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Biomedical subjects

F D Wolinsky

Publications and source records attributed to F D Wolinsky.

At least 55 records · Page 3Linked to original sources
PubMed1995

Hospitalization for major depression among older Americans.

BACKGROUND: The objective of this study was to report the pattern of hospitalization for major depression among older Americans and to examine correlates of those hospitalizations. We sought to investigate the hypothesis that hospitalization for major depression would be more common among those respondents with declining functional status whose ability to adapt to this decline was impaired by inadequate social support systems or economic stressors. METHODS: The data were taken from Version 5 of the Longitudinal Study on Aging (LSOA), which includes 7,527 subjects who were aged 70 and older in 1984. We identified all subjects with any hospitalizations for which major depression was a discharge diagnosis (ICD9-CM codes 296.2, 296.3, 300.4, and 311), and all subjects for whom depression was the primary discharge diagnosis. Only patients with a first-listed discharge diagnosis of depression were considered to have been hospitalized for major depression. RESULTS: The yearly incidence of hospitalization for which depression was the primary discharge diagnosis was 0.1%. The mean length of stay was 14.6 days and the mean hospital charge was $6,742. Length of stay and charges did not vary by hospital type (general vs psychiatric), but both charges and length of stay were significantly longer when major depression was the primary discharge diagnosis rather than a secondary diagnosis. Patients with a hospitalization for major depression had more hospitalizations, longer total lengths of stay, and greater total hospital charges over the seven-year period as compared to patients with at least one hospitalization for any other reason. These differences in hospital resource use dissipated when hospitalizations for depression were excluded. Hospitalization for major depression was not associated with gender, race, education, or social support. Hospitalization for major depression was independently associated with a forced residential move, a history of nursing home stays, decline in household activities of daily living, younger age, and perceived health rated as less than excellent. CONCLUSIONS: One older American per thousand is hospitalized each year with a primary discharge diagnosis of major depression. These individuals did not have evidence of greater total hospital resource use if episodes of hospitalization for depression are eliminated. Hospitalization for major depression was more common among those with a loss of independent living.

Aged↗
PubMed1995

Changes in physician utilization over time among older adults.

Although much is known from cross-sectional studies about the use of physician services among older adults, little is known about the consistency of or changes in that utilization over time. Hierarchical multivariable regression analysis of data on the 2,430 older adults who were enrolled in the LSOA and successfully reinterviewed in 1986, 1988, and 1990 is used to model changes in the number of physician visits between 1984 and 1990 based on the predisposing, enabling, and need (including functional status) characteristics measured in 1984, and subsequent changes in functional status. Overall, 19 percent of the variance in physician utilization is explained, with 8 percent coming from the introduction of the need characteristics, 4.7 percent from the subsequent introduction of the number of physician visits at baseline, and 4.9 percent from the subsequent introduction of changes in functional status. Declines in each of the functional status measures are significantly associated with increases in physician utilization, although improvements are fundamentally unrelated.

Activities of Daily Living↗
PubMed1995

Hospital utilization profiles among older adults over time: consistency and volume among survivors and decedents.

Medicare claims data are used to model hospital utilization patterns for the 4,660 survivors and 2,867 decedents of the Longitudinal Study on Aging (LSOA). When the volume of hospital utilization was collapsed into four categories based on the mean annual number of hospital episodes and consistency was defined as a maximum absolute deviation from that mean of 1.5 or less, 42.6 percent of the LSOA respondents were found not to have any hospital admissions, and another 24.7 percent were found to be consistently low users. Only 4.8 percent were consistently high users, with an additional 6.8 percent being inconsistently high users. Multiple regression identified prior physician and hospital utilization, as well as poor perceived health, as the most important predictors of the volume and consistency of hospital utilization among survivors, as well as of the volume of hospital utilization among decedents. Among decedents, consistency was primarily related to geographic region and prior physician utilization.

Activities of Daily Living↗
PubMed1995

The risk of mortality among older adults over an eight-year period.

Mortality risks over an 8-year period are assessed among the 7,527 older adults interviewed as part of the Longitudinal Study on Aging. Using a modified version of the behavioral model, hierarchical methods are used to sequentially introduce the predisposing and enabling characteristics, disease history, disabilities and functional limitations, perceived health, and health services utilization both at and after baseline. Based on their partial r statistics (shown in parentheses), the proportional hazard analyses identify the mean annual number of hospital episodes after baseline (.13), age (.07), female gender (-.05), non-kin social supports (-.03), body mass (-.03), and having a history of diabetes (.03) as the six most salient predictors. These six variables account for 80% of the overall model fit.

Activities of Daily Living↗
PubMed1995

Antecedents and consequences of physical activity and exercise among older adults.

The antecedents and consequences of four markers of physical activity and exercise are examined for the 6,780 baseline self-respondents to the Longitudinal Study on Aging. These dichotomous markers reflect having a level of physical activity greater than one's peers (45.8%), getting as much exercise as needed (58.9%), having a regular exercise routine (28.4%), and walking a mile or more at least once a week (29.9%). The major factors associated with engaging in these behaviors are having fewer lower body limitations, better perceived health, more non-kin social supports, not worrying about one's health, and having a sense of control over one's health. When added to traditional models predicting subsequent (over the next 6 to 8 years) mortality, nursing home placement, hospital resource consumption, and changes in functional status, the four markers of physical activity and exercise have numerous statistically and substantively significant associations, all of which involve better health outcomes.

Aged↗
PubMed1995

Predicting hospital costs among older decedents over time.

To explain the variation in total real hospital costs among elderly patients who died between 1984 and 1991, a cohort analytic study of the nationally representative sample of elderly subjects included in the Longitudinal Study on Aging (N = 7,527) was carried out. The cohort comprised the subset of 1,778 community-dwelling Americans who were age 70 years and older in 1984, had one or more subsequent hospital episodes, and died by 1991. Hospital charges for 1984 through 1991 were taken from the Medicare Automated Data Retrieval System. Annual hospital charges were adjusted for inflation (restated in 1984 dollars) using the hospital market basket component of the consumer price index. The natural logarithm of aggregated real charges was used in the analysis. Mean total real hospital charges were $24,956 (SD = $27,847). A standard multivariable regression model explained 9.7% of the variance in real total hospital charges. After incorporating additional measures reflecting a respondent's distribution (mean and standard deviation) of comorbidities (as measured by the number of ICD-9-CM codes [truncated at five]) during all hospitalizations in the observation window, the cause of death, and the concentration of charges in the last year of life, the explained variance increased to 29.3%. The most important explanatory factors were the two variables controlling for the distribution of comorbidity, the variable controlling for population density, and the dichotomous variable indicating that the patient's death was related to an acute myocardial infarction. Total real hospital resources consumed by elderly decedents vary substantially. The concentration of resources consumed in the last year of a respondent's life was only marginally significant in predicting total real hospital charges over an 8-year observation window.

Aged↗
PubMed1994

Risk factors for underimmunization in poor urban infants.

OBJECTIVE: To assess risk factors for underimmunization in poor urban infants. DESIGN: Prospective cohort study. SETTING: A large municipal teaching hospital in the Midwest. PARTICIPANTS: A total of 464 healthy, full-term newborn infants delivered at a large municipal teaching hospital who were to be discharged to the care of their mothers. Mothers were interviewed 24 to 72 hours post partum regarding personal and financial characteristics and 9 to 12 months later to determine where immunizations had been received. MAIN OUTCOME MEASURES: Immunization status at 3 and 7 months of age. RESULTS: Despite availability of free vaccine to most patients, only 67% had received their first set of immunizations by 3 months of age, and only 29% were up-to-date by 7 months of age. Marital status, coresidence with the infant's grandmother, adequacy of prenatal care, and perceived barriers to care were significant independent predictors of initiation of immunizations by 3 months and completion of immunization by 7 months. Poverty was also an independent predictor of immunization status at 7 months. Perceived susceptibility to common symptoms and perceived benefit of medical care to prevent disease were inversely related to immunization status at 7 months. CONCLUSIONS: These data suggest that poor urban infants of single mothers and of mothers who received inadequate prenatal care, and those not living with their grandmother should be targeted for tracking and follow-up to ensure adequate immunization. The provision of free vaccine alone will not guarantee adequate immunization coverage of poor urban children.

Adult↗
PubMed1994

The risk of hip fracture among noninstitutionalized older adults.

The risk of hip fracture among the 7,527 respondents to the Longitudinal Study on Aging (LSOA) is prospectively modeled using logistic regression techniques. Based on existing studies, a seven-stage hierarchical model serially introduces ecological, demographic, and social factors as well as general health status before considering symptoms and diseases conductive to hip fracture, falling history and body mass, and previous hip fracture. Interaction terms involving age and White women are then introduced to explore novel hypothesis. Of the LSOA respondents, 368 (4.9%) experienced hip fracture between 1984 and 1991. Significant risks of hip fracture were associated with age, female gender, White race, being hospitalized (for any cause) in the year prior to baseline, having fallen at least once in the year prior to baseline, and leaner body mass. The risk associated with increasing age diminishes over the life course. Similarly, the protective effect of body mass diminishes over the life course. Finally, previous ecological findings are clarified by identifying an elevated risk for White women living in the rural South.

Accidental Falls↗
PubMed1994

Hospital resource consumption among older adults: a prospective analysis of episodes, length of stay, and charges over a seven-year period.

After linking their administrative records and interview data, the consumption of Medicare-reimbursed hospital resources during 1984 through 1990 by the 7,527 LSOA respondents was prospectively assessed using a two-part design. First, logistic regression was used to model whether a hospital episode occurred. Second, among those having had hospital episodes, OLS regression was used to model the number of episodes, as well as the natural logarithms of the total length of stay and the total charges. The risk of hospitalization was mostly associated with being male, prior hospital and physician utilization, and lower body limitations. Among those hospitalized: (a) greater numbers of episodes were mostly associated with prior hospital and physician utilization, and poorer perceived health; (b) longer lengths of stay were mostly associated with prior hospital and physician utilization, and poorer perceived health; and, (c) higher charges were mostly associated with population density, poorer perceived health, and prior physician and hospital utilization. Decedents consistently consumed substantially more hospital resources than survivors.

Activities of Daily Living↗
PubMed1994

Gender, race, and health: the structure of health status among older adults.

A previously developed model of disease, disability, functional limitation, and perceived health was examined for race and/or gender biases. This model focuses on (a) the direct effects of three factors on perceived health status, (b) how disability, functional limitations, and self-rated health interrelate, and (c) how race and gender condition these interrelationships. The results confirm the construct validity of separate dimensions of disability and functional limitation, and indicate that their differential effects are further modified by gender. Eight significant differences in structural effects are identified, including one gender effect among both blacks and whites, and seven additional gender effects among whites. In the structural model, then, most differences are gender differences among whites. The significant racial differences within gender were found only in the measurement model. Race differences for upper body disability and perceived health are consistent across gender. Sex differences, however, in measures of basic ADLs and household ADLs are not consistent across race. The findings confirm earlier conclusions that differences in the measurement of health exist between males and females, and between blacks and whites, but that the differences in the causes of perceived health exist only between males and females.

Aged↗
PubMed1994

Health services utilization among older adults: conceptual, measurement, and modeling issues in secondary analysis.

Much is written about the use of health services by older adults. Many such studies involve secondary analyses of existing data sources and rely on the behavioral model of health services utilization as the conceptual framework. This essay suggests that for both independent and dependent variables, severe shortcomings in the breadth and depth of the available data, and the numbers of intervals at which data have been recorded, continue to limit our understanding of the use of health services by older adults.

Aged↗
PubMed1994

Medical students' and housestaff's opinions of computerized order-writing.

BACKGROUND: Greater use of computers has been touted as one way in which health care quality can be enhanced while reducing costs. The authors assessed factors associated with acceptance of computerized order-writing. METHOD: From April 1990 through October 1991 a survey was administered to 275 medical students and housestaff who used computer workstations to write all their orders on the general medicine wards at Wishard Memorial Hospital. The survey assessed computer literacy, ease of workstation use, effects on practice and time management, and usefulness of information provided. RESULTS: A total of 212 (77%) of the computer-workstation users responded. Opinions were generally positive. Those of junior students were the most positive, with opinions declining progressively for senior students, interns, and residents. The housestaff were most critical of time spent using the workstations, although they required less time to write orders than the students did. CONCLUSION: The favorableness of the respondents' opinions declined as the level of training increased, a trend that was independent of computer literacy. Hence, increasing computer use by physicians will probably require modification of the educational and socialization process rather than mere reliance on increasing computer literacy.

Analysis of Variance↗
PubMed1994

The effect of gender and race on the measurement properties of the CES-D in older adults.

Having observed a three-fold difference in the prevalence of significant symptoms of depression among four race-gender groups of elderly adults attending an urban primary care practice, we investigated the extent to which these differences might be explained by variability in the measurement properties of the Centers for Epidemiologic Studies depression scale (CES-D). Although the internal consistency of the CES-D was acceptable for all groups, 5% of our patients were excluded for inability to complete the minimum required number of CES-D items, and nearly 40% of patients required response imputation for the allowable one to four items that they could not answer. Imputation was most frequently required for items tapping positive affect. Principal components factor analysis was performed separately for respondents answering all items and for respondents with imputed values. In both analyses we found important race-gender differences in factor structure. Moreover, the factor structure for those with imputed values was markedly different from that of respondents answering all items, including a dissolution of the positive affect dimension. Neither the race-gender differences in factor structure nor the differences among those with and without imputed data were resolved by eliminating respondents with poor education, cognitive impairment, or alcoholism, or by varying the assumptions for data imputation. However, the disparities in factor structure were essentially resolved by eliminating five CES-D items, suggesting the need to modify the CES-D in populations like ours. Although eliminating these five items results in a more pure factor structure, it does not resolve the differences in prevalence of depressive symptoms. These differences may, however, be partially due to differential response tendencies among the race-gender groups.

Black or African American↗
PubMed1994

Reliability and validity of an instrument to measure maternal health beliefs.

Noncompliance with recommended preventive pediatric care continues to be a major problem, especially in inner-city pediatric clinics. There has been little evaluation of the maternal beliefs that are associated with such noncompliance, perhaps because there are no instruments which have been assessed for reliability and validity. To evaluate the internal consistency and construct validity of a maternal health belief instrument, we interviewed 500 mothers of healthy full-term newborns postpartum. Forty-eight items measured the maternal health beliefs, according to Health Belief Model constructs (perceived susceptibility, perceived severity, perceived benefits of medical care, perceived barriers, and health motivation). Construct validity was assessed by principal components factor analysis. Eight internally consistent indices emerged, including illnesses having high and low perceived susceptibility, and low and moderate perceived benefit. Logistical access barriers and economic access barriers were also distinct. Perceived severity and health motivation formed single indices. This maternal health belief instrument was internally consistent in the study sample and showed evidence of construct validity. These indices may make important independent contributions to understanding variation in preventive well-child care utilization.

Adult↗
PubMed1994

The Parent Health Belief Scales: replication in an urban clinic population.

Health locus of control (HLC) has been used to operationalize general health motivation. This study was undertaken to evaluate the internal consistency and construct validity of Tinsley and Holtgrave's Parent Health Belief Scales (PHBS) as a measure of maternal HLC toward their children's health. Five hundred mothers (71% of eligible consecutive admissions) of newborns admitted to the normal newborn nursery of a large municipal teaching hospital were interviewed 24 to 72 hours after delivery. Principal components factor analysis of the PHBS did not support the originally hypothesized three-dimensional factor structure of the PHBS. In addition, the original subscales did not have adequate internal consistency reliability. Further assessment of construct validity by comparison with maternal preventive health behaviors showed some evidence of construct validity for the scales when compared with breastfeeding behavior. When the three items written as reverse-coded Internality items are not reversed, a reliable seven-item Externality scale emerges which contains items originally thought to represent all three dimensions of HLC.

Adult↗
PubMed1994

Subsequent hip fracture among older adults.

Subsequent hip fracture among the 368 Longitudinal Study on Aging respondents who fractured their hips from 1984 through 1991 was prospectively examined. Case-by-case review of the billing records indicated that 27 subsequent hip fractures occurred, for a rate of 1 every 33.8 person-years. Multivariable proportional hazard regression revealed that increased risks of subsequent hip fracture were associated with poor perceived health status and dizziness.

Age Factors↗