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Hurricane Katrina. It was found that older age and higher education, but not sex, were associated with the perception of moderate to complete emotional recovery. It was expected that it would be found that participants would report a worsening of health, but most people reported similar or better health as the previous year (~1 year after Hurricane Katrina), even though most had at least one chronic condition. Study limitations include the cross-sectional design, which made it difficult to establish cause and effect and small sample size. Study strengths include a sample that was assembled through multiple venues, providing an opportunity for a wide cross-section of the returning population, and a good response rate (75%). Hurricane Katrina and its aftermath had far-reaching consequences for the lives of those who were affected.5–8 The findings of the current study suggest that, at least 2 years after Katrina, older adults and those with higher education reported moderate to complete emotional recovery and stable health, which may reflect the lessening effect of the disaster and, perhaps, progress toward significant complete recovery in general.8–10 Older adults who survived disaster may be more resilient than younger people because of life experiences. Future studies should examine the characteristics of resilience in older adults longitudinally and how they can contribute to the process of recovery given their likelihood of earlier recovery. Sandra Y. Moody, MD, BSN Division of Geriatrics, Department of Medicine, University of California, San Francisco, California San Francisco Veterans Affairs Medical Center, San Francisco, California Kameda Medical Center, Kamogawa, Japan Edwina M. Newsom, AA Institute for Health and Aging, University of California, San Francisco, California Kenneth E. Covinsky, MD, MPH Division of Geriatrics, Department of Medicine, University of California, San Francisco, California San Francisco Veterans Affairs Medical Center, San Francisco, California
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Conflict of Interest: This work was supported by National Institutes of Health (NIH) Grant NIA 5R01AG28621. This publication was supported by the National Center for Research Resources and the National Center for Advancing Translational Sciences, NIH, through UCSF-CTSI Grant UL1 RR024131. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH. There are no conflicts for any of the authors. Author Contributions: Moody: study conception and design, data acquisition and interpretation, preparation of manuscript, approval of final version to be published. Newsom: subject and data acquisition and analysis, critical review of manuscript, approval of final version to be published. Covinsky: study design, data interpretation, critical review of manuscript, approval of final version to be published. Sponsor’s Role: None.
REFERENCES 1. Adams V, Kaufman SR, van Hattum T et al. Aging disaster: Mortality, vulnerability, and long-term recovery among Katrina survivors. Med Anthropol 2011;30:247–270. 2. Stewart AL, Greenfield S, Hays RD et al. Functional status and well-being of patients with chronic conditions: Results from the Medical Outcomes Survey. JAMA 1989;262:907–913. 3. RAND Medical Outcomes Study: 36-Item Short Form Survey Instrument [on-line]. Available at www.rand.org/health/surveys_tools/mos/mos_core_ 36items_survey.html Accessed December 17, 2013. 4. Bolin R, Klenow DJ. Response of the elderly to disaster: An age-stratified analysis. Int J Aging Hum Dev 1982–1983;16:283–296. 5. Bourque LB, Siegel JM, Kano M et al. Weathering the storm: The impact of hurricanes on physical and mental health. Ann Am Acad Polit Soc Sci 2006;604:129–151. 6. Sharma AJ, Weiss EC, Young SL et al. Chronic disease and related conditions at emergency treatment facilities in the New Orleans area after Hurricane Katrina. Disaster Med Public Health Prep 2008;2:27–32. 7. Jiao Z, Kakoulides SV, Moscona J et al. Effect of Hurricane Katrina on incidence of acute myocardial infarction in New Orleans three years after the storm. Am J Cardiol 2012;109:502–505. 8. Norris FH, Perilla JL, Riad JR et al. Stability and change in stress, resources, and psychological distress following natural disaster: Findings from Hurricane Andrew. Anxiety Stress Coping 1999;12:363–396. 9. Groen JA, Polivka AE. Going home after Hurricane Katrina: Determinants of return migration and changes in affected areas. Demography 2010;47:821–844. 10. Vu L, VanLandingham MJ. Physical and mental health consequences of Katrina on Vietnamese immigrants in New Orleans: A pre- and postdisaster assessment. J Immigr Minor Health 2012;14:386–394.
ACKNOWLEDGMENTS We are indebted to the late Gay Becker, PhD, who was responsible for the initial funding of this award. We would also like to acknowledge the contributions of all study participants and the research team of the original project, “Age, Disruption, and Life Reorganization After Hurricane Katrina,” including Ms. Taslim van Hattum for interviewing participants. We are also indebted to Barbara Grimes, PhD, Department of Epidemiology and Biostatistics CTSI Biostatistics Consulting Unit, University of California at San Francisco, for assisting with the statistical analyses. An abstract of this study was presented at the 2013 Annual Scientific Meeting of the American Geriatrics Society in the Presidential and International Poster Sessions, Grapevine, Texas.
PREFERENCES OF OLDER ADULTS WITH CANCER FOR INVOLVEMENT IN DECISION-MAKING ABOUT RESEARCH PARTICIPATION To the Editor: Older adults remain underrepresented in cancer clinical trials because of frequent comorbidities and related trial ineligibility but also because physicians are less likely to discuss this option with them.1,2 Physicians might perceive that older adults are less able to provide consent because they tend to be less actively involved in decisionmaking than their younger counterparts.3 The lower health literacy levels of older adults may also play a role.4 To the knowledge of the authors, no study focused on older adults’ decision-making regarding research participation.
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The aim of the current study was to compare the desire for involvement regarding research participation of older (≥65) and younger individuals with cancer, controlling for education level and research literacy. A questionnaire was mailed to 745 individuals treated for colorectal cancer, breast cancer, or a hematological malignancy at a French regional cancer center.5 A logistic model was used to study the factors associated with a wish for completely passive involvement (“I would let the doctor make the decision alone”) in a hypothetical decision to participate in a medical research.6 Subjects’ research literacy was estimated using a single question about basic knowledge of clinical trial procedures (“Do you think French law makes signed consent necessary for patient participation in a clinical trial?”). Of 574 respondents (aged 20–89), 190 (33.1%) were aged 65 and older (65–74, 21.4%; 75–84, 10.3%; ≥85, 1.4%). Older adults were more likely to be male, to have been treated for colorectal cancer, and have lower education and research literacy levels (Table 1). There were no age differences in self-reported participation in treatment trials (≥65, 5.5% vs
JUNE 2014–VOL. 62, NO. 6
Hurricane Katrina. It was found that older age and higher education, but not sex, were associated with the perception of moderate to complete emotional recovery. It was expected that it would be found that participants would report a worsening of health, but most people reported similar or better health as the previous year (~1 year after Hurricane Katrina), even though most had at least one chronic condition. Study limitations include the cross-sectional design, which made it difficult to establish cause and effect and small sample size. Study strengths include a sample that was assembled through multiple venues, providing an opportunity for a wide cross-section of the returning population, and a good response rate (75%). Hurricane Katrina and its aftermath had far-reaching consequences for the lives of those who were affected.5–8 The findings of the current study suggest that, at least 2 years after Katrina, older adults and those with higher education reported moderate to complete emotional recovery and stable health, which may reflect the lessening effect of the disaster and, perhaps, progress toward significant complete recovery in general.8–10 Older adults who survived disaster may be more resilient than younger people because of life experiences. Future studies should examine the characteristics of resilience in older adults longitudinally and how they can contribute to the process of recovery given their likelihood of earlier recovery. Sandra Y. Moody, MD, BSN Division of Geriatrics, Department of Medicine, University of California, San Francisco, California San Francisco Veterans Affairs Medical Center, San Francisco, California Kameda Medical Center, Kamogawa, Japan Edwina M. Newsom, AA Institute for Health and Aging, University of California, San Francisco, California Kenneth E. Covinsky, MD, MPH Division of Geriatrics, Department of Medicine, University of California, San Francisco, California San Francisco Veterans Affairs Medical Center, San Francisco, California
LETTERS TO THE EDITOR
1191
Conflict of Interest: This work was supported by National Institutes of Health (NIH) Grant NIA 5R01AG28621. This publication was supported by the National Center for Research Resources and the National Center for Advancing Translational Sciences, NIH, through UCSF-CTSI Grant UL1 RR024131. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH. There are no conflicts for any of the authors. Author Contributions: Moody: study conception and design, data acquisition and interpretation, preparation of manuscript, approval of final version to be published. Newsom: subject and data acquisition and analysis, critical review of manuscript, approval of final version to be published. Covinsky: study design, data interpretation, critical review of manuscript, approval of final version to be published. Sponsor’s Role: None.
REFERENCES 1. Adams V, Kaufman SR, van Hattum T et al. Aging disaster: Mortality, vulnerability, and long-term recovery among Katrina survivors. Med Anthropol 2011;30:247–270. 2. Stewart AL, Greenfield S, Hays RD et al. Functional status and well-being of patients with chronic conditions: Results from the Medical Outcomes Survey. JAMA 1989;262:907–913. 3. RAND Medical Outcomes Study: 36-Item Short Form Survey Instrument [on-line]. Available at www.rand.org/health/surveys_tools/mos/mos_core_ 36items_survey.html Accessed December 17, 2013. 4. Bolin R, Klenow DJ. Response of the elderly to disaster: An age-stratified analysis. Int J Aging Hum Dev 1982–1983;16:283–296. 5. Bourque LB, Siegel JM, Kano M et al. Weathering the storm: The impact of hurricanes on physical and mental health. Ann Am Acad Polit Soc Sci 2006;604:129–151. 6. Sharma AJ, Weiss EC, Young SL et al. Chronic disease and related conditions at emergency treatment facilities in the New Orleans area after Hurricane Katrina. Disaster Med Public Health Prep 2008;2:27–32. 7. Jiao Z, Kakoulides SV, Moscona J et al. Effect of Hurricane Katrina on incidence of acute myocardial infarction in New Orleans three years after the storm. Am J Cardiol 2012;109:502–505. 8. Norris FH, Perilla JL, Riad JR et al. Stability and change in stress, resources, and psychological distress following natural disaster: Findings from Hurricane Andrew. Anxiety Stress Coping 1999;12:363–396. 9. Groen JA, Polivka AE. Going home after Hurricane Katrina: Determinants of return migration and changes in affected areas. Demography 2010;47:821–844. 10. Vu L, VanLandingham MJ. Physical and mental health consequences of Katrina on Vietnamese immigrants in New Orleans: A pre- and postdisaster assessment. J Immigr Minor Health 2012;14:386–394.
ACKNOWLEDGMENTS We are indebted to the late Gay Becker, PhD, who was responsible for the initial funding of this award. We would also like to acknowledge the contributions of all study participants and the research team of the original project, “Age, Disruption, and Life Reorganization After Hurricane Katrina,” including Ms. Taslim van Hattum for interviewing participants. We are also indebted to Barbara Grimes, PhD, Department of Epidemiology and Biostatistics CTSI Biostatistics Consulting Unit, University of California at San Francisco, for assisting with the statistical analyses. An abstract of this study was presented at the 2013 Annual Scientific Meeting of the American Geriatrics Society in the Presidential and International Poster Sessions, Grapevine, Texas.
PREFERENCES OF OLDER ADULTS WITH CANCER FOR INVOLVEMENT IN DECISION-MAKING ABOUT RESEARCH PARTICIPATION To the Editor: Older adults remain underrepresented in cancer clinical trials because of frequent comorbidities and related trial ineligibility but also because physicians are less likely to discuss this option with them.1,2 Physicians might perceive that older adults are less able to provide consent because they tend to be less actively involved in decisionmaking than their younger counterparts.3 The lower health literacy levels of older adults may also play a role.4 To the knowledge of the authors, no study focused on older adults’ decision-making regarding research participation.
1192
LETTERS TO THE EDITOR
JUNE 2014–VOL. 62, NO. 6
The aim of the current study was to compare the desire for involvement regarding research participation of older (≥65) and younger individuals with cancer, controlling for education level and research literacy. A questionnaire was mailed to 745 individuals treated for colorectal cancer, breast cancer, or a hematological malignancy at a French regional cancer center.5 A logistic model was used to study the factors associated with a wish for completely passive involvement (“I would let the doctor make the decision alone”) in a hypothetical decision to participate in a medical research.6 Subjects’ research literacy was estimated using a single question about basic knowledge of clinical trial procedures (“Do you think French law makes signed consent necessary for patient participation in a clinical trial?”). Of 574 respondents (aged 20–89), 190 (33.1%) were aged 65 and older (65–74, 21.4%; 75–84, 10.3%; ≥85, 1.4%). Older adults were more likely to be male, to have been treated for colorectal cancer, and have lower education and research literacy levels (Table 1). There were no age differences in self-reported participation in treatment trials (≥65, 5.5% vs
