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PubMed1992

An operational definition of the homebound.

Homebound status is a critical eligibility criterion for Medicare reimbursement of some home care services, yet little discussion has been undertaken to establish a valid definition of it. We propose an operational definition of homebound status, and we measure its validity for community-dwelling elderly in the Massachusetts Health Care Panel Study (MHCPS). The MHCPS is a longitudinal study of a cohort of elderly persons (N = 1,625), which began in 1974, with follow-up surveys in 1976, 1980, and 1985. Validity was measured by comparing responses from the operational measure to persons' responses to questions that we judged should be associated with a valid measure of homebound status. This construct validity method resulted in correlations that were significant and in the expected direction, and that suggested that this operational measure is a highly specific, moderately sensitive, valid measure. These results underscore the need for researchers investigating the homebound to discuss the validity and limitations of their homebound measures, and in what context these measures are useful.

Activities of Daily Living↗
PubMed1992

Joint impairment and hand function in the elderly.

OBJECTIVE: To test the contribution of joint impairment to observed hand function (grip strength and Williams Test) in the elderly, using a multivariate model. DESIGN: Cross-sectional observational data (baseline data from an ongoing longitudinal study). SUBJECTS: Five hundred forty-one persons over age 60, including continuing care retirement community (n = 222), homebound (n = 72), and ambulatory (n = 247) respondents. Mean age at assessment 76.7, (SD = 9.0). MEASUREMENT: Independent variables included sociodemographics, physician measures of upper joint impairment, an index of comorbidities derived from physical examination or chart abstract, self-assessed arthritis pain, depression, and anxiety. The dependent variables included grip strength and a modified Williams Test [Williams Test (M)]. MAIN RESULTS: The multiple regression explained 59% (Adjusted R2 = .59) of the variance in grip strength, with joint impairment accounting for a change in R2 of .07. Upper joint impairment and grip strength accounted for 3% and 5%, respectively, of the variance in the Williams Test (M) (total amount of explained variance = 45%). CONCLUSIONS: Demographics explain most of the variance in grip strength and performance on the Williams Test (M). Controlling for demographics, musculoskeletal disease represented by joint impairment is associated with diminished grip strength. Reduced grip strength is associated with poorer performance on the Williams Test (M).

Activities of Daily Living↗
PubMed1993

A new outlook for rehabilitation: creative art therapy.

Each year illness, accidents, and age leave thousands of people homebound and feeling as though their lives are over. Within each person, however, is the seed of creativity that, when nurtured through creative art therapy, can bloom to vastly improve the quality of health and life, regardless of the individual's physical limitations.

Art Therapy↗
PubMed1993

Joint impairment and ambulation in the elderly.

OBJECTIVE: To test the impact of joint impairment on ambulation in the elderly, using a multivariate model. DESIGN: Cross-sectional observational study (baseline data from an ongoing longitudinal study). SUBJECTS: Five hundred thirty-two persons over age 60, including continuing care retirement community (CCRC) (n = 222), homebound (n = 63), and ambulatory (n = 247) respondents. Mean age at assessment = 76.6 (SD = 6.6). MEASUREMENT: Independent variables included sociodemographics, physician measures of lower joint impairment, an index of cormorbidities derived from physical examination or chart abstract, self-assessed arthritis pain, depression, and anxiety. The dependent variable, ambulation, was measured as walk-rate, based on the time required to walk 50 feet. MAIN RESULTS: For the total sample, 61% of the subjects were impaired in more than one lower joint group, with almost 50% of the homebound impaired in more than three joint groups. Demographics (particularly age and education) explained much of the variance in walk-rate. After controlling for demographics and membership in the groups purposely sampled (CCRC, homebound, ambulatory), lower joint impairment accounted for an additional 7% of the variance in walk-rate. Total amount of variance explained by the model was 56% (Adjusted R2 = .56). A 3-point change in lower joint impairment score, equivalent to the maximum impairment score for a single joint group, is associated with a 4-second change in the mean time required to walk 50 feet. The knee and lower spine joints contributed most to the impact of the lower joint impairment measure. CONCLUSIONS: Among the elderly, age and education are strong predictors of performance on a walk-rate test. Independent of demographics and non-musculoskeletal conditions, joint impairment is associated with diminished walking ability in this population.

Activities of Daily Living↗
PubMed1995

Predictors of hand function in older persons: a two-year longitudinal analysis.

OBJECTIVE: To validate a hierarchical model of hand function in older persons, using longitudinal data. DESIGN: Longitudinal observational study (2-year data from an ongoing longitudinal study). SUBJECTS: 689 persons older than age 60, including Continuing Care Retirement Community (n = 230), homebound (n = 204), and ambulatory (n = 255) respondents. Mean age at baseline 76.6 (SD = 8.8). MEASUREMENT: Independent variables included sociodemographics, physician measures of upper joint impairment, self-reported comorbidity, arthritis pain, depression, and anxiety. The dependent variables included grip strength and a timed manual performance test. MAIN RESULTS: Using generalized estimated equations (GEE) to test our hierarchial model, we found that gender and upper extremity joint impairment were the strongest predictors of a longitudinal measure of grip strength. Grip strength, in turn, along with demographics, comorbidity, and a measure of psychological status, was significantly related to timed manual performance. CONCLUSIONS: The longitudinal analyses confirmed a previous cross-sectional finding that upper extremity joint impairment contributes significantly to reduced grip strength, which, in turn, contributes to reduced hand performance on a timed test.

Activities of Daily Living↗
PubMed1986

Pastoral care in home health: key issues.

Many patients discharged from the hospital undergo months and even years of isolation from pastoral support. Parish pastoral ministries for discharged patients often are inadequate, and most sick persons, especially the elderly, are reluctant to contact their pastor for support while homebound. Thus the need for pastoral services in home health care is urgent. But the problems of patients and care givers in home health differ in many ways from problems in the hospital or the long-term care facility. Distinctive strategies must be developed for addressing key issues.

Home Care Services↗
PubMed1985

Cognitive therapy to achieve personal goals: results of telephone group counseling with disabled adults.

Physical disability alters a person's lifestyle and can be detrimental in its effects on mood and activity. We describe a counseling program for severely disabled persons who participated in cognitive therapy by telephone. Therapy involved solving problems related to personal dissatisfaction, loneliness, or depression. The treated group reported significantly less loneliness after treatment and were observed by their families to demonstrate more social role skills than the control group. High goal attainment reported by the treated groups was significantly correlated with decreased loneliness, positive changes in social role skills, and family expectations. Treating affective problems with scheduled telephone contact should be further evaluated because of the observed effectiveness and potential for reaching homebound clientele.

Adult↗
PubMedDate not supplied

Home visits in a rural office practice: clinical spectrum and effect on utilization of health care services.

OBJECTIVE: To describe the clinical features of home visits and their role in continuity of care, costs, and benefits in a rural office practice. DESIGN: Prospective study of all home visits performed during a 26-month period. SETTING: A general medicine teaching office practice located in rural Virginia. PATIENTS: All persons to whom home visits were made during the study period. MAIN RESULTS: 138 home visits were made to 47 patients who had a mean age of 73.2 years. Home visits accounted for 1.4% of patient encounters in the practice, required a mean of 7.1 miles of one-way travel and a mean of 48 minutes, including travel time, to complete, and generated $36 in income per visit. Most patients (27 of 47) were not permanently homebound. Reasons for patients' being homebound were grouped into six categories (acute illness, frail elderly, terminal illness, advanced chronic disease, neurologic problem, and miscellaneous reasons). The reasons for visits were grouped into four categories (acute self-limited illness, exacerbation of chronic disease, routine follow-up of chronic disease, and psychosocial problem). Physicians judged that 80% of home visits represented appropriate use of their services. In addition, 46% of home visits made an emergency room visit unnecessary, and 9% made a hospital admission unnecessary. At the time of 75% of home visits, physicians reported personal benefits of making the visit. CONCLUSIONS: Home visits have an important role in the care of ambulatory as well as permanently homebound patients. While physicians judged most home visits to be appropriate and personally beneficial, these visits required more time and generated less revenue than did office visits for comparable problems. Because home visits generated as well as prevented the use of medical services, their impact on the overall cost of medical care in this setting is unclear.

Acute Disease↗
PubMed1996

Predictors of change in walking velocity in older adults.

OBJECTIVE: To determine factors that predict change in walking velocity in older people using a multivariate model. DESIGN: Longitudinal observational study. SUBJECTS: A total of 588 persons older than age 60, including subjects residing in a continuing care retirement community (CCRC) (n = 248), and homebound (n = 79) and ambulatory (n = 261) subjects. Mean age at baseline = 77. MEASUREMENT: Independent variables included demographics, physician measures of lower-extremity joint impairment and other musculoskeletal and neurological variables, comorbidities derived from physical examination and chart abstract, self-assessed arthritis pain, depression, and anxiety. The major dependent variables were 2- and 4-year decline in walking velocity below a threshold associated with nursing home placement. MAIN RESULTS: From baseline to Year 4, median walking velocity declined from 61.8 to 53.0 m/min, and the proportion of subjects above a threshold value of 11.5 m/min declined from 95.3% to 80.4%. Age, joint impairment, and weakness of quadriceps, measured at baseline, predicted 2-year and 4-year decline in walking velocity. CONCLUSIONS: The findings indicate that joint impairment and quadriceps strength contribute significantly to crossing a clinically significant threshold in walking velocity among older people over time. Future research is needed to determine whether these risk factors can be modified through preventive interventions such as muscle-strengthening exercises and pain medication.

Activities of Daily Living↗