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Biomedical subjects

T Wetle

Publications and source records attributed to T Wetle.

At least 19 recordsLinked to original sources
PubMed1995

Difficulty with holding urine among older persons in a geographically defined community: prevalence and correlates.

OBJECTIVE: The goal of this study was to estimate the prevalence and correlates of difficulty holding urine among a population of community-dwelling older people. DESIGN: Population-based cross-sectional study. SUBJECTS: A population census identified all residents aged 65 years and older residing in East Boston, Massachusetts, in 1982. MEASURES: Data collected via in-home interviews were used to estimate the prevalence of difficulty holding urine and to provide information regarding potential correlates of urinary difficulty. RESULTS: Of the 3809 study participants (85% response rate), 28% reported having "difficulty holding urine until they can get to a toilet" at least some of the time, and 8% reported difficulty "most" or "all of the time." Difficulty was associated with age and sex; 44% of women and 34% of men reported some difficulty (P < .001), and 9% of women and 6% of men (P < .001) reported difficulty most or all of the time. For respondents aged 65 to 74 years, 40% reported some difficulty, compared with 47% of those aged 85 and older (Ptrend < .001); difficulty most or all of the time was reported by 6% of those aged 65 to 74 and 12% of those aged 85 and older (Ptrend < .001). Difficulty holding urine was associated with important health and functional measures including depression, stroke, chronic cough, night awakening, fecal incontinence, problems with activities of daily living, decreased frequency and ease in getting out of the house, and poor self-perception of health. CONCLUSIONS: Difficulty holding urine is a prevalent condition among older people living in the community and is associated highly with a number of health conditions and functional problems.

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PubMed1994

Short-term variability of self report of incontinence in older persons.

OBJECTIVE: Virtually all estimates of the prevalence and incidence of incontinence in the community rely on self-reported continence status. The goal of this study was to assess the reliability of this measure in older adults. DESIGN: Telephone interviews administered approximately 2 weeks apart. SETTING: Community-based congregate living facility. PARTICIPANTS: A convenience sample of approximately 100 residents was contacted by letter; 48 of 51 (94%) who indicated their willingness to participate were interviewed. They included eight men and 40 women > 70 years old (79% > 80 years old), virtually all of whom were independent in basic ADLs and 83% of whom reported their health as good or excellent. MEASUREMENT: Responses to a structured questionnaire. MAIN RESULTS: The prevalence of urinary incontinence was 40% at baseline and 44% on re-interview; the prevalence of fecal incontinence was 17% on both occasions. All Spearman correlations for items related to urinary incontinence characteristics were between .80 and .86, except for a question related to stress incontinence (r = .62); correlations for fecal incontinence were .67-.69. CONCLUSION: Prevalence estimates of incontinence are stable over a 2-week period. However, the variability of individual responses, while relatively low, was within the range previously reported for estimates of incidence and remission rates of incontinence in community-dwelling elderly. This, variability should be taken into consideration when interpreting previous studies and designing future ones.

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PubMed1994

Case managers and physicians: communication and perceived problems.

OBJECTIVE: To describe case managers' perceptions of the physician-case manager relationship. DESIGN: A qualitative field study using in-depth open-ended interviews was used to elicit case managers' experiences and practices. A multidisciplinary team analyzed transcripts using an adaptation of the "grounded theory" approach of Glaser and Strauss. PARTICIPANTS/SETTING: Case managers were selected for interview using a maximum variation sampling strategy within an established state-wide case management agency. MAIN OUTCOME MEASURES: Transcript analysis allowed for the organization of observations into themes, which were merged across interviews to generate theses. RESULTS: Case managers report that: (1) The case manager role is poorly understood by physicians. (2) Physicians lack insight into the social and environmental aspects of home-bound elderly people. (3) Access to physician services is often difficult to obtain. (4) Power struggles occasionally surface in care planning. (5) Decisions by physicians and case managers regarding the care of frail elderly are often made from different agenda. CONCLUSIONS: From the perspective of case managers, gaps in interprofessional communication may hinder the optimal care of frail elderly individuals.

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PubMed1994

Relative importance to elderly patients of effectiveness, adverse effects, convenience and cost of antihypertensive medications. A pilot study.

This pilot study was designed to investigate the attitudes of elderly patients regarding the choice of drugs for the treatment of hypertension. A questionnaire was administered to a sample of elderly patients receiving antihypertensive therapy regarding effectiveness, adverse effects, cost and convenience. Forced choices were used in order to reflect practice realities. 44 patients, mean age 75.2 years, rated effectiveness and adverse effects more important than cost and convenience. Choices regarding adverse effect risk were slightly influenced by costs of the drugs and insurance status of the patients. Choices regarding convenience were heavily influenced by financial considerations. Our study indicates that elderly patients are most concerned about effectiveness and safety, and express a willingness to pay more for these qualities in their antihypertensive drugs.

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PubMed1992

Predictors of advance directive restrictiveness and compliance with institutional policy in a long-term-care facility.

OBJECTIVE: To ascertain factors influencing the level of advance directives selected by nursing home residents or surrogates and the time delay to documentation of these choices in the medical record after implementation of a facility-wide policy. DESIGN: Longitudinal cohort study of nursing home residents followed from date of advance directive policy initiation or time of admission for a maximum of 21 months from study commencement. SETTING: A 315-bed multilevel nursing home. PARTICIPANTS: Four hundred twenty-four nursing home residents (mean age 85, 74.9% female, 96.1% white). OUTCOME MEASURES: Level of advance directive status chosen--full code, do not resuscitate (DNR) or palliative care only--and date documented in the medical record. RESULTS: Factors predictive of restricted advance directives (DNR or palliative care) included age greater than 85 years (P = 0.025), documented use of a surrogate decision maker (P = 0.001), low physical function (P less than 0.001), low cognitive function (P less than 0.001), and having a nursing home-employed physician (P = 0.001). These results were confirmed using logistic regression models. Median time to directive documentation decreased from 54 days for residents admitted in the first quarter to 1 day for residents admitted in the fourth quarter of the year following initiation of an advance directive policy. CONCLUSION: In logistic models, nursing home-employed physicians were more likely to write restricted advance directive orders than community-based physicians even after controlling for resident age, cognitive status, and physical function. In addition, implementation of a formal nursing home advance directive policy can shorten time to physician documentation of resident advance directive status.

Activities of Daily Living↗
PubMed1992

Public-private partnerships: the Connecticut model for financing long-term care.

Responses to the growing crisis in long-term care financing have included efforts to negotiate partnerships between the private and public sectors for the purpose of developing innovative models for long-term care insurance. One such set of models has been encouraged by support from the Robert Wood Johnson Foundation's "Long Term Care Insurance Program" grants. The Connecticut Partnership for Long Term Care uses a cooperative approach to encourage the development of private sector long-term care insurance products that are integrated with Medicaid eligibility determinations. The Connecticut model is described, accompanied by a history of its development, and a comparison is made with other models currently under consideration by national policy analysts.

Connecticut↗
PubMed1992

A taxonomy of ethical issues in case management of the frail older person.

Present-day case managers find themselves facing a broad range of ethical issues and value conflicts. For managers of the frail older person, these issues may relate to (a) the client, (b) the client's family, (c) the manager's agency, (d) interdisciplinary interactions, (e) interagency dynamics, and (f) the entire service system. An eight-point strategy for conflict resolution can be effectively applied to these ethical conflicts.

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PubMed1990

Short-term variability of measures of physical function in older people.

Self reported physical function was assessed in telephone interviews approximately 3 weeks apart for a sample of 193 persons aged 69 or older. Three measures of physical function were used: a modified Activities of Daily Living scale, three items proposed by Rosow and Breslau, and five items from among those used by Nagi. Agreement between first and second interviews was very good; most subjects reported no impairment in function at either interview. Among those who reported some impairment, the degree of limitation within the specific activities reported as limited and the total number of activities with any degree of limitation agreed exactly for most and within one level for almost all subjects. There was no evidence to suggest that age or cognitive impairment affected the variability of the responses, and reported declines and improvements in function were about equally common.

Activities of Daily Living↗
PubMed1988

Illness behavior in the aged. Implications for clinicians.

A better understanding of the processes through which elderly individuals perceive, evaluate, and act on symptoms will enable physicians to respond more appropriately to the needs of older patients. This paper reviews existing evidence on how the experience of chronic disease and the atypical presentation of symptoms influence symptom recognition and reporting among elderly individuals. A discussion of research on health perceptions suggests that some elderly may inappropriately deny illness and delay seeking medical care, while others with overly negative health perceptions may make excessive physician visits. An overview is presented of the process by which elderly individuals come to seek care from their physicians, combining evidence from the diverse literatures on chronic illness, atypical presentation of disease, and health perceptions. We conclude by discussing the practical implications of this information for clinicians working with the elderly.

Activities of Daily Living↗
PubMed1987

Differences in the appraisal of health between aged and middle-aged adults.

This study examines whether the aged and the middle aged differ in their self-appraisal of health. Data were obtained through interviews and medical records from a probability sample of 460 individuals aged 45 to 89 years old. The aged evaluated their health more pessimistically than the middle aged, after controlling for physical health, psychological distress, gender, and education. The aged's perception of health was significantly worse than the middle aged's for persons having diagnoses in each of the following diagnostic categories: rheumatism and musculoskeletal deformities, nervous system and sense disorders, and digestive problems. A stronger association was found between perceived poor health and depressive symptoms among the aged than the middle aged. The importance of psychological distress on the aged's health assessment and subsequent illness behaviors is discussed.

Aged↗
PubMed1987

Differences in determinants of physician use between aged and middle-aged persons.

The authors examined whether there are differences in the determinants of physician use between aged and middle-aged individuals. Data were obtained through interviews and medical records from a probability sample of 460 individuals aged 45-89 years old. Physical health measures were important predictors for both age groups, but there were differences in the relative importance of specific variables. The number of diagnoses was more important in predicting physician use for the middle-aged and bed days was more significant for the aged. Psychologic factors played a slightly greater role in predicting physician use for the aged, and enabling and predisposing variables were somewhat more important for the middle-aged. Utilization during the year before the interview was associated with subsequent physician use for both age groups, but the correlation was weaker among the aged. Age differences in the predictors of physician use are believed to result from the unique illness response elicited by chronic, as opposed to acute, illness.

Age Factors↗