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Scholarly Works (4 results)

  • Thesis
  • Peer Reviewed
UC Merced Electronic Theses and Dissertations (2019)

Nearly one in six U.S. residents are over the age of 65. The proportion of older adults in the U.S. is anticipated to grow to 22.1% of the total population by 2050. The cost of treating age related conditions and injuries is expensive, government programs including Medicaid paid over $550 Billion in 2017, and makes up between 14-16% of the federal budget each year. With the high cost of treating age related conditions and injuries, and the proportion of older adults continuing to increase every year, it is imperative that researchers and government entities find and invest in preventative measures in order to reduce injury and related healthcare costs.

Among the many age-related injuries older adults suffer, falls are arguably the most important to address. It is estimated that one in three older adults has a fall every year. In 2016, falls were the seventh leading cause of death among older adults. Approximately one third of all fallers require medical attention after experiencing a fall. Over 800,000 older adults are hospitalized each year due to fall related injuries. Injuries sustained as a result of a serious fall include various fractures, traumatic brain injuries, and other cuts and bruises.

Home modifications, and more recently smart home technologies, can help increase the safety of older adults living in the community. With older adults wanting to “age in place”, installing these modifications and technologies before an accident happens may lower rates of injury. Today, dozens of companies sell various smart home devices for the consumer market. Bud despite the high demand for these technologies by the American consumer, the ability of these devices to keep older adults safe, and how older adults value these technologies, remains uncertain.

These home technologies may be particularly beneficial to older adults living in rural areas due to the increased isolation and limited access to healthcare resources. Previous research indicates rural populations have a greater proportion of older adults compared to urban areas, yet lack the infrastructure to provide specialty care to this population.

It is estimated that more than 60 million family members provide some sort of informal care to an older adult relative. Of all of these family members, nearly 40% report spending 20 or more hours a week providing this unpaid care. Previous research has failed to examine how these family members feel about home modifications and technologies for their older adult relative. Finding ways to ease the burden of caring for older family members will significantly better the situations of many family relatives.

This dissertation aims to cover three areas.

1. Identify people at risk of suffering subsequent fall injuries. Find the average time between an initial fall injury and a subsequent fall injury, and find average time between an initial fall injury and death.

2. Examine the preferences of older adults living in a rural area towards various smart home technologies and home modifications.

3. Examine the preferences of family members of older adults regarding smart home technologies and home modifications.

    Cover page: Dissertation: Examining and investigating home modifications and smart home technologies to reduce fall injury among older adults.
    • Article
    • Peer Reviewed
    UC Merced Previously Published Works (2018)

    Objective

    This study evaluated whether emergency department (ED) patient presentations for problems related to mental and substance use disorders could be validly monitored by a syndromic surveillance system that uses chief complaints to identify mental disorders.

    Methods

    The study used syndromic surveillance data on 146,315 ED visits to participating Fresno County, California, hospitals between January 1 and December 31, 2013. Free-text patient chief complaints are automatically classified into syndromes based on the developer's algorithms. Agreement was assessed between the algorithm's syndrome classification of mental health and substance abuse (MHSA) disorders and ICD-9-CM discharge diagnostic codes. Diagnosis and ED utilization patterns among patients with at least one visit with an MHSA syndrome classification were also examined.

    Results

    Approximately 8% of ED visits during the study period received an MHSA syndrome classification. Overall agreement between MHSA syndrome classification and psychiatric- or substance use-related ICD-9 discharge diagnoses was high (κ=.92, 95% confidence interval=.91-.92). Sensitivity (100%) and specificity (98.6%) of the MHSA syndrome classification were also very high. MHSA syndrome-classified patients exhibited high levels of health care and morbidity burden compared with other patients.

    Conclusions

    ED chief complaints can be utilized to reliably and validly ascertain the incidence of patient presentations for mental and substance use disorders in contexts in which discharge diagnoses are not routinely available. Wider adoption of MHSA-related syndrome algorithms by syndromic surveillance systems could be valuable for public mental health surveillance, service delivery, and resource planning efforts.
      Cover page: Syndromic Surveillance of Mental and Substance Use Disorders: A Validation Study Using Emergency Department Chief ComplaintsCreative Commons 'BY-NC-ND' version 4.0 license
      • Article
      • Peer Reviewed
      UC Merced Previously Published Works (2019)

      Background

      Violent injuries are a leading cause of morbidity and mortality among youths. Little is known about adolescents' patterns of and risk factors for repeat assault injuries, yet understanding who is at risk for repeated assaults is important for intervention and prevention efforts. Investigating these questions in population-based adolescent samples is particularly critical.

      Objective

      Our aim was to estimate the 5-year cumulative incidence of and risk factors for repeat emergency department (ED) visits for assault injury among adolescents experiencing an index assault visit, and compare the method of injury for adolescents' first and second visits.

      Methods

      Statewide, longitudinal data from California were used to follow 17,845 adolescents who reported to an ED with assault-related injuries in 2010. Incidence rate ratios were estimated to examine risk factors for repeat assault injury within 1 year and 5 years following the index visit.

      Results

      A total of 3273 (18.3%) assaulted adolescents experienced one or more additional assault injury ED visits during the full follow-up period. Only 37.3% of these repeat assaults occurred within the first year following the index assault. Of adolescents with a repeat assault injury, the method of injury often changed and followed no clear pattern. Sociodemographic characteristics (e.g., older age, black race) and history of prior ED visits for assault and mental health problems predicted increased risk of repeat assault.

      Conclusions

      Previous work may underestimate the rate of repeated assault among adolescents. Adolescents with a history of violence involvement and mental health problems are at elevated risk for repeated assault, and should be targeted for intervention.
        Cover page: Repeat Assault Injury Among Adolescents Utilizing Emergency Care: A Statewide Longitudinal Study
        • Article
        • Peer Reviewed
        UC Merced Previously Published Works (2019)

        Objective

        This study investigated patient- and area-level characteristics associated with adolescent emergency department (ED) patients' risk of subsequent ED visits for self-harm.

        Method

        Retrospective analysis of adolescent patients presenting to a California ED in 2010 (n = 480,706) was conducted using statewide, all-payer, individually linkable administrative data. We examined associations between multiple predictors of interest (patient sociodemographic factors, prior ED utilization, and residential mobility; and area-level characteristics) and odds of a self-harm ED visit in 2010. Patients with any self-harm in 2010 were followed up over several years to assess predictors of recurrent self-harm.

        Results

        Self-harm patients (n = 5539) were significantly more likely than control patients (n = 16,617) to have prior histories of ED utilization, particularly for mental health problems, substance abuse, and injuries. Residential mobility also increased risk of self-harm, but racial/ethnic minority status and residence in a disadvantaged zipcode decreased risk. Five-year cumulative incidence of recurrent self-harm was 19.3%. Admission as an inpatient at index visit, Medicaid insurance, and prior ED utilization for psychiatric problems or injury all increased recurrent self-harm risk.

        Conclusions

        A range of patient- and area-level characteristics observable in ED settings are associated with risk for subsequent self-harm among adolescents, suggesting new targets for intervention in this clinical context.
          Cover page: Predictors of self-harm emergency department visits in adolescents: A statewide longitudinal study
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