Home health care workers for community-dwelling adults and play an important role in supporting patients with confirmed suspected coronavirus disease 2019 (COVID-19) who remain at home. These are mostly middle-aged women racial/ethnic minorities typically earn low wages. Despite being integral to patient care, these often neglected by the medical community society large; thus, developing a system capable of addressing COVID-19 crisis future pandemics requires better understanding experiences...

Understanding how wealth influences the end-of-life experience is crucial for improving patient care and policy, particularly with regard to symptom burden. To examine prevalence of 12 symptoms by categories; association between a composite measure high burden; whether this mediated multimorbidity, functional impairment, or dementia. This cohort study used data from Health Retirement Study (HRS), nationally representative survey older adults in US, on decedents who died January 1, 2000,...

opioids months later?We do know that indiscriminate opioid use has been responsible for a lot of pain, suffering, and death in the US, we must seriously consider any all attempts to relieve pain suffering associated with overuse opioids.Restricting initial prescriptions 7 or fewer days is reasonable because patients new onset should be reevaluated week if continues.But worry restricting shorter periods, such as 3 5 days, occurred 6 states this study, may result acute going untreated having...

Greater purpose in life is associated with lower rates of certain chronic diseases. Whether can protect against development prediabetes or type 2 diabetes unknown. To examine the association between and blood glucose control among adults ≥50 years. We conducted a longitudinal cohort study 3,907 participants Health Retirement Study who at baseline did not have prediabetes. Baseline was measured using Ryff Keyes' Scales Psychological Well-Being grouped into tertiles (high, medium, low). used...

The Medicare hospice benefit was originally designed around a cancer disease paradigm but increasingly serves people living with dementia. At this time, almost half of all older adults receiving care have Yet there is minimal evidence as to whether benefits dementia outside nursing facilities. We asked and how the perceived quality last-month-of-life differed between without use among associated compared for those who did not hospice. used nationally representative data from National Health...

To measure the association between spousal depression, general health, fatigue and sleep, future care recipient healthcare expenditures emergency department (ED) use.Prospective cohort study.Health Retirement Study.Home-dwelling dyads in which one individual (care recipient) was aged 65 older had or more activity of daily living instrumental disabilities enrolled Medicare Part B (N = 3,101).Caregiver sleep (Jenkins Sleep Scale), depressive symptoms (Center for Epidemiologic Studies...

BACKGROUND/OBJECTIVES Hospice care confers well‐documented benefits to patients and their families, but it is underutilized. One potential reason inadequate family support make end‐of‐life decisions for older adults on hospice at home. We assessed the association between amount of use among a population decedents specific illness types. DESIGN Prospective cohort study using National Health Aging Trends Study waves 2011 2017, linked Medicare claims data. SETTING Contiguous United States....

Abstract Background/Objectives The majority of end‐of‐life (EOL) caregiving is provided by unpaid family members. An increasing number older adults are kinless (without close family/partnerships) and may have insufficient caregiver support to remain at home the EOL. We therefore determined what proportion EOL assessed association kinlessness with care. Design Retrospective analysis Health Retirement Study decedents, 2002–2015. Setting US population‐based sample. Participants Decedents age...

This study assesses whether Medicare Advantage enrollment was associated with greater racial and ethnic disparities in home health use during the last year of life compared traditional Medicare.

Background Many older adults with trauma have pre-existing serious illness like dementia, frailty, and organ insufficiency are candidates for palliative care to improve outcomes reduce downstream healthcare utilization. We hypothesize that baseline pain, depressive symptoms, unpaid caregiving needs associated increased utilization in the year after admission seriously ill adults. Methods Using Health Retirement Study (2008–2018) linked Medicare claims, we identified aged ≥66 years admitted...

This study investigates disparities between older adults based on urbanicity in the United States. We analyzed data from 8259 participants aged 65+ 2018 Health and Retirement Study. The mean age was 74 (SD 8). Low-urbanicity (29%) were more likely white (88% vs. 77%, p < .001), had lower education (20% 16%, -value = .017), higher rates of hypertension (69% 66.3%, .035), lung disease (15% 11%, =<.001), cognitive impairment (24% 19%, .001). After adjustment for demographics, they less...

Medicare Advantage (MA) plans have increasing flexibility to provide nonmedical services support older adults aging in place the community. However, prior research has suggested that enrollees with functional disability (hereafter, "disability") were more likely than those without leave MA plans. This indicates might not meet needs of disability. We used data for 2011–16 from National Health and Aging Trends Study linked claims measure characterize switches either direction between...

BACKGROUND/OBJECTIVE Depression impacts quality of life at all stages, but the epidemiology depression in last year is unknown. This study's objectives were to document depressive symptoms prior death and assess how trajectory varies by sociodemographic clinical factors. DESIGN Observational, cross‐sectional, cohort study using Health Retirement Study. SETTING Population‐based survey. PARTICIPANTS A total 3274 individuals who died within 12 months after assessment. MEASURES Primary outcome:...

Abstract Background/Objectives Approximately 2 million people, or 6% of older adults in the United States, are homebound. In cross‐sectional studies, homebound have high levels morbidity and mortality, but there is little evidence longitudinal outcomes after becoming The aim this research to prospectively assess over 6 years dynamics status, ongoing community residence, death a population community‐dwelling who newly Design/setting Prospective cohort study using 2011–2018 data from National...

Abstract Background Over the past decade, medical care has shifted from institutions into home settings—particularly among persons with dementia. Yet it is unknown how home‐based clinical services currently support dementia, and what factors shape access. Methods Using National Health Aging Trends Study linked to Medicare claims 2012–2017, we identified 6664 community‐dwelling adults age ≥ 70 years enrolled in fee‐for‐service Medicare. Annual assessment of dementia status was determined via...

Background: Hospice use among Medicare decedents increased from 21.6% in 2000 to 51.6% 2019. Whether this growth has been accompanied by more referrals hospice directly the community is not known. Objective: To assess trends place of care before enrollment. Design: Retrospective cohort 2011 2018. Subjects: age ≥66 years. Measure: Location enrollment last 90 days life, defined as: with and without home health, short- or long-term nursing facility, inpatient hospital. A county-level random...

Variants in the CDKN2A tumor suppressor are associated with Familial Melanoma (FM), although for many variants linkage is weak. The effects of missense on protein function and pathogenicity often unclear. Multiple methods (e.g., laboratory, computational, epidemiological) have been developed to analyze whether a variant pathogenic or not. It not yet clear how integrate these data types into strategy classification. We studied 51 using cell cycle arrest assay. There was continuum results...

<h3>PURPOSE</h3> Variation in end-of-life care the United States is frequently driven by health system. We assessed association of primary physician involvement at end life with patterns. <h3>METHODS</h3> analyzed 2010 Medicare Part B claims data for US hospital referral regions (HRRs). The independent variable was ratio physicians to specialist visits last 6 months life. Dependent variables included rate deaths, and intensive use life, percentage patients seen more than 10 physicians,...

This study assesses patterns of caregiving, death, and recovery after incident disability in older adults. We used the Health Retirement Study to follow a cohort adults age ≥65 years United States with activities daily living (ADLs) or instrumental (IADLs; n = 8,713). Rates care function state were assessed biennially: deceased, nursing home dwelling, at paid help, both unpaid no assistance recovered. In 2 disability, 22.1% recovered 46.8% died. Transitions between states occurred...

IMPORTANCE A large and growing population of older adults with multimorbidity, cognitive impairment, functional disability live in the community, but many never or rarely leave their homes. Being homebound is associated decreased access to medical services, poor health outcomes, increased mortality. Yet, it unknown what factors, particular socioeconomic are new onset status. OBJECTIVE To evaluate association between income risk becoming homebound. DESIGN Observational cohort study using 2011...

Abstract Background As more Americans age in place, it is critical to understand care delivery the home. However, data on range of home-based services provided by Medicare limited. We define a taxonomy clinical home funded through fee-for-service and methods identify receipt those services. Methods analyzed Fee-for-service (FFS) claims from nationally-representative cohort older adults, National Health Aging Trends Study (NHATS), care. included 6,664 NHATS enrollees ≥ 70 living community,...