Showing papers in "Journal of Aging and Health in 1997"
TL;DR: The findings point to the potential benefits of increasing seniors' sense of control as a means to promote exercising and to increase leisure activity participation and, consequently, to enhance well-being.
Abstract: Although the physical and psychological benefits of feeling in control are well-documented in the research literature, the mechanisms that account for these effects have received less attention. The present study was designed to examine the potential mediating role of exercising and participation in nonphysical leisure activities, such as attending cultural events, involvement in volunteer organizations, and so on, in the relation between perceived control and well-being in seniors. The results indicated that an internal locus of control was positively related to exercising and participation in leisure activities. Exercising and leisure activity participation, in turn, were predictive of better perceived health and greater life satisfaction. These findings point to the potential benefits of increasing seniors' sense of control as a means to promote exercising and to increase leisure activity participation and, consequently, to enhance well-being.
167 citations
TL;DR: Health behaviors of a sample of older adult spouse caregivers are described and the predictors of decreased self-care since caregiving began are investigated and multiple regression results indicate that caregivers who experience greater developmental burden, report a greater number of depressive symptoms, perform agreater number of activities of daily living in caregiving and spend more hours in a day providing care are at greater risk for negative health behavior change.
Abstract: This study describes the health behaviors (alcohol consumption, exercise, sleep patterns, smoking, and weight maintenance) of a sample of older adult spouse caregivers (N = 233) and investigates the predictors of decreased self-care since caregiving began. Multiple regression results indicate that caregivers who experience greater developmental burden, report a greater number of depressive symptoms, perform a greater number of activities of daily living (ADL) tasks in caregiving and spend more hours in a day providing care, and who have lower self-efficacy for both self-care and spouse care are at greater risk for negative health behavior change. Results have implications for the identification of caregivers who may be particularly vulnerable to the negative health impact of caregiving.
144 citations
TL;DR: Although African American caregivers were less likely to report depression and role strain, there was no interaction by race in the process influencing caregiver distress.
Abstract: This study investigated the relationship between race, finding meaning (as a positive psychological resource variable), and the outcomes of caregiver depression and global role strain among 77 African American and 138 White spouse caregivers of persons with dementia. Finding provisional meaning had a direct negative relationship with depression and global role strain. Although African American caregivers were less likely to report depression and role strain, there was no interaction by race in the process influencing caregiver distress.
143 citations
TL;DR: Whereas African Americans were less likely to complain of deterioration in memory, actual decline was greater for African Americans than for Whites and predicted a decline in cognitive function as measured by the SPMSQ 3 years later.
Abstract: Of a representative, racially mixed community sample of older adults in North Carolina, 59% of Whites and 49% of African Americans reported worsening memory. The complaint about memory was positively correlated with age, depressive symptomatology, and physical function but not with level of cognitive function as measured by the Short Portable Mental Status Questionnaire (SPMSQ) at baseline. In a controlled analysis of longitudinal data, initial SPMSQ score, age, African American race, lower education, depressive symptomatology, and physical deficits at baseline, but not memory complaint, predicted a decline in cognitive function as measured by the SPMSQ 3 years later. Whereas African Americans were less likely to complain of deterioration in memory, actual decline as measured by the SPMSQ was greater for African Americans than for Whites.
142 citations
TL;DR: The results suggest that certain common life event stressors may have an impact on mental health, both singly and in combination.
Abstract: We examined the effect of a series of common stressful life events on change in depressive symptoms among the elderly. The subjects were 1,962 noninstitutionalized people 65 years of age or older f...
97 citations
TL;DR: Findings suggest that caregivers who experience deterioration in levels of physical health and burden and who use in- home respite on a short-term or spoadic basis may be especially vulnerable to the chronic stress of providing long-term in-home care.
Abstract: This study examined the predictors of caregiver depression and "adaptation" over time in a sample of 202 family caregivers of cognitively impaired adults. By examining caregiver adaptation (i.e., a...
90 citations
TL;DR: The results suggest that twin pairs surviving into very late life are similar to a representative sample of nontwins of the same age in health status and biobehavioral functioning, which support the generalizability of twin studies for understanding genetic and environmental influences on aging, health, and behavior.
Abstract: Twin studies are a powerful approach for estimating genetic and environmental influences in later life, but the usual requirement that both twins are alive may introduce a selection bias in gerontological studies relative to representative samples of nontwins. In the present study, samples of older twins and nontwins in Sweden were compared across the domains of vitality, well-being, physical and cognitive functioning, and health utilization to evaluate possible selection bias. One member of each twin dyad in the OCTO-Twin Study of intact twin pairs older than age 80 was randomly selected (N = 128) and compared with a population-based sample of nontwins (N = 324) from the OCTO Study. Multiple regressions adjusting for differences in demographic variables showed significant effects for twin status in only 3 of 20 comparisons. The results suggest that twin pairs surviving into very late life are similar to a representative sample of nontwins of the same age in health status and biobehavioral functioning. Th...
77 citations
TL;DR: It is shown that utilization of health care depends on interaction between physical and mental health, attitudinal, and social factors and living alone was the greatest predictor of the utilization of increased levels of caregiving services.
Abstract: The purpose of this paper is to predict health care utilization in the very old from a combination of individual-based factors such as physical and mental health, health attitudes and beliefs, sociodemographic characteristics, and life circumstances. This study was conducted within the context of the Berlin Aging Study (BASE). Higher use of medications was most strongly predicted by more medical diagnoses, better cognitive status, and health attitudes. Physician contact was only weakly predicted by physical health variables, hypochondriasis, and living alone. In contrast, living alone was the greatest predictor of the utilization of increased levels of caregiving services, while having children nearby served as a protective factor against the need for more formal caregiving services. These results show that utilization of health care depends on interaction between physical and mental health, attitudinal, and social factors.
74 citations
TL;DR: Males and females with high education maintained better functioning at later ages than those with low education, and mortality was higher, after conditioning on disability, in both the male and female low-education than themale and female high-education groups.
Abstract: The authors used mortality data for 1982 to 1991 linked to survey records from the 1982, 1984, and 1989 National Long Term Care Surveys to calculate gender differences over age in mortality and fun...
72 citations
TL;DR: Of the cognitive functions, only everyday memory was independently associated with IADL disability, and the importance of emotional functioning, fluid intelligence, and everyday memory for the disablement process is demonstrated.
Abstract: This study focused on the association between aspects of emotional and cognitive functioning and two stages of the disablement process model, functional limitations, and instrumental activities of ...
52 citations
TL;DR: Weight change was significantly associated with higher scores on standardized measures of burden and stress and with lower education, poorer self-rated health, more psychotropic medication use, and caring for patients who had been hospitalized for stroke or a frail elderly condition.
Abstract: This study evaluated weight change and caregiver stress in 200 informal caregivers to elderly patients discharged from a rehabilitation hospital. Previous laboratory and epidemiologic studies have ...
TL;DR: It is suggested that improved understanding of functional status will occur from studies that take into consideration the differences between functional limitation and ADL disability.
Abstract: Activity of daily living (ADL) and instrumental ADL (IADL) data from the 1989 National Long-Term Care Survey (NLTCS) are used to replicate two domains of functional status with a total of five dimensions among them. LISREL analysis of the 14,415 Black and White older adults obtained from the 1989 NLTCS screen replicates three ADL disability dimensions (basic, household, and advanced) with few modifications, except among Black males. Similarly, analysis of the 4,297 Black and White disabled older adults replicates five functional status dimensions (3 ADL disability dimensions plus lower- and upper-body functional limitation dimensions) with few modifications, except among Black males. These results suggest that improved understanding of functional status will occur from studies that take into consideration the differences between functional limitation and ADL disability. The results also indicate that further research on the validity of functional reports among Black males is needed.
TL;DR: It was found that 63% of the initially nondisabled who survived to the next interview remained able to do the basic activities of daily living without help, at least until a few months before death.
Abstract: Disability among deceased subjects in the Duke Established Population for Epidemiologic Studies of the Elderly (EPESE) survey was analyzed to determine the risk of becoming disabled before or during the final year of life and the predictors of this disability. The method was a comparison of the baseline characteristics of decedents who became disabled with the characteristics of decedents who were not disabled. It was found that 63% of the initially nondisabled who survived to the next interview remained able to do the basic activities of daily living without help, at least until a few months before death. Multivariate analysis showed that initial age, income, depression, and self-rated health were strong and independent predictors of becoming disabled. The findings suggest that reducing poverty, depression, and illness may reduce the risk of disability in the final year.
TL;DR: Analysis of weighted data indicate that there were fewer differences in health by race among older persons who lived alone compared to elders who lived with others, and where racial differences did exist, they could only sometimes be accounted for by population composition factors that are known to influence health.
Abstract: This investigation was initiated to determine whether older African Americans who live alone are in poorer health than their White counterparts who live under the same circumstances. Data on 5 meas...
TL;DR: Results suggest a multiple etiology in which biological, psychological, and sociocultural factors all play a role in generating behavior problems in the long-term care setting.
Abstract: This study identified personal risk factors associated with behavior problems among nursing home residents using data based on a national survey of nursing home residents. Data are based on the Institutional Population Component of the 1987 National Medical Expenditure Survey and include nursing home residents living in licensed facilities on January 1, 1987. Multiple regression analyses were conducted to examine characteristics of residents that place them at risk of behavior problems. Independent variables include physical functioning, sensory impairment, cognitive impairment, psychiatric diagnoses, and demographics. Eleven behavior problems grouped into four categories based on factor analysis serve as dependent variables: wandering/safety, aggressive behaviors, collecting behaviors, and delusions/hallucinations. Risk factors emerging as predictors included sex (male), cognitive impairment, ADL dependency, incontinence, psychiatric history, receptive communication, walking, and difficulty seeing. Risk ...
TL;DR: There was no evidence that social interaction mediated the effects of either anxiety or extroversion on health, and the structure of psychosocial characteristics of the healthy elderly sample was revealed in the pattern of correlations between personality, social interaction, and locus of control.
Abstract: One hundred and thirty-five initially healthy men and women older than 65 years of age were studied prospectively to identify factors associated with health outcomes. At study onset, measures of personality, social interaction, and health locus of control were obtained while participants were still healthy. A reliable health outcome measure was developed, based on the annual objective coding of morbidity. Correlations between variables showed significant associations between age, a less independent personality trait, and poor health outcomes. Anxiety and low levels of social interaction were associated with poor health after 8 years. Gender and health locus of control were not significantly related to health outcomes. A path analysis showed significant direct paths between age and trait anxiety and 8-year health outcomes, and indirect paths between anxiety and extroversion and 8-year health, by way of social interaction. There was no evidence that social interaction mediated the effects of either anxiety ...
TL;DR: Exploratory factor analysis and multiple regression analysis revealed that risk factors for poor nutritional health-seeking behaviors in older adults include advanced age, low economic resources, and male gender.
Abstract: Health-seeking behaviors are described by Harris and Guten (1979) as any behavior of an individual that promotes, protects, or maintains one's health, regardless of actual or perceived health status. The purpose of this study was to determine if nutritional health-seeking behavior (Bausell, 1986) comprised one or more factors for older adults (N = 256). Participants were in their 60s (n = 90), 80s (n = 91), and 100+ (n = 75). Exploratory factor analysis indicated that nutritional health-seeking behavior items formed two factors: avoid (i.e., avoiding unhealthy nutritional behavior) and seek (i.e., attempting or seeking healthy nutritional behavior). Multiple regression analysis revealed that risk factors for poor nutritional health-seeking behaviors in older adults include advanced age, low economic resources, and male gender. Protective factors included in the personality factors of self-discipline, enthusiasm, sensitivity, and warmth.
TL;DR: Predicting death and community discharge become increasingly problematic as stay lengthens, and comparing observed versus expected discharge outcomes has limited usefulness as a quality-improvement tool.
Abstract: This article's purpose was to identify predictors of discharge outcomes of VA nursing home stays Using data tapes, diagnostic and assessment data were assembled on elderly individuals admitted to VA nursing homes nationwide during Fiscal Year 1987 Six-month outcomes for 3 groups were considered: all residents (n = 5,895), and those remaining in care after 6 (n = 2,815) and 12 months (n = 1,812), respectively Logistic regression was used to evaluate predictors of death and community discharge Limited activities of daily living (ADL) dependency, younger age, and receipt of rehabilitation services most consistently predicted community discharge ADL dependency, older age, oxygen use, terminally ill prognosis, malignancy, and congestive heart failure most consistently predicted mortality For both dependent variables, predictive ability declined as stay length increased Predicting death and community discharge become increasingly problematic as stay lengthens Comparing observed versus expected discharge
TL;DR: Investigation of health and sociodemographic variables associated with co-residency patterns among older patients and their adult children following discharge from an acute care hospital indicates that the overall level of caregiver involvement in activities of daily living and instrumental activities ofdaily living were strong predictors of parent and adult children forcing a joint household.
Abstract: This study investigated health and sociodemographic variables associated with co-residency patterns among older patients and their adult children following discharge from an acute care hospital. Data for the analysis were obtained from 172 adult children caring for functionally impaired parents. Logistic regression was employed to determine the probability that an older parent establishes co-residency with the adult child following hospitalization instead of remaining in a separate household. Results indicate that the overall level of caregiver involvement in activities of daily living (ADL) and instrumental activities of daily living (IADL) were strong predictors of parent and adult children forcing a joint household. Increased household income of caregivers was inversely related to co-residency. Decisions about co-residency following hospitalization appear to hinge both on parental need and the resources of the adult child, suggesting that the decision to move together is largely one of need and not pre...
TL;DR: It is concluded that geriatrics specialty care does not eliminate the age-associated decline in mammography use that has been previously described and factors associated with Mammography use in this sample were similar to those that have been described in younger populations of women.
Abstract: Thirty-two personal characteristics were examined as potential predictors of mammography use in the past year in a geriatric clinic. Interviews assessed demographic, health status, health service utilization, health belief, and psychological and social variables (n = 242, mean age = 76 years). Four variables were independently associated with mammography use in logistic regression analysis: age, historical mammography use, perceived severity, and perceived barriers. The inverse relationship between age and mammography use in the past year was not modified by health status, functional status, and the other independently predictive variables. The authors conclude that geriatrics specialty care does not eliminate the age-associated decline in mammography use that has been previously described. The factors associated with mammography use in this sample were similar to those that have been described in younger populations of women. Variables examined because of specific gerontologic considerations were not ind...
TL;DR: The findings show that the perceived seriousness of the bodily change and the general health context of the older person in which it has occurred are conducive to interpreting a bodily change as an illness symptom.
Abstract: Based on a community random sample of 406 elderly, factors that persuade an elderly person to interpret a bodily change as a symptom of illness are described. Three measures of such illness interpretation among 27 different bodily changes are used in analysis: giving an illness label to the change, consulting a physician for it, and/or using self-care for treatment. The three types of representations across all 27 bodily changes taken together, as well as among five typical complaints most commonly experienced, are reported. The findings show that the perceived seriousness of the bodily change and the general health context of the older person in which it has occurred are conducive to interpreting a bodily change as an illness symptom.
TL;DR: Risks varied in strength, presence, and direction of impact across the four dimensions of disability; as a result, analyses using an aggregated measure were misleading.
Abstract: The purpose of this article was to determine whether risk factors for four dimensions of disability differ and whether it is legitimate to use aggregated disability measures in risk factor analyses. Using data from the baseline Duke Established Populations for Epidemiologic Studies of the Elderly survey (n = 4,162), the authors examined four measures of disability--basic activities of daily living (ADLs), household ADLs, advanced ADLs, and mobility--and an aggregated measure consisting of these four measures summed. Sociodemographic risk factors were examined using stagewise multivariate regression analysis for the five measures of disability. Weighted least squares with an arbitrary distribution function estimator were used to determine differences in each risk factor's performance across the unaggregated measures. Risk factors varied in strength, presence, and direction of impact across the four dimensions of disability; as a result, analyses using an aggregated measure were misleading.
TL;DR: Treatment for mental illness provided by either general practice physicians or by mental health specialists appears to have few impacts on mortality, but a statistically significant treatment effect is found only for residents with schizophrenia, other psychoses, or anxiety disorders when treated bymental health specialists.
Abstract: This article examines the impact of mental health services on the mortality rate for mentally ill nursing home residents. Previous research has documented the unmet need for mental health services among nursing home residents. Some research using small data sets has indicated patient benefits from treatment. This article examines the issue using data from the nationally representative National Nursing Home Survey. In a series of multivariate logistic regressions, treatment for mental illness provided by either general practice physicians or by mental health specialists appears to have few impacts on mortality. A statistically significant treatment effect is found only for residents with schizophrenia, other psychoses, or anxiety disorders when treated by mental health specialists. The results are discussed with reference to ongoing reforms for mental health care in nursing homes.
TL;DR: Results reveal that NDI information, used to supplement reinterview information, can substantially reduce bias due to the differential loss of participants to follow-up.
Abstract: To reduce the potential bias resulting from differential loss to follow-up in the Longitudinal Study of Aging (LSOA), information obtained from household contact methods was supplemented with infor...
TL;DR: GEM had a modest beneficial effect on the health behavior of frail older persons manifesting some symptoms of psychological distress, and reduced outpatient use among patients who scored higher on a measure of somatization.
Abstract: A randomized, controlled trial compared prospective 16-month health service use among 160 frail, elderly veterans receiving outpatient geriatric evaluation and management (GEM) or usual primary care (UPC). In this secondary analysis, multivariable regression was used to determine if the psychosocial assessment and support provided by the GEM team moderated the use of medical services by patients in psychological distress. The results indicate that GEM reduced outpatient use among patients who scored higher on a measure of somatization (p< .05), but GEM increased outpatient use among patients with higher manifest anxiety (p≤ .05). Psychological distress was not a factor in the use of inpatient services. GEM had a modest beneficial effect on the health behavior of frail older persons manifesting some symptoms of psychological distress.
TL;DR: This study attempted to determine whether a community population of elders would be receptive to wearing an undergarment worn to protect against hip injuries and the characteristics of those who would and would not be receptive.
Abstract: Hip fractures among elders resulting from falls are a growing concern as the proportion of elders increases and health care costs mount. A recent innovation is the development of an undergarment worn to protect against hip injuries. This study attempted to determine whether a community population of elders would be receptive to wearing such a garment and the characteristics of those who would and would not be receptive. It was assumed that receptivity can be predicted by variables that have been shown to relate to risks of falling. Predictor characteristics represent three domains: demographic/predisposition, health/mobility, and social support. A logistic regression procedure was employed to determine the probability and odds of receptivity among elders given a profile of specific characteristics. Results were interpreted with reference to past research on risks of falling.
TL;DR: For men and women, the unadjusted odds ratios for proxy evaluations exhibited a monotone relationship to 3-year and 7-year mortality rates and were predictive of 7- year mortality, while for women only the fair and poor evaluations were significant, and only for men.
Abstract: The ability of self-evaluations of health to predict mortality remains despite efforts to explain their contribution. To further the understanding of global evaluations, this study investigated whether proxy evaluations of health status also predict mortality. Data from the Longitudinal Study of Aging were used. For men and women, the unadjusted odds ratios for proxy evaluations exhibited a monotone relationship to 3-year and 7-year mortality rates and were predictive of 7-year mortality. This monotone relationship remained even after controlling for other factors when predicting 7-year mortality rates. However, only the fair and poor evaluations were significant, and only for men. The adjusted relationship when predicting 3-year mortality was not completely monotone, although good and poor proxy evaluations were significant. This suggests that proxy evaluations are useful, and that there are aspects of health status that are currently unmeasured but that should lend themselves to being quantified.
TL;DR: The author assessed the potential need for visiting nursing and rehabilitation services on a national level to estimate the volume of services expected for Japan's proposed new long-term care insurance, suggesting a sharp rise in demand once the new insurance is fully implemented.
Abstract: The author assessed the potential need for visiting nursing and rehabilitation services on a national level to estimate the volume of services expected for Japan's proposed new long-term care insurance. Baseline data were obtained from the national survey on freestanding visiting nursing stations conducted in September 1994, in which the population of 18,500 patients was professionally assessed by visiting nurses. The baseline data were then applied to the national sampling survey on households conducted in June 1992, in which respondents self-reported their activities of daily living (ADL) and health status. There are estimated to be 836,000 noninstitutionalized elderly with disability. Their need for visiting nursing and rehabilitation services is expressed as 48.26 million visits or 57.33 million working hours annually. Current service volume accounts for only 5% of the potential need, suggesting a sharp rise in demand once the new insurance is fully implemented.