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At least 19 recordsLinked to original sources
PubMed1987

Interstate variation in elderly Medicaid nursing home populations. Comparisons of resident characteristics and medical care utilization.

Nursing home care in the United States is financed primarily through the federal-state Medicaid program. Because Medicaid nursing home programs are administered within the individual states, there may be interstate differences in the characteristics of Medicaid nursing home residents and their utilization of medical care. We used Medicaid claims and enrollment data for calendar 1981 from three large states--Michigan, California, and New York--to study this question. We found that the populations of elderly Medicaid nursing home residents in each of the three states had similar characteristics. In contrast to the homogeneity of resident characteristics, there were pronounced interstate differences in the use of medical care, particularly for the relation between nursing homes and hospitals. California was characterized by frequent turnover among elderly Medicaid nursing home residents and a high rate of transfers to and from hospitals. One third of residents entered the nursing home in the study year, 43% of enterers came from the hospital, and 51% of enterers were discharged within 180 days of admission, usually to the community. In New York, both turnover among elderly Medicaid nursing home residents and interinstitutional transfers were less frequent. However, those residents entering from the hospital had an average pre-entry hospital stay of 60 days, three to five times that of the other two states. Medicaid payments per day of nursing home care totaled +60 per day, twice those in the other two states. Michigan was characterized by patterns of medical care utilization intermediate between these two extremes. These findings suggest caution in the interpretation of single-state studies of nursing home residents, particularly for those of the dynamic relation between nursing homes and hospitals. They also suggest that further study of the experience of the individual states could provide valuable insights into the effects of different levels of nursing home reimbursement and different policies for transfers between nursing homes and hospitals.

Aged↗
PubMed1991

The relationship between residents' characteristics, their stress experiences, and their psychosocial adjustment at one medical school.

Empirical research focused on the stressful aspects of residency training has largely ignored the interactions between residents' psychosocial and demographic characteristics, stressful experiences, emotional responsivity, and coping styles. This article presents the results of a questionnaire, completed by 165 residents, that consisted of the Profile of Mood States, the Hassles Scale, the Ways of Coping Questionnaire, and a series of questions regarding demographic data, social support system features, and residency stress factors. The residents reported that time demands and indebtedness were the major sources of stress in their residency programs. Social support variables were significantly related to the degrees to which the residents successfully coped with daily stress factors. While the women residents reported higher stress levels than did the men, they did not report higher levels of emotional distress. Finally, the lengths of time residents had spent in training were significantly related to the levels of their mood disturbances and daily hassles.

Adaptation, Psychological↗
PubMed1987

The association of bacteriuria with resident characteristics and survival in elderly institutionalized men.

Ninety-one elderly male residents of a skilled nursing facility were classified as nonbacteriuric (41%), intermittently bacteriuric (34%), or continuously bacteriuric (25%) on the basis of urine cultures obtained over a 3-year period. Bacteriuric and nonbacteriuric residents were similar in age, number of diagnoses and medications, and mobility. However, bacteriuric residents were more frequently confused or demented, whether continuously bacteriuric (78%) or intermittently bacteriuric (62%) compared with nonbacteriuric residents (42%) (p less than 0.04). In addition, bacteriuria was significantly associated with incontinence of bladder (96% of continuous, 66% of intermittent, and 25% of nonbacteriuric; p less than 0.001) and bowel (52%, 39%, and 5.5%, respectively; p less than 0.002). At 6 years of follow-up there were no differences in survival among the three groups. Urinary tract infection caused or contributed to only two (2.9%) deaths. Thus, in this population, bacteriuria was associated with higher functional disability but not with increased mortality.

Aged↗
PubMed1991

Effects of sheltered care environments and resident characteristics on the development of social networks.

Two hundred and thirty-four members of a 1973 sample of sheltered care residents, three-fourths of whom had schizophrenic disorders, were followed up between 1983 and 1985 to examine the role of supportive and of transitional, high-expectation sheltered care environments in the development of residents' social networks. The influences of revolving-door treatment experiences, psychopathology, and institutionalization were taken into account. The results showed that supportive rather than transitional, high-expectation environments contributed to the development of emotionally and instrumentally supportive social networks. Higher levels of psychopathology and a history of institutionalization resulted in the absence of certain support relationships. Surprisingly, revolving-door treatment experiences were related to positive support and social network outcomes.

Adult↗
PubMed1977

Resident characteristics and staff behavior in two hospitals for mentally retarded adults.

Results of part of a study aimed at evaluating the implications of different nurse staffing levels were reported. Two samples of 30 patients were observed in the two hospitals and measures were obtained of the proportion of time they were involved in adaptive and maladaptive activities, the frequency with which they interacted in particular ways with the nursing staff, and their Adaptive Behavior Scale scores. When these various measures were examined, we found that those patients who needed more attention received it but not necessarily of the appropriate type. While such results are understandable and even perhaps predictable, they do serve to reveal a situation deserving remedial attention. We in fact suggested that one possible means of countering this tendency to ignore the less attractive patients is for the nursing staff to be assigned much smaller groups of patients than is customary.

Adult↗
PubMed1986

Field-based generation and social validation managers and staff competencies for small community residences.

Characteristics and competencies for four staff positions in community residences for individuals with mental retardation were identified utilizing multiple empirical and deductive methods with field-based practitioners and field-based experts. The more commonly used competency generation methods of expert opinion and job performance analysis generated a high degree of knowledge and skill-based competencies similar to course curricula. Competencies generated by incumbent practitioners through open-ended methods of personal structured interview and critical incident analysis were ones which related to personal style, interpersonal interaction, and humanistic orientation. Although seldom included in staff, paraprofessional, or professional training curricula, these latter competencies include those identified by Carl Rogers as essential for developing an effective helping relationship in a therapeutic situation (i.e., showing liking, interest, and respect for the clients; being able to communicate positive regard to the client). Of 21 core competency statements selected as prerequisites to employment for all four staff positions, the majority (17 of 21) represented interpersonal skills important to working with others, including responsiveness to resident needs, personal valuation of persons with mental retardation, and normalization principles.

Employee Performance Appraisal↗
PubMed1985

The impact of quality on cost in the provision of long-term care.

Regulatory and reimbursement policies in the health care industry have generally been developed on the assumption that a trade-off exists between quality enhancement and cost control. In this study of 494 proprietary, nonprofit, and government nursing home facilities in New York State, I examined the relationship between quality and costs while controlling for facility characteristics and resident characteristics. I found that although the capital-intensive aspects of patient care quality make a significant impact on costs, the labor-intensive aspects of patient care quality do not. I discuss the policy implications of these findings.

Costs and Cost Analysis↗
PubMed1991

Suicides among older United States residents: epidemiologic characteristics and trends.

Suicide rates for elderly US residents decreased between 1950 and 1980, but have increased recently. We analyzed suicide mortality trends using national mortality data for the period 1980 through 1986. Suicide rates during this period increased for each 5-year age group over age 65. Elderly White males have the highest suicide rates and experienced a rate increase of 23%. The rate for Black males rose by 42%. Divorced males have the highest age-adjusted sex- and martial status-specific rates, and experienced a rate increase of 38% over the 7-year period. Suicide rates among older US residents vary by region of the country and are highest in the West. Rates increased in all regions except the Northeast. Fire-arms are the most common method of suicide in the elderly, and firearm use increased during this period from 60% to 66% of all suicides. Given the recent increase in suicide rates for the elderly and the magnitude of the problem in this age group, it is again important to direct our attention to the problem of suicide in the elderly and recognize the need for effective prevention strategies.

Aged↗
PubMed1977

Discharge patterns of residents from halfway houses for male alcoholics.

Length of stay (LOS) data for male alcoholics discharged from eitht halfway houses were examined in the light of the hypothesis that the rate of discharge would be a linear function of time. In general, the hypothesis was confirmed, although the rate of discharge for four houses was significantly accelerated during the first two weeks of residence. Further analysis showed that both resident characteristics and house structure (defined in terms of the number of hours of formal activities each week) contributed significantly to LOS. Resident characteristics accounted for 5.3% of the variance in LOS when house structure was controlled, and structure accounted for 1.6% of variance when resident characteristics were controlled. No significant interaction effects were detected. Implications of these results are discussed.

Adult↗
PubMed1991

Tumor-associated macrophages share in vitro growth characteristics with resident but not elicited macrophages.

Recent studies have shown that tissue macrophages are capable of proliferation and that this capability is enhanced by various cytokines, including macrophage colony-stimulating factor (M-CSF) and granulocyte-macrophage colony-stimulating factor (GM-CSF). Tumor-associated macrophages (TAM) have been demonstrated to proliferate in vitro, but no information is currently available on the ability of M-CSF and GM-CSF to enhance this response. To address this problem, limiting dilution analysis was utilized to examine the proliferative ability of macrophages isolated from two murine tumors of distinct origin following growth in secondary hosts. As a means of comparison, resident peritoneal macrophages (RPM) and thioglycolate-elicited macrophages (TEM) were also analyzed. Results indicate that a rare subset of TAM and RPM is capable of proliferation and that M-CSF and GM-CSF enhance the frequency of TAM and RPM which proliferate, but do not enhance the growth of TEM.

Animals↗
PubMed1978

Alteration of some functional and metabolic characteristics of resident mouse peritoneal macrophages by lymphocyte mediators.

Resident mouse peritoneal macrophages were incubated in Sephadex G-100 fractions of supernates from concanavalin A-stimulated lymphocytes. A significant effect of the lymphocyte supernatant fractions containing mediators on macrophage 5'-nucleotidase, glucose-1 14C oxidation, cell maintenance, and migration is reported. The 5'-nucleotidase was depressed to an extent similar to that seen in activated macrophages obtained from Listeria-infected mice. On the other hand, glucose-1-14C oxidation was enhanced, but not to the same degree as seen in the counterparts in vivo. Whereas migration inhibitory factor (MIF) and cell adherence-augmenting activity were found in a number of adjacent fractions, the metabolic effects were found predominantly in a single fraction. Resident peritoneal macrophages or those elicited by the injection of a lymphocyte-derived chemotactic factor were more responsive with respect to the biochemical changes than caseinate-elicited macrophages. On the other hand, caseinate-elicited macrophages appeared to be more sensitive with respect to the effects of mediator(s) on cell retention. A possible dissociation between MIF and cell-adherence augmenting activity, on the one hand, and the entities that stimulate glucose-1-14C oxidation is reported, based on fractionation studies, and loss of the latter activity upon storage of lymphocyte supernates.

Animals↗
PubMed1990

[Biochemical polymorphic systems and psychological characteristics in residents of the Soviet North-East].

15 biochemical polymorphic systems (AcP, PGM, GPT, GLO-1, EsD, PGP, Pp, AK, Gc, Hp, Tf, BO, MN, Le, P) were comparatively studied which possess psychodiagnostic features investigated by means of all-round personality study and 16-factors Kettle personality inventory in 340 healthy residents of Magadan. With the aid of computer cluster analysis, psychodiagnostic features were revealed which authentically differentiate clusters consisting of 5 combined polymorphic systems, three of them being different. Frequency of particular loci participation in differentiation of persons for psychodiagnostic tests is well-coordinated with a degree of their participation in genotype differentiation in those who left and remained in the region. Interrelations between psychological personality features and individual heterozygosis for 12 loci with codominant inheritance are determined. Authentic differences between low- and highly-heterozygous individuals are revealed using the same psychodiagnostic parameters as those in the cluster analysis.

Adaptation, Physiological↗
PubMed1992

Risk factors that predict staff failure to release nursing home residents from restraints.

This study identifies resident characteristics related to nursing staff failure to provide consistent release from physical restraints as required by regulation. The lengths of intervals during which residents were restrained were measured and correlated with the staff's perception of degree of care burden and resident behavioural characteristics in order to identify risk factors related to the absence of consistent release. Staff perceptions of residents' verbal aggressiveness (multiple R = -.30, p < .01), physical aggressiveness (multiple R = -.25, p < .03) and unpleasantness (multiple R = -.25, p < .03) are the three characteristics most predictive of the length of time residents continuously remain restrained.

Aged↗
PubMed1992

Recognition of depression by internal medicine residents.

We studied the ability of internal medicine residents to recognize depressive symptoms in a population of lower socio-economic primary care patients. Four hundred twenty patients completed the short form of the Beck Depression Inventory (BDI). Simultaneously, the resident caring for the patient estimated the degree of depression for each patient. One-fourth of the patients scored at or above the moderately depressed level on the BDI and the residents rated 23 percent of their patients as at least moderately depressed. However, the accuracy of the residents' assessment of his or her individual patient was poor (correlation = 0.42, sensitivity = 0.46, specificity = 0.84). Patients with a prior history of psychiatric disorder scored higher on the BDI and were given higher ratings of depression. No other pre-existing medical condition was significantly associated with a higher or lower BDI score. The amount of alcohol consumed and the amount smoked, were both associated with higher BDI scores. Residents varied in their sensitivity to their patients' BDI scores. Some showed high agreement with BDI scores, others low. There were no specific resident characteristics (e.g. year of training, resident gender) that could explain this variability. Patients with a history of depression were given lower resident ratings compared to other patients and patients with a history of depression were given lower resident ratings than predicted by their BDI scores. Residents' ability to accurately diagnose and treat depression in the underprivileged primary care patient can be facilitated by the institution of depression screening in the ambulatory clinic.

Adolescent↗