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PubMed2006

Linguistic disparities in health care access and health status among older adults.

BACKGROUND: English proficiency may be important in explaining disparities in health and health care access among older adults. SUBJECTS: Population-based representative sample (N=18,659) of adults age 55 and older from the 2001 California Health Interview Survey. METHODS: We examined whether health care access and health status vary among older adults who have limited English proficiency (LEP), who are proficient in English but also speak another language at home (EP), and who speak English only (EO). Weighted bivariate and multivariate survey logit analyses were conducted to examine the role of language ability on 2 aspects of access to care (not having a usual source of care, delays in getting care) and 2 indicators of health status (self-rated general health and emotional health). RESULTS: Limited-English proficient adults were significantly worse off (1.68 to 2.49 times higher risk) than EO older adults in 3 of our 4 measures of access to care and health status. Limited-English proficient older adults had significantly worse access to care and health status than EP older adults except delays in care. English proficient adults had 52% increased risk of reporting poorer emotional health compared with EO speakers. CONCLUSIONS: Provision of language assistance services to patients and training of providers in cultural competence are 2 means by which health care systems could reduce linguistic barriers, improve access to care, and ultimately improve health status for these vulnerable populations.

Aged↗
PubMed1995

The SF-36 in an Australian sample: validating a new, generic health status measure.

The SF-36 is a self-reported, 36-item, generic measure of health status that has been validated for adult age groups in the United States, the United Kingdom and in some non-English-speaking countries. The Australian Bureau of Statistics used it in the 1995 National Health Survey and it has been used in health status measurement, in monitoring health outcomes and in clinical trials. The validity of the SF-36 was examined in the National Centre for Epidemiology and Population Health Record Linkage Study using a sample of 555 respondents to the National Heart Foundation Risk Factor Prevalence Survey in 1989; they were followed up in 1992. Items chosen for the scale had been used in health status assessment and had stood the test of time. The health concepts measured demonstrated good internal consistency. The eight scales of the SF-36 formed factors as predicted in the general health dimensions of physical and mental health. The component scales of the SF-36 demonstrated good discrimination between people with and without health conditions, including those with medical and those with psychiatric types of conditions. Although the SF-36 was a valid measure of general health status among Australian respondents, further work is needed to establish clinical validity and to produce population norms for Australia. Use of the SF-36 will allow Australian and international comparison of health status from the point of view of the users of health services.

Adult↗
PubMed1988

The stability of health status in rheumatoid arthritis: a five-year study of patients with established disease.

We employed a health status measure to describe the outcomes of rheumatoid arthritis patients over five years. Of the 410 rheumatoid arthritis patients who were originally administered the Arthritis Impact Measurement Scales (AIMS), 299 completed a follow-up five years later. Data were analyzed using nine health status scales, three components of health status, and an overall arthritis impact item. Results for survivors indicated that there were no clinically important deteriorations in any of these measures. In fact, small improvements on most measures were found. The health status changes were similar for patients originally in a clinical trial and for those receiving routine specialty care. Age was found to positively relate to improvements in psychological status and overall arthritis impact, but we were unable to demonstrate any consistent effects of sex, marital status, education, or disease duration. Our results contrast with other studies that have noted major declines over time in the health status of patients with rheumatoid arthritis. Furthermore, level of education was not a major determinant of morbidity in this group. These results suggest that health status in certain patients with rheumatoid arthritis is more stable than previously thought. This has implications for both clinical practice and clinical research in rheumatology.

Arthritis, Rheumatoid↗
PubMed2000

Assessment of changes in general health status using the short-form 36 questionnaire 1 year following coronary artery bypass grafting.

OBJECTIVE: The problem addressed in the study was to gain a greater understanding of the health benefits of coronary artery bypass grafting (CABG). The purpose of the study was to assess general health status, using the short-form (SF)-36 questionnaire, approximately 12 months following CABG, and to document any associations between pre-operative health status, level of social support, coronary artery disease (CAD) risk factors, CAD symptom severity and post-operative health status. METHODS: The study was prospective and observational in design and included assessments at two time points, namely pre-operatively in a hospital outpatient department (1995-1996) and post-operatively at home (1996-1997). Two hundred and fourteen patients awaiting elective CABG were recruited a month before the expected date of operation. Pre-operative assessment included: (1), severity of symptoms; (2), CAD risk factors; (3), SF-36 questionnaire; and (4), social activities questionnaire. Post-operative assessment measured health status using the SF-36 instrument (mean, 16.4 months). Correlation and multiple linear regression analyses were used to identify factors associated with improved health status following CABG. RESULTS: Two hundred and fourteen patients were assessed pre-operatively and underwent CABG. There was a 4.8% 30-day mortality rate, and 183 patients were followed for a mean of 16.4 months after CABG. SF-36 scores following CABG were improved across all of the eight domains (P<0.001). A higher social network score and higher pre-operative health status were associated with improved health status. Patients with lower health levels (SF-36 scores) prior to CABG were less likely to gain improvement in health (SF-36 scores) following CABG. Lower SF-36 scores following operation were influenced by the presence of diabetes mellitus, cigarette smoking, younger age, a high socio-economic deprivation category and higher alcohol intake. Many patients had uncorrected CAD risk factors at pre-operative assessment. CONCLUSIONS: The SF-36 instrument was shown to be a useful and sensitive tool to assess differences and changes in the general health status of patients before and following CABG. High levels of social support were associated with improved health status post-operatively. Lower pre-operative general health status, the presence of diabetes mellitus and cigarette smoking were associated with poorer post-operative general health status.

Activities of Daily Living↗
PubMed1994

Predictors of perceived health status in elderly men and women. The Cardiovascular Health Study.

Baseline data on the perceived health status of participants (N = 5,201) in the Cardiovascular Health Study of the Elderly (CHS) are reported. The authors examined the predictive utility of health-related factors representing eight different domains, assessed gender differences in the prediction of perceived health, and tested a hypothesis regarding the role of known clinical conditions versus subclinical disease in predicting perceived health. Multivariate analyses showed that the majority of the explained variance in self-assessed health is accounted for by variables that fall into four general categories. Although gender differences were small, the analysis showed that the relative importance of several predictor variables did vary by gender.

Aged↗
PubMed2003

Health status and Canada's immigrant population.

Given the framework of the 1984 Canada Health Act, the health status of immigrants should be similar to average levels within whole of Canada. Yet, assuming equality of health status between immigrant and non-immigrants, or between immigrant groups is likely an unrealistic and simplistic assumption, given unseen barriers affecting accessibility, the restructuring of the Canadian health care system, and problems with the provision of health care resources to the immigrant population. Using the National Population Health Survey, this paper focuses upon the health status of the immigrant population relative to that of non-immigrants within Canada, with reference to diagnosed conditions, self-assessed health, and the Health Utilities Index Mark 3. Findings indicate that, with the exception of the most recent arrivals, immigrants experience worse health status across most dimensions relative to non-immigrants. Multivariate analysis reveals that age, income adequacy, gender, and home ownership are dimensions upon which health status differs between the two groups.

Adolescent↗
PubMed1989

Applicability of a health status model to osteoarthritis.

A five-component model of health status has been operationalized by the Arthritis Impact Measurement Scales (AIMS) to serve as a core for the health status assessment of individuals with rheumatoid arthritis (RA). These five components of health status are Lower Extremity Function, Upper Extremity Function, Affect, Symptom, and Social Interaction. To test the utility of this model, this study examines the stability and the applicability of the five-component model in a different rheumatic disease, osteoarthritis (OA). The model displays similar characteristics between OA and RA for Upper Extremity Function, Affect, and Social Interaction. Pain, however, appears to be more strongly associated with Physical Activity in the OA sample, suggesting that pain as a measured symptom of OA is closely related to ambulation, while pain as a symptom of RA may be more a manifestation of joint involvement and less dependent upon walking and climbing. This study presents the AIMS as a means of assessing five components of health status in either OA or RA.

Aged↗
PubMed2004

Health status versus utilities of patients with end-stage liver disease.

BACKGROUND: Health-related quality of life (HRQL) in patients with end-stage liver disease (ESLD) can be evaluated using either health-status questionnaires or utility assessment techniques. The two approaches have never been compared in terms of the values they assign to health prior to liver transplantation. STUDY DESIGN: We assessed health status of patients with ESLD using validated disease-specific instruments covering multiple domains (measures of disease, psychological status, personal function, social/role function, and general health perception). We also elicited utilities using formal approaches (standard gamble [SG] and time tradeoff [TTO]) and a simpler alternative (visual analog scale [VAS]). PATIENTS: Outpatients and inpatients at a single center prior to liver transplantation (n = 78). PRINCIPAL FINDINGS: Health status was generally poor (median physical symptoms score on a 0-1 [worst to best] scale, 0.33; psychological symptoms, 0; happiness, 0.50; personal function, 0; social/role function, 0.40; and general health perception, 0.40). The median VAS score was 0.50. The median TTO was 0.79, indicating that half of the patients in our sample chose healthier life in return for a 21% shorter life expectancy. The median SG score was 0.50, indicating that half of the patients were willing to take up to a 50% risk of death in exchange for perfect health. CONCLUSIONS: Both health status measures and utility assessments indicate that HRQL is compromised in patients awaiting liver transplantation. Despite the overall consistency between the two approaches, however, health status measures do not serve as reasonable proxies for utilities. For formal economic evaluations such as cost effectiveness analyses, only direct measures of utility can be used to quantify health states.

Adult↗
PubMed1993

Hardiness, self-care practices and perceived health status in older adults.

The purpose of this study was to examine the relationship among hardiness, self-care practices and perceived health status in older adults. A random sample of older adults (n = 72) was selected from the population of a small north-eastern town in the United States. Self-report data were obtained on the Health-Related Hardiness Scale as a measure of hardiness, the Personal Lifestyle Questionnaire as a measure of self-care practices and the Visual Analogue Scale as a measure of perceived health status. It was hypothesized that older adults who had higher levels of hardiness and self-care practices would have a higher perceived health status and that hardiness and self-care practices combined would explain more of the variance in perceived health status than either variable taken individually. Statistical analyses supported the three hypotheses. The obtained significant correlation between hardiness and perceived health status was -0.68 (P < 0.001) (hardiness negatively scored). For self-care practices and perceived health status, the correlation was 0.46 (P < 0.001). The illness index, income and living circumstance accounted for 46% of the variance in perceived health status scores. Hardiness and self-care practices accounted for an additional 10% of the variance in perceived health status once these demographic and illness variables were controlled. Implications for nursing practice, education and research are discussed. Recommendations included replication of the study with a larger, more heterogeneous population. Suggestions for further investigation of the relationship between resistance resources such as hardiness and self-care practices and health status are presented.

Adaptation, Psychological↗
PubMed1994

Determinants of self-reported health status in ankylosing spondylitis.

OBJECTIVE: To assess the relative contributions of disability related variables, personality traits and social network characteristics to self-reported general health status in ankylosing spondylitis (AS). METHODS: For 144 patients with AS (modified New York criteria; 112 men) the following variables were assessed cross sectionally: disability related variables (age, duration of disease, spinal mobility, physicians' global assessment), personality traits (neuroticism, social inadequacy, self-esteem, health locus of control) and loneliness. Health status was assessed by means of 3 self-administered instruments: Sickness Impact Profile, Health Assessment Questionnaire for the Spondyloarthropathies and Self-assessed Function. RESULTS: Factor analysis of the 3 health status instruments suggested one underlying health status score. This derived health status score correlated significantly with each of the disability related variables, the personality traits and loneliness (p < 0.05), but not with social inadequacy and physician oriented health control. In multiple regression analysis 4 variables contributed significantly, together explaining 44% of the total variance of the derived health status score: neuroticism 25%, physicians' global assessment 8%, internal oriented health control 6% and spinal mobility 5% (p < 0.001). CONCLUSION: In AS, self-reported health status is more strongly related to personality traits than to the degree of disability. When assessing health status in AS by self-report, personality traits must be taken into account.

Adult↗
PubMed2004

Relationship between health status and use of screening mammography and Papanicolaou smears among women older than 70 years of age.

BACKGROUND: Older women whose life expectancy is less than 5 years are unlikely to benefit from screening mammography or Papanicolaou (Pap) smears. Since life expectancy is better predicted by health status than by age alone, guidelines recommend considering an older woman's general health when making screening decisions. OBJECTIVE: To determine whether screening mammography and Pap smears are targeted to healthy older women and are avoided in women with limited life expectancies. DESIGN: Cross-sectional population-based study. SETTING: California. PATIENTS: 4792 women 70 years of age or older who participated in the California Health Interview Survey between November 2000 and October 2001. MEASUREMENTS: Predictor variables included age and health status. Health status was measured by using the Medical Outcomes Study 12-item Short Form Physical Summary Scale. The main outcome was self-reported receipt of screening mammography within the previous 2 years and a screening Pap smear within 3 years. RESULTS: Seventy-eight percent of women reported recent screening mammography, and 77% reported a recent Pap smear. Screening rates decreased with advancing age. However, within each age group, the percentage of women reporting screening did not significantly decrease with worsening health status (P > 0.1 for all comparisons). More than half of women 80 years of age or older in the worst health quartile reported recent screening, representing approximately 81,000 mammograms and 35,000 Pap smears. LIMITATIONS: This study relied on self-report, and the interview response rate was 63.7%. CONCLUSIONS: Rates of recent screening mammography and Pap smears are high among older women in California. Although screening rates drop with advancing age, women in poor health do not avoid screening. Screening should be better targeted to healthy older women and should be avoided in women with limited life expectancies for whom risks of screening outweigh potential benefits.

Aged↗
PubMed2001

Do health behaviour and psychosocial risk factors explain the European east-west gap in health status?

BACKGROUND: Mortality rates are much more favourable in Western European countries than in those of Eastern Europe. Health behaviour and psychosocial factors have been suggested to be important contributors to East-West differences in mortality and health status. METHODS: To compare reported health status as well as health behaviours and psychosocial factors which may be related to unequal health status in different parts of Europe, standardised postal surveys of representative populations samples were conducted in six Eastern and Western European areas. RESULTS: Higher mortality in the eastern populations was associated with more reported morbidity and generally more negative health ratings. Health behaviours and psychosocial factors were also more negative in the East. Multivariate analyses suggested that the East-West difference in health status may be partly explained by differences in health behaviours and psychosocial factors. CONCLUSION: Efforts to promote health in Eastern Europe should concentrate both on the promotion of healthier lifestyles and on improvement of social and economic conditions.

Adult↗
PubMed2005

Physical and mental health status of older long-term cancer survivors.

OBJECTIVES: To assess the physical and mental health status of older long-term cancer survivors. DESIGN: Cohort study using propensity score methods to control for baseline differences between cancer survivors and controls. SETTING: General community population in the United States. PARTICIPANTS: Nine hundred sixty-four cancer patients who had survived for more than 4 years and 14,333 control patients who had never had cancer from a population-based sample of Americans aged 55 and older responding to the 2002 Health and Retirement Study. MEASUREMENTS: Medical conditions, symptoms, health behaviors, health status, mobility, activities of daily living, mental health diagnoses, self-rated memory, depressive symptoms, cognitive function, and self-reported life expectancy. RESULTS: Cancer survivors reported higher rates of lung disease (13.9% vs 9.6%; P=.001), heart condition (29.3% vs 22.9%; P<.001), arthritis (69.4% vs 59.4%; P<.001), incontinence (26.6% vs 19.7%; P=.001), frequent pain (36.4% vs 29.4%; P=.005), and obesity (27.0% vs 24.2%; P=.001) than individuals without cancer but lower rates of smoking (12.0% vs 14.8%; P=.03). Cancer survivors were less likely than persons without cancer to report excellent or very good health status (37.2% vs 44.6%; P<.001) and had more mobility (P<.001) and activity of daily living (P=.01) limitations. Cancer survivors did not differ from persons without cancer in rates of depression or cognitive function (both P>.2) but were less optimistic about their life expectancy (P=.004). CONCLUSION: The physical health status of older long-term cancer survivors is somewhat worse than that of comparable persons who have never had cancer, but they have surprisingly similar mental health status. Future research is needed to understand factors contributing to poorer health status and identify patients at highest risk of long-term cancer-related problems.

Aged↗
PubMedDate not supplied

Measuring health status in HIV disease: challenges from a sleep study.

This article reports on the challenges of measuring health status in a study that tested whether there were differences in sleep and well-being between a group of persons with HIV who reduced their caffeine intake from baseline by 90% or greater for 30 days (n = 44) versus a group of persons with HIV who continued their usual caffeine consumption (n = 44). The MOS-HIV Health Survey summary scores were used as health status measures and as covariates. While results indicated that physical and mental health status improved among experimental group subjects, several methodological considerations are offered for further HIV/AIDS researchers: (1) How should health status with various degrees of disease progression be classified? (2) How can health status from different CD4 and HIV viral load measurements be properly inferred? (3) If opting to also employ a health status questionnaire, should general or disease-specific instruments be used?

Adult↗
PubMed2005

Health status rated with the Medical Outcomes Study 36-Item Short-Form Health Survey after spinal cord injury.

OBJECTIVE: To describe the health status of Australians with spinal cord injury (SCI). DESIGN: Survey. SETTING: Australian population-based sample. PARTICIPANTS: Participants (N=305) with SCI at recruitment to a randomized trial. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) health questionnaire. RESULTS: Compared with the general population, our sample reported significantly lower scores in 6 SF-36 domains (physical function, role-physical, bodily pain, general health, social function, vitality) and the physical component summary (PCS) score, but unexpectedly higher mental component summary (MCS) scores (difference in mean MCS scores, 4.6; 95% confidence interval [CI], 2.4-6.8). Compared with people with tetraplegia, those with paraplegia had better physical function and PCS scores (difference, 21; 95% CI, 17-24; difference, 3; 95% CI, 1-5, respectively), and worse bodily pain scores (difference, 9; 95% CI, 2-15). Recent urinary infections were associated with worse general health, vitality, mental health, and MCS scores. Receiving family or external physical care was associated with worse physical function and PCS scores, but better mental health and MCS scores. Older age at injury was associated with lower bodily pain and PCS scores. CONCLUSIONS: Using the SF-36, Australians with SCI rate their physical (not mental) health status as worse than the general population.

Adolescent↗