the influence of these variables on their macronutrient intake. Results: The macronutrient contributions to the total energy intake of these Gujarati Asian Indian immigrants were as follows: carbohydrate 57%, protein 12% and total fat 33%. The diets were low in cholesterol (<100 mg/day) and high in dietary fiber (≥25 g/day). Reported intakes of vitamin D, calcium (women only), potassium (women only), copper and zinc were less than two-thirds of the recommendations. Significant differences (p < 0.05) in macronutrient intake were observed based on length of residence in the U.S. and SES. Regression analysis indicates age, total energy intake, length of residence in the U.S. and SES to have a significant influence on the nutrient intake of these Gujarati Asian Indian immigrants. Conclusion: The nutrient intakes of these Gujarati Asian Indian immigrants indicate both inadequacies and excesses of select macro and micronutrients. These nutrient inadequacies and excesses can impact overall health and risk of chronic diseases of these individuals. Further investigation of the influence of the diets of these immigrants on their health is warranted.

A Conceptual Framework For Identifying Unmet Health Care Needs of Community Dwelling Elderly

Assessing the unmet health care needs that affect the quality of life of older persons is an important task facing both aging services agencies and health departments. This article reviews various strategies for assessing unmet health care needs and a presents comprehensive framework for assessing such needs. Needs for health services are categorized by their function, such as basic maintenance, supportive, rehabilitative, treatment, promotive, and preventive needs. Factors contributing to unmet needs are categorized by the types of barriers to using existing services. These barriers include recognition or awareness of need, knowledge about services, and availability, accessibility, affordability, and acceptability of services. Means of data collection for different types of unmet health care needs are presented. Recommendations for using the proposed framework are made to both health departments and aging services agencies.

Social Integration and Health Among Asian Indian Immigrants in the United States

Abstract This research examines the relationship between social integration and health status (i.e., prevalence of chronic health conditions) among older first generation Asian Indian (AI) immigrants in the U.S. Data were collected through a telephone survey from 226 respondents (50 years and over) in the Southeastern U.S. The correlates of health status were determined using a Poisson regression analysis. The prevalence of major chronic conditions such as heart disease, diabetes and hypertension in this sample was similar to those found in other studies of AI immigrants. Better health was associated with greater perceived support and having relatives nearby, whereas poorer health was associated with higher body mass index, longer residence in the U.S., being older, and being female. Implications for interventions designed to address the diversity within this immigrant community are discussed.

Agitation and dementia-related problem behaviors and case management in long-term care.

Existing data on case management (CM) time were analyzed to investigate the impact of agitation and dementia-related behavior problems on the use of CM time by older clients (N = 242) in a Medicaid waiver-funded home and community-based services program. Among clients with dementia (n = 73), regression analysis revealed that having problem behaviors resulted in increased use of CM time. Among clients with behavior problems, those with greater functional ability consumed greater CM time. Content analysis revealed that most CM activity focused on service coordination rather than on direct attempts to manage problem behaviors. Implications for CM programs include the need to consider case mix when allocating caseload size and provision of specific training on interventions to address behavior problems.

The beliefs predicting support for heroin legalization

Two studies were conducted for the purpose of identifying those beliefs and perceptions about heroin which predict being for or against heroin legalization. In Study One the results of a 45-item instrument assessing the attitudes and beliefs of 359 students at Georgia State University were factor analyzed. The identified factors were entered into a multiple regression predicting support for heroin legalization. In Study Two, an item from each of the six strongest factors identified in Study One was included in a questionnaire along with a two-item measure employed in Study One to identify support for legalization. A ninth item was added and the questions were asked in a polling of 805 representative Georgia citizens. The primary findings from Study One were replicated in Study Two. The factors are described and the implications of the findings for policy are discussed.

Period Effects on the Mix of Formal and Informal In-Home Care Used by Urban Elderly

Changes in the mix of formal and informal home care used by noninstitutionalized elderly between 1975 and 1987 are examined. This period saw many changes in health care policies, an increase in female labor force participation, and changes in demographic characteristics of elders, all of which could be expected to influence the pattern of care used by elders. Using data from the 1975 General Accounting Office study in Cleveland, Ohio, and its 1987 follow-up, cohorts of young-olds (ages 65-76 years) and old-olds (ages 77-88 years) were compared for their use of formal and informal care. There were no increases in the proportion of people using home care, and there was no observable trend toward increased reliance on formal care. Differences did emerge in the mix of formal and informal services used. For the young-old cohort, more persons received formal nursing services and informal supervision services in 1987. The mix of services used by the old-old cohort revealed no observable period effects. Implications of these findings are discussed in relation to the social changes mentioned earlier.