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Older adults with multimorbidity are susceptible to shingles due to deterioration of immune function related to coexisting chronic disorders and immunological change. Although the association between individual chronic diseases and incident shingles has been documented, little is known about the effect of having multiple conditions on the risk for developing a new case of the disease. Multimorbidity is a normal condition with advanced aging. This paper examines risk of shingles onset associated with multimorbidity defined as having one or more chronic diseases including hypertension, diabetes, cancer, heart disease, lung disease, arthritis, and stroke) among older American. Data for this study come from the 1992 -2016 Health and Retirement Study. The study finds that risk for onset of shingles linearly increases with number of chronic disorders when age, gender, and race/ethnicity were adjusted (adjusted OR: 1.58, 95% CI; 1.37, 1.80 for those with 1 chronic condition vs adjusted OR: 3.43, 95% CI: 2.21, 5.53 for those with 6 conditions). The risks for multimorbidity were little changed after additional adjustments for socioeconomic status and health behaviors. The effect of multimorbidity on developing shingles is greater among young-old adults in their 50s than among the older-old adults aged 80 and higher. Our finding challenges the single-disease framework that is often used in previous studies examining risk factors for shingles. Our finding highlights the need for primary prevention and treatment of multimorbidity for reduction of shingles cases among older adults, especially young old adults in 50s.

Pain and depression, two of the common symptoms among chronically ill older adults, have been found to be related in various populations; however, further knowledge is needed about their relationships and moderating factors among community-dwelling, chronically ill older adults, particularly in lower-income, rural areas with limited healthcare resources. Therefore, this study aimed to examine the association between pain level and depression among chronically ill older adults in rural areas. A total of 100 residents of a rural county in West Alabama, who are 55+ and have chronic illnesses and pain, were recruited from four community senior centers and were interviewed using a structured questionnaire. Pain levels were assessed by the Philadelphia Geriatric Center (PGC) Pain Scale, and depression by an abbreviated version of the Center for Epidemiologic Studies Depression Scale (CES-D). Bivariate correlation and multivariate analysis were conducted. The correlation between pain and depression was significantly positive (r = .35, p < .001). The results of the model indicated that pain scores and other control variables explained approximately 18 percent of the variance in depression. The multivariate analysis results confirmed that those who had higher pain scores were significantly likely to have increased depression scores (b = 4.97, SE = 1.52, p < .01). Education marginally significantly moderated the relationship between pain and depression (p = .059). The previously reported positive pain-depression relationship exists among chronically ill older adults in rural areas, calling for tailored interventions to reduce their pain and its impact on depression.

Challenges due to burden of disease can affect adherence to self-care behaviors and optimal health outcomes in those living with T2DM. This study utilized state- and national-level data from the 2015 BRFSS to compare QoL measured by the prevalence of physical and mental burden days among older adults (OAs) compared to younger adults living with T2DM. The results of our analysis showed that OAs living in the US were significantly less likely to experience at least one mental burden day when compared to their younger counterparts (OR =0.61, 95% CI: 0.58, 0.64), while gender, education, race, BMI, and depression, CVD, or another chronic condition were significantly associated with the odds of experiencing at least one mental burden day. Whereas, in Kentucky OAs were less likely to experience at least one mental burden day when compared to their younger counterparts (OR= 0.48, 95% CI: 0.35, 0.66). Gender, education, BMI, and depression were significantly associated with the odds of experiencing at least one mental burden day or one physical burden day. The findings of this study suggests that the questions used by BRFSS to measure QoL may not be the most suitable for OAs who likely have different criteria for self-reported mental or physical burden days. When assessing QoL or burden of disease among the aging at a population level, considerable thought should be given into the questions asked and if they appropriately examine patient-level QoL in this population.

Stroke is a common health concern in the U.S. with 795,000 new strokes each year. Women dominate these numbers, with 55,000 more strokes per year than men, yet they are underrepresented in stroke research. Some research indicates that women have worse physiological and psychosocial outcomes after stroke than men, yet little is known about how they experience recovery. This study used a qualitative phenomenological approach to address the question: “What is the experience of stroke recovery for community dwelling women age 60 or older?” The participants were 10 women, ages 60 – 78, with times post-stroke ranging from 4 months to 15 years. They participated in 2 semi-structured interviews, with auto-photography used to enhance sharing of information. Between the two interviews, they were provided with a digital camera and asked to take pictures that helped to explain their lives before and after stroke. During the 2nd interview, participants described their pictures, and answered additional questions about their recovery. Interviews were transcribed verbatim, and the narratives were coded and analyzed thematically to describe how this sample of individuals experienced stroke recovery. Four overarching themes emerged from the data: 1) the stroke event, 2) a new chapter, 3) meaning and process of recovery, and 4) self-identity. In general, narratives revealed that recovery is described as a complex, individualized, and subjective experience that extends beyond overt physical abilities. Participants in this study experienced changes in self-identity and described a “new normal” after stroke. Implications and recommendations for rehabilitation, research, and policy are discussed.

Despite its importance for blood pressure control, antihypertensive medication adherence remains a challenge in older adults. Explicit and implicit attitudinal ambivalence toward medications (holding both positive and negative explicit attitudes, and discrepant explicit and implicit attitudes, respectively) may underlie low adherence. We examined whether race, age, or sex affect the associations between attitudes, ambivalence, and adherence. A questionnaire and implicit association test captured medication attitudes from hypertensive adults aged ≥55 (n=199). Adherence was measured with the Krousel-Wood Medication Adherence Scale (K-Wood-MAS-4). Higher scores on the attitudes and adherence scales indicate more positive attitudes and worse adherence, respectively. Associations and effect modification by sex, race (white vs. nonwhite), and age (

Unhealthy lifestyle behaviors, including poor diet over many years, contribute to the development of chronic diseases, especially overweight/obesity, hyperglycemia, hypercholesterolemia and hypertension. Because poor diet is common to the diseases, it supports the notion of concurrently managing comorbidities through improved diet. Therefore, the purpose of this study was to assess differences in diet quality and nutrient intakes, in adults aged 65 years and older, by the number of chronic conditions. Data from 7,169 adults, aged 65 years and older, from the 2005-2016 National Health and Nutrition Examination Survey were assessed for selected chronic diseases from laboratory data: overweight/obesity (body mass index >25); hyperglycemia (glycated hemoglobin >5.7%); hypercholesterolemia (total cholesterol >200 mg/dL); hypertension (blood pressure >120/80 mmHg). The number of chronic diseases was computed per participant. Dietary intakes and diet quality score were assessed using 24-hour dietary recalls. Few adults had none of the selected chronic disease (n=79;1.4%), with others presenting 1 indicator (n=677;9.8%), 2 indicators (n=1,762;25%), 3 indicators (n=2,741;38.9%) and all 4 indicators (n=1,910;24.9%). Diet quality was significantly lower in those with three or four chronic diseases (P

Objectives: Although the rate of cannabis use by older adults is increasing more quickly than all other age groups, little is known about the reasons older adults use cannabis and the outcomes they experience. With this research, we investigated older adults' perceptions and experiences of medical cannabis use to treat and/or manage chronic conditions, specifically as a substitute for prescription drugs. Methods: Researchers relied on qualitative inquiry in the form of semi-structured, one-on-one interviewing to investigate the phenomenon of medical cannabis use for the management of chronic conditions. Results: Our findings suggest that older adults are open to medical cannabis as an alternative to pharmaceutical drugs, hopeful with regard to the management of symptoms and pain, and aware of and astute at managing issues related to stigma both from their physicians and family and friends. Furthermore, older adults describe the frustrations with education, awareness, and lack of support with dosing. Conclusions: Participations found medical cannabis use to be beneficial in managing chronic conditions and alleviating symptoms such as chronic pain. Findings are presented as an interpretation of the participants' perceptions of their medical cannabis use. Implications for putting medical cannabis use into everyday practice as well as policy implications are considered. Clinical Implications: This information will help clinicians better support older adults desiring to use medical cannabis. This research will help clinicians learn more about factors impacting medical cannabis use, and the types of information and assistance that may aid older adults in their health and well-being with the use of medical cannabis to treat chronic conditions.

More than 62% of adults aged 65+ have more than one chronic condition; this number increases to more than 82% for those 85+. Older adults simultaneously experience changes in their relationships due to negative relational life events, including illness, injury, or death of a loved one. Stressors occurring in tandem can overload psychological resources and increase risk for poor mental health. Informed by the stress process model, we assessed the influence of relational life events on depressive symptoms over time and evaluated the moderating effects of chronic condition onset. Self-reports of four stressful life events, five chronic conditions, and depressive symptoms as measured by the CES-D came from 2,948 older adults participating in the ORANJ BOWL panel. Using longitudinal multilevel mixed effect modeling, we examined trajectories of depressive symptoms across three waves. While depressive symptoms increased over time, they were greater for people who experienced more relational life events and the onset of more chronic conditions. Participants who reported experiencing all four relational life events but no chronic conditions had an average CES-D score of 5.28 (p

Managing type 1 diabetes involves coordinating complex daily behaviors that benefit from higher cognitive function. One’s spouse’s cognitive function may also be beneficial as spouses may collaborate in daily adherence behaviors and may be especially beneficial for older adults who may be experiencing poorer cognitive function. We examined: 1) whether one’s own and one’s spouse’s cognitive function predicted lower (better) HbA1c, 2) whether collaborating with a more cognitively capable spouse was especially beneficial, and 3) whether the benefit of partners’ cognitive ability occurred through better adherence. 199 couples were recruited where one member was diagnosed with type 1 diabetes for at least one year (52% females, average age 46.8 years, range 25.9-74.9, average duration of diabetes 27 years). Both patients and spouses completed the information subtest from the Wechsler Adult Intelligence Scale-Fourth Addition as a measure of general intelligence. Patients rated the collaborative involvement of their spouse in their diabetes and their adherence to their medical regimen. Multiple regressions revealed that spouse’ higher intelligence uniquely and solely predicted better HbA1c over patient’s intelligence. Collaborating with a spouse of lower intelligence was associated with higher HbA1c for older adults; collaborating with a spouse of higher intelligence was associated with somewhat lower HbA1c. Mediational analyses indicated that spouse’s intelligence was associated with higher HbA1c through better adherence behaviors. The results suggest that individuals with type 1 diabetes who have a spouse of lower cognitive function may benefit from support from others in their network to manage their diabetes.

Spouses are commonly involved in supporting and regulating their partners’ diabetic diet. Older spouses also may be managing their own condition that requires changes to their diet. Little is known about the extent to which this spousal involvement is reciprocal and if there are individual differences in the provision of diet-related support and control (regulation). This study sought to understand the reciprocity of diet-related support and both positive and negative forms of control, whether personality traits predicted the provision of diet-related spousal involvement, and whether gender moderated these associations. We used data from a cross-sectional survey of 150 couples (50+ years) in which one member had type 2 diabetes (Mage=65.94; Mmarital length=33.46; 50.7% male patients; 58.7% of spouses had a condition that required changes to their diet). The provision and receipt of social support and two forms of social control were moderately correlated within individuals (patient rs=.36-.45, ps

Background: National and state surveys have found that only 8% - 17% of people know what palliative care (PC) is. Anecdotal reports also suggest many of those knowledgeable have misconceptions about PC. This lack of knowledge or misconceptions about PC can serve as barriers to accessing palliative care for seriously ill patients. Additionally, individuals often use the internet to seek health information, but it is unclear if this improves palliative care health literacy. Methods: We used the Health Information National Trends Survey 5, Cycle 2 (2018), a nationally representative dataset (n=3,504) to compare self-rated PC knowledge level with actual knowledge. We conducted chi-square and logistic regression to examine the association between PC knowledge and seeking health information on the internet. Results: About 33% of participants self-reported having PC knowledge. When these individuals were queried about specific PC knowledge, 58% failed to answer three basic questions correctly. After controlling for demographic and socioeconomic status, using the Internet to seek health information was positively associated with being knowledge about PC (P=0.006, OR=1.64), while having less than high school education was associated with lower PC knowledge. Implications: We found that self-reported PC knowledge may not reflect actual PC knowledge and thus clinicians should be sure to define the service when introducing it to patients. In addition, since use of internet in seeking health information is significantly associated with PC knowledge, it is important to ensure that internet PC information is valid, reliable, easy to access, and presented in simple language.

Pain symptoms are underreported in older adults (i.e., those ages ≥65), because many consider it a part of aging. Pain is highly prevalent in patients with heart failure (HF). HF is increasing in incidence with the aging population. Pain is also an important risk factor for rehospitalization among home healthcare patients with HF. However, little is known about the pain experiences of older adults with HF after hospital discharge. Accordingly, this study sought to describe pain and other symptoms among older adults with HF in the home healthcare setting using a mixed-methods approach. We conducted semi-structured interviews. We used the Edmonton Symptom Assessment Scale and Brief Pain Instrument on older adults (N=17) with HF in the home healthcare setting within 10 days of hospital discharge. The mean age was 76±9.25 years, nearly 50% were female, and most (90%) were White. The majority of participants managed pain with medications. Loss of appetite had the highest mean severity score (3.88±2.50) of symptoms measured. The mean score for pain at its worst was 4.94±3.07. Pain interfering with sleep had the highest mean score (4.24±3.36). Using content analysis we identified 4 distinct themes regarding the pain experience: (1) differences in the pain experiences before and after being diagnosed of HF, (2) symptoms accompanied with pain, (3) health care providers’ pain assessment, and (4) knowledge about pain management. These findings will contribute to the development and evaluation of a pain assessment and management protocol targeting older adults with HF in the home healthcare setting.

Cardiovascular disease (CVD) is a leading cause of adult mortality in China, accounting for 45% of deaths from noncommunicable disease. Moreover, Chinese health status and health services are disproportionately divided between urban and rural areas. This study examined rural-urban differences in age trajectories of CVD risk, measured by C-reactive protein (CRP), high-density lipoprotein (HDL) cholesterol, body mass index (BMI), and waist circumference. This study also investigated whether community factors, including recreational amenities, infrastructure availability, physical environment, public facilities, and health services, may explain such rural-urban disparities. We used data from the baseline data of the China Health and Retirement Longitudinal Study (2011), including 11, 528 respondents from 440 communities, who were aged 45 and older and participated in the biomarker survey. Multilevel models revealed that rural adults had a higher level of HDL and lower levels of CRP, BMI, and waist circumference compared to their urban counterparts. Rural adults also had slower age-related increases in trajectories for CRP, HDL and BMI. Associations of physical environment and public facilities with CVD risks were largely explained by rural-urban disparity. However, the availability of infrastructure explained both between- and within- rural-urban differences in BMI and waist circumference. Models were controlled for previously diagnosed CVD conditions, individual demographic characteristics, self-rated health, activities of daily living, depressive symptoms, physical activity, smoking and drinking behaviors. Findings contribute to the understanding of prevalence and disparities in biomarker risks for CVD among Chinese middle-aged and older adults. Intervention implications are discussed to address the emerging health disparities.