Migration, health status and utilization of health services.
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Adolescent↗
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Cognitive status, depressive symptoms, and health status as predictors of functional disability among elderly persons with low-to-moderate education: The Faenza Community Aging Study.
OBJECTIVE: The authors examined the impact of very early dementia and symptoms of depression on functional disability in a community-based group of 216 elderly people with low-to-moderate education level. METHODS: The combined effect of very early dementia and symptoms of depression on functional disability was assessed with a logistic-regression model in which functional disability was the dependent variable. The same model was repeated with each item on the Instrumental Activities of Daily Living scale as the dependent variable. RESULTS: Very early dementia alone was strongly associated with functional disability, and this association tripled in subjects with both very early dementia and symptoms of depression. In fact, whereas subjects with very early dementia had an 11-fold higher risk than normal persons for disability, subjects with both very early dementia and symptoms of depression showed a 37-fold higher risk for functional dependence. CONCLUSIONS: Elderly people who suffer from very early dementia and who also have symptoms of depression are at very high risk for functional disability and have a great need for accurate diagnostic assessment. If confirmed, the results are relevant for prevention because people who suffer from very early dementia and have symptoms of depression may be a suitable target group for intervention before the development of severe disability.
Activities of Daily Living↗
[Health status measurement and public health].
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Health Status Indicators↗
Health status prediction in critically ill children: a pilot study introducing Standardized Health Ratios.
Performance of intensive care is usually quantified by means of standardized mortality rates, where standardization is directed towards the severity of illness on admission. However, as more critically ill patients survive, functional outcome and quality of life of these patients becomes more important. In a prospective study in a 10-bed tertiary paediatric intensive care unit (ICU), admission and follow-up health status were collected for 209 surviving patients. For this cohort of patients, health status 1 year after admission was also predicted, using the quantified health-utility-index (HUI), as a value between 0 and 1. For this purpose, two alternative multiple regression models were constructed. The most important predictors of 1-year health status were the level of sensation, mobility and cognition on admission to which self-care, systolic blood pressure, oxygen, Glascow Coma Scale, glucose and age may be added. The two alternative predictive models performed equally well (R2 = 0.83 and 0.84 respectively), indicating that health status could be predicted to a significant degree. The concept of relating expected future health status (based on base-line health status), with actual (observed) health status is denoted with the Standardized Health Ratio (SHR). In combination with the Standardized Mortality Ratios (SMR), such a ratio may become a new comprehensive indicator of performance in intensive care medicine.
Adolescent↗
Health status of hospitalised elderly in Morogoro Regional Hospital.
OBJECTIVE: To assess the elderly's nutritional status, major health and socio-economic problems. DESIGN: A cross-sectional, descriptive study. SETTING: Hospitalised care, in Morogoro General Hospital, Morogoro, Tanzania. SUBJECTS: One hundred and twenty one elderly patients admitted in the hospital for various health problems between November 1998 and March 1999. RESULTS: Body Mass Index (BMI) ratios indicated that 26% of the subjects were suffering from Chronic Energy Deficiency (CED) of varying grades. Fourteen percent had CED grade I, 10% CED grade II and two per cent had CED grade III. The study ranked cardiovascular disorders and respiratory tract diseases the most prevalent diseases (30% and 28% respectively). These were followed by malaria (15%). Cardiovascular diseases were more prevalent among women than men while the respiratory diseases were opposite. The general tradition that African elderly people do live with and are taken care by their children seems to hold no longer, as the majority of the subjects (80%) either live alone or with their spouses only, while 14% lived with their relatives (including their children). The majority of the elderly did not have any regular income, and they depended on other people for their living. CONCLUSION: As Tanzania undergoes demographic and economic transformations, the elderly are increasing while their welfare decreases. This has more effects on their health status. Old tradition of children living with their elderly is declining due to urbanisation, rural urban migration and the trend towards nuclear families. The government is urged to establish specific systems of taking care of this vulnerable group.
Aged↗
Self-reported comprehensive health status of adult brain tumor patients using the Health Utilities Index.
BACKGROUND: The comprehensive health status of adult survivors of brain tumors is largely unexplored. METHODS: Using a multiattribute approach embodied in a 15-item self-assessment questionnaire, the overall burden of morbidity was measured in 50 brain tumor patients who were attending a neurooncology outpatient clinic. The comprehensive health status was accorded utility scores, and comparisons were made with health status measurements of the general population. RESULTS: The questionnaire was completed with ease by 90% of the respondents. Among the respondents, only 10% of the patients did not report some form of morbidity, and 80% reported multiple impairments. The most prevalent impairments occurred in the attributes of sensation, emotion, and cognition (in this predominantly ambulant group); each of these elements was limited in the majority of patients. A surprising finding was the self-report of pain by nearly 50% of the respondents. CONCLUSIONS: In this group of patients, the burden of morbidity and its complexity greatly exceeded that reported for the general population and were inadequately revealed by Karnofsky performance scores. The use of multiattribute health status measurement tools offers numerous advantages and should be employed in the routine clinical management of cancer patients.
Brain Neoplasms↗
Urban/rural elderly health status differences: the dichotomy reexamined.
Health policy research analyzes urban/rural differences as a simple dichotomy. Research characterizes the rural elderly as having a higher incidence of sickness, dysfunction, disability, restricted mobility, and acute and chronic conditions than their urban counterparts. However, population density as a dichotomy may obscure urban, rural, or urban/rural differences. Interviews measuring health status were conducted with a representative sample of 2,300 elderly people in six Northeastern Ohio counties constituting an urban/rural continuum. On medical condition, use of medical aids, and symptoms, health status improved significantly when moving from rural to urban, but correlations were small. Using dichotomies, urban elderly reported fewer medical conditions and symptoms than rural elderly, but four other health-status variables revealed no significant association and results differed depending on how dichotomies were defined. When individual communities were compared few urban/rural patterns emerged. Controlling for demographics did not change interpretations. Findings question blanket assertions about urban/rural health-status differences. Medical resources may be misallocated. Rather than assuming poor health status among the rural elderly, researchers must verify differences through community-based research.
Aged↗
Using health status measures with the seriously mentally ill in health services research.
Changes in the delivery of mental health care have prompted interest in using generic health status measures to test the effect of system change on those receiving treatment. Of special concern are those with serious and persistent mental illness who may be neglected when cost containment efforts reduce the availability of treatment services. This population may be affected by these changes, which might go undetected if investigators use scales that measure only pathology and not the full spectrum of well-being. The purpose of this study was to test the feasibility of using self-report health status measures with this population, to describe the psychometric properties of the scales, and to report the health status scores of a random sample of the Medicaid psychiatrically disabled population. We found that the four health status scales had adequate psychometric properties, that score variability was high, the distributions normal, and that patterns of association with more traditional clinical measures were of the expected size and direction. One scale, General Health Perceptions, had reliability and item-to-score correlation below acceptable levels.
Adult↗
[Satisfaction with health status in the German Federal Republic and the former German Democratic Republic--a comparison].
The subjective feeling of the status of health by persons residing in the FRG and GDR is compared on the basis of data from the German Socio-Economic Panel (SOEP), which were collected shortly before the merger of both states. The subjective state of health is on the whole approximately similar in both states. Differences in influencing factors are revealed by multivariate analysis.
Adolescent↗
An assessment of Hispanic health status.
The health-care systems in urban communities are facing major challenges. They are being forced to reduce costs while maintaining and improving quality. Compounding these systems issues are the inequalities in health access and barriers that persist within certain segments of the population. Hispanic Americans make up a significant and growing segment of American society; one particularly important issue for Hispanics is staying healthy. Lack of health insurance, environmental stressors, limited access to provider services, and language barrier are a few of the social inequalities that add to the difficulty in receiving health care. To reduce the inequalities and improve access to quality health care, an assessment may be necessary. An investigation into the trends in the health status, beliefs, and practices of Hispanics would be appropriate in order to address their health needs. These inquiries must go beyond having knowledge of different countries of familial origin to include knowledge of differing cultures, socioeconomic status, and experiences within the health-care system.
Attitude to Health↗
The health status of elderly veteran enrollees in the Veterans Health Administration.
OBJECTIVES: To examine the health status of elderly veteran enrollees, stratified by age group, and compare with nonveteran populations. DESIGN: Cross-sectional study. SETTING: Outpatient. PARTICIPANTS: A total of 1,406,049 veteran enrollees were surveyed, and 887,775 returned the questionnaire (63.1%). Of these, 663,729 (74%) were aged 65 and older. MEASUREMENTS: Patient demographics, comorbid conditions, and health status, which was assessed using the Veterans 36-item short form (SF-36), a reliable and valid measure of health-related quality of life (HRQoL). RESULTS: Elderly veteran enrollees are a group with poor health status across all scales of the Veterans SF-36. Significant decline in HRQoL was found in patients grouped by increasing age (65-74, 75-84, and > or =85). Of the Veterans SF-36 scales, the role physical and role emotional scales and physical functioning presented the largest decrements by age group. The elderly veteran enrollees had poorer health status than older people enrolled in Medicare managed care, ranging from 0.5 to 1 standard deviations worse. CONCLUSION: Elderly veteran enrollees have substantial disease burden, as reflected by major impairments across multiple dimensions of HRQoL. These findings bear important implications for use of services, suggesting that the Veterans Health Administration will require considerable resources to provide care for its aging population.
Aged↗
Sampling elderly in the community: a comparison of commercial telemarketing lists and random digit dialing techniques for assessing health behaviors and health status.
A study of health behaviors in four communities in the western United States in 1988 provided the opportunity to compare two methods of sampling elderly respondents for a telephone interview. The Polk telemarketing lists were used to identify 1,407 respondents aged 65 years and older in four communities, where 253 respondents in the same age group were also identified by the method of random digit dialing. Individuals identified from the Polk lists received a letter prior to the initial telephone contact. The overall response rate was 49.3% for random digit dialing and 57.3% for the Polk lists. On the average, the identification of one elderly respondent using the Polk lists required about 20-25% as much interviewer time per subject identified as was required by the random digit dialing method. The elderly identified by the Polk lists were significantly older than those identified by random digit dialing, and the proportions of the Polk sample who were married, white, or had an income of greater than $10,000 were slightly higher than those of the random digit dialing sample. Among 40 variables measuring various health behaviors, indicators of health status, and participation in health-related programs and classes, only three differed significantly between the two samples. The authors conclude that sampling from commercial telemarketing lists was an efficient method of identifying elderly respondents and that in these four communities, the estimates of health behaviors and health status were comparable with those obtained by random digit dialing techniques.
Aged↗
Health status measurement in the evaluation of health promotion.
A step beyond treatment and even the prevention of disease is coming onto the health agenda. It is health promotion--"the advancement of well-being and the avoidance of health risks by achieving the optimal levels of the behavioral, societal, environmental and biomedical determinants of health." It differs from medical service in that the latter is directed largely toward overcoming poor health, disequilibrium with one's environment. Health promotion is aimed at maintaining the level of health and, insofar as possible, strengthening the potential (resources) for health. The emergence of health promotion raises an issue for those concerned with health status measurement: whether we consider health as having only biologic elements as traditionally understood in biomedical science, and role (performance) elements as traditionally understood in sociomedical science; or whether we add to these considerations a view of health as the dynamic equilibrium of individuals or groups of people with their environment, their capacity to live physically, mentally, and socially. The latter view entails measuring the health of people on a continuum extending from "perfect" harmony with one's environment and maximum potential for responding to adversities, on the one hand, to extreme invalidism and no reserves, i.e., the premorbid state, at the other extreme. That view also entails expanding attention to the whole population, not just the sick. It also means considering the relative emphasis to be given conceptual and methodologic work, individual versus community responsibilities for health, and the alleged medicalization of life.
Health Promotion↗
Linking health-status measurements to the international classification of functioning, disability and health.
With the approval of the International Classification of Functioning, Disability and Health by the World Health Assembly in May 2001, the concurrent use of both health-status measures and the International Classification of Functioning, Disability and Health is expected. It is therefore important to understand the relationship between these two concepts. The objective of this paper is to provide a systematic and standardized approach when linking health-status measures to the International Classification of Functioning, Disability and Health. The specific aims are to develop rules, to test their reliability and to illustrate these rules with examples. Ten linking rules and an example of their use are presented in this paper. The percentage agreement between two health professionals for 8 health-status instruments tested is also presented. A high level of agreement between the health professionals reflects that the linking rules established in this study allow the sound linking of items from health-status measures to the International Classification of Functioning, Disability and Health.
Activities of Daily Living↗
Preventive health services use, lifestyle health behavior risks, and self-reported health status of women in Ohio by ethnicity and completed education status.
This study assessed the health status and behavior of college-educated and non-college-educated African American women and European American women in Ohio. Analyses focused on health services utilization, health status, and life style/health behaviors from the 1998 Ohio Family Health Survey. College-educated African American women used more preventive health services and had better health status than non-college-educated African American women. Even so, college-educated African American women still had higher body mass index values, lower health status, and higher percent currently smoking than college-educated European American women. We conclude that college-educated African American women may face unique barriers to implementing all types of health-promoting behaviors available consequent to their higher education. Partnerships with respected community institutions, such as churches, may help these women develop good health practices in their entire community as well as in themselves.
Adult↗
Black-white disparities in health status in Missouri.
Historically, the overall health status as measured by life expectancy and infant mortality of Black and White Missourians has been significantly different. We analyzed birth, death, child death and communicable disease data to determine if Blacks have narrowed the gap in health status. The overall health status of Black and White Missourians improved over the last two decades. However, the gap in health status still remains, and in some cases, has gotten worse. This occurred despite the increase in health care financing through Medicare and Medicaid. To narrow the gap in health status between Blacks and Whites requires addressing prevention and the social problems along with the medical problems.
Adolescent↗
The health status and needs of community elderly living alone.
The purpose of this study was to understand the characteristics, physical health status, mental health status, social supports, health needs, and social services utilization among community elderly living alone. The relationship between demographic data, mental health status, and social supports for the community elderly living alone was also examined. A cross sectional survey was conducted. Five hundred and twenty community elderly living alone were selected by systematic random sampling from Taipei City. A total of 320 subjects aged 65 and over completed the face to face interview. A structured questionnaire developed by the authors was used to collect the data. The contents of the questionnaire included demographic data, life style, physical health status, mental health status, social supports, social services utilization and health needs. The results showed that most of the subjects were male, aged 65-74, with religion and satisfied with life and economic status. Most of the subjects had more than one chronic disease. The most frequently reported diagnosis was arthritis, followed by hypertension and osteoporosis. The self-reported physical, mental health status and social supports among the majority of subjects were good. Financially subsidized medical services, free health examination and home visits by public health nurses were the most frequently used services. The most imperative health needs among the community elderly living alone were medical services, financial subsidy and arrangement of the leisure activity setting. The associated factors of mental health status and social supports were explored and discussed. The results of this study could be used to develop comprehensive health services and health education programs for the community elderly living alone.
Activities of Daily Living↗
Profile of medical charges for children by health status group and severity level in a Washington State Health Plan.
OBJECTIVE: To identify children and evaluate patterns of charges for pediatric medical care, by overall health status, severity of illness, and categories of medical service. Data Sources Enrollment, claims, and charges data from a Washington State health plan. The study population includes all children ages 0 to 18 years during calendar year 1999. STUDY DESIGN: Children were classified into clinically defined health status groups and severity levels using Clinical Risk Groups (CRGs). Health plan charges were analyzed according to core health status group, severity level, and category of service. DATA COLLECTION: The three secondary data sources were obtained electronically from the health plan and cleaned for unique members and data quality before analysis. PRINCIPAL FINDINGS: Children classified as healthy (85.2 percent) had mean and median annual charges of dollar 485 and dollar 191. Children with one or more chronic conditions (9.5 percent) had mean and median charges increasing by status and severity group from dollar 2,303 to dollar 76,143 and from dollar 1,151 to dollar 19,456, and accounted for 45.2 percent of all charges. Distribution of charges varied across health status groups. Healthy children had 70.6 percent of their charges in outpatient and physician services. Children classified in the complex, catastrophic, and malignancy groups had 67 percent of their charges in inpatient encounters. Children with chronic conditions accounted for 31.8 percent of all physician, 41.8 percent of outpatient, 47.7 percent of pharmacy, 60.7 percent of inpatient, and 75.8 percent of all other charges. CONCLUSIONS: Children with chronic conditions account for a disproportionately high percentage of children's health expenditures. They account for different percentages of expenses for different medical services. These percentages vary according to health status and severity. This analysis can be used to identify and track groups of children for various purposes.
Adolescent↗