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PubMed1995

Continuing care retirement communities: prospects for reducing institutional long-term care.

Continuing care retirement communities (CCRCs) combine housing and long-term care (LTC) services, including personal and nursing home care. The amount of LTC that is prepaid varies by type of CCRC, with one-third offering extensive (fully prepaid) contracts for LTC. CCRCs are a potentially promising model for LTC delivery because they offer a full continuum of services and can substitute less expensive supportive care for institutional care. Using data on CCRCs, we tested one central hypothesis: Provision of supportive services, particularly when combined with capitation, reduces use of nursing home care. To test this hypothesis, we studied the effect of various contract types for LTC services offered by CCRCs and provision of support services on utilization of nursing home and personal care units. Compared with other types of CCRCs, those offering completely prepaid LTC coverage reduced use of nursing home care by 13 percent and personal care by 5 percent. CCRCs with prepaid LTC coverage did not use more stringent health screening at entry, so "cream-skimming" does not appear to explain this result. However, affordability is an important issue: CCRC residents with extensive contracts were wealthier than were other CCRC residents.

Aged↗
PubMed1999

A retired shipyard worker with rapidly progressive pulmonary interstitial fibrosis.

We present a case of progressive interstitial fibrosis in a retired shipyard worker who was exposed to asbestos during the postwar era of the late 1940s and 1950s, when asbestos exposures in the workplace were not regulated. Forty years later, at 63 years of age, the patient presented with restrictive lung disease. The patient was diagnosed with asbestos-related pleural disease and parenchymal asbestosis. He remained stable for the next 7 years, but then he began to manifest rapid clinical progression, which raised the possibility of an unusual variant of asbestosis, a concomitant interstitial process, or an unrelated disease. Lung biopsy was not undertaken because of the patient's low pulmonary reserve and limited treatment options. An empiric trial of oral steroids was initiated, but his pulmonary status continued to deteriorate and he died of pulmonary failure at 72 years of age. Many diseases result in pulmonary interstitial fibrosis. Ideally, open lung biopsy should be performed, but this procedure inevitably causes complications in many patients with end-stage restrictive lung disease. Furthermore, while the presence of asbestos bodies in tissue sections is a sensitive and specific marker of asbestos exposure, neither this finding nor any other charge is a marker indicative of asbestosis or the severity of asbestosis. With the enactment of the Asbestos Standard in the United States, asbestos exposures have been decreasing in this country. However, industries that produce asbestos products and wastes continue to expand in developing countries. Prevention of asbestos-related lung disease should be a global endeavor, and asbestos exposures should be regulated in both developed and developing countries.

Asbestos↗
PubMed1993

Endometriosis in cynomolgus monkeys retired from breeding.

Twenty-seven cases of endometriosis were found in 94 female cynomolgus monkeys retired from breeding. The ages of the affected monkeys (28.7% of all the monkeys) ranged from 11 years to 23 years of age with an average of 15.3 years. There was no significant difference in the incidence of endometriosis between groups which had or had not undergone a cesarean section. Time after the last pregnancy was significantly longer in the affected monkeys than in the non-affected ones. These cases were histopathologically classified into four types: 1) pelvic endometriosis with formation of endometrial cysts (51.8% of the affected monkeys), 2) pelvic endometriosis invading other organs without formation of endometrial cysts (3.7%), 3) uterine adenomyosis (22.2%), 4) combined pelvic endometriosis and uterine adenomyosis (22.2%).

Age Factors↗
PubMedDate not supplied

Screening mammography and Pap tests among older American women 1996-2000: results from the Health and Retirement Study (HRS) and Asset and Health Dynamics Among the Oldest Old (AHEAD).

BACKGROUND: We wanted to determine the frequency of self-reported receipt of screening mammography and Papanicolaou (Pap) tests in older women and investigate important predictors of utilization, based on 2 national longitudinal surveys. METHODS: This cohort study includes participants from 4 waves (1994-2000) of the Health and Retirement Study (HRS)--5,942 women aged 50 to 61 years, and 4 waves (1993-2000) of the Asset and Health Dynamics Among the Oldest Old (AHEAD) survey--4,543 women aged 70 years and older. The self-reported receipt of screening mammograms and Pap smears in the most recent 2 years were reported in 1996 and 2000 for HRS, with predictors of receipt measured in 1994 and 1998. In AHEAD, the self-reported receipt of screening mammograms and Pap smears in the most recent 2 years were reported in 1995 and 2000, with predictors of receipt measured in 1993 and 1998. RESULTS: Receipt of mammography is stable at 70% to 80% among women aged 50 to 64 years, then declines to around 40% among those aged 85 to 90 years. For Pap tests there is a decline from 75% among women aged 50 to 54 years to 25% in those aged 85 to 90 years. For both mammography and Pap tests, the rates increased in all groups from 1995/1996 to 2000. Higher education, being married, higher income, not smoking, and vigorous exercise were consistently associated with higher rates of receipt. CONCLUSIONS: Although the use of mammography and Pap tests for screening declines into old age, use has been increasing recently. The large and increasing number of tests performed might not be justified given the lack of evidence of effect in older age-groups.

Age Factors↗
PubMedDate not supplied

Trends in medication use and functioning before retirement age: are they linked?

This paper explores the extent to which changes in medication use during the 1990s are linked to improvements in functioning among Americans before they reach retirement age. Using two cross-sections from a survey of Americans ages 51-61, we examined changes between 1992 and 1998 in the prevalence of functional limitations and medication use associated with five chronic conditions: hypertension, diabetes, lung disease, stroke, and arthritis. We found no evidence linking increases in medication use to improvements in functioning. Instead, increases in educational attainment offset the negative effects of increases in obesity and arthritis over this period. Findings underscore the need for caution in projecting forward improvements in old-age functioning when considering the future of Medicare, Medicaid, and other programs that serve the elderly with disabilities.

Arthritis↗
PubMed2004

Water exercise prevents femur density loss associated with ovariectomy in the retired breeder rat.

The effect of non-weight-bearing exercise on skeletal bone remains controversial. The objective of this pilot study was to examine the effects of water exercise training on femur density and serum alkaline phosphatase activity in ovariectomized and sham-operated (ovaries left intact) retired breeder rats. Exercised animals swam at progressively increasing duration from 5 minutes to 75 min.d(-1), 5 d.wk(-1), for a 6-week conditioning period. Exercised rats had greater (p < 0.02) soleus muscle citrate synthase activity than sedentary rats, confirming an aerobic training effect. Femur density (g.cm(-3)) was greater (p < 0.0007) for exercised rats than sedentary rats but lower (p < 0.01) for ovariectomized rats compared to sham rats. Serum alkaline phosphatase activity tended (p < 0.06) to be greater for exercised rats compared to sedentary rats. These results indicate that dynamic water-flotation exercise prevents the femur bone loss associated with ovariectomy in rats. We conclude that this form of exercise could be beneficial in maintaining bone density in hormone-deficient postmenopausal women, especially the elderly who may not be able to perform weight-bearing activities.

Animals↗
PubMed2004

FISH chromosome aberration analysis on retired radiation workers from the Sellafield nuclear facility.

Chromosome analysis using fluorescence in situ hybridization was undertaken on 294 retired workers from the British Nuclear Fuels plc facility at Sellafield, 95 with external occupational exposure <50 mSv, 108 with 50-499 mSv, and 91 with >500 mSv. In univariate analyses, external dose (P <10-s) and age (P = 0.0075) were significantly associated with translocation frequency, but no effect was found for smoking status. In a multivariate analysis with age and external dose as continuous variables, the slopes were 0.017 +/- 0.0075 x 10(-2) translocations per cell per year for age (P = 0.024) and 1.11+/- 0.190 x 10(-2) translocations per cell per sievert for external dose (P < 10(-5)). The dose response for translocation induction for occupational workers is similar to the linear component of in vitro dose-response curves, thus supporting the use of translocation frequency for retrospective biological dosimetry in situations of chronic low-dose exposure occurring over many years. The dose response obtained in this study is lower than the linear component of the dose response for stable chromosome aberrations obtained for the Japanese atomic bomb survivors. Thus, if chromosome aberration levels are indicative of cancer risk, this would suggest that low-dose risks derived from the Japanese atomic bomb survivor data will overestimate the risks associated with the occupational exposure encountered by the men in this study.

Age Distribution↗
PubMedDate not supplied

Effects of blood donation on arterial blood pressure in retired racing Greyhounds.

The purpose of this study was to evaluate changes in systolic arterial blood pressure (SABP) immediately after collection of blood for transfusion in retired racing Greyhounds. We prospectively evaluated 19 blood donor Greyhounds before and after the collection of a unit (450 mL) of blood. The SABP was measured with Doppler in the right forearm after the dogs had been in the blood collection room for a few minutes (PRE-FLOOR) and again 5-10 minutes after the dogs were placed on the table where they would be bled (PRE-TABLE). A total of 3-5 minutes after completing the blood collection, the SABP was measured again while the dogs were still in lateral recumbency on the table (POST-TABLE) and once more 60-90 minutes later, when the dogs were on the floor after completing the donation (POST-FLOOR). All dogs were monitored for clinical signs of hypotension, including depression, weakness, collapse, and pallor, for a minimum of 2 hours after donation. There was a significant difference in SABP for the group between PRE-FLOOR and POST-TABLE (P = .02) and between PRE-TABLE and POST-TABLE determinations (P = .01). There were no significant differences for any of the other time points; there were no adverse events. Therefore, we conclude that the collection of 450 mL of blood from normal Greyhounds results in a short-lived yet significant decrease in SABP, but the likelihood of adverse events is negligible.

Animals↗
PubMed1996

Liability for managed care decisions: the Employee Retirement Income Security Act (ERISA) and the uneven playing field.

As managed care organizations expand their programs of quality assurance and physician evaluation, more medical malpractice lawsuits may be brought against managed care organizations on the ground that, like hospitals, they are legally responsible for negligent corporate acts that injure patients. However, the federal Employee Retirement Income Security Act (ERISA) shields managed care organizations from liability when they are part of an employee group health plan governed by ERISA. Unlike patients with other types of insurance, patients in ERISA health plans do not have a malpractice remedy for a managed care organization's negligence. A few federal appeals courts recently recognized that ERISA plans can be vicariously liable for their physicians' medical malpractice, but only if the physician is the plan's employee or agent. Yet ERISA still prohibits negligence claims against ERISA health plans for injuries resulting from denial of plan benefits, failure to use qualified physicians, utilization review, or improper plan administration. Current managed care operations do not neatly distinguish between administering benefits and controlling quality of care. Neither should the law. ERISA should be amended to provide employees with the same remedies that patients in non-ERISA plans enjoy.

Compensation and Redress↗
PubMed1994

Effect of cheese on intestinal transit time and other indicators of bowel function in residents of a retirement home.

Effects of increased intake of cheese on intestinal transit time and other indicators of bowel function were studied in 21 retirement home residents (18 women and 3 men; age, 68-87 years). The study was divided into four succeeding periods: 1) 1-week basal period (usual diet); 2)3-week cheese period (extra cheese was offered as such on bread or used in cooking); 3) 3-week no-cheese period (all cheese on bread was replaced with cured meats and cold cuts, and no cheese was used in cooking); 4) 3-week follow-up period (usual diet). During the last week of each period a questionnaire was filled out on fecal frequencies, consistency of feces (soft, normal, hard), and occurrence of abdominal pain and flatulence. Use of laxative medications and therapeutic foods (prunes) was registered. Eleven of the 21 subjects collected fecal samples for the determination of fecal wet weight and intestinal transit time by means of radiopaque Sitzmark capsules. Intakes of cheese, fiber-containing foods, and fluids by these 11 subjects during meals offered in the cafeteria were recorded on a prefilled questionnaire. In spite of a 10-fold increase in the intake of cheese no change in intestinal transit time, fecal frequency, fecal wet weight, consistency of feces, and occurrence of gastrointestinal symptoms was observed. The use of laxative medication was higher during the cheese period, but no change in the combined use of laxative medication and therapeutic foods (prunes) was observed.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1980

Osteoarthritis of the hip and knee joint in retired football players.

The possible relationship between football playing and osteoarthritis in the hip and knee joints has been examined. The results of clinical and radiographic examinations of 57 retired football players and a corresponding control group were compared. Osteoarthritis of the hip joint was found to occur significantly more often in the football players than in the controls. Such a relationship could not be found regarding the knee joint.

Adult↗
PubMed2003

Alcohol use in a continuing care retirement community.

The purpose of this study was to explore alcohol use among older adults living in a continuing care retirement community (CCRC) and to consider differences in overall health, number of chronic illnesses, falls, age, and exercise behavior between those who drink moderately versus those who do not. A one-time face-to-face interview was conducted with a total of 316 residents living in an urban CCRC in the northeast. The participants were 86.6 6 6.3 years of age, and the majority were women (79%), unmarried (75%), White (9%), and middle to upper socioeconomic status (100%). The majority of these individuals (63%) drank moderately, consuming at least one drink daily. No difference was found between men's and women's drinking behaviors (chi 2 = .47, p > .05). Adults who drank moderately were older (F = 8.7, p < .05), more likely to exercise regularly (chi 2 = 27, p < .05), and were more likely to have had a fall (F = 3.7, p < .05). No statistically significant difference was found between the groups related to perceptions of overall health, number of chronic illnesses, number of medications, overall or number of medications that interact with alcohol, or cognitive status. Although not statistically significant, a greater percentage of individuals who drink moderately had fractures (12%) when compared to the percentage of individuals who do not drink at least moderately (7%). Recognizing both benefits and risks to alcohol use in older adults suggests that an individual approach to educating these individuals about their use of alcohol should be conducted.

Accidental Falls↗
PubMedDate not supplied

Determinants of disabling foot pain in retirement village residents.

The aim of this study was to evaluate the relative contribution of structural foot characteristics and comorbidities to the presence of disabling foot pain in older people. One hundred seventy-two people (55 men and 117 women) aged 62 to 96 years (mean +/- SD, 80.1 +/- 6.4 years) who lived in a retirement village underwent tests of foot posture, range of motion, and deformity in addition to completing a medical history questionnaire. Disabling foot pain was determined using the Manchester Foot Pain and Disability Index. Thirty-eight subjects (22%) reported disabling foot pain. Subjects with disabling foot pain had a higher body mass index and were more likely to be female; to report osteoarthritis in the spine, hips, hands or wrists, and feet; and to report pain in the back, hips, and hands or wrists. The only significant difference between the groups regarding structural foot characteristics was that those with disabling foot pain exhibited more severe hallux valgus deformity. The strongest determinants of disabling foot pain revealed by a discriminant function analysis were foot osteoarthritis, pain in the hips, and pain in the hands or wrists. These findings indicate that disabling foot pain in older people is more closely related to pain and osteoarthritis in other body regions than to structural characteristics of the foot, and they suggest that more severe forms of foot pain in older people may be a component of a general chronic pain syndrome or a polyarticular form of osteoarthritis.

Aged↗
PubMed1993

A little help, a lot of independence. Retirement community advances the cause of aging with dignity.

Sometimes the elderly need only a little extra help to make it on their own. When this is the case, it behooves providers of healthcare and social services to meet those needs and allow these individuals to maintain the dignity of independent living as they age. At Resurrection Retirement Community, an independent living facility on Chicago's northwest side, the Garden Annex fills this niche in a unique model of independent living with additional services. Services include three meals a day in the common dining room, laundry service for household linen, and weekly maid service. Residents enjoy varied activities, exercise sessions, and socialization with friends and neighbors. They also have access to such amenities as daily religious services, a library, a beauty salon, and banking facilities. To live in the Garden Annex, prospective residents must meet certain physical and mental criteria and be able to function somewhat independently. In contrast to assisted living facilities, the Garden Annex does not provide nursing care or assistance with personal care. However, residents may take advantage of the continuum of care offered by Resurrection Health Care Corporation. They are afforded access to a medical center, a long-term care facility, and physicians' services.

Activities of Daily Living↗
PubMed1993

Resident medical care utilization patterns in continuing care retirement communities.

This article presents the findings of an evaluation of medical care service utilization by two elderly cohorts: one living in continuing care retirement communities (CCRCs) and the other living in traditional community settings. CCRC residents' overall use of Medicare-covered medical services did not differ significantly from that of the traditional community-residing elders. Both groups incurred annual per capita expenditures of approximately $2,000. In their last year of life, however, CCRC residents displayed significantly lower expenditures for hospital care ($3,854 versus $7,268) but higher expenditures for Medicare or non-Medicare-covered nursing home care ($5,565 versus $3,533).

Aged↗
PubMedDate not supplied

Exercise restores seniors' strength and spirits. Fitness plans keep residents of retirement community independent and socially active.

Statistics, an independent study, and anecdotal reports are documenting the health benefits of regular exercise for older adults living at the McAuley Center, a continuing care retirement community in West Hartford, CT. As part of its commitment to holistic health, the center links residents with an on-site fitness counselor, who develops an individualized exercise program and helps motivate residents to stick with it. Residents can choose from individual personal training or rehabilitation programs or group programs such as aerobics or line dancing. The results speak for themselves. For the past five years, only 0.05 percent of the falls at the McAuley Center occurred among the 21 percent of the residents who exercise regularly. In addition, residents and staff alike report increased social interactions among those who exercise. Overall, residents and staff say the benefits of regular exercise contribute significantly to the goal of independent living at the McAuley Center.

Accidental Falls↗
PubMedDate not supplied

Behind the physician licensure numbers: false impressions, retirement crisis, and migration.

This communication examines the supply of primary-care physicians at the state level. It shows that the number of actively practicing physicians is considerably less than the number of licensed physicians; the age distribution of primary-care physicians has a bulge in the ages younger than 50, and this bulge may lead in the near future to an unexpected increase in physician attrition due to retirement; and, at the state level, migration may be playing the dominant role in determining the total supply of primary-care physicians.

Age Distribution↗