American indian older adult

IMPORTANCE: Federal and state policymakers continue to pursue work requirements and premiums as conditions of Medicaid participation. Opinion polling should distinguish between general policy preferences and specific views on quotas, penalties, and other elements. OBJECTIVE: To identify views of adults in Kentucky regarding the design of Medicaid work requirements and premiums. DESIGN, SETTING, AND PARTICIPANT: A cross-sectional survey was conducted via telephone and the internet from June 27 through July 11, 2019, of 1203 Kentucky residents 9 months before the state intended to implement Medicaid work requirements and mandatory premiums...

IMPORTANCE: Nomenclature in the field of neurodegenerative diseases presents a challenging problem. Inconsistent use of terms such as Alzheimer disease and dementia has compromised progress in clinical care, research, and development of therapeutics. Dementia-associated stigma further contributes to inconsistent and imprecise language. The result is a lack of clarity that produces confusion with patients and the general public and presents communication challenges among researchers. Therefore, the Advisory Council on Research, Care, and Services of the National Plan to Address Alzheimer's Disease authorized a committee to make recommendations for improvement...

BACKGROUND: Because COVID-19 case data do not capture most SARS-CoV-2 infections, the actual risk of severe disease and death per infection is unknown. Integrating sociodemographic data into analysis can show consequential health disparities. METHODS: Data from September 2020--November 2021 from six national surveillance systems in matched geographical areas were merged and analyzed to estimate numbers of COVID-19-associated cases, emergency department visits, and deaths per 100,000 infections...

The American Society of Bone and Mineral Research (ASBMR) Professional Practice Committee charged an ASBMR Task Force on Clinical Algorithms for Fracture Risk to review the evidence on whether current approaches for differentiating fracture risk based on race and ethnicity are necessary and valid. To help address these charges, we performed a systematic literature review investigating performance of calculators for predicting incident fractures within and across race and ethnicity groups in middle-aged and older US adults...

BACKGROUND AND OBJECTIVES: Mortality rates for neurologic diseases are increasing in the United States, with large disparities across geographical areas and populations. Racial and ethnic populations, notably the non-Hispanic (NH) Black population, experience higher mortality rates for many causes of death, but the magnitude of the disparities for neurologic diseases is unclear. The objectives of this study were to calculate mortality rates for neurologic diseases by race and ethnicity and-to place this disparity in perspective-to estimate how many US deaths would have been averted in the past decade if the NH Black population experienced the same mortality rates as other groups...

OBJECTIVES: The sociohistorical experiences of Asian American older adults (AAOA) vary, but limited research has examined how immigration status operates as social determinants. This study builds on an existing framework to examine the relationship among social determinants and the differential effects of immigration status on cognitive difficulties among AAOA. METHODS: Using 5-year estimate data from the 2019 American Community Survey, the study sample consisted of AAOA aged 65 years and older identifying as Chinese, Filipino, Indian, Japanese, Korean or Vietnamese (N=100,584)...

IMPORTANCE: Inadequate representation of older patients, women, and racial minority individuals in cardiovascular clinical trials limits both the generalizability of trial findings and inclusivity in access to novel therapies and therapeutic strategies. OBJECTIVE: To report on temporal trends in the representation of older patients, women, and racial and ethnic minority individuals in clinical trials studying treatments for valvular heart disease. EVIDENCE REVIEW: All published clinical trials enrolling more than 100 adults with any valvular heart disease published between 2005 and 2020 were included after searches with PubMed and ClinicalTrials...

IMPORTANCE: Social isolation is associated with adverse health outcomes, yet its implications for hospitalization and nursing home entry are not well understood. OBJECTIVE: To evaluate whether higher levels of social isolation are associated with overnight hospitalization, skilled nursing facility stays, and nursing home placement among a nationally representative sample of community-dwelling older adults after adjusting for key health and social characteristics, including loneliness and depressive symptoms...

IMPORTANCE: The Deterioration Index (DTI), used by hospitals for predicting patient deterioration, has not been extensively validated externally, raising concerns about performance and equitable predictions. OBJECTIVE: To locally validate DTI performance and assess its potential for bias in predicting patient clinical deterioration. DESIGN, SETTING, AND PARTICIPANTS: This retrospective prognostic study included 13 737 patients admitted to 8 heterogenous Midwestern US hospitals varying in size and type, including academic, community, urban, and rural hospitals...

IMPORTANCE: Current data identifying COVID-19 risk factors lack standardized outcomes and insufficiently control for confounders. OBJECTIVE: To identify risk factors associated with COVID-19, severe COVID-19, and SARS-CoV-2 infection. DESIGN, SETTING, AND PARTICIPANTS: This secondary cross-protocol analysis included 4 multicenter, international, randomized, blinded, placebo-controlled, COVID-19 vaccine efficacy trials with harmonized protocols established by the COVID-19 Prevention Network...

IMPORTANCE: Older patients using many prescription drugs (hyperpolypharmacy) may be at increased risk of adverse drug effects. OBJECTIVE: To test the effectiveness and safety of a quality intervention intended to reduce hyperpolypharmacy. DESIGN, SETTING, AND PARTICIPANTS: This randomized clinical trial allocated patients 76 years or older who used 10 or more prescription medications to a deprescribing intervention or to usual care (1:1 ratio) at an integrated health system with multiple preexisting deprescribing workflows...

BACKGROUND: Prior studies have reported a reversal or stalling of stroke mortality trends in the United States, but the literature has not been updated using recent data. A comprehensive examination of contemporary trends is crucial to informing public health intervention efforts, setting health priorities, and allocating limited health resources. This study assessed the temporal trends in stroke death rates in the United States from 1999 through 2020. METHODS: We used national mortality data from the Underlying Cause of Death files in the Centers for Disease Control and Prevention's Wide-ranging Online Data for Epidemiologic Research (WONDER)...

Although substance misuse (primarily alcohol and prescribed benzodiazepines and opioids) among Americans aged ≥60 years is becoming an escalating health concern, substance use disorder (SUD) is often underestimated and/or undiagnosed, preventing older adults from receiving needed treatment. Chronic medical conditions, mental health issues, and psychosocial stressors increase older adults' risks for developing SUD. Racial/ethnic minority groups (e.g., American Indian, Alaska Native) experiencing health care inequities and limited resources are more vulnerable to developing SUD...

IMPORTANCE: Limiting the use of high-risk medications (HRMs) among older adults is a national priority to provide a high quality of care for older beneficiaries of both Medicare Advantage and traditional fee-for-service Medicare Part D plans. OBJECTIVE: To evaluate the differences in the rate of HRM prescription fills among beneficiaries of traditional Medicare vs Medicare Advantage Part D plans and to examine the extent to which these differences change over time and the patient-level factors associated with higher rates of HRMs...

BACKGROUND: Participation and active engagement in meaningful activities support the emotional and physical well-being of older adults. In 2020, the onset of the COVID-19 pandemic altered lives, including the ability to participate in meaningful activities. This study compared meaningful activity engagement before and at the beginning of the COVID-19 pandemic in a nationally representative, diverse sample >65 years between 2015 and 2020. METHODS: We described the proportions and characteristics of National Health and Aging Trends Study participants and their engagement in four activities: visiting friends or family, attending religious services, participating in clubs/classes/other organized activities, and going out for enjoyment...

IMPORTANCE: The incidence of melanoma in situ (MIS) is increasing more rapidly than any invasive or in situ cancer in the US. Although more than half of melanomas diagnosed are MIS, information about long-term prognosis following a diagnosis of MIS remains unknown. OBJECTIVE: To evaluate mortality and factors associated with mortality after a diagnosis of MIS. DESIGN, SETTING, AND PARTICIPANTS: This population-based cohort study of adults with a diagnosis of first primary MIS from 2000 to 2018 included data from the US Surveillance, Epidemiology, and End Results Program, which were analyzed from July to September 2022...

OBJECTIVES: This study aimed to evaluate the diversity of clinical trials informing assessments conducted by the Institute for Clinical and Economic Review (ICER). METHODS: This was a cross-sectional study of pivotal trials included in completed ICER assessments over 5 years (2017 -2021). Representation of racial/ethnic minority groups, females, and older adults was compared to the disease-specific- and US-population, using a relative representation cut-off of 0...

IMPORTANCE: Discussions about goals of care are important for high-quality palliative care yet are often lacking for hospitalized older patients with serious illness. OBJECTIVE: To evaluate a communication-priming intervention to promote goals-of-care discussions between clinicians and hospitalized older patients with serious illness. DESIGN, SETTING, AND PARTICIPANTS: A pragmatic, randomized clinical trial of a clinician-facing communication-priming intervention vs usual care was conducted at 3 US hospitals within 1 health care system, including a university, county, and community hospital...

OBJECTIVE: To characterise risk factors for fatal drowning in California, USA to inform priorities for prevention, policy and research. METHODS: This retrospective population-based epidemiological review of death certificate data evaluated fatal drowning events in California from 2005 to 2019. Unintentional, intentional, and undetermined drowning deaths and rates were described by person (age, sex, race) and context-based variables (region and body of water). RESULTS: California's fatal drowning rate was 1...

IMPORTANCE: Addiction treatment rapidly transitioned to a primarily telehealth modality (telephone and video) during the COVID-19 pandemic, raising concerns about disparities in utilization. OBJECTIVE: To examine whether there were differences in overall and telehealth addiction treatment utilization after telehealth policy changes during the COVID-19 pandemic by age, race, ethnicity, and socioeconomic status. DESIGN, SETTING, AND PARTICIPANTS: This cohort study examined electronic health record and claims data from Kaiser Permanente Northern California for adults (age ≥18 years) with drug use problems before the COVID-19 pandemic (from March 1, 2019, to December 31, 2019) and during the early phase of the COVID-19 pandemic (March 1, 2020, to December 31, 2020; hereafter referred to as COVID-19 onset)...