Publications by authors named "B G Winchester"

218 Publications

Cardiometabolic Conditions and All-Cause Dementia among American Indian and Alaska Native Peoples.

J Gerontol A Biol Sci Med Sci 2021 Apr 7. Epub 2021 Apr 7.

University of Colorado Denver, Colorado School of Public Health, Denver, CO.

Background: Diabetes, hypertension, and cardiovascular disease (CVD) are modifiable lifestyle-related cardiometabolic conditions associated with dementia. Yet, little is known regarding these associations among American Indian and Alaska Native (AI/AN) peoples. Thus, we examined the association of diabetes, hypertension, and cardiovascular disease (CVD) with all-cause dementia among AI/ANs aged ≥ 65 years.

Methods: This was a cross-sectional analysis of the Indian Health Service Improving Health Care Delivery Data Project. Our study population was a 1:1 matched sample of 4,074 AI/ANs aged ≥ 65 years and Indian Health Service active users during fiscal year 2013. We employed international Classification of Diseases 9th Revision Clinical Modification (ICD-9) diagnostic codes for all-cause dementia, hypertension, and CVD. Diabetes was measured with a validated algorithm to identify adults with diabetes that uses diagnoses, laboratory test results, and medication criteria.

Results: Multivariable analyses revealed that diabetes and CVD were associated with increased odds of all-cause dementia and hypertension was not. CVD types associated with all-cause dementia differed with cerebrovascular disease having the strongest association. Analyses stratified by gender revealed that diabetes and CVD were associated with increased odds of all-cause dementia for women and only CVD was associated with all-cause dementia for men.

Conclusions: Training and support of primary care clinicians, addressing cultural considerations, and ensuring inclusion of AI/ANs in research are steps that could help meet AI/AN peoples' needs. Our findings underscore to the importance of improved management and control of diabetes and CVD, which may lead to the prevention of dementia among older AI/ANs.
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April 2021

Putting Self-Management in the Context of Community-Dwelling American Indians Living With Type 2 Diabetes.

Diabetes Educ 2020 02 22;46(1):108-117. Epub 2019 Dec 22.

Public Health and Human Services, Eastern Band of Cherokee Indians, Cherokee, North Carolina.

Purpose: The purpose of this qualitative descriptive study was to examine the National Standards for Diabetes Self-Management Education and Support (DSMES) defined diabetes self-care behaviors (healthy eating, being active, taking medication, monitoring, problem solving, reducing risk, and healthy coping) in the context of older community-dwelling American Indians (AIs).

Methods: Secondary theme analysis of transcribed semistructured qualitative interview data from 28 participants in the Native Elder Care Study aged >60 years identified factors that influence the DSMES self-care behaviors in the context of community-dwelling AIs.

Results: Four themes that characterized barriers, facilitators, and opportunities for DSMES to support self-care behaviors included community food security, care partners in self-care, community opportunities for diabetes support, and blending of both health worlds.

Conclusion: Tribal communities have contemporary strengths and cultural traditions that can be activated to enhance diabetes self-management education and support. Diabetes educators can work in tandem with community health representatives to strengthen the social and community support within which individual AIs with type 2 diabetes mellitus live. Community-based participatory research with AI caregivers, dyads, families, youth, and Indian Health Service clinicians may help to improve tribal food policy and school health initiatives, as well as develop intergenerational interventions for modeling effective diabetes self-management.
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February 2020

Depressive Symptoms and All-Cause Mortality in Older American Indians with Type 2 Diabetes Mellitus.

J Am Geriatr Soc 2019 09 7;67(9):1940-1945. Epub 2019 Aug 7.

College of Health and Human Sciences, Western Carolina University, Cullowhee, North Carolina.

Objectives: American Indians experience disproportionately high rates of poor mental health and type 2 diabetes mellitus (T2DM). We examined the association between depressive symptoms and all-cause mortality in older American Indians with T2DM.

Design: We used the Native Elder Care Study survey data from community-dwelling American Indians aged 55 years or older, linked to data extracted from participants' electronic health records. We focused on those who had an International Classification of Diseases-Ninth Revision diagnosis of T2DM in their electronic health records.

Setting: The study was conducted with a federally-recognized tribe with approximately 16,000 enrolled members, most of whom reside on or near tribally-owned lands that span several rural counties.

Participants: Participants were among the Native Elder Care Study participants with a final analytic sample of 222.

Measurements: We measured depressive symptoms with the Centers for Epidemiologic Studies-Depression (CES-D) scale. We used Cox proportional hazard models to examine the association between depressive symptoms and all-cause mortality in the final analytic sample of 222 subjects.

Results: Survival curves revealed that individuals in the third and fourth CES-D scale categories had higher mortality than those in the first and second categories. Mortality risk was significantly higher for participants with CES-D scale scores in the third highest compared with the lowest category (hazard ratio = 2.07; 95% confidence interval = 1.07-4.04), after adjustment for demographic characteristics, health behaviors, obesity, and prevalent T2DM complications. Analyses with the CES-D scale as a continuous variable also showed a positive association with mortality.

Conclusion: The impact of mental health on older American Indians with T2DM is often overlooked, yet it is vital to clinical and public health practice. Our findings underscore the importance of addressing the mental health needs of this population, particularly because depression in older patients is often undetected or inadequately treated. J Am Geriatr Soc 67:1940-1945, 2019.
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September 2019

Frailty in Older American Indians: The Native Elder Care Study.

Gerontol Geriatr Med 2019 Jan-Dec;5:2333721419855669. Epub 2019 Jun 27.

Cherokee Indian Hospital, NC, USA.

Frailty is often described as a reduction in energy reserves, especially with respect to physical ability and endurance, and it has not been examined in American Indians. The goals of this study were to estimate the prevalence of frailty and identify its correlates in a sample of American Indians. We examined data from 411 community-dwelling American Indians aged ≥55 years. Frailty was measured with weight loss, exhaustion, low energy expenditure, slowness, and weakness characteristics. Slightly over 44% of participants were classified as pre-frail and 2.9% as frail. Significant correlates of a combined pre-frail and frail status identified in the fully adjusted analyses were younger age, female gender, lower levels of education, increased number of chronic medical conditions, and increased number of activities of daily living limitations. Marital status, chronic pain, and social support were not associated with pre-frail/frail status. Our findings point to specific areas in need of further research, including use of frailty measures that also capture psychosocial components and examining constructs of physical resilience. Targeting those with multiple chronic medical conditions may be an important area in which to intervene, with the goal of reducing risk factors and preventing frailty onset.
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June 2019

Dietary Beliefs and Management of Older American Indians With Type 2 Diabetes.

J Nutr Educ Behav 2019 Jul - Aug;51(7):826-833. Epub 2018 Dec 20.

Public Health and Human Services, Eastern Band of Cherokee Indians, Cherokee, NC.

Objectives: This qualitative study examined dietary-related beliefs and self-management among older American Indians with type 2 diabetes mellitus (T2DM).

Design: Semistructured in-person interviews were conducted and digitally recorded.

Setting: Southeastern American Indian tribal community.

Participants: A total of 28 noninstitutionalized older tribal members aged >60 years.

Phenomenon Of Interest: Study participants' beliefs and experiences with dietary practices and management related to T2DM.

Analysis: Transcribed qualitative interviews were coded using an inductive content analysis approach.

Results: Four themes regarding T2DM dietary beliefs and T2DM dietary management emerged from the analyses: diet changes, portion control, health care professional and family influence, and barriers to healthy eating. Study participants described how their beliefs, practices, and experiences in these 4 areas related to T2DM.

Conclusions And Implications: American Indian older adults face a variety of challenges to dietary management of T2DM. Future research efforts can focus on assessing how social support can be leveraged to facilitate healthy diets for American Indians with T2DM. Clinicians and diabetes educators and Native communities have an instrumental role in identifying culturally appropriate messages and programs to help persons effectively manage T2DM.
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September 2020