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Biomedical subjects

C Gruman

Publications and source records attributed to C Gruman.

14 recordsLinked to original sources
PubMed2001

Medicaid estate planning: perceptions of morality and necessity.

PURPOSE: Although several studies have examined the magnitude and prevalence of Medicaid estate planning (MEP), little is known about factors that influence individual behaviors in this area. Normative data regarding public perceptions of and motivations for MEP are nonexistent. This study explored views about MEP among community-dwelling older adults and family caregivers. DESIGN AND METHODS: Eighteen focus groups were completed (N = 155), with a stratified homogeneous sample to ensure representation from individuals of varying race/ethnicity, experience with nursing home and home care services, and socioeconomic status. Analyses of transcripts were completed with NUD*IST 4.0 software. RESULTS: Disincentives for MEP included losing control of one's assets, Medicaid stigma, and perceived immorality of MEP. Incentives for MEP included preservation of one's estate and protection of a spouse. Finally, variability in accessibility to and awareness of MEP was described. IMPLICATIONS: This exploratory study identifies motivations for individual behaviors and describes evolving social norms regarding MEP; implications for policy and research are discussed.

Aged↗
PubMed2000

Attrition in an exercise intervention: a comparison of early and later dropouts.

OBJECTIVE: To identify reasons for dropout and factors that may predict dropout from an exercise intervention aimed at improving physical function in frail older persons. DESIGN/SETTING: An 18-month randomized controlled intervention in a community setting. The intervention comprised 2 groups: class-based and self-paced exercise. PARTICIPANTS: 155 community-dwelling older persons, mean age 77.4, with mildly to moderately compromised mobility. MEASUREMENTS: The primary outcome measure was dropout. Dropouts were grouped as: D0, dropout between baseline and 3-month assessment, and D3, dropout after 3-month assessment. MEASUREMENTS: Measurements of demographics, health, and physical performance included self-rated health, SF-36, disease burden, adverse events, PPT-8, MacArthur battery, 6-minute walk, and gait velocity. RESULTS: There were 56 dropouts (36%), 31 in first 3 months. Compared with retained subjects (R), the D0 group had greater disease burden (P = .011), worse self-perceived physical health (P = .014), slower usual gait speed (P = .001), and walked a shorter distance over 6 minutes (P<.001). No differences were found between R and D3. Multinomial logistic regression showed 6-minute walk (P<.001) and usual gait velocity (P<.001) were the strongest independent predictors of dropout. Controlling for all other variables, adverse events after randomization and 6-minute walk distance were the strongest independent predictors of dropout, and self-paced exercise assignment increased the risk of dropout. CONCLUSIONS: We observed baseline differences between early dropouts and retained subjects in disease burden, physical function, and endurance, suggesting that these factors at baseline may predict dropout. Improved understanding of factors that lead to and predict dropout could allow researchers to identify subjects at risk of dropout before randomization. Assigning targeted retention techniques in accordance with these factors could result in decreased attrition in future studies. Therefore, the results of selective attrition of frailer subjects, such as decreased heterogeneity, restricted generalizability of study findings, and limited understanding of exercise effects in this population, would be avoided.

Activities of Daily Living↗
PubMed2000

Physicians' voices on physician-assisted suicide: looking beyond the numbers.

Most empirical research examining physician views on physician-assisted suicide (PAS) has used quantitative methods to characterize positions and identify predictors of individual attitudes. This approach has generated limited information about the nature and depth of sentiments among physicians most impassioned about PAS. This study reports qualitative data provided by 909 physicians as part of a larger survey (N = 2,805) regarding attitudes toward and experiences with PAS and palliative care. Emergent themes illustrate important clinical, social, and ethical considerations in this area. The data illustrate the diverse and ardent responses that PAS evokes among certain physicians. The role of physicians' personal values is central to discussions about legalization of PAS. Polarized views such as those expressed by physicians in this study are not likely to be reconciled, thereby constraining the development of public policy regarding PAS.

Attitude of Health Personnel↗
PubMed2000

Individualized care: perceptions of certified nurse's aides.

Despite substantial attention devoted to the development of individualized care in nursing homes during recent years, empirical research assessing progress is limited. Further, few studies have explored the experiences of certified nurse's aides (CNAs) in this regard. This survey examines the perceptions and experiences of CNAs in providing individualized care. CNAs (n = 254) were asked to describe a number of current practices and obstacles to implementing individualized care in nursing homes. The majority of respondents reported experiencing: flexibility to change daily schedules; supervisor assistance with challenging residents; active participation in care planning; freedom to test new approaches to care; and supervisors who are open to CNA suggestions. Several barriers to individualized care were also described, including: inadequate staffing; poor team communication; staff attitudes; and a lack of knowledge and training in alternative approaches. These findings provide important insights into the supports and obstacles to implementing individualized care in nursing homes from the perspective of CNAs.

Attitude of Health Personnel↗
PubMed2000

Physician-assisted suicide in Connecticut: physicians' attitudes and experiences.

OBJECTIVE: This study examined aspects of physician attitudes toward physician-assisted suicide (PAS) not fully examined to date: evaluation of risks related to PAS, particularly the presence of depression, and the influence of religious and professionally-based values. DESIGN: Anonymous, self-administered mailed questionnaire using Dillman methodology. PARTICIPANTS: Targeted sample of physicians licensed by the Connecticut Department of Public Health in 1997 (n = 2,805 completed surveys; 40% response rate). DATA INCLUDE: Physician and patient characteristics, attitudes toward physician assisted suicide, and confidence in treating depression. RESULTS: Religious affiliation, religiosity, ethnicity and medical specialty were strongly associated with views on PAS. Seven percent of respondents had been asked to write a lethal prescription during the past year, 15% of whom (n = 24) had complied with at least one request. CONCLUSIONS: Most respondents expressed concern regarding certain risks associated with PAS, including movement toward involuntary euthanasia and the influence of undetected depression. Findings raise practical issues to be addressed through statutory or professional safeguards if PAS were to be legalized.

Adult↗
PubMed2000

Mammography utilization in a skilled nursing facility.

OBJECTIVE: To examine mammography utilization and subsequent clinical decisions in a skilled nursing facility in women aged 75 years and older with no history of breast cancer. METHODS: This study was a retrospective medical chart review of 95 women living in a skilled nursing facility aged 75 years and older who did not have a history of breast cancer. RESULTS: One-hundred seventy-nine mammograms were performed on 95 patients with an average of 1.9 mammograms per patient. Forty-five percent of the women had some evidence of abnormal results requiring further investigation. DISCUSSION: Determining the utility of screening mammography in long-term care populations is essential to the development of appropriate guidelines. Future research should further explore the influence of patient preferences and psychological burden.

Aged↗
PubMed2000

Preferences for CPR among the elderly: the influence of attitudes and values.

OBJECTIVES: While many older individuals wish to forgo cardiopulmonary resuscitation regardless of potential positive outcomes, others desire this intervention despite low chances of survival. This study examines the extent to which health, function, attitudes, and values influence preferences for cardiopulmonary resuscitation. DESIGN: An in-person, physician-administered survey. SETTING: Three clinical sites affiliated with a university-based geriatrics program. PARTICIPANTS: One hundred three individuals age 65 or older with ability to speak, read, and write English. MEASUREMENTS: Demographic, health and functional status, social involvement, religiosity, attitudes, and values were assessed. A standard description of cardiopulmonary resuscitation was followed by open-ended questions regarding treatment preferences. RESULTS: Mean age was 81 (+/- 7), 66% were women and 78% had an advance directive. The majority (75%) declined cardiopulmonary resuscitation. Women were more likely to decline cardiopulmonary resuscitation. Attitudes toward life were the strongest predictors for the cardiopulmonary resuscitation decision. Family issues were important, especially the prospect of becoming a burden, as well as the outcome of cardiopulmonary resuscitation. CONCLUSION: Attitudes toward life, perceived outcome of cardiopulmonary resuscitation, and family issues play a significant role in end-of-life treatment decision-making.

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PubMed1999

Medicaid eligibility workers discuss Medicaid estate planning for nursing home care.

This study was part of a multiphase project examining the perceptions of elder law attorneys, certified financial planners, and Medicaid eligibility workers regarding Medicaid estate planning (MEP) for nursing home care. Focus group methodology (5 groups, N = 32 participants) was used to explore the perspectives and experiences of Medicaid eligibility workers, who are responsible for interpreting, administering, and enforcing federal and state regulations. Findings describe factors influencing MEP, enforcement of regulations, and potential policy responses to MEP. Participants identified numerous impediments to effective implementation of current regulations. Recommendations for improved policy include redefinition of spousal assessment policies, other valuable consideration determinations, and penalty period formulas.

Aged↗
PubMed1999

Developing individualized care in nursing homes: integrating the views of nurses and certified nurse aides.

Despite recent attention devoted to the development of individualized care in nursing homes, empirical research assessing changes in practice is quite limited, and very few studies have explored specifically the experiences and perceptions of certified nurse aides (CNAs). This study reports findings from a comparative analysis conducted on a data set including quantitative and qualitative data from CNAs (N = 289) and nurses in Connecticut (N = 245). Measures of obstacles to individualized care and needs for future supports were explored. A number of significant differences in perceptions of obstacles to providing individualized care were found. The nurses were significantly more likely to identify the following impediments to change: cost (p < .0001), concepts not integrated into work (p < .0001), lack of administrative support (p < .10), and staff attitudes (p < .10). The CNAs were significantly more likely to report inadequate staffing (p < .001), lack of interdisciplinary teams (p < .001), and resident and family attitudes (p < .01) as problematic. These findings suggest substantial discordance among nurses and CNAs on a number of important issues surrounding individualized care. Such disparate perceptions pose challenges to nursing homes committed to the implementation of individualized care alternatives. Successful approaches must consider the various vantage points of caregivers and administrators.

Aged↗
PubMed1999

The physician-assisted suicide policy dilemma: a pilot study of the views and experiences of Connecticut physicians.

Development of fully informed public policy regarding physician-assisted suicide (PAS) requires a thorough understanding of the experiences, attitudes, and beliefs of physicians with respect to this issue. This study gathered data on physician characteristics, attitudes toward PAS, factors influencing attitudes toward PAS, and sensitivity to the role of depression in a sample of 397 psychiatrists, internists, and family practitioners in Connecticut. Central considerations included: the influence of religious values, professional discipline and practice patterns, and ability to diagnose depression in a single evaluation. Psychiatrists were significantly more likely to be supportive of PAS than were internists or family practitioners. Most respondents expressed concern regarding the influence of depression on PAS requests. A subset of physicians endorse PAS yet do not share such concern about risks, suggesting substantial challenges for policy-makers.

Attitude of Health Personnel↗
PubMed1998

Medicaid estate planning: practices and perceptions of Medicaid workers, elder law attorneys, and certified financial planners.

This study examined Medicaid estate planning (MEP) through the experiences and perceptions of three groups in Connecticut: Medicaid eligibility workers (n = 128), elder law attorneys (n = 41), and certified financial planners (n = 29). Respondent groups varied significantly with regard to their perceptions of prevalence and magnitude of MEP, the nature of transferred assets, mechanisms for transfers, and characteristics of the "typical" client participating in asset divestiture for the purpose of qualifying for Medicaid. This substantial lack of concordance among those professionals most closely involved with MEP poses challenges for policy and research in this area.

Aged↗
PubMedDate not supplied

Predicting service utilization after psychiatric hospitalization.

The purposes of this study were to determine (1) the extent of service utilization in the posthospitalization period and (2) the probability of specified service utilization outcomes for patients with given characteristics, using ordered logit models. The sample consisted of former inpatients who were evaluated for 6 months and responded to a mailed questionnaire or telephone interview at both the 3- and 6-month follow-up points. Significant independent predictors of service utilization at 6 months were the diagnosis, length of hospital stay, history of suicide attempts, perceived stress, and medication compliance at 3 months. High service utilization was evident in a sizable proportion of the sample and could be predicted using this model.

Adult↗