60 research outputs found
Depression and Oxidative Stress: Results From a Meta-Analysis of Observational Studies
To perform a systematic review and meta-analysis that quantitatively tests and summarizes the hypothesis that depression results in elevated oxidative stress and lower antioxidant levels
CAPABLE trial: A randomized controlled trial of nurse, occupational therapist and handyman to reduce disability among older adults: Rationale and design
AbstractBackgroundAs the population ages, it is increasingly important to test new models of care that improve life quality and decrease health costs. This paper presents the rationale and design for a randomized clinical trial of a novel interdisciplinary program to reduce disability among low income older adults based on a previous pilot trial of the same design showing strong effect.MethodsThe CAPABLE (Community Aging in Place, Advancing Better Living for Elders) trial is a randomized controlled trial in which low income older adults with self-care disability are assigned to one of two groups: an interdisciplinary team of a nurse, occupational therapist, and handyman to address both personal and environmental risk factors for disability based on participants' functional goals, or an attention control of sedentary activities of choice. Both groups receive up to 10 home visits over 4months.OutcomesThe primary outcome is decreased disability in self-care (ADL). Secondary outcomes are sustained decrease in self care disability as well as improvement in instrumental ADLS, strength, balance, walking speed, and health care utilization. Careful cost tracking and analysis using intervention data and claims data will enable direct measurement of the cost impact of the CAPABLE approach. CAPABLE has the potential to leverage current health care spending in Medicaid waivers, Accountable Care Organizations and other capitated systems to save the health care system costs as well as improving low income older adults' ability to age at home with improved life quality
Education in Time: Cohort Differences in Educational Attainment in African-American Twins
OBJECTIVES:Educational opportunities for African-Americans expanded throughout the 20(th) century. Twin pairs are an informative population in which to examine changes in educational attainment because each twin has the same parents and childhood socioeconomic status. We hypothesized that correlation in educational attainment of older twin pairs would be higher compared to younger twin pairs reflecting changes in educational access over time and potentially reflecting a "ceiling effect" associated with Jim Crow laws and discrimination. METHODOLOGY AND PRINCIPAL FINDINGS:We used data from 211 same-sex twin pairs (98 identical, 113 fraternal) in the Carolina African-American Twin Study of Aging who were identified through birth records. Participants completed an in-person interview. The twins were predominantly female (61%), with a mean age of 50 years (SD = 0.5). We found that older age groups had a stronger intra-twin correlation of attained educational level. Further analysis across strata revealed a trend across zygosity, with identical twins demonstrating more similar educational attainment levels than did their fraternal twin counterparts, suggesting a genetic influence. DISCUSSION:These findings suggest that as educational opportunities broadened in the 20th century, African-Americans gained access to educational opportunities that better matched their individual abilities
Examining mindfulness-based stress reduction: Perceptions from minority older adults residing in a low-income housing facility
<p>Abstract</p> <p>Background</p> <p>Mindfulness-based stress reduction (MBSR) programs are becoming increasingly common, but have not been studied in low income minority older populations. We sought to understand which parts of MBSR were most important to practicing MBSR members of this population, and to understand whether they apply their training to daily challenges.</p> <p>Methods</p> <p>We conducted three focus groups with 13 current members of an MBSR program. Participants were African American women over the age of 60 in a low-income housing residence. We tape recorded each session and subsequently used inductive content analysis to identify primary themes.</p> <p>Results and discussion</p> <p>Analysis of the focus group responses revealed three primary themes stress management, applying mindfulness, and the social support of the group meditation. The stressors they cited using MBSR with included growing older with physical pain, medical tests, financial strain, and having grandchildren with significant mental, physical, financial or legal hardships. We found that participants particularly used their MBSR training for coping with medical procedures, and managing both depression and anger.</p> <p>Conclusion</p> <p>A reflective stationary intervention delivered in-residence could be an ideal mechanism to decrease stress in low-income older adult's lives and improve their health.</p
Stress, poverty, frailty and mortality in older women
Background. Socioeconomic status health disparities exist even in the oldest age groups. These disparities are only partially explained by differential prevalence of disease risk factors. Objectives. This dissertation is the results of two related studies. The objectives of the first were to examine the extent to which perceived income inadequacy increased mortality risk in community dwelling older women, whether this risk was mediated by a cumulative index of biological dysregulation (allostatic load), and whether the relationship differed for African-American and Caucasian women. The objective of the second study was to investigate whether allostatic load was related to the frailty syndrome. Design and methods. The first study used Cox proportional hazards modeling to estimate the effect of perceived income inadequacy and biological dysregulation on five-year mortality rates. The second study used ordinal logistic regression to examine the relationships between allostatic load and frailty in the baseline examination of two complementary population-based cohort studies. Sample. Women's Health and Aging studies participants were drawn from a Medicare sampling frame of Eastern Baltimore City and county. This sample of 728 women had an age range of 70–79. Findings. Forty four percent of women were robust, 46% were pre-frail, and 10% were frail. Allostatic load ranged from 0–8. For each one unit increase in income inadequacy, participants were almost 70% more likely to die in 5 years independent of age, education, absolute income, and race. For each increase in allostatic load, participants were 14% more likely to die. The effects of inadequate income and allostatic load were independent. The association between income inadequacy and mortality was stronger for African-Americans than for Caucasians. Further, each unit increase in allostatic load score was associated with increasing levels of frailty controlling for race, age, education, smoking, and co-morbidities. Conclusions. Perception of adequacy of financial resources may be a better predictor of mortality than income, particularly for African-Americans. Future research could use income inadequacy as an additional measure of resources in older women. This dissertation also suggests that frailty is associated with allostatic load
Complexities and actualization: embedding a home-based functional improvement intervention within a Medicaid Waiver
Life-course financial strain and health in African-Americans
Differential exposure to financial strain may explain some differences in population health. However, few studies have examined the cumulative health effect of financial strain across the life-course. Studies that have are limited to self-reported health measures. Our objective was to examine the associations between childhood, adulthood, and life-course, or cumulative, financial strain with disability, lung function, cognition, and depression. In a population-based cross-sectional cohort study of adult African-American twins enrolled in the US Carolina African American Twin Study of Aging (CAATSA), we found that participants who reported financial strain as children and as adults are more likely to be physically disabled, and report more depressive symptoms than their unstrained counterparts. Participants who reported childhood financial strain had lower cognitive functioning than those with no childhood financial strain. We were unable to detect a difference in lung function beyond the effect of actual income and education in those who reported financial strain compared to those who did not. Financial strain in adulthood was more consistently associated with poor health than was childhood financial strain, a finding that suggests targeting adult financial strain could help prevent disability and depression among African-American adults.USA Financial strain African Americans Disability Ethnicity Twins Lifecourse
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