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PubMed1993

Housing factors and perceived health status among Japanese women living in aggregated dwelling units.

An epidemiologic survey was conducted of the 818 households in a community consisting of aggregated dwelling units in Tokyo, Japan, in order to assess the relationship between housing environment and psychological or physical health status of the female residents. Psychological health status was assessed by the 28-item General Health Questionnaire in Japanese translation. Main housing factors such as internal density (person-to-room ratio) and floor level (vertical location) of the dwelling unit did not have significant effects on the psychological health status of the sample of Japanese women, but the internal density generally did not exceed 1.5 persons per room. However, physical health status might be associated with floor level: women living at the highest levels complained of more symptoms than did those at lower floor levels, when the type of dwelling unit (i.e., high-rise, low or medium height building) was not taken into account. Poor psychological health status was found among women who were dissatisfied with the plan of their house or with the room arrangement, were anxious about earthquake or other accidents, perceived the house as inadequate for the children, were annoyed by indoor noise, and complained of outdoor noise.

Adolescent↗
PubMed1989

Selection of neighborhood controls for a study of coronary artery disease.

This report describes the selection process for a neighborhood control group recruited between February 1985 and July 1986 to augment a hospital-based case-control study investigating the relation of traditional and nontraditional risk factors to coronary artery atherosclerosis. A total of 219 cases with angiographically defined coronary artery disease residing within a 60-mi (96-km) radius of Winston-Salem, NC, were assigned to surveyors to be matched. Thirty-seven per of the study population were rural, 92% were white, 58% were male, and 52% were older than 50 years of age. One hundred and eighty-seven controls were age-(+/- five years), sex-, and race-matched pairwise to cases. After locating the residence of the case, the surveyor systematically visited neighboring households to ascertain eligibility status of residents. To achieve a match, a maximum of three visits was made to the neighborhood; up to 25 households were surveyed per visit. Refusal rate was less than 5% of eligible matches. Young white urban males were the easiest to match, while rural females, especially older persons, were the most difficult. Average time to complete an assignment included 129 minutes for travel, 237 minutes for surveying the neighborhood, and 62 minutes for clerical tasks. Average distance traveled was 85 mi (136 km) per case. As expected, the time and distance to complete a case were greater in rural than urban areas. The average cost per case was $122.97.

Age Factors↗
PubMed1997

Managing for quality in a nursing home: a resident-directed approach.

As the population ages, the need for nursing care services will increase. Consumer focus on quality of life as well as reduction of expenditures poses a major challenge to the traditional nursing home, which often reinforces dependent resident behavior. The authors propose various strategies for improving life satisfaction and functional status of residents as well as efficiency and productivity of staff.

Long-Term Care↗
PubMed2006

Study on the hemorheological parameters of oldest-old residents in the East-Hungarian city, Debrecen.

The aim of this study was to assess social and health status of residents older than 90 years in an East-Hungarian city. The investigation involved 70 subjects, measuring routine laboratory parameters and plasma viscosity. Mean cholesterol, erythrocyte sedimentation rate (ESR), collagen cross links and plasma viscosity values exceeded the reference range, but mean red blood cell count, hematocrit and hemoglobin were below it. Plasma viscosity was found pathologically elevated in 51% of cases. We compared these results with an earlier laboratory screening test performed on the same population with the age range of 60 to 90 years. In this cohort the mean fibrinogen concentration, ESR, HDL-cholesterol and collagen cross links values were higher, but mean cholesterol, triglyceride, total protein, hemoglobin and hematocrit values were lower than the reference range.

Aged, 80 and over↗
PubMed1995

Health insurance coverage and use of services among low-income elders: does residence influence the relationship?

This research uses a nationally representative sample of 1,425 low-income elders from the 1987 National Medical Expenditure Survey (NMES) to assess the independent and interaction effects of health insurance coverage and residence on the use of seven health care services: doctor visits, visits to other personnel, telephone contact, emergency room visits, overnight hospital stays, outpatient visits, and prescription medicines. It is hypothesized that (a) elders without insurance to supplement Medicare; (b) those who lived in nonmetropolitan areas use fewer health services; and (c) insurance status and residence interact to influence use of health services, with nonmetropolitan elders using fewer services than those living in metropolitan areas, regardless of insurance type. Using multivariate statistical analyses with both main effects and interaction term models, the data indicate that the type of insurance that low-income elders have is associated with their use of health services, and that residence has only modest effect. Individuals who have Medicaid, and to a lesser extent private supplements, use services more frequently than do those without supplements. Finally, despite the hypothesis, residence does not interact with insurance status in influencing use of services; the relationship between insurance and use of services does not vary across area of residence. The data suggest that the ability to pay, rather than supply constraints associated with nonmetropolitan areas, are of primary importance in determining health care use among low-income elders.

Aged↗
PubMed2006

Family members as proxies for satisfaction with nursing home care.

BACKGROUND: Many benefits to collecting and reporting satisfaction information from nursing home residents, including promoting quality initiatives, consumer choice, and improved care, have been described. Yet barriers to collecting resident satisfaction information exist, the most significant of which is the often low cognitive status of residents. An alternative source of information can come from family members serving as proxies for the residents. A study was conducted to explore the agreement and association of nursing home residents' responses with family member proxy responses. METHODS: Satisfaction data from 286 paired residents and family members in 42 facilities were collected in 1999. The satisfaction questionnaire consisted of 16 items evaluating the art of care, technical quality, efficacy, amenities of the care environment, and global satisfaction. Bias indexes, intraclass correlation coefficients, and Pearson's product-moment correlation coefficients were used to compare resident and proxy responses. RESULTS: In general, proxy satisfaction ratings were higher than the same ratings given by residents. Proxy ratings varied less from residents' ratings for the amenities items, which were considered the most concrete items. Proxy ratings were much higher for the art of care and efficacy domain items--the least concrete questions. DISCUSSION: Proxy ratings do not necessarily substitute for resident ratings and are dependent on the nature of the question asked. Examining resident-proxy responses at different points in time may be useful.

Aged↗
PubMed1996

Alcohol consumption among the elderly in a general population, Erie County, New York.

OBJECTIVES: Relatively few studies of drinking among the elderly have been completed despite the growing proportional representation of the elderly in the US population. This study sought to estimate the prevalence of and to observe whether active or health-oriented lifestyles are associated with heavy drinking among the elderly. METHODS: Random-digit dialing telephone interviews were conducted with 2325 Erie County, New York, general population residents aged 60 years or older. RESULTS: The prevalence of heavy drinking was 6%. Adjusted analyses showed positive associations between heavy drinking and being male, having suburban residency, and currently using cigarettes. Negative relationships were observed between heavy drinking and socioeconomic status, rural residency, and degree of health orientation. Age and level of active lifestyle were not significant contributors to the model. CONCLUSIONS: Of the studied variables, health orientation offers the greatest opportunity to address heavy drinking among the elderly.

Aged↗
PubMed2000

Nursing assistants detect behavior changes in nursing home residents that precede acute illness: development and validation of an illness warning instrument.

BACKGROUND: Acute illness causes considerable morbidity and mortality in nursing home residents but is often difficult to recognize early. Nursing assistants often notice early signs of acute illness but do not methodically document or communicate their observations with medical staff. OBJECTIVE: To enhance nursing assistants' observation and documentation of signs of acute illness by developing a validated, standardized instrument for communication with medical staff. DESIGN: Observational cohort study. SETTING: Urban not-for-profit nursing home. SUBJECTS AND METHODS: Candidate instrument items were generated in focus group interviews with nursing home staff. Twenty-three nursing assistants completed the instrument on 74 nursing home residents over 4 weeks. Acute illness, the primary outcome, was identified by nurse report and chart review and determined according to preset criteria. MEASUREMENTS: Predictive validity was assessed by determining the relationship between instrument responses and development of acute illness within 7 days. Interobserver agreement was calculated between morning and afternoon nursing assistants' responses. Convergent validity was assessed by comparing instrument responses with three standard status indicators. RESULTS: The instrument consisted of 12 items that assessed behavioral and functional status changes. Residents with an instrument-recorded change were more likely to develop an acute illness within 7 days than those with no change (risk ratio 4.1, 95% confidence interval 2.6, 6.3). A final five-item instrument had a sensitivity of 53% and a specificity of 93% for acute illness. Nursing assistants' documentation of signs of illness preceded chart documentation by an average of 5 days. Interobserver agreement between morning and afternoon nursing assistants was 76%. Correlation of responses with standard indicators of functional, mental, and global status was high. CONCLUSIONS: A new instrument developed for nursing assistants to document behavioral and functional status changes in nursing home residents demonstrates fair sensitivity and high specificity for acute illness. Close monitoring of patients with a positive instrument might avert morbidity and mortality from acute illness by allowing earlier treatment.

Activities of Daily Living↗
PubMed1988

Financing residency training in urology.

Five educators concerned with changes occurring in the financing of medical education and care reviewed the present status of residency programs and their financing. Future support depends on political decisions as well as demonstrable needs. The effects of anticipated reductions in funding for residents and their programs may be countered by the development of alternative sources and the restructuring of present programs for more efficient operation. The need for leadership is clear.

Costs and Cost Analysis↗
PubMed1996

A short DSM-III-R-based diagnostic instrument for screening mental disorders in geriatric institutions.

A screening instrument based on the DSM-III-R was developed in order to differentiate aged persons with or without a DSM-III-R mental disorder. The usefulness of this instrument was investigated in six geriatric institutions with 171 residents aged 65 to 93 years in Finland. The nursing staff independently rated the mental status of residents; researchers (a psychiatrist and general practitioner) made a diagnosis based on DSM-III-R criteria. The majority of the residents (mean 69%, varying from 33% to 84% in different institutions) had a DSM-III-R mental disorder. This screening instrument functioned well in differentiating residents without a mental disorder from those with DSM-III-R mental disorder: The nursing staff's agreement was 90%, kappa.71, sensitivity .90, and specificity .88. However, only half the cases of depression were diagnosed correctly: Sensitivity was .50 and specificity .95. With a more specific 9-class diagnostic instrument based mainly on DSM-III-R categories, agreement was only moderate (68%) and kappa .59. The instrument developed in this study seemed to be a useful screening method when applied by the staff, but accurate diagnostics require psychiatric knowledge, especially of depression.

Aged↗
PubMed1997

Socioeconomic status and perinatal outcome according to residence area in the city of Malmö.

BACKGROUND: Maternal socioeconomic status is known to influence perinatal outcome. Antenatal care is free of charge in Sweden and all pregnant women are followed according to a standardized protocol of surveillance. The city of Malmö in southern Sweden is divided into 124 townships with great differences in socioeconomic standard. The aim of this study was to evaluate perinatal outcome according to the address of residence of the mothers within the city of Malmö. METHODS: Perinatal outcome of 7056 pregnancies was related to three socioeconomic characteristics of the 124 townships in Malmö: percentage of immigrants, percentage of inhabitants on social welfare and the median income. RESULTS: Maternal age was lower, number of abortions and parity were higher in low income areas. Perinatal complications were also more frequent, including low birthweight, small-for-gestational age newborns, maternal anemia, infections, and low 1- and 5-minute Apgar scores. Premature rupture of membranes was associated with low income areas. Symphysiolysis and pre-eclampsia were more frequent in the high income areas. CONCLUSION: Although maternity care is provided free of charge, perinatal complications were more frequent in areas of lower socioeconomic status. In order to improve perinatal outcome, antenatal surveillance should be intensified in low class socioeconomic areas.

Female↗
PubMed2001

Flavor enhancement of food improves dietary intake and nutritional status of elderly nursing home residents.

BACKGROUND: Taste and smell losses occur with aging. These changes may decrease the enjoyment of food and may subsequently reduce food consumption and negatively influence the nutritional status of elderly persons, especially those who are frail. The objective of this study was to determine if the addition of flavor enhancers to the cooked meals for elderly residents of a nursing home promotes food consumption and provides nutritional benefits. METHODS: We performed a 16-week parallel group intervention consisting of sprinkling flavor enhancers over the cooked meals of the "flavor" group (n = 36) and not over the meals of the control group (n = 31). Measurements of intake of the cooked meals were taken before and after 8 and 16 weeks of intervention. Appetite, daily dietary intake, and anthropometry were assessed before and after the intervention. RESULTS: On average, the body weight of the flavor group increased (+1.1 +/- 1.3 kg; p <.05) compared with that of the control group (-0.3 +/- 1.6 kg; p <.05). Daily dietary intake decreased in the control group (-485 +/- 1245 kJ; p <.05) but not in the flavor group (-208 +/- 1115 kJ; p =.28). Intake of the cooked meal increased in the flavor group (133 +/- 367 kJ; p <.05) but not in the control group (85 +/- 392 kJ). A similar trend was observed for hunger feelings, which increased only in the flavor group. CONCLUSION: Adding flavor enhancers to the cooked meals was an effective way to improve dietary intake and body weight in elderly nursing home residents.

Aged↗
PubMed2007

Physical activity and health: evidence from a study of deprived communities in England.

This study aims to explore the relationship between physical activity levels and the self-reported health status of residents living in deprived communities in England. A cross-sectional interview survey was conducted in communities in receipt of funding from the New Deal for Communities (NDC) regeneration programme. A sample of 848 addresses was selected by random sampling from within each of the 39 NDC areas, and one adult from each household was selected for interview. A total of 19 574 residents were interviewed between July and October 2002. The main outcome measures were physical activity level and health status assessed using four self-reported health measures: health in the last 12 months, health change in the last 12 months, long-standing illness or disability and a mental health-related quality-of-life score. There are large regional and demographic variations in respect of NDC residents' physical activity levels. The areas with the lowest levels of physical activity are mainly located in northern industrial towns. Residents who did little or no physical activity were more than twice as likely to feel that their health was not good (adjusted OR 2.54, 95% CI 2.35-2.75).

Adolescent↗
PubMedDate not supplied

The Short Portable Mental Status Questionnaire: assessing cognitive ability in nursing home residents.

BACKGROUND: The Short Portable Mental Status Questionnaire (SPMSQ) and other brief tests of cognitive functioning have been widely used to screen for cognitive dysfunction; however, they are rarely used to assess cognitive ability. OBJECTIVES: To discern whether the SPMSO might adequately substitute for longer assessments in the prediction of memory performance in older adults. METHOD: The SPMSQ and grocery list and prose recall tests were administered to 67 cognitively intact nursing home residents (mean age = 75 years). Demographic characteristics and self-rated health were recorded. RESULTS: The number of items missed on the SPMSQ predicted up to 32% of the variance in more extensive list and prose recall measures, even with demented patients excluded. The SPMSQ retained a strong predictive relationship to memory after age variance was removed, accounting for 11-16% of the variance. CONCLUSIONS: The SPMSQ may be useful as a general measure of cognitive abilities in nursing home residents.

Aged↗
PubMed1998

Identifying health status and health risks of older rural residents.

Older rural residents are vulnerable in both health status and access to health services. This descriptive study was designed to assess the general health status and risk factors of older rural residents age 65 and over. Cluster analysis methods were used to group older adults into unique clusters of individuals with similar health risks. Although strategies are generally targeted at those with limitations in two or more activities of daily living, community health nurses might need to initiate interventions much earlier. Findings of this study can help community health providers, policymakers, and administrators strategically plan to meet the health care needs of various groups of at-risk older rural populations.

Aged↗
PubMed1999

Consequences of MRSA carriage in nursing home residents.

A prospective cohort study with 1 year follow-up evaluated the relation between MRSA carriage and mortality, likelihood of hospitalization and functional status in residents of a nursing home for the elderly. Included were all 447 residents living in the home in early June 1994. From all patients, swabs were taken from nose, throat and perineum. Additional swabs (sputum, urine or wounds) were taken when indicated. The relative risk (RR) of dying within 6 months in MRSA carriers compared to non-carriers was 2.29 (95% CI = 1.04-5.04). This RR remained stable (1.57-2.40) after adjustment for co-variables using Mantel-Haenszel stratified analysis. After I year, the RR was reduced to 1.30 (95% CI = 0.65-2.58). Univariate survival analysis confirmed a difference in survival between carriers and non-carriers after 6 months (log-rank P = 0.04) and no difference after 1 year. Cox regression analysis resulted in a hazard ratio for dying within 6 months of 1.73 (95% CI = 0.72-4.17). No relation was found between carriage and either likelihood of hospitalization or indicators of functional status. These results are compatible with a possible relation between 6 months mortality and MRSA carriage in nursing home patients. It calls for a large scale, multicentre cohort study in order to either confirm or refute these findings.

Aged↗
PubMed2002

Compliance with medical and dental treatments in children and adolescents renal transplant patients.

In recent years, the number of pediatric organ transplants has increased. As the life expectancy of pediatric transplant recipients continues to rise the number of transplant children visiting dental clinics increases accordingly. These patients need medical and dental treatment for life due to the kind of medication they take and its effects on the oral cavity. However, satisfactory compliance with medical treatment has not been reported. We analyze the degree of association between compliance with medical/dental treatments, biological variables (age and number of transplant surgeries) and social-economical variables (family type, schooling, place of residence and economical status) in infant and adolescent renal transplant patients, in a retrospective descriptive study. 74 infant and adolescent renal transplant patients aged 16.7 +/- 1.23 years were studied. Information on age, time in dialysis treatment, time since the transplant surgery, number of transplants, social-economical status, parents' schooling, family type, place of residence and compliance with prescribed treatment was collected from clinical records and guided questionnaires. Tables of contingence for Chi square test were constructed for all variables to test association among them. The statistical analysis showed that compliance with both medical and dental treatments were positively associated with family type and schooling. Association with place of residence and economical status was not observed. No association was observed with age and number of transplants. Pediatric transplant patients who live in unsupportive homes and whose parents' schooling is poor, are a vulnerable group which should be periodically motivated to promote satisfactory compliance with the prescribed treatment.

Adolescent↗