Temporary disability among independently living adults with major disabling conditions.
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Activities of Daily Living↗
Biomedical subjects
L G Branch
Publications and source records attributed to L G Branch.
Practice patterns of male and female dentists.
The 1985 ADA Survey of Dental Practice was used to compare practice characteristics of 1,414 males and 110 females who graduated from dental school in or after 1975. Similarities and differences in practice, patient, and productivity characteristics were identified among male and female dentists. Additionally, multivariate analyses showed gender, practice type, and age as significant predictors of productivity.
Adult↗
A prospective study of incident comprehensive medical home care use among the elderly.
This prospective study directly examines, in a defined community population, the extent to which a wide array of characteristics predict utilization of an important long-term care (LTC) service--medical home care--over a two-year interval among the cohort of 3,706 people aged 65 or older. The overall age-sex adjusted rate of two-year incident home care use was 3.2 per cent. For both men and women, the rates among the aged 85 or older group were approximately 12 times the rates of those aged 65 to 74. The multivariate predictors of incident home care, adjusted for age and sex, were five: receiving help with at least one activity of daily living (ADL), being dependent in Rosow-Breslau functional health areas, being homebound, more errors in mental status items, and no involvement with social groups. The dominance of indicators of frailty in physical function and cognitive function are consistent with the predictors of another group of LTC clients, those who subsequently enter nursing homes. However, in the present study the ratios of medical home care use were similar for those living alone and for those living with others in the multivariate model, suggesting the possibility of differences between home care and institutional LTC clients.
Activities of Daily Living↗
Alcohol, tobacco, and cannabis use by independently living adults with major disabling conditions.
Data from an 18-month prospective study of 205 adults with major disabling conditions revealed that there is a positive but not statistically significant association (p greater than .10) between respondents' scores on a scale which measures both numbers and amounts of substances (alcohol, tobacco, and cannabis) used and bed disability days. There are also nonsignificant positive relationships between scale scores and five of six measures of utilization of medical care.
Activities of Daily Living↗
Total charges for inpatient medical rehabilitation.
Descriptive information on inpatient charges for a sample of 151 individuals discharged from three Boston area medical rehabilitation facilities is presented in this article. The total charges for inpatient rehabilitation were nearly $3 million, and the mean charge was $19,568. Also presented are a description of how charges vary by medical, demographic, social, and external factors and an identification of predictors of total charges for inpatient medical rehabilitation. These results establish a reference point for developing prospective payment systems for inpatient medical rehabilitation.
Analysis of Variance↗
Health indicators for an aging population.
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Aged↗
A comparative analysis of the influence of financing on Boston's neighborhood health center dental programs in 1979 and 1985.
This study determined whether or not income and other structural components of 15 Boston neighborhood health centers in 1979 and 1985 had a systematic influence on their dental productivity as measured by dental visits. Health center revenue sources, health center costs, dental program costs, dental and medical manpower, and type of facility license were analyzed in relation to dental visits using secondary data from multiple sources. Dental costs and dental manpower were substantial predictors of dental visits for both periods of time. Stepwise regression analyses suggest that in 1979, the type of license and the type of grants received also were associated with the number of dental visits. In 1985, however, none of the revenue variables showed an association with dental visits when controlling for dental manpower and dental costs.
Boston↗
Continuing care retirement communities: self-insuring for long-term care.
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Aged↗
A prospective evaluation of the effect of managed care on medical care utilization among severely disabled independently living adults.
We conducted an 18-month longitudinal evaluation of a model-managed medical care program for severely disabled, independently living adults. Regression analyses using an additive model (no interaction effects) suggest that persons in the study group did not have statistically significantly different utilization experiences than members of the comparison group. Regression analyses that include interaction effects suggest that, for certain segments of the cohort, the study group's utilization experience was significantly lower than that of members of the comparison group. Persons in the study group with higher baseline emergency room (ER) utilization had significantly fewer hospital admissions (P = 0.0055). The participants with better self-assessments of health experienced significantly fewer hospital days per person (P = 0.0075) and days per person hospitalized (P = 0.0056), and persons with organizational affiliations reported significantly fewer ER visits (P = 0.0264).
Activities of Daily Living↗
Predicting charges for inpatient medical rehabilitation using severity, DRG, age, and function.
We examined the effectiveness of using diagnosis related groups (DRGs), Severity of Illness Index (SII), age and function at admission to predict inpatient charges for medical rehabilitation. Data from our sample of 199 indicate that DRGs alone explained approximately 12 per cent of the variation in charges for inpatient rehabilitation while SII explained 26 per cent of the variation. SII, DRG, and age together yielded the highest regression coefficient, accounting for nearly 39 per cent of the variation in total charges; SII and age accounted for 36 per cent of the variation. Within DRG categories, SII was the only important predictor of inpatient charges accounting for 23 per cent of the variation in charges among stroke patients (DRG 014) and 28 per cent of the variation in charges among hip fracture patients (DRG 210). Function at admission was not a useful predictor of inpatient rehabilitation charges within DRGs. These results suggest that SII and age may be useful in developing a DRG-based prospective payment system for inpatient medical rehabilitation.
Activities of Daily Living↗
Assessing physical function in the elderly.
This article emphasizes the complexity underlying the assessment of physical function. The concept of physical function is multidimensional; individuals or groups can be assessed; the assessments can be either preintervention measures or outcome measures. Six issues of measurement are discussed: verbal report versus behavior; self-reported versus proxy-reported information; capacity versus performance; assumptions in Activities of Daily Living and Instrumental Activities of Daily Living measurement; differences between items and instruments; and the search for a summary index. Specific instruments are reviewed.
Activities of Daily Living↗
Factors affecting dental utilization of elders aged 75 years or older.
Data collected from 496 elders aged 75 years or older participating in the Massachusetts Health Care Panel Study were analyzed by means of multiple regression to determine the principal predictors of perceived need for care and of dental users. The relationship between perceived need and use of services also was examined. The significant variables influencing perceived need in elders were poorer self-perceived oral health, having some teeth, and reporting a dental visit within two years. Dental users were best predicted by dentate status, a history of alcohol consumption, and perceived need for care. Although the variables of perceived need and being a user each influenced the other, both were more influenced by a common significant predictor variable, dentate status.
Aged↗
Cardiac disability. The impact of coronary heart disease on patients' daily activities.
We studied 100 men with clinically stable coronary heart disease. Their capacity for exertion as defined by treadmill test was compared with the physical and social avocational activities they carried out in their daily routine, as reported by them. Exercise capacity (treadmill time) was strongly correlated with a physician's independent assessment of symptomatic status (anginal history). Although participation in some relatively strenuous elective activities was related slightly to exercise capacity, participation in many household duties and social undertakings bore no relationship to exercise capacity or to other measures of the severity of the underlying heart disease. The patients' own perceptions of their cardiac limitation varied for different activities and for some activities it was determined as much by their own concern and outside advice as by cardiac symptoms. Decreased capacity for exertion seems to exert surprisingly little influence on a cardiac patient's daily routine and interventions aimed at altering one of these measures of performance will not necessarily affect the other.
Activities of Daily Living↗
Moderate alcohol and decreased cardiovascular mortality in an elderly cohort.
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Age Factors↗
Impairment and disability in the aged.
Data on 776 survivors of the Massachusetts Health Care Panel Study are used to examine the relationship between impairment and disability among noninstitutionalized aged. Using multiple regression we examined the relationship of sight, hearing, and musculoskeletal impairments with physical and social disability, controlling for age, gender, income, and living situation. Findings suggest that impairments do not inevitably lead to disability. Musculoskeletal and visual impairments are strongly related to physical disability. None of the impairments studied in this sample are related to increasing social disability. These results suggest that physical and social disabilities may be distinct concepts with quite different determinants.
Activities of Daily Living↗
Increased green and yellow vegetable intake and lowered cancer deaths in an elderly population.
In a prospective cohort study of 1271 Massachusetts residents 66 years of age or older, we examined the association between consumption of carotene-containing vegetables and subsequent five year mortality. Dietary information was obtained by food frequency questionnaire in 1976. The relative risk of cancer mortality was examined within quintiles of green and yellow vegetable score (calculated from intake of carrots or squash, tomatoes, salads or leafy vegetables, dried fruits, fresh strawberries or fresh melon, and broccoli or brussel sprouts). After controlling for age and smoking behavior, those in the highest quintile of intake of these carotene-containing vegetables had a risk of cancer mortality which was 0.3 (95% confidence limits 0.10-0.96) that of those in the lowest quintile. The trend of decreased cancer risk with increasing intake of carotene containing vegetables was significant (p = .026). This relationship is consistent with the hypothesis that carotene may act as an inhibitor of carcinogenesis.
Aged↗
Framingham Disability Study: relationship of disability to cardiovascular risk factors among persons free of diagnosed cardiovascular disease.
The relationship between physical disability and cardiovascular risk factors among persons free of diagnosed cardiovascular disease was examined. Between 1948 and 1951, a cohort of adult, Framingham, Massachusetts, residents was assembled for a longitudinal examination of cardiovascular disease. Twenty-seven years after the participants' initial examination (between 1976 and 1978), members of the cohort who were still participating in the Framingham Heart Study were interviewed to ascertain their self-assessed ability to perform various physical activities. A score on the cumulative disability index was assigned to 2,021 persons free of diagnosed cardiovascular disease. Analyses controlled for noncardiovascular health conditions which were identified as related to disability. Among women, both long-term and current hypertension and body mass index, as well as diabetes, were associated with disability. Among men, long-term hypertension was related to disability. Age-specific analyses indicated that, for women, current hypertension was statistically significantly related to disability in the middle and oldest age groups; long-term hypertension was related to disability in the middle age group. Both long-term and current measures of diabetes in the oldest age group and long-term measure of cigarette use in the middle age group of women were also related to disability. Age-specific analyses among men indicated that the only statistically significant risk factor was long-term hypertension in the youngest age group. Cholesterol was not related to disability. Results suggest that certain cardiovascular risk factors should be considered in efforts to understand further the development of disability.
Age Factors↗
When elders fail to visit physicians.
Among people over age 70, 17% reported instances of not seeing a physician during the previous year when they thought they should for any one of four reasons, and 12% specifically because they thought the problem was due to their age. Elders with lower income, lower morale, and diminished health status were more likely to report instances of not seeing the physician for reasons of perceived transportation problems, cost difficulties, or because they thought the problem was due to their age; those with higher incomes, without private insurance, living alone, male, and with lower morale were more likely to report instances of noncontact because of appointment difficulties. Elders who attributed problems to their age were more likely to be out of annual contact with a physician, as were those with less formal education, fewer functional problems, and higher morale. Elders reporting appointment difficulties in fact had increased reported frequencies of physician visits, as did those closer to age 70 than age 90, those with worse perceived health, and more functional problems. Strategies for influencing utilization are presented.
Activities of Daily Living↗