Trajectory of functional status among older Taiwanese: Gender and age variations

[[abstract]]Current findings on gender and age differences in health trajectories in later life are equivocal and largely based upon data derived from Western developed nations. This study examines gender and age variations in the trajectory of functional status among older adults in Taiwan, a non-Western newly industrialized society. Data came from a sample of some 3500 Taiwanese aged 60 and over, initially surveyed in 1989 and subsequently followed in 1993, 1996, 1999, and 2003. Hierarchical linear models with time-varying covariates were employed in depicting the dynamics of functional status across gender and age. Women and the old–old experienced higher levels of disability and rates of increase than their male and young–old counterparts. Moreover, older women bore a disproportionately larger burden of disability. There are therefore significant gender and age variations in the trajectory of functional status among older Taiwanese. These findings provide evidence for the generalizability of prior observations to a non-Western society

Racial and ethnic variations in preventive dental care utilization among middle-aged and older Americans, 1999-2008

Objective: This study examined recent trends of preventive dental care utilization among Americans aged 50 and above, focusing on variations across racial and ethnic groups including Whites, Blacks, Hispanics, American Indians/Alaska Natives, and Asians. Methods: Self-reported information on oral health behaviors was collected from 644,635 participants in the Behavioral Risk Factor Surveillance System between 1999 and 2008. Results: Despite a significant upward trend of frequency of dental cleaning from 1999 to 2008 (OR = 1.02), in 2008 still only 56–77% of any ethnic or racial group reported having had a dental cleaning in the previous 12 months. Relative to Whites, Blacks (OR = 0.65) were less likely to have a dental cleaning in the previous 12 months. These variations persisted even when SES, health conditions, health behaviors, and number of permanent teeth were controlled. In contrast, Hispanics, Asians, and American Indians/Alaskan Natives did not differ from Whites in dental cleanings. Discussion: This is the first study to provide national estimates of the frequency of dental cleaning and associated trends over time for five major ethnic groups aged 50 and above in the U.S. simultaneously. Our findings suggest that public health programs with an emphasis on educating middle-aged and older minority populations on the benefits of oral health could have a large impact, as there is much room for improvement. Given the importance of oral health and a population that is rapidly becoming older and more diverse, the need for improved dental care utilization is significant

Social stratification and tooth loss among middle‐aged and older Americans from 1988 to 2004

Objectives Tooth retention has improved over the past few decades, but it is not known whether these trends have been observed across all demographic/socioeconomic subgroups. We examined number of missing teeth among dentate individuals ( n  = 9, 113) as well as edentulism and systematically modeled their trends over time by using clinical examination data. Methods We investigated the association between social stratification and trends in tooth retention among adults ages 50+ from 1988 to 2004, using four waves of the National Health and Nutrition Examination Surveys ( NHANES ) ( n  = 11 812). Results The prevalence of edentulism declined from 24.6% in NHANES III (1988–1994) to 17.4% in 2003–2004, and the mean number of missing teeth declined from 8.19 to 6.50. Older participants, Blacks, the less educated and those with lower income were higher on both edentulism and number missing teeth. Both edentulism and number of missing teeth declined over time, but their patterns varied. For edentulism, age and socioeconomic related disparities decreased over time due to more decline among older and low‐income participants. For missing teeth, there was less decrement among older and low‐income participants, resulting in increased age and socioeconomic related disparities. Conclusions Our study found disparities in trends of tooth loss across demographic/socioeconomic strata. Findings suggest that racial/ethnic disparities are partially explained by socioeconomic status. Interventions designed to improve oral health for older adults, particularly those with low levels of income, need special attention.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/109563/1/cdoe12116.pd

P1‐100: Cognitive function and oral hygiene behavior in later life

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/152607/1/alzjjalz201205376.pd

Edentulism trends among middle‐aged and older adults in the United States: comparison of five racial/ethnic groups

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/90571/1/j.1600-0528.2011.00640.x.pd

Self-reported physical health among the aged in Wuhan, China

It has long been recognized that cross-cultural differences in health and illness reflect not only genuine variation in the incidence and prevalence of morbidity, disability, and mortality, but also the social processes by which these data were generated. These processes may be far removed from the biological reality. The conceptualization and measurement of physical health, therefore, can benefit, from adopting a comparative perspective. This paper aims to extend the generalizability of a three-dimensional model of self-reported physical health among the aged to China. Data came from a probability sample of approximately 2,700 urban and rural Chinese, aged 60 or older, living in the Wuhan area. The model, which consists of chronic illness, functional status, and self-rated health as three interrelated dimensions, was previously evaluated empirically using national data on the aged gathered in the U.S. and Japan. The model, which was found to apply equally well to the American and Japanese aged, also fit the Chinese data well. However, results also indicated cross-national differences (1) in the effects of age and sex on the prevalence of chronic disease and disability and (2) in the effects of education on disability and self-rated health.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/42994/1/10823_2004_Article_BF00971527.pd

Oral health among white, black, and Mexican‐American elders: an examination of edentulism and dental caries

Objectives: To examine racial/ethnic disparities in oral health among older Americans. Methods: Differences in frequency of edentulism and number of decayed, missing, and filled teeth were assessed in 2,679 non‐Hispanic white, 742 non‐Hispanic black, and 934 Mexican‐American individuals aged 60 and older from the National Health and Nutrition Examination Survey (1999‐2004). Results: Controlling for potential confounding variables, blacks and Mexican‐Americans had significantly higher numbers of decayed teeth but fewer numbers of filled teeth than whites. Although blacks had a lower likelihood of being edentulous than whites, dentate blacks had a higher number of missing teeth. Compared with whites, Mexican‐Americans were less likely to be edentulous, and dentate Mexican‐Americans had fewer missing teeth. Our study also showed that blacks and Mexican‐Americans had less frequent dental checkups than whites. Conclusions: Oral health disparities are persistent across racial/ethnic groups for older Americans despite the fact that the differences between groups typically diminish when socioeconomic, health‐related, and behavioral factors are considered in the models. Our study suggests that reducing racial/ethnic oral health disparities requires multiple clinical approaches.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/88103/1/j.1752-7325.2011.00273.x.pd

Functional recovery of older people with hip fracture: does malnutrition make a difference?

Aim To report a study of the effects of protein‐energy malnutrition on the functional recovery of older people with hip fracture who participated in an interdisciplinary intervention. Background It is not clear whether protein‐energy malnutrition is associated with worse functional outcomes or it affects the interdisciplinary intervention program on the functional recovery of older people with hip fracture. Design A randomized experimental design. Methods Data were collected between 2002–2006 from older people with hip fracture ( N  = 162) in Taiwan. The generalized estimating equations approach was used to evaluate the effect of malnutrition on the functional recovery of older people with hip fracture. Results The majority of older patients with hip fracture were malnourished (48/80, 60% in the experimental group vs. 55/82, 67% in the control group) prior to hospital discharge. The results of the generalized estimating equations analysis demonstrated that subjects suffering from protein‐energy malnutrition prior to hospital discharge appeared to have significantly worse performance trajectories for their activities of daily living, instrumental activities of daily living, and recovery of walking ability compared with those without protein‐energy malnutrition. In addition, it was found that the intervention is more effective on the performance of activities of daily living and recovery of walking ability in malnourished patients than in non‐malnourished patients. Conclusion Healthcare providers should develop a nutritional assessment/management system in their interdisciplinary intervention program to improve the functional recovery of older people with hip fracture.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/99041/1/jan12027.pd

Old-Age Support System and Policy Reform in China

With the on-going economic transition from the central planned system to a marketoriented system, the population aging process in China is also accelerating, and the support system for the elderly becomes an important issue demanding attention. With data from Chinese national statistics and a regional probability sampling survey in Wuhan Area, two supporting systems for the aged in China are examined in this paper. After a briefing of the population aging process in China, a detailed discussion of the two supporting systems, i.e. the formal and the informal support systems for the aged, including arrangement, operation and funding mechanisms of the systems, is made in terms of policy reform. Then follows an international comparison to highlight features and problems of the Chinese systems. Finally, solutions are proposed for the restructuring of China's pension systems