Biomedical subjects

V A Freedman

Publications and source records attributed to V A Freedman.

16 recordsLinked to original sources

PubMed2001

Aggregate changes in severe cognitive impairment among older Americans: 1993 and 1998.

OBJECTIVES: This study explored whether improvements in cognitive functioning occurred during the 1990s among older Americans and investigated several possible explanations for such changes. METHODS: Using the 1993 Asset and Health Dynamics of the Oldest Old study (N = 7,443) and 1998 Health and Retirement Survey (N = 7,624), this study examined aggregate changes in the proportion of the noninstitutionalized population aged 70 and older with severe cognitive impairment. Impairment was measured for self-respondents using a modified version of the Telephone Interview Cognitive Screen; for proxy respondents, ratings of memory and judgment were used. Logistic regression was used to investigate potential explanations for aggregate changes. RESULTS: The percentage of older Americans with severe cognitive impairment declined from 6.1% in 1993 to 3.6% in 1998 (p < .001). The decline was statistically significant among self-respondents but not among those with proxy interviews. Improvements between 1993 and 1998 were not explained by shifts in demographic and socioeconomic factors or by changes in the prevalence of stroke, vision, or hearing impairments. DISCUSSION: As a group, older persons, especially those well into their 80s, appear to have better cognitive functioning today than they did in the early 1990s.

Age Factors↗

PubMed2001

Persistent, consistent, widespread, and robust? Another look at recent trends in old-age disability.

OBJECTIVE: The purpose of this study was to provide new evidence on disability trends among elderly persons from 1982 to 1996. METHODS: The sample includes 124,949 participants aged 70 and older in the 1982-1996 National Health Interview Surveys. Logistic analysis was used to estimate the trend in disability prevalence after controlling for various sociodemographic factors. RESULTS: We found that: (a) the prevalence of disability has declined, but the gains did not persist throughout the entire period or accelerate over time; (b) only routine care disability has declined, whereas more severe personal care disability shows no improvements; (c) estimates are robust to the exclusion of the nursing home population but may be sensitive to growth in the assisted living population; (d) estimates of decline in disability prevalence are fairly consistent across five national surveys; (e) gains have been concentrated among the most educated elderly persons; and (f) gains in education appear to be an important confounder of the improvements. DISCUSSION: Evidence from several surveys using various measures indicates that disability has declined among elderly persons. Determining the causes of the improvements should be a high priority in future research efforts.

Age Distribution↗

PubMed2000

Implications of asking "ambiguous" difficulty questions: an analysis of the second wave of the asset and health dynamics of the oldest old study.

OBJECTIVES: This study explores the analytic implications of using questions about difficulty with daily activities that do not specify whether to consider assistance. METHODS: For 1,054 Asset and Health Dynamics of the Oldest Old Study Wave 2 respondents, we compared responses to questions about difficulty without reference to assistance (ambiguous difficulty) to those about difficulty without help or equipment (underlying difficulty) and difficulty with help or equipment, if used (residual difficulty). We modelled predictors of discordance by means of logistic regression. RESULTS: Discordance exists for 15% of respondents between summary variables indicating underlying and ambiguous difficulty with one or more activities. Discrepancies are evenly split between respondents reporting (a) underlying but no ambiguous difficulty and (b) ambiguous but no underlying difficulty. Discordance also exists for 15% of respondents between summary variables indicating residual and ambiguous difficulty with one or more activities: most of these discrepancies involve reports of ambiguous but no residual difficulty. Most respondent characteristics investigated are not significant predictors of discrepancies. DISCUSSION: Analysts should be aware that (a) ambiguously worded questions appear to be a better proxy for underlying than for residual difficulty, (b) discrepancies seem to be lower for separate activities than for summary variables indicating difficulty with one or more activities, and (c) being Hispanic and receiving help may affect reporting discrepancies.

Activities of Daily Living↗

PubMed2000

Incorporating assistive devices into community-based long-term care: an analysis of the potential for substitution and supplementation.

OBJECTIVES: This article examines the use of assistive devices as a part of the long-term care arrangements of community-dwelling older Americans. It examines the potential for assistive devices to substitute for and supplement personal care assistance. METHODS: Data from the Phase 2 Disability Supplements to the 1994-1995 National Health Interview Surveys are used to compare the use of personal care and equipment among persons reporting difficulty with a given activity of daily living. RESULTS: The capacity of equipment to substitute for or supplement personal care is highly task-specific and depends on the characteristics of the devices and the personal care providers. In general, those using simple devices are less likely to use informal care, whereas those using complex devices are more likely to use formal care services. DISCUSSION: Technology has the potential to confer quality of life enhancements for older persons and their caregivers and cost savings for payers.

Activities of Daily Living↗

PubMed2000

Contribution of chronic conditions to aggregate changes in old-age functioning.

OBJECTIVES: This study explored the role of various chronic conditions in explaining recent improvements in functioning among older Americans. METHODS: We used the Supplements on Aging to the 1984 and 1994 National Health Interview Surveys to examine changes among Americans 70 years and older in reports of chronic conditions and functional limitations. We decomposed functioning changes into condition-related components, controlling for demographic shifts. RESULTS: The percentage of older Americans with upper- and lower-body limitations declined from 5.1% and 34.2%, respectively, in 1984 to 4.3% and 28.5% in 1995, and the average number of lower body limitations decreased. During the same period, reports of 8 of 9 chronic conditions increased, but many of these conditions had less debilitating effects on functioning. Reductions in the debilitating effects of various chronic conditions--particularly arthritis--are important in explaining declines in limitations experienced by older Americans. CONCLUSIONS: Earlier diagnosis and improved treatment and management of chronic conditions, rather than prevention, may be important contributing factors to improvements in upper- and lower-body functioning among older Americans.

Activities of Daily Living↗

PubMed1999

Long-term admissions to home health agencies: a life table analysis.

This article uses the first national survey of home health agencies and their patients to characterize the complete length-of-use distribution for an elderly admissions cohort. Of the 26 million older Americans admitted to home health agencies in 1992, 36% received care for at least three months, 22% for at least six months, and 15% for at least one year. Analyses suggest that one-year limits on Medicare's home health benefit would have affected a relatively small percentage of new admissions (less than 13%) but would have amounted to 300,000 or so beneficiaries in 1992. In contrast, proposals to limit Medicaid would have affected a more substantial proportion of home health agency admissions (about one fourth) but only a relatively small number of older Americans (30,000 in 1992). Such length of use limits would also disproportionately affect those at highest risk for nursing home admission: very old, unmarried, minority women with relatively unstable chronic conditions.

Aged↗

PubMed1999

The role of education in explaining and forecasting trends in functional limitations among older Americans.

Using the Survey of Income and Program Participation, we document the importance of education in accounting for declines in functional limitations among older Americans from 1984 to 1993. Of the eight demographic and socioeconomic variables considered, education is most important in accounting for recent trends. The relationship between educational attainment and functioning has not changed measurably, but educational attainment has increased greatly during this period. Our analysis suggests, all else being equal, that future changes in education will continue to contribute to improvements in functioning, although at a reduced rate.

Activities of Daily Living↗

PubMed1998

Understanding trends in functional limitations among older Americans.

OBJECTIVES: This report documents trends in functional limitations among older Americans from 1984 to 1993 and investigates reasons for such trends. METHODS: We applied logistic regression to data for noninstitutionalized Americans aged 50 years and older from the Survey of Income and Program Participation. We focused on 4 functional limitation measures unlikely to be affected by changes in role expectations and living environments: reported difficulty seeing words in a newspaper, lifting and carrying 10 pounds, climbing a flight of stairs, and walking a quarter of a mile. RESULTS: We found large declines in the crude prevalence of functional limitations, especially for those 80 years and older. Generally, changes in population composition explained only a small portion of the downward trends. Once changes in population composition and mobility-related device use were considered for difficulty walking, significant improvements in functioning remained for the 65- to 79-year-old group. CONCLUSIONS: Changes in population composition, device use, survey design, role expectations, and living environments do not appear to account completely for improvements in functioning. We infer that changes in under-lying physiological capability--whether real or perceived--likely underlie such trends.

Activities of Daily Living↗

PubMed1998

Single women and the dynamics of Medicaid.

OBJECTIVE: To investigate transitions in and out of Medicaid for a cohort of single adult women of childbearing age in order to address questions that arise as policymakers try to encourage transitions from welfare to work. DATA SOURCES: Longitudinal data from Waves 2 through 8 of the 1990 panel of the Survey of Income and Program Participation, a nationally representative survey of American adults covering May 1990-1992. STUDY DESIGN: We estimate a series of discrete-time logit models with duration dependence to obtain transition probabilities among Medicaid, privately insured, and uninsured spells. Explanatory variables in the models include prior insurance history, income limits on Medicaid by state, and important socioeconomic and demographic characteristics. We use these models to characterize insurance spells for a cohort of single women. PRINCIPAL FINDINGS: Most Medicaid spells are relatively short. Over half end in a year or less; only one spell out of seven lasts longer than five years. Two-thirds of Medicaid disenrollees become uninsured. Former welfare recipients are prone to frequent changes in insurance status. In states with more generous income limits for AFDC, women stay on Medicaid longer, but they do not move into the program at a faster rate. CONCLUSIONS: Imposing time limits on Medicaid eligibility would affect only a small proportion of Medicaid spells but would eliminate a significant proportion of the caseload at a point in time. In considering changes in Medicaid that would encourage transitions from welfare to work and would alter the dynamics of Medicaid, policymakers need to consider how transitions both in and out of private insurance and Medicaid would be affected.

Adult↗

PubMed1997

Differences across payors in charges for agency-based home health services: evidence from the National Home and Hospice Care Survey.

OBJECTIVE: To investigate charge and payment differentials for home health services across different payors. DATA SOURCES: The 1992 National Home and Hospice Care Survey, a nationally representative survey of home and hospice care agencies and their patients, collected by the National Center for Health Statistics. STUDY DESIGN: We compare the average charge for a Medicare home health visit to the average charge for patients with other sources of payment. In making such comparisons, we control for differences across payors in service mix and agency characteristics. PRINCIPAL FINDINGS: Agencies charge various payors different amounts for similar services, and Medicare is consistently charged more than other payors. CONCLUSIONS: Findings imply the potential existence of payment differentials across payors for home health services, with Medicare and privately insured patients likely to be paying more than others for similar services. Such conclusions raise the possibility that, as in other segments of the healthcare market, cost-shifting and price discrimination might exist within the home health industry. Future research should explore these issues, along with the question of whether Medicare is paying too much for home health services.

Fees and Charges↗

PubMed1996

Family structure and the risk of nursing home admission.

Given the high costs associated with institutionalization, understanding factors related to nursing home admissions is of considerable interest. The family is particularly relevant to a discussion of nursing home admission, given its critical role in providing care to older disabled persons. Using data from the New Haven EPESE, we examine the relationship between family structure and the risk of first nursing home admission. Family structure is defined more broadly than in most previous studies and includes not only the spouse, but also sons, daughters, and siblings. Because of the relatively lengthy follow-up period of the EPESE, we are able to depart from previous methodological conventions, adopting a continuous time survival model with age at admission as the outcome and time-varying measures of family structure and health. Results show that married older persons have about half the risk of nursing home admission of unmarried persons, and that having at least one daughter or sibling reduces an older person's chance of admission by about one-fourth.

Age Factors↗

PubMed1996

Designing home care benefits: the range of options and experience.

This article presents a framework identifying important home care benefit design decisions and reviews existing designs that have been adopted in practice. Four basic designs were identified, based on a review of 55 home care benefits drawn from public programs in the United States and foreign countries, and from private long-term care insurance policies in the United States. Three of these designs-service entitlements, managed-service benefits, and cash disability allowances--have each been adopted by public programs in the United States and abroad, and by private insurance policies in the United States. A fourth design--individualized cash benefits--has been adopted in only one experimental program. The designs observed in practice are remarkably varied, providing evidence that many alternative designs are feasible. Experimentation, particularly with cash disability allowances, is needed to determine the relative costs and benefits of various designs.

Aged↗

PubMed1995

A case study on the use of multiple imputation.

Multiple imputation is a relatively new technique for dealing with missing values on items from survey data. Rather than deleting observations for which a value is missing, or assigning a single value to incomplete observations, one replaces each missing item with two or more values. Inferences then can be made with the complete data set. This paper presents an application of multiple imputation using the 1987-1988 National Survey of Families and Households. We impute several binary indicators of whether the respondent's elderly mother/mother-in-law is married. Descriptive statistics are then presented for the sample of adult children with an unmarried mother or mother-in-law.

Adult↗

PubMed1994

Family networks: predictors of nursing home entry.

Despite the importance of kin in caring for older relatives, few studies have examined the relationship between the family network and the risk of nursing home placement. Data from a cohort of noninstitutionalized elderly persons living in New Haven in 1982 were used to predict nursing home admission through 1985. Logistic regression analyses show that older persons who have regular contact with kin have a lower risk of institutionalization. For men, the spouse is most important in reducing the risk of entry; for women, having regular contact with at least one family member--of any relation--reduces the risk of entry.

Aged↗

PubMed1993

Kin and nursing home lengths of stay: a backward recurrence time approach.

There are numerous hypotheses about the role played by kin in decreasing the length of elderly persons' nursing home stays, yet few studies have explicitly examined the relationship between kin and episode length. Here we use backward recurrence time data from the Current Resident File of the 1985 National Nursing Home Survey to estimate models in which the hazard of leaving a nursing home depends upon covariates . Women admitted at age 65 or older stay, on average, 26 months in an institution, while men have an average stay of 19 months. Controlling for demographic factors, insurance status, and various chronic and morbid conditions, we find that, on average, having a living spouse decreases the length of stay by four months for men and three months for women. Having a living child decreases the mean length of stay for women by three months, but has no effect on the mean length of stay for men. Findings underscore the importance of family members in shortening the lengths of time spent by older persons in nursing homes.

Aged↗

PubMed1991

Intergenerational transfers: a question of perspective.

Informal intergenerational transfers have traditionally been examined from the perspective of the older generation; more recent studies have proceeded from the perspective of adult children. Drawing upon principles of formal demography, we establish the mathematical relationship between the two generations' perspectives. We then consider the importance of generational perspective with regard to prevalence estimates of intrafamily transfers. Transfers examined include coresidence, household and financial assistance, and personal caregiving. Results have implications for projection of future trends in intrafamily transfers and for data collection.

Adult↗