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Low-income Latino immigrants are understudied in elder abuse research. Limited English proficiency, economic insecurity, neighborhood seclusion, a tradition of resolving conflicts within the family, and mistrust of authorities may impede survey research and suppress abuse reporting. To overcome these barriers, promotores, local Spanish-speaking Latinos, were recruited and trained to interview a sample of Latino adults aged 66 and older residing in low-income communities. The promotores conducted door-to-door interviews in randomly selected census tracts in Los Angeles to assess the frequency of psychological, physical, and sexual abuse; financial exploitation; and caregiver neglect. Overall, 40.4% of elderly Latino adults had experienced some form of abuse or neglect within the previous year. Nearly 25% reported psychological abuse, 10.7% physical assault, 9% sexual abuse, and 16.7% financial exploitation, and 11.7% were neglected by their caregivers. Younger age, higher education, and experiencing sexual or physical abuse before age 65 were significant risk factors for psychological, physical, and sexual abuse. Years lived in the United States, younger age, and prior abuse were associated with greater risk of financial exploitation. Years spent living in the United States was a significant risk factor for caregiver neglect. Abuse prevalence was much higher in all mistreatment domains than findings from previous research on community-dwelling elderly adults, suggesting that low-income Latino immigrants are highly vulnerable to elder mistreatment or that respondents are more willing to disclose abuse to promotores who represent their culture and community. [ABSTRACT FROM AUTHOR]

Objectives To determine the association between nurse staffing and postsurgical outcomes for older black adults, including 30-day mortality and failure to rescue. Design A cross-sectional study of University of Pennsylvania Multi- State Nursing Care and Patient Safety Survey data, linked to 2006-2007 administrative patient discharge data from four states ( CA, PA, NJ, FL), American Hospital Association Annual Survey data, and a U. S. Census-derived measure of socioeconomic status ( SES). Risk-adjusted logistic regression models with correction for clustering were used for the analysis. Setting Five hundred ninety-nine adult nonfederal acute care hospitals in California, Pennsylvania, New Jersey, and Florida Participants Five hundred forty-eight thousand three hundred ninety-seven individuals ages 65 and older undergoing general, orthopedic, or vascular surgery (94% white, 6% black). Measurements Thirty-day mortality and failure to rescue (death after a complication). Results In models adjusting for sex and age, 30-day mortality was significantly higher for black than white participants (odds ratio ( OR) = 1.42, 95% confidence interval ( CI) = 1.32-1.52). In fully adjusted models that accounted for SES, surgery type, and comorbidities, as well as hospital characteristics, including nurse staffing, the odds of 30-day mortality were not significantly different for black and white participants. In the fully adjusted models, one additional patient in the average nurse's workload was associated with higher odds of 30-day mortality for all patients ( OR = 1.03, 95% CI = 1.01-1.05). A significant interaction was found between race and nurse staffing for 30-day mortality, such that blacks experienced higher odds of death with each additional patient per nurse ( OR = 1.10, 95% CI = 1.03-1.18) compared to whites ( OR = 1.03, 95% CI = 1.01-1.06). Similar patterns were detected in failure-to-rescue models. Conclusion Older surgical patients experience poorer postsurgical outcomes, including mortality and failure to rescue, when cared for by nurses with higher workloads. The effect of nurse staffing inadequacies is more significant in older black individuals. [ABSTRACT FROM AUTHOR]

Objectives To examine the association between routine physical activity and risk of 3-year mortality in Mexican Americans aged 75 and older. Design Longitudinal study involving a population-based survey. Setting Hispanic Established Population for the Epidemiologic Study of the Elderly ( H- EPESE) survey conducted in the southwestern United States ( TX, CO, AZ, NM, CA). Participants Mexican- American men and women aged 75 and older ( N = 948) participating in the H- EPESE. Measurements Responses to the Physical Activity Scale for the Elderly ( PASE) were assessed in 2005-06. Mortality was determined according to report of relatives at 3-year follow-up and from the National Death Index. Covariates included sociodemographic characteristics, financial strain, smoking status, body mass index, activities of daily living, depressive symptoms, cognitive function, and comorbid conditions. Results The mean age of the sample was 82.2 ± 4.5. Cox proportional hazard regression estimated that the hazard ratios of death for persons in the low, moderate, and high quartiles of physical activity ( PASE scale) ranged from 0.36 (95% confidence interval ( CI) = 0.21-0.62) to 0.50 (95% CI = 0.31-0.82) compared to persons in the sedentary quartile after adjusting for covariates. Conclusion Routine physical activity involving household and leisure activities was associated with lower 3-year risk of mortality in a sample of older Mexican Americans living in the community. [ABSTRACT FROM AUTHOR]

Objectives To examine in cognitively normal elderly adults whether vascular factors predict cognitive decline and whether these associations are mediated by magnetic resonance imaging ( MRI) measures of subclinical vascular brain injury. Design Prospective multisite longitudinal study of subcortical ischemic vascular diseases. Setting Memory and aging centers in California. Participants Seventy-four participants who were cognitively normal at entry and underwent at least two neuropsychological evaluations and two MRI examinations over an average follow-up of 6.9 years. Measurements Item response theory was used to create composite scores of global, verbal memory, and executive functioning. Volumetric MRI measures included white matter hyperintensities ( WMHs), silent brain infarcts ( SBIs), hippocampus, and cortical gray matter ( CGM). Linear mixed-effects models were used to examine the associations between vascular factors, MRI measures, and cognitive scores. Results History of coronary artery disease ( CAD) was associated with greater declines in global cognition, verbal memory, and executive function. The CAD associations remained after controlling for changes in WMHs, SBIs, and hippocampal and CGM volumes. Conclusion History of CAD may be a surrogate marker for clinically significant atherosclerosis, which also affects the brain. Structural MRI measures of WMHs and SBIs do not fully capture the potential adverse effects of atherosclerosis on the brain. Future longitudinal studies of cognition should incorporate direct measures of atherosclerosis in cerebral arteries, as well as more sensitive neuroimaging measures. [ABSTRACT FROM AUTHOR]

Language-related communication barriers between minority patients and their physicians may contribute to racial and ethnic disparities in mental health care. Accordingly, the current study sought to examine whether perceived mental health needs and discussion of these needs differed as a function of race or ethnicity and language concordance in older Latinos and Asian and Pacific Islanders ( APIs). Using the 2007 California Health Interview Survey, the analytical sample included Latinos and APIs aged 55 and older (N = 2,960) who reported having seen a primary care provider within the past 2 years. Multivariable logistic regression was used to examine differences according to race or ethnicity and language concordance status (three groups: English-language concordant, other-language concordant, language discordant) in perceived mental health needs and discussion of those needs with a physician, adjusting for respondents' sociodemographic characteristics and mental health status. There were no significant differences in respondents' perceptions of their mental health needs across race or ethnicity or level of language concordance status ( Ps > .41), although there were significant differences in whether respondents had discussed their mental health needs with their physicians according to participant race or ethnicity and language concordance status (adjusted odds ratio = 0.47, P = .04). Specifically, Spanish language-concordant Latinos were just as likely to discuss their mental health needs with their physicians as English language-concordant Latinos. In contrast, Asian language-concordant APIs were less likely to discuss their mental health needs with their physicians than English language-concordant APIs. There were no significant differences between language-discordant and English language-concordant older adults in predicting discussion of mental health concerns. These findings underscore the importance of overcoming language-related and cultural barriers to improve patient-provider discussions of older adults' mental health needs. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented which is concerned with research which investigated the treatment and outcomes of elderly adults with cerebral aneurysms and subarachnoid hemorrhage at comprehensive stroke centers.