Journal of Aging and Health

Objective: This study considers whether rural status or living in a particular region of the United States has effects on mental and physical health. The analyses examine whether there are independent and interactive effects of rural status and region of residence on health, beyond individual level factors related to poverty. Methods:Ordinary least squares (OLS) regression models are used to examine the relationships between rural and regional residence and health across three time periods. Results: Negative health effects of rural residence were found only in the South region. Positive health effects of rural residence were found only in the Midwest region. There are no observed health risks associated with rural or regional residence across group. Discussion: The results indicate a cumulative risk of rural and Southern residence for older men and women. Living in a rural place in the midwestern United States seems to provide unique sources of health benefits.

Objective: This study developed and assessed an instrument to identify older people at high risk of abuse based on Reis and Nahmiash's Indicators of Abuse (IOA) screen. Method: A total of 108 people 65 and older, hospitalized in internal medicine departments at two major hospitals in Israel, were screened together with their principal caregivers. The interview was based on the expanded IOA (E-IOA) and a list of evident signs of abuse. Results: Reliability and validity of the E-IOA were tested and confirmed. Indicators proved to be a significant predictor of evident signs of abuse. The E-IOA correctly discerned 92.7% of those at high risk for abuse and 97.9% of those who did not suffer abuse. The main indicators for risk were behavioral problems, emotional problems, and family problems of the caregiver and the elderly person. Fourteen (13%) experienced abuse. Discussion: The proposed assessment tool can be an instrumental guide to identify elderly people who suffer abuse (unidentified) or who are at high risk.

Objective: This study used qualitative methods to explore patients' beliefs about control of their end-of-life health and health care. Method: The authors recruited 30 elderly patients from a large, urban Veterans Administration medical center in the United States and engaged them in semistructured interviews about end-of-life care concepts. Using grounded theory methods, they coded, categorized, and compared responses. Results: The authors discovered that patients' decisions about using life sustaining treatment were interconnected with their beliefs about their degree of control over circumstances and the role of external factors, including a higher power; institutions and individuals; medical interventions; medical conditions; and luck, chance, or fate. Discussion: The results shed light on why patients do or do not take active roles in advance decisions concerning the use of life-sustaining treatment.

Objective: Compare missing data and reliability of health care evaluations between African Americans and Whites in Medicare managed care health plans. Method: Consumer Assessment of Healthcare Providers and Systems (CAHPS) 3.0 health plan survey data collected from 109,980 Medicare managed care enrollees (101,189 Whites, 8,791 African Americans) in 321 plans. Participants self-administered the survey and four single-item global ratings of care. Results: Missing data rates were significantly higher for African Americans than Whites on all CAHPS items (p < .0001). Internal consistency reliability estimates for the CAHPS scales did not differ significantly between African Americans and Whites, but plan-level reliability estimates for the scales and global rating items were significantly lower for African Americans than Whites. Discussion: Higher missing data rates and lower plan-level reliability estimates for African American Medicare managed care enrollees suggest caution in making race/ethnicity comparisons. Future efforts are needed to enhance the quality of data collected from older African Americans.

Objective: The purpose of this study was to determine if person factors, situation factors, and cognitive appraisal predict health outcomes during the first week postrelocation in older adults relocating to a nursing home.Method: Data were collected using face-to-face interviews with a convenience sample of 114 older adults. The study was guided by Lazarus and Folkman’s stress-appraisal-coping framework. Results: Hierarchical regression analyses accounted for 12% of the variance in self assessed health, 48% of the variance in anxiety, and 55% of the variance in depressive symptoms. For all three health outcomes, at least one type of cognitive appraisal provided additional explanation of the dependent variable beyond that of the person and situation factors. Discussion: The findings provide additional empirical evidence for Lazarus and Folkman’s stress-appraisal-coping framework. Findings from this study emphasized the importance of mastery, social support, and cognitive appraisal of the older adult relocating successfully to a nursing home.

Objective: It is critical to identify modifiable factors associated with functional recovery from hip fracture. The authors examined the association between pain intensity and two functional endpoints—instrumental activities of daily living and social activity participation—after hip fracture. Method: A total of 270 cognitively intact, community-dwelling persons older than 65 who underwent surgical hip fracture repair in New Haven, Connecticut, were followed for 12 months. Results: Pain intensity was strongly negatively associated with both instrumental and social functioning (p values < .001). Increases in pain intensity between 6 and 12 months were also associated with concurrent decreases in function (p values < .001). These relationships were partly explained by depressive symptoms and a marker of physical ability—gait speed. Discussion: Interventions to control pain may enhance functional status after hip fracture; however, pain relief must be maintained to sustain recovery. Attention to the complex relationships among pain, depressive symptoms, and physical impairments should inform intervention development.