Evaluating special care units: the importance of definitional clarity.
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Aged↗
Biomedical subjects
J Magaziner
Publications and source records attributed to J Magaziner.
Reproductive correlates of bone mass in elderly women. Study of Osteoporotic Fractures Research Group.
Results from previous studies of reproductive factors and bone density have been conflicting; some demonstrate a beneficial effect, but others show a detrimental effect on bone density. The present study investigates the association of parity, lactation, and menstruation with radial bone density in 2230 white women, 65 years of age and older. Bone density was assessed by single-photon absorptiometry. Linear multiple regression was utilized to determine if reproductive factors were associated with radial bone density. The number of births, duration of menstrual bleeding, age at menarche, and years menstruating were significant independent predictors of postmenopausal bone density of the radius. A 1.4% increase in distal radius bone density was observed with each additional birth. Women who began menstruation at age 9 had 6.3% higher bone density than women who began at age 16. Women who menstruated for 3 days during each menstrual cycle had 2.8% less distal radius bone density than women who bled for 7 days. Each decade of menstruation was associated with a 2% greater distal radius bone density. No difference in bone density was demonstrated for women who breast-fed and women who did not. Length of the menstrual cycle, amount of menstrual flow, and irregularity of the menstrual cycle were not significantly associated with radial bone mineral density. In conclusion, pregnancy and menstruation are associated with postmenopausal bone density of the radius.
Abortion, Induced↗
Mental health service use by the elderly in nursing homes.
OBJECTIVES: Because current Omnibus Budget Reconciliation Act regulations influence the disposition of US nursing home residents who have mental illness, National Nursing Home Survey (1985) data are analyzed for predictors of mental health service use. METHODS: Elderly residents' rates of mental health service use are presented. Logistic regression yielded odds ratios for treatment by both mental health specialists and general practitioners for client and service system variables. RESULTS: Among the two thirds of elderly residents with a mental disorder (including dementia), only 4.5% receive any mental health treatment in a 1-month period. The ratio of specialist to general practitioner care is approximately 1:1. Patients seen by a specialist are likely to be younger (aged 65 to 74); live in the Northeast; and have a diagnosis of schizophrenia (13:1), dementia (3:1), or other mental disorders (5:1). Prior residence in a psychiatric hospital predicts care by both health professional types. Rural location, nonproprietary ownership of the nursing home, and aggressive behavior point to general physician care. CONCLUSIONS: Our findings indicate significant neglect of the mental health needs of older nursing home residents and underscore the importance of monitoring the regulations for screening and treatment of mental disorders under the Omnibus Budget Reconciliation Act.
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Social support networks of white and black elderly people at risk for institutionalization.
The literature examining the role of social network size and support in moderating the relationship between stress and illness in the aged population has not taken racial differences into account. This study compares the potential moderating influence of social network size and support on the relationship between life stress and depressive symptoms for black and white community-dwelling elderly people at increased risk for institutionalization. Study data come from in-person interviews with a sample of 191 old-old (75 years and older) and poor residents of a three-census-tract area in Pittsburgh. Approximately 50 percent were white and 50 percent were black. Results indicate that the moderating effects of social network size and support were different for the black people than for the white people in this sample. For white aged people, having greater social support and a larger social network reduces the association between stress and depressive symptoms, as expected. For black elderly people, however, having more network members and receiving support from them is associated with a stronger relationship between stress and depressive symptomatology.
Black or African American↗
Prevalence and characteristics of nursing home-acquired infections in the aged.
OBJECTIVES: This study provides estimates of the prevalence of infections in all patients from a representative sample of 53 Maryland nursing homes; identifies risk factors for these infections; and describes diagnostic procedures carried out. METHODS: The records of 4,259 patients in a stratified random sample of 53 Maryland nursing homes were reviewed for diagnostic procedures, medical, functional, and behavioral status. Infections were identified by signs, symptoms, and laboratory findings. RESULTS: Study patients were characteristic of aged patients in US nursing homes. The prevalence of infections actually acquired in the nursing home (80% of all infections) was 4.4%. Multivariate analysis revealed that skin infections (35% of nursing home-acquired infections) were associated with skin ulcers and inversely with urine incontinence. Fevers of uncertain source (13%) were associated with bladder catheters. Symptomatic urinary infections (12%) and lower respiratory infections (12%) were associated with bedfast status, and the latter with tracheostomy and lung disease. Skin ulcers, urethral catheters, and bedfast status were markers for nursing home-acquired infection. The prevalence of infection in patients with all three markers was 32%; in patients with none, 2%. Fewer than a quarter of the four most common nursing home-acquired infections received an evaluation which met minimal diagnostic criteria established by a panel of infectious disease specialists and geriatricians. Patients with dementia, those in large homes (greater than 150 beds), and those in urban homes were less likely to be evaluated in a manner meeting these criteria. CONCLUSIONS: Use of three characteristics (ie skin ulcers, urethral catheters, bedfast status) to identify patients at risk for nursing home-acquired infections may allow targeted infection surveillance and prevention programs. In addition, nursing home-acquired infections are not evaluated uniformly across patients and facilities, suggesting the need to establish, through further study, guidelines for such evaluations.
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Special care units for persons with dementia.
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Dementia↗
Reliability of proxy response on mental health indices for aged, community-dwelling women.
The correspondence between respondent and proxy response was evaluated on 4 mental health measures (Affect Balance Scale, Center for Epidemiological Studies Depression Scale, Mental Status Questionnaire, and Mini-Mental State Examination) with a sample of 538 respondent-proxy pairs. Results indicated that respondent and proxy responses were strongly associated, particularly for the cognitive measures. This association was found even for respondents classified as depressed or cognitively impaired. Although there was evidence of proxy bias, with proxies underrating affective status and overrating cognitive status, the magnitude of the bias proved small for all scales but the Mental Status Questionnaire. Examination of response comparability by proxy characteristics showed that choice of proxy affected agreement and bias. Implications of these findings for survey research are discussed.
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Predictors of functional recovery one year following hospital discharge for hip fracture: a prospective study.
This study evaluates predictors of recovery in walking ability, PADLs, and IADLs one year following hospital discharge for hip fracture. The sample consisted of 536 hip fracture patients aged 65 and older admitted from the community to one of seven Baltimore area hospitals between 1984 and 1986 and surviving one year post-hospital discharge. A large proportion of hip fracture patients do not regain pre-fracture PADL and IADL levels; most recovery in walking ability and ability to perform PADL and IADLs occurs by 6 months. Those who are older, have longer hospital stays, and are rehospitalized, exhibit poorer recovery, as do those displaying chronic or acute cognitive deficits and depressive symptomatology while hospitalized. Also, contact with one's social network following hospital discharge is associated with greater recovery. Findings point to the importance of psychosocial factors for recovery and suggest areas where hospital-based interventions and discharge planning efforts should focus.
Activities of Daily Living↗
Acute and custodial care among impaired aged.
The authors surveyed a community-based population of 628 persons who were 65 and over and who lived either in a rural Maryland county or in Baltimore. For each subject, the number of different medical problems, the subject's capacity to perform physical tasks, and the ability to function were assessed. The number and type of medical problems tended to be the best predictors of whether or not hospital or physician's office care were used, and of the volume of physician's office visits for subjects who sought outpatient care. The subject's ability to function was the best predictor of whether or not the subject used a paid home aide and the volume of family caregiving. Implications for research on association between need and use of long-term care are discussed.
Activities of Daily Living↗
Community resources and mental health of older women living alone.
The relationship between community resources and mental health was examined in a community sample of 807 women 65 years and older. Results indicate that those living alone are no more depressed or cognitively impaired than those in other living arrangements, but they are less likely to believe someone will be available to assist them for a long or short time or in an emergency. In addition, those living alone who have more neighbors and more children in the neighborhood are more likely to believe short and long-term community care will be available if needed.
Activities of Daily Living↗
Polymedicine use among community resident older women: how much a problem?
In a community-based study of older women describing the prevalence of specific medication combinations, the risk of deleterious consequence from polymedicine was concentrated in a minority of older women. There were few prevalent medication combinations, and many of the more common combinations were unavoidable. These results suggest that broad, community-based drug education programs may be less effective than those targeting medical providers and multi-drug users.
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Survival experience of aged hip fracture patients.
Hip fracture has long been considered a major threat to survival in aged populations. This report describes the survival experience of 814 aged, community dwelling hip fracture patients treated in seven Baltimore hospitals between 1984 and 1986: 4.3 per cent died during hospitalization; 8.2, 12.6, and 17.4 per cent died within three, six, and 12 months after fracture, respectively. The mortality rate for the entire population approaches expected mortality approximately six months post-fracture, but varies by age and sex. The most important factors predicting mortality are presence of serious concomitant illness and marked delirium (in the absence of dementia) at the time of hospital admission. The authors suggest that medical factors that may contribute to patient disorientation be investigated and treated, when possible, in an effort to improve the survival status of hip fracture patients.
Age Factors↗
Demographic and epidemiologic considerations for developing preventive strategies in the elderly.
More than 29 million Americans are aged 65 and older, over 12 percent of the US population. This number is expected to increase to 35 million by the turn of the century and to 67 million by the year 2050. Growth is expected to be greatest among the oldest and most disabled members of this group, those aged 85 and older. Persons 65 and older are the largest consumers of medical care; their care needs will be even greater as we enter and move through the twenty first century. Most persons needing long-term care will reside in the community, not in nursing homes. In light of these projections, we must be concerned with community based prevention at all levels.
Activities of Daily Living↗
Patient-proxy response comparability on measures of patient health and functional status.
The present study evaluates the response comparability between 361 elderly hip fracture patients admitted from the community to seven Baltimore area hospitals between 1984 and 1986 and interviewer selected proxies on items pertaining to patients' pre-fracture health and functional status. Agreement across items ranges from very poor to good and varies with respect to the health or functional area assessed. Proxies tend to overestimate patient disability relative to the patients themselves, especially with regard to capacity to perform instrumental activities of daily living. Although proxies who report the greatest contact with patients respond most comparably to the patients, when they do disagree, proxies with the greatest patient contact tend to overestimate patient disability. The authors suggest that attention to item construction and phrasing may improve response comparability.
Activities of Daily Living↗
Living density and psychopathology: a re-examination of the negative model.
Most density-pathology research has assumed that dense living conditions have 'pathological' effects on urban dwellers. This study considers the possibility that both low and high density may be problematic and that in-unit and out-unit density may have interacting effects. The data included all first admissions from Chicago to 44 in-patient psychiatric facilities in Illinois during 1960-61. After controlling for socioeconomic status (SES) and race, living alone, which defines low in-unit density, was associated with high admission rates, but only when the outside density was low. Among those not living alone, the contribution of density to admissions was age-linked, with interactions between in-unit and out-unit density observed in the older ages. The results lead to the general conclusions that the negative model guiding earlier research is inadequate and that in-unit and out-unit density have interacting effects on the risk of psychopathology.
Adaptation, Psychological↗
Health and living arrangements among older women: does living alone increase the risk of illness?
This study compares the physical, mental, and functional health of aged women living alone to those living with a husband and to those living with others, and considers whether living arrangements lead to health problems or if health problems influence the choice of living arrangements. Data were collected in 1984 during the first wave of a prospective study of 807 women 65 years or older living in an area consisting of 20 contiguous census tracts in Baltimore, MD. Multivariate analyses demonstrate no particular disadvantage associated with living alone for this group of elderly women. After controlling for age and socioeconomic status, analyses indicate that it is those living with persons other than their husbands who are most impaired. In addition, poor health does not appear to result from living arrangement; rather, those who are sickest choose to live with others because of health problems.
Activities of Daily Living↗
Community care of older women living alone.
This paper compares the formal and informal care used by women living alone and women living with others using data from a household survey of women over 65. In contrast to those living with others, who use few formal services and receive most of their care from the children they live with, those living alone rely on a diverse group of informal caregivers and formal services, many of which are provided in their homes. Women living alone also report using mechanical devices more often, and are less confident that assistance will be available in the event of illness. Results are discussed from psychological and organizational perspectives.
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Predicting performance on the Mini-Mental State Examination. Use of age- and education-specific equations.
Inclusion of a mental status examination in research and clinical screening instruments lengthens the protocol, thereby adding to the difficulty of using instruments addressing all relevant issues under study without taxing participants. The purpose of the present study was to evaluate the possibility of substituting a subset of items from the widely used Mini-Mental State Examination (MMSE) for the entire examination in order to reduce the time needed to screen for cognitive status. Study data came from a health study of 783 community-dwelling, white females, 65 years of age and over, selected randomly from a 20-census-tract area of northeast Baltimore. Results indicate that seven MMSE items can be used to reliably predict total MMSE scores. Because of an age X education interaction in the prediction of total MMSE scores, four age X education-specific predictive equations were developed. These four equations are most useful for predicting continuous MMSE scores rather than for categorizing individuals according to impaired versus unimpaired status. A short form of the MMSE and four age X education-specific scoring equations are presented and their potential utility discussed.
Age Factors↗