Factors Associated with Women’s Chronic Disease Management: Associations of Healthcare Frustrations, Physician Support, and Self-Care Needs

Previous research emphasizes the importance of reducing healthcare frustrations and enhancing physician supports to help patients engage in recommended healthcare regimens. However, less is known about how these factors are associated with aging women's knowledge about self-care behavior. This study examined the sociodemographics, health indicators, healthcare-related frustrations, and perceptions of physician support associated with middle-aged and older adult females' self-reported need for help to learn how to take better care of their health. Data were analyzed from 287 females with one or more chronic conditions who completed The National Council on Aging (NCOA) Chronic Care Survey. A logistic regression model was developed. Women who were non-White (OR = 2.26, P = 0.049) were more likely to need help learning how to better manage their health. Those who had some college education or more (OR = 0.55, P = 0.044) and lower healthcare-related frustrations (OR = 0.44, P = 0.017) and perceived to have more physician support (OR = 0.49, P = 0.033) were less likely to need help learning how to better manage their health. Findings can inform the planning, implementation, assessment, and dissemination of evidence-based self-management programs for middle-aged and older women within and outside of clinical settings

Changes in depressive symptoms among older adults with multiple chronic conditions: Role of positive and negative social supports

Depression severely affects older adults in the United States. As part of the social environment, significant social support was suggested to ameliorate depression among older adults. We investigate how varying forms of social support moderate depressive symptomatology among older adults with multiple chronic conditions (MCC). Data were analyzed using a sample of 11,400 adults, aged 65 years or older, from the 2006–2012 Health and Retirement Study. The current study investigated the moderating effects of positive or negative social support from spouse, children, other family, and friends on the association between MCC and depression. A linear mixed model with repeated measures was used to estimate the effect of MCC on depression and its interactions with positive and negative social support in explaining depression among older adults. Varying forms of social support played different moderating roles in depressive symptomatology among older adults with MCC. Positive spousal support significantly weakened the deleterious effect of MCC on depression. Conversely, all negative social support from spouse, children, other family, and friends significantly strengthened the deleterious effect of MCC on depression. Minimizing negative social support and maximizing positive spousal support can reduce depression caused by MCC and lead to successful aging among older adults

Evidence-Based Program to Reduce Fall-Related Risk Among Older Adults: A Comparison of Program Efficacy by Ethnicity

Despite rapid growth among the Hispanic population in the United States, seniors within this ethnic group are typically underrepresented in evidence-based programs. The purpose of this study is to examine the relative efficacy of A Matter of Balance/Volunteer Lay Leader Model (AMOB/VLL), an eight session fall risk prevention program, for non-Hispanic White and English-speaking Hispanic participants on key study outcomes. Data were collected from 1,233 seniors enrolled in AMOB/VLL in Texas. Compared to non-Hispanic White participants, a significantly larger proportion of Hispanic participants were younger (?2=50.23, df=3, p<0.001), had less than a high school education (?2=200.31, df=2, p<0.001), and resided in less affluent areas. From baseline to post-intervention, significant improvements in falls efficacy (t=- 9.13, df=167, p<0.001), days limited from usual activity (t=1.99, df=164, p=0.049), and unhealthy mental days (t=2.51, p=0.013) were seen among Hispanic participants. Significant improvements among nonHispanic White participants were observed for falls efficacy (t=-15.90, df=868, p<0.001). Although significant improvements were found for each ethnic group, the magnitude of improvement among Hispanic participants exceeded that of non-Hispanic Whites in some aspects. Identifying participant characteristics and positive outcomes specific to Hispanics can inform strategies to maximize program reach and effectiveness among this vulnerable and underserved population

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. The purpose of this study is to compare the extent to which middle-aged adults from lower- and higher-income areas have engaged in CDSME courses, and to identify the sociodemographic characteristics of lower-income, middle aged participants. METHODS: The results of this study were produced through analysis of secondary data collected during the Communities Putting Prevention to Work: Chronic Disease Self-Management Program initiative. During this initiative, data was collected from 100,000 CDSME participants across 45 states within the United States, the District of Columbia, and Puerto Rico. RESULTS: Of the entire sample included in this analysis (19,365 participants), 55 people lived in the most impoverished counties. While these 55 participants represented just 0.3% of the total study sample, researchers found this group completed courses more frequently than participants from less impoverished counties once enrolled. CONCLUSION: These results signal a need to enhance participation of middle-aged adults from lower-income areas in CDSME courses. The results also provide evidence that can be used to inform future program delivery choices, including decisions regarding recruitment materials, program leaders, and program delivery sites, to better engage this population

The Utility of Rural and Underserved Designations in Geospatial Assessments of Distance Traveled to Healthcare Services: Implications for Public Health Research and Practice

Health disparities research in rural populations is based on several common taxonomies identified by geography and population density. However, little is known about the implications of different rurality definitions on public health outcomes. To help illuminate the meaning of different rural designations often used in research, service delivery, or policy reports, this study will (1) review the different definitions of rurality and their purposes; (2) identify the overlap of various rural designations in an eight-county Brazos Valley region in Central Texas; (3) describe participant characteristic profiles based on distances traveled to obtain healthcare services; and (4) examine common profile characteristics associated with each designation. Data were analyzed from a random sample from 1,958 Texas adults participating in a community assessment. K-means cluster analysis was used to identify natural groupings of individuals based on distance traveled to obtain three healthcare services: medical care, dental care, and prescription medication pick-up. Significant variation in cluster representation and resident characteristics was observed by rural designation. Given widely used taxonomies for designating areas as rural (or provider shortage) in health-related research, this study highlights differences that could influence research results and subsequent program and policy development based on rural designation