Examining Health Inequities in A1C Control over Time across Individual, Geospatial, and Geopolitical Factors among Adults with Type 2 Diabetes: Analyses of a Sample from One Commercial Insurer in a Southern State.

Introduction: Type 2 diabetes impacts millions and poor maintenance of diabetes can lead to preventable complications, which is why achieving and maintaining target A1C levels is critical. Thus, we aimed to examine inequities in A1C over time, place, and individual characteristics, given known inequities across these indicators and the need to provide continued surveillance.

Methods: Secondary de-identified data from medical claims from a single payer in Texas was merged with population health data.

Lifetime adversity predicts depression, anxiety, and cognitive impairment in a nationally representative sample of older adults in the United States.

Objective: Although life stress and adversity are well-known risk factors for mental health problems and cognitive impairment among older adults, limited research has comprehensively examined the impact of both childhood and adulthood adversity on psychiatric and cognitive impairment symptoms over a prolonged period. To address this issue, we investigated how lifetime adversity exposure is related to symptoms of depression, anxiety, and cognitive impairment in a nationally representative, longitudinal sample of older adults in the United States.

Method: We analyzed data from the Health and Retirement Study (1992-2016).

Group-based trajectory analysis identifies varying diabetes-related cost trajectories among type 2 diabetes patients in Texas: an empirical study using commercial insurance.

Background: The trend of Type 2 diabetes-related costs over 4 years could be classified into different groups. Patient demographics, clinical factors (e.g.

Using Nursing Interventions Classifications to Document Faith Community Nursing Transitional Care.

One out of five Medicare beneficiaries is readmitted within 30 days after hospital discharge, and as many as three in four readmissions are preventable. This study describes transitional care interventions (TCIs) delivered by one faith community nurse (FCN) to at-risk seniors living in a certain ZIP code. Two years of nursing documentation (2,280 interventions) were translated into Nursing Interventions Classification standardized nursing language.

Longitudinal associations between time-varying insomnia symptoms and all-cause health care services utilization among middle-aged and older adults in the United States.

Objective: To examine longitudinal associations between time-varying insomnia symptoms (difficulty initiating sleep, difficulty maintaining sleep, early-morning awakenings, and nonrestorative sleep) and all-cause health care services utilization (HSU), including overnight hospital stays, nursing home stays, and home health care services among middle-aged and older adults.

Data Sources: The Health and Retirement Study (HRS), a nationwide, population-representative survey of primarily middle-aged and older adults in the United States.

Study Design: This study is an analysis of prospective data from the HRS for a cohort of 13,168 adults (aged ≥50 years; females = 57.

Longitudinal associations between insomnia symptoms and all-cause mortality among middle-aged and older adults: a population-based cohort study.

To date, there is no scientific consensus on whether insomnia symptoms increase mortality risk. We investigated longitudinal associations between time-varying insomnia symptoms (difficulty initiating sleep, difficulty maintaining sleep, early-morning awakening, and nonrestorative sleep) and all-cause mortality among middle-aged and older adults during 14 years of follow-up. Data were obtained from 2004 through 2018 survey waves of the Health and Retirement Study in the United States for a population-representative sample of 15 511 respondents who were ≥50 years old in 2004.

Associations of the COVID-19 pandemic with older individuals' healthcare utilization and self-reported health status: a longitudinal analysis from Singapore.

Background: The COVID-19 pandemic has challenged the capacity of healthcare systems around the world and can potentially compromise healthcare utilization and health outcomes among non-COVID-19 patients.

Objectives: To examine the associations of the COVID-19 pandemic with healthcare utilization, out-of-pocket medical costs, and perceived health among middle-aged and older individuals in Singapore.

Method: Utilizing data collected from a monthly panel survey, a difference-in-differences approach was used to characterize monthly changes of healthcare use and spending and estimate the probability of being diagnosed with a chronic condition and self-reported health status before and during the COVID-19 outbreak in 2020.

Factors associated with caregiver distress among home care clients in New Zealand: Evidence based on data from interRAI Home Care assessment.

Objective: To identify factors associated with caregiver distress among home care clients in New Zealand.

Methods: The cohort consisted of 105,978 community-dwelling people aged 65 years or older requiring home care services in New Zealand who had at least one informal caregiver. Bivariate and multivariable logistic regression analyses were used to identify factors associated with caregiver distress.

Insomnia symptoms and incident heart failure: a population-based cohort study.

Aims: Heart failure (HF) is an ongoing epidemic and a serious clinical and public health issue. Currently, little is known about prospective associations between insomnia symptoms and HF incidence. We investigated the longitudinal associations between time-varying insomnia symptoms (difficulty initiating sleep, difficulty maintaining sleep, early-morning awakening, non-restorative sleep) and incident HF.

Local Health Department and Hospital Collaboration Around Community Health Needs Assessment to Improve Health Outcomes.

The objectives of this study were to examine the relationships between local health department (LHD) and nonprofit hospital collaboration around community health needs assessment (CHNA), levels of collaboration, and selected community health outcomes. Data were obtained from multiple sources including the National Profile of Local Health Departments. Results showed that high levels of LHD-hospital collaboration around CHNA were associated with lower self-reported poor or fair health, lower years of potential life lost per 100 000 population, and lower premature age-adjusted mortality per 100 000 population.

Is Colorectal Cancer Screening Associated with Stages of Weight Control Among Korean Americans Aged 50-75 Years Old?: Implications for Weight Control Practice.

Objective: To examine the associations of colorectal cancer (CRC) screening with stages of weight control among Korean Americans (KAs) using the transtheoretical model and provide implications for their weight control practice.

Methods: A quantitative, cross-sectional survey was employed to collect data on current weight control behaviors and intentions, CRC screening history, previous cancer diagnosis, body mass index, number of chronic conditions, perceived health status, health insurance, and sociodemographics. Purposive sampling was implemented to recruit KA participants in the Atlanta metropolitan area in the USA from May 2015 to February 2016.

Impact of self-assessed health status and physical and functional limitations on healthcare utilization and mortality among older cancer survivors in US.

Purpose: The purpose of this study was to examine the impact of physical limitations, functional limitations and self-assessed health status on mortality and healthcare utilization among older cancer survivors.

Methods: National Medicare Current Beneficiary Survey (MCBS) cost and use data from 2008 to 2013 were used for analysis. Physical limitations, Activities of Daily Living (ADL), and Instrumental Activities of Daily Living (IADL) were assessed on multiple questions, and self-assessed health was measured on a five-point scale (1-5: Excellent-Poor).

How the Daily Smartphone is Associated With Daily Travel, Physical Activity, and Self-Perceived Health: Evidence From 2017 National Household Travel Survey.

Knowledge of how smartphone use in daily life, rather than in the context of intervention, may influence people's behaviors and health is limited and mixed. The 2017 National Household Travel Survey (NHTS) data were used to examine the associations between daily smartphone use and several outcomes, including engaging in vigorous physical activity, self-perceived being healthy, and the adjusted mean differences for total trips and active travels among older adults (≥65 years) as well as among young and middle-aged groups (18-64 years), respectively. The prevalence of daily smartphone use declined with increasing age.

A Multi-Level Analyses of Charges and Cost of Fall-Related Hospitalizations Among Older Adults: Individual, Hospital, and Geospatial Variation.

The growing population of older adults has attracted concern from policymakers due in part to the fact that they are at higher risk of costly and potentially injurious falls. Responding to this concern, this study investigated fall-related hospitalizations among those aged 65 and older. Hospitalizations rose from 49,299 to 58,931, with charges and costs (estimated based on charges) increasing from $2.

Emergency department and inpatient utilization among U.S. older adults with multiple chronic conditions: a post-reform update.

Background: The Affordable Care Act (ACA) was enacted to enhance access to care primarily among nonelderly and low-income populations; however, several provisions addressed key determinants of emergency department (ED) and inpatient visits among Medicare beneficiaries over age 65 years. We take stock of the overall changes in these visits among older Medicare beneficiaries, focusing on those with multiple chronic conditions (MCCs), and provide a nationally representative post-reform update.

Methods: We analyzed a sample of 32,919 older adults (65+) on Medicare from the 2006-2015 Medical Expenditure Panel Survey (MEPS).

Self-Check-In Kiosks Utilization and Their Association With Wait Times in Emergency Departments in the United States.

Background: Delayed care in emergency departments (EDs) is a serious problem in the United States. Patient wait time is considered a critical measure of delayed care in EDs. Several strategies have been employed by EDs to reduce wait time, including implementation of self-check-in kiosks.

Use of mobile health applications for health-promoting behavior among individuals with chronic medical conditions.

Background: Chronic medical conditions (CCs) are leading causes of morbidity and mortality in the United States. Strategies to control CCs include targeting unhealthy behaviors, often through the use of patient empowerment tools, such as mobile health (mHealth) technology. However, no conclusive evidence exists that mHealth applications (apps) are effective among individuals with CCs for chronic disease self-management.

Engaging the Underrepresented Sex: Male Participation in Chronic Disease Self-Management Education (CDSME) Programs.

Females are more likely than males to participate in evidence-based health promotion and disease prevention programs targeted for middle-aged and older adults. Despite the availability and benefits of Stanford's Chronic Disease Self-Management Education (CDSME) programs, male participation remains low. This study identifies personal characteristics of males who attended CDSME program workshops and identifies factors associated with successful intervention completion.

Restricted Social Engagement among Adults Living with Chronic Conditions.

: Social engagement is key to health and quality of life. Little is known about social engagement patterns of middle-aged and older adults who live with one or more chronic illnesses. This study investigated social engagement restrictions among middle-aged and older adults with chronic conditions and factors associated with these restrictions.

Use of a Unique Farmers' Market Program Targeting Lower-Income Community Members.

We examined use of a farmers' market that leverages community partnerships to provide free produce to lower-income persons. Participants (n = 422) were asked to complete a questionnaire and given an ID number, which was used to track market use from 2014 to 2015. Chi square tests were used to examine associations between 2014/2015 market use and reasons for market use, financial support received, and how attendees had learned about the market.

Self-care difficulties and reliance on support among vulnerable middle-aged and older adults with chronic conditions: A cross-sectional study.

Objectives: Chronic conditions are pervasive among middle-aged and older adults. This study identified: (1) factors associated with participants reporting difficulties self-managing their chronic condition(s); and (2) factors associated with participants' reliance on external sources for ongoing help and support to improve their health and manage their health conditions.

Study Design: Cross-sectional data were collected using the National Council on Aging Chronic Care Survey, a nationally representative telephone survey of adults aged 45 years and older with at least one chronic condition.

Multilevel Comparisons of Hospital Discharge among Older Adults with a Fall-Related Hospitalization.

Objective: We examined multilevel factors associated with hospital discharge status among older adults suffering a fall-related hospitalization.

Data Sources: The 2011-2013 (n = 131,978) Texas Inpatient Hospital Discharge Public-Use File was used.

Study Design/methods: Multilevel logistic regression analyses estimated the likelihood of being discharged to institutional settings versus home.

Factors Associated With Pain Frequency Among Adults With Chronic Conditions.

Context: Chronic pain affects approximately 100 million Americans, but little is known about the factors associated with pain frequency.

Objectives: This article examines participants' sociodemographics, medical history, health care access and utilization, self-management barriers, and social support associated with pain frequency among a sample of middle-aged and older adults with one or more chronic condition.

Methods: Data were from the National Council on Aging Chronic Care Survey.

Chronic disease self-management education courses: utilization by low-income, middle-aged participants.

Background: Individuals living in lower-income areas face an increased prevalence of chronic disease and, oftentimes, greater barriers to optimal self-management. Disparities in disease management are seen across the lifespan, but are particularly notable among middle-aged adults. Although evidence-based Chronic Disease Self-management Education courses are available to enhance self-management among members of this at-risk population, little information is available to determine the extent to which these courses are reaching those at greatest risk.

Unmet Primary Care Needs in Diabetic Patients with Multimorbidity in a Medically Underserved Area.

Background: Diabetic patients with multimorbidity in medically underserved minority communities are less engaged in primary care and experience high emergency department (ED) utilization. This study assesses unmet primary care needs among diabetic patients in a medically underserved area (MUA).

Community Context: A suburb of Memphis-Whitehaven, Tennessee (Shelby County, ZIP codes 38109 and 38116)-majority African American (96.