Biomedical subjects

James S Goodwin

Publications and source records attributed to James S Goodwin.

At least 19 recordsLinked to original sources

PubMed2006

Impact of osteoarthritis on rehabilitation for persons with hip fracture.

OBJECTIVE: To determine the impact of osteoarthritis (OA) on length of rehabilitation stay, Functional Independence Measure (FIM Instrument) ratings at discharge and followup, functional gain, and percentage of patients discharged home. METHODS: We conducted a retrospective cohort analysis using a national registry of US medical rehabilitation inpatients. We obtained standardized data for all patients admitted after a hip fracture between 1994 and 2001. Our primary analytical method was multiple regression analysis. Outcome variables were length of stay, FIM Instrument ratings at discharge and followup, functional gain, and percentage of patients discharged home. The predictor variable was the presence of OA. Covariates were age, sex, race/ethnicity, other comorbidity, admission FIM ratings, total hip replacement, and time to followup. RESULTS: We studied 1,953 patients with OA and 11,441 patients without OA admitted to inpatient rehabilitation facilities after hip fracture. Mean +/- SD length of stay for patients with OA was 18.1 +/- 10.0 days versus 16.5 +/- 8.9 days for those without OA (P < 0.01). After adjusting for age, sex, race/ethnicity, comorbidity, admission FIM ratings, and total hip replacement, OA was associated with a longer rehabilitation stay (1.4 days; P < 0.01) and slightly higher discharge FIM ratings; however, OA was not associated with lower weekly rehabilitation gain, followup FIM ratings, and percentage discharged home. CONCLUSION: Persons with hip fracture and OA had longer inpatient rehabilitation length of stay than persons without OA, but there were similarities in weekly rehabilitation gain and percentage discharged home.

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PubMed2006

Ascertainment of Hispanic ethnicity on California death certificates: implications for the explanation of the Hispanic mortality advantage.

OBJECTIVES: We determined the size and correlates of underascertainment of Hispanic ethnicity on California death certificates. METHODS: We used 1999 to 2000 vital registration data. We compared Hispanic ethnicity reported on the death certificate to Hispanic ethnicity derived from birthplace for the foreign-born and an algorithm that used first and last name and percentage of Hispanics in the county of residence for the US-born. We validated death certificate nativity by comparing data with that in linked Social Security Administration records. RESULTS: Ethnicity and birthplace information was concordant for foreign-born Hispanics, who have mortality rates that are 25% to 30% lower than those of non-Hispanic Whites. Death certificates likely underascertain deaths of US-born Hispanics, particularly at older ages, for persons with more education, and in census tracts with lower percentages of Hispanics. Conservative correction for under-ascertainment eliminates the Hispanic mortality advantage for US-born men. CONCLUSIONS: Hispanic ethnicity is accurately ascertained on the California death certificate for immigrants. Immigrant Hispanics have lower age-adjusted mortality rates than do non-Hispanic Whites. For US-born Hispanics, the mortality advantage compared with non-Hispanic Whites is smaller and may be explained by underreporting of Hispanic ethnicity on the death certificate.

Adolescent↗

PubMed2006

Late gastrointestinal toxicity after radiation for prostate cancer.

BACKGROUND: The current study was designed to determine rates and predictors of late, lower gastrointestinal toxicity after radiation therapy in a population-based cohort of older men with prostate cancer. METHODS: The study population consisted of men with localized or regional stage prostate cancer who were age > or =66 years and were diagnosed between 1992 and 1999 who were identified in the Surveillance, Epidemiology, and End Results (SEER)-Medicare database. Gastrointestinal diagnoses were ascertained through claims from 6 to 60 months after diagnosis. The relative rates of diagnoses in the radiation group versus the nonradiation group were used as a means of estimating toxicity from radiotherapy. Cox modeling was used to determine factors associated with gastrointestinal diagnoses. RESULTS: A total of 57,955 men were included, 24,130 of whom were treated with radiation therapy. Among patients with 5 years of follow-up, the rates of gastrointestinal diagnoses were 19.4% higher in irradiated patients than among patients who did not have local therapy. Hemorrhage was the most common diagnosis, and was increased by 18.9% among patients treated with radiation (39.6% of irradiated patients vs. comparison rates of 18.2% in patients treated with radical prostatectomy and 20.7% in patients with no local therapy). Diagnostic lower endoscopies were performed in an additional 20.9% of men (32.4% of men treated with radiation vs. 12.7% of men who underwent prostatectomy). In all, 4.4% of irradiated men were hospitalized with a gastrointestinal diagnosis versus comparison rates of 3.2% among men with no local therapy. In multivariate models, increasing patient age, hormonal therapy, comorbidity, diabetes, peripheral vascular disease, and hemorrhoids were all associated with gastrointestinal diagnoses consistent with toxicity, whereas tumor stage and grade were not predictors. CONCLUSIONS: Lower gastrointestinal toxicity after radiation therapy for prostate cancer continues for at least 5 years and may be more common than previously reported.

Adult↗

PubMed2006

Variation in false-positive rates of mammography reading among 1067 radiologists: a population-based assessment.

BACKGROUND: The accuracy of mammography reading varies among radiologists. We conducted a population-based assessment on radiologist variation in false- positive rates of screening mammography and its associated radiologist characteristics. METHODS: About 27,394 screening mammograms interpreted by 1067 radiologists were identified from a 5% non-cancer sample of Medicare claims during 1998-1999. The data were linked to the American Medical Association Masterfile to obtain radiologist characteristics. Multilevel logistic regression models were used to examine the radiologist variation in false-positive rates of screening mammography and the associated radiologist characteristics. RESULTS: Radiologists varied substantially in the false-positive rates of screening mammography (ranging from 1.5 to 24.1%, adjusting for patient characteristics). A longer time period since graduation is associated with lower false-positive rates (odds ratio [OR] for every 10 years increase: 0.87, 95% Confidence Interval [CI], 0.81-0.94) and female radiologists had higher false-positive rates than male radiologists (OR = 1.25, 95% CI, 1.05-1.49), adjusting for patient and other radiologist characteristics. The unmeasured factors contributed to about 90% of the between-radiologist variance. CONCLUSIONS: Radiologists varied greatly in accuracy of mammography reading. Female and more recently trained radiologists had higher false-positive rates. The variation among radiologists was largely due to unmeasured factors, especially unmeasured radiologist factors. If our results are confirmed in further studies, they suggest that system-level interventions would be required to reduce variation in mammography interpretation.

Adult↗

PubMed2006

Determinants of androgen deprivation therapy use for prostate cancer: role of the urologist.

BACKGROUND: The use of androgen deprivation therapy for prostate cancer has been increasing, even in settings for which there is weak or no evidence of efficacy. This pattern suggests that factors other than the typical patient and tumor characteristics may be driving its use. We assessed the importance of the physician as a determinant of the use of androgen deprivation therapy in prostate cancer in a population-based, retrospective cohort study using the Surveillance, Epidemiology and End-Results-Medicare linked database. METHODS: Participants included 61 717 men with incident prostate cancer diagnosed from January 1, 1992, through December 31, 1999, and 1802 urologists providing care to them within 1 year of cancer diagnosis. Multilevel analyses were used to estimate and partition the variance in use of androgen deprivation therapy within 6 months of diagnosis between patient or tumor characteristics and urologist to examine the relative contribution of each component to androgen deprivation therapy. RESULTS: The percentage of the total variance in the use of androgen deprivation therapy attributable to the urologist was consistently higher than that attributable to tumor or patient characteristics. This pattern was most pronounced for patients diagnosed from January 1, 1997, through December 31, 1999, in which 22.56% of the total variance in use of androgen deprivation therapy was attributable to the urologist, 9.71% to tumor characteristics (stage or grade), and 4.29% to patient characteristics (age, ethnicity, socio-economic status, comorbidity, geographic region, or year of diagnosis). CONCLUSIONS: Which urologist a patient sees may be more important in determining whether they will receive androgen deprivation therapy than tumor or patient characteristics.

Aged↗

PubMed2006

Use and outcomes of adjuvant chemotherapy in older women with breast cancer.

PURPOSE: This study was undertaken to determine patterns and outcomes of adjuvant chemotherapy use in a population-based cohort of older women with primary breast cancer. PATIENTS AND METHODS: Women were identified from the Surveillance, Epidemiology, and End Results-Medicare-linked database who met the following criteria: age > or = 65 years, stage I to III breast cancer, and diagnosis between 1991 and 1999. Adjuvant chemotherapy use was ascertained by Common Procedural Terminology J codes. Logistic regression analysis was performed to determine factors associated with chemotherapy use. Multivariate Cox proportional hazards models were used to calculate the hazard of death for women with and without chemotherapy. RESULTS: A total of 41,390 women met study criteria, of whom 4,500 (10.9%) received chemotherapy. The use of adjuvant chemotherapy more than doubled during the 1990s, from 7.4% in 1991 to 16.3% in 1999 (P < .0001), with a significant shift toward anthracycline use. Women who were younger, white, with lower comorbidity scores, more advanced stage disease, and estrogen receptor (ER) -negative disease were significantly more likely to receive chemotherapy. Chemotherapy was not associated with improved survival among women with lymph node-negative (LN) disease or LN-positive, ER-positive disease (hazard ratio [HR], 1.05; 95% CI, 0.85 to 1.31). However, among women with LN-positive, ER-negative breast cancer, chemotherapy was associated with a significant reduction in breast cancer mortality (HR, 0.72; 95% CI, 0.54 to 0.96). A similar significant benefit of chemotherapy was seen in the subset of women age 70 years or older (HR, 0.74; 95% CI, 0.56 to 0.97). CONCLUSION: In this observational cohort, chemotherapy was associated with a significant reduction in mortality among older women with ER-negative, LN-positive breast cancer.

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PubMed2006

Mammography use among older women of seven Latin American and Caribbean cities.

BACKGROUND: To describe the prevalence of mammography use, and to estimate its association with sociodemographics. METHODS: A sample of 6207 women aged 60 and older from the first interview of Health, Well-Being and Aging in Latin America and the Caribbean Study (SABE) in seven cities (Buenos Aires, Bridgetown, Havana, Mexico, Montevideo, Santiago, and Sao Paulo). The outcome was reporting a mammogram within the last 2 years. RESULTS: Prevalence of mammography use ranged from 9.8% in Havana to 34.4% in Sao Paulo. Independent predictors of mammography use across cities were older age (lowest odds ratio [OR] = 0.92, 95% confidence interval [CI] 0.89-0.95), higher education (highest OR = 1.14, 95% CI 1.08-1.20), public health insurance (lowest OR = 0.28, 95% CI 0.11-0.76), or no insurance (lowest OR = 0.08, 95% CI 0.02-0.34) compared with private insurance. In a combined sample of six cities, higher education was associated with higher mammography use, but older age and insurance (public: OR = 0.54, 95% CI 0.45-0.65; no insurance: OR = 0.30, 95% CI 0.23-0.40; compared with private insurance) were associated with lower mammography use. CONCLUSIONS: Prevalence of mammography use across cities was lower than that reported for Hispanic populations in the US. In the overall sample, mammography use was increased in highly educated people and decreased in people without insurance.

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PubMed2006

Impact of a scientific presentation on community treatment patterns for primary breast cancer.

BACKGROUND: The publication of results from randomized clinical trials can have a dramatic effect on treatment patterns, but the impact of oral presentations at national scientific meetings is unknown. We investigated the temporal association between the oral presentation of the results from the Cancer and Leukemia Group B (CALGB) Study 9344 at the May 1998 meeting of the American Society of Clinical Oncology, which showed that paclitaxel improves survival of women with lymph node-positive breast cancer, and use of taxane chemotherapy for breast cancer. METHODS: We studied chemotherapy use in 3341 women identified through the Surveillance, Epidemiology, and End Results-Medicare database who were diagnosed with stage I-III breast cancer in 1994-1999 at age 65 years or older and received adjuvant chemotherapy, as identified through claims data, within 1 year of diagnosis. We assessed the temporal association between the CALBG presentation and taxane use with piecewise regression analysis. Multivariable logistic regression analysis was used to determine which patient characteristics were associated with taxane use. RESULTS: The use of taxanes increased substantially after the CALGB presentation, with absolute rates of taxane use of 5.2% before May 1998 and 23.6% in May 1998 and later. Initially, this increase was confined to patients with lymph node-positive disease (40% of whom were receiving taxanes by the end of 1999), but over time it extended to patients with lymph node-negative disease (15% of whom were receiving taxanes by the end of 1999). In multivariable analysis, patients who were treated in May 1998 or later were statistically significantly more likely to have received a taxane than patients treated before this date (estimated relative risk = 6.84, 95% confidence interval = 5.71 to 8.07). Younger patient age, larger number of lymph nodes involved, higher tumor grade, and larger tumor size were also independently associated with adjuvant taxane use. CONCLUSIONS: The oral presentation of a single study at a national conference was temporally associated with an increase in the use of taxanes for primary breast cancer, even before study publication or Food and Drug Administration approval.

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PubMed2006

Risk of the "androgen deprivation syndrome" in men receiving androgen deprivation for prostate cancer.

BACKGROUND: Androgen deprivation therapy for prostate cancer has been associated with a spectrum of adverse effects, such as depression, memory difficulties, and fatigue, termed the androgen deprivation syndrome. Primary care physicians providing follow-up care for men with prostate cancer will be faced with managing these effects. We therefore sought to estimate the incidence of these effects and, by using a control group, ascertain whether these effects were related to androgen deprivation itself. METHODS: We assessed the risk of physician diagnoses of depression, cognitive impairment, or constitutional symptoms in Medicare data following androgen deprivation using a sample of 50 613 men with incident prostate cancer and 50 476 men without cancer, from 1992 through 1997, in the linked Surveillance, Epidemiology, and End Results-Medicare database. Cox proportional hazards regression was used to adjust for confounding variables. RESULTS: Of men surviving at least 5 years after diagnosis, 31.3% of those receiving androgen deprivation developed at least 1 depressive, cognitive, or constitutional diagnosis compared with 23.7% in those who did not (P<.001). After adjustment for variables such as comorbidity, tumor characteristics, and age, the risks associated with androgen deprivation were substantially reduced or abolished: relative risk (RR) for depression diagnosis, 1.08 (95% confidence interval [CI], 1.02-1.15); RR for cognitive impairment, 0.99 (95% CI, 0.94-1.04); and RR for constitutional symptoms, 1.17 (95% CI, 1.13-1.22). CONCLUSION: Depressive, cognitive, and constitutional disorders occur more commonly in patients receiving androgen deprivation, but this appears to be primarily because patients receiving androgen deprivation are older and have more comorbid conditions and more advanced cancers.

Aged↗

PubMed2006

High anxiety is associated with an increased risk of death in an older tri-ethnic population.

BACKGROUND AND OBJECTIVES: The health consequences of anxiety in late life have not been adequately investigated. We sought to examine the association between anxiety and death in an older tri-ethnic population. METHODS: A longitudinal population-based study of 506 older noninstitutionalized non-Hispanic Whites, non-Hispanic Blacks, and Hispanics aged 75 years or older from Galveston County. RESULTS: Average age was 80.8 (SD 4.4) and 50.8% were women. Older non-Hispanic Whites (21.6%) reported the highest prevalence of anxiety, followed by Hispanics (12.4%) and non-Hispanic blacks (11.3%) (P=.0001). High anxiety was significantly associated with an increased hazard of all cause death (HR 1.52; 95% CI 1.02, 2.28) and cardiovascular death (HR 1.90; 95% CI 1.06, 3.36); and was associated with an increased hazard of cancer death (HR 2.38; 95% CI 0.88, 6.45) during 5-years of follow-up. CONCLUSION: There is a high prevalence of anxiety in late life. Our results indicate an association between anxiety and increased risk of death in persons aged 75 and older.

Activities of Daily Living↗

PubMed2006

Weight change and mortality among older Mexican Americans.

BACKGROUND AND AIMS: Weight changes are predictors of health outcomes in older people. The purpose of this study is to examine the association between 2-year weight change and mortality in older Mexican Americans. METHODS: Seven year prospective cohort study of 1,749 non-institutionalized Mexican American men and women aged 65 and older residing in five Southwestern states. Measures include self-reports of medical conditions (heart attack, stroke, diabetes, hypertension, hip fracture or cancer), functional disability, high depressive symptoms, smoking status, a summary performance score of lower body function, hand grip muscle strength, and body mass index (BMI). Weight change was examined by comparing the baseline weight to the weight two years later to estimate the hazard of death within the following five-year period. RESULTS: Of the 1,749 subjects, 396 (22.6%) lost 5% or more weight, 984 (56.3%) had weight that remained stable, and 369 (21.1%) gained 5% or more weight between baseline and the 2-year follow-up period. Of the ones who lost 5% of weight, 28% died as compared to 19.7% and 15.2% of those whose weight remained stable and those who gained weight after 5 years, respectively. The hazard ratio (HR) of death for the group that lost 5% or more of their weight compared to the reference group (stable weight) was 1.35 (95% CI 1.06-1.70) after controlling for demographic variables, BMI, and waist circumference at baseline and 1.32 (95% CI 1.04-1.67) after controlling for all covariates. The HR of death for the group that gained 5% or more of weight was 0.78 (95% CI 0.58-1.05) after controlling for demographic variables, BMI, and waist circumference at baseline and 0.77 (95% CI 0.57-1.04) after controlling for all covariates. CONCLUSIONS: Weight loss is an independent predictor of mortality among older Mexican Americans, after controlling for relevant risk factors.

Aged↗

PubMed2006

Pancreatic cancer in the general population: Improvements in survival over the last decade.

BACKGROUND: It is unknown whether the improved survival seen at high-volume centers has been translated to all patients with pancreatic cancer. OBJECTIVE: To use the Surveillance, Epidemiology, and End Results (SEER) database to evaluate population-based trends in surgical resection and survival. METHODS: All patients diagnosed with pancreatic cancer from 1988-1999 were identified. The survival and proportion of patients undergoing surgical resection were compared for each of three equal time periods. RESULTS: There were 24,016 patients with pancreatic cancer. 19,533 had stage data available. 9% had localized, 29% had regional, and 62% had distant disease. Resection rates increased for patients with localized and regional disease over the three time periods. Survival increased for patients with regional and distant disease. For regional pancreatic cancer patients, 2-year survival increased from 9.5% to 13.5% (p < 0.0001) and from 21.5% to 28.9% following surgical resection (p = 0.002). For resected local/regional pancreatic cancer, the year of diagnosis was and independent predictor of improved survival (p = 0.0001). CONCLUSIONS: SEER patients with regional and distant pancreatic cancer have improved survival over the past decade in both unadjusted and adjusted models. The improvement is most striking for patients with regional disease and reflects increased resection rates and improved resection techniques over time.

Female↗

PubMed2006

Nutritional status is altered in the self-neglecting elderly.

Elder self-neglect is the most common form of elder mistreatment. Individuals who cannot provide basic needs for themselves may develop social, functional, and physical deficits. The systematic characterization of self-neglecting individuals is the goal of the Consortium for Research in Elder Self-Neglect of Texas project. This study reports on the nutritional status of self-neglecting elderly. Self-neglectors (SN) were recruited based on referrals along with matched control (CN) subjects. Data are for 40 SN subjects (age 76 +/- 7 y) and 40 CN subjects (76 +/- 7 y). Blood samples were collected and analyzed for indices of nutritional status. SN subjects had a greater serum concentration of total homocysteine than CN subjects (13.6 +/- 4.5 vs. 11.6 +/- 5.6 micromol/L, P < 0.05) and a lower concentration of red blood cell folate (1380 +/- 514 vs. 1792 +/- 793 nmol/L, P < 0.05). Plasma beta-carotene and alpha-tocopherol were lower in SN subjects (0.28 +/- 0.2 vs. 0.43 +/- 0.33 micromol/L; 23.2 +/- 9.3 vs. 27.8 +/- 9.3 micromol/L, P < 0.05). SN subjects had a lower serum concentration of 25-hydroxyvitamin D than CN subjects (33.7 +/- 16.4 vs. 44.1 +/- 19.6 nmol/L, P < 0.05). These differences in markers of nutritional status show that the self-neglecting elderly are at risk for altered nutritional status, particularly of folate, antioxidants, and vitamin D. Evaluation of these data in relation to other functional and cognitive assessments are critical for evaluating the relation between nutrition and self-neglect.

Aged↗

PubMed2006

Socioeconomic status and survival in older patients with melanoma.

OBJECTIVES: To determine the association between socioeconomic status (SES) and survival in older patients with melanoma. DESIGN: Retrospective cohort study. SETTING: Surveillance, Epidemiology and End Results (SEER): a population-based cancer registry covering 14% of the U.S. population. PARTICIPANTS: Twenty-three thousand sixty-eight patients aged 65 and older with melanoma between 1988 and 1999. MEASUREMENTS: Outcome was melanoma-specific survival. Main independent variable was SES (measured as census tract median household income) taken from the SEER-Medicare linked data. RESULTS: Subjects residing in lower-income areas (< or =30,000 dollars/y) had lower 5-year survival rates (88.5% vs 91.1%, P < .001) than subjects residing in higher-income areas (>30,000 dollars/y). In Cox proportional hazard models, higher income was associated with lower risk of death from melanoma (hazard ratio = 0.88, 95% confidence interval = 0.79-0.98, P = .02) after adjusting for sociodemographics, stage at diagnosis, thickness, histology, anatomic site, and comorbidity index. There was an interaction effect between SES and ethnicity and survival from melanoma. For whites and nonwhites (all other ethnic groups), 5-year survival rates increased as income increased, although the effect was greater for nonwhites (77.6% to 90.1%, 1st to 5th quintiles, P = .01) than for whites (89.0% to 91.9%, 1st to 5th quintiles, P < .001). CONCLUSION: Older subjects covered by Medicare residing in lower-SES areas had poorer melanoma survival than those residing in higher-SES areas. Further research is needed to determine whether low SES is associated with late-stage disease biology and poorer early detection of melanoma.

Aged↗

PubMed2006

The relationship between depressive symptoms and shoulder mobility among older women: assessment at one year after breast cancer diagnosis.

OBJECTIVE: To examine the association between depressive symptoms and shoulder range of motion at one year after breast cancer diagnosis, controlling for patient characteristics, tumour stage and cancer therapy (surgery, axillary node dissection and radiation). DESIGN: Prospective trial of nurse case management involving 187 older women with complete data, age 60 years and older, newly diagnosed with breast cancer, from 1 November, 1993 to 31 October, 1996 in south-eastern Texas. Depressive symptoms, sociodemographic characteristics and breast cancer treatment were measured at two months and shoulder range of motion at 12 months. The relationship among the variables was evaluated with bivariate chi-square statistics and logistic regression analysis. All logistic models also included a variable indicating whether or not the woman received nurse case management, to control for intervention status. RESULTS: Increasing depressive symptoms at baseline were associated with lower arm mobility at 12 months following breast cancer diagnosis. Each unit increase in depressive symptoms at baseline was associated with an 8% decreased odds of having full range of motion of the shoulder (odds ratio (OR) 0.92, 95% confidence interval (CI) 0.87, 0.97), after controlling for relevant patient and treatment factors. CONCLUSION(S): Older women with depressive symptoms have an elevated risk of not fully recovering shoulder mobility after being treated for breast cancer. Future studies are needed to assess benefits from early intervention with psychological and or physical interventions in the presence of depressive symptoms on shoulder mobility.

Activities of Daily Living↗

PubMed2006

Referral to medical oncology: a crucial step in the treatment of older patients with stage III colon cancer.

PURPOSE: Adjuvant chemotherapy for stage III colon cancer produces a substantial survival benefit, but many older patients do not receive chemotherapy. This study examines factors associated with medical oncology consultation and evaluates the impact of such consultation on chemotherapy use. PATIENTS AND METHODS: We used the Surveillance Epidemiology and End Results-Medicare linked database and identified 7,569 patients, aged 66-99, with stage III colon cancer diagnosed from 1992-1999. Modified Poisson regression was used to assess the relative risk for seeing a medical oncologist and for receiving chemotherapy as a function of individual characteristics. RESULTS: 78.08% of patients saw a medical oncologist within 6 months of diagnosis. Patients who were female, white, married, had low comorbidity scores, were diagnosed in more recent years, or had four or more positive lymph nodes were more likely to see a medical oncologist. Patients seeing a medical oncologist were 10 times more likely to receive chemotherapy (odds ratio, 9.98; 95% confidence interval, 8.21-12.14), after controlling for demographic and tumor characteristics. Chemotherapy use increased over time, but was substantially lower among older, black, and unmarried patients. CONCLUSIONS: Referral to medical oncology is one of the most important factors associated with receipt of chemotherapy among older patients with stage III colon cancer. Comorbidity decreases the likelihood of receiving chemotherapy, but its effect is the same for those who see a medical oncologist and all patients combined. Ensuring that high-risk patients are referred to medical oncology is a crucial step in quality care for patients with colon cancer.

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PubMed2006

Anxiety in persons 75 and older: findings from a tri-ethnic population.

PURPOSE: Little research has been reported about anxiety in older populations. We assessed the prevalence of anxiety and examined associations between anxiety and sociodemographic, physical, mental, and functional health characteristics in an older tri-ethnic population. DESIGN AND METHODS: A cross-sectional, population-based study of older, noninstitutionalized non-Hispanic Whites, non-Hispanic Blacks, and Hispanics was conducted from the baseline assessment of the Health of the Public (HoP) database. Measurements included a self-report anxiety scale and physical, mental, and functional health. Data were analyzed with general linear models and logistic regression models. RESULTS: Overall, 31.4% reported anxiety (score > or = 45); 32.3% of woman and 30.5% of men (P=.67). Older Hispanics (22.2%) reported the lowest prevalence of anxiety followed by non-Hispanic Blacks (26.6%) and non-Hispanic Whites (44.3%) (P=.0001). Common predictors of anxiety seen after linear and logistic regression included being married, White, and increasing number of medications and depressive symptoms. IMPLICATIONS: Anxiety is prevalent in older adults. The findings also indicate higher rates of anxiety in older non-Hispanic Whites compared with older non-Hispanic Blacks and Hispanics.

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PubMed2006

Predictors of healthcare utilization among older Mexican Americans.

OBJECTIVE: To examine the effects of predisposing, enabling, and need factors on physician and hospital use among older Mexican Americans. DESIGN: A two-year prospective cohort study. SETTING: Five Southwestern states: Texas, New Mexico, Colorado, Arizona, and California. PARTICIPANTS: A population-based sample of 1987 non-institutionalized Mexican American men and women age > or =65 years. MAIN OUTCOMES MEASURES: Physician and hospital utilization. Predictor variables included predisposing, enabling, and need factors. Ordinary least square and logistic regression analysis were used to model the effects of predictor factors specified in the Andersen model of health service use on physician and hospital use. RESULTS: After two years of follow-up, predisposing and enabling factors accounted for <5% of the variance in physician and hospital use. Need factors explained 21% of the variance in physician use and 7% of the variance in hospital use. Older age; being female; insurance coverage; having arthritis, diabetes, heart attack, hypertension, stroke, or cancer; and number of medications were factors associated with higher physician utilization. Subjects with arthritis, diabetes, hip fracture, high depressive symptoms, activities of daily living (ADL) disability, or high number of medications increased the odds of having any hospitalization. Subjects with diabetes, heart attack, hip fracture, ADL disabled, and high number of medications had a greater number of hospital nights than their counterparts. CONCLUSIONS: Older age, female sex, insurance coverage, and prevalent medical conditions are determinants of healthcare use among older Mexican Americans.

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