ABSTRACT
OBJECTIVES: To examine education differentials in screening, awareness, treatment and control of hypercholesterolemia overall and in 3 race/ethnic groups. METHODS: We analyzed data for a nationally representative sample of 8,429 men and women ages 20 to 85 years, self-reported as white, black, Mexican American, or other race/ethnicity, who participated in the National Health and Nutrition Examination Survey from 1999-2002. RESULTS: Participants with < high school education were 2.5 times less likely than participants with > or = high school education to have been screened for hypercholesterolemia, after adjusting for age and gender (odds ratio: 0.4, 95 % confidence interval: 0.3-0.5, and similar across race/ethnic group). Multivariable models for awareness, treatment and control showed no significant trends associated with education after adjusting for age, gender, race and comorbidities. CONCLUSIONS: Higher education significantly increased the odds of being screened for hypercholesterolemia overall and within each race/ethnic group. Education differentials were strongest for hypercholesterolemia screening, and weak or no longer apparent for subsequent steps of awareness, treatment and control. Focusing public health policy on increasing screening for individuals with low education might greatly improve their chances of preventing or mitigating morbidity related to hypercholesterolemia and subsequent cardiovascular disease.
Subject(s)
Black People/education , Educational Status , Health Education , Health Knowledge, Attitudes, Practice , Hypercholesterolemia/diagnosis , Hypercholesterolemia/ethnology , Hypercholesterolemia/therapy , Mass Screening , Mexican Americans/education , White People/education , Adult , Aged , Aged, 80 and over , Anticholesteremic Agents/therapeutic use , Cholesterol/blood , Cholesterol, HDL/blood , Cholesterol, LDL/blood , Coronary Disease/blood , Coronary Disease/diagnosis , Coronary Disease/ethnology , Coronary Disease/prevention & control , Female , Humans , Hypercholesterolemia/blood , Male , Medication Adherence/ethnology , Middle Aged , Risk Factors , Young AdultABSTRACT
This article discusses the assessment of chronic pain in older patients. First, the epidemiology and impact of chronic pain in the elderly are addressed. Next, common barriers to pain assessment are reviewed. An effective approach to pain assessment in the older patient is described, including the important pearls of history-taking and the physical examination, as well as recommendations for the evaluation of functional status and psychosocial well-being. The article concludes with a review of multidimensional and unidimensional pain assessment tools, and a discussion of methods for pain assessment in the cognitively impaired.
Subject(s)
Pain/etiology , Rheumatic Diseases/complications , Chronic Disease , Cognition Disorders/epidemiology , Comorbidity , Humans , Pain/diagnosis , Pain/epidemiology , Pain/physiopathology , Pain/psychology , Pain Measurement , Physical ExaminationSubject(s)
Heart Failure/therapy , Palliative Care/organization & administration , Diastole , Goals , Heart Failure/complications , Hospice Care/organization & administration , Humans , Patient Care Planning/organization & administration , Patient Care Team/organization & administration , Patient Selection , SystoleABSTRACT
This article will discuss the assessment of chronic pain in older patients. First, the epidemiology and impact of chronic pain in the elderly will be addressed. Next, common barriers to pain assessment will be reviewed. An effective approach to pain assessment in the older patient will then be described, including important pearls for history-taking and the physical examination, as well as recommendations for the evaluation of functional status and psychosocial well-being. The article will conclude with a review of multidimensional and unidimensional pain assessment tools and a discussion of methods for pain assessment in the cognitively impaired.
