Faculty Bibliography

Falls are common events that threaten the independence and health of older adults. Studies have found a wide range of fall statistics in different ethnic and racial groups throughout the world. These studies suggest that fall rates may differ between different racial and ethnic groups. Studies also suggest that the location of falls, circumstances of falls, and particular behaviors may also be different by population. Also migration to new locations may alter an individual's fall risk. However, there are few studies that directly compare ethnic and racial differences in falls statistics or examine how known fall risk factors change based on race and ethnicity. This paper reviews the existing literature on how falls may differ between different racial and ethnic groups, highlights gaps in the literature, and explores directions for future research. The focus of this paper is community dwelling older adults and immigrant populations in the United States.

OBJECTIVES: To determine whether greater burden of geriatric conditions would have contrasting effects on quality of care (QOC) than nongeriatric, general medical conditions. DESIGN: Cross-sectional observation over 1 year of ambulatory care. SETTING: The Assessing Care of Vulnerable Elders-2 study. PARTICIPANTS: Older adults prospectively screened for falls, incontinence, and dementia (N = 644). MEASUREMENTS: Participant-level QOC in absolute percentage points calculated using 65 ambulatory care care-process quality indicators (QIs) for 13 general medical and geriatric conditions (#QIs provided/#QIs eligible). Secondary outcomes were geriatric QOC (a subset of 38 geriatric care QIs) and medical QOC (the 27 remaining nongeriatric QIs). Exposure variables were number of six medical conditions (medical comorbidity) and six geriatric conditions (geriatric comorbidity), controlling for age, sex, number of primary care visits, and site. RESULTS: Medical and geriatric comorbidity were unrelated to each other (correlation coefficient = 0.04, P = .27) yet had opposite effects on QOC. Each additional medical condition was associated with a 3.2-percentage point (95% confidence interval (CI) = 2.3-4.2 percentage point) increment in QOC, and each additional geriatric condition was associated with 4.9-percentage point (95% CI = 3.5-6.5 percentage point) decrement in QOC. Participants with greater geriatric comorbidity received poorer medical and geriatric QOC. CONCLUSION: Greater burden of geriatric conditions, or geriatric multimorbidity, is associated with poorer QOC. Geriatric multimorbidity should be targeted for better care using a comprehensive approach.

Falling is expected to increase among older adults due to demographic shifts. We investigated the epidemiology of falling in the U.S. from 1998 to 2010, hypothesizing that any increase would be due to changes in the population's age-structure. We used data from 7 waves (1998-2010) of the Health and Retirement Study, a nationally-representative longitudinal health survey. The sample included adults >65 years (n>10,590 for each wave). We defined falling as >1 self-reported falls in the prior 2 years. Covariates included: sociodemographic characteristics, 6 diseases, 4 geriatric conditions, body mass index, and participation in prior waves. Cross-sectional and longitudinal analyses used age-stratified logistic models to investigate fall prevalence across waves. Fall prevalence increased from 28.2% (1998) to 36.3% (2010). Fall injury showed no change in prevalence. Stratifying by age (1 year age cohorts), fall prevalence increased from 1998 to 2010 for adults age 65 to 82 years (Figure). Using fully adjusted age-stratified logistic models across waves, linear time predicted increased fall prevalence for all but 3 age strata (p<.05). Increased fall prevalence was not associated with respondents' participation in prior interview waves (either immediate preceding wave or total number of waves). Contrary to our hypothesis, the increase in fall prevalence (1998-2010) is not largely due to demographic changes. Rather, more older adults (at each year of age from 65 to 82) reported falling. A next step is to examine whether this increase in self-report is due to an increase in fall prevalence or an increase in falls awareness. (Figure presented)

40% of Medicare beneficiaries with diabetes (DM) are >76 years. This group is not included in clinical trials, so we have poor understanding of DM's natural history in this population and limited evidence to guide its treatment. We hypothesized that 1) clinical databases can provide valuable information about this group and 2) compared to other ages, DM patients >76 years have differing trajectories for hemoglobin A1c (A1c), LDL cholesterol, and systolic/ diastolic blood pressures (SBP/

Background: Improving quality of care for people with multiple chronic conditions (MCCs) requires performance measures reflecting the heterogeneity and scope of their care. Since most existing measures are disease specific, performance measures must be refined and new measures must be developed to address the complexity of care for those with MCCs. Objectives: To describe development of the Performance Measurement for People with Multiple Chronic Conditions (PM-MCC) conceptual model. Study Design: Framework development and a national stakeholder panel. Methods: We used reviews of existing conceptual frameworks of performance measurement, review of the literature on MCCs, input from experts in the multistakeholder Steering Committee, and public comment. Results: The resulting model centers on the patient and family goals and preferences for care in the context of multiple care sites and providers, the type of care they are receiving, and the national priority domains for healthcare quality measurement. Conclusions: This model organizes measures into a comprehensive framework and identifies areas where measures are lacking. In this context, performance measures can be prioritized and implemented at different levels, in the context of patients' overall healthcare needs.

OBJECTIVE: To describe the prevalence of physical function limitations among a nationally representative sample of adults with prediabetes. RESEARCH DESIGN AND METHODS: We performed a cross-sectional analysis of 5,991 respondents>/=53 years of age from the 2006 wave of the Health and Retirement Study. All respondents self-reported physical function limitations and comorbidities (chronic diseases and geriatric conditions). Respondents with prediabetes reported no diabetes and had a measured glycosylated hemoglobin (HbA1c) of 5.7-6.4%. Descriptive analyses and logistic regressions were used to compare respondents with prediabetes versus diabetes (diabetes history or HbA1c>/=6.5%) or normoglycemia (no diabetes history and HbA1c<5.7%). RESULTS: Twenty-eight percent of respondents>/=53 years of age had prediabetes; 32% had mobility limitations (walking several blocks and/or climbing a flight of stairs); 56% had lower-extremity limitations (getting up from a chair and/or stooping, kneeling, or crouching); and 33% had upper-extremity limitations (pushing or pulling heavy objects and/or lifting>10 lb). Respondents with diabetes had the highest prevalence of comorbidities and physical function limitations, followed by those with prediabetes, and then normoglycemia (P<0.05). Compared with respondents with normoglycemia, respondents with prediabetes had a higher odds of having functional limitations that affected mobility (odds ratio [OR] 1.48), the lower extremities (OR 1.35), and the upper extremities (OR 1.37) (all P<0.01). The higher odds of having lower-extremity limitations remained after adjusting for age, sex, and body mass index (OR 1.21, P<0.05). CONCLUSIONS: Comorbidities and physical function limitations are prevalent among middle-aged and older adults with prediabetes. Effective lifestyle interventions to prevent diabetes must accommodate physical function limitations.