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Biomedical subjects

T Wetle

Publications and source records attributed to T Wetle.

At least 37 records · Page 2Linked to original sources
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↗
PubMed1986

Elder abuse screening and intervention.

Elder abuse and neglect are forms of family violence, a growing societal concern. Estimates suggest that 500,000 to 1.5 million cases of abuse and neglect occur annually in this country. This article describes the nurse practitioner's legal liability for reporting suspected cases of elder abuse and neglect. In addition, specific screening guidelines for this problem are outlined. Assessment parameters for evaluating suspected cases of elder abuse are described.

Aged↗
PubMed1984

HMO enrollment of Medicare recipients: an analysis of incentives and barriers.

Although there has been increased interest in use of the health maintenance organization (HMO) model to resolve a variety of problems relating to provision of health care to older individuals, less than 2 percent of Medicare beneficiaries are currently enrolled in HMOs. This paper examines both legislative and operational barriers to HMO enrollment of the elderly. Legislative reforms, HMO organizational structures, and marketing strategies thought to encourage enrollment of the elderly are discussed.

Aged↗
PubMed1983

The three tier family support system in care of the elderly.

Changes in work and social patterns have led to reexamination of the role of the three tier family in caring for the elderly. This paper examines current knowledge about the changing function of the three tier family, the benefits to the family and the elders, and the potential problems and costs of such arrangements. Recommendations are made regarding social policies and formal supports which will encourage and enhance positive function of multi-generational families.

Adult↗
PubMedDate not supplied

The patient self-determination act and advance directive completion in nursing homes.

OBJECTIVES: To assess the prevalence of advance directives among nursing home residents before and after passage of the Patient Self-Determination Act (PSDA) and to identify factors associated with advance directive completion. DESIGN: Prestudy and poststudy nursing home admissions using medical record reviews and a companion cross-sectional survey of alert and oriented residents. SETTING: Six nursing homes in Connecticut. PARTICIPANTS: Residents (N = 635) from 6 randomly chosen nursing homes in the greater Hartford and greater New Haven areas. MAIN OUTCOME MEASURES: The existence of a documented advance directive, the timing of advance directive completion, and reported reasons for completion and noncompletion. RESULTS: The prevalence of advance directives documentation in nursing home medical records has increased significantly since the implementation of the PSDA (4.7% [14/300] before vs 34.7% [104/300] after PSDA; odds ratio, 10.84; P < .001). The increase in documented advance directives was significant after controlling for sociodemographic and health status factors (odds ratio, 11.5; P < .001). Residents admitted to the nursing homes from hospitals (vs from their home or other source), residents with more education, and residents paying privately for nursing home care (vs using Medicare or Medicaid benefits) were more likely to have documented advance directives. Younger residents (aged < 75 years) were less likely than older residents to have completed a directive. Among the 35 interviewed residents, the most common reason for completing an advance directive was experience with a prolonged death of a friend or family member. Only 1 of the interviewed residents reported that the information provided under the PSDA at the time of admission was an important factor in choosing to complete an advance directive. CONCLUSIONS: Nearly 35% of the residents in the post PSDA cohort had an advance directive documented in the medical record. Most residents with advance directives had completed them more than 6 months before the nursing home admission. The major effect of the PSDA for nursing homes has been to enhance the documentation of existing advance directives. Little evidence exists that providing advance directive information at the time of nursing home admission has enhanced the completion of an advance directive after admission.

Advance Care Planning↗