https://dash.harvard.edu/bitstream/handle/1/5344195/understanding%20differences.pdf

Understanding Differences in Health Behaviors by Education

http://people.stern.nyu.edu/wgreene/Lugano2013/Terza_J-Basu_A-Rathouz_P-ResidualInclusion.pdf

Two-stage residual inclusion estimation: Addressing endogeneity in health econometric modeling

Age and cumulative advantage/disadvantage theory have obvious logical, theoretical, and empirical connections, because both are inherently and irreducibly related to the passage of time. Over the past 15 years, these connections have resulted in the elaboration and application of the cumulative advantage-disadvantage perspective in social gerontology, especially in relation to issues of heterogeneity and inequality. However, its theoretical origins, connections, and implications are not widely understood. This article reviews the genesis of the cumulative advantage/disadvantage perspective in studies of science, its initial articulation with structural-functionalism, and its expanding importance for gerontology. It discusses its intellectual relevance for several other established theoretical paradigms in sociology, psychology, and economics. On the basis of issues deriving from these perspectives and from the accumulating body of work on cumulative advantage and disadvantage, I identify several promising directions for further research in gerontology.

Cumulative Advantage/Disadvantage and the Life Course: Cross-Fertilizing Age and Social Science Theory

Evaluating the quality of medical care.

http://www.antoniocasella.eu/salute/lancet_crisis_health_27mar13.pdf

Financial crisis, austerity, and health in Europe

Free for All? Lessons from the RAND Health Insurance Experiment.

It is often asserted that economic inequality narrows after age 65 when benefit programs replace labor markets as principal income sources. However, analysis of recent Census data suggests inequality is greatest among elderly people. The worst off one-fifth of the elderly (disproportionately unmarried women, minorities, and the physically impaired) receives 5.5% of the elderly's total resources, whereas the best off one-fifth receives 46%. Equalizing effects of Social Security are more than outweighed by private pensions, asset income, and other sources. Findings suggest a process of cumulative economic advantage and disadvantage throughout the life course.

Cumulative Advantage, Cumulative Disadvantage, and Inequality Among Elderly People

Background The prescribing of antipsychotic drugs has been increasing in nursing homes (NHs) since the availability of second-generation antipsychotic agents, also known as the atypicals, but there is little information on the appropriateness of such prescribing. Methods A retrospective analysis using the nationally representative data set of the Medicare Current Beneficiary Survey merged to Minimum Data Sets assessments, medication administration records, and Medicare claims. We identified a sample of 2.5 million Medicare beneficiaries in NHs during 2000-2001 (unweighted n = 1096) to assess prevalence of antipsychotic use, rates of adherence to NH prescribing guidelines, and changes in behavioral symptoms. Results Approximately 693 000 (unweighted n = 302), or 27.6%, of all Medicare beneficiaries in NHs received at least 1 prescription for antipsychotics during the study period: 20.3% received atypicals only; 3.7%, conventionals only; and 3.6%, both atypicals and conventionals. Less than half (41.8%) of treated residents received antipsychotic therapy in accordance with NH prescribing guidelines. One (23.4%) in 4 patients had no appropriate indication, 17.2% had daily doses exceeding recommended levels, and 17.6% had both inappropriate indications and high dosing. Patients receiving antipsychotic therapy within guidelines were no more likely to achieve stability or improvement in behavioral symptoms than were those taking antipsychotics outside the guidelines. Conclusions This study detected the highest level of antipsychotic use in NHs in over a decade. Most atypicals were prescribed outside the prescribing guidelines and for doses and indications without strong clinical evidence. Failure to detect positive relationships between behavioral symptoms and antipsychotic therapy raises questions about the appropriateness of prescribing.

https://jamanetwork.com/journals/jamainternalmedicine/articlepdf/486595/ioi50011.pdf

The quality of antipsychotic drug prescribing in nursing homes.

Objective: The authors examine the impact of two caregiving stressors, care receivers' behavior problems (an objective stressor) and caregivers' feelings of overload (a subjective stressor), on three dimensions of caregiver health. Method: The participants were 234 primary caregivers of elderly relatives with dementia living in the community who completed a comprehensive interview about their current care situation, including stressors and health. Results: Higher levels of both objective and subjective stressors were associated with all three dimensions of caregiver health: poorer self-reported health, more negative health behaviors, and greater use of health care services. The association between objective stressors and health was mediated by caregivers' feelings of overload. Conclusions: These findings demonstrate caregivers' vulnerability to the effects of stressors across three dimensions of health and also underscore the importance of subjective appraisals of stress.

The caregiver stress process and health outcomes.

The demand for home health care has skyrocketed in recent years. The aging population and the push for more efficient delivery of hospital services have fueled this growing demand. However, health care financing reforms have constrained the industry's growth. Home health agencies struggle to deliver high-quality services while staying within the financial limitations imposed by reimbursement changes. Telehomecare is one way to provide cost-effective care in the current environment. Personal computers and video equipment can transmit data over ordinary telephone lines and allow home health providers to monitor patients and provide care at a much lower cost than earlier technologies that required wider bandwidth telephone lines and more complex equipment. But can telehomecare yield cost-savings for home health agencies? This article addresses the costs associated with a telehomecare intervention in a large, urban, home health agency. The purpose of the study was two-fold: (1) to test the effects of telehomecare on clinical outcomes, and (2) to estimate the financial costs associated with providing telehomecare services. Our results show that, while telehomecare imposes additional expenses for care delivery, it contributes substantial savings without compromising quality. Additionally, we found that the financial benefit increases exponentially as the duration of the patient care episode increases.

Dennis G. Shea

Papers

Free for All? Lessons from the RAND Health Insurance Experiment.

Cumulative Advantage, Cumulative Disadvantage, and Inequality Among Elderly People

The quality of antipsychotic drug prescribing in nursing homes.

The caregiver stress process and health outcomes.

Cost analysis of telehomecare.