HIGH-DEDUCTIBLE HEALTH PLANS AND COST OF HEARING AIDS AMONG ADULTS WITH HEARING LOSS: IMPLICATIONS FOR DISPARITIES

Abstract High-deductible health plans (HDHPs) have shown potential to curb rising healthcare costs. We examined use and cost of hearing aids (HAs), comparing HDHPs with non-HDHPs. Using the 2009-2016 Truven Marketscan claims, we identified adults aged 50-64 who were diagnosed with hearing loss (HL) and whether they used HAs or not (n=1,247,113). We applied multivariable generalized linear models, adjusting for age, gender, hierarchical condition categories (HCCs). To control for potential selection bias, we applied an inverse propensity score weighting. Our outcomes of interest included: (1) utilization and (2) total and out-of-pocket costs of HAs (inflation adjusted to 2016 dollars), comparing HDHPs with non-HDHPs. Number of enrollees in HDHPs increased by 343%, from 1,717 in 2009 to 7,615, in 2016. The percentage of patients who used HA increased from 9.5% (95% CI:0.09-0.10) to 15% (95% CI:0.14-0.15) within non-HDHPs and from 5% (95% CI:0.04-0.06) to 16% (95% CI:0.15-0.17) within HDHPs. The average adjusted cost sharing and total cost of HAs increased by 74% ($85 to $148) and 52% ($589 to $894), respectively, among non-HDHPs; they increased by 80% ($173 to $312) and 91% ($589 to $1,126), respectively, among HDHPs. Average out-of-pocket costs for HAs in HDHPs were twice as much as in non-HDHPs (p <0.0001). Total and out-of-pocket costs for hearing aids were substantially higher among HDHPs compared with non-HDHPs. Many employers have started offering only HDHPs, leaving their employees with no other health insurance option. Higher cost sharing may worsen the existing socioeconomic disparities in access to HAs.

and Other.Nutritional status was measured using Mini Nutritional Assessment (MNA).Ordered logistic regression analysis was utilized to assess the association between ethnic identity and nutritional status.Results revealed that the Indigenous ethnicity was significantly associated with worse nutritional status compared to Mestizo and Other even after controlling for a range of covariates including socio-economic status, health related factors, and social support.These findings suggest the existence of underlaying factors hindering the nutritional status of among indigenous older adults in Ecuador.Considering the information revealed by SABE, interventions and other strategies should be targeted and designed specifically accounting for the needs, preferences, and culture of the most vulnerable population.

RACIAL BIAS IN STAFF OPTIMISM ABOUT ADL IMPROVEMENT AMONG NURSING HOME RESIDENTS
Research on bias in health care has shown disparity in provision of care to and health outcomes of African Americans.Patient optimism was associated with improved physical and psychosocial outcomes, and nurse optimism was correlated with patient perceptions of care.We estimated effects of race using logistic regression, controlling for ADLs, cognitive impairment, and gender on both staff optimism and resident optimism about capacity for improvement in ADLs in a probability sample (n=2604) of nursing home residents who were evaluated with the resident assessment instrument (RAI).We found no difference between African American and White residents' optimism about their own capacity for improvement.Staff findings were quite different.Staff were most optimistic about the potential of residents who needed ADL assistance OR=1.82; 95% ] over those who were ADL dependent or those who only needed oversight.Most importantly, it was in the oversight category of ADL impairment where the greatest indication of racial prejudice occurred.Staff were much less likely to be optimistic about African American residents (16%) compared to White residents (30%).With all control variables entered, staff were still less willing to be optimistic about African American resident improvement (AOR=0.65;95% CI [0.44-0.96].The implications of these findings are troubling.It is unlikely that staff would expend energy on improving the functioning of the African American residents whom they believe cannot improve.Further research is needed on the extent to which prejudice in nursing homes is accompanied by discrimination and how the bias can be overcome.High-deductible health plans (HDHPs) have shown potential to curb rising healthcare costs.We examined use and cost of hearing aids (HAs), comparing HDHPs with non-HDHPs.Using the 2009-2016 Truven Marketscan claims, we identified adults aged 50-64 who were diagnosed with hearing loss (HL) and whether they used HAs or not (n=1,247,113).We applied multivariable generalized linear models, adjusting for age, gender, hierarchical condition categories (HCCs).To control for potential selection bias, we applied an inverse propensity score weighting.Our outcomes of interest included: (1) utilization and (2) total and out-of-pocket costs of HAs (inflation adjusted to 2016 dollars), comparing HDHPs with non-HDHPs.Number of enrollees in HDHPs increased by 343%, from 1,717 in 2009 to 7,615, in 2016.The percentage of patients who used HA increased from 9.5% (95% CI:0.09-0.10) to 15% (95% CI:0.14-0.15)within non-HDHPs and from 5% (95% CI:0.04-0.06) to 16% (95% CI:0.15-0.17)within HDHPs.The average adjusted cost sharing and total cost of HAs increased by 74% ($85 to $148) and 52% ($589 to $894), respectively, among non-HDHPs; they increased by 80% ($173 to $312) and 91% ($589 to $1,126), respectively, among HDHPs.Average outof-pocket costs for HAs in HDHPs were twice as much as in non-HDHPs (p <0.0001).Total and out-of-pocket costs for hearing aids were substantially higher among HDHPs compared with non-HDHPs.Many employers have started offering only HDHPs, leaving their employees with no other health insurance option.Higher cost sharing may worsen the existing socioeconomic disparities in access to HAs.

OPPRESSIVE EXPERIENCES AMONG DEAF DIVERSE SENIOR CITIZENS
None of the limited literature on deaf seniors focuses on their experiences of oppression.There is an article that demonstrates that not many mental health professionals have the skills to work with deaf seniors.Obstacles have been noted in the literature among deaf people in general terms of being oppressed with employment, doctors, education, family discrimination, stereotyping, stigmas and cultural conflicts because they are deaf.The obstacles facing deaf seniors had not been specifically explored before this research.The shift attention to deaf seniors is needed in order to make their experiences known and at the same time their lives, values, and strengths need to be understood and recognized.Ninety-one deaf seniors from five states aged between 50 years and 93 years were interviewed to describe their recent experience on oppression.They shared their common experiences on oppression such as lack of communication with their doctors, hearing co-workers, and family members, struggling to get promoted at work, and being left out in the neighborhood.According to the deaf seniors, the community did not acknowledge or accommodate the special needs they had as deaf seniors.Their detailed descriptions provide consistent evidence that supports the importance of cultural awareness for medical and mental health professionals.The professionals are to enhance better understanding of experiences among deaf seniors.This lack of awareness highlights the need for research about deaf seniors' experiences of oppression and for research on what professionals should know about the special needs of this population.

LIFE EXPECTANCY WITH CHRONIC DISEASE AMONG OLDER MEXICAN AMERICANS
Kerstin G. Emerson, 1 Anqi Pan, 1 and Hanwen Huang 1 , 1. University of Georgia, Athens, Georgia, United States The Hispanic Paradox research consistently shows a survival advantage among Hispanics, where they have significantly longer life expectancy compared to non-Hispanic Whites.However, less is known about the quality of these additional years of life.Our goal was to calculate life expectancy for older Hispanics in the US, and to determine what proportion of their lives they could expect to live with chronic conditions.We used data from 2004-5 of the Hispanic Established Population for the Epidemiological Study of the Elderly (Hispanic-EPESE), linked to vital status data through 2016.To determine life expectancy with/ without chronic conditions, we used Sullivan's method.Chronic conditions included: diabetes, stroke, heart attack, arthritis, hypertension, and cancer.Finally, we mapped life expectancy without chronic conditions across neighborhood characteristics.The sample consisted of 2,069 Mexican Americans aged 75 and older.Results showed that at age 75, Mexican Americans could expect to live a large portion of their lives with at least one chronic condition (88%).The largest proportion of life lived with disease was for hypertension (61%), arthritis (59%), and diabetes (33%).There was no pattern by neighborhood characteristics for disease-free life expectancy.Gender differences could not be examined because of small sample sizes.Our findings show that regardless of neighborhood characteristics, Mexican Americans can expect to live a high proportion of their life with at least one chronic condition.This is particularly high for hypertension, diabetes, and arthritis.It is important to consider quality as well as quantity of life when exploring the Hispanic Paradox.

META-SYNTHESIS: OLDER ADULT SURVIVORS' RESILIENCE
Roberta R. Greene, 1 Harriet Cohen, 2 Nancy A. Greene, 3 and Shira Hantman 4 , 1. University of Texas at Austin, Austin, Texas, United States, 2. Jewish Family Service of Dallas,Dallas,Texas,United States,3. Johnson C. Smith University,Charlotte,North Carolina,United States,4. Tel Hai College,Upper galilee,Israel,Israel This paper presents the results of a meta synthesis of 8 qualitative studies that examined resilience among 270 older adult survivors following potentially traumatic adverse events (Bonanno, 2004).The primary data involved information about survivors' critical events during the Holocaust , the Cambodian genocide, and the discriminatory practices of the Jim Crow U.S. South.A narrative approach to gerontology was used to collect and analyze the original data.known as a constant comparison data analysis ( Glaser & Strauss, 2009;Miles & Huberman, 1994).This allowed for the understanding of risks such as such as discrimination, imprisonment, genocide, and possible loss of life and the development of themes of resilience at the personal, interpersonal, sociocultural, and societal levels (Kenyon & Randall, 2001) The meta synthesis of secondary data involved coding the original findings, grouping them into descriptive themes, and generating new overarching analytical themes (Thomas & Harden, 2008).The most prevailing theme at the personal-level (internal feelings) was overcoming the grief of losing a loved one.Interpersonal-level themes (relationships between people) were related to staying connected to family.Sociocultural-level themes (the beliefs and mores of the time) centered on making meaning of a critical event within its Elham Mahmoudi, 1 and Neil Kamdar 2 , 1. University of Michigan, Department of Family Medicine, Ann Arbor, Michigan, United States, 2. University of Michigan, Ann Arbor, Michigan, United States