Supporting statements and rationale.
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Aged↗
Biomedical subjects
V Mor
Publications and source records attributed to V Mor.
Determinants of need and unmet need among cancer patients residing at home.
De-hospitalization of cancer treatment, particularly for those with advanced disease, can complicate adjustment and strain the capacity of caregiver networks to meet patients' daily needs. Outpatient staff should be able to recognize patients who need help to meet their daily needs as well as those who are not getting enough help. This study describes the physiological and social determinants of need and unmet need for assistance among 629 cancer patients with advanced disease initiating a course of outpatient chemotherapy and/or radiation therapy. Areas of needs examined through telephone interviews with participating patients were: personal care, instrumental tasks (housework, shopping, and cooking), and transportation. Physiological factors (metastases, disease stage, and functional status) were associated with need for assistance in all three areas. Also, older age (over 65) and low income predicted need for help with personal care, and women were more likely than men to report illness-related need for assistance with instrumental tasks and transportation. Unmet need was primarily associated with patients' social support system (e.g., children living nearby and perceived resiliency of network helpers). These findings highlight the need for outpatient staff to evaluate patients' informal care resources as well as patients' symptoms and impairments in deciding who should be referred for home care services.
Activities of Daily Living↗
QOL measurement scales for cancer patients: differentiating effects of age from effects of illness.
Increasingly, researchers studying the effects of medical treatments and health policy initiatives consider morbidity and not just mortality outcomes. Since older cancer patients are increasingly involved in chemotherapeutic and radiation therapy trials, it is important to know that commonly used quality of life measures are applicable to the aged as well as the younger population. Do older patients manifest poorer quality of life at various points in the disease course than do younger patients? We analyzed data from three studies on (1) newly diagnosed cancer patients, (2) patients on chemotherapy, and (3) advanced cancer patients regarding quality of life and compared the scores observed among older and younger individuals. After correcting for comorbidity and physical frailty, we found no quality of life differences between older and younger patients.
Activities of Daily Living↗
Advocacy. Necessary to achieve cancer control goals.
As resources become increasingly scarce, oncology professionals and consumers of oncology services are increasingly engaging in advocacy efforts to achieve goals in cancer control. Effective advocacy includes both legislative and direct educational efforts.
Aged↗
Caregiver burden and unmet patient needs.
Four-hundred eighty-three patients with cancer and their informal caregivers were studied. Patients reported on met and unmet needs in personal care activities (bathing and dressing), instrumental activities (heavy and light housekeeping, cooking, shopping), transportation (medical and general), and home health care (health/treatment assistance). A minority (18.9%) experienced an unmet need. Hierarchical logistic regression was used to identify significant predictors of any unmet need. Patients were more likely to report any unmet needs when their illness/treatment resulted in restricted activity days, when their financial resources were reduced enough for them to apply for Medicaid or Public Assistance, or when their caregivers were not their spouses. Although in general, the likelihood of an unmet need decreased as the number of domains of assistance provided by the caregiver increased, if that care was associated with a high level of burden, the odds of a patient reporting an unmet need actually increased.
Adult↗
Preferences of HIV-infected patients for aggressive versus palliative care.
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Acquired Immunodeficiency Syndrome↗
Daily living needs of cancer outpatients.
The proportion of patients who receive intensive medical treatment outside the hospital environment has increased steadily over the past two decades. Active cancer chemotherapy outpatients (N = 413) receiving treatment in the community were surveyed to document the prevalence and to identify the correlates of their daily living needs. Overall, 90% of the sample required help with some type of Personal, Instrumental or Administrative activity. Patients reported need for assistance with heavy housekeeping, shopping and completion of forms and paperwork most often. More than one-quarter (26.7%) of those requiring help reported that their need was unmet. Males, patients reporting poor physical functioning, and patients with children at home reported a greater level of need. Unmet need varied as a function of level of confidence in the ability of others to provide help, the number of helpers available as well as level of physical functioning and age. The relation between these results and potential intervention strategies to assist patients in meeting their needs is discussed.
Activities of Daily Living↗
The relationship of spousal caregiver burden to patient disease and treatment-related conditions.
The prevalence and intensity of different caregiving burdens experienced by spousal caregivers and the association of these burdens with various patient illness and treatment-related conditions were examined in a sample of 295 married cancer patients and their spouses. The spousal caregivers were confronted with a wide range of burdens associated with their caregiving responsibilities. Objective, as compared to subjective, caregiver burdens were more strongly associated with patient disease and treatment-related conditions. Compared to husbands, wives experienced more burden and these burdens were more strongly associated with the various disease and treatment conditions.
Adult↗
Health care utilization and functional status in the aged following a fall.
Falls in the aged may lead to increases in health care utilization and declines in functional status. The Longitudinal Study of Aging was analyzed to test the hypotheses that use of the health care system is greater in elderly persons subsequent to a fall in the preceding year than in those who have not fallen and that fallers are more likely to decline in function than are nonfallers. One-time fallers and, especially repeated fallers, (2 or more falls in the preceding year) were at greater risk of subsequent hospitalization, nursing home admission, and frequent physician contact than were nonfallers, after controlling for age, sex, self-perceived health status, and difficulties with activities of daily living. Similarly, one-time fallers, and especially repeated fallers, were at greater risk of reporting subsequent difficulties with activities of daily living, instrumental activities of daily living, and more physically demanding activities. These findings highlight the significant impact that falls have on the health care system and on the individual.
Accidental Falls↗
The relation of dizziness to functional decline.
OBJECTIVE: to assess the effect of dizziness on the probability that an older person will die or become functionally disabled within 2 years. Dizziness is a common symptom for which the prognosis is uncertain. This report compares the prognoses for dizzy and not-dizzy older people in order to assist clinicians who diagnose and treat these patients. DESIGN: a prospective study of a representative sample of elderly (70+) non-institutionalized Americans. Elderly subjects (n = 3,798) in the Longitudinal Study of Aging (LSOA) were asked questions about the presence of dizziness, medical conditions, and functional disability in 1984. The cohort was reinterviewed about functional disability in 1986. OUTCOME MEASURE: transition from functional ability to disability after 2 years. RESULTS: Bivariate analyses showed that dizziness predicts functional decline but not mortality. Multivariate models revealed that age, race, sensory impairment, vascular disease, and other morbidity are independent predictors of becoming disabled. Controlling for these potential confounders, dizziness does not predict an increased probability of becoming disabled. CONCLUSION: Elderly people who are dizzy should be evaluated for the presence of these related conditions.
Aged↗
Working group recommendations: measuring outcomes of care in geriatric evaluation and management units.
Issues related to measuring outcomes of care in geriatric evaluation and management (GEM) units were identified by the outcomes working group of the GEM evaluation conference. GEM units have as a major goal the improvement or maintenance of both physical and psychosocial function. Suggested outcome measures for physical health included survival, restricted activity days, general health perceptions, comprehensive physical function, and miscellaneous specific types of functioning. In the area of psycho-social function, the working group suggested measuring cognitive function, affect/life satisfaction, social function, and satisfaction with care. The patient's caregiver (eg, spouse or child) is often an important target of GEM care, and the group suggested measuring caregiver burden, life satisfaction, and assessment of patient behavior problems. While the primary goal of GEM units is to improve health status, their effects on the utilization and cost of health care are important to decisions about wide-spread implementation and funding. The group therefore suggested a comprehensive assessment of these outcomes. Among the large array of recommended outcomes, the most important were thought to be mortality, function, and cost.
Activities of Daily Living↗
Health services research on HIV disease: what's new, what's unique?
The human and social costs of the human immunodeficiency virus are mounting rapidly in the U.S. and abroad. It is likely that this disease will help catapult us into health care reform in the current decade. Hopefully, health services research on HIV disease will contribute to the debate on what the nature of this reform should be. We need to understand the implications of access barriers facing those with no insurance as distinct from those with public insurance. We must grapple with and understand the implications for estimating the costs of AIDS, of open-ended, publicly funded acute care for persons with HIV. Furthermore, we must understand the long-term care needs of chronically ill AIDS patients with frequent periodic life-threatening acute events and the optimum structure(s) necessary to provide such care. Above all, we must be sensitive to the rapidly evolving treatments for HIV and the fact that these can make cost projections completely obsolete almost before they are made. Health services research on HIV disease must, of necessity, focus on many of the traditional themes of our emerging discipline. At the same time, the fact that it is an infectious disease with an observable transformation into a chronic condition has implications for the way we study it and how we define the emergence of clinical disease. This has implications for how we conduct health services research on the entity and may push us toward a new set of methodologies that borrow more from epidemiology than cost accounting.
Costs and Cost Analysis↗
Patterns of survival with AIDS in the United States.
We examined patterns of survival with AIDS (acquired immune deficiency syndrome) using the Centers for Disease Control (CDC) "AIDS Public Information Data Set." Analyses used a census of 23,271 cases diagnosed between January 1, 1984 and December 31, 1986. Three Cox proportional hazards models were fit to the data. The first used clinical and demographic parameters only in an effort to replicate Rothenberg's analysis of survival for patients diagnosed in New York City prior to 1986. The second model included variables that capture the effect of time of diagnosis in order to determine whether temporal trends exist. The third model included variables indicating the geographic region from which the cases were reported. The results of these models support earlier findings of demographic and clinical survival correlates. Controlling for covariates, patients diagnosed during 1986 lived significantly longer than those diagnosed earlier; the difference was most profound when Pneumocystis carinii (PCP) was present. Last, we observed large regional differences; their implications for health services planning are discussed.
Acquired Immunodeficiency Syndrome↗
Patterns of secondary prophylaxis with aerosol pentamidine among persons with AIDS.
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Acquired Immunodeficiency Syndrome↗
AIDS case management: the client's perspective.
The Robert Wood Johnson Foundation's AIDS Health Services Program uses case management to provide community-based care for people with AIDS. This article reports data concerning implementation of case management, based on interviews with program clients in nine communities. Some clients receive case management from a community-based organization (CBO), while others have clinic-based case managers. Clinic clients are more likely to be disadvantaged. Over 25 percent of respondents report having no case manager at either site, and 10 percent report having two case managers. Those who need social services are more likely to have a case manager. Between 18 and 25 percent have had no contact with their case manager in a month, but over 50 percent have had multiple contacts. Frequency of contact is positively related to having needs for social services. Evaluations of case managers are favorable, but there is some dissatisfaction with ease of access. Having a case manager is positively related to having service needs met. Results suggest that (1) efforts to coordinate care through case management must deal with the existence of clinics and CBOs as distinct treatment sites with differing clientele, and (2) explicit policies concerning eligibility for case management and frequency of monitoring must be developed.
Acquired Immunodeficiency Syndrome↗
Pre-diagnostic symptom recognition and help seeking among cancer patients.
Failure to recognize symptoms which signal cancer may delay contact with the medical care system, thus decreasing the chances of diagnosis at an early stage of disease. We investigated the determinants of cancer symptom recognition and delay in seeking medical care in a population-based sample of 625 newly diagnosed lung, breast and colorectal cancer patients. Although the majority (79.5%) of patients reported noticing symptoms prior to diagnosis, one quarter of these patients (24.7%) delayed longer than three months in seeking medical care. Contrary to the findings of research based on clinic samples, logistic regression analysis revealed that no demographic or social support factors were predictive of symptom recognition or delay, with the exception that older colorectal cancer patients were less likely to notice symptoms, but also less likely to delay. Lung and colorectal patients diagnosed with advanced disease were more likely to notice symptoms than patients with local disease. Results of a content analysis of patients' remarks indicate that breast cancer patients were significantly more likely than lung or colorectal cancer patients to attribute their symptoms to cancer (p less than .001). Symptoms common to lung and colorectal cancer appear to be attributed to other, less serious causes. Given the lack of demographic predictors of symptom recognition and delay in seeking care, we suggest that education programs address risk groups for specific cancers, rather than the general public as a whole, grouping together all cancers and cancer symptomatology.
Aged↗
Designing the national resident assessment instrument for nursing homes.
In response to the Omnibus Reconciliation Act of 1987 mandate for the development of a national resident assessment system for nursing facilities, a consortium of professionals developed the first major component of this system, the Minimum Data Set (MDS) for Resident Assessment and Care Screening. A two-state field trial tested the reliability of individual assessment items, the overall performance of the instrument, and the time involved in its application. The trial demonstrated reasonable reliability for 55% of the items and pinpointed redundancy of items and initial design of scales. On the basis of these analyses and clinical input, 40% of the original items were kept, 20% dropped, and 40% altered. The MDS provides a structure and language in which to understand long-term care, design care plans, evaluate quality, and describe the nursing facility population for planning and policy efforts.
Centers for Medicare and Medicaid Services, U.S.↗
A comparison of hospital and community case management programs for persons with AIDS.
To determine whether locus of AIDS case management affects the content of this service, a survey of case managers in 42 major American cities was conducted. One hundred seventy-one case managers working in both public hospitals and community-based organizations (CBOs) responded. Hospital case managers were substantially more likely to report clinical training than CBO case managers. Hospital case managers' case loads were more likely to include drug users and patients with more urgent needs such as housing and drug abuse treatment. While CBO case managers were more likely to work to develop services in the community, hospital case managers reported working more closely with medical staff and discharge planning committees. CBO case managers reported greater difficulty obtaining a number of key services for their clients including home health care, housekeeping, and entitlements; hospital case managers reported greater difficulty obtaining emotional support volunteers. These results indicate that locus of case management strongly affects the structure and content of this service. The importance of these findings for future program planning is discussed.
Acquired Immunodeficiency Syndrome↗