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Biomedical subjects

F D Wolinsky

Publications and source records attributed to F D Wolinsky.

At least 19 recordsLinked to original sources
PubMed1995

Hospitalization for major depression among older Americans.

BACKGROUND: The objective of this study was to report the pattern of hospitalization for major depression among older Americans and to examine correlates of those hospitalizations. We sought to investigate the hypothesis that hospitalization for major depression would be more common among those respondents with declining functional status whose ability to adapt to this decline was impaired by inadequate social support systems or economic stressors. METHODS: The data were taken from Version 5 of the Longitudinal Study on Aging (LSOA), which includes 7,527 subjects who were aged 70 and older in 1984. We identified all subjects with any hospitalizations for which major depression was a discharge diagnosis (ICD9-CM codes 296.2, 296.3, 300.4, and 311), and all subjects for whom depression was the primary discharge diagnosis. Only patients with a first-listed discharge diagnosis of depression were considered to have been hospitalized for major depression. RESULTS: The yearly incidence of hospitalization for which depression was the primary discharge diagnosis was 0.1%. The mean length of stay was 14.6 days and the mean hospital charge was $6,742. Length of stay and charges did not vary by hospital type (general vs psychiatric), but both charges and length of stay were significantly longer when major depression was the primary discharge diagnosis rather than a secondary diagnosis. Patients with a hospitalization for major depression had more hospitalizations, longer total lengths of stay, and greater total hospital charges over the seven-year period as compared to patients with at least one hospitalization for any other reason. These differences in hospital resource use dissipated when hospitalizations for depression were excluded. Hospitalization for major depression was not associated with gender, race, education, or social support. Hospitalization for major depression was independently associated with a forced residential move, a history of nursing home stays, decline in household activities of daily living, younger age, and perceived health rated as less than excellent. CONCLUSIONS: One older American per thousand is hospitalized each year with a primary discharge diagnosis of major depression. These individuals did not have evidence of greater total hospital resource use if episodes of hospitalization for depression are eliminated. Hospitalization for major depression was more common among those with a loss of independent living.

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PubMed1995

Antecedents and consequences of physical activity and exercise among older adults.

The antecedents and consequences of four markers of physical activity and exercise are examined for the 6,780 baseline self-respondents to the Longitudinal Study on Aging. These dichotomous markers reflect having a level of physical activity greater than one's peers (45.8%), getting as much exercise as needed (58.9%), having a regular exercise routine (28.4%), and walking a mile or more at least once a week (29.9%). The major factors associated with engaging in these behaviors are having fewer lower body limitations, better perceived health, more non-kin social supports, not worrying about one's health, and having a sense of control over one's health. When added to traditional models predicting subsequent (over the next 6 to 8 years) mortality, nursing home placement, hospital resource consumption, and changes in functional status, the four markers of physical activity and exercise have numerous statistically and substantively significant associations, all of which involve better health outcomes.

Aged↗
PubMed1995

Predicting hospital costs among older decedents over time.

To explain the variation in total real hospital costs among elderly patients who died between 1984 and 1991, a cohort analytic study of the nationally representative sample of elderly subjects included in the Longitudinal Study on Aging (N = 7,527) was carried out. The cohort comprised the subset of 1,778 community-dwelling Americans who were age 70 years and older in 1984, had one or more subsequent hospital episodes, and died by 1991. Hospital charges for 1984 through 1991 were taken from the Medicare Automated Data Retrieval System. Annual hospital charges were adjusted for inflation (restated in 1984 dollars) using the hospital market basket component of the consumer price index. The natural logarithm of aggregated real charges was used in the analysis. Mean total real hospital charges were $24,956 (SD = $27,847). A standard multivariable regression model explained 9.7% of the variance in real total hospital charges. After incorporating additional measures reflecting a respondent's distribution (mean and standard deviation) of comorbidities (as measured by the number of ICD-9-CM codes [truncated at five]) during all hospitalizations in the observation window, the cause of death, and the concentration of charges in the last year of life, the explained variance increased to 29.3%. The most important explanatory factors were the two variables controlling for the distribution of comorbidity, the variable controlling for population density, and the dichotomous variable indicating that the patient's death was related to an acute myocardial infarction. Total real hospital resources consumed by elderly decedents vary substantially. The concentration of resources consumed in the last year of a respondent's life was only marginally significant in predicting total real hospital charges over an 8-year observation window.

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PubMed1992

Widowhood, health status, and the use of health services by older adults: a cross-sectional and prospective approach.

Using data from the LSOA, we examined the relationship between widowhood, health status, and the use of health services. Controlling for the characteristics specified in the behavioral model, a cross-sectional assessment of the 2,354 respondents widowed at baseline showed that regardless of how the recency of widowhood is modeled, it is not related to any measure of health status, and it is only marginally associated with two measures of health services utilization: nursing home placement and death. A prospective assessment of the 4,113 respondents reinterviewed at follow-up produced similar results. Becoming widowed did not alter previous reports of health status, nor prior patterns of physician or hospital utilization. Being widowed did, however, significantly increase the likelihood of being placed in a nursing home. For the 14 respondents who were both widowed and placed in a nursing home after baseline, the sequence is always widowhood first, and then nursing home placement.

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PubMed1992

The risk of nursing home placement and subsequent death among older adults.

This article examines the effects of the characteristics specified in the behavioral model of health services utilization and measured at baseline on the subsequent risk of nursing home placement and death within four years. Analyses of the 5,151 respondents in the Longitudinal Study on Aging indicate that the risk for nursing home placement is greater for older adults, Whites, those who lived alone, persons with telephones, those with fewer nonkin social supports, those who did not feel that they had much control over their future health, those with more household ADL or lower body limitations, and those who had been in the hospital during the year prior to baseline, or in a nursing home at any time before baseline. Among the 549 respondents placed in nursing homes, the risk of dying there was greater for older adults, men, those who had not lived in multigenerational households, persons who did not worry about their health, individuals with more upper body limitations, and respondents having a history of valvular heart disease or cancer. The odds of dying were 2.74 times greater among the 549 respondents placed in nursing homes than among the 4,602 respondents who remained in the community.

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PubMed1992

Perceived health status and mortality among older men and women.

This article separately examines the relationship of perceived health status and mortality for the 1,599 men and 2,904 women self-respondents in the Longitudinal Study on Aging. Using hierarchical logistic regression, the zero-order relationships are decomposed by the serial introduction of demographic, socioeconomic, health status, and psychosocial factors. For men, only those in poor health are significantly more likely to die than those in excellent health (adjusted odds ratio = 1.754), all other things being equal. For women, those in fair or poor health are more likely to die than those in excellent health (adjusted odds ratios = 1.870 and 2.181, respectively), all other things being equal.

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PubMed1992

Falling, health status, and the use of health services by older adults. A prospective study.

In this study, data from the Longitudinal Study on Aging were used to prospectively assess the relationship between repetitive falling or falling only once in the year before baseline and changes in health status and the use of health services. Multiple and logistic regression were used to control for a variety of known covariates, in addition to the baseline values of the target outcomes. Repetitive falling was associated with decreased health status, measured by various activities of daily living and disability indices, at both 2- and 4-year follow-ups. One fall, however, was never associated with deteriorating health status. Similarly, repetitive falling was related to a decreased likelihood of visiting a physician (at the first follow-up, only), but to an increased likelihood of hospitalization, nursing home placement, and death (at both follow-ups). Falling just one time, however, was only associated with an increased likelihood of nursing home placement. Based on outcome trajectories, two subpopulations of repetitive fallers were identified. One subpopulation was consistent with the rapid deterioration hypothesized by the "spiral" response to falling, and includes about 35% of the repetitive fallers (i.e., those who die within 4 years of baseline). The other subpopulation was consistent with the initial decline and subsequent stabilization hypothesized by the "drop-stabilization" response.

Accidental Falls↗
PubMed1992

Evaluation of teaching medical ethics by an assessment of moral reasoning.

This study assessed the hypothesis that the formal teaching of medical ethics promotes a significant increase in the growth and development of moral reasoning in medical students. Results indicated a statistically significant increase (P less than or equal to 0.0005) in the level of moral reasoning of students exposed to a medical ethics course compared to the control group that was not exposed to the medical ethics course. When the posttest scores were adjusted by subtracting the pretest scores, the differences were even more significant (P less than or equal to 0.0002). This study confirmed similar findings of another study using a different instrument of assessment. Brief discussion is given of the fundamental premise that the appropriate function of teaching medical ethics in our modern pluralistic society is to improve students' moral reasoning about value issues regardless of what their particular set of moral values happens to be.

Education, Medical, Undergraduate↗
PubMed1991

Study of the influence of veterinary medical education on the moral development of veterinary students.

Although veterinary medicine endorses high moral character and adherence to a code of ethics, to our knowledge, virtually no studies have examined the influence of veterinary medical education on the moral development of its students. Using the Kohlberg standard moral judgment interview, this study examined that relationship in a sample of 20 veterinary medical students (16.0% of the veterinary college's student body). The students were tested at the beginning and at the end of their veterinary medical education to determine whether their moral reasoning scores had increased to the same extent as those of other postgraduate students. It was found that normally expected increases in moral reasoning did not occur over the four years of veterinary medical education for these students, suggesting that their veterinary medical educational experience somehow inhibited their moral reasoning ability rather than facilitated it. With a range of moral reasoning scores between 313 and 436, the mean increase from first year to fourth year of 12.5 points was not statistically significant. Statistical analysis revealed no significant correlations between the moral reasoning scores on age or gender, although there were significant correlations with Medical College Admissions Test scores and grade point average scores.

Education, Veterinary↗
PubMed1991

The use of health services by older adults.

Using baseline data on the 5,151 respondents surveyed as part of the panel design of the Longitudinal Study on Aging (LSOA), this article estimates, cross-sectionally, the relationships hypothesized in the behavioral model of health services utilization. In addition to the traditional indicators of the predisposing, enabling, and need characteristics, the richness of the LSOA permits the inclusion of measures of multigenerational living arrangements, kin and nonkin social supports, health worries and the sense of health control, health insurance coverage, residential stability, and several multiple-item scales of functional limitations. Despite these innovations, the ability of the behavioral model to accurately predict the use of health services by older adults remains relatively unchanged. Important conceptual clarifications involving the hypothesized relationships, however, are identified and discussed.

Activities of Daily Living↗
PubMed1990

Correlates of a measure of coping in older veterans: a preliminary report.

Sense of Coherence (SOC) is a specific measure of perception of coping ability which is examined here in relation to demographic characteristics and measures of physical and mental health status of older veterans (N = 240). Results suggest that the SOC is strongly correlated with measures of subjective health status. It does not uniquely contribute to that dimension but does exhibit appropriate psychometric properties to encourage its use in further research.

Activities of Daily Living↗
PubMed1990

Progress in the development of a nutritional risk index.

The development of a 16-item nutritional risk index (NRI) is chronicled from its inception through its application in three studies designed to assess its reliability and validity. Study I involved a survey of 401 community-dwelling elderly in St. Louis, Missouri who were interviewed at baseline, 4-5 mo later, and 1 yr later. Study II involved a cross-sectional survey of 377 male outpatients attending two clinics at the St. Louis Veterans Administration Medical Center. Study III involved a cross-sectional survey of 424 community-dwelling elderly in Houston, Texas. Internal consistency reliability coefficients ranged between 0.47 and 0.60, and test-retest reliability coefficients ranged between 0.65 and 0.71. Validity was established by using the NRI to predict the use of health services, as well as by correlating it with a variety of anthropometric, laboratory, and clinical markers of nutritional status. The utility of the NRI for future applications is discussed.

Aged↗
PubMed1990

A comparison of in-house and regionalized computerized tomography scanning: clinical impact and cost.

Over a two-year interval, computerized tomography (CT) scans at an urban, 400-bed Department of Veterans Affairs medical center (VAMC) were obtained in three ways. First, an in-house low-efficiency machine was used. Then, scans were done at another area hospital, in effect duplicating some aspects of regionalizing services. Finally, a high-efficiency in-house machine was used. Clinical outcomes and costs of diagnosing 181 bronchogenic cancer patients were compared across the three time periods to identify any differences associated with regionalization of CT services. Patient groups were homogeneous with respect to sociodemographic characteristics, clinical presentation, and severity of disease. The first part of the analysis investigated whether the site of CT scanning affected clinical outcomes. Diagnostic procedures, surgical results, mortality, and length of stay were compared using one-way analysis of variance. Significant differences were found only for conventional tomography and CT utilization rates. While conventional tomography declined across the periods, CT utilization increased, exceeding national trends. The second part of the analysis examined the costs of CT scanning. During the regionalized period, the hospital paid a fixed fee of $519 per scan. Estimated costs of in-house scans were $285 in the low-efficiency and $141 in the high-efficiency periods. Charge-based payments made to the external facility and differences in the volumes of patients scanned internally account for the cost differences. The analysis showed that while regionalized CT scanning did not compromise the quality of care for these VA patients, it was more costly. Results suggest that VA hospital administrators should carefully consider ownership and payment arrangements when comparing regionalized and in-house provision of services.

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PubMed1990

The legacy of stress research. The course and the impact of this journal.

The Journal of Health and Social Behavior (JHSB) is examined to determine its relative stature and impact in the social science community. We conducted both empirical comparisons of average impact (based on the Social Science Citation Index) and content analysis. Over an 11-year period beginning in 1977, JHSB has maintained an enviable position among sociology journals, ranking significantly higher than the American Journal of Sociology and Social Forces. In addition, it ranks quite favorably when compared with the dominant journals of the allied social science disciplines. The preeminence of the JHSB is attributed to the legacy of stress research that was perceived to dominate this period. Ironically, the recently mandated change in editorial goals eschewing such an identification with stress research has begun to undermine the overall stature of the journal, primarily by reducing the impact of articles on stress that appear in it. We discuss the mechanisms that have influenced the course and the impact of this journal.

Evaluation Studies as Topic↗
PubMed1989

Clinical validation of a nutritional risk index.

This research assessed the clinical validity of a nutritional risk index (NRI). Subjects were 377 male veterans, aged 55+, attending general medicine and geriatric outpatient clinics. Data were collected by personal interviews, anthropometric measurements, laboratory assay of nutritional parameters, three-day food records, and medical record reviews. Although the results showed that the NRI correlated significantly with only two nutritional measures (body mass index, total energy intake), critical values or threshold levels of NRI were identified that significantly discriminated low risk from high risk patients on four nutritional parameters (body mass index, total energy intake, laboratory risk, and medications risk). It was concluded that the NRI is a valid measure of health status and contains a nutritional dimension.

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