Biomedical subjects
Publications and source records attributed to B Berkman.
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With increasing numbers of elderly people, and the escalating costs of health care, screening becomes increasingly important for identifying those older people with social health care needs who appear in their primary care physicians' offices. Many people are not aware of available social services. Families with serious social problems are not finding the help they need. The aim of this study was to develop and refine a questionnaire as a screening tool to identify elderly outpatients in primary care settings who are at high risk for psychological, social or environmental needs. This study identified those ten factors at each site which were most indicative that further intervention was needed. There were consistencies among the coordinators across sites in terms of what factors triggered intervention. Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs) were more likely to be predictive of the coordinator's intervention than were other factors.
Although the total number of social workers within the academic medical center will probably decrease because of decreasing hospital bed usage, the role for those who remain will be that of a clinical specialist, a sophisticated and adaptable practitioner who can work flexibly under minimal supervision. The valued social work practitioner will be an independent player on the health care team who assumes a significant role which no other member of that team is equipped to take. Advanced training is more important today than ever before in the evolution of social work practice in academic health care. However, this training is not now available within the parameters of the two year master's program.
Dramatic changes in patient care delivery have been stimulated by advances in technology and new approaches to the financing of health care. Traditionally, the American health care system has been based on a paradigm of unpredictable acute simple disease, a model that has become inappropriate as increasing numbers of patients are presenting with multiple, chronic health problems. Because chronic illnesses are determined by many factors, such as an individual's social, psychological, and physical environment; genetic makeup; and health care accessibility factors, the hospital, once the dominant organization in health care, must become part of a primary care network of community-oriented delivery systems focused on chronic disease management. In this model, the social worker treats the patient throughout the continuum of care. Therefore, dynamic training that addresses the changing health care environment will be needed. In addition, social workers will need to work as members of a team in addressing the needs of patients for preventive, curative, and rehabilitative services.
Advances in medical science have led to effective treatments for cancer; however, there are myriad myths and biases related to older people and cancer that pervade both patients' and professionals' ideas on causation, course of illness, treatment, and recovery, and act as hindrances to early detection, treatment, and rehabilitation. The geriatric population is comprised of a heterogeneous group of persons who are not categorized easily according to chronologic age. Health care professionals are particularly susceptible to ageist stereotyping and negative attitudes toward the elderly because they lack training in caring for older people. In the future, the elderly will be better educated, expect greater participation in decision-making, and be less likely to postpone entry into the medical care system. There is a need to educate both health care professionals and the elderly population about the myths and realities of cancer detection and treatment.
A needs assessment survey of 268 polio survivors residing in Maine explored the incidence of postpolio syndrome as well as perceived need for and access to social and health care services. A large proportion reported experiencing postpolio syndrome. Although knowledgeable of their condition, a majority perceived that they had no access to knowledgeable physicians or social and health care services and most were having difficulty coping. Findings indicate that polio survivors' self-appraisal of their illness status is related to their perceived need for and access to social and health care services. The need for community-based services, including medical, rehabilitative, educational, and social work services, is indicated.
There are some elderly patients who receive social work services during an initial hospitalization and experience an early unplanned readmission, when they again are in need of social work assistance. This research identified factors which differentiated social work patients who were readmitted to the hospital within one month and were again referred to social work services from those who were not readmitted. Three factors were found to be predictive of readmission to social work: longer length of stay in the initial hospitalization; presence of barriers which complicated the social work service plan undertaken in the first admission; and provision of social work services in the initial admission which were limited to information and referral only.
As resources become increasingly scarce, oncology professionals and consumers of oncology services are increasingly engaging in advocacy efforts to achieve goals in cancer control. Effective advocacy includes both legislative and direct educational efforts.
Elder patients with cardiac disease are at high risk for physical deterioration during post hospital recovery and suffer frequent early readmission. It is important to identify such patients who frequently need help with discharge planning from social workers during their first admission. This study utilized computerized data on 628 patients, 238 of whom were readmissions. Question was raised as to what factors (functional, psychological, social and environmental), differentiated patients who were readmitted from those who were not. Using logistic regression, three variables: marital status, presence of coping difficulty and age of patients were identified as predictors of readmission within three months. Those who were married were less likely to be readmitted. Those with coping difficulties and older individuals were more likely to be readmitted. The accuracy of prediction, using these three factors, was 61 percent. Of those patients predicted as not being readmitted, sixty-nine percent were correctly predicted, while 39 percent were readmitted. Of patients predicted as readmissions, 49 percent were correctly predicted, while 51 percent were not. The major limitation of this study was that key physiological determinants of readmission were not collected. It is imperative that a valid screening device for predicting who is at risk for readmission should include physiological preconditions as well as functional and psychosocial data.
As technological advances within biomedicine uncover more complex and confusing situations, social workers are forced to deal with the patient and family with greater uncertainty. To competently address today's biomedical environment with an anticipation of tomorrow's advances is an incredible challenge. The focus of the theoretical framework necessary as the foundation for health care practice has shifted from an emphasis on psychopathology to a focus on what people do well, on their adaptive capacities with the goal of preventing maladaptive behavior. Therefore, the focus of practice must be on factors that affect normal or typical growth and development in the course of living and must include an understanding of the interaction between the biological, psychological, cognitive, social, cultural, and environmental dimensions of social functioning.
Present screening methods to identify older patients in need of posthospital care planning are overly sensitive and lack specificity, with the rate of false-positive screenings reaching 65 percent. Research was undertaken to develop a computerized screening mechanism to identify elderly cardiac patients at high risk for posthospital care needs. Using the data from the Medicus Nursing Productivity and Quality of Patient Care Classification System (NPAQ) as potential predictive factors, the false-positive screening rate was reduced to 26 percent. Early and accurate identification of these patients may prove beneficial to patients and their families and to social workers and hospital administrators. It can improve social worker efficiency in developing and implementing an adequate posthospital care plan, thus enhancing patient recovery.
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The advent of presymptomatic and prenatal testing in Huntington disease (HD) may change the reproductive behavior of persons at risk for HD. In order to assess future change, an analysis of fertility and reproductive fitness was carried out on 999 affected and 2,253 unaffected offspring from 235 New England families. Ascertainment biases observed for persons born before 1910 and after 1929 reduced the sample to 250 HD cases and 201 unaffected sib controls born between 1910 and 1929. No increase in reproductive rate was found in HD-affected men compared to male control sibs. A small increase in fertility averaging 0.5 child was seen in HD-affected females compared to unaffected females, but this difference was not significant. The increase in mean number of children for HD females is accounted for in part by a small number of affected women who had very large families. No evidence was found to suggest that any increase in reproductive rate for affected persons was related to offspring being born after HD onset. The fitness of both HD-affected and unaffected females was not significantly different from that of the general population of Massachusetts.
A retrospective study of 82 elderly "failure to thrive" (FTT) inpatients suggests that FTT is diagnosed when the elderly patient's functional ability to live with multisystem diseases, cope with the ensuing problems, and manage his/her own care are remarkably diminished and no longer responsive to health care interventions. In an attempt to clarify the clinical picture of FTT, we used standardized questionnaires to abstract data from medical charts.
The effectiveness of hospital social work preadmission screening and assessment is compared with postadmission screening and assessment. Outcome variables include length of stay, readmission rates, posthospital home management, resource attainment, and satisfaction with hospital services. The patients screened postadmission were assessed within forty-eight hours of admission, while the patients screened preadmission were assessed one to two weeks prior to admission. Telephone follow-up was conducted with both groups. Preadmission patients reported better home management and attained more resources. Patients' satisfaction with hospital care was inversely related to the need for more resources in the post-hospital period.
One hundred thirty-one individuals at 50% risk of inheriting Huntington disease (HD) responded to a survey to study their attitudes toward taking a genetic test based on the identification of a genetically linked DNA polymorphism. Ninety-six percent of the respondents believe that presymptomatic testing should be available, and 66% say they will use it themselves. Fewer married individuals, in comparison to those single, separated, and divorced, intend to take the test. Many respondents (40%) said their primary reason for wanting to be tested is to end the uncertainty in their lives. Results suggest that there will be self-selection in test use, with many individuals who believe they will be depressed or possibly suicidal with a positive test result deciding not to be tested or unsure about testing. However, 15% of those who want to be tested acknowledge that they may be at risk for suicide if they are probable gene carriers. Only 12% of all respondents say they will be likely to use prenatal testing, suggesting that initial demand may be low in New England. Implementation of presymptomatic testing challenges health care providers to develop strategies to care for otherwise healthy persons who will be given a diagnosis years before the onset of illness.
Sixty hospitalized elderly cardiac patients were tested using the Geriatric Functional Rating Scale (GFRS) and were followed four months postdischarge. Significant relationships were found between GFRS scores and readmission status. These data substantiate the potential usefulness of GFRS as a predictive instrument to identify those high-risk hospitalized elderly cardiac patients who need social-health services in the posthospital recovery period.
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