Tang S.T.,Chang Gung University |
Liu T.-W.,National Health Research Institute |
Shyu Y.-I.L.,Chang Gung University |
Koong S.L.,Bureau of Health Promotion |
Hsiao S.C.,Bureau of Health Promotion
Palliative Medicine | Year: 2012
Background: With increasing patient age in Western countries, evidence indicates a pervasive pattern of decreasing healthcare expenditures and less aggressive medical care, including end-of-life (EOL) care. However, the impact of age on EOL care for Asian cancer patients has not been investigated.Purpose: To explore how healthcare use at EOL varies by age among adult Taiwanese cancer patients.Methods: Retrospective cohort study using administrative data among 203,743 Taiwanese cancer decedents, 2001-2006. Age was categorized as 18-64, 65-74, 75-84, and â‰¥ 85 years.Results: Elderly (â‰¥ 65 years) Taiwanese cancer patients were significantly less likely than those 18-64 years to receive aggressive treatment in their last month of life, including chemotherapy, >1 emergency room visits, >1 hospital admissions, >14 days of hospitalization, hospital death, intensive care unit admission, cardiopulmonary resuscitation, intubation, and mechanical ventilation. However, they were significantly more likely to receive hospice care in their last year of life.Conclusion: Elderly Taiwanese cancer patients at EOL received less chemotherapy, less aggressive management of health crises associated with the dying process, and fewer life-extending treatments, but they were more likely to receive hospice care in their last year and to achieve the culturally highly valued goal of dying at home. © 2011 The Author(s).
Wang K.-C.,Cheng Hsin General Hospital |
Wang K.-C.,Graduate Institute of Medical science |
Woung L.-C.,Taipei Medical University Hospital |
Woung L.-C.,National Taiwan University Hospital |
And 6 more authors.
Neuroepidemiology | Year: 2012
Background/Aims: Detailed information on the age- and sex-specific relationships between diabetes and Alzheimer's disease (AD) is scarce. This study aims to prospectively investigate the age- and sex-specific incidence density and relative hazards of AD in relation to diabetes. Methods: A total of 615,529 diabetic patients and 614,871 age- and sex-matched random controls were linked to the claim data from 2000-2008 to identify the first occurrence of a primary or secondary diagnosis of AD. Incidence density was calculated under the Poisson assumption. We also assessed the age- and sex-specific risk of AD in relation to diabetes with the Cox proportional hazards regression model. Results: Over nearly 9 years of follow-up, a total of 4,615 diabetic subjects developed AD, representing a cumulative incidence rate of 0.75% (n = 3,873; 0.63% in controls). The overall incidence densities of AD for diabetic men and women, respectively, were 0.82 and 1.15 per 1,000 person-years, which were higher than those for control men and women (0.63 and 0.89 per 1,000 person-years, respectively). Diabetic patients had a significantly higher hazard ratio (HR) of AD [1.45, 95% confidence interval (CI) 1.38-1.52]. Diabetic women ≥65 years had a higher HR (1.52, 95% CI 1.42-1.62) than diabetic women <65 years (1.34, 95% CI 1.15-1.56). Conclusion: Diabetes may increase the risk of AD in both sexes and in all ages. A higher HR of AD was especially notable in older diabetic women. Copyright © 2012 S. Karger AG, Basel.
Greenlund K.J.,Centers for Disease Control and Prevention |
Keenan N.L.,Centers for Disease Control and Prevention |
Clayton P.F.,Bureau of Health Promotion |
Pandey D.K.,University of Illinois at Chicago |
Hong Y.,Centers for Disease Control and Prevention
American Journal of Public Health | Year: 2012
Life expectancy at birth has increased from 74 years in 1980 to 78 years in 2006. Older adults (aged 65 years and older) are living longer with cardiovascular conditions, which are leading causes of death and disability and thus an important public health concern. We describe several major issues, including the impact of comorbidities, the role of cognitive health, prevention and intervention approaches, and opportunities for collaboration to strengthen the public health system. Prevention can be effective at any age, including for older adults. Public health models focusing on policy, systems, and environmental change approaches have the goal of providing social and physical environments and promoting healthy choices.
Yu N.-C.,Yu Neng Chun Diabetes Clinic |
Su H.-Y.,Taipei Medical University Hospital |
Chiou S.-T.,Bureau of Health Promotion |
Chiou S.-T.,National Yang Ming University |
And 6 more authors.
Diabetes Research and Clinical Practice | Year: 2013
Aims: To understand the trends of ABC control in 5 years interval in Taiwan. Methods: We compared two waves of nationwide surveys (n = 7541 and n = 5599, mainly type 2 diabetes) to examine the trends of ABC control across 5 years in accredited Diabetes Health Promotion Institutes in Taiwan. Results: The percentages of subjects who had HbA1c lower than 7% (A), both SBP and DBP lower than 130/80. mmHg (B), and total cholesterol lower than 160. mg/dl or LDL cholesterol lower than 100. mg/dl (C) increased by 6.5% (from 32.4% to 34.5%), 22.0% (from 30.9% to 37.7%), and 57.8% (from 35.3% to 55.7%), respectively, with a resulting total ABC attainment rate from 4.1% to 8.6%. A subgroup of 720 diabetic subjects who participated in both surveys showed the same pattern of changes in B and C but had a slight deterioration of glycemic control. Logistic regression analysis revealed that diagnosis of type 1 diabetes, lower BMI and individuals not requiring insulin were independently associated with attainment of ABC goals in 2006 and 2011. An accountabilities examination revealed that annular tests of HbA1c, BP and lipids were all above 90% in both surveys. Conclusions: We observed an improvement of individual and overall attainments of ABC goals across 5 years in Taiwan owing to recent implementation of several diabetes care models and initiatives. We anticipate that these improvements will translate into reductions of both macrovascular and microvascular complications. © 2012 Elsevier Ireland Ltd.
Hidajat M.,University of Utah |
Zimmer Z.,University of California at San Francisco |
Saito Y.,Nihon University |
Lin H.-S.,Bureau of Health Promotion
European Journal of Ageing | Year: 2013
Research has implicated religious activity as a health determinant, but questions remain, including whether associations persist in places where Judeo-Christian religions are not the majority; whether public versus private religious expressions have equivalent impacts, and the precise advantage expressed as years of life. This article addresses these issues in Taiwan. 3,739 Taiwanese aged 53+ were surveyed in 1999, 2003, and 2007. Mortality and disability were recorded. Religious activities in public and private settings were measured at baseline. Multistate life-tables produced estimates of total life expectancy and activity of daily living (ADL) disability-free life expectancy across levels of public and private religious activity. There is a consistent positive gradient between religious activity and expectancy with greater activity related to longer life and more years without disability. Life and ADL disability-free life expectancies for those with no religious affiliation fit in between the lowest and highest religious activity groups. Results corroborate evidence in the West. Mechanisms that intervene may be similar in Eastern religions despite differences in the ways in which popular religions are practiced. Results for those with no affiliation suggest benefits of religion can be accrued in alternate ways. © 2013 Springer-Verlag Berlin Heidelberg.
Glei D.A.,Georgetown University |
Goldman N.,Princeton University |
Lin Y.-H.,Bureau of Health Promotion |
Weinstein M.,Georgetown University
Research on Aging | Year: 2011
Identifying how biological parameters change with age can provide insights into the physiological determinants of disease and, ultimately, death. Most prior studies of age-related change in biomarkers are based on cross-sectional data, small or selective samples, or a limited number of biomarkers. We use data from a nationally representative longitudinal sample of 639 Taiwanese aged 54 and older in 2000 to assess changes over a six-year period in a wide range of biomarkers. Markers that increased most with age were glycoslyated hemoglobin, interleukin-6, and norepinephrine. Markers that decreased most with age were diastolic blood pressure and creatinine clearance. For example, glycoslyated hemoglobin increased by 8% to 13%, depending on sex and age at baseline, over this six-year period. Several standard clinical risk factors exhibited little evidence of age-related change. Further research is needed to determine whether the observed variation between individuals in biomarker changes represents differences in underlying physiological function that are predictive of future health and survival. © The Author(s) 2011.
Chang F.-C.,National Taiwan Normal University |
Chung C.-H.,National Communications Commission |
Yu P.-T.,Bureau of Health Promotion |
Chao K.-Y.,Bureau of Health Promotion
Health Education Research | Year: 2011
The present study evaluated the impact of Taiwan's graphic cigarette warning labels and smoke-free law on awareness of the health hazards of smoking and thoughts of quitting smoking. National representative samples of 1074 and 1094 people, respectively, were conducted successfully by telephone in July 2008 (pre-law) and March 2009 (post-law). Results reveal that the prevalence of thinking about the health hazards of smoking among smokers increased from 50.6% pre-law to 79.6% post-law, while the prevalence among non-smokers increased from 68.8 to 94.1% during the same period. The prevalence rates of smokers who reported thinking of quitting rose from 30.2% pre-law to 51.7% post-law. Multivariate analyses results indicated that the implementation of graphic warning labels and the smoke-free law significantly increased the odds of awareness about the health hazards of smoking [odds ratio (OR) = 6.39, 95% confidence interval (CI) = 4.84-8.44] and thoughts of quitting smoking (OR = 2.39, 95% CI = 1.48-3.87). In conclusion, the implementation of a smoke-free law in combination with graphic cigarette warning labels has been effective in increasing thoughts about the health hazards of smoking and quitting smoking. © The Author 2010.
Cornman J.C.,Jennifer C. Cornman Consulting |
Glei D.,Georgetown University |
Rodriguez G.,Princeton University |
Goldman N.,Princeton University |
And 2 more authors.
Journals of Gerontology - Series B Psychological Sciences and Social Sciences | Year: 2011
Objectives. This study assesses whether socioeconomic and demographic differences in reported mobility limitations are attributable to differential perceptions of mobility difficulty that result in the differential use of response categories. Methods. Data come from the Social Environment and Biomarkers of Aging Study and its parent study, the Taiwan Longitudinal Study of Aging. Ordered probit models with person-specific cut-points are used to test whether, after controlling for underlying mobility using objective performance measures, cut-points for reporting mobility limitations vary across groups defined by demographic and socioeconomic characteristics. Results. Age is the only characteristic that is consistently associated with the location of the cut-points for reporting mobility difficulty: At the same level of underlying mobility difficulty, older adults are more likely than younger adults are to report difficulty with all tasks except short walks. Other variables showed differences but only for one specific activity, for example, urban residents are more likely to report difficulty running than are rural residents with the same underlying level of mobility function. Discussion. For most mobility activities, there are no systematic differences in the perception of difficulty by individual characteristics. Thus, for older Taiwanese adults, differences in mobility limitations associated with socioeconomic status are more likely to reflect underlying differences in function than differences in how these groups report the same capacity. The usual loss of mobility with age, however, reflects both a decrease in capacity and a lowering of the threshold for reporting difficulty. © The Author 2010.
Chang F.-C.,National Taiwan Normal University |
Hu T.-W.,University of California at Berkeley |
Lo S.-Y.,Bureau of Health Promotion |
Yu P.-T.,Bureau of Health Promotion |
And 2 more authors.
Tobacco Control | Year: 2010
Objectives In 2002, Taiwan launched a program to encourage doctors to provide brief cessation counseling to their patients during routine outpatient visits. This study is to compare and analyse the annual prevalence rate of receiving advice to quit smoking from health professionals before (2004) and after (2005, 2006) the increase in funding and the withdrawal of additional funding (2007). Methods We analysed pooled data from 2004 to 2007 Taiwan Adult Tobacco Survey, an annual random digit dialling telephone survey, to estimate the prevalence of receiving quit advice among ever smokers across these years. Smoking characteristics and the socioeconomic factors of smokers associated with receipt of advice to quit smoking were also examined. Results The prevalence rate of receiving quit advice increased from 21.1% in 2004 to 28.2% in 2006, and then decreased slightly to 27.6% in 2007 after the funds were cut. Multivariate analyses results indicated that increasing financing for smoking cessation services in 2005, being male, older, a daily cigarette user, having previously attempted to quit, perceiving oneself as having poor health and being aware of the benefits of smoking cessation services were significantly positively associated with receiving quit advice from health professionals. In contrast, smokers who were younger, female and occasional cigarette users were less likely to receive quit advice. Also, smokers with socioeconomic disadvantages were not less likely to receive quit advice. Conclusions During the period of increased funding for smoking cessation services, the rates of receiving quit advice increased among all smokers and across different socioeconomic groups.
Chapin R.K.,University of Kansas |
Sergeant J.F.,Bureau of Health Promotion |
Landry S.,University of Kansas |
Leedahl S.N.,University of Kansas |
And 3 more authors.
Gerontologist | Year: 2013
Purpose: Stigma and lack of access to providers create barriers to mental health treatment for older adults living in the community. In order to address these barriers, we developed and evaluated a peer support intervention for older adults receiving Medicaid services. Design and Methods: Reclaiming Joy is a mental health intervention that pairs an older adult volunteer with a participant (older adult who receives peer support). Volunteers receive training on the strengths-based approach, mental health and aging, goal setting and attainment, community resources, and safety. Participant-volunteer pairs meet once a week for 10 weeks. Participants establish and work toward goals (e.g., better self-care, social engagement) that they feel would improve their mental health and well-being. Aging services agencies provide a part time person to manage the program, match volunteers and participants, and provide ongoing support. Outcomes evaluation for this pilot study included pre/postintervention assessments of participants. Results: Thirty-two participants completed the intervention. Pre/postassessment group means showed statistically significant improvement for depression but not for symptoms of anxiety. Quality-of-life indicators for health and functioning also improved for participants with symptoms of both depression and anxiety. Implications: The Reclaiming Joy peer support intervention has potential for reducing depression and increasing quality of life in low-income older adults who have physical health conditions. It is feasible to administer and sustain the intervention through collaborative efforts with minimal program resources and a small amount of technical assistance. © 2012 © The Author 2012. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved.