Journal of Aging and Health

Consistency and change between 1984 and the last reinterview (either two, four, or six years later) on 22 individual functional status markers and the five summary scales that they form are examined among the 5,986 members of the Longitudinal Study on Aging who were reinterviewed at least once. At baseline, at least three-fifths of the respondents are without limitations on any individual marker. At the last reinterview, at least 43.4% of the respondents are without such limitations. Among those who had limitations at baseline, at least one-fifth get better. For those without limitations at baseline, one-seventeenth to two-fifths get worse. Difficulties in walking and doing heavy housework were the most common, most likely to develop, and least likely to resolve of any of the ADL or IADL items, and lower body limitations were more common, more likely to develop, and less likely to resolve than upper body limitations. Linear panel analysis of the five summary scales indicates that the top predictors of increased functional limitation are baseline levels of functional limitation, older age, decedent status, and poorer perceived health (in that order). Other less consistent and less robust predictors include the length of the exposure window, being female, having a history of arthritis, lower educational attainment, having fewer nonkin social supports, higher prior physician visit levels, and not living alone.

We compared the prior and current costs of persons age 65 and older enrolling in a Social/Health Maintenance Organization in each of four sites with samples of persons using standard Medicare benefits in each site. Analyses were adjusted for individual health differences using case mix scores. Costs were examined in the year before S/HMO enrollment or prior to the sampling of a person using regular Medicare services as well as costs during the study. Costs during the study are analyzed using a two-stage procedure where first the propensity to enroll in a S/HMO is modeled and then costs derived from either Medicare sources or shadow prices assigned to service units provided in a S/HMO are modeled. The costs for case mix groups with different health and functional characteristics varied significantly. Cost differences between case mix classes differed between the S/HMO and FFS populations.

The objective of this study was to determine whether racial differences in hypertension in a random sample of community-dwelling older adults also remained significant in a sample of successful agers. Data for the random sample of community-dwelling older adults came from the Duke University Established Populations for Epidemiologic Studies of the Elderly (4,162 community-dwelling adults age 65 and older) and showed strong racial differences in hypertension. Data for successful agers came from the Duke MacArthur (428 of EPESE respondents in the top 30% in terms of physical, cognitive, and psychosocial performance). The mean of two sitting blood pressure measurements was the dependent variable for both sets of analyses. Independent variables included demographics and health factors. Using logistic regression, odds ratios in the Duke EPESE and Duke MacArthur samples for race were similar (Duke EPESE odds ratio = 1.30; Duke MacArthur odds ratio = 1.29). Sample size differences affected statistical significance. However, race differences in hypertension in older adults appear to be unexplained by socioeconomic status or other usual explanatory variables. Even among successful agers, racial differences in hypertension persist.

Factors predicting death in the ninth decade of life may differ from predictors in younger age groups. A prospective study was carried out on 210 subjects entering a residential home at the age of 68 to 79 years and of 287 subjects aged ≥ 80 years who included 91 survivors from the first group; all subjects were followed until 78% of them had died. A Cox analysis was carried out with death as end point and 13 potential risk factors as covariates. Mildly impaired mobility at entry, defined as the need for help to walk 300-400 yards for various reasons, smoking, bacteriuria, and presence of ECG abnormalities were significant death risk predictors before age 80. Beyond this age, only mildly impaired mobility and serum cholesterol levels ≤5.9 mmol/L, as compared with levels ≥8.0 mmol/L, remained significant. Higher hematocrit levels were predictors of survival before and after age 80. Systolic blood pressure, age, sex, weight, and socioeconomic status had no effect in either group. The data show that survival after age 80 is related only to adequate physical mobility and high hematocrit and cholesterol levels, regardless of the levels of other common risk factors.

This study has attempted to validate the Geriatric Depression Scale translated version (Chinese) with a psychiatric outpatient sample (N= 461) of males and females aged 60 or above, from 10 government-maintained psychiatric outpatient clinics between January 1992 and February 1993. Reliabilities and validities were exceptional. Internal consistency reliability was .89 (alpha), and the test-retest reliability was .85 (alpha). Criterion-related (psychiatrist diagnosis) validity was good at .95, and concurrent validity (with CES-D) was .96. Item analysis also confirmed consistency—all 30 items were significantly correlated with the full GDS. However, its sensitivity (70.6%), specificity (70.1%), false negatives (29.4%), and false positives (29.9%), though acceptable, were not as impressive. The overall result has shown that the GDS is generally applicable to the Chinese elderly population and is good for measuring depressive symptoms. The scale can be easily applied in the community by health care professionals. However, further follow-up studies are recommended.

This exploratory study uses Andersen's service utilization model to examine the relationship between the leisure activity patterns of older people and their knowledge and use of health and social services. Hierarchical stepwise multiple regression analyses of data from 418 people ages 65 and older in rural Québec revealed that leisure activity patterns may explain a greater amount of variation in service knowledge and use than conventional need characteristics such as physical and psychological health. Various activity patterns were significantly related to knowledge and use of services even after controlling for variables such as age and health status. Although some types of leisure activities appeared to augment knowledge and use of services, others seemed to deter it. Future explanatory models of service utilization among the elderly should be expanded to include leisure activity patterns.

Risk factors for institutionalization and death for up to four years for a nationwide cohort (n = 6,488) of males discharged alive from Department of Veterans Affairs (DVA) nursing homes were identified through linked records of the DVA. Two-year cumulative probabilities of nursing home readmission, hospitalization, and death among nursing home discharges were 0.30, 0.61, and 0.24, respectively. Using multivariate survival analyses, chronic functional impairments and past nursing home use were important predictors of nursing home readmission, whereas hospitalizations for exacerbations of chronic medical conditions were predictors of hospitalization and death. Past hospitalizations predicted all three outcomes. Differences in risk factors for nursing home readmission as compared with hospitalization or death among DVA nursing home dischargees suggest that high-risk patients can be identified at nursing home discharge and that different types of interventions will be necessary to decrease nursing home readmission as compared with hospitalization or death. Future development of linked record systems across multiple settings, both within and outside the DVA, will help to further characterize persons at high risk of institutionalization or death and to design and evaluate targeted interventions to decrease this risk.