Biomedical subjects

L Levy-Storms

Publications and source records attributed to L Levy-Storms.

7 recordsLinked to original sources

PubMed2004

The minimum data set depression quality indicator: does it reflect differences in care processes?

PURPOSE: The objective of this work was to determine if nursing homes that score differently on prevalence of depression, according to the Minimum Data Set (MDS) quality indicator, also provide different processes of care related to depression. DESIGN AND METHODS: A cross-sectional study with 396 long-term residents in 14 skilled nursing facilities was conducted: 10 homes in the lower (25th percentile: low prevalence 0-2%) quartile and 4 homes in the upper (75th percentile: high prevalence 12-14%) quartile on the MDS depression quality indicator. Ten care processes related to depression were defined and operationalized into clinical indicators. Measurement of nursing home staff implementation of each care process and the assessment of depressive symptoms were conducted by trained research staff during 3 consecutive 12-hr days (7 a.m. to 7 p.m.), which included resident interviews (Geriatric Depression Scale), direct observations, and medical record review using standardized protocols. RESULTS: The prevalence of depressive symptoms according to independent assessments was significantly higher than prevalence based on the MDS quality indicator and comparable between homes reporting low versus high rates of depression (46% and 41%, respectively). Documentation of depressive symptoms was significantly more common in homes reporting a high prevalence rate; however, documentation of symptoms on the MDS did not result in better treatment or management of depression according to any care-process measure. Psychosocial prevention and intervention efforts, such as resident participation in organized social group activities, were not widely used within either group of homes. IMPLICATIONS: The MDS depression quality indicator underestimates the prevalence of depressive symptoms in all homes but, in particular, among those reporting low or nonexistent rates. The indicator may be more reflective of measurement processes related to detection of symptoms than of prevention, intervention, or management of depression outcomes. A depression quality indicator should not be eliminated from MDS reports because of the importance and prevalence of the condition. However, efforts to improve nursing home staff detection of depressive symptoms should be initiated prior to the use of any MDS-based depression indicator for improvement purposes. Homes that report a low prevalence of depression according to the nationally publicized MDS quality indicator should not be regarded as providing better care.

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PubMed2000

The transition from home to nursing home mortality among people with dementia.

OBJECTIVES: This article examines the impact of nursing home admission on mortality among persons with dementia, comparing social selection and social causation explanations of excess deaths occurring immediately after relocation. METHODS: Data from a multiwave panel survey of caregivers to persons with Alzheimer's Disease (N = 555) are analyzed with proportional hazard models of time from illness onset to death of the care recipient and, for those admitted to a nursing home (N = 272), time from admission until death (N = 272). RESULTS: Relocation is associated with a two-fold increase in mortality risk net of health status. Social selection effects were found for poor health, advanced age, being male, and being White. Patients admitted for reasons other than poor health also experienced elevated mortality immediately following admission, which is inconsistent with a social selection interpretation. However, none of the specific indicators of stressful admission or unsatisfactory nursing home conditions are significantly related to mortality. DISCUSSION: These data demonstrate selection processes for postadmission mortality, but indicate that the admission of patients in poor health may not fully account for the elevation in mortality that occurs immediately following admission.

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PubMed1998

The persistence of race and ethnicity in the use of long-term care.

We examine the use of nursing homes, formal personal care, informal Activities of Daily Living (ADL) assistance, and no care to identify racial differences in their use. Using the 1987 National Medical Expenditure Survey of both nursing homes and the community, multinominal logistic regressions controlled for predisposing, enabling, and need variables as well as other types of service use. Additional state-level variables make few changes in race/ethnicity parameters, indicating that race/ethnicity are not simply proxies for state-level variables. Older African Americans are less likely to use nursing homes than similar whites, with the lower institutionalization replaced by a higher use of paid home care, informal-only care, and no care. This suggests that formal in-home community care is not fully compensating for the racial differences in nursing home use. Persistent effects of race/ethnicity could be the result of culture, class, and/or discrimination that may impair equitable access to services.

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PubMed1997

The impact by race of changing long-term care policy.

Long-term care policy has evolved with little attention to racial differences in the need for and use of services. Using 1987 National Medical Expenditure Survey data on nursing home care, formal in-home personal care, and informal-only help, a model was created to show how different races would use each type of care if: (1) a universal home-care benefit was established, (2) existing Medicaid home-care benefits were ended, or (3) the income level for Medicaid eligibility was substantially reduced. Expanded community care benefits would primarily serve severely disabled older whites. Reductions in long-term care benefits or eligibility would disproportionately impede access to long-term care for severely disabled older African-Americans. These differences indicate that race must be taken into account in long-term care policy initiatives.

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PubMed1995

Access to paid in-home assistance among disabled elderly people: do Latinos differ from non-Latino whites?

OBJECTIVES: The purpose of this study was to compare the national prevalences and predictors of paid in-home functional assistance among disabled Latino and non-Latino elderly people who receive such assistance. METHODS: Data were derived from the 1988 wave of the National Center for Health Statistics Longitudinal Study on Aging and the 1988 Commonwealth Fund Commission Survey of Elderly Hispanics. Logistic regression was used to model paid care use and to calculate estimated probabilities of such use. RESULTS: Among Latino and non-Latino Whites 74 years of age and older who received functional assistance, similar proportions used paid assistance. Predictors of paid care coincided with established models for non-Latino Whites only. Disabled Latinos had a lower estimated probability of using paid assistance when they were highly disabled and socially isolated but had a higher estimated probability when their children lived nearby. CONCLUSIONS: The effects of disability and social support differ among non-Latino White and Latino elderly people. Latino elderly people with high anticipated needs obtain less paid assistance than similar non-Latino Whites. In addition to a reduction in financial barriers, improving access to long-term care services requires addressing this diversity in service use patterns.

Activities of Daily Living↗

PubMedDate not supplied

The effect of dining location on nutritional care quality in nursing homes.

BACKGROUND: Nutritional care quality in nursing homes (NHs) is often characterized by inadequate and poor quality feeding assistance and inaccurate medical record documentation of residents' oral food and fluid intake. OBJECTIVE: To describe the effect of dining location on indicators of nutritional care quality in NH residents. DESIGN AND METHODS: A cross-sectional study in 34 NHs with 761 residents. RESULTS: Nutritional care quality was significantly better according to two of four indicators if a resident ate meals in the dining room compared to their rooms. First, residents who were rated by NH staff as requiring assistance to eat were more likely to receive assistance in the dining room compared to their rooms. Second, NH staff medical record documentation of oral food and fluid consumption was more accurate when residents ate in the dining room. CONCLUSIONS: Residents at risk for unintentional weight loss should eat their meals in a common area, such as the dining room, to promote adequate feeding assistance care provision and accurate medical record documentation of oral food and fluid consumption.

Aged↗

PubMedDate not supplied

Gender and ethnic differences in the timing of first sexual intercourse.

CONTEXT: Whether the effect of gender on the risk of first intercourse in influenced by adolescents ethnicity has received limited attention in research on age at first sex. Such information could provide a more complete understanding of adolescent sexual behavior. METHODS: Life-table analysis using data from a population-based, ethnically diverse sample of 87/Los Angeles County youths was employed to estimate the median age at first sex for each gender-and-ethnicity group. Multivariate analysis using proportional hazards techniques was conducted to determine the relative risk of sexual activity among teenagers in each group. RESULTS: Overall, the teenagers in the sample had a median age at first sex of 16.9 years. Black males had the lowest observed median (15.0), and Asian American males the highest (18.1); white and Hispanic males, and white and black females, reported similar ages (about 16.5 years). Hispanic and Asian American females had rates of first sex about half that of white females, although these protective effects were explained by differences in family structure. Even after controlling for background characteristics, black males had rates of first sex that were about 3-5 times the rates of the other gender-and-ethnicity groups. In addition, Asian American males were less likely than Hispanic males to be sexually experienced, and Hispanic males had almost twice the rates of sexual activity of Hispanic females. CONCLUSIONS: Socioeconomic conditions account for ethnic differences among females in the age at first sex, and cultural influences may contribute to the difference between Hispanic males and females; explanations for black males, however, remain elusive.

Adolescent↗