Through the lens of the Hispanic Paradox, this thesis examines healthy and unhealthy life expectancy changes occurring from 1997 to 2015 among Hispanics, non-Hispanic blacks, and non-Hispanic whites in the United States. The goal is to determine how Hispanics –disaggregated by nativity status– fare relative to other racial-ethnic groups in regard to changes in the percentage of total life expectancy that is lived in a healthy state (i.e. compression and expansion of morbidity). Using the Sullivan method, multi-state life tables were created with functional limitation prevalence data from the National Health Interview Survey. Results indicate that most subpopulation groups experienced periods of both morbidity compression and expansion from 1997 to 2015, though patterns of change varied by race-ethnicity and gender. Partial support was found for the Hispanic paradox given that similar trends in the percentage of total life expectancy lived disabilityree existed between non-Hispanic whites and foreign-born Hispanics.

Many older adults develop restrictions in the performance of activities that are essential to daily living, referred to as functional limitations. Functional limitations can lead to disability, the inability to complete tasks necessary to function in society. A better understanding of how impairments in body systems affect functional limitations and disability in older adults could lead to improved medical management of older adults. The purpose of this study was to examine how impairments in lower extremity muscle performance (strength, power, and endurance) are related to functional limitations and disability in community dwelling older adults. Thirty-four subjects were recruited to participate in this cross-sectional analysis study with 30 individuals completing the study. The Keiser 420 Leg Press was used to measure impairments in lower extremity muscle performance. Functional limitations were classified through the Short Physical Performance Battery, the Six-Minute Walk Test, the Late Life Function and Disability Index (LLFDI) Functional Limitation Component, and average walking speed, average walking distance and average number of steps per day over a six-day period obtained from the AMP 331 physical activity monitor. Disability was measured through the LLFDI Disability Component Limitation Category. Regression analysis was used to examine the direct effect between impairments in muscle performance and functional limitations. Mediation analysis was used to examine the indirect effect of impairments on disability. The results of this study support a relationship between impairments in lower extremity strength and power to functional limitations and disability in community dwelling older adults. Impairments in lower extremity power consistently demonstrated a stronger relationship than strength to all measures of functional limitations and disability. The results of this study did not support a relationship of impairments in endurance to functional limitations or disability. The overall findings of this study would indicate that community dwelling older adults should focus on maintaining and improving lower extremity strength and power across a range of relative intensities in order to decrease functional limitations and disability.

No description available.

Elderly Black and Hispanic adults have poorer overall health, higher disability rates, and lower life expectancies than elderly Whites and other racial and ethnic minority group members. There are also sex differences in health, with women more likely to suffer from non-life threatening chronic conditions and men more likely to suffer from acute conditions. Health pathways, or the processes to good or poor health, are shaped by race, SES, and sex. This study focuses on the race and SES literature, framing race and SES inequalities within a cumulative advantage lens. Using Hierarchical Linear Modeling techniques to examine data from the Health and Retirement Survey, this study finds that there are racial differences in health through health problems, health insurance, and health care treatment, and that Black, Hispanic, and other racial and ethnic minority group members have worse self-reported health than Whites in old age. This study also finds evidence of cumulative advantage through friends in the neighborhood, and finds evidence of cumulative disadvantage through health problems and hospital and nursing home treatment. There are also cumulative disadvantages for women, who have more functional limitations in old age than their male counterparts, and these disadvantages grow over time. This study adds support to the race literature, by furthering understandings of race and SES as interconnected but not interchangeable systems of inequality. In lieu of the findings, this study provides implications for future research and ways to reduce racial health disparities in old age. / Ph. D.

In this study, we analyzed elderly people in Thailand to identify the validity of suggested cutoff points of physical measures, handgrip strength, usual walking speed, and a composite score of both measures to predict functional limitations. Moreover, we examined whether these physical performance measures are accurate indicators of the investigated health outcomes. Methods: Using Receiver Operating Characteristics (ROC) analysis, we investigated a sample of 8272 respondents aged 60 to 79 years. All data were based on the 2009 National Health Examination Survey (NHES IV) of Thailand. Results: For males aged 60 to 69 years, handgrip strength was used as an indicator of functional limitations. The cutoff point for disabilities in the activities of daily living (ADLs) was 29.5 kg, while in other limitations it ranged from 28.7 to 31.3 kg. In contrast, usual walking speed was able to indicate ADL disabilities at 0.7 m per second (m/s). As one might expect, the cutoff points for males aged 70 to 79 years were lower than for males in the 60 to 69 age group. For females, handgrip strength was able to indicate ADL disabilities at 16.5 kg for both the 60 to 69, and 70 to 79 age groups. Likewise, walking speed was indicative of ADL disabilities at 0.6 m/s for both age groups. Interestingly, the composite measure increases the ability to detect ADL disabilities in the younger group but not in the older group. The area under the curve (AUC) of cutoffs measuring the detection power of a diagnostic test was varied, ranging from 0.535 to 0.7386. Conclusions: The cutoff points of three measures varied according to sex and type of functional limitations. Our findings also showed that physical performance measures were useful for identifying people with an increased risk of functional limitations, particularly for ADL disabilities. However, although the AUC of the cutoffs of other functional limitations were relatively low, they should be considered with caution.

Background/Aim: During the past two decades, major advances in maternal-fetal medicine, neonatology, and the development of regionalized perinatal care have resulted in dramatic increases in survival rates, by more than 60%, of extremely immature (EI) infants born at less than 26 completed weeks of gestation, creating a new infant population. Studies of school-age outcomes in children with an extremely low birth weight of < 1000 g, born in the1980s, indicated that these children had a substantially high prevalence of low-severity neuropsychological deficits, behavioral problems, and difficulties at school. Information on school-age outcomes of extremely preterm children born in the 1990s is sparse, and mainly restricted to the neurobehavioral and developmental outcome. The aim of this research was to investigate the comprehensive neurological, developmental, functional, and mental health status and health care needs of children born at 23-25 weeks of gestation in the 1990s, allowing a total view of the child in the context of the family, his peers, school, and the health care system. The ultimate aim was to obtain a clearer understanding of the functional capacities of these vulnerable children and the possibilities of ameliorative interventions, as a basis for planning and provision of services for this growing population. Methods: We studied 11-year-old children born from 1990 through 1992 before 26 completed weeks of gestation in all of Sweden. All had been evaluated at a corrected age of 36 months. Of 89 eligible children, 86 (97%) were studied at a mean age of 11 years. An equal number of children born at term served as controls. The following methods were used: 1) well validated, mailed questionnaires filled out by the parents, class teachers and the children themselves; 2) structured interviews were conducted with a parent or a primary caregiver; 3) review of pediatric case records and records from other specialist health care services; and 4) anthropometric measurements (length, weight, head circumference and body mass index) from birth to 11 years of age. The following domains were explored: current health status, growth attainment, mental health assessment, emotional well-being, adaptive functioning and social competencies, school performance, executive functions, and learning and language skills. Relations of socioeconomic background and of environmental and perinatal risk factors to the long-term outcome were evaluated. Results: EI children compared with the controls had significantly higher rates of specific diagnoses or disabilities including neurosensory impairment (15% vs 2%, respectively), asthma (20% vs 6%), poor motor skills (26% vs 3%), poor visual perception (21% vs 4%), poor learning skills (27% vs 3%),poor adaptive functioning (42% vs 9%), and poor academic performance (49% vs 7%). As a consequence of these disabilities, significantly more EI children than controls had chronic conditions, which included functional limitations (64% vs 11%), compensatory dependency needs (59% vs 25%), and services above those routinely required by children in general (67% vs 22%). Regarding growth attainment, EI children had significantly lower values for all three growth parameters (length, weight and head circumference) than the controls at 11 years. They showed a sharp decline in weight and height z scores up to 3 months’ corrected age, followed by good catch-up growth in both weight and height up to 11 years. EI children did not exhibit catch-up growth in head circumference after the first 6 months of life. Preterm birth and parental height were significant predictors of 11-year height, and group status (prematurity) correlated strongly with head circumference. Our results also suggest that the EI children had a significantly greater risk for poorer mental health and poorer emotional well-being than the control participants, including internalizing (anxiety/depression, withdrawn behavior and somatic complaints), and attention, social, and thought problems. No differences in externalizing problems were found between the EI cohort and controls. Multivariable analyses disclosed a number of significant predictors of behavioral adjustment: group status (EI vs control), family function, social risk, male gender, and presence of a chronic medical condition. Concerning school performance, more than half (59%) of our EI cohort were experiencing school difficulties and 15%, compared with 5% of the control children were attending special schools or having full-time special education. Despite fewer adaptive skills in the EI cohort these children were not different from the controls in respect to being happy and being positively adjusted in their day-to-day life. Compared with controls, EI children had a significantly increased risk for executive dysfunctions in most of the areas assessed (Attention control and Attention switching, Hypoactivity, Planning/organizing, and Working memory). EI children were also at increased risk for deficient skills in language tasks (comprehension, communication, and expression) and in the four standard measures of learning skills (reading/writing, math, general learning, and coping in learning). However, only a relatively small number of EI children exhibited severe impairments in executive or non-executive skills. Multivariate analyses revealed that prematurity, executive dysfunction and male gender were associated with poor learning skills. Conclusions and implications: Children born extremely immature have significantly greater health problems and special health care needs that require ongoing services through the school years. However, it is notable that very few children have severe impairments that curtail major activities of daily living. The overall results of this study are reassuring. Despite having an increased risk for mental health problems, executive dysfunctions and school difficulties, 85% of the EI children were in the mainstream schools and a majority were not having major adjustment difficulties. In terms of growth, most of our EI children showed good catch-up in late childhood and were within 2SD of their mean midparental height at 11 years of age. Although biological immaturity is associated with an increased risk for a substantial number of behavioral/emotional problems, improvement of the modifiable environmental factors will benefit the outcome in EI children. We also believe that knowledge of the course of development of psychopathological conditions from early childhood to adolescence and beyond is crucial for identifying the need for intervention and prevention strategies. Thus when there is evidence to suggest neuropsychological and behavioral or emotional problems, early identification and preventive measures might help families to manage these from an early stage. Our findings further suggest that current preterm follow-up programs might benefit from the addition of psychological and family services to traditional neurodevelopmental assessments, especially in the neonatal period and first years of life.

Family and friends provide substantial daily assistance to older adults with disabilities, but little is known about how that caregiving impacts the health of older adults. Using survey data on a nationally-representative sample of older adults and their caregivers, matched with Medicare claims, I explored several aspects of the relationship between caregiving and the health of older adults receiving care. I relied largely on Andersen’s behavioral model, which describes health services use as a product of predisposing, enabling, and need characteristics. I found that 33%-37% of older adults with unmet care needs at one point in time still have them one year later. I also found frequent change in the composition of older adults’ networks of caregivers. Having a formal caregiver was associated with lower odds of unmet care needs for women; conversely, men receiving care from a spouse had three times lower odds of unmet care needs than those receiving care from a non-spousal caregiver. Some caregivers use services such as respite care, training, and support groups, but some caregivers lack access to desired services. I found that caregivers reporting unmet service need were more likely to be Black and Hispanic, while service use was higher among caregivers providing help on a regular schedule. Care-recipient health and function was associated with both service use and unmet service need, but available measures of local caregiver service supply were not. Older adults frequently seek care in emergency departments (EDs), but this care may not always be necessary or desirable. I hypothesized, but did not find, that caregiver service use was associated with care-recipient ED use. Instead, chronic health conditions and other need factors were the strongest predictors of ED use. I found that care-recipients of male caregivers had lower rates of ED utilization for reasons that were urgent and not preventable. I also found that care-recipients of adult children had lower rates of non-urgent ED utilization than care-recipients of more distantly-related or unrelated caregivers. These findings suggest that unmet care needs might be reduced by improving access to formal care for older women with functional limitations and monitoring unmarried older men. In addition, improving service access for Black and Hispanic caregivers, and for caregivers who provide unscheduled care, could reduce caregivers’ unmet service need. Finally, targeting training and support services to male spousal caregivers could improve access both to needed daily care and to emergency care. Future research should focus on replicating these analyses after more data become available and on developing alternate measures of caregiver service supply.

Le vieillissement de la population canadienne qui est appréhendé dans les années à venir entrainera son lot de défis pour l’administration des soins et services de longue durée. Par contre, une amélioration de l’état de santé fonctionnelle de la population pourrait atténuer le rythme de croissance du nombre d’aînés en état d’incapacité. Utilisant les données transversales de l’Enquête nationale sur la santé de la population (ENSP) et de l’Enquête de santé dans les collectivités canadiennes (ESCC), cette recherche analyse les tendances dans les niveaux d’incapacité chez les personnes de 65 ans et plus vivant dans les ménages privés au Canada entre 1994 et 2005, ainsi que les caractéristiques sociodémographiques associées au risque d’être en incapacité. Les résultats montrent que la prévalence de l’incapacité est à la baisse durant la période, et que parmi les personnes en incapacité, la proportion présentant une incapacité légère a diminué. Tout étant égal par ailleurs, certaines caractéristiques sociodémographiques augmentent le risque pour une personne âgée d’être en incapacité, notamment l’âge, être une femme, la faible scolarité, et être veuf, séparé ou divorcé. Cependant, les limites relativement importantes quant à la qualité des données font en sorte que nous devons interpréter ces résultats avec prudence. / The ongoing aging of the Canadian population that will accentuate in the coming years will cause a lot of challenges for health care administration and long-term services. However, improved functional health status of the population could reduce the rate of growth in the number of disabled elderly. Using cross-sectional data from the National Population Health Survey (NPHS) and the Health Survey (CCHS), this study analyzes trends in disability levels among people aged 65 years old and over living in private households in Canada between 1994 and 2005, and the sociodemographic characteristics associated with the risk of being disabled. The results show that the prevalence of disability has been declining during the period, and that among people with disability, the proportion with mild disabilities has decreased. Other things being equal, several sociodemographic characteristics increase the risk for an elderly to declare be disabled. These include age, being a woman, low education, and being widowed, separated or divorced. However, important limitations on data quality lead us to interpret these results with caution.

Le vieillissement de la population canadienne qui est appréhendé dans les années à venir entrainera son lot de défis pour l’administration des soins et services de longue durée. Par contre, une amélioration de l’état de santé fonctionnelle de la population pourrait atténuer le rythme de croissance du nombre d’aînés en état d’incapacité. Utilisant les données transversales de l’Enquête nationale sur la santé de la population (ENSP) et de l’Enquête de santé dans les collectivités canadiennes (ESCC), cette recherche analyse les tendances dans les niveaux d’incapacité chez les personnes de 65 ans et plus vivant dans les ménages privés au Canada entre 1994 et 2005, ainsi que les caractéristiques sociodémographiques associées au risque d’être en incapacité. Les résultats montrent que la prévalence de l’incapacité est à la baisse durant la période, et que parmi les personnes en incapacité, la proportion présentant une incapacité légère a diminué. Tout étant égal par ailleurs, certaines caractéristiques sociodémographiques augmentent le risque pour une personne âgée d’être en incapacité, notamment l’âge, être une femme, la faible scolarité, et être veuf, séparé ou divorcé. Cependant, les limites relativement importantes quant à la qualité des données font en sorte que nous devons interpréter ces résultats avec prudence. / The ongoing aging of the Canadian population that will accentuate in the coming years will cause a lot of challenges for health care administration and long-term services. However, improved functional health status of the population could reduce the rate of growth in the number of disabled elderly. Using cross-sectional data from the National Population Health Survey (NPHS) and the Health Survey (CCHS), this study analyzes trends in disability levels among people aged 65 years old and over living in private households in Canada between 1994 and 2005, and the sociodemographic characteristics associated with the risk of being disabled. The results show that the prevalence of disability has been declining during the period, and that among people with disability, the proportion with mild disabilities has decreased. Other things being equal, several sociodemographic characteristics increase the risk for an elderly to declare be disabled. These include age, being a woman, low education, and being widowed, separated or divorced. However, important limitations on data quality lead us to interpret these results with caution.

Made available in DSpace on 2014-12-17T14:13:25Z (GMT). No. of bitstreams: 1 JairSVJ.pdf: 494758 bytes, checksum: ff6d790cbf26c2b6783c7734bbfc33e1 (MD5) Previous issue date: 2008-09-29 / Funda??o de Amparo a Pesquisa do Estado da Bahia / The identification of the factors that interfere in the decline of functional conditions is useful in the planning of actions addressing the improvement in the conditions of the lives of elderly people. The purpose of this investigation was to analyze the relationship between social demographics and health aspects of the functional condition in elderly women of low income of the Brazilian northeast. This crosssectional study involved a representative sample of 222 women with an average age of 70 years (? 7.1), belonging to coexisting groups and that were resident in the urban area of the municipal district of Jequi? /Bahia. In order to achieve this objective, a battery of physical tests of functional aptitude was carried out previously tested in pilot study, anthropometric measurements collected with a comparison of the measures referred to the reported weight and height as well as the application of an interview with questions containing subjects related to social demographic variables, clinical conditions and health, physical conditions and behaviors. Descriptive statistics Proceedings (frequency, average, standard deviation and percent distribution) were used for statistic analysis, and the calculation of the respective odds ratio by binary logistics regression, for the analysis of factors hierarchically grouped; p<0.05. The prevalence of 56% (n=122) of women considered with moderated or serious type of functional limitations was found, In which from multi-varied hierarchical analysis, significant association was verified with the age group over 80 years (p=0.02), conditions of widowhood (p=0.04), presence of arterial hypertension (p=0.001), and physical inactivity during leisure time (p=0.03). On the other hand for functional incapacities the prevalence was of 46.8% (n=104) being associated to the increase of the age (p=0.01), hospitalization (p=0.02), absence of physical activities along their lives (p=0.001) and the occurrence of alterations in the cognitive function (p=0.001). The normative table for the parameters of physical fitness generated conducive to health professionals in the diagnosis of health conditions and the prescription of physical exercises. The identified characteristics that are associated with the functional limitations / functional incapacities suggest a complex causal net in the determination of the functional condition in elderly women. However, actions addressed to the incentive of the practice of physical activities in the leisure time and the preservation of the cognitive function can contribute to a life with more quality for these people. This research was multidisciplinary approach to involve elements of psychology, nutrition and Physical Education in the elucidation of the object of study related to the functional condition of elderly women / A identifica??o de fatores que interferem no decl?nio da condi??o funcional ? ?til no planejamento de a??es direcionadas as melhorias nas condi??es de vida das pessoas idosas. O prop?sito dessa investiga??o foi o de analisar a rela??o dos aspectos s?cio-demogr?ficos e referentes a sa?de com a condi??o funcional em mulheres idosas de baixa renda do nordeste brasileiro. Este estudo teve um delineamento transversal, tendo uma amostra representativa de 222 mulheres, com m?dia de 70 anos (? 7,2) pertencentes a grupos de conviv?ncia e que eram residentes na zona urbana do munic?pio de Jequi?, Bahia. Para tanto foi conduzida uma bateria de testes de desempenho f?sico para avalia??o da aptid?o funcional previamente testada em estudo piloto, coletadas medidas antropom?tricas com a compara??o de medidas referidas com as reportadas para o peso e estatura, al?m da aplica??o de uma entrevista contendo quest?es relativas ?s vari?veis s?cio-demogr?ficas, condi??es cl?nicas, sa?de percebida, condi??es f?sicas e comportamentais. Para an?lise estat?stica foram utilizados procedimentos da estat?stica descritiva (freq??ncia, m?dia, desvio padr?o e distribui??o percent?lica) e o c?lculo da respectiva raz?o de chances mediante regress?o log?stica bin?ria, para an?lise de fatores hierarquicamente agrupados; p<0,05. Encontrou-se uma preval?ncia de 56% (n=122) de mulheres consideradas com limita??es funcionais do tipo moderada ou grave, nos quais a partir de an?lise multivariada hierarquizada, verificaram-se associa??o significativa com a faixa et?ria superior a 80 anos (p=0,02), condi??es de viuvez (p=0,04), presen?a de hipertens?o arterial (p=0,001), e inatividade f?sica no lazer (p=0,03). J? para as incapacidades funcionais a preval?ncia foi de 46,8% (n=104) sendo associada ao aumento da idade (p=0,01), hospitaliza??o (p=0,02), aus?ncia de pr?ticas de atividades f?sicas ao longo da vida (p=0,001) e a ocorr?ncia de altera??es na fun??o cognitiva (p=0,001). A tabela normativa para os par?metros de aptid?o f?sica gerada favorece aos profissionais de sa?de no diagn?stico das condi??es de sa?de e na prescri??o de exerc?cios f?sicos. As caracter?sticas identificadas que se associaram ?s limita??es funcionais/incapacidades funcionais sugerem uma complexa rede causal na determina??o da condi??o funcional em mulheres idosas. No entanto, a??es direcionadas ao incentivo da pr?tica de atividades f?sicas no lazer e a preserva??o da fun??o cognitiva podem contribuir para uma vida com mais qualidade a estas pessoas. Esta investiga??o teve a abordagem multidisciplinar ao envolver elementos da psicologia, nutri??o e da Educa??o F?sica na elucida??o do objeto de estudo relacionado ? condi??o funcional de mulheres idosas.