Background: Misclassification of Medicare beneficiaries’ race/ethnicity in administrative data sources is frequently overlooked and a limitation in health disparities research. Objective: To compare the validity of 2 race/ethnicity variables found in Medicare administrative data [enrollment database (EDB) and Research Triangle Institute (RTI) race] against a gold-standard source also available in the Medicare data warehouse: the self-reported race/ethnicity variable on the home health Outcome and Assessment Information Set (OASIS). Subjects: Medicare beneficiaries over the age of 18 who received home health care in 2015 (N=4,243,090). Measures: Percent agreement, sensitivity, specificity, positive predictive value, and Cohen κ coefficient. Results: The EDB and RTI race variable have high validity for black race and low validity for American Indian/Alaskan Native race. Although the RTI race variable has better validity than the EDB race variable for other races, κ values suggest room for future improvements in classification of whites (0.90), Hispanics (0.87), Asian/Pacific Islanders (0.77), and American Indian/Alaskan Natives (0.44). Discussion: The status quo of using “good-enough for government” race/ethnicity variables contained in Medicare administrative data for minority health disparities research can be improved through the use of self-reported race/ethnicity data, available in the Medicare data warehouse. Health services and policy researchers should critically examine the source of race/ethnicity variables used in minority health and health disparities research. Future work to improve the accuracy of Medicare beneficiaries’ race/ethnicity data should incorporate and augment the self-reported race/ethnicity data contained in assessment and survey data, available within the Medicare data warehouse.

Objective: To test the hypothesis that hospitalization in old age is associated with subsequent cognitive decline. Methods:As part of a longitudinal population-based cohort study, 1,870 older residents of an urban community were interviewed at 3-year intervals for up to 12 years. The interview included a set of brief cognitive tests from which measures of global cognition, episodic memory, and executive function were derived. Information about hospitalization during the observation period was obtained from Medicare records.Results: During a mean of 9.3 years, 1,335 of 1,870 persons (71.4%) were hospitalized at least once. In a mixed-effects model adjusted for age, sex, race, and education, the global cognitive score declined a mean of 0.031 unit per year before the first hospitalization compared with 0.075 unit per year thereafter, a more than 2.4-fold increase. The posthospital acceleration in cognitive decline was also evident on measures of episodic memory (3.3-fold increase) and executive function (1.7-fold increase). The rate of cognitive decline after hospitalization was not related to the level of cognitive function at study entry (r ϭ 0.01, p ϭ 0.88) but was moderately correlated with rate of cognitive decline before hospitalization (r ϭ 0.55, p ϭ 0.021). More severe illness, longer hospital stay, and older age were each associated with faster cognitive decline after hospitalization but did not eliminate the effect of hospitalization. Conclusion:In old age, cognitive functioning tends to decline substantially after hospitalization even after controlling for illness severity and prehospital cognitive decline. Neurology ® 2012;78:950-956

The intricate cultural and linguistic diversity among U.S. Chinese older adults, coupled with their demographic characteristics and residential pattern, present challenges and opportunities in implementing a population-based study of older adults. Implications for the research and practice in relation to future minority aging and social sciences studies are discussed.

This study aims to investigate the prevalence of elder abuse and neglect in an urban Chinese population. A cross-sectional study was performed in a major urban medical center in NanJing, China. A total of 412 participants completed the survey and 145 (35%) participants screened positive for elder abuse and neglect. The mean age of the victims was 69 years and 59% were male. Caregiver neglect was the most common form of abuse, followed by financial exploitation, psychological abuse, physical abuse, sexual abuse, and abandonment. Thirty-six percent of the victims suffered multiple forms of abuse and neglect. In the logistical regression analyses of the data, female gender, lower education and lower income were demographic risk factors associated with elder abuse and neglect. A better understanding of these and additional risk factors associated with elder abuse and neglect in older Chinese people is needed.

Our recent survey of an elderly cohort in mainland China suggests that elder abuse and neglect are common. Unfortunately, there is minimal knowledge about the risk factors for elder abuse and neglect among this population. We aimed to examine depression as a risk factor for elder abuse and neglect among Chinese elderly. A cross-sectional study was performed in a major urban medical center in NanJing, China. Depression was assessed using the Geriatric Depression Scale and direct questions were asked regarding abuse and neglect experienced by the elderly since the age of 60; 412 patients completed the survey. The mean age of the participants was 70 and 34% were female. Depression was found in 12% of the participants and elder abuse and neglect was found in 35% of the participants. After multiple logistical regression, feeling of dissatisfaction with life (OR, 2.92; 95% CI, 1.51-5.68, p < 0.001), often being bored (OR, 2.91; CI, 1.53-5.55, p < 0.001), often feeling helpless (OR, 2.79; CI, 1.35-5.76, p < 0.001), and feeling worthless (OR, 2.16; CI, 1.10-4.22, p < 0.001) were associated with increased risk of elder abuse and neglect. Multiple logistic regression modeling showed that depression is independently associated with elder abuse and neglect (OR, 3.26; CI, 1.49-7.10, p < 0.003). These findings suggest that depression is a significant risk factor associated with elder abuse and neglect among Chinese elderly.

Background: While decreased hemoglobin concentration is common in the elderly, the relationship of the entire range of hemoglobin concentrations with cognitive function is not well understood. Methods: Cross-sectional analyses were conducted utilizing data from community-dwelling, older persons participating in the Rush Memory and Aging Project. Proximate to first available hemoglobin measurement, 21 cognitive tests were administered to measure global cognitive function along with semantic memory, episodic memory, working memory, perceptual speed and visuospatial abilities. Results: For 793 participants without clinical dementia, stroke or Parkinson’s disease, the mean age was 81.0 years (SD = 7.2); 595 (75%) were women, and 94% were white. The mean hemoglobin concentration was 13.3 g/dl (SD = 1.3). 17% of the cohort had anemia. Using linear regression models adjusted for age, education, gender, body mass index, mean corpuscular volume and glomerular filtration rate, both low and high hemoglobin levels were associated with lower global cognitive function (parameter estimate = –0.015, SE = 0.007, p = 0.019). Low and high hemoglobin levels were associated with worse performance on semantic memory (parameter estimate = –0.201, SE = 0.008, p = 0.010) and perceptual speed (parameter estimate = –0.030, SE = 0.010, p = 0.004), but not the other specific cognitive functions. Conclusions: Low and high hemoglobin concentrations in older persons are associated with a lower level of cognitive function in old age, particularly in semantic memory and perceptual speed.

Elder abuse and psychological distress are both important geriatric syndromes and are independently associated with premature morbidity and mortality. Despite recent advances, there has been little systematic exploration of the association between elder abuse and psychological distress. This systematic review synthesizes the qualitative and quantitative studies on the relationship between elder abuse and psychological distress, namely psychological distress as a risk factor and/or a consequence of elder abuse. Moreover, through this review, future research directions for elder abuse and psychological distress and their implications for practice and policy to improve the health and aging of vulnerable populations are also highlighted.

This qualitative study aims to investigate the cultural understandings of loneliness, identify the contexts of loneliness, and to examine its effect on the health and well-being of U.S. Chinese older adults. Despite loneliness is one of the main indicators of well-being, little attention has been paid to understanding loneliness among immigrant older adults. This study utilizes both survey questionnaires and semi-structured focus group methods to investigate the feelings of loneliness among U.S. Chinese older adults. Based on interviews with 78 community-dwelling Chinese older adults in Chicago Chinatown, this community-based participatory research study (CBPR) shows loneliness is common among U.S. Chinese older adults. It was frequently identified through emotional isolation and social isolation. Social, psychological and physical health factors could contribute to the experience of loneliness. In addition, the health of older adults with loneliness may be associated with worsening overall health, elder mistreatment, health behavior changes and increased health care utilizations. This study has implications for healthcare professionals, social services agencies and policy makers. Our findings point to the needs for healthcare professionals to be more alert of the association of loneliness and adverse health outcomes. Communities and social services agencies should collectively take a lead in reducing social isolation, improving intergenerational relationships, and increasing social networks and companionship for this group of vulnerable older adults.