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Objective To explore the accuracy of rehabilitation service use reports by older adults as well as variation in accuracy by demographic characteristics, time since use, duration, and setting (inpatient, outpatient, home). Design Longitudinal observational study. Setting Participants' homes. Participants Community-dwelling adults ages 65 and older (N=4228) in the 2015 National Health and Aging Trends Study who were enrolled in Medicare Parts A and B for 12 months before their interview. Interventions Not applicable. Main Outcome Measures Respondents were asked whether they received rehabilitation services in the past year and the duration and location of services. Healthcare Common Procedure Coding System codes and Revenue Center codes were used to identify Medicare-eligible rehabilitation service. Results Survey-based reports and Medicare claims yielded similar estimates of rehabilitation use over the past year. Self-reported measures had high sensitivity (77%) and positive predictive value (80%) and even higher specificity and negative predictive value (approaching 95%). However, in adjusted models, sensitivity was lower for black enrollees, the very old, and those with lower education levels. Conclusions Survey-based measures of rehabilitation accurately captured use over the past year, but differential reporting should be considered when characterizing rehabilitation use in certain subgroups of older Americans. [ABSTRACT FROM AUTHOR]

Objective To determine the characteristics of community-dwelling older adults receiving fall-related rehabilitation. Design Cross-sectional analysis of the fifth round (2015) of the National Health and Aging Trends Study (NHATS). Fall-related rehabilitation utilization was analyzed using weighted multinomial logistic regression with SEs adjusted for the sample design. Setting In-person interviews of a nationally representative sample of community-dwelling older adults. Participants Medicare beneficiaries from NHATS (N=7062). Interventions Not applicable. Main Outcomes Measures Rehabilitation utilization categorized into fall-related rehabilitation, other rehabilitation, or no rehabilitation. Results Fall status (single fall: odds ratio [OR]=2.96; 95% confidence interval [CI], 1.52–5.77; recurrent falls: OR=14.21; 95% CI, 7.45–27.10), fear of falling (OR=3.11; 95% CI, 1.90–5.08), poor Short Physical Performance Battery scores (score 0: OR=6.62; 95% CI, 3.31–13.24; score 1–4: OR=4.65; 95% CI, 2.23–9.68), and hip fracture (OR=3.24; 95% CI, 1.46–7.20) were all associated with receiving fall-related rehabilitation. Lower education level (less than high school diploma compared with 4-y college degree: OR=.21; 95% CI, .11–.40) and Hispanic ethnicity (OR=.37; 95% CI, .15–.87) were associated with not receiving fall-related rehabilitation. Conclusions Hispanic older adults and older adults who are less educated are less likely to receive fall-related rehabilitation. Recurrent fallers followed by those who fell once in the past year were more likely to receive fall-related rehabilitation than are older adults who have not had a fall in the past year. [ABSTRACT FROM AUTHOR]

Abstract: Race- and poverty-related disparities in physical function are well documented, though little is known about effects of race and poverty on functional decline and the progression of disability. We examined cross-sectional and longitudinal relationships between race, poverty and lower extremity function using data from moderately to severely disabled women in the U.S. Women''s Health and Aging Study. Severity of lower extremity functional limitation was determined from scaled responses of reported difficulty walking ¼ mile, walking across a room, climbing stairs, and stooping, crouching or kneeling. Usual walking speed assessed over 4m was our objective measure of function. Of the 996 women who described themselves as black or white, 284 (29%) were black and 367 (37%) were living at or below 100% of the federal poverty level. Independent of demographic and health-related factors, among white women, the poor exhibited consistently worse lower extremity function than the non-poor; this association, however, was not observed in black women. Among the non-poor, black women had slower walking speeds, and reported more limitation in lower extremity function than their non-poor white counterparts, even after adjusting for demographic variables and health-related characteristics. After 3 years, accounting for baseline function, demographic and health-related factors, race and poverty status were unrelated to functional decline. Thus, while race and poverty status were associated with functional deficits in old age, they do not appear to impact the rate of functional decline or progression of disability over 3 years. [Copyright &y& Elsevier]

Type II diabetes mellitus (DM) is associated with increased risk of dementia; however, few studies have examined the longitudinal association between DM and cognitive outcomes in large nationally representative cohorts. We investigated these associations in 7605 participants enrolled in the National Health and Aging Trends Study, a nationally representative prospective study of Medicare beneficiaries ≥65, from 2011 to 2015. Participants or proxy respondents reported DM and dementia diagnosis, and participants completed immediate and delayed recall word list learning tests and the Clock Drawing Test. In multivariable-adjusted generalized linear mixed models, baseline DM diagnosis was associated with decline on immediate and delayed word recall and the Clock Drawing Test. In Cox proportional hazards models, DM also predicted incident dementia in older age groups at baseline. These findings further support the notion that DM is associated with cognitive outcomes, suggesting that treatment and prevention of DM may reduce the risk of these outcomes. However, more studies are needed to better understand whether DM treatments affect this relationship. [ABSTRACT FROM AUTHOR]

To examine whether physical frailty onset before, after, or in concert with cognitive impairment is differentially associated with fall incidence in community-dwelling older adults. A longitudinal observational study. Data from 1337 older adults age ≥65 years and free of physical frailty or cognitive impairment at baseline were obtained from the National Health Aging Trends Study (2011‒2017), a nationally representative cohort study of US older adult Medicare beneficiaries. Participants were assessed annually for frailty (physical frailty phenotype) and cognitive impairment (bottom quintile of clock drawing test or immediate and delayed recall; or proxy-report of diagnosis of dementia or AD8 score of ≥2). Incident falls were ascertained annually via self-report. Multinomial logistic regression was performed to estimate the association between order of first onset of cognitive impairment and/or frailty and incident single or repeated falls in the 1-year interval following their first onset. Of the 1,337, 832 developed cognitive impairment first (termed "CI first"), 286 developed frailty first (termed "frailty first") and 219 had co-occurrence of cognitive impairment and frailty within one year (termed "CI-frailty co-occurrence") over 5 years. Overall, 491 (34.5%) had at least 1 fall during the 1-year interval following the onset of physical frailty and/or cognitive impairment. After adjustment, "CI-frailty co-occurrence" was associated with a more than 2-fold increased risk of repeated falls than "CI first" (odds ratio 2.35, 95% confidence interval 1.51‒3.67; P <.001). No significant difference was found between participants with "frailty first" and "CI first" (P =.07). In addition, the order of onset was not associated with risk of a single fall. Older adults experiencing "CI-frailty co-occurrence" had the greatest risk of repeated falls compared with those with "CI first" and "frailty first". Fall risk screening should consider the order and timing of onset of physical frailty and cognitive impairment. [ABSTRACT FROM AUTHOR]

Objective: To assess whether loss of consistency or systematic measurement error is introduced by allowing older individuals to use a cane during measurement of self-selected walking speed (SSWS).Study Design and Setting: Observational study of women aged 65+ (Women's Health and Aging Study I, n=1,002).Results: Of individuals who use a cane in daily life, 201 (50.76%) did not use an aid during testing. The Coefficient of Variation was low in individuals who reported cane use in daily life but did not use one in testing (10.72%), and did not vary substantially if a cane was used (12.04%). The Intra-Class Correlation Coefficient was high: 0.958 for those who reported cane use in daily life but did not use one during testing and 0.962 for those who used a cane. In both groups, Bland-Altman plots revealed a small systematic difference between the first and second trials. There was no evidence of effect modification of the association between SSWS and mobility disability by cane use during testing.Conclusion: This observational study found neither evidence of poorer consistency nor increased measurement bias in SSWS recorded while using a cane compared to using no assistive device. [ABSTRACT FROM AUTHOR]

Objectives: To quantify and characterize the chronic conditions of older Americans who live in nursing homes (NHs) but have minimal disability and might be able to live in less restrictive and less expensive settings. Design: Secondary analysis of the 1999 National Nursing Home Survey. Participants: NH staff memebers familiar with the care of residents who were 65 years or older and had resided in the NH for more than 100 days. Measurements: We defined “higher-functioning” residents as those who received help from NH staff in 0-2 activities of daily living. We then classified these higher-functioning residents according to their conditions requiring chronic care: impaired mobility, conditions requiring rehabilitation, mental health disorders, incontinence, severe sensory impairment, and medical conditions (congestive heart failure, chronic obstructive pulmonary disease, diabetes mellitus, Parkinson’s disease). Results: One-fifth (19.8%) of the NH residents met the criteria for “higher-functioning” (n=1145). Of these, 64.1% had mental disorders, 40.4% had impaired mobility, 20.6% were incontinent, 18% had conditions requiring rehabilitative therapy, 8.7% had severe sensory impairment, and 43.0% had one or more of the four medical diagnoses. Conclusion: Many higher-functioning long-stay nursing home residents have chronic care needs that are similar to those of older adults who live in private residences. Many such persons may be able to live in community settings. [Copyright &y& Elsevier]