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Biomedical subjects

L M Verbrugge

Publications and source records attributed to L M Verbrugge.

At least 19 recordsLinked to original sources
PubMed1991

Risk factors for disability among U.S. adults with arthritis.

This article studies risk factors for physical and social disability among U.S. adults ages 55+ who have arthritis, compared to non-arthritis persons of those ages. The dependent variables refer to difficulties in walking, physical functioning (motions and strength), personal care, and household care. The data set is the Supplement on Aging (SOA) (n = 16,148) that accompanied the 1984 National Health Interview Survey. The SOA data are cross-sectional; relationships of risk factors to disability suggest causation but do not directly demonstrate it. Logistic regressions show that risk factors are similar for arthritis and non-arthritis people, with one important exception. (1) The similarities are: For both groups, odds of disability rise with age, diminish with education, and are higher for non-whites and non-married persons. Disability rises with number of chronic diseases and impairments, and it is elevated for underweight persons (Body Mass Index (BMI) less than 20; further analysis indicates this reflects incomplete control of their severe illness status). Long duration of arthritis and recent medical care for it are associated with disability. (2) The exception is: Severe overweight (BMI greater than or equal to 30) is a disability risk factor for arthritis people, but not for non-arthritis people. Previous research has shown that obesity/overweight is a risk factor for etiology of osteoarthritis; our analysis now shows its continued importance for disability when the disease is present.

Activities of Daily Living↗
PubMed1991

Levels of disability among U.S. adults with arthritis.

This article studies the excess levels of disability experienced by persons with arthritis, compared to persons without the disease. The data set is the Supplement on Aging (1984 National Health Interview Survey); it has information for a national probability sample of community-dwelling persons ages 55 + (N = 16,148). (1) Arthritis people have more difficulty in physical functions, personal care, and household care than do nonarthritis persons. The excess disability is greatest for physical functions (walking, reaching, stooping, etc.). Disabled arthritis people have especially high degrees of difficulty in physical activities that require endurance and strength. (2) Various models are tested for walking, grasping, shopping, and light housework to show how comorbidity propels disability for arthritis people and to show arthritis' own contribution to disability in the presence of other chronic conditions. Difficulties escalate for arthritis people when they have other concurrent conditions. These models affirm that arthritis has a pronounced effect on physical dysfunctions, but these are not readily translated into personal and household care problems. Apparently, arthritis people often make successful accommodations so their roles and daily activities are not seriously affected by the disease.

Activities of Daily Living↗
PubMed1990

Disability.

Physical, mental, and social disability are defined. A sociomedical scheme for disability research is presented. How physical and social disability are measured in general health surveys and in arthritis research is described and evaluated. Societal and individual impacts of arthritis are distinguished. The public health importance of arthritis compared with other chronic conditions is portrayed, and the empirical literature on links between arthritis, impairment, physical disability, and social disability is reviewed. Osteoarthritis is at the forefront of the discussion because of its prevalence, but the theoretical and measurement issues presented are broadly relevant for the rheumatic diseases.

Arthritis↗
PubMed1989

Patterns of change in disability and well-being.

Longitudinal data that track the course of disability and well-being are being collected for older populations, with remeasurements taken at annual or longer intervals. These can miss much of the genuine dynamics that older people experience. This analysis uses a data set with fine-grained data on health and function. It involves 165 persons ages 55 and over who were followed for minimum of 1 year (up to 2 years) after hospitalization for a chronic condition (six of which were specified). Within that period, each person had nine separate contacts for assessment of cognitive, physical, social, and emotional function. Respondents also kept health diaries continuously for a year. This article reports patterns of change for the diaries only, focusing on two items recorded daily: self-rated health and activity level. We analyze the data visually, by plots of these items over time for each person, and statistically, by numerical indicators of changes and levels for the items. Differentials in changes and levels by patient characteristics (e.g., age, sex, marital status, diagnosis) were explored. Most people experience a posthospital improvement, with the majority attaining their usual levels of well-being and activity, despite their serious illness. But this recovery is usually interrupted by episodes of low well-being and activity and even further hospital stays. Statistical analyses show that, overall, physical health suffers a small decline over the year whereas activity levels tend to improve. Health is worst and activity levels lowest, gains are smallest and declines largest, for elderly (ages 75 and older) men and for nonmarried people, especially men. Together, the visual and statistical analyses confirm the profound dynamics in health and function that middle-aged and older people with chronic conditions experience.

Activities of Daily Living↗
PubMed1989

Comorbidity and its impact on disability.

Older people often suffer from comorbidity, or several chronic conditions simultaneously. Disability rises rapidly as the number of chronic conditions grows, although very ill people who acquire another condition experience attenuated increases. High prevalence conditions such as arthritis tend to have a low or occasionally moderate impact for community residents, while low prevalence ones such as osteoporosis have a high impact; paired conditions sometimes give extra propulsion to disability, as when cerebrovascular disease and hip fracture co-occur. Further research is needed to pin-point combinations of conditions posing great risks and to identify demographic segments in which comorbidity has elevated effects.

Activities of Daily Living↗
PubMed1989

The twain meet: empirical explanations of sex differences in health and mortality.

Health statistics routinely show higher morbidity and health services use for women, while mortality rates are higher for men. This analysis empirically identifies reasons for women's poorer health. It is based on retrospective (interview) and prospective (health diaries) data from the Health In Detroit Study. Three kinds of risk factors, which may help explain females' excess, are considered: acquired risks, psychosocial aspects, and health-reporting behavior. Men and women differ markedly in acquired risks: smoking and job hazards are higher for men, but inactivity, nonemployment, stress, and many other factors are higher for women. Psychosocial aspects predispose women to more illness and health care. Women also had keener interest in the survey. When all of the risk factors are controlled, the morbidity gap narrows considerably. In fact, indicators of general and chronic health reverse to reveal higher morbidity for men. Similarly, females' excesses for therapeutic care (short- and long-term disability, medical visits, lay consultation, drug use) diminish when risks and morbidity level are controlled. They actually reverse to a male excess for disability and medical care. Though most of the unveiled male excesses are statistically nonsignificant, their pattern allows a reasonable interpretation. Our results are closely compatible with recent analyses of sex mortality differences in several California sites, which could not eliminate men's mortality excess by controlling for social factors. In conclusion, contemporary women's poorer health profile stems largely from their roles and stress (acquired risks), and to a smaller degree from their health attitudes. When social factors are taken into account, health data suggest a disadvantage for men, and mortality data maintain men's disadvantage. Do the reasons lie in biology?

Female↗
PubMed1988

Daily symptoms and behavioral responses. Results of a health diary with older adults.

Research on the health care behavior of older adults in response to symptoms will benefit from having data collection methods that can monitor health actions as they occur on a daily basis. In the present study, symptom experiences over a 2-week period and the actions taken in response to them were studied with a self-kept daily diary. Participants were 142 community-resident older persons, aged 62-94. Diary information about number of daily symptoms and the accompanying pain/discomfort was correlated with health perceptions and psychosocial indices obtained in an interview prior to the diary period. Women tended to take a more active response to symptoms than men, particularly in the area of personal care actions. Preventive health behaviors were not strongly related to symptom-related actions. Satisfaction with one's income was the only predictor of seeking professional assistance. Overall, the diary method is feasible to use with older adults, although certain groups may require special consideration (e.g., the visually impaired, persons with multiple symptoms per day, or those with a limitation on writing ability).

Age Factors↗
PubMed1987

Exploring the iceberg. Common symptoms and how people care for them.

Despite the importance of daily symptoms for people's quality of living, they are seldom studied (thus, the "iceberg of morbidity"). We begin by reviewing United States and British studies that have information on daily symptoms experienced by adults. The most common ones are respiratory (largely from colds) and musculoskeletal (largely from arthritis, injury, overexertion). Using health diaries kept for 6 weeks by a population-based sample of adults, we report the frequency of respiratory and musculoskeletal symptoms, their specific types and causes, and what factor urge people to take therapeutic actions for them. The most popular action for both is prescription or nonprescription drugs, followed by lay consultation, then restricted activity, and lastly seeking medical care. On Respiratory Days, how miserable a person feels is the main stimulus to action; other morbidity aspects of the day also rank high. Sociodemographic groups scarcely differ in their responses to respiratory symptoms. The situation is similar for Musculoskeletal Nondisease Days (injury/overexertion). But for Musculoskeletal Disease Days (arthritis), sociodemographic characteristics figure more strongly in care, and the day's degree of morbidity less. These results signal basic differences in how people approach chronic and acute health problems: For chronic ones, they devise strategies of care (determined partly by their roles, attitudes, and resources) over months and years, and apply them during flare-ups. For acute problems, decisions about care are made in the short run and hinge mostly on symptoms. Our analysis also considers how actions complement or substitute for each other: Self-care actions (nonprescription drug use and restricted activity) tend to co-occur, and so do actions based on medical care (prescription drug use and medical contact). The two domains substitute in one way (nonprescription drug use greatly reduces chances of prescription drug use) and join in another (restricted activity increases chances of medical contact).

Acute Disease↗
PubMed1986

From sneezes to adieux: stages of health for American men and women.

This article traces health from daily symptoms to death for American (U.S.) men and women in three age groups 17-44, 45-64, 65+. How do leading problems change as our perspective shifts from daily symptoms to annual incidence and prevalence rates of diseases and injuries; then to problems that induce long term limitations; to conditions brought to physicians for care; to diagnoses for hospital stays; and finally to causes of death? We study the top 15 conditions in each of these stages of health. Young adults are bothered most by acute and chronic respiratory diseases, but deaths among them are due to diseases and violent injuries that seldom figure in daily life. Fatal chronic diseases becomes more prevalent in middle ages and spur professional care, but they rarely cause daily symptoms. For older people, life threatening chronic conditions stretch through all stages of health. Arthritis also becomes a dominant facet of symptoms, social limitations and ambulatory care. Men's and women's leading daily symptoms are very similar; so are their leading acute and chronic conditions, limiting conditions, diagnoses for health care and causes of death. What distinguishes the sexes is the rate, not the ranks, of health problems they suffer. We elaborate the iceberg of morbidity metaphor, as a device to highlight stage, age and sex differences in health.

Acute Disease↗
PubMed1986

Role burdens and physical health of women and men.

This article looks at role burdens experienced by women and men, asking if heavy burdens are linked with poor physical health status and frequent health care. The role burden variables refer to job schedule, feelings about roles and life, time constraints and pressures, family dependency, and levels of role involvement and responsibility. The data source is the Health In Detroit Study, which has health items from a retrospective interview and prospective health diaries. Results show that dissatisfaction with roles/life and feelings of very great or very little time pressure are associated with poor health. To a lesser extent, very low or very high objective time constraints, irregular and short job schedules, no or high family dependency, and very low or very high income responsibility are linked with poor health. By contrast, having numerous roles is associated with good health. Some of these results point toward social causation (how the quantity and quality of roles influence health) and others to social selection (how health influences role involvements). The relationships are similar for women and men. But women are more at risk of poor health because, more often than men, they tend to have few roles (especially nonemployment), more dissatisfaction with their main role and life, low time constraints, low income responsibility, and irregular job schedules. In conclusion, role burdens may lie more in subjective feelings about one's activities than in their objective characteristics. Having low quality roles may jeopardize health, whereas having numerous ones can help maintain or enhance it.

Adult↗
PubMed1985

Social roles and health trends of American women.

The statistical results concur closely with descriptive ones presented earlier, indicating that the latter are not results of random variations. The main effects of employment, the contingent effects of parenthood, and the time trends modeled here are the same as reported earlier. (Only two differences occur. First, among white married women, mothers have statistically more acute conditions than nonmothers. We saw this parenthood effect earlier for nonemployed married women, but not for employed ones [results were inconsistent]. The statistical analysis smooths those inconsistencies and reveals that employed mothers also experience more acute conditions than their nonmother peers. Second, among white married women, older housewives show statistically increased chronic limitation over time. Earlier we saw a rise for housewives without children. The latter parenthood effect is statistically smaller than the age effect.) The singular advantage of the statistical analysis has been its ability to highlight interaction effects among the variables, some of which were not considered in the descriptive section. Comparing the models, note how those for short- and long-term disability are very similar to each other but distinctly different from the acute-condition models. This means that social roles and age influence short- and long-term disability in the same way. Specifically, both are greater for older and nonemployed women, being especially high for older nonemployed women and housewives without children. By contrast, the most consistent factor affecting acute-condition incidence and impact is presence of children. Children increase their mothers' experience of acute problems but reduce the amount of recuperative time and medical care taken for them.

Adolescent↗