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Browsing by Subject "Social determinants"
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Item Exploratory analysis of medication adherence and social determinants of health among older adults with diabetes(Elsevier, 2023-11-15) Blakely, M. L.; Sherbeny, F.; Hastings, T. J.; Boyd, L.; Adeoye-Olatunde, O. A.; Biostatistics and Health Data Science, School of MedicineBackground: Diabetes is the fifth leading cause of death in the United States (US), affecting approximately 27%, or 15.9 million adults 65 years of age and older. Diabetes is the most expensive chronic condition in the US and accounts for the second largest avoidable healthcare cost. Adherence to long-term medication treatment plans is crucial among patients with diabetes because it decreases risk of developing comorbid conditions and improves quality of life. Greater exposure to adverse social determinants of health (SDOH) over an individual's lifespan can result in worse health outcomes. Hence, it is important to obtain a better understanding of how social determinants of health (SDOH) influence patients' behaviors and affect medication adherence among older adults with diabetes. Objectives: Identify and prioritize SDOH associated with medication adherence among a nationally representative sample of older adults with diabetes. Secondary objectives were to characterize SDOH, estimate medication adherence, and explain implications for health disparity populations among older adults in the US who have been diagnosed with diabetes. Methods: This study used a cross-sectional secondary data analysis to examine the National Health and Nutrition Examination Survey database, identifying associations between SDOH and medication adherence among older adults with diabetes in the US. Results: A total of 1807 respondents' data were included in the analyses. Nearly three-quarters (73.9%) of patients were considered adherent to their oral diabetes medications. Multivariable analysis revealed significant differences in medication adherence based on disability status (p = 0.016), household balanced meals (p = 0.033), and interview language (p = 0.008). Conclusions: Results revealed those with a disability, those who could not afford a balanced meal, and/or those who spoke English were associated with a higher likelihood of being nonadherent to their diabetes medications in comparison to individuals not in these groups. These findings can assist in developing SDOH-centered medication adherence strategies for pharmacists to implement with older patients with diabetes.Item Insights into the Social Determinants of Health in Older Adults(Scientific Research Publishing, 2022) Perez, Felipe P.; Perez, Carmen A.; Chumbiauca, Magali N.; School of Social WorkIn this paper, we review the social determinants of health in older adults and their complex interrelationship with medical diseases. Also, we provide recommendations to address these determinants in the integrated healthcare plan. The social determinants in older adults and its influence in health outcomes have been studied for decades. There is solid evidence for the interrelationship between social factors and the health of individuals and populations; however, these studies are unable to define their complex interrelatedness. Health is quite variable and depends on multiple biological and social factors such as genetics, country of origin, migrant status, etc. On the other hand, health status can affect social factors such as job or education. Addressing social determinants of health in the integrated healthcare plan is important for improving health outcomes and decreasing existing disparities in older adult health. We recommend a person-centered approach in which individualized interventions should be adopted by organizations to improve the health status of older adults at the national and global level. Some of our practical recommendations to better address the social determinants of health in clinical practice are EHR documentation strategies, screening tools, and the development of linkages to the world outside of the clinic and health system, including social services, community activities, collaborative work, and roles for insurance companies.Item Sensitivity and Specificity of Real-World Social Factor Screening Approaches(SpringerLink, 2021-11-12) Vest, Joshua R.; Wu, Wei; Mendonca, Eneida A.; Health Policy and Management, School of Public HealthHealth care organizations are increasingly documenting patients for social risk factors in structured data. Two main approaches to documentation, ICD-10 Z codes and screening questions, face limited adoption and conceptual challenges. This study compared estimates of social risk factors obtained via screening questions and ICD-10 Z diagnoses coding, as used in clinical practice, to estimates from validated survey instruments in a sample of adult primary care and emergency department patients at an urban safety-net health system. Financial strain, transportation barriers, food insecurity, and housing instability were independently assessed using instruments with published reliability and validity. These four social factors were also being collected by the health system in screening questions or could be mapped to ICD-10 Z code diagnosis code concepts. Neither the screening questions nor ICD-10 Z codes performed particularly well in terms of accuracy. For the screening questions, the Area Under the Curve (AUC) scores were 0.609 for financial strain, 0.703 for transportation, 0.698 for food insecurity, and 0.714 for housing instability. For the ICD-10 Z codes, AUC scores tended to be lower in the range of 0.523 to 0.535. For both screening questions and ICD-10 Z codes, the measures were much more specific than sensitive. Under real world conditions, ICD-10 Z codes and screening questions are at the minimal, or below, threshold for being diagnostically useful approaches to identifying patients' social risk factors. Data collection support through information technology or novel approaches combining data sources may be necessary to improve the usefulness of these data.Item Unequal access: Tobacco Retail in the Indianapolis Metro Area(The Polis Center, Indiana University at Indianapolis, 2017-07) Comer, Karen; Davila, Kelly; Hollon, Deb; Nowlin, MattRetail access to various smoking products is an important consideration when discussing community action to improve a community’s health. Studies show that tobacco outlet density and proximity are linked to tobacco use–particularly in poor areas. We used socioeconomic data culled from the SAVI community information system to examine the density and proximity of tobacco outlets relative to vulnerable communities in Marion County. The report serves as a companion piece to the IU Richard M. Fairbanks School of Public Health’s September 2016 Report on the Tobacco Epidemic in Marion County and Indiana.Item Why the cognitive "fountain of youth" may be upstream: Pathways to dementia risk and resilience through social connectedness(Wiley, 2022) Perry, Brea L.; McConnell, Will R.; Coleman, Max E.; Roth, Adam R.; Peng, Siyun; Apostolova, Liana G.; Neurology, School of MedicineResearch suggests social connectedness may help older adults with dementia maintain cognitive functionality and quality of life. However, little is known about its specific social and biological mechanisms. This paper proposes two pathways through social bridging (i.e., cognitive enrichment through expansive social networks) and bonding (i.e., neuroendocrine benefits of integration in cohesive social networks). We provide preliminary evidence for these pathways using neuroimaging, cognitive, and egocentric social network data from the Social Networks and Alzheimer's Disease (SNAD) study (N = 280). We found that network size, density, and presence of weak ties (i.e., social bridging) moderated the association between brain atrophy and cognitive function, while marriage/cohabitation (i.e., social bonding) moderated the association between perceived stress and cognitive function. We argue that social connectedness may have downstream implications for multiple pathophysiological processes in cognitive aging, even negating existing structural damage to the brain, making it a strong candidate for clinical or policy intervention.