Biomedical subjects

R Turner Goins

Publications and source records attributed to R Turner Goins.

13 recordsLinked to original sources

PubMed2006

Using GIS in a first national mapping of functional disability among older American Indians and Alaska Natives from the 2000 census.

BACKGROUND: Geographical information systems (GIS) have been used mainly in understanding infectious diseases and environmental threats in health research. Here, GIS was used to examine patterns of functional disability as one impact of chronic disease in American Indians and Alaska Natives. The study purpose was to create the first national mapping of functional disability for AIANs using the 2000 U.S. Census. RESULTS: American Indians and Alaska Natives over age 65 reported disability at a rate of 57.6% versus 41.9% for all people over 65 (P < or = 0.0001). Regional differences in levels and type of disability were evident. CONCLUSION: Maps help visualize those who might otherwise be 'lost' from the data. The significance of this study is that gerontologic programs and policies are data-driven, yet there is a lack of reliable national level data from US health systems on functional disability among American Indians and Alaska Natives. One study limitation was that Census questions regarding disability differed from traditional measures of activities of daily living and instrumental activities of daily living. An immediate policy recommendation would be to incorporate standard activities of daily living and instrumental activities of daily living language into future Census for a comprehensive, linked database for the future.

Aged↗

PubMed2005

The Prevention Research Centers Healthy Aging Research Network.

BACKGROUND: The Prevention Research Centers Healthy Aging Research Network (PRC-HAN), funded by the Centers for Disease Control and Prevention's (CDC's) Healthy Aging program, was created in 2001 to help develop partnerships and create a research agenda that promotes healthy aging. The nine universities that participate in the network use their expertise in aging research to collaborate with their communities and other partners to develop and implement health promotion interventions for older adults at the individual, organizational, environmental, and policy levels. CONTEXT: The population of older adults in the United States is growing rapidly; approximately 20% of Americans will be aged 65 years or older by 2030. The health and economic impact of an aging society compel the CDC and the public health community to place increased emphasis on preventing unnecessary disease, disability, and injury among older Americans. METHODS: The PRC-HAN has a broad research agenda that addresses health-promoting skills and behaviors, disease and syndrome topics, and knowledge domains. The network chose physical activity for older adults as its initial focus for research and has initiated two networkwide projects: a comprehensive, multisite survey that collected information on the capacity, content, and accessibility of physical activity programs for older adults and a peer-reviewed publication that describes the role of public health in promoting physical activity among older adults. In addition to participating in the core research area, each network member works independently with its community committee on PRC-HAN activities. CONSEQUENCES: As a result, the network is 1) expanding prevention research for older adults and their communities; 2) promoting the translation and dissemination of findings to key stakeholders; 3) strengthening PRC-HAN capacity through partnerships and expanded funding; and 4) stimulating the adoption of policies and programs by engaging policymakers, planners, and practitioners. In 2003, the PRC-HAN initiated an internal evaluation to better define the network's contributions to healthy aging, formalize internal processes, and better equip itself to serve as a model for other PRC thematic networks. The PRC-HAN is conducting a pilot evaluation for eventual inclusion in the PRC national evaluation. INTERPRETATION: The PRC-HAN has established itself as an effective research network to promote healthy aging. It has developed trust and mutual respect among participants, forged strong ties to local communities, and shown the ability to combine its expertise in healthy aging with that of partners in national, state, and local organizations.

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PubMed2005

Self-rated health among vulnerable older adults in rural Appalachia.

CONTEXT: Self-rated health (SRH) predicts service use, morbidity, and mortality. Additionally, SRH has been associated with indices of psychological well-being. PURPOSE: The main focus of the study was to investigate important differences among the lower spectrum of SRH (ie, fair and poor) on indices of well-being. METHODS: In-person interviews collected data from 207 (M age = 75.8) older rural adults. Data were used to examine differences between those reporting poor, fair, and good or excellent SRH on measures of demographics, and physical and psychological health. RESULTS: Significant differences emerged between levels of SRH in relation to measures of physical and psychological health. Specifically, individuals with poor SRH were significantly more likely to have (1) illnesses, (2) problems with basic and cognitive tasks of daily living, and (3) depressed affect than individuals reporting good or excellent health. Individuals with poor SRH were significantly more likely to have problems with basic and cognitive tasks of daily living than individuals with fair SRH. No significant differences were found between people reporting fair and good or excellent SRH on illnesses and depressed affect. CONCLUSIONS: Results suggest that future research should investigate the expansion of the lower-end of the SRH measure to more accurately assess SRH among vulnerable, rural older adults. Such efforts would better inform health care providers, practitioners, and policy makers in rural areas as to how SRH affects the well-being of vulnerable older adults.

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PubMed2005

Perceived barriers to health care access among rural older adults: a qualitative study.

CONTEXT: Many rural elders experience limited access to health care. The majority of what we know about this issue has been based upon quantitative studies, yet qualitative studies might offer additional insight into individual perceptions of health care access. PURPOSE: To examine what barriers rural elders report when accessing needed health care, including how they cope with the high cost of prescription medication. METHODS: During Spring 2001, thirteen 90-minute focus groups were conducted in 6 rural West Virginia communities. A total of 101 participants, aged 60 years and older, were asked several culminating questions about their perceptions of health care access. FINDINGS: Five categories of barriers to health care emerged from the discussions: transportation difficulties, limited health care supply, lack of quality health care, social isolation, and financial constraints. In addition, 6 diverse coping strategies for dealing with the cost of prescription medication were discussed. They included: reducing dosage or doing without, limiting other expenses, relying on family assistance, supplementing with alternative medicine, shopping around for cheapest prices, and using the Veteran's Administration. CONCLUSIONS: Overall, rural older adults encounter various barriers to accessing needed health care. Qualitative methodology allows rural elders to have a voice to expound on their experiences. Research can contribute valuable information to shape policy by providing a forum where older adults can express their concerns about the current health care delivery system.

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PubMed2005

Emerging services for community-based long-term care in urban China: a systematic analysis of Shanghai's community-based agencies.

China's rapid economic reforms, coupled with the changes in age composition of the demographic structure, have greatly affected the traditional family support system. In response to these changes, efforts to develop new models of community-based long-term care (CBLTC) for elders in China have received growing attention. This paper provides a systematic analysis of the current status of emerging CBLTC systems in Shanghai, China. It covers several domains of the system: service delivery, workforce, financing, and quality of care management. Several main issues involved in the development of the emerging system are addressed, and relevant policy implications are presented in the paper.

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PubMed2005

Disparities in chronic disease risk factors and health status between American Indian/Alaska Native and White elders: findings from a telephone survey, 2001 and 2002.

We compared prevalence estimates of chronic disease risk factors and health status between American Indian/Alaska Native (AIAN) and White elders. We used 2001 and 2002 Behavioral Risk Factor Surveillance System data to estimate the prevalence of smoking, physical inactivity, obesity, diagnosed diabetes, and general health status. For all health behavior and status measures, American Indians/Alaska Natives reported greater risk than did Whites. Risk factors among AIAN elders need to be addressed to eliminate disparities in chronic diseases.

Alaska↗

PubMed2004

The effects of depressed affect on functional disability among rural older adults.

This study investigates functional disability among some of the nation's most vulnerable older adults: rural Medicaid recipients. Data were provided by 221 older adults (mean age = 75.9 years; 82% women) who were receiving community-based long-term care services through Medicaid. Participants self-reported functional ability involving the completion of six basic activities of daily living (BADLs), three cognitive instrumental activities of daily living (IADLS), and four physical IADLs. Self-reports of depressed affect and the number of physical health conditions were also obtained. Path analysis was used to examine all of the associations among age, gender, number of chronic health conditions, depressed affect and functional disability. The tested model was significant [chi2 (DF = 3, n = 221) = 5.052, p = 0.168; TLI = 0.945; CFI = 0.992; RMSEA = 0.056] and explained 45.1% of the variance in BADL disability. Depressed affect significantly predicted disability in cognitive IADLs and physical IADLs, which predicted disability in BADLs. Age and gender had indirect effects on BADL, through their association with cognitive IADLs and physical IADLs. The number of chronic health conditions exerted both indirect and direct effects on BADL disability. Results are discussed within the context of the growing literature that suggests the importance of psychological variables as predictors of functional disability. Moreover, we discuss whether community-based long-term care is appropriate for older adults with high levels of functional disability.

Activities of Daily Living↗

PubMed2004

Health differences among Lumbee Indians using public and private sources of care.

CONTEXT: Of 2.4 million American Indians, approximately 60% are eligible to receive Indian Health Service (IHS) benefits, leaving many to seek care elsewhere. It is unknown if their quality of care, health behaviors, and health status vary by source of care, as demonstrated for other populations. PURPOSE: The purpose of this study was to determine whether preventive services, health behaviors, and number of health conditions vary as a function of having non-IHS public versus private physicians as sources of usual care. METHODS: 1,177 Lumbee Indians, who are ineligible to receive IHS services, completed a telephone interview that included information on receipt of preventive measures, tobacco use, physical activity, breast self-examination, and medical conditions. Frequencies, chi-squares, t tests, odds ratios, and confidence intervals were used to compare variables by source of care. FINDINGS: 939 respondents (80%) had a private and 210 (18%) a public health clinic physician as their usual source of care; 28 (2%) reported having neither. Logistic regression analyses, restricted to the 1,149 participants who reported either a private or public source of care, revealed no differences in receipt of preventive services or health status by usual source of care. Smokeless tobacco use was less common among persons using private than public providers. CONCLUSIONS: Lumbees whose usual source of care was a public clinic physician did not differ in receipt of preventive services or in health status compared to their counterparts who received care from a private physician. More targeted research into health similarities and differences arising from access to public and private sources of care is warranted.

Adult↗

PubMed2004

Access, relevance, and control in the research process: lessons from Indian country.

OBJECTIVE: To illustrate successful strategies in working with American Indian (AI) and Alaska Native (AN) communities in aging and health research by emphasizing access, local relevance, and decision-making processes. METHODS: Case examples of health studies involving older AIs (greater than or equal to 50 years) among Eastern Band Cherokee Indians, a federally recognized reservation; the Cherokee Nation, a rural, nonreservation, tribal jurisdictional service area; and Lakota tribal members living in Rapid City, South Dakota. RESULTS: Local review and decision making reflect the unique legal and historical factors underpinning AI sovereignty. Although specific approval procedures vary, there are common expectations across these communities that can be anticipated in conceptualizing, designing, and implementing health research among native elders. CONCLUSIONS: Most investigators are unprepared to address the demands of health research in AI communities. Community-based participatory research in this setting conflicts with investigators' desire for academic freedom and scientific independence. Successful collaboration promises to enhance research efficiencies and move findings more quickly to clinical practice.

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PubMed2004

Using online modules is a multi-modality teaching system: a high-touch high-tech approach to geriatric education.

Making geriatric education available to rural faculty/preceptors, students, and practitioners presents many challenges. Often the only options considered for educating those in the health professions about geriatrics are either traditional face-to-face courses or distance education programs. The purpose of this paper was to examine the use of Web-based modules or courses and other distance learning technology in concert with traditional learning modalities. The Mountain State Geriatric Education Center explored the use of a multi-modal approach within a high-touch, high-tech framework. Our findings indicate the following: it is important to start where participants are ready to begin; flexibility and variety are needed; soliciting evaluative feedback from participants is valuable; there is a need to integrate distance learning with more traditional modalities; and a high-tech, high-touch approach provides a format which participants find acceptable, accessible, and attractive. This assertion does not rule out the use of technology for distance education but rather encourages educators to take advantage of a wide range of modalities, traditional and technological, to reach rural practitioners, faculty, and students.

Computer-Assisted Instruction↗

PubMed2003

Effect of obesity on health-related quality of life among Appalachian elderly.

BACKGROUND: There is a paucity of research on health behaviors, health status, and overall health-related quality of life among Appalachian elderly. Identifying factors among older adults that place them at risk for low health-related quality of life is important for targeting unmet health needs and guiding community efforts to help improve population health. METHODS: For this study, we examined the relationship between obesity and health-related quality of life among Appalachians aged 65 years or older using the 2000 Behavioral Risk Factor Surveillance Survey data. RESULTS: Our results showed that obese elderly Appalachians report poorer self-rated health and more days of poor physical health compared with their nonobese counterparts. CONCLUSION: The goals put forward in Healthy People 2010 include the reduction of obesity and enhancement of quality of life. If such health disparities are to be eliminated and quality of life enhanced, a sustained effort to identify their determinants among Appalachian elderly is needed.

Age Factors↗

PubMed2003

Awareness and use of home- and community-based long-term care by rural American Indian and white elderly with co-morbid diabetes.

The purposes of this study were to determine if there are any differences in awareness and utilization of available home- and community-based long-term care (HCBLTC) between rural American Indian and white elderly with co-morbid diabetes, and to examine how they learned about HCBLTC programs. Survey data were analyzed from 62 American Indians and 64 whites aged 65 years or older living in the community. The American Indian respondents were more likely to be aware of and to have used HCBLTC programs compared to their white counterparts. The most common way that the American Indian participants learned about HCBLTC programs was through health care referrals, while the most common way for whites was through friends.

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PubMed2003

Guardianship capacity evaluations of older adults: comparing current practice to legal standards in two states.

This study examined the evaluations of capacity of alleged incapacitated persons (AIPs) between two states and compared the thoroughness of the evaluations to state law. These evaluations are frequently the only source of information on cognitive and psychiatric symptoms, functional abilities, and current treatments. One hundred nineteen evaluations of capacity were reviewed using the Guardianship Evaluation Review Instrument. Findings indicated that states differed on the AIP's age, presence at the court hearing, and description of current treatments. Overall, data suggested that evaluation thoroughness was substandard. In over 75% of cases, full guardianship was granted. Issues on terminology, concern regarding evaluators and courts, and ways for evaluators and the court to fulfill their responsibilities to older adults are discussed.

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